Page 46 - NAME OF CONDITION: REFRACTIVE ERRORS
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a)  Clinical Diagnosis:

                An adequate history taking, coupled with a comprehensive evaluation goes a long way in
                establishing  a  clinical  diagnosis  which  can  then  be  confirmed  by  microbiological
                examination.  Patients  come  with  varying  degrees  of  pain,  photophobia,  watering  and
                redness of eyes and may also complain of defective vision, especially if the visual axis is

                involved.

                History
                Eliciting a proper history with regards to nature of trauma and use of TEM is crucial step in
                the management of microbial keratitis. Trauma with vegetable matter such as paddy husks
                or onions are more likely to cause a fungal keratitis. Contact with contaminated or
                brackish  water  is  likely  to  produce  Acanthamoeba  keratitis.  In  cases  of  contact  lens
                wearers, it is imperative to take history of wearing schedule and lens care.

                Examination
                The ocular examination includes recording visual acuity, an external eye examination and
                slit-lamp biomicroscopy of affected and normal eye.

                Visual Acuity measurement
                Due to acute infection of the involved eye, it is difficult to record visual acuity accurately.
                However,  an  approximate  visual  acuity  with  or  without  optical  correction  will  give  a
                baseline  data  to  aid  in  the  appropriate  management  strategy  and  also  to  monitor  the
                healing process.

                External Examination

                An external examination should be performed with particular attention to the following:
                      General appearance of the patient
                      Facial examination
                      Eyelids and lid closure
                      Conjunctiva

                      Nasolacrimal apparatus
                      Corneal sensation
                Slit-lamp Biomicroscopy
                Should include evaluation of the following:
                   Eyelid margins: Inflammation, ulceration, eyelash, and abnormalities including trichiasis,
                   irregularities, and lacrimal punctal anomalies.

                   Conjunctiva:  Discharge,  inflammation,  morphologic  alterations  (e.g.  follicles,  papillae,
                   cicatrization,  keratinization,  membrane,  pseudomembrane,  ischemia,  and  foreign
                   bodies).
                   Sclera:  Inflammation,  (e.g.  infectious,  versus  autoimmune),  ulceration,  scarring  /
                   thinning, nodules, ischemia.



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