Author: Ana Majdak
Primary Examiner (Aalen University): Prof. Dr. Anna Nagl
Co-Supervisor: Dr. Matjaž Mihelčič, M.Sc. Vision Science and Business (Optometry)
Purpose of the Master Thesis:
Optometrists in optometric practice regularly see patients presenting with a wide range of ocular symptoms, from a mild ache after a long day of screen work to a sudden red eye which turns out to be emergency. Causes behind any symptom can range from benign and self-limiting to sight- or life-threatening and telling them apart during the exam is not always straightforward. This thesis aims to build a practical, symptom-based differential diagnosis guide for optometrists working within the Croatian scope of optometric practice. For each presenting symptom, guide describes the most likely causes, examination findings which matter most for telling them apart and if patient can be managed within optometric care or needs referral and if so, how urgently. Since many of the more serious or unusual conditions covered in this thesis are encountered rarely in everyday optometric practice, this guide is also intended to serve as a quick, reliable reference when such presentations do occur, helping optometrist recognize a pattern they may not have seen in a long time.
Methods:
This thesis is written as a narrative qualitative literature review. Sources were found through PubMed, Google Scholar and Cochrane Library, together with clinical reviews from StatPearls collection. Standard reference textbooks were included, most extensively Kanski's Clinical Ophthalmology. Rather than organizing material by diagnosis, each chapter was built around a single presenting symptom, since this is how patients actually describe their complaints in optometric practice. Every chapter follows the FOLDAR framework (Frequency, Onset, Location, Duration, Associated symptoms, Relief/Radiation) for clinical history, together with objective findings and a management plan graded by urgency.
Results:
Sixteen chapters were developed, covering ocular symptoms most commonly encountered in optometric practice, from blurred vision, red eye and diplopia all the way to less frequently discussed presentations such as proptosis, ptosis, anisocoria, photophobia and nyctalopia. Within each chapter, presenting symptom is broken down into subtypes based on key examination findings, such as whether a red eye is painful or painless, or whether enlarged pupil reacts better to light or to a near target and every underlying condition is described once in full, in full and cross-referenced wherever it comes up under more than one symptom. Four-level urgency classification (Emergency, Urgent Referral, Routine Referral, Optometric Care) is applied consistently throughout, given specific limits of the Croatian optometric scope of practice, where prescribing medication, performing procedures and pupil dilation all fall outside what optometrist are legally allowed to do. A first demo version of an interactive tool, built from summary tables and flowcharts, was also made and is described in Conclusion and Appendix. It has not been tested yet and needs to be improved in practice.
Conclusion:
Organizing the differential diagnosis by presenting symptom, rather than by disease, matches how patients actually present in optometric practice. The same underlying condition often appears under more than one symptom, so each condition is described in full once and cross-referenced everywhere else it is relevant, keeping the guide consistent without requiring optometrist to search across chapters. The urgency grading applied throughout makes guide usable during a real exam, showing clearly what falls within optometric scope and what needs referral, and how urgently. This guide should be useful both for optometric students learning this material for the first time and for optometrists in practice who need a quick, reliable reminder for the less common presentations covered here.
Keywords:
differential diagnosis; optometric practice; Croatia; ocular symptoms; urgency classification; referral; FOLDAR framework
