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Acute angle closure glaucoma symptoms

Symptoms: Sudden onset of pain, nausea/vomiting, HA, halos, decreased vision

Acute angle closure glaucoma signs

Signs: Increased IOP, cloudy cornea, narrow angle, red eye that gets pain when lights turn off, fixed mid-dilated pupil, increased cup to disc ratio, visual field loss.

Ruptured globe signs and symptoms

Symptoms: History of trauma, loss of vision
Signs: Leaking fluid, distortion of organ, bollus sub hemorrhage, decrease IOP

CRAO is referred to as a:

stroke of the eye

CRAO risk factors:

crack/meth/talc drug use, coagulation problems, usually in older pts.

CRAO symptoms:

Sudden, painless vision loss or visual field loss

Signs of arterial occlusion:

APD, cherry red spot

Viral conjunctivitis usually caused by:

adenovirus, enterovirus

Viral conjunctivitis: Symptoms

More pain than itchyness

Viral conjunctivitis: Signs

Red, diffuse eyes, swollen conjunctiva (chemosis) mucous/serous discharge (not purulent) cervial adenopathy. *Hx of URI

Allergic conjunctivitis symptoms:

More itchyness than pain. Signs same as viral: diffuse redness, conjunctival swelling

Diabetic retinopathy: Symptoms

*Yellow exudates from macula, Glaucoma, "Spoke and wheel cataract"- loose blue/yellow because cataract is brown

Diabetic retinopathy: Signs

pre-retinal hemorrhages, neovascularization secondary ischemic retina,

Retinal Detachment: Risk factors

high myopia, trauma, boxing hx, family hx, eye surgery, old age

Retinal Detachment: Symptoms

Painless, decrease in vision, flashing lights for more than 30 minutes (golden), burst of floaters, veil falling over part of vision

Retinal Detachment: Signs

Displaced retina with folds, free floating blood in vitreous

Pituitary tumor: Symptoms

Loss of peripheral vision (bitemporal hemianopia)

Pituitary tumor: Signs

Optic nerve chiasm compression

Temporal arteritis: basic definition

inflammation of medium sized arteries; disease of the elderly

Temporal arteritis: Symptoms:

Jaw pain or claudication with chewing, headache, scalp tenderness, vision loss, vision field loss, weight loss, fever, night sweats, malaise, polymyalgia rheumatica

III nerve palsy can be caused by:

aneurysm, tumor, brain herniation, ischemia

Signs/Symptoms of III nerve palsy

Eye goes down and out, drooping eyelid, dilated pupil, *diplopia

Two types of III nerve palsy

1. Pupil involving (masses: aneurysm, tumor, brain herniation)
2. Pupil sparing (ischemia, stroke- diabetes, HTN)

Myasthenia gravis signs/symptoms

Drooping eyelids and double vision that worsens later in the day and worsens with fatigue

Zoster signs/symptoms

Hutchinson's sign- lesion that appears on the tip of the nose that precedes ophthalmic zoster. Dendritic fluorescein staining. *Respects the midline

Orbital compartment syndrome: symptoms

Pain that increases with movement, decreased vision, decreased color vision

Orbital compartment syndrome: signs

Increased IOP, proptosis (bulging globe), decreased extra ocular movements, APD

Macular degeneration: Symptoms

Gradual decline in visual acuity, especially central vision. Distortion of central vision: wavy lines. Scotomata in central vision: missing areas.

Macular degeneration: Signs

Drusen (yellow) spots, atrophy, normal cup:disc, bleeding subretinal hemorrhage, neovascular net

Risk factors for subconjunctival hemorrhage

Straining, heave lifting, trauma, HTN

Tx of subconjunctival hemorrhage

Full eye exam, reassurance that it will resolve on own. If repeated, check BP

Tx chemical burn

Copious flushing with saline, diffuse fluorescin stain

If possible foreign body, what test should you run?

CT/Xray, fluorescin dye and flip lid. NO MRI

Tx for possible ruptured globe:

CT, cover/shield, IV antibiotics, refer to ophthalmology for surgery

Tx for viral conjunctivitis:

NO topical steroids. Patient can use artificial tears, cold compresses, handwashing. Self limiting.

Differential diagnosis of leukocoria in children

Retinoblastoma, cataract, retinopathy of prematurity.

Diabetic patients must have their eyes:

dilated and full exam once a year, look for exudates, check sugar.

Tx for diabetic patients with non proliferative

observation yearly if no retinopathy, sooner if retinopathy is present.

Tx for diabetic patients with proliferative

Check for glaucoma

Blepharitis is:

inflammation of the eyelids (associated with chronic conjunctivitis)

Tx of blepharitis:

Warm compresses 1-4x/day followed by eye lid scrubs with baby shampoo. Lid massge, antibiotics if needed, topical or oral

Corneal abrasion Tx

Antibiotic ointment, pain management

Tx for herpes:

Refer to ophthalmology, cold compresses, anti-virals, NO STEROIDS rx in primary care

Orbital cellulitis tx:

Tx to prevent orbital compartment syndrome: IV Antibiotics, CT scan, drain abscess, ENT referral for mucormycosis if DM
Risk factor: Preexisting sinusitis

Hyphema definition

Blood in the anterior chamber of the eye. In front of the iris, but behind the cornea.

Hyphema tx:

bed rest w/ head elevation, avoid ASA and activity for 1-2 weeks, steroids to reduce scarring, atropine will dilate pupil and decrease pain, IOP x2-3 days requires draining

Hypopyon definition

Pus in the anterior chamber of the eye. In front of the iris by behind the cornea.

The anterior chamber is from the ___ to the ____

cornea to iris

The posterior chamber is the ___ to the ___

iris to the lens

Where do you check for cataracts?

Posterior chamber

Choroid:

Vascular coat of eye between sclera and retina, extending from the ora serrate to optic nerve. Consists of blood vessels united by CT, contains pigmented cells.

Ciliary body:

1. Sits directly behind iris. 2. Secretes aqueous humor 3. Contains ciliary muscle that changes the shape and thus the refractive power of the lens by tightening and relaxing the tension on the lens.

Conjunctiva:

Mucous membrane that covers sclera and reflexes back to cover underside of eyelids. makes it so you can't lose your contact behind your eye. doesn't cover cornea

Fundus oculi:

Posterior inner part of eye as seen with an ophthalmoscope. Contains the retina, optic disc, macula and fovea.

Lens:

allows light into the retina. Ciliary body control the shape/power of the lens

Accommodation:

The ability to change focus from far to near.

Limbus cornea:

The edge of the cornea where it unites with the sclera.

Posterior segment:

Vitreous, retina, disc. Best seen with dilation, look for disc edema, pallor, blood, cotton-wool spots, Roth spots

Retina:

innermost layer of the eye, immediate instrument of vision, receives images transmitted through the lens

Tarsal/Meibomian glands

Branched sebaceous alveolar glands embedded in the tarsus and opening on the margin of the eyelid.

Uveitis:

Non specific term for any intraocular inflammatory disorder.

Risks of contact lenses:

Giant papillary conjunctivitis, which is painless, so flip the eyelids to check. Scratched cornea, allergic conjunctivitis, infection- pseudomonas

APD

When light is shown in one eye then immediatly moved to the other eye, the consensual response is seen in the second eye, then the direct response catches up. At this point the difference can be detected. In APD consensual response > direct response

Pinhole testing

* What the patient's vision would be like with glasses. used to overcome refractive error, if the pt doesnt have their glasses with them or their rx is out of date. Test the pt with a tiny hole punched in a sheet of paper.

Pupil evaluation

1. anisocoria: inequality of the size of the pupils.
2. Horner's syndrome: disruption of sympathetic innervation, worsens in the dark, small/affected pupil doesn't dilate
3. Triad (sympathetic control): miosis, ptosis, anhydrosis
4. Adie's pupil: disruption of parasympathetic innervation, worse in the light, large/affected pupil does not contrict.

DDx Diplopia (6)

1. CN II/IV palsy
2. CN IV palsy: vertical double vision
3. Subluxed lens
4. Orbital fx- muscle entrapment
5. Grave's disease (proptosis)
6. Myasthenia gravis

Leading causes of visual loss (6)

#1. AMD- central vision loss
2. Glaucoma
3. Cataract
4. Diabetes: glaucoma, diabetic retinopathies
5. Corneal blindness
6. Retinopathy of prematurity

DDx III nerve palsy (3)

1. Myasthenia gravis (dropping of eyelids, double vision, worse later in the day and with fatigue)
2. Horner's syndrome (anhydrosis, small pupils (miosis), dropping of eyelids (ptosis)
3. Grave's disease (proptosis, misalignment of eyes, double vision)

DDx White spots on cornea (4)

1. Fungal/bacterial infection (consider GC/Chlamydia)
2. Corneal ulcer- contact lens use
3. Chemical/Herpetic Keratitis
4. Vitamin A deficiency

What are you worried about with a young patient with CRAO?

Atrial septal defect

Retinoblastoma sx:

poor vision w/o explanation, family Hx, leukocoria, strabismus- eye turning out

IOP sign

eyeballs are hard

What are you worried about in young patients with CRAO?

atrial septal defect

What should you do in older patients with CRAO?

ESR/CRP in case they have enteritis

What should you do with a patient with viral conjunctivitis with corneal involvement?

refer to ophthalmology

Ptosis is:

drooping of the eyelids

What conditions manifest with APD?

CRAO, orbital compartment syndrome

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