Diagnosis of Photosensitivity
Photosensitivity Diagnosis: Book Excerpts
Diagnosis of Photosensitivity: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Photosensitivity:
Diagnostic Tests for Photosensitivity: Online Medical Books
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for more information about diagnostis of Photosensitivity.
PHOTOPHOBIA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a history of exposure to drugs or toxins? Quinine, cocaine, atropine, and ApresolineŽ are just a few of the drugs that may cause photophobia.
- Are there abnormalities on the eye examination? Almost any condition of the eye may cause photophobia, including conjunctivitis, blepharitis, keratitis, iritis, corneal ulcers, and retinitis.
- Are there abnormal tonometry readings? The eye may appear normal, but the tonometry may disclose glaucoma.
- Is there nuchal rigidity? The presence of nuchal rigidity, especially with fever, would suggest meningitis. Without fever or with only a low-grade fever, the presence of nuchal rigidity should suggest subarachnoid hemorrhage.
DIAGNOSTIC WORKUP
A careful eye examination including tonometry and slit lamp examination should be done. A referral to an ophthalmologist may be necessary to accomplish this. If there is nuchal rigidity, a CT scan followed by a spinal tap should be done in conjunction with a neurologic consultation. If there is fever without nuchal rigidity, the workup can proceed as outlined on
page 168
. A histamine test may be helpful in diagnosing migraine.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Photophobia:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Corneal abrasion
-
Conjunctivitis
–Viral: Watery discharge; adenovirus most
common, also herpes simplex
–Allergic: Usually bilateral
–Chemical: History of exposure
–Bacterial (rare): Purulent discharge
-
Migraine headache: Normal eye and neurologic exam, headache, phonophobia
-
Idiopathic anterior uveitis/iritis (often associated with a triad of pain, photophobia, and blurred vision)
–Ankylosing spondylitis
–Reiter's syndrome
–Inflammatory bowel disease
–Psoriatic arthritis
–Sarcoidosis
–Infections (e.g., Lyme disease, herpes
simplex/zoster, tuberculosis, syphilis)
–Postoperative reactions
-
Meningitis/encephalitis
-
SAH
-
Influenza
-
Lightly pigmented eye
-
Mydriatic use
-
Keratoconjunctivitis sicca, or dry eye syndrome
-
Less common etiologies (“zebras”) include albinism, total color blindness, vitamin A deficiency, measles, posterior uveitis, congenital glaucoma, sinusitis, mononucleosis, influenza, Colorado tick fever, babesiosis, botulism, and acute viral hepatitis (A, B, or E)
Workup and Diagnosis
- History and physical examination
–Focused history for exposure to foreign bodies (e.g., woodworking or other flying debris), allergens, exposure to others with URI and/or conjunctivitis, systemic symptoms (e.g., arthritis)
–Physical exam should include a detailed neurologic exam, ocular exam (including dilated fundoscopic and slit-lamp exam if possible), eyelid eversion to rule out foreign bodies, fluorescein staining of the cornea to rule out abrasion, and intraocular pressure measurement
-
Head CT scan without contrast if subarachnoid hemorrhage is suspected
-
Lumbar puncture if subarachnoid hemorrhage or meningitis is suspected
-
CBC and/or blood cultures if suspect meningitis
- Further workup is based on examination
–If anterior uveitis is suspected, targeted testing may include CBC, ESR, ANA, ACE level (sarcoidosis), RPR (syphilis), PPD, chest X-ray (TB/sarcoidosis), Lyme titers, Chlamydia cultures (Reiter's syndrome), HLA-B27 assay, sacroiliac spine films (ankylosing spondylitis), and colonoscopy (inflammatory bowel disease)
–If optic neuritis is diagnosed, an MRI of the brain and orbits is indicated to evaluate for multiple sclerosis
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
PHOTOPHOBIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis of photophobia is the same as that for blurred vision (see page 83).
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Photophobia:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
If the patient reports photophobia, find out when it began and how severe it is. Did it follow eye trauma, a chemical splash, or exposure to the rays of a sun lamp? If photophobia results from trauma, avoid manipulating the eyes. Ask the patient about eye pain and have him describe its location, duration, and intensity. Does he have a sensation of a foreign body in his eye? Does he have other signs and symptoms, such as increased tearing and vision changes?
Next, take the patient’s vital signs and assess his neurologic status. Assess visual activity, unless the cause is a chemical burn. Follow this with a careful eye examination, inspecting the eyes’external structures for abnormalities. Examine the conjunctiva and sclera, noting their color. Characterize the amount and consistency of any discharge. Then check pupillary reaction to light. Evaluate extraocular muscle function by testing the six cardinal fields of gaze, and test visual acuity in both eyes.
During your assessment, keep in mind that although photophobia can accompany life-threatening meningitis, it isn’t a cardinal sign of meningeal irritation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Photosensitivity reactions:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Characteristic skin eruptions in sun-exposed areas and a patient history of recent exposure to light or certain chemicals suggest a photosensitivity reaction. A photopatch test for ultraviolet A and B (UVA and UVB) done while the patient is on the drug may aid diagnosis and identify the causative light wavelength. Other studies must rule out connective tissue disease, such as lupus erythematosus and porphyrias.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Photophobia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If your patient reports photophobia, find out when it began and how severe it is. Did it follow eye trauma, a chemical splash, or exposure to the rays of a sun lamp? If photophobia results from trauma, avoid manipulating the eyes. Ask the patient about eye pain and have him describe its location, duration, and intensity. Does he have a sensation of a foreign body in his eye? Does he have any other signs and symptoms, such as increased tearing and vision changes?
Next, take the patient’s vital signs and assess neurologic status. Assess visual activity, unless the cause is a chemical burn. Follow this with a careful eye examination, inspecting the eyes’external structures for abnormalities. Examine the conjunctiva and sclera, noting their color. Characterize the amount and consistency of any discharge. Check pupillary reaction to light. Evaluate extraocular muscle function by testing the six cardinal fields of gaze, and test visual acuity in both eyes.
During your assessment, keep in mind that although photophobia can accompany life-threatening meningitis, it isn’t a cardinal sign of meningeal irritation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Photophobia:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If your patient reports photophobia, find out when it began and how severe it is. Did it follow eye trauma, a chemical splash, or exposure to the rays of a sun lamp? If photophobia results from trauma, avoid manipulating the eyes. Ask the patient about eye pain, and have him describe its location, duration, and intensity. Does he have a sensation of a foreign body in his eye? Does he have any other signs and symptoms, such as increased tearing and vision changes?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Photophobia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient reports photophobia, find out when it began and how severe it is. Did it follow eye trauma, a chemical splash, or exposure to the rays of a sun lamp? If photophobia results from trauma, avoid manipulating the eyes. Ask the patient about eye pain and have him describe its location, duration, and intensity. Does he have a sensation of a foreign body in his eye? Does he have other signs and symptoms, such as increased tearing and vision changes? Does he have nuchal rigidity and severe headache?
Next, take the patient's vital signs and assess his neurologic status. Assess visual activity, unless the cause is a chemical burn. Follow this with a careful eye examination, inspecting the eyes'external structures for abnormalities. Examine the conjunctiva and sclera, noting their color. Characterize the amount and consistency of any discharge. Then check pupillary reaction to light. Evaluate extraocular muscle function by testing the six cardinal fields of gaze, and test visual acuity in both eyes.
During your assessment, keep in mind that although photophobia can accompany life-threatening meningitis, it isn't a cardinal sign of meningeal irritation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
PHOTOPHOBIA:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis of photophobia is the same as that of
blurred vision .
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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