Professional Documents
Culture Documents
for LU 6
• This is a REVIEW:
• Repeat of some of your lectures last year.
• Aim: give you guidelines regarding what to
study; from now on you need to do a lot of
self study
• The pace of the lecture will therefore be a
little faster than first-timers: about 40
sec/slide
• This entire lecture is in your handout
• Just a guideline of topics to study
• YOU MUST STUDY ON YOUR OWN
• Ophtha is “another world”
• New terms, new skills, a lot of procedures
• The general rules of the Medical Profession hold
true
– TREAT THE PATIENT
– TAKE A CONCISE YET GOOOOOD HISTORY
– IF YOU ARE IN DOUBT: ASK! This is the importance
of the hierarchy in the Medical World
– THINK OF NOTHING- BUT TO GIVE PERFECT
SERVICE AND EVERYTHING, EVERYTHING ELSE
WILL FOLLOW
BASIC EYE EXAM
Visual Acuity Testing
• VA = 6/15 +3
• 6/12 - 2
Visual Acuity Testing
• If patient is unable to read the 6/60 line at
6 meters.
– Move the patient closer to a distance JUST
ENOUGH for the patient to be able to read
JUST THE FIRST LINE
• VA measurement = numerator is replaced by the
new distance where the patient was able to read
the first line e.g. 3/60
Visual Acuity Testing
• Finger Counting is never done at a
distance of 6 meters or more
• If VA improves with PH, likely that poor
vision is due to an EOR
Vision in Infants
• When testing VA in infants
– Make sure that the only stimulus being used
is visual (no auditory stimuli e.g. bells)
– Observe if infant becomes irritable when one
eye is covered compared to the other
– Record VA as
• (+) dazzle/
• Centered, steady, maintained, able to fixate,
follows object
Near Vision
• Near vision : NV
– If patient is able to read only figures larger
than those corresponding to the J16 line,
Near Vision is recorded as >J16
Gross Examination
• Check eyelids and eyelash, check position
of lids
• Check for proptosis, exophthalmos
• Check corneal clarity and corneal light
reflex
• Check sclera
• Check pupil size and pupillary light
reaction
• Check extraocular muscle movement
INTRAOCULAR PRESURE
• Normal IOP 8-21 mmHg (Goldmann
applanation tonometer)
• IOP difference greater than 2 mmHg in
both eyes: glaucoma screening is
recommended
• Palpation tonometry: hypotonic, soft, firm
or hard
• Do not palpate if you suspect an open eye
injury !
FUNDUSCOPY
• Check media
• Check disc (difference of O.2 in CD ratio
between eyes is suspicious)
• Check retinal vessels
• Check for presence of hemorrhages,
exudates or other lesions
• Check macular area and foveal reflex
Common OPD
Complaints and Conditions
COMMON EYE COMPLAINTS
• Decreased visual acuity
• Photophobia
• Colored Haloes
• Red eye
• Painful eye
• Protrusion
• Squint
• Inability to move eye
• Exudation
• Itching
Decreased Visual Acuity:
Error of Refraction
• Distance vision
– All children by age 3 should have v.a. checked
– Errors of Refraction
• Myopia
• Hyperopia
• Near or Reading vision
– Errors of Refraction
• Myopia
• Hyperopia
• Presbyopia
Decreased Visual Acuity: Cataracts
Note: check ROR, Dilated Pupil Exam
Decreased Visual Acuity: Corneal Leukoma
Decreased Visual Acuity: Glaucoma
Potentially blinding: check C/D ratio
Decreased VA: Retinal Diseases:
Hypertensive Ret: AV
crossing changes Macular edema / star
• Discharge: bacterial
– Purulent: creamy white
– Mucopurulent:
yellowish
• Discharge: allergic
– Serous: white stringy
Bacterial Conjunctivitis
• Discharge
– Mucopurulent:
yellowish
Bacterial Conjunctivitis
• Exudation: “mattering”
– Conjunctival or eyelid
inflammation
– Not in acute glaucoma
Allergic Conjunctivitis
• Hyperemia/dilation of
the conjunctival blood
vessels
• Can have white
stringy discharge
Stringy discharge
Red Eye Differentials
Scleritis
• Potentially serious
• Inflammation: focal or
diffuse
• Usually painful
• Usually chronic
• r/o collagen vascular
disease
• r/o rheumatoid
diseases
Red Eye Differentials
Subconjunctival Hemorrhage
• blood between conjunctiva and sclera with
areas of intact white sclera
Red Eye Differentials
Blunt trauma
• Hyphema vs Hypopyon
Red Eye Differentials
Pterygium
• Triangular fold of vascular conjunctiva
creeping into cornea
Red Eye Differentials
Corneal Foreign Body
• Surrounded by a rust ring and edema
• Pain, foreign body sensation, tearing
Red Eye Differentials
Tarsal Conjunctival FB
Adnexal Eye Disease
Staph blepharitis: chronic
• Inflamed eye lids
• Swollen eye lids
• Oily discharge
• Eyelashes clump
together
• Forms COLARETTE
around eyelash
Adnexal Eye Disease
Seborrheic Blepharitis
• Dry, flaky lashes
• Red lid margins
Adnexal Disease
External Hordeolum
• Focal Staph infection
• Red and painful
• Acute swelling of
glands of zeiss and
moll also meibomian
glands
• Points towards skin
• May be quite large
Adnexal Disease
Internal Hordeolum
• Meibomian gland
• Points towards
conjunctiva
ADNEXAL DISEASE:
Chalazion
• Eyelids
– Chalazion: focal,
chronic,
granulomatous
infection of meibomian
gland
• Large non tender lid
mass
• May be chronic result of
hordeolum
• r/o sebaceous cell
carcinoma
Adnexal Eye Disease: Potentially
Life Threatening
ADNEXAL DISEASE
• Lacrimal system
– Dacryocystitis
• Results from
obstruction of
nasolacrimal duct
• Pain, edema, erythema
over lacrimal sac
• Discharge from puncta
is sign of infection
Adnexal Disease
Nasolacrimal Duct Obstruction
• Most common
congenital
abnormality
• May be transient
• May open in 3 weeks
• Tears and mucus
may accumulate
which may result into
dacryocystitis
Protrusions
• Exophthalmos
– Forward protrusion of
globe
– Retraction of lids
– r/o leukemia in kids
• Orbital mass
– Chemosis
– Hyperemia of conj
– Prolapse over lid
– Fixed eye: no EOM
Protrusion: Life Threatening
• Tumors
– Melanoma
– Retinoblastoma
STRABISMUS
• Phoria
– Latent tendency for misalignment
– May elicit problem by covering eyes alternately
• TROPIA
– manifest when both eyes open
• ESOphoria/tropia: eyes directed inwards
• EXOphoria/tropia: eyes directed outwards
• Vertical
– hyper and hypo
Strabismus
3rd Cranial Nerve Paresis
• Ptotic lid
• Failure to adduct
• Failure to elevate
• Failure to abduct
This is how you flip upper lid. Foreign body has been removed.
CORNEAL FB & ABRASION
ER MANAGEMENT
• Put topical anesthetic for exam purpose only
• Examine under strong light and magnification
• Remove FB with forceps or cotton swabs if
possible
• May irrigate with sterile saline solution
• Cover with broad spectrum topical antibiotics
(every 1 hour)
• Place semi-pressure eye patch
• Prompt referral to ophthalmologist
Perforating Injuries of the Eye
PERFORATING INJURIES
• One of the most common reason for admission
to eye ward at PGH
• Majority of patients are male and children (30%)
are common
• Work or play related, assault and accidental
trauma
• Corneal, limbal, corneo-scleral, scleral etc.
• Intraocular structures are usually involved
• Common cause of endophthalmitis and
blindness
Perforating Injuries
• Sharp objects: wire, walis ting-ting, BBQ
stick, needles, knives, scissors etc.
• Projectiles: metal fragment, nail, glass
fragment, dart etc.
• Blasts: firecrackers explosion, gun blast,
dynamite, pillbox etc.
Intraocular FB: IOFB
0-2 y.o. cat’s eye reflex, squint, glaucoma, dilated pupil, extruding eyeball
REFER IMMEDIATELY TO A TERTIARY CENTER
OCULAR PHARMACOLOGY
Good Luck!
STUDY!
Enjoy!