-Pain in the eye
Chemical burn, flash burn to cornea, keratitis, glaucoma, iritis, temporal arteritis, retrobulbar neuritis
-Sudden loss of vision
Macular degeneration, retinal artery occlusion, retinal detachment, retinal vein occlusion, retrobulbar neuritis
-Transient loss of vision
Carotid artery disease, migraine, papilledema, severe
Myasthenia gravis, thyroid disorders, diabetes, third
nerve palsy from any cause
Third nerve palsy, diabetes, myasthenia gravis
-Flashes of light
Blow-out fracture of orbit, hyphema
-Discharge and matting of lids in morning
Any external disease of eye
-Swelling of lids
Bilateral blepharoconjunctivitis, acute allergies, thyroid
-Halos around lights
Angle-closure glaucoma, cataracts
-Blurred vision in the elderly
Macular degeneration, cataracts, ischemic optic neuropathy
-Persistent tearing in one eye
Dacryocystitis, blocked tear duct, entropion, ectropion,
trichiasis, chalazion, Bell's palsy
-Englarging nodule on lid
Basal cell carcinoma
-Foreign body sensation
Corneal foreign body, corneal abrasion, Herpes simplex keratitis
Dry eye syndrome from any cause, conjunctivitis,
ocular irritation: dust, wind, ultraviolet lights
Often tension, hypertension, brain tumor, migraine, cluster headaches, etc.
-Blurred distance vision in adult
Diabetes, cataract, macular edema
-Spots before eye
Retinal tear, vitreous detachment
-Pain behind the eye
Sinus disease, thyroid disorders, orbital tumor (rare), aneurysm of the carotid artery (rare)
-Eruption on skin
Atopic allergy, seborrhea, Herpes zoster, drug reaction
-Devised to detect abnormalities in the central 20 degrees in the field of vision
-Essentially consists of vertical and horizontal lines with a central dot
-Squares are 5 mm in size and subtend an angle of 1 degree at 30 cm.
-Greatest value in detecting small areas of macular or perimacular edema in which visual distortion is prominent
-Patient looks at the central black dot, one eye at a time, while covering the other eye
-Illumination should be good, reading glasses should be worn if rquired
1) Is the center spot visible? If not, central scotoma may be present.
2) While viewing the center, can you see all four sides? If not, an arcuate scotoma or a cecocentral scotoma may be present.
3) Do you see the entire grid? Are there any defects? If any areas are absent, then a paracentral scotoma may be present.
4) Are the horizontal and vertical lines straight and parallel? If not, then metamorphopsia is present. The parallel lines may bend inward, indicating micropsia, or bend outward, indicating macropsia.
-The best way to reduce occupational risk of "bloodborne" infection is to follow universal precautions based on the concept that every patient should be treated with the same level of precautionary and preventive measures to ensure the safety of everyone involved, including health care personnel
-From Occupational Safety and Health Adminstration (OSHA)
1) Wash hands before and after patient contact, and immediately if hands become contaminated with blood or other body fluids.
2) Wear gloves wherever there is a possibility of contact with body fluids.
3) Wear masks whenever there is a possibility of contact with body fluids via airborne route.
4) Wear gowns if exposed skin or clothing is likely to be soiled.
5) During resuscitation procedures, ensure that pocket masks or mechanical ventilation devices are readily available for use.
6) Clean spills of blood or blood-containing body fluids with a solution of household bleach and water in a 1:100 solution for smooth surfaces and 1:10 solution for porous surfaces.
7) Health care professionals who have open lesions, dermatitis, or other skin irritations should not participate in direct patient care activities or handle contaminated equipment.
8) Contaminated needles should never be bent, clipped, or recapped. Immediately after use, contaminated sharp objects should be discarded into a puncture-resistant "sharps" contained designed for this purpose.
9) Contaminated equipment that is reusable should be cleaned of visible organic material, placed in an impervious container, and returned to central hospital supply or some other designated place for decontamination and reprocessing
10) Instruments and other reusable equipment used in performing invasive procedures should be disinfected and sterilized as follows:
-Enter the patient's vascular system or other normally sterile areas of the body: sterilized before being used for each patient.
-Touch intact mucous membranes, but do not penetrate body surfaces: sterilized when possible or undergo high-level disinfection
-Do not touch patient or touch intact skin: cleaned with detergent
11) Body fluids to which universal precautions always apply are as follows: blood, serum/plasma, semen, vaginal secretions, cerebrospinal fluid, vitreous fluid, peritoneal fluid, amniotic fluid, and wound exudates
12) Body fluids to which universal precautions apply only when blood is visible: sweat, tears, sputum, saliva, nasal secretions, feces, urine, vomitus, and breast milk
-Leading cause of severe central vision loss in people older than 50 years in developed nations
-Two types of AMD: nonexudative AMD (atrophic) and neovascular AMD (wet)
-Severe vision loss usually occurs in neovascular AMD
-Common risk factors: age, positive family history, smoking, hyperopia, light iris color, hypertension, elevated serum cholesterol, female gender, and cardiovascular disease
1) Absent foveal reflex: architecture of fovea is slightly altered so the foveal pit is not seen
2) Pigment mottling: scattered areas of clumping and atrophy of the retinal pigment epithelium
3) Drusen: small, yellowish-white lesions located between the retinal pigment epithelium and Bruch's membrane
4) Subretinal neovascularization: new blood vessels can leak serum or blood and cause a serous or hemorrhagic detachment of the pigment epithelium
5) Disciform degeneration of the macula: if serum or blood leaks into the macula, the healing process can lead to gliosis, which leaves a flat grayish white scar
-Applied directly to the eye to abolish corneal sensation
-Surface anesthesia permits the application of instruments such as the tonometer for the measurement of intraocular pressure
-Used to perform surgery, remove foreign bodies, and facilitate eamination with lenses, such as gonioscopy
-Ex. proparacaine, Alcaine, Paracaine, Ophthaine, Ophthetic, etracaine, cocaine, etc. "-caine"
Gram positive: Staphylococcus, Streptococcus
Gram negative: Gonococcus, Meningococcus
Gram negative: Pseudomonas, Haemophilus, Moraxella
Gram positive: Corynebacterium, Bacillus, Mycobacerium
Herpes simplex, Herpes zoster, Adenovirus
Candida, Fusarium, Aspergillus
-Used to illuminate and examine under magnification the anterior segment of the eye
-Enables the observer to view binocularly the conjunctiva, sclera, cornea, iris, anterior chamber, lens, and anterior portion of the vireous, and it permits the detection of disease in these areas
-Attachments permit examination of the angle structures, ciliary body, and fundus
-Attachment of applanation tonometer for measurement of intraocular pressure
-Photographic attachments enable photography of the anterior segment of the eye
-Of special importance in conditions such as dendritic keratitis, corneal foreign body, and early lens changes (well-illuminated and highly magnified)
-Before fundus photography, the patient's pupils must be dilated
-Wide-angle cameras generally require a proportionally larger pupil for acceptable results
-The larger the pupil, the easier it is to obtain good photographs
-In the presence of opacity, such as centeral cataract, a poor image of the fundus results if properly centered. With dilation, the camera can be placed off center, creating a clearer photograph
-The use of cycloplegia is also recommended to minimize accommodation and maintain clarity
-The examiner should position the camera to produce a well-delineated circular image of the viewing bulb filament on the cornea
-Correct saturation, or maximum intensity of the correct color of the fundus is achieved by moving the camera toward or away from the eye
-When the camera is placed slightly off center and moved closer to the eye, an orange to bright yellow crescent appears on one side, indicating the maximum saturation beyond which the examienr should not go
-In attempting photography through a small pupil or other media opacity, it may be impossible to avoid bluish haze or crescent but should be minimized as much as posible.
-Flash settings can be adjusted accordingly for light or dark fundi
-The photographic sequence should begin with the posterior pole of the right eye and should include the disc and macula for positive identification of the eye being photographed
-A fundus camera must be equipped with a rapid-recycling, high-output power supply with an exciter and barrier filter combination
-The exciter filter is placed in the path of the light and allows only a specific wavelength of blue light to strike the fundus
-When fluorescein is introduced into the circulation of the eye, the blue light excites the fluorescein molecules to a higher state of activity, causing them to emit a greenish yellow light of a higher wavelength, creating a fluorescence that we record.
-The barrier filter is positioned to filter out the blue exciter light and allow only the excited yellow-green light of actual fluorescence to strike the image sensor
-As a means of dealing with pseudofluorescence, a "control" photograph of the area to be documented should be taken
-Before it is undertaken, the patient is informed of the procedure and its implications, and consent is obtained
-Five phases: pre-arterial (choroidal flush), arterial, arteriovenous, venous, and late recirculation
-Measures the central anterior curvature of the cornea
-Valuable in eye examinations, particularly for detecting and measuring corneal astigmatism
-Consists of a target that is imaged by the cornea and telescoped to observe this image
-The measurement of the target image reveals the corneal curvature in diopters with the variation in curvature (astigmatism)
-Invaluable in cases of irregular astigmatism, asymmetric astigmatism, oblique astigmatism, conical cornea (keratoconus), and nystagmus
-The keratometer should be kept covered with the dust cover supplied
1) Dirt on the daylight-blue fitler sometimes causes smudges in the mire imagery. The filter can be removed easily and cleaned by removing the two screws that hold the lamp housing to the body of the instrument.
2) When carbon deposits begin to form on the lamp bulb, the mire imagery will be diminished. if this occurs, a new bulb should be used in the instrument.
3) The lower part of the lamp housing is removed easily for insertion of a new bulb. To replae the bulb, rotate the instrument by turning the set until the lamp housing is removed from the central carriage.
4) There is also an attachment that can be used for checking keratometer measurements. To calibrate, use a spherical test ball of known radius of curvature inserted into the holder. When the correct radius of curvature is obtained, the accuracy of the keratometer can be confirmed; if out of alignment, should be reapired by a trained professional
-Healthy recocognition of the imporance of autonomy: the right of people to make their own decisions about what they will and will not allow
-Informed consent represents a partnership between medical professionals and their patients
-Doctors have a fiduciary duty to ensure that each patient understands the treatment recommendations
-The obligation of the physician remains to at least attempt to demonstrate that the patient does indeed have some comprehension of the meical plan
-More than just a signed paper "consent form"; process, documented in the patient's health record wherein the physcian or trained delegate educates the ptient and asks for his/her participation in the decision-making process
-If the medical encounter is to involve aspects of risk, in particular risks of bodily harm as in surgery of laser treatment, then formal informed consent, preferably documented by the patient's signature, is required
-The eye doctor must infor the patient of all common risks, no matter how small (including those that might result not only in changes in function but also appearance), and also serious risks, no matter how uncommon.
-Comprehension is another foundation of informed consent. Patients may refuse treatment, even if their decision will result in death or blindness if they are deemed to have the capacity to do so
-If the decision-making capacity of the patient is in question, a substitute decision maker must be found
-Even when the patient is deemed capable, the ophthalmologist must ensure that the necessary information for decision making is presented in an understandable way.
-The patient must be given the opportunity to ask questions and receive answers before making a voluntary decision without influence or coercion.