Oxford American Handbook of Ophthalmology

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Oxford American Handbook of
Ophthalmology

Oxford American Handbook of Ophthalmology

Oxford American Handbook of
Ophthalmology One of the fi rst and most vital skills acquired by those involved in eye  care is the accurate and effi cient taking of an ophthalmic history. In oph-
thalmology clinical examination is very rewarding, probably more so than
in any other specialty. However, this is additional to, rather than instead
of, the history.
Apart from the information gained, a rapport is established which
should help the patients to tolerate the relatively invasive ophthalmic
examination. The patients are also more likely to accept any subsequent
explanation of diagnosis and ongoing management if they know they have
been listened to.
Presenting illness (PI)
Why are they here?
The patient’s initial illness (i.e., complaint) often helps to direct additional
questioning and examination. Routine eye care referral has a valuable role
in screening for asymptomatic disease (notably glaucoma) but may gener-
ate unnecessary referrals for benign variants (e.g., anomalous discs, early
lens opacities).

History of presenting illness (HPI)
The analysis of most ophthalmic problems center around general ques-
tions regarding the onset, precipitants, associated features (e.g., pain, red-
ness, discharge, photophobia, etc.), duration, relieving factors, recovery,
and specifi c questions of the presenting illness (i.e., complaints) (Box 1.1).
Even after clinical examination, further information may be needed to
include or rule out diagnoses.

we

Although some of these processes can be formalized as algorithms, their
limitations should be recognized; they cannot compare to the multivariate
processing, recognition of exceptions, and calculation of diagnostic prob-
abilities subconsciously practiced by an experienced clinician.

Oxford American Handbook of Ophthalmology