Page 36 - NAME OF CONDITION: REFRACTIVE ERRORS

*Situation 1: At Secondary Hospital/ Non-Metro situation: Optimal

Standards of Treatment in Situations where technology and
resources are limited

a) Clinical Diagnosis:

History taking, comprehensive evaluation of the eye and understanding of the
general epidemic prevalence of this condition in the society is crucial to establish a
diagnosis . Patients usually come with typical history of matting of eye lashes on
waking, copious purulent discharge, redness, gritty foreign body sensation, itching
and rarely may even present with distortion of vision, photophobia and coloured
haloes.

Examination: The ocular examination includes recording visual acuity, an external

eye examination and slit-lamp biomicroscopy.
Visual acuity measurement: Due to acute infection of the involved eye, it is difficult
to record visual acuity accurately. Although visual acuity is normal in patients with

conjunctivitis, discharge sliding across the eye may cause visual disturbance vision
colored haloes resulting in under estimation of true visual potential.

External examination:

The following points should be looked for:
1. Abnormalities of skin like signs of eczema, roseacea, seborrhea.
2. Look for regional enlargement of lymph nodes (pre auricular).
3. Abnormalities of eye lid and adnexa like swelling, ulceration and discolouration
and laxity.
4. Examination of conjunctiva to look for chemosis, sub conjunctival hemorrhage,
discharge cicatricial changes and symblepharon.

Slit-lamp Biomicroscopy:
Should include evaluation of the following:
1. Eye lid margins: To look for inflammation, ulceration, nodules, vesicles and
keratinization.
2. Eye lashes: loss of eye lashes, crusting, scurf, nits and lice.
3. Lacrimal puncta and canaliculi for pouting and discharge
4. Tarsal and forniceal conjunctiva for presence and size of papillae and follicles,

membranes, pseudo membranes, ulceration, masses, hemorrhages and
cicatricial changes like foreshortening and symblepharon.

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