Drooping eyelids and double vision that worsens later in the day and worsens with fatigue
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
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
Blood in the anterior chamber of the eye. In front of the iris, but behind the cornea.
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
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?
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.
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.
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
Posterior inner part of eye as seen with an ophthalmoscope. Contains the retina, optic disc, macula and fovea.
allows light into the retina. Ciliary body control the shape/power of the lens
The ability to change focus from far to near.
The edge of the cornea where it unites with the sclera.
Vitreous, retina, disc. Best seen with dilation, look for disc edema, pallor, blood, cotton-wool spots, Roth spots
innermost layer of the eye, immediate instrument of vision, receives images transmitted through the lens
Branched sebaceous alveolar glands embedded in the tarsus and opening on the margin of the eyelid.
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
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
* 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.
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.
#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
poor vision w/o explanation, family Hx, leukocoria, strabismus- eye turning out
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?