(2) Lacrimal, Lid, Neuro-Ophtho, Retinal, Vascular Disorders, Vision Abnormalities

What Lacrimal Disorder is this?

• Inflammatory condition of the lacrimal sac, typically caused by obstruction of the nasolacrimal duct

Dacryocystitis

What is the Etiology for Dacryocystitis?

Bacterial

• S. aureus

• B-hemolytic Streptococci

What Lacrimal Disorder is this?

• Signs of periorbital cellulitis

  • Erythema

  • Warmth

  • Swelling

• Tenderness and purulent discharge from the tear duct

Dacryocystitis

How is Dacryocystitis treated?

• Warm compresses

• Abx treatment

  • 2nd/3rd gen Cephalosporins

  • Tobramycin Dextramethisone

• Wound care

• Address underlying obstruction

What Lid Disorder is this?

• Inflammation of the lid margins (edges of the eyelids)

• Tiny oil glands near the base of the eyelashes become clogged, causing irritation and redness

Blepharitis

What is the Etiology for Blepharitis?

• Staphylococcus

• Streptococcus

• Seborrhea

What Lid Disorder is this?

• Red rims

• Scales

• Crusting

• Dandruff-like deposits

• Scruffy and fibrous scales

• Thick, cloudy discharge (meibomian gland obstruction)

Blepharitis

How is Blepharitis treated?

• Lid scrubs using diluted baby shampoo on cotton-tipped swabs

• Massage to express meibomian gland

• Topical Abx, if infection is suspected

• Systemic Abx, for severe cases

What Lid Disorder is this?

• Relatively painless

• Slow-growing blockage, causing inflammation in the oil gland of the eyelid

Chalazion

What Lid Disorder is this?

• Insidious onset with minimal irritation

• Lesion appears white to grayish

• Becomes pruritic and causes erythema of the involved lid and adjacent conjunctiva

Chalazion

How is Chalazion treated?

• Warm compresses

• Referral to ophthalmologist

  • Elective excision

  • Steroid injection

What Lid Disorder is this?

• A condition where the edge of the eyelid EVERTED (outward) 2º to advanced age, trauma, infection, or palsy of the facial nerve

Ectropion

What Lid Disorder is this?

• Lower lid sags away from the eye

• Eye cannot close completely when blinking

  • Causes dry and irritated eyes

Ectropion

How is Ectropion treated?

• Surgical repair

• Excessive tearing

• Exposure

• Cosmetic distress

• Lubricating eye drops

What Lid Disorder is this?

• A condition where the lid and lashes are turned IN, 2º to scar tissue or spasms of the orbicularis ocular muscles

Entropion

What Lid Disorder is this?

• Signs of periorbital cellulitis

  • Erythema

  • Warmth

  • Swelling

• Tenderness and purulent discharge from the tear duct

• Patients c/o foreign body sensation

Entropion

How is Entropion treated?

• Surgical repair if the condition cannot be managed

• Excessive tearing

• Exposure

• Cosmetic distress

What Lid Disorder is this?

• An acute development of a small, mildly painful nodule

• A pustule within a gland in the upper or lower eyelid

• Due to a blocked oil duct

• Typically near the eyelash and lives on the outside of the eyelid

Hordeolum / Stye

What is the Etiology of Hordeolum / Stye?

BACTERIAL

• Staphylococcus

• Streptococcus

What Lid Disorder is this?

• Acute onset of pain and edema of the involved eyelid

• Palpable, indurated area in the involved eyelid

• Central area of purulence with surrounding erythema

Hordeolum / Stye

How is Hordeolum / Stye treated?

• Abx therapy

  • 2nd gen Cephalosporins

  • Ciprofloxacin

• Wound care

• Address underlying obstruction

• Warm compresses

What Lid Disorder is this?

• Blocked oil gland that is painless

• Appears on the inside of the eyelid, usually surfacing as a bump

Chalazion

What Neuro-Ophthalmologic Disorder is this?

• A condition characterized by involuntary, repetitive, and uncontrolled movements of the eyes

• Can cause the eyes to move rapidly and alternatively from side to side, up and down, or in a circular pattern

Nystagmus

What can cause Nystagmus?

• Inner Ear Disorders

• Brain Disorders

• Vision Problems

• Medications

• Metabolic Disorders

What Inner Ear Disorders can cause Nystagmus?

• Meniere’s disease

• Labyrinthitis

What Brain Disorders can cause Nystagmus?

• MS

• Stroke

• Brain tumors

What Vision Problems can cause Nystagmus?

High degree of nearsightedness or farsightedness

What Medications can cause Nystagmus?

• Antiseizure drugs

• Sedatives

• Alcohol

What Metabolic Disorders can cause Nystagmus?

• Thyroid disorders

• Certain vitamin deficiencies

What Neuro-Ophthalmologic Disorder is this?

• Complaints of involuntary eye movement

• Visual disturbances like blurred vision, double vision, head nodding, and head shaking

• Classic presentation of “null point”

Nystagmus

How is Nystagmus treated?

• Treat the underlying cause

• Medication therapy

  • Gabapentin

  • Botulism injections

• Surgery

• Vision therapy

What Neuro-Ophthalmologic Disorder is this?

• Inflammation of the optic nerve, which is the nerve that transmits visual information from the eye to the brain

• Common causes include MS, Lyme, and cytomegalovirus

Optic Neuritis

What Neuro-Ophthalmologic Disorder is this?

• Acute unilateral, painful vision loss or blurred vision

• Loss of color vision

• Pain with eye movement

• Headaches

• Flashing lights

Optic Neuritis

How is Optic Neuritis treated?

• Self-resolving over several weeks to months

• Steroids to reduce inflammation

• Permanent vision impairment may occur

What Neuro-Ophthalmologic Disorder is this?

• Optic disc swelling that is caused by increased intracranial pressure

• Optic disc is the point where the optic nerve enters the back of the eye

• Increased pressure inside the skull can cause the optic nerve to swell at the disc

Papilledema

What Neuro-Ophthalmologic Disorder is this?

• Transient vision alteration

  • Temporary loss or impairment of vision in one eye, double vision, headaches, and pulsatile tinnitus

• Flickering

• Asymptomatic at times

Papilledema

What can cause Papilledema?

• Malignant HTN

• Hemorrhagic stroke

• Acute subdural hematoma

• Brain tumor

• Intracerebral hemorrhage

How is Papilledema treated?

• Identify the underlying cause for ICP

• Steroids to reduce inflammation

• Diuretics to decrease CSF production

• Topiramate to reduce ICP

• Surgical intervention

• Optic nerve sheath fenestration

• Lifestyle modifications

What Retinal Disorder is this?

• Eye disorder that affects the macula, which is the central part of the retina responsible for sharp, central vision

• MC type, caused by aging, gradual loss of central vision

  • Difficulty reading details

Dry Macular Degeneration

What Retinal Disorder is this?

• Eye disorder that affects the macula, which is the central part of the retina responsible for sharp, central vision

• Least common and more severe type

  • Blood vessels grow into the retina, causing rapid vision loss

Wet Macular Degeneration

What risk factors are associated with Macular Degeneration?

• Age (usually > 60)

• Family history

• Smoking

• Obesity

• HTN

• HLD

• Saturated fat diet

What Retinal Disorder is this?

• Blurred or distorted central vision

• Difficulty seeing details up close

• Need bright light when reading

• Colors appear less bright

• Black spots in vision

Macular Degeneration

How is Macular Degeneration treated?

• No cure

• Anti-VEGF injections to slow blood vessel growth

• Vitamin supplements

• Regular eye exams

What Retinal Disorder is this?

• When the retina (light-sensitive layer of the tissue at the back of the eye) becomes separated or detached from the underlying supportive tissue

• Vitreous (gel-like substance that fills the eye) can shrink and pull on the retina, causing it to detach

Retinal Detachment

What can cause Retinal Detachment?

• Age

• Injury or trauma

• Diabetic retinopathy

• Extreme nearsightedness / Myopia

• Eye surgery

What Retinal Disorder is this?

• Sudden increase in floaters or flashes of lights

• Blurred or disoriented vision

• Curtain-like shadow or blind spots in the visual field

Retinal Detachment

How is Retinal Detachment treated?

• MEDICAL EMERGENCY

• Prompt tx to prevent permanent vision loss

  • Surgery using laser cryotherapy

  • Vitrectomy to reattach the retina

What Retinal Disorder is this?

• Condition that describes damage or disease of the retina (light-sensitive layer of tissue at the back of the eye)

• Sequelae of DM2

• Damage to the blood vessels in the retina due to high blood sugar levels

• Leading cause of blindness in adults

Diabetic Retinopathy

What Retinal Disorder is this?

• Condition that describes damage or disease of the retina (light-sensitive layer of tissue at the back of the eye)

• HTN which causes retinal blood vessels to become narrow and leak

Hypertensive Retinopathy

What can cause Retinopathy?

• HTN

• DM

What Retinal Disorder is this?

• Floaters

• Blurred vision

• Distortion

• Progressive visual acuity loss

Retinopathy

How is Retinopathy treated?

• Optimize glucose control

• BP regulations

• Laser photocoagulation

• Eye surgery (Vitrectomy)

What Vascular Disorder is this?

• Blockage of the main artery supplying blood to the retina

• Can cause sudden and severe vision loss

Central Retinal Artery Occlusion (CRAO)

What Vascular Disorder is this?

• Occurs when the main vein that drains blood from the retina becomes blocked

• Leads to swelling and hemorrhages in the retina

Central Retinal Vein Occlusion (CRVO)

What Vascular Disorder is this?

• Sudden, painless, profound vision loss in 1 eye

• Vision loss described as “current coming down” or “blackout”

• Afferent pupillary defect

  • Impaired pupillary light reflex

• Cherry red spot on macula

Central Retinal Artery Occlusion

What Vascular Disorder is this?

• Sudden, painless, profound vision loss in 1 eye

• Less severe

• Dilated and tortuous retinal veins

• Retinal edema and thickening

• Cotton-wool spots

• “Blood and thunder” retina

Central Retinal Vein Occlusion

What can cause Central Retinal Artery/Vein Occlusion?

• Atherosclerosis / Plaques 2º to CAD

• Blood clots 2º to a-fib

• Trauma

• Coagulable states, such as pregnancy, OCPs, etc

How is Central Retinal Artery/Vein Occlusion treated?

• Emergency referral to ophtho

• Recumbent position

• Gentle ocular massage

• Vessel dilation and paracentesis

• Workup and management of atherosclerotic disease (CAD) or arrhythmias (A-fib)

What Vision Abnormality is this?

• Refers to a temporary loss of vision in one eye that typically lasts from a few seconds to a few minutes

• Caused by a temporary disruption in the blood supply to the eye or the optic nerve that carries visual information from the eye to the brain

Amaurosis Fugax

What can cause Amaurosis Fugax?

• CAD plaque build-up (MCC)

• Giant cell arthritis

• Emboli (traveling blood clots)

• Migraines (+/- aura)

What Vision Abnormality is this?

• Sudden vision lost in 1 eye

• May be complete blindness or dark “curtain” or “shade” moving across the visual field

• Painless, returning to normal after ~1 hr

• Warning sign of stroke 2º to atherosclerosis

Amaurosis Fugax

How is Amaurosis Fugax treated?

• Prompt evaluation by ophtho / neurologist / vascular

• Figure out exact cause

• Treat the cause

What Vision Abnormality is this?

• Commonly known as" “lazy eye”

• Vision disorder that occurs during childhood

• Occurs when one eye becomes stronger than the other and the brain starts favoring the stronger eye, ignoring inputs from the weaker eye

Amblyopia

What can cause Amblyopia?

• Strabismus

• Farsightedness

• Cataract

What Vision Abnormality is this?

• Reduced visual acuity in weak eye

• Patient has strabismus (cross eyes)

• Ptosis

Amblyopia

How is Amblyopia treated?

• Involves forcing the brain to use the weaker eye, usually by patching or blurring the stronger eye for periods of time

• Atropine eye drops to blur strong eye temporarily

• Vision therapy exercises

• Early detection is KEY

What Vision Abnormality is this?

• Eye diseases that can lead to vision loss and blindness by damaging the optic nerve, ultimately caused by increased pressure within the eyes

Glaucoma

What Vision Abnormality is this?

• Eye disease that can lead to vision loss and blindness by damaging the optic nerve, ultimately caused by increased pressure within the eyes

• Most common type

• Effects patients > 40 y/o and MC in African American patients with PMHx DM2

• Chronic, asymptomatic and potentially blinding disease affecting ~2% of the population

Open-Angle Glaucoma

What Vision Abnormality is this?

• Loss of peripheral vision

• Headaches

• Rainbow color halos around lights

• Nausea and vomiting

• Red eyes

Open-Angle Glaucoma

How is Open-Angle Glaucoma treated?

• Referred to ophtho

• BBs (epinephrine component medications)

What Vision Abnormality is this?

• Eye disease that can lead to vision loss and blindness by damaging the optic nerve, ultimately caused by increased pressure within the eyes

• Medical emergency, resulting from complete closure of the angle

• Painful eye and loss of vision

Angle-Closure Glaucoma

What Vision Abnormality is this?

• Steamy cornea

• Fixed mid-dilated pupil

• Decreased visual acuity and tearing

• Anterior chamber is narrowed

• Pressure is acutely elevated

• Nausea and vomiting

Angle-Closure Glaucoma

What is the GOLD STANDARD for diagnosing Glaucoma?

Gonioscopy

How is Angle-Closure Glaucoma treated?

• Ophtho consult

• IV carbonic anhydrase inhibitors

• Topical BBs

• Diuretics (Mannitol)

• Surgical iridectomy

What Vision Abnormality is this?

• Inflammation affecting the sclera (outer covering of the eye)

• Caused by autoimmune diseases, such as RA

• Types:

  • Anterior (MC)

  • Posterior

Scleritis

What can cause Scleritis?

• Autoimmune diseases (SLE, scleroderma, etc)

• Unknown cause

What Vision Abnormality is this?

• Pain and redness to the eye

• Blurred vision

• Tearing

• Extreme sensitivity to light

Scleritis

How is Scleritis treated?

• Steroids

  • Systemic or localized eye drops

• NSAIDs

• Antivirals

What Vision Abnormality is this?

• Often referred to as cross eyed or hypertropia

• Misalignment disorder of the eye, causing one eye to deviate inward towards the nose and the other eye to deviate outward

Strabismus

What can cause Stabismus?

• Problem with the eye muscles

• Problem with the nerves transmitting information

• Problem with the control center in the brain that directs eye movement

What Vision Abnormality is this?

• Eyes that look misaligned

• Frequently blinking or squinting

• Doesn’t tend to align together

Strabismus

How is Strabismus diagnosed?

Cover uncover test

How is Strabismus treated?

• Wearing glasses

• Temporary eye patch

• Surgery to correct eye muscle

What can result from untreated Strabismus?

Loss of binocular vision

What Ocular disorder is this?

• AKA pink eye

• Inflammation of the conjunctiva (thin, clear membrane that covers the white part of the eye and inner surface of eyelids)

Conjunctivitis

What can cause Conjunctivitis?

• Viral

  • Adenoviruses

• Bacterial

  • Staph aureus, Strep pneumoniae

• Allergies

• Irritants

  • Smoke, chemicals, foreign bodies in the eye

What Ocular disorder is this?

• AM crusting (Bacterial)

• Redness of the eyes

• Excessive tearing or discharge from the eyes

• Itching or burning sensation in the eyes

• Lymph node swelling (Allergic)

Conjunctivitis

How is Conjunctivitis treated?

• Allergic:

  • Antihistamines and avoid trigger allergens

• Bacterial:

  • Abx drops

    • Ciprofloxacin, Tobramycin Dexamethasone

• Artificial tears

• Cold compresses

• Proper hygiene

What Ocular disorder is this?

• Clouding of the eye’s natural lens, which lies behind the iris and the pupil

• Lens is typically transparent, but over time, it can become cloudy or opaque, causing vision problems

Cataracts

What can cause Cataracts?

• Age-related changes (MC)

  • Proteins in the lens can clump together and cloud it

• UV light, tanning beds

• DM

• Smoking

• Medications

  • Corticosteroids

• Eye injury or trauma

• Nutrition deficiencies

  • Vit C and E

What Ocular disorder is this?

• Blurred or cloudy vision

• Double vision or ghost images

• Fading or yellowing of colors

Cataracts

How are Cataracts treated?

• Cannot be prevented or reversed with medication

• Surgical removal of clouded lens

• Replacement with an artificial intraocular lens (IOL)

What Corneal Disorder is this?

• Open sore or erosion that develops on the cornea (clear, dome-shaped front surface of the eye)

• Caused by keratitis

• Medical EMERGENCY that can cause vision problems and even lead to blindness if left untreated

Corneal Ulcer

What can cause Corneal Ulcers?

• Bacterial, viral, or fungal infections

  • Eye injuries

  • Contact lens wearers

  • Conditions that weaken the immune system

• Trauma

  • Scratches

  • Abrasions

• Dry eyes

  • Insufficient tear production or poor tear quality

  • Entropion or ectropion

What Corneal Disorder is this?

• Pain, redness, excessive tearing

• Blurry or hazy vision

• White or gray spot on the cornea

Corneal Ulcer / Keratitis

How are Corneal Ulcers / Keratitis treated?

• Abx, antifungal (Natamycin), or antiviral (Acyclovir) drops

• Ophtho consult

• Surgical intervention, if severe

What Corneal Disorder is this?

• General term for the group of disease processes, leading to corneal ulceration

• Inflammation that accompanies ulceration

• Inflammation of the cornea caused by various microorganisms, such as bacteria, viruses, fungi, parasites

Keratitis

What can cause Bacterial Keratitis?

• Staph aureus, Pseudomonas aeruginosa, Strep pneumoniae

• Occurs due to eye injuries, contact lens wear, or eye surgery

What can cause Viral Keratitis?

• HSV, VZV, Adenoviruses

• Can be primary or reactivate from previous infections

What can cause Fungal Keratitis?

• Candida, Aspergillus, Fusarium

• Especially in individuals with compromised immune systems or in agricultural settings