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
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
Retinal Detachment: Symptoms
Painless, decrease in vision, flashing lights for more than 30 minutes (golden), burst of floaters, veil falling over part of vision
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
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
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
Tx of subconjunctival hemorrhage
Full eye exam, reassurance that it will resolve on own. If repeated, check BP
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 of blepharitis:
Warm compresses 1-4x/day followed by eye lid scrubs with baby shampoo. Lid massge, antibiotics if needed, topical or oral
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.
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.
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.
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.
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
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 should you do with a patient with viral conjunctivitis with corneal involvement?
refer to ophthalmology