Use of the slit-lamp for anterior segment examination of the eye Case Study

Use of the slit-lamp for anterior segment examination of the eye - Case Study Example In my clinical placement in the Ophthalmology, I had a chance to examine a patient who presented complaining of decrease in vision. For confidentiality and ethical reasons, the identity of this patient remains undisclosed. However, this 65-year-old gentleman presented to the clinic, and when I was instructed to do a slit-lamp examination, it felt that it was an opportunity to use academic learning in practice, and I was very excited. In order to arrive at a diagnosis, I obtained these systemic medical history and family ocular history, since these are important for assessing a patient's risk factors for ocular disease. Just as with other body systems, reliable historical information allows the clinician to more appropriately direct the physical examination (Quillen, 1999).I probed into his recent complaints in terms of the onset, duration, and associated symptoms, since knowledge about these can guide me to the correct diagnosis. I asked him about his prior good and equal vision in b oth eyes. Then I asked him whether the problem were on the both eyes, and how could he not note it for last 1 year. He said that he was going on with his frequent changes in glasses, which he thought was natural at his age. While watching television, he suddenly discovered that his vision in the right eye was a lot better than the left, and when he attempted to watch TV with one eye, he was surprised to discover that with the left eye alone, the pictures were hazy. Moreover, he could see better at the periphery than at the centre. He had no pain, distortion of the sight, and no double vision. These were very suggestive and significant pieces of information since they narrow down the clinical differential diagnosis further, and helps the examiner to design the clinical examination in a better way. The suggestive better peripheral vision, differential vision between the eyes and absence of distortion, pain, and double vision led to the impression that I need to focus in the anterior s egment of the eye while conducting his examination (Age-Related Eye Disease Study Research Group, 2001). General Examination When I decided to carry out an examination, I felt that a patient with decreasing vision requires a complete examination to determine the cause of the visual decline. Therefore, I started to do a systematic examination. I performed a general examination of the eyes in good diffuse light, and I felt that it would lead me to the possible diagnosis, so later I can do a slit-lamp examination. The general examination began with the examination of the eyelids and the conjunctival sac. He was elderly and had some amount of sagging of the eyelids. On palpation, the lid margins did not demonstrate any swelling. There was no redness in the conjunctivae. The eyelashes were normal. There was no evidence of any inflammation or blepharitis in both the lid margins. In order to examine the conjunctival sac, it was necessary to expose the palpebral conjunctiva and the fornices. Due to age, his fornices were shallow. There was no crusting, follicles, conjunctival papillae, or pseudomembrane indicating chronic or acute inflammation contributing his diminished vision. I drew down his lower lid while he was asked to look towards the ceiling, and the lower fornix looked normal. This excluded any inflammation of the lower lid and swelling that can compromise vision temporarily. The upper lid was everted to examine the upper palpebral conjunc