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Clinical investigation

What to do when you suspect a neuro-ophthalmic condition

Dr Aaron Yeung

16/07/2018

A good history is critical

Disorders of the brain and nervous system that affect the eye and vision are often complex to diagnose – most neuro-ophthalmic disorders are not ‘spot’ diagnoses. Consequently, much information can be gleaned when obtaining a thorough from the patient.

While you should have some structure or regularity to the way you take a history, be flexible enough to explore potential flags as you come across them in the course of speaking to the patient.

  1. Information about the presenting complaint

*Remember to distinguish between time of onset vs when the patient first noticed the symptoms (e.g. a patient who rubs one eye when ‘irritated’ and notices that the other eye has no vision will not be able to determine the time of onset).

  1. Subsequent questioning

Importantly, remember to ask open-ended questions rather than direct questions, as this will provide you with much more detailed answers that can help to guide your subsequent line of questioning.

Ask: ‘how have you been lately?’, ‘any trouble combing your hair?’ or ‘any trouble eating?’

Not: ‘do you have a headache?’ or ‘have you lost weight?’
 

Follow with a thorough clinical examination

When you suspect a neuro-ophthalmic condition, always assess:

 

Refer as appropriate

By this stage, you may or may not have a list of differential diagnoses. If referral is appropriate, choose an ophthalmologist with neuro-ophthalmic training to allow further investigations and intervention (if appropriate) in a timely manner.


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