Eyes

EYES

Sensory organ of vision

Bony orbital cavity surrounded by a cushion of fat
protecting the eye
Eyelids further protect the eye
Eyelashes filter dust & dirt
 Structure & Function
External Anatomy

External anatomy
Palpebral fissure
Limbus
Canthus
Caruncle
Structure & Function
External Anatomy (cont.)

External anatomy
Tarsal plates
Meibomian glands
Conjunctiva
Lacrimal apparatus
Structure & Function
External Anatomy (cont.)

Tarsal Plates: strips of connective tissue that give the

upper lid its shape

Meibomian glands: modified sebaceous glands that

secrete an oily lubricant stopping the tears from
overflowing & helps form a seal when the lids are
closed
Structure & Function
External Anatomy (cont.)

Conjuctiva: transparent protective covering of exposed

part of eye
Palpebral conjunctiva
Bulbar conjunctiva
Cornea: covers & protects iris & pupil
Structure & Function
External Anatomy (cont.)

Lacrimal apparatus- irrigation

Lacrimal gland secretes tears
Drain into puncta
Then drain into nasolacrimal sac through the
nasolacrimal duct & empty into the inferior meatus inside
the nose
The levator palpebrae: Muscle that raises the upper
eyelid and is innervated by the oculomotor nerve, CN III
Structure & Function
External Anatomy (cont.)

Extraocular muscles
Six muscles attach the eyeball to its orbit & direct the
eye
Give eye straight & rotary movement
Four straight (rectus) muscles
Two slanting (oblique) muscles
Structure & Function
External Anatomy (cont.)

Extraocular muscles (cont.)

Each muscle is coordinated , or yoked, with one in
the other eye ensuring that when tow eyes move,
their axes always remain parallel (conjugate
movement)
Parallel axes are important because human brain has
a binocular, single-image visual system
Structure & Function
External Anatomy (cont.)

Extraocular muscles (cont.)

Extraocular muscle movement is stimulated by three
cranial nerves
CN VI: Abducens nerve, innervates the
lateral rectus muscle
Abducts the eye
CN IV: Trochlear nerve, innervates the
superior oblique muscle
CN III: Oculomotor nerve, innervates the
rest- superior, inferior & medial rectus &
inferior oblique muscles
Structure & Function
Internal Anatomy

Eye: a sphere of three concentric coats

Outer fibrous
sclera
Middle vascular
Choroid
Inner nervous
retina
Structure & Function
Internal Anatomy

Outer layer
Sclera- tough, protective, white covering
Continuous anteriorly with smooth, transparent cornea
covering the iris & pupil
Cornea- part of refracting media of eye, bending
incoming light rays so that they will be focused on
inner retina
Sensitive to touch
Corneal reflex- blink
CN- V (trigeminal) carries the afferent sensation into the
brain and CN- VII (Cranial) carries the efferent message
that stimulates the blink
Structure & Function
Internal Anatomy

Middle Layer
Choroid- heavily vascularized to supply blood to retina
& has dark pigmentation to prevent light from
reflecting internally
Continuous anteriorly with ciliary body & iris
Muscles of ciliary body control the thickness of lens
Iris- functions as a diaphragm, varying opening at the
pupil
Controls amount of light admitted into retina
Iris contracts the pupil in bright light & accommodate for
near vision; dilate the pupil in dim light & accommodate for
far vision
Structure & Function
Internal Anatomy

Middle layer (cont.)

Pupil- round & regular; size determined by
parasympathetic/sympathetic chains of autonomic
NS
Parasympathetic stimulation through CN III causes
constriction of the pupil
Sympathetic stimulation dilates the pupil & elevates the
eyelid
Pupil size also reacts to amount of light & to
accommodation, or focusing an object on retina
Structure & Function
Internal Anatomy

Middle layer (cont.)

Lens- biconvenx disc located posterior to pupil
Transparent, it serves as a refracting medium keeping a
viewed object in focus on retina
Bulges for focusing on near objects
Flattens for far objects
Anterior & posterior chambers contain clear, watery
aqueous humor produced continually by ciliary body
Structure & Function
Internal Anatomy

Inner Layer
Retina- visual receptive layer of eye where light
waves are changed into nerve impulses
Optic Disc- area in which fibers from retina converge
to form the optic nerve
Retinal vessels- paired artery and vein extending to
each quadrant
Macula- receives & transduces light from the center
of the visual field.
Slightly darker pigmented region surrounding the fovea
centralis- area of sharpest & keenest vision
Structure & Function
Visual Pathways & Visual Fields

Light rays are refracted through transparent media,

the cornea, aqueous humor, lens, and vitreous body,
striking the retina
The retina transforms light stimulus into nerve impulses
conducted to the visual cortex of the occipital lobe
Image formed on retina is upside down & reversed
All retinal fibers collect to form optic nerve, but maintain
same spatial arrangement
At optic chiasm, fibers from both visual fields cross over
Left optic tract now has fibers from left half of each retina,
and right optic tract contains fibers only from right; thus right
side of brain looks at left side of the world
Visual Pathways
Structure & Function
Visual Pathways & Visual Fields

Pupillary light reflex- normal constriction of pupils

when bright light shines on retina
Direct light reflex- one eye exposed to bright light
pupils constrict
Consensual light reflex- simultaneous constriction of
the other pupil
This occurs d/t the optic nerve that carries the sensory
afferent message in and then synapses with both sides of
the brain
Structure & Function
Visual Pathways & Visual Fields

Fixation- a reflex direction of the eye toward an

object attracting persons attention
Image fixed in center of visual field, the fovea
centralis
Rapid ocular movements to put target back on the fovea
& slower movements to track target and keep its image
on fovea
May be impaired r/t ETOH, drugs, fatigue & inattention
Structure & Function
Visual Pathways & Visual Fields

Accommodation- adaptation of the eye for near

vision
Accomplished by increasing the curvature of the lens
thru the movement of the ciliary muscles
Convergence (motion toward) of the axes of the eyeballs
Pupillary constriction
Structure & Function
Developmental Competence

Aging Adult
Pupil size decreases
Lens lose elasticity, becoming hard & glasslike-
decreasing ability to change shape to accommodate
for near vision; presbyopia
By age 70, normally transparent fibers of lens begin
to thicken & yellow, the beginning of cataracts
Visual acuity may diminish gradually after age 50, &
more so after age 70
Structure & Function
Developmental Competence

Aging Adult (cont.)

Most common causes of decreased visual functioning
in older adults are:
Cataract formation- resulting from a clumping of proteins
in lens
Glaucoma- increased introocular pressure; chronic open-
angle glaucoma is most common type
Macular degeneration- breakdown of cells in macula of
retina
Loss of central vision is most common cause of blindness;
person is unable to read fine print or do fine work
Subjective Data

Vision
difficulty
(decreased acuity, blurring, blind spots)
Floaters, Halos, Scotomas, Night Blindness
Pain

Sudden onset, Photophobia

Strabismus, Diplopia
Redness, swelling
Watering, discharge
History of ocular problems
Glaucoma

Use of eye aides

Self-Care behaviors
Subjective Data

Vision difficulty
Difficulty seeing or any blurring? Blind spots? Come
on suddenly or progress slowly? One eye or both?
Constant? Come and go?
Objects out of focus? Clouding of objects?
Do spots move in front of your eyes? One or many?
Both eyes or one?
Halos/rainbows around object?
Blind spots? Any loss of peripheral vision?
Night blindness?
Subjective Data

Pain
Any eye pain?
Come on suddenly?
Quality: burning or itching? Or sharp, stabbing pain;
pain with bright light? Photophobia
Foreign body sensation? Or deep aching? Or
headache in brow area?
Subjective Data

Strabismus, diplopia: Any history of crossed eyes?

When? Does this occur with eye fatigue?
Ever see double? Constant, or does it come and go?
One eye or both?
Redness, swelling:
Any redness or swelling in eyes?
Any infections? Now or in the past? When do these
occur? In a particular tie of year?
Subjective Data

Watering, discharge:
Any watering or excessive tearing?
Any discharge? Any matter in the eyes? Hard to open
eyes in the morning? What color is the discharge?
How do you remove the matter from the eye?
Past history of ocular problems:
Any history of injury or surgery to eye? Allergies?
Subjective Data

Glaucoma
Have you ever been Txd for glaucoma? Results?
Family Hx?
Use of glasses or contact lenses
Wear glasses or contacts? How do they work for you?
Last time your Rx was checked? Was it changed?
If you wear contact lenses, are there any problems
such as pain, photophobia, watering or swelling?
Subjective Data

Self-care behaviors
How do you care for your contacts? How long do you
wear them? How do you clean them? Do you remove
them for certain activities?
Last vision exam? Ever tested for color?
Any environmental conditions at home or work that
may affect your eyes? If so, do you wear goggles to
protect your eyes?
What medications are you taking? Systemic or topical?
If you have experienced vision loss, how do you cope?
Subjective Data

Additional history for aging adults

Have you noticed any visual difficulty with climbing stairs or
driving? Any problem with night vision?
Cataract hx? Any loss or progressive blurring of vision?
Do your eyes ever feel dry or burn? What do you do for this?
Any decrease in usual activities, such as reading or sewing?
Last time tested for glaucoma?
Any aching pain around eyes? Any loss of peripheral vision?
If you have glaucoma, how do you manage your eye drops?
Objective Data

Preparation
Position person standing for vision screening; then
sitting up with head at your eye level
Equipment needed
Snellen eye chart
Handheld visual screener
Opaque card or occluder
Penlight
Objective Data

Central Visual Acuity

Snellen Eye chart- 20 ft away
Near Vision- Jaeger card
14 inches away
Presbyopia- condition in which
The lens of the eye loses its ability to
Focus making it difficult to see
Objects up close.
Objective Data

Test Visual Fields

Confrontation Test
Measure of peripheral vision; compares persons
peripheral vision with yours
Position yourself at eye level with person ~2 ft away
Direct person to cover one eye, and with other eye to look
straight at you
Cover own opposite eye to persons covered one; you are
testing uncovered eye
Hold pencil or flicker your finger as a target midline btwn you &
person, and slowly advance it in from periphery in several
directions
Objective Data

Test Visual field

Confrontation test (cont.)
Ask person to say now as the target is first seen; this
should be as your first see the object
Objective Data

Insepct Extraocular muscle function

Corneal light reflex (the Hirschberg Test)
Assess parallel alignment of eye axes by shining a light
toward persons eyes
Direct person to stare straight ahead as you hold the light
about 12 inches away
Note reflection of light on corneas; should be in exact
same spot on each eye
Objective Data

Insepct Extraocular muscle function

Cover Test
Test detects small degrees of deviated alignment by interrupting
fusion reflex that normally keeps two eyes parallel
Ask person to stare straight ahead at your nose even though
gaze may be interrupted
Cover one eye, note uncovered eye, normal response is a
steady fixed gaze
Macular image has been suppressed on covered eye
Ifmuscle weakness exists, covered eye will drift into a relaxed
position
Now uncover eye and observe for movement, it should stare
straight ahead, if it jumps to re-establish fixation, eye muscle
weakness exists
Objective Data

Inspect Extraocular muscle function

Diagnostic position test
Six Cardinal positions of
Gaze- will elicit any muscle
Weakness during movement
*Nystagmus
* Lid lag
Objective Data

Inspect external ocular structures

General
Ability to move around without obstacles
Facial expression; relaxed expression-
adequate vision
Eyebrows
Symmetrical
Present bilaterally, move symmetrically
with facial expression changes
No scaling or lesions
Objective Data

Inspect external ocular structures

Eyelids & lashes
The upper lids normally overlap the superior part of
the iris and approximate completely with the lower
lids when closed. The skin is intact without redness,
swelling, discharge, or lesions
Eyeballs
Aligned normally in their sockets with no protrusion
or sunken appearance
Objective Data

Inspect external ocular structures

Conjunctiva & Sclera
Ask the person to look up; using thumbs, slide lower
lids down along orbital rim
Inspect exposed area; eyeball should look moist &
glossy
Conjunctivae clear & pink over lower lids & white
over sclear
Note any color change, swelling or lesions
Objective Data

Inspect external ocular structures

Lacrimal Apparatus
Ask the person to look down; with thumbs, slide outer
part of upper lid up along bony orbit to expose under
lid, inspect for any redness or swelling
Press index finger against lacrimal sac to assess for
blockage
Excessive tearing may indicate blockage of the
nasolacrimal duct
Objective Data

Inspect Anterior eyeball structures

Cornea & Lens
Shine a light from side across cornea, inspect for smoothness &
clarity
Iris & pupil
Normal iris= flat, round/regular shape & even coloration
Normal pupils= round/regular & equal size in both eyes
Test pupillary light reflex= darken room, ask person to gaze into
the distance (dilates pupils); advance a light in from side and
not response
Normally you will see constriction of same-sided pupil (a direct light
reflex) and simultaneous constriction of other pupil (consensual light
reflex)
Objective Data

Inspect Anterior eyeball structures

Test for Accomodation
Ask the person to focus on a distant object, this dilates the
pupils
Then have the person shift the gaze to a near object, such
as your finger held about 3 inches from the persons nose
Normal response includes
Pupillary constriction
Convergence of the axes of the eyes
Record normal response to all these maneuvers as PERRLA, or
pupils equal, round, react to light, and accomodation
Objective Data

Inspect ocular fundus

Use of the ophthalmoscope
Set of lenses that control
focus
Unit of strength of each lens
Is diopter:
*Black #s indicate positive diopter,
they focus on NEARER objects
*Red #s show negative diopter & focus on objects
FARTHER away
Objective Data

Inspect Ocular Fundus

To examine person
Darken room to help dilate pupils
Select large round aperature with white light for routine
examination
If pupils are small use smaller white light
Ask person to keep looking at mark on wall across room
Staring at distant fixed object helps to dilate pupils and to
hold retinal structures still
Objective Data

Inspect ocular fundus

To examine person (cont)
Begin ~10 in away from person at angle of 15 degrees
to persons line of vision
Note red glow filling persons pupil; this is red reflex
caused by reflection of ophthalmoscope light off inner
retina
Keep sight of red reflex, adjust angle to find it again
As you advance, adjust lens to #6 and note any
opacities in media; these appear as dark shadows or
black dots interrupting red reflex; normally none are
present
Objective Data

Inspect Ocular fundus

To examine person (cont)
Progress toward person until foreheads almost touch
Adjust diopter to bring ocular fundus into sharp focus; if you
and person have normal vision this should be at 0
Moving diopters compensates for near or farsightedness
Use red lenses for nearsighted eyes
Use black lenses for farsighted eyes
Moving in on 15-degree lateral line should bring your view just
to optic disc
If disc is not in sight, track a blood vessel, as it grows larger it
will lead to disc
Objective Data

Inspect ocular fundus

To examine person (cont)
Systematically inspect structures in ocular fundus
Optic disc
Retinal vessels
General background
Macula
Objective Data

Inspect ocular fundus

Optic disc
Most prominent landmark is optic disc, located on
nasal side of retina
Color: Creamy, yellow-orange to pink
Shape: round or oval
Margins: distinct & sharply demarcated, although nasal
edge may be slightly fuzzy
Cup-disc ratio: distinctness varies; when visible,
physiologic cup is brighter yellow-white than rest of
disc; width not more than disc diameter
Objective Data

Inspect ocular fundus

Optic disc (cont):
Diameter of disc, or DD, is standard measure for
other fundus structures
To describe finding, note its clock-face position &
relationship to disc in size & distance (ie. Macula at
5:00, 3 DD from disc)
Objective Data

Inspect ocular fundus

Retinal vessels
Follow a paired artery and vein out to periphery in
four quadrants noting these points:
Number- paired artery & vein pass to each quadrant;
vessels look straighter at nasal side
Color- arteries brighter red than veins
A:V ratio- ratio comparing artery-to-vein width is 2:3 or
4:5
Caliber- arteries & veins show a regular decrease in
caliber as they extend to periphery
Objective Data

Inspect ocular fundus

Retinal vessels (cont)
A-V, arteriovenous crossing- artery and vein may
cross paths; not significant if within 2 DD of disc & no
sign of interruption in blood flow is seen
Tortuosity- mild vessel twisting when present in both
eyes is usually congenital and not significant
Pulsations- present in veins near disc as their
damage meets intermittent pressure of arterial
systole; hard to see
Objective Data

Inspect ocular fundus

General background of fundus
Color normally varies from light red to dark brown-red; view
of fundus should be clear; no lesions should obstruct retinal
structures
Macula
1 DD in size, located 2 DD temporal to disc
Inspect last in exam; bright light causes some watering,
discomfort & pupillary constriction
Normal color somewhat darker than rest of fundus but even and
homogenous
Clumped pigment may occur with aging
Objective Data

Macula
Objective Data
Developmental competence

Aging adult
Visual acuity
Perform same exams
Central acuity may decrease >70 yo, peripheral vision may diminish
Ocular structures
Eyebrows may show loss of outer 1/3 to hair; remaining hair may
be coarse
Skin around eyes may show wrinkles or crows feet
Eyes may appear sunken from atrophy of orbital fat; orbital fat may
herniate, causing bulging at lower lids and inner third of upper lids
Lacrimal apparatus may decrease tear production, causing eye
dryness and burning sensation
Objective Data
Developmental competence

Aging Adult
Ocular structures (cont)
Pingueculae- yellowish, elevated nodules are d/t thickening of
the bulbar conjuctiva from prolonged exposure to sun, wind,
& dust. Appear at 3 & 9 oclock positions
Cornea may look cloudy with age
Arcus senilis commonly seen around cornea
Gray-white arc or circle around limbus d/t deposition of lipid material

Xanthelasma: soft, raised yellow plaques occuring on lids at

inner canthus
Commonly occur around 5th decade of life, more common in women
Objective Data
Developmental competence

Aging Adult
Ocular structures (cont)
Pupils small in old age, pupillary light reflex may be
slowed
Lens loses transparency and looks opaque
Ocular fundus
Retinal structures generally have less shine, blood
vessels look paler, narrower and attenuated; artieroles
appear paler and straighter with a narrower light reflex
Drusen, benign degenerative hyaline deposits are normal
development on retinal surface
Often symmetrically placed in eyes with no effect on vision
Abnormal Findings
Extraocular Muscle Dysfunction

Strabismus
Esotropia

Exotropia
Paralysis
Abnormal Findings-Abnormalities in the Eyelids

Periorbital edema
Exophthalmos (protruding eyes)
Enophthalmos (sunken eyes)
Ptosis (drooping upper lid)
Upward palpebral slant
Ectropion
Entropion
Abnormal Findings - Lesions on the Eyelids

Blepharitis (inflammation of the eyelids)

Chalazion
Hordeolum (stye)
Dacryocystitis (inflammation of the lacrimal sac)
Dacryoadenitis (inflammation of the lacrimal
gland)
Basal cell carcinoma
Abnormal Findings- Abnormalities in the Pupil

Unequal pupil sizeanisocoria

Monocular blindness
Constricted and fixed pupilsmiosis
Dilated and fixed pupilsmydriasis
Argyll Robertson pupil
Tonic pupil (Adies pupil)
Cranial nerve III damage
Horners syndrome
Abnormal Findings- Vascular Disorders of the
External Eye

Conjunctivitis
Subconjunctival hemorrhage
Iritis (circumcorneal redness)
Acute glaucoma
Abnormal Findings- Abnormalities in the
Retinal Vessels and Background

Arteriovenous crossing (nicking)

Narrowed (attenuated) arteries
Vessel nicking
Diabetic retinopathy
Microaneurysms
Intraretinal hemorrhages
Exudates
Hypertensive Retinopathy

Acute and chronic hypertensive changes may manifest

in the eyes, respectively, from acute changes from
malignant hypertension and chronic changes from long-
term, systemic hypertension.

Ocular changes can be the initial finding in an

asymptomatic patient with hypertension, necessitating
a primary care referral.

Arteriosclerotic changes are chronic changes resulting

from systemic hypertension. In the retina,
atherosclerosis and arteriolosclerosis predominate.
Arteriolar Changes: Copper
Wiring

Findings:
Full and tortuous.
Develop an increased light reflex with a
bright coppery luster.
Arteriolar Changes: Silver
Wiring

Findings:
Portion of a narrowed artery
develops such an opaque wall
that no blood is visible within
it.
Arteriovenous Crossing/A-V
Nicking

Chronic hypertension stiffens

and thickens arteries.

Findings:
Vein appears to stop abruptly on
either side of the artery.

Picture: At AV crossing points

(arrow,) arteries indent and
displace veins.
Tapering

Findings:
Vein appears to taper
down on the side of the
artery.
Banking

Findings:
Vein is twisted on the
distal side of the artery
and forms a dark, wide
knuckle.
Hypertensive Retinopathy
Classification

Keith-Wagener-Barker Classification (1939)

Group 1:
Slight narrowing, sclerosis, and tortuosity of the retinal arterioles.
Mild, asymptomatic hypertension.

Group 2:
Definite narrowing, focal constriction, sclerosis, and AV nicking.
Blood pressure is higher and sustained.
Few, if any, symptoms referable to blood pressure.
Hypertensive Retinopathy
Classification

Keith-Wagener-Barker Classification (1939)

Group 3:
Retinopathy (cotton-wool patches, arteriolosclerosis, hemorrhages).
Blood pressure is higher and more sustained.
Clinical manifestations of headaches, vertigo, and nervousness.
Mild impairment of cardiac, cerebral, and renal function.

Group 4:
Neuroretinal edema, including papilledema.
Siegrist streaks, Elschnig spots.
Blood pressure persistently elevated.
Clinical manifestations: headaches, asthenia, loss of weight, dyspnea, and visual disturbances.
Impairment of cardiac, cerebral, and renal function.
Differential Diagnosis

Branch retinal artery occlusion

Branch retinal vein occlusion
Central retinal artery occlusion
Central retinal vein occlusion
Eales Disease
Ocular manifestations of HIV
Optic neuropathy, anterior ischemic
Papilledema
Pseudopapilledema
Examples: Hypertensive
Retinopathy

Findings:
Marked A-V crossing
changes along inferior
vessels.
Copper wiring of arterioles.
Cotton-wool spot superior
to disc.
Examples: Hypertensive
Retinopathy

Findings:
Punctuate exudates ->
scattered and radiating
from fovea forming a
macular star.
Two soft exudates about 1
disc diameter from disc.
Flame-shaped hemorrhages
sweeping toward 7 oclock
and 8 oclock.
Diabetic
Retinopathy
 Diabetic Retinopathy

iabetic retinopathy is the leading cause of new blindness in

DD

persons aged 25-74 years in the United States.

Microaneurysms are the earliest clinical sign of diabetic
retinopathy.
Common Findings:
Microaneurysms
Dot and blot hemorrhages
Flame-shaped hemorrhages
Retinal edema and hard exudates
Cotton-wool spots
Venous loops and venous beading
Intraretinal microvascular abnormalities
Macular edema
Diabetic Retinopathy

Mild Nonproliferative Retinopathy:

At this earliest stage, microaneurysms occur.
Small areas of balloon-like swelling in the retina's tiny
blood vessels.
At least one microaneurysm, and also dot, blot or
flame-shaped haemorrhages in all four fundus
quadrants.
Diabetic Retinopathy

Moderate Nonproliferative
Retinopathy:
As the disease progresses, some
blood vessels that nourish the retina
are blocked.
Presence of hemorrhages,
microaneurysms, and hard
exudates.
Intraretinal microaneurysms and dot
and blot haemorrhages of greater
severity, in one to three quadrants.
Cotton wool spots, venous calibre
changes including venous beading,
and intraretinal microvascular
abnormalities are present but mild.
Diabetic Retinopathy

Severe Nonproliferative Retinopathy:

At least one of the following should be present:
Severe haemorrhages and microaneurysms in all
four quadrants of the fundus.
Venous beading, which is more marked in at least
two quadrants.
Intraretinal microvascular abnormalities, which are
more severe in at least one quadrant.
Diabetic Retinopathy

Proliferative Retinopathy:
Neovascularization is the hallmark.
Micro-vascular pathology with
capillary closure in the retina leads to
hypoxia of tissue -> hypoxia leads to
release of vaso-proliferative factors
which stimulate new blood vessel
formation to provide better
oxygenation of retinal tissue.
new vessels growing on the retina =
neovascularisation elsewhere (NVE)
and those on the optic disc are called
neovascularisation of the disc (NVD).
These new vessels can bleed and
produce haemorrhage into the
vitreous.
Differential Diagnosis

Branch retinal vein occlusion

Central retinal vein occlusion
Macroaneurysm
Macular edema, Diabetic
Ocular Ischemic Syndrome
Retinopathy, Diabetic (nonproliferative)
Retinopathy, Hemoglobinopathies
Retinopathy, Valsalva
Sickle Cell Diease
Terson Syndrome
Macular
Degeneration
Macular Degeneration

Age-related macular degeneration (ARMD) is the

leading cause of irreversible vision loss in the
industrialized world.

AMD is a degenerative retinal disease, presumably

caused by both genetic and environmental factors.

Types:
Dry Atrophic (more common, but less severe)
Wet Exudative/Neovascular
Macular Degeneration

Drusen = undigested
cellular debris
Hard and sharply defined
Soft and confluent with
altered pigmentation
Differential Diagnosis

Angioid Streaks
ARMD, Nonexudative
Chorioretinopathy, Central Serous
Choroidal Rupture
Melanoma, Choroidal
Multifocal Choroidopathy Syndromes
Neovascular Membranes, Subretinal
Neovascularization, Choroidal
Presumed Ocular Histoplasmosis Syndrome
Retinal Detachment, Exudative