Cataract
-A clouding of the lens sufficient to reduce vision
S/S:
Cloudy or blurry vision
Lights are too bright and/or give off a glare or halo.
Poor night vision, Diplopia
Colors seem faded
Increased nearsightedness, and distortion of vision in either eye.
Diagnostic:
Impaired red reflex from the fundus
Examine dilated eye with a slit lamp.
Management:
Surgical extraction is the only treatment.
Optic Neuritis
-A common inflammatory disease of the optic nerve
S/S:
“the doctor sees nothing, and the patient sees nothing”
Acute inflammation/demyelination of optic nerve → acute monocular vision loss/blurriness and pain.
- MS = MCC (can also be from ethambutol)
Diagnostic:
MRI
Management:
Virtually all pts. experience a gradual recovery of vision after a single episode, even without treatment.
15 year risk for MS development = 50%
Pinguecula
S/S:
A small, raised conjunctival nodule, usually at the nasal limbus.
Diagnostic: Clinical Exam
Management: No treatment is typically needed.
Pterygium
S/S:
Resembles a pinguecula but has crossed the limbus to encroach on the corneal surface.
Diagnostic:
Clinical exam, ophthalmology referral
Management:
Removal is justified when symptoms of irritation to blurring develop, but recurrence is common.
Ectropion
-An outward turning of the lid margin
S/S:
Drying of eyes
Outward truing of the eyelid
Diagnostic: Clinical exam
Management:
Artificial tears
Referral, non-urgent
Entropion
-An inward turning of the lid margin
S/S:
Corneal abrasion from eyelashes
Diagnostic: Clinical Exam
Management:
Artificial tears
Referral, non-urgent
Dacryocystitis
-In inflammatory condition of the lacrimal sac, typically caused by obstruction of the nasolacrimal duct.
S/S:
Periorbital cellulitis, swelling around the eye
Erythema, warmth
Tenderness and purulent discharge from the tear duct.
Diagnostic:
pressure on lacrimal sac → reflux of tears and purulent material from punctum = confirmation.
Management:
Warm compress + Cringler massage
May require surgery
Empiric oral antibiotics should include gram+ and gram- coverage.
Uveitis
-Inflammation of the middle layer of the eye (uvea)
Most common type is an inflammation of the iris called iritis (anterior uveitis)
Red circle is AROUND the iris.
S/S:
Acute anterior Uveitis:
Sudden redness and blurry vision often with photophobia
Posterior Uveitis:
Gradual loss of vision, commonly with floaters, in a variably inflamed eye
Miosis
Diagnostic:
Slit lamp exam
Tonometry → measures pressure inside the eye
Fundoscopic exam.
Management:
Any pt. with suspected acute uveitis → Referred urgently
Emergently if visual loss or pain is severe.
Any pt. with suspected chronic uveitis → urgent referral if more than mild visual loss.
UV Keratitis
-Also called Actinic Keratitis
UV burns of the cornea are usually caused by use of a sunlamp without eye protection, exposure to welding arc, or exposure to sun while skiing.
S/S:
No immediate symptoms.
About 6-12 hours later → pt. complains of agonizing eye pain and severe photophobia
Diagnostic:
Slit lamp exam → diffuse punctate fluorescein staining of both corneae.
Management:
Treatment consists of patching
Instillation of 1-2 drops of 1% cyclopentolate → relieve discomfort of ciliary spasm
Typically recover 24-48hrs without complications.
Keratoconjunctivitis sicca
-AKA dry eye
S/S:
Buring Foreign-body sensation
injection
Photophobia
Diagnostic:
Symptoms of dry eye
Schirmer test
a strip of filter paper is placed at the edge of the eyelid → used to measure the number of tears produced during the next 5 minutes.
Management:
Artificial Tears and lubricants.
Papilledema
-Bilateral optic disc swelling from raised intracranial pressure.
S/S:
Headache
Transient visual obscurations in one eye or two
Visual field testing shows enlarged blind spots and peripheral constriction
Diagnostic:
Difficult to differentiate from other optic disc edema by fundus examination alone
Noninvasive MR vascular imaging
Management:
Visual acuity not affected unless severe, longstanding, or accompanied by macular edema and hemorrhage.
Emergent referral.