Common chief complaints & Causes

Common chief complaints that you will come across when diagnosing a patient-
Persistent loss of vision-Transient loss of vision- Floaters-Flashes of light

Persistent loss of vision-

• Focusing problems are the most common complaints. Everyone eventually needs glasses to
  attain perfect vision, and fitting lenses occupies half the eye care professional's day
• Cataracts are cloudy lenses that occur in everyone in later life. Unoperated cataracts are
  the leading cause of blindness worldwide. In the USA, over 2.8 million cataract extractions are
  performed each year
• Diabetes affects 14 million Americans, increasing from 0.3% at age 20 to 10% of the population
  after age 70. Diabetic retinopathy is the leading cause of blindness in the USA in those under 65
  years of age
• Macular degeneration causes loss of central vision and is the leading cause of blindness over
  age 65. Signs are present in 25% of people over age 75
• Glaucoma is a disease of the optic nerve that is worsened by elevated eye pressure. It usually
  occurs after age 35 and affects 2 million Americans, with black persons affected five times
  as often as white persons. Peripheral vision is lost first, with no symptoms until it is far advanced. Progression to blindness is uncommon if discovered early. This is why there are so
  many state-sponsored eye-pressure screenings 

 
Transient loss of vision lasting less than 1–2 hour, with or without flashing lights

• In younger patients, think of migraines spasm of cerebral arteries. With aging, consider emboli from arteriosclerosis plaques

 Floaters

•  Almost everyone will at some time see shifting spots due to suspended particles in the normally
  clear vitreous. They are usually physiologic, but may result from hemorrhage, retinal detachments, or other serious conditions

 Flashes of light

•  Sparks may be due to traction of the vitreous on the retina and are sometimes associated with the onset of a retinal hole or detachment. Insults to the visual center in the occipital cortex are usually ischemic and cause more organized jagged lines of light
•  Night blindness (nyctalopia)
  
  Double vision (diplopia)
•  Strabismus, which affects 4% of the population,
  is the condition where the eyes are not looking
  in the same direction. The binocular diplopia
  disappears when one eye is covered. In straighteyed
  persons, diplopia is caused by hysteria or a
  beam-splitting opacity in one eye which does not
  disappear by covering the other eye
  
  Light sensitivity (photophobia)
• Usually a normal condition treated with tinted lenses,
  but could result from inflammation of the eye or
  brain; internal reflection of light in lightly pigmented
  or albinotic eyes; or dispersion of light by mucus,
  lens or corneal opacities, or retinal degeneration
  
  Itching
• Most often due to allergy or dry eye
  
  Headache
• Headache patients present daily to rule out eye
  causes and to seek direction
  1 Headache due to blurred vision or eye-muscle
  imbalance worsens with use of eyes
  2 Tension causes 80–90% of headaches. It worsens
  with anxiety and is often associated with temple
  and neck pain
  3 Migraine occurs in 10% of the population.
  There is a severe recurrent, pounding headache
  often accompanied by nausea, blurred vision, and
  flashing zigzag lights. It is relieved by rest
  4 Sinusitis causes a dull ache about the eyes and
  occasional tenderness over the sinus. There may
  be an associated nasal stuffiness and a history of
  allergy relieved with decongestants
  5 Menstrual headaches are cyclical
  6 Giant-cell arteritis occurs in elderly persons and
  may cause headache, loss of vision, pain on
  chewing, temporal scalp tenderness, arthritis,
  loss of weight, and weakness. An erythrocyte
  sedimentation rate over 40 and a positive
  temporal artery biopsy confirms the diagnosis.
  Prompt high-dose systemic steroid therapy should
  be started since blindness or death can occur
  7 Sharp ocular pains lasting for seconds are often
  referred from nerve irritations in the neck, nasal
  mucosa, or intracranial dura, which like the eye are also
  innervated by the trigeminal nerve
  8 Headaches that awaken the patient and are
  prolonged or associated with focal neurologic
  symptoms should be referred for neurologic study
  
  Visual hallucinations
• Occurs in dementia, psychosis, brain disease, and
  from medications