Eye Assessment
Pain
Redness/Swelling
Watering/Discharge
History of Ocular Problems
Vision Changes/Difficulty
Have you had any difficulty seeing?
Have you experienced any blurred vision?
Have you experienced any blind spots?
Have you experienced any increased difficulty seeing at night?
If Yes:
Is this specific change constant or does it come and go?
Does/did it come on gradually or all of a sudden?
Is the change present in one or both eyes?
Do objects appear out of focus or are you experiencing any grayed vision?
Do spots move in front of your eyes? How many?
Do you see any halos around objects or rings around lights?
Are you experiencing any eye pain?
When did your pain come on? Suddenly or gradually?
What is the quality of your pain? How would you describe it?
Is there anything that seems to make your pain better or worse?
What is the severity of your pain? On a scale of 1 to 10 how severe is your pain?
Are there any other associated symptoms?
Do you have a headache in your ocular or brow area?
Strabismus, diplopia
Do you have a history of or do you currently have crossed eyes?
If Yes: Is this due to eye fatigue? Is that constant or does it come and go?
Have you been experiencing double vision?
If Yes: Is it constant or does it come and go? Does it go away if you cover up one eye or the other?
Have you noticed any redness or swelling in one or both of your eyes?
Do you have a history of or do you currently have an eye infection?
If Yes: When do these eye infections usually occur? Is there a specific time of year associated with your eye infections? Is there anyone else in your household with the same infection?
Have you experienced any excessive watering or tearing of one or both eyes?
Have you experienced any discharge from one or both eyes?
Any history of eye injury?
Any history of eye surgery?
Glaucoma
Have you ever been tested for glaucoma?
Do you have any family history of glaucoma?
Glasses/Contact Lenses
Do you use either glasses or contact lenses?
If Yes:
How well do they work for you?
When was the last time your prescription was checked or changed?
When you wear contact lenses, do you experience any pain, eye watering, photophobia, or swelling of your eye?
How do you care for your contacts? How long do you wear them? How do you clean them? How often and when do you remove your contacts? Do you remove them for certain activities?
Any history of allergies?
Patient Centered Care
Do you smoke?
Which medications are you currently taking? Do you take any medications specifically for your eyes?
Have you been exposed to any environmental conditions which may be harmful to your eyes?
If the patient has experienced vision loss or changes:
When was your last vision test?
If Yes: Do you wear eye protection in those instances?
How do you cope with your vision loss/changes?
Do you have the necessary tools you need?
Have you maintained your living environment the same?
Do you sometimes fear complete loss of vision?
Have you experienced dry eye or a burning sensation in your eye?