optic system assessment, an evaluation of the patient’s eyes, vision, and current and past disorders or injuries that may be responsible for abnormalities in the individual’s optic system. ▪ METHOD: The patient is interviewed to determine if vision is blurred, double, decreased, or absent in one or both eyes or diminished peripherally at night or in bright light. The interviewer asks if halos or lights are seen and if the patient collides with unfamiliar objects or is unable to distinguish objects held too close or too far; if the eyes water, itch, or feel tender, painful, or fatigued; and if an injury to the eye, face, or head has occurred. Observations are made of the patient’s general appearance, vital signs, kind of eyeglasses or contact lenses worn, the amount of tearing, ability to blink, tendency to rub the eyes, and visual acuity. Evidence is recorded of conjunctivitis, drainage, optic hemorrhage, edema or ptosis of the eyelids, exophthalmos, strabismus, nystagmus, scleral edema, chalazion, lacerations, contusions, or a foreign body in the eye. Carefully noted are signs of aging; glaucoma; cataract; retinal detachment; and the presence of multiple sclerosis, diabetes mellitus, myasthenia gravis, gonorrhea, thyroid dysfunction, sinus problems, or cerebral trauma or tumors. The patient’s report of previous eye operations or treatments, head or face trauma, arteriosclerosis, glomerulonephritis, retinal degeneration, episodes of coma, therapy with oxygen, and drug misuse are investigated, as well as a family history of glaucoma or diabetes. Also explored are the possibility that the patient has a hazardous job or recreation (and note is made of any safety precautions taken); the individual’s misuse of alcohol; and use of medication, especially antibiotics, antiemetics, miotics, mydriatics, and acetazolamide. Diagnostic aids available for the evaluation include a test of visual fields, an x-ray film of the orbit and skull, an ophthalmoscopic examination, tonometry, a brain scan, and microscopic studies of conjunctival scrapings. ▪ INTERVENTIONS: A health care provider conducts the interview, observes the patient, and assembles pertinent background data and the results of the diagnostic procedures. ▪ OUTCOME CRITERIA: A careful assessment of the patient’s eyes and vision and of certain aspects of the medical, family, and social history is a significant aid in establishing the diagnosis of an optic system disorder.
