Vision history Taking Eye Pain SOCRATES Associated features: Do you wear contact lenes -> corneal ulcerations. Is there pain when you move your eyes -> iritis or scleritis? Are the lids stuck together in the morning -> conjunctivitis Have you had an injury or worked with dust, metal grinders or welding -> injury, foreign body or flash burn. Have you had arthritis or rashes -> vasculitis. Past medical history: History of previous eye problems. History of arthritis History or vasculitis or other vascular disease History of multiple sclerosis History of thyroid diseases. History of diabetes History of atrial fibrillation. Occupation and exposure to fragment exposure to metal. Previous eye surgery Medications history: Corticosteroid use -> cataracts. Anti-cholinergic -> glaucoma from acute angle closure. Amiodarone -> corneal deposits Chloroquine and chlorpromazine -> renal toxicity Ethambutol and isoniazid -> optic neuropathy Visual Loss Bilateral blindness of a sudden onset Bilateral occipital lobe infarction. Bilateral occipital lobe trauma. Bilateral optic nerve damage e.g. in alcohol poisoning. Somatization or conversion reaction. Unilateral blindness of a sudden onset: Retinal or vein occlusion. Temporal arthritis. Optic neuritis Nonarteritic optic neuropathy. Bilateral blindness of a gradual onset: Cataracts Macular degeneration. Bilateral optic nerve compression Bilateral chiasmal compression Bilateral optic nerve damage for example tobacco amblyopia. Differentials TIA 10 minutes Sensory loss Muscle weakness Loss of consciousness Aphasia Dysarthria Stroke More than 10 minutes Lasting effects Muscle weakness Loss of consciousness Sensory loss Aphasia Dysphagia Migraines Photophobia Phonophobia Headache Disabling Nausea Vomit Cancer Weight loss Changes to appetite Increased head pressure Night sweats Fever Visual changes Meningitis Photophobia Neck stiffness Fever Seizures Fits ICH Headache Focal neurological symptoms. Cushing’s triad: Low RR Low HR Low BP Confusion Fixed pupils SAH Thunderclap headache Radiates to neck and back. Worse headache Opisthotonus -> head and lower limbs hyperextended backward and the trunk arching forward Meningeal signs Nonspecific features Impaired consciousness Fever Sweating Hemodynamic instability Signs due to mass effect CN disorders Altered medial status -> may have delirum Focal neurological deficits Seizures Prodromal symptoms Sudden and severe headache Transient diplopia