Chapter 7: Systemic Health Screening

INTRODUCTION

7.1 INTRODUCTION TO SYSTEMIC HEALTH SCREENING

Primary eye care practitioners frequently encounter manifestations of systemic disease. A number of systemic diseases, particularly those of infectious or inflammatory nature, affect the eyes as well as other organs or tissues within the body. Ocular related findings such as headaches or blurred vision are often the first symptom of a variety of systemic conditions, and the primary eye care provider may be the first healthcare professional sought by the patient for their concerns.

Occasionally, ocular signs present that may suggest the presence of a potentially life-threatening condition such as a space-occupying lesion in the brain, severe hypertension, or carotid artery disease. Many of these conditions can be detected by carefully listening to the patient’s symptoms and the use of the problem-specific procedures described in this chapter. The patient is then referred to the appropriate provider in a timely manner.

The procedures included in this chapter are generally not considered part of the core ocular examination. Rather they are problem-specific tests that are employed when indicated by the patient’s symptoms, case history, or abnormal test results noted during other procedures. Most of the techniques in this chapter will be used more frequently in examining elderly patients because they are at higher risk for many systemic diseases. Practitioners with a predominantly elderly patient population may choose to include some of these techniques in their core routine examination. Blood pressure measurement is sometimes performed routinely as an initial screening procedure, especially in offices that utilize ancillary personnel. All of these techniques may be used with any age group, when indicated.

Throughout this chapter, reference is made to the standard precautions whenever the examiner touches the patient (see Procedure 2.2). These standards are essential in the prevention of the spread of infection. Vigorous hand washing with soap and water or an alcohol-based hand sanitizer is recommended by the Centers for Disease Control and Prevention (CDC) before and after every patient encounter. Disposable surgical gloves may also be used but should not substitute for hand washing.

7.2 BLOOD PRESSURE EVALUATION (SPHYGMOMANOMETRY)

Purpose

Sphygmomanometry with the use of a stethoscope is used to determine blood pressure. This method determines the pressure in the arteries at the height of ventricular contraction (systolic pressure) and ventricular relaxation (diastolic pressure). Measurement readings are recorded in millimeters of mercury (mmHg).

Equipment

• Stethoscope with a two-sided head (bell and diaphragm).

• Blood pressure cuff is commonly used with an aneroid manometer. Other types are available, such as automated, hybrid or mercury, the latter, less commonly used due to its safety profile. Use appropriate cuff size (pediatric, ...