Intended for healthcare professionals

Student Education


BMJ 2002; 325 doi: (Published 01 October 2002) Cite this as: BMJ 2002;325:0210362
  1. Sophia Pathai, senior house officer in ophthalmology1,
  2. Andrew McNaught, consultant ophthalmic surgeon1
  1. 1Gloucestershire Eye Unit, Cheltenham General Hospital

In the first article of a new series, Sophia Pathai and Andrew McNaught explain how to take an ophthalmic history and do an ophthalmic examination

  • What do you do when called to see a patient with new onset atrial fibrillation who suddenly wakes up in the morning with loss of vision in one eye?

  • An elderly woman is admitted with nausea and vomiting. The working diagnosis is small bowel obstruction. You notice she has a rather red eye. Is it just conjunctivitis?

  • A patient with rheumatoid arthritis has been complaining of gritty, sore eyes for a week. You've tried chloramphenicol ointment, and it's not getting better. Is there something else going on?

The answers to these problems, and more, will be outlined in this series of articles. Although ophthalmology is a specialist subject, we hope to show you that you don't need amazing ophthalmic knowledge or specialist equipment to elicit the clinical signs that often point to the diagnosis. Most of the time you will need to refer the patient to the ophthalmologist for further management, but imagine how impressive your referral will be when you can give a differential list rather than just “red eye--possible conjunctivitis?” Seriously, having some basic practical ophthalmic knowledge and skills will ensure that you are able to assess the severity of an eye condition and the need for, or urgency of, referral. It means that you will hopefully consider the possibility of acute angle closure glaucoma in your elderly patient with acute abdominal pain and a red eye.

The ophthalmic and medical history

It's important to remember that it's not just the ophthalmic history that is important; the patient's current medical problem and past medical history are often highly relevant to the ophthalmic diagnosis.

On the ward the presenting complaint will often be of an acute nature such as …

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