Introduction à la prise d’antécédents de l’œil et au dépistage de la vision Copy

Introduction to history taking of the eye and vision screening

Occupational health should involve an integrated holistic approach to the worker’s health needs. It is the process of integrating thorough history taking with the physical assessment of the eye and the vision screening, to get the best results possible.

When conducting a vision screening test, a thorough history should be taken from the worker / person being tested. The history will assist in the interpretation of the results. Current data should be compared to previous data to determine changes and implementation of measures to ensure optimal health and safety for the individual. Remember the first interview on record will serve as the baseline information against which all additional and future information will be benchmarked.

The vision screening technician’s role in history taking should be as follows:

To build a relationship with the worker and gain their trust
To use interviewing skills to obtain a detailed and precise history from the worker
To record the information and data accurately
To interpret the information and data appropriately
To advise the worker on the outcome of the visual assessment

Considerations should be:

Effective communication, both verbal and non-verbal
Accurate writing skills as the technician must be able to write (easy to understand) reports such as the history, examination, and visual assessment findings
Protection of the worker’s privacy and confidentiality
A methodical approach to the visual assessment
Integration of history taking and physical assessment into the findings of the visual assessment
Correct identification of the normal and abnormal findings from the history, physical assessment, and vision screening

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History Taking for Vision Screening

Before a visual assessment is done a thorough history should be taken from the worker. This will assist in the interpretation of the results. The vision screening technician should work in a systematic order to obtain this information. A good ocular history should always include:

The demographics of the worker being tested
The occupational history
Medical history
Surgical and trauma history
History specific to the eyes
Medication
Recreational history

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Demographics

It is important to correctly identify the person coming for a vision test and to fully understand where the employee comes from, the culture, socio-economic background, and beliefs as this affects how the worker will respond to treatment, care, and management. Demographic data should include:

Name and Surname
Address and contact details
Gender
Identity number – verify this using statutory documents such as a driver’s license or ID book
The name of the employer / company
The position employed in and department

Other information is important for the overall occupational health assessment but not important at this stage of the examination. The focus is the eyes and vision.

Occupational history

A comprehensive occupational history should be taken starting from the first employment up to the current position and should include informal work done. Ask specific questions to determine exactly what the worker does daily, do not just ask for a job description. For example: If the worker is a “machine operator” ask the worker to explain what the machine does (cut, saw, grind etc.). When taking an occupational history look at past and current employment. Remember the focus is only on vision and the eyes, therefore work history involving the eyes and vision.

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General history

During this phase of the history, it is important to establish the health of the worker. Several diseases and many medicines affect the eyes and vision, so a detailed medical and surgical history is important. When taking a medical history split the history into the following groups:

Chronic conditions / diseases
Acute conditions / diseases
Past and present – for both chronic and acute history
Surgical and trauma history
Ocular history
Medication
Recreational history
Family history

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Chronic Diseases

Chronic diseases are defined as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living. Chronic diseases such as heart disease, cancer, and diabetes are the leading causes of death and disability worldwide.

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Diabetes

People who suffer from diabetes for many years may be at risk of a condition known as diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness worldwide9. This condition is related to high blood sugar levels and affects the blood vessels of the eye and the retina, which can result in serious loss of vision and blindness. Diabetics also run a higher risk of developing cataracts and glaucoma. Monitoring for retinal changes can help prevent blindness and other diabetic complications.

Figure 7.1: Diabetic Retinopathy3


High Blood Pressure (Hypertension)

Uncontrolled, elevated blood pressure can be linked to a host of health issues, including diabetes, heart disease, and obesity. High blood pressure damages the tiny, delicate blood vessels that supply blood to the eyes, causing:

Retinopathy: Damage to the light-sensitive retina can lead to bleeding in the eye, blurred vision, and complete loss of vision. It is an even greater risk if the workers have both diabetes and high blood pressure.
Choroidopathy: Fluid build-up under the retina is called choroidopathy. It can result in distorted vision or sometimes scarring that impairs vision.
Nerve damage or optic neuropathy: Blocked blood flow can damage the optic nerve, leading to bleeding within the eye and vision loss.

High Cholesterol

Low-Density Lipoprotein (LDL) can have devastating consequences to both systemic and ocular health. LDL transports cholesterol to artery walls and body tissue, for this reason, elevated LDL levels are considered a risk to health13. LDL can lead to narrowing of the veins and arteries, buildup in the walls of veins and arteries creates plaques. As a result of plaque buildup clots develop in an artery or as a result of plaque breaking off and moving to a narrower artery leading to a loss of function of the area supplied by the affected artery. When this artery is in the heart, it can lead to a heart attack. In the brain, it is a stroke. And in the eye, it is referred to as a retinal artery occlusion14.

Acute Condition / Disease

An acute disease appears suddenly and lasts for a short amount of time. This is different from chronic diseases, which develop gradually and remain for months on end. Some examples include the influenza virus, ear infections, sinusitis, and the common cold.

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Surgical History

Surgery, the branch of medicine that is concerned with the treatment of injuries, diseases, and other disorders by manual and instrumental means. A history of the surgical procedures that a worker has had, and complications therefrom involving the eyes is important when taking a surgical history.

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Trauma History

Trauma in the context of eyes and vision means the physical injury caused by a direct blow to the eye. The trauma may affect not only the eye, but the surrounding area, including adjacent tissue and bone structure. There are many different forms of trauma, varying in severity from minor injury to medical emergencies. Traumatic injury is caused by various forces from outside of the body, which can either be blunt or penetrating (sharp). Blunt trauma includes falls, road traffic crashes; crush injuries, assaults (punches, kicks) and burns. Penetrating trauma involves shooting, stabbing, or falling onto a sharp object (known as impalement). The eye can be injured (traumatised) in several different ways.

What are the types and causes of the most common eye injuries?

Chemical exposures and burns:

A chemical burn can occur in several ways but is most often the result of a liquid splashing into the eye. Many chemicals, such as soap, are irritants only and do not usually cause permanent damage. Acids and alkalis are highly caustic and may cause severe and permanent damage to the ocular surface.

Acids (such as sulfuric acid found in car batteries) or alkaline substances (such as lye found in drain cleaner and ammonia) can splash into the eyes.
Rubbing the eye when working with chemicals can transfer chemicals on the hands to the eye.
Aerosol exposure is another method of potential chemical injury.

Figure 7.2: Acid burn to the right10

Subconjunctival haemorrhage (bleeding):

This is a collection of blood lying on the surface of the white of the eye (sclera). The sclera is covered by the conjunctiva, which is the transparent blood vessel containing membrane that lies over the sclera. Subconjunctival haemorrhage may accompany any eye injury. It may also be spontaneous. The degree of subconjunctival haemorrhage is not necessarily related to the severity of the injury.

Figure 7.3: A Subconjunctival Bleed11

Corneal abrasions:

The cornea is the transparent tissue that is located in front of the pupil and iris. A corneal abrasion is a scratch or a traumatic defect in the surface of the cornea. People with corneal abrasions often report that they were “poked” in the eye by an object, a metallic object, a fingernail, or a tree branch or that may have worn their contact lens too long.

Figure 7.4:

Traumatic iritis:

This type of injury can occur in the same way as a corneal abrasion but is more often a result of a blunt blow to the eye, such as from a fist, a club, or an air bag in a car. The iris is the coloured part of the eye. Iritis simply means that the iris is inflamed.

Figure 7.5: Iritis13

Hyphemas and orbital blowout fractures:

These injuries are associated with significant force from a blunt object to the eye and surrounding structures. Examples would be getting hit in the face.

Figure 7.6: An example of a Hyphema14

Hyphaemia’s are the result of bleeding in the eye that occurs in the front part of the eye, called the anterior chamber.
Orbital fractures are breaks of the facial bones surrounding the eye (socket). An orbital blowout fracture is a break in the thin bone that forms the floor of the orbit and supports the eye (orbital floor fracture).
Lacerations (cuts) to the eyelids or conjunctiva (the clear covering over the white of the eye): These injuries commonly occur from sharp objects but can also occur from a fall.
Lacerations to the cornea and the sclera: These injuries are potentially very serious and are frequently associated with trauma from sharp objects made of metal or glass.

Foreign bodies in the eye:

A foreign body is a small piece of metal, wood, or plastic.

Corneal foreign bodies are embedded in the cornea and, by definition, have not penetrated the eye itself. Iron containing metal foreign bodies in the cornea can cause a rusty stain in the cornea, which also requires treatment.
Intra-orbital foreign bodies are located in the orbit (or eye socket) but have not penetrated the eye.
Intraocular foreign bodies are injuries in which the outer wall of the eye has been penetrated by the object, which is now lodged within the eye itself.

Figure 7.7: All examples of foreign bodies in the eye15

Ultraviolet keratitis (or corneal flash burn): The most common light-induced trauma to the eye is ultraviolet keratitis, which is “sunburn” of the cornea. Common sources of damaging ultraviolet (UV) light is welding arcs and tanning booths
Solar retinopathy: Damage to the central part of the retina caused by staring at the sun.
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Medication

Medication has side effects and some of these side effects may cause eye problems. Most of these side effects are minor, like slight dryness or itchiness. Several types of medications can cause serious trouble with your vision. Some classes of drugs cause more severe eye problems — typically only after they have been used for several years.
For example, corticosteroids (oral/systemic and topical eye drops) such as prednisone, prednisolone and betamethasone can cause cataracts and glaucoma after years of use. Corticosteroids are widely used to treat autoimmune diseases like rheumatoid arthritis and psoriasis, leukaemia, lymphoma, and asthma. Corticosteroids suppress inflammation, which makes them an important group of drugs despite their serious side effects17.

Certain medicines can affect the eyes

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A list of medication causing photosensitivity is available at: https://www.dhs.wisconsin.gov/radiation/medications.htm

Recreational History

Everyone needs a break from the humdrum of daily life and work stress to relax. Some people attend music concerts, watch, or take part in sports, go diving, hunting or target practice, others simply kick back and listen to music. Unfortunately, recreational activities affect vision. It is for this reason the technician must take a recreational history.

Common recreational activities that pose a danger to the eyes

Outdoor activities involving sun exposure. A common hazard for the eyes is prolonged contact with the sun its ultra-violet rays. These powerful rays can cause permanent, irreversible damage to the inner part of the eyes. Sunbathing and other outdoor activities contribute to UV exposure.
Excessive television viewing poses another risk; eyes constantly adjust to focus on different colours, sizes, and objects, and often focus on the screen at a close distance for long periods of time. This type of eyestrain can cause headaches, blurred vision, and other serious complications.
Playing video games for hours is another culprit that can affect the eyes. Video games are constantly changing, and the images are moving and popping out. The eyes work hard to follow everything and keep it all in focus
Using a computer or similar device can cause eyestrain as well. “Computer Vision Syndrome” refers to the burred and fuzzy images seen after sitting and staring at a computer for a long time.
Sport is another activity that can lead to serious eye injuries. Certain sports involving small balls like tennis, racquetball, baseball, squash, hockey, cricket, and ping-pong pose a high risk for eye injury. Any sport where an object is loose or flying through the air can be dangerous to the eyes.
Smoking is a threat when it comes to the health of the eyes. Smokers have a higher risk for cataracts, macular degeneration, and other eye diseases.
Gardening can be harmful to the eyes because of the dirt that can be disturbed during weeding and planting and chemicals that may be used to eradicate pests and weeds. Dirt and dust molecules can cause irritation and may even scratch the cornea of the eye.
Mowing the lawn and using a weed eater can be threatening to the eyes because of flying debris and UV ray exposure.
Cleaning the house is another task that poses eye danger. Any time chemicals are used that have harmful ingredients, the eyes are at risk. If a chemical or cleaner splashes into the eyes it can cause extreme irritation and may result in eye damage
Swimming or sitting in a hot tub may be harmful to the eyes. The chlorine and bacteria in the water can cause eye infections or other complications. Contact lens wearers are at a higher risk for these types of complications because the lenses will hold the chemicals or bacteria directly on the eye

Figure 7.8: Examples of Sport that can cause injury or trauma to the eyes18


General questions

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For a full and detailed list of hereditary ocular diseases use the following link:


https://www.rpbusa.org/rpb/resources-and-advocacy/resources/rpb-vision-resources/hereditary-ocular-disease/