Eye Disorders 2 (copy)

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.