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Diagnosis of Color blindness

Color blindness Diagnosis: Book Excerpts

• Ask the following questions - EYE PAIN
• Ask the Following Questions - SCOTOMA
• Ask the following questions - BLINDNESS
• Approach to the Diagnosis - EYE PAIN
• Approach to the Diagnosis - BLURRED VISION, BLINDNESS, AND SCOTOMATA
• History and physical examination - Eye pain
• History and physical examination - Scotoma
• History and physical examination - Scotoma
• History and physical examination - Night blindness [Nyctalopia]
• History and physical examination - Eye pain [Ophthalmalgia]
• History - Scotoma
• Differential Overview - Eye Pain
• History - Eye pain
• History - Eye pain
• History - Scotoma
• History - Night blindness
• History and physical examination - Scotoma
• History and physical examination - Eye pain [Ophthalmalgia]
• Approach to the Diagnosis - EYE PAIN
• Approach to the Diagnosis - Blurred Vision, Blindness, and Scotomata

Diagnostic Tests for Color blindness: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Color blindness.

EYE PAIN: Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is there redness of the eye? Redness of the eye suggests definite eye pathology. Without redness, one should suspect disease in the adjacent structures or retrobulbar neuritis.
2. If there is redness, is there periorbital edema as well? Periorbital edema should suggest a cavernous sinus thrombosis or herpes zoster.
3. If there is periorbital edema, is there a rash? A rash, particularly vesicular rash, would suggest herpes zoster.
4. In cases without redness of the eye, is there any abnormality on examination both with the naked eye and with the ophthalmoscope? A dilated pupil would certainly suggest glaucoma; ophthalmoscopic examination may show optic neuritis or retinal detachment. A visual field examination may detect optic neuritis, retrobulbar neuritis, and retinal artery occlusion. A visual acuity check may pick up a refractive error.
5. Finally, is there headache associated with the eye pain? This would be suggestive of migraine or cluster headache.

DIAGNOSTIC WORKUP

The primary care specialist may want to treat cases of obvious conjunctivitis without a culture and sensitivity. However, a smear and culture is useful especially if Neisseria is suspected. A smear may also reveal eosinophils suggesting allergic conjunctivitis. The primary care specialist may also use fluorescein dye to diagnose a foreign body. Most primary care physicians feel competent to use tonometry to diagnose glaucoma and may feel competent to use a slit lamp. However, when there is any doubt about the diagnosis, the most cost-effective approach is to refer the patient to an ophthalmologist.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

SCOTOMA: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is it transient? If the scotomas are transient, then migraine, transient ischemic attacks, and retrobulbar neuritis should be suspected.
2. Are there abnormalities on the eye examination other than the optic nerve? On a careful eye examination, the clinician may find corneal opacities, muscae volitantes, cataracts, choroiditis, glaucoma, retinitis, retinal hemorrhage, and detached retina.
3. Are there other neurologic signs? The presence of other neurologic signs may suggest multiple sclerosis, carotid artery thrombosis or insufficiency, basilar artery thrombosis or insufficiency, and pseudotumor cerebri, among other disorders.

DIAGNOSTIC WORKUP

This should include a careful eye examination with slit lamp, tonometry, and visual field examinations. If the initial findings suggest an ocular disorder, referral to an ophthalmologist should be made. If the neurologic examination is abnormal, the patient should be referred to a neurologist, rather than ordering expensive tests such as a CT scan, MRI scan, VEP studies, angiography, and spinal fluid examinations.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

BLINDNESS: Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is it transient? Transient blindness may occur in transient ischemic attacks, epilepsy, migraine, and hypertension.
2. Is it a sudden onset? The sudden onset of blindness may occur in optic neuritis, retinal vein thrombosis, central retinal artery occlusion, vitreous hemorrhage, detached retina, carotid artery thrombosis, temporal arteritis, injuries to the optic nerve, retrobulbar neuritis, fracture of the skull, glaucoma, posterior cerebral artery occlusion, multiple sclerosis, and hysteria.
3. Is it unilateral or bilateral? Unilateral blindness may occur in glaucoma, vitreous hemorrhage, optic neuritis, retinal vein thrombosis, central retinal artery thrombosis, carotid artery thrombosis, temporal arteritis, injury to the optic nerve, fractured skull, brain tumors, retinoblastomas, and sphenoid ridge meningiomas. Bilateral blindness may occur in posterior cerebral artery occlusion, pituitary tumors, retinitis pigmentosa, hereditary optic atrophy, uveitis, toxic amblyopia, cataracts, glaucoma, multiple sclerosis, and iritis.
4. Is there papilledema? The presence of papilledema should make one suspect optic neuritis, retinal vein thrombosis, and space-occupying lesions of the brain.
5. Are there abnormalities on ophthalmoscopic examination? Besides papilledema, there may be changes on the ophthalmoscopic examination in iritis, glaucoma, papillitis from optic neuritis, retinal vein thrombosis, central retinal artery occlusion, vitreous hemorrhage, detached retina, and retinoblastoma.

DIAGNOSTIC WORKUP

Referral to an ophthalmologist is usually the first step in a good workup. If one is not available, a careful eye examination including slit lamp examination, visual acuity evaluation, tonometry, and visual field studies should be done. If these are unrevealing, a referral to an ophthalmologist or neurologist should be made without further delay. Additional studies would include a CT scan or MRI of the brain and orbits, carotid scans, spinal tap, VEP studies, and four-vessel cerebral angiography. An EEG would be useful in diagnosing hysterical blindness and malingering.

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

EYE PAIN: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The approach to the diagnosis of eye pain involves a careful search for inflammation of the various anatomic structures; then a drop or two of fluorescent dye is inserted and the cornea inspected for lacerations, herpes ulcers, and foreign bodies. Finally, tenometry may be done. Referral to an ophthalmologist is often necessary, but the astute clinician will want to x-ray the sinuses, ask about a history of migraine, do a visual field, and rule out systemic diseases beforehand.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

BLURRED VISION, BLINDNESS, AND SCOTOMATA: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

A careful eye examination with magnification and fluorescence to rule out a foreign body and ulcers is essential in the acute case of blurred vision. Ophthalmoscopic examination may reveal optic neuritis or a retinal vein thrombosis. Visual field examination by confrontation may reveal a field defect. If these test results are negative, ocular tension should be checked to rule out glaucoma. A history of migraine, the use of birth control, and alcohol intake must be investigated. If there is headache on the side of the lesion, a sedimentation rate is done, steroids should probably be started immediately, and referral to a neurologist made promptly in case temporal arteritis is possible, especially in the aged. Otherwise, referral to an ophthalmologist is necessary. The ophthalmologist will perform visual field examinations with perimetry, a slit lamp examination, and look for refractive errors. If other neurologic findings are present, a CT scan, skull x-ray film, and spinal tap may be indicated. A neurologic consultant can determine this.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Eye pain: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does he have headaches? If so, find out how often and at what time of day they occur.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Scotoma: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

First, identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests  —  confrontation testing and the Amsler grid   —  may also help in identifying a scotoma.

Next, test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure are necessary.

Explore the patient’s medical history, noting especially eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Scotoma: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

First, identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests—confrontation testing and the Amsler grid—may also help in identifying a scotoma.

Next, test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure (IOP) are necessary.

Explore the patient’s medical history, noting especially any eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Night blindness [Nyctalopia]: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient complains of difficulty seeing at night, ask when he first noticed the problem. Is it intermittent or steadily worsening? Is it worse at certain times or in certain conditions? Also, ask about other ocular symptoms, such as eye pain, blurred or halo vision, floaters or spots, and photophobia.

Explore any history of glaucoma, cataracts, and familial degeneration of vision. If no ocular problems are apparent, briefly evaluate the patient’s nutritional status for vitamin A deficiency.

Examine the eyes for ptosis, abnormal tearing, discharge, and conjunctival injection. Test visual acuity and visual fields in both eyes and, if trained and equipped, measure intraocular pressure. Check pupillary response, and evaluate extraocular muscle function by testing the six cardinal fields of gaze.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Eye pain [Ophthalmalgia]: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient’s eye pain doesn’t result from a chemical burn or from acute angle-closure glaucoma, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or a discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of severe pain that developed suddenly. Does he have headaches? If so, find out how often and at what time of day they occur.

During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the eyelids and conjunctivae for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye, page 322.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Scotoma: History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

 A. Nature of the scotoma. Try to establish whether the field loss is monocular or binocular. Binocular scotomas, which imply chiasmal or posterior chiasmal lesions, are vascular (stroke, transient ischemic attack, migraine, ruptured arteriovenous malformation) or compressive in nature (pituitary mass, meningioma, glioma). Establish with the patient the location of the defect. Scotomas that migrate through the visual field include vitreous floaters, vitreous hemorrhage, scintillating scotoma of migraine, and so forth. An altitudinal field loss is likely a prechiasmal lesion [i.e., optic nerve disease (e.g., ischemic optic neuropathy, glaucoma) or retina disease (e.g., detached retina, retina vascular occlusion)]. Central scotomas are commonly seen in optic nerve and macular lesions with macular degeneration by far the most common in the elderly. Macular holes, optic neuritis, toxic or metabolic optic neuropathy, central serous choroidopathy, maculopathy secondary to medications (hydroxychloroquine, thioridazine, chlorpromazine, quinine, tamoxifen), and others are examples of macular-induced central scotomas. Peripheral vision loss, if bilateral and homonymous, indicates a stroke opposite the side of field loss. Tumors, arteriovenous malformations, and migraines can cause hemianopias. Glaucoma, detached retina, retinitis pigmentosa, chronic papilledema, and previous laser treatment for diabetes are also common entities affecting peripheral vision.

 B. Onset and timing of scotoma. A scotoma of sudden onset will be secondary to some kind of vascular event: embolic, hypoperfusion, inflammatory, or hemorrhagic. Transient vision loss lasting seconds can occur with temporal arteritis, papilledema, or vertebrobasilar insufficiency. Visual loss lasting minutes to hours occurs in temporal arteritis or amaurosis fugax. Visual changes lasting weeks to months represent retinal vein occlusion, expanding compressive lesion, papilledema, and if associated with pain on eye movement, optic neuritis. Gradual progressive visual field loss occurs with compressive masses; however, acute expanding lesions from infectious, inflammatory (e.g., sarcoid, Tolosa-Hunt), aneurysmal, or apoplexy of a pituitary mass can cause rapid vision loss. Monocular vision loss after head trauma suggests injury to the intracanalicular portion of the optic nerve, compressive fracture of the sphenoid bone, or edema to the optic nerve. Emergent computed tomography (CT) scan with neurosurgical or ophthalmic consultation and high-dose intravenous steroids are needed.

 C. Associated symptoms. The presence of neurologic signs or symptoms can localize the area of the pathology. Amaurosis fugax implies ipsilateral internal carotid disease or cardiac disease. History of vertigo, diplopia, and urinary incontinence in a young patient with a monocular central scotoma implies multiple sclerosis. Older patients with acute monocular vision loss associated with periorbital pain and headaches, fatigue, jaw claudication, or muscle aches strongly suggests temporal arteritis. Transient dimming or loss of vision in one or both eyes with orthostatic changes can be seen with papilledema of intracranial hypertension. Progressive monocular visual loss with proptosis obviously implies an orbital mass (optic nerve glioma, meningioma, cavernous hemangioma), but asymmetric thyroid-related orbitopathy can present a similar picture. Monocular loss progressing over time without orbital signs can be seen with an intracanalicular or intracranial optic nerve mass.

 D. Past medical and social history. Diabetes and hypertension are the two most common causes of ischemic optic neuropathy (ION). ION presents as a sudden painless monocular vision loss, altitudinal in nature, with an APD. The risk of retinal vascular occlusions is much greater in patients with diabetes mellitus or hypertension. The risk is greater with tobacco use. A history of rheumatic fever, heart murmur, or cardiomyopathy is significant for an embolic source. Sudden vision loss without an APD in a diabetic patient is most likely a vitreous hemorrhage. An acquired immunodeficiency syndrome patient with a CD4 count less than 50 × 10³ with visual scotomas needs to be evaluated for cytomegalovirus retinitis. A history of alcohol abuse or a psychiatric patient with bilateral vision loss and change in mental status needs urgent chemistries for anion gap acidosis with hemodialysis if methanol ingestion is suspected. An intravenous drug user can suffer a vascular occlusion from talc.

Physical examination

A. Visual acuity. The vision of each eye should be assessed with spectacles or contact lenses in each eye independently. Central scotomas are seen with optic nerve, macular disease, or (rarely) an occipital tip lesion; and Snellen visual acuity will be decreased.

B. Visual fields. Confrontation field test is performed with each eye independently. Briefly flash several fingers in each of the four quadrants. Bilateral field loss in the same field of vision in each eye indicates injury posterior to the chiasm. Bitemporal field defects are seen with chiasmal lesions (pituitary masses, craniopharyngiomas, and others). Monocular field defects are seen in retina and optic nerve disease.

 C. Pupil examination. The presence of a prominent APD, which implies optic nerve injury, will help to differentiate central scotomas caused by macular disease. An APD is commonly seen with optic neuritis, optic neuropathy (ischemic and traumatic), asymmetric glaucomatous damage, optic nerve tumors, and central retinal artery or vein occlusion. An APD is not seen in early papilledema and minimally with macular degeneration, macular holes, or choroidopathy.

D. Fundus examination. Direct ophthalmoscopy can give a quick assessment of the red reflex (i.e., a dim red reflex in a diabetic with vitreous hemorrhage). Vitreous floaters can occasionally be seen as shadows in the red reflex. Examine the nerve for edema, pallor, or glaucomatous cupping. Macular scarring or pigmentary change is most commonly seen with macular degeneration.

 E. Other examinations. A neurologic assessment is needed for a patient with bilateral field loss, screening for contralateral paresis and other focal deficits, palpation of the temporal artery for tenderness or diminished pulse if the history suggests giant cell arteritis, as is auscultation of the carotids for bruits and the heart for a murmur in a patient with amaurosis fugax or stroke. Glaucoma can be screened with tonometry. Check arms and legs for signs of intravenous drug abuse.

» READ BOOK EXCERPT ONLINE »

Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000

Eye Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Conjunctivitis

❑ Corneal abrasion

❑ Foreign body

❑ Sinusitis

❑ Migraine

❑ Acute glaucoma

❑ Orbital cellulitis

❑ Zoster prodrome

❑ Orbital fracture

❑ Keratitis

❑ Scleritis

❑ Iritis

❑ Optic neuritis

❑ Temporal arteritis

Diagnostic Approach

A foreign body sensation occurs with a foreign body, corneal abrasion, or keratoconjunctivitis sicca. Itching is associated with allergic and vernal conjunctivitis. Photophobia occurs with iritis and herpes simplex keratitis. Deep pain suggests acute glaucoma or posterior scleritis. Pain on eye movement is found with optic neuritis, sinusitis, and influenza.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Eye pain: History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

If the patient’s eye pain doesn’t result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does he have headaches? If so, find out how often and at what time of day they occur.

Physical examination

During the physical examination, don’t manipulate the eye if you suspect trauma. Carefully assess the lids and conjunctiva for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye.)

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Eye pain: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient’s eye pain doesn’t result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does he have headaches? If so, find out how often and at what time of day they occur.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Scotoma: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Explore the patient’s medical history, noting especially any eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Night blindness: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient complains of difficulty seeing at night, ask when he first noticed the problem. Is it intermittent or steadily worsening? Is it worse at certain times or in certain conditions? Also, ask about other ocular symptoms, such as eye pain, blurred or halo vision, floaters or spots, and photophobia.

Explore any history of glaucoma, cataracts, and familial degeneration of vision. If no ocular problems are apparent, briefly evaluate the patient’s nutritional status for vitamin A deficiency.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Scotoma: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

Explore the patient's medical history, noting especially eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.

Identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests—confrontation testing and the Amsler grid—may also help in identifying a scotoma.

Next, test the patient's visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure are necessary.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Eye pain [Ophthalmalgia]: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If the patient's eye pain doesn't result from a chemical burn, take a complete history. Have the patient describe the pain fully. Is it an ache or a sharp pain? How long does it last? Is it accompanied by burning, itching, or discharge? Find out when it began. Is it worse in the morning or late in the evening? Ask about recent trauma or surgery, especially if the patient complains of sudden, severe pain. Does the patient wear contact lenses? How often are they removed or replaced if they're disposable? Does he have headaches? If so, find out how often and at what time of day they occur.

During the physical examination, don'tmanipulate the eye if you suspect trauma. Carefully assess the lids and conjunctiva for redness, inflammation, and swelling. Then examine the eyes for ptosis or exophthalmos. Finally, test visual acuity with and without correction, and assess extraocular movements. Characterize any discharge. (See Examining the external eye.)

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

EYE PAIN: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The approach to the diagnosis of eye pain involves a careful search for inflammation of the various anatomic structures; then a drop or two of fluorescent dye is inserted and the cornea inspected for lacerations, herpes ulcers, and foreign bodies. Finally, tonometry may be done. Referral to an ophthalmologist is often necessary, but the astute clinician will want to x-ray the sinuses, ask about a history of migraine, do a visual field, and rule out systemic diseases beforehand.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Blurred Vision, Blindness, and Scotomata: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

A careful eye examination with magnification and fluorescence to rule out a foreign body and ulcers is essential in the acute case of blurred vision. Ophthalmoscopic examination may reveal optic neuritis or a retinal vein thrombosis. Visual field examination by confrontation may reveal a field defect. If these test results are negative, ocular tension should be checked to rule out glaucoma. A history of migraine, the use of birth control pills, and alcohol intake must be investigated. If there is headache on the side of the lesion, a sedimentation rate is done, steroids should probably be started immediately, and referral to a neurologist made promptly in case temporal arteritis is possible, especially in an aged individual. Otherwise, referral to an ophthalmologist is necessary. The ophthalmologist will perform visual field examinations with perimetry and a slit lamp examination, and will look for refractive errors. If other neurologic findings are present, a CT scan, skull x-ray film, and spinal tap may be indicated. A neurologic consultant can determine this. -1.5pt

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

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