Professional Documents
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ANATOMY
PATHOLOGY
1. retinal diseases
a. diabetic retinopathy
b. retinal detachment
c. age related macular degeneration
d. CRA occlusion
e. CRV occlusion
2. Glaucoma
3. Cataracts
4. Conjunctival disease
a. Conjunctivitis
b. Sub-conjunctival hemorrhage
5. Keratitis
a. Herpes simplex keratitis
6. Peri-orbital cellulitis
7. Uveitis
1. RETINAL DISEASES
1a. DIABETIC RETINOPATHY
-
PROLIFERATIVE
Advanced form
Rapidly progresses into blindness
As the damage progressessecretes
angiogenesis factoroptic nerve getting
covered by abnormal
vesselshemorrhages in the vitreous
chambersight threatening.
PRESENTATION
a. Vision may decrease slowly or rapidly.
b. Vitreal hemorrhages may develop suddenly
c. Patient may complain of floaters in their vision.
DIAGNOSIS
a. screening on annual basis
b. Fluorescein angiography - identifies vessels which should undergo laser
photocoagulation which selectively destroys focal areas of the retina and
diminishes the production of angiogenesis Factor which causes the
proliferative retinopathy.
TREATMENT
a. Tight control of glucose, blood pressure(<140/90) and lipids (ldl<100, if CAD
ldl<70).
b. Proliferative retinopathy- immediate laser photocoagulation
PATHOGENESIS:
o spontaneous and may result from trauma
o Predisposing factors: myopia and surgical extraction of cataracts.
o Traction can also occur from:
Proliferative retinopathy from diabetes
Retinal vein occlusion
Age related macular degeneration
CLINICAL PRESENTATION:
o Blurry vision UNIlaterally w/o pain/redness
o Patient may complain of seeing floaters or flashes at the periphery of
vision.
o curtain coming down (retinal falls off the sclera behind it)
DIAGNOSIS
o Ophthalmologic examination
TREATMENT:
o Re-attach the retina by:
Leaning their head back to promote the chance that the retina will
fall back into place
Mechanical reattachment to the sclera surgically by
laser photocoadulation,
cryotherapy
injection of expansile gas into the vitreal cavity
buckle/belt can be placed around the sclera to push the sclera
forward so that it can come in contact with the retina
vitreous can be removed and the retina can be surgically attached
to sclera
PATHOGENESIS
o MCC of legal blindness in older persons
o Formation of deposits of drusen (extracellular material collecting into
yellowish deposits), small granular subretinal deposits that are age
related
- CLINICAL PRESENTATION
DRY
WET
- AKA atrophic
- AKA exudative form
- Slowly progressive visual loss
- Rapid distortions of vision over
in the elderly
weeks to months
- DIAGNOSIS: Drusen on dilated
- Abnormal growth of vessels from
eye exam
the chroroidal circulation into the
- TREATMENT: zinc, V c/e, beta
subretinal space
carotene
leakagesubretinal fluid and a
localized exudative renal
detachment
- DIAGNOSIS: Fluorescein
angiography
- TREATMENT: VEGF inhibitors
(Ranibizumab/Bevacizumab)
1d. and 1e. CENTRAL RETINAL ARTERY OCCLUSION VS CENTRAL RETINAL VEIN
OCCLUSION
Pathogenesis
Clinical
presentation
Ophthalmosc
opy
Diagnosis
Treatment
2. GLAUCOMA
Pathogenesi
s
Open- angle
UNKNOWN
Diagnosis
Treatment
Closed- angle
Ophthalmologic emergency precipitated
by anticholinergic affects (TCA,
ipratropium)
Red, painful hard to palpate
Fixed midpoint pupil
Cornea hazy cloudiness, marked
diminishment of visual acuity.
1. IV Acetazolamide
2. IV urea
3. IV osmotic diuresis
(manitol/glycerol)
4. Pilocarpine (open canal of
schlemm)
5. Beta blockers (decrease the
production of humor)
6. Laser tubeculopathy
3. CATARACTS
-
PATHOGENESIS
o Opacification of lens
o Slowly progressive blurry vision over months to years
o Glare from the headlights of cars is problem at night
o Color perception if reduced in general
o Ass/w cigarette smoking
CLINICAL PRESENTATION
o Mature easily visible of P.E
o Earlier stages slit-lamp
TREATMENT
o Surgical removal with placement of intraocular lens
4. CONJUNCTIVAL DISEASES
-
PATHOGENESIS
o Any infectious agent (bacterial, viral, fungal)
CLINICAL PRESENTATION
BACTERIAL
VIRAL
- Unilateral
- Bilateral
- Marked purulent discharge from the
- Severe itching
eye
- Enlarged preauricular lymphadenopat
- In the morning with crusted eyelids
- Pupils are reactive and no photophobi
- Less itching
- Normally reactive pupil
TREATMENT: symptomatically with topical
- Normal ocular pressure
antihistamine/decongestants
- No impairement of visual acuity
TREATMENT: topical antibiotics
a. Erythromycin Ointment
b. Sulfacetamide Drops
c. Topical fluroquinolones
4A. SUBCONJUNCTIVAL HEMORRHAGE
- MCC- trauma, particularly in the presence of thrombocytopenia
- Collection of hematoma stops at limbus (b/w conjunctiva and cornea)
- Because this prevents the blood from covering the cornea
- There is no impairment of vision
- No intraocular/intra-vitreal damage
- NO specific therapy is necessary
5. KERATITIS
-
PATHOGENESIS
o Infection/inflammation of the cornea
o Usually, due to trauma to the cornea with the inoculation of bacterial/fungal
elements
PRESENTATION
o Severe pain in the eye
o Sensation that something is caught under the eyelid
DIAGNOSIS
o Fluorescein staining with blue light - Characteristic dendritic pattern over the
cornea
-
TREATMENT
o Oral acyclovir, famcuclovir, valacyclovir
o Topical trifluridin 1% solution
o Idoxiuridine
o NEVER USE STEROIDS- worsen the growth of virus and acts as a fertilizer
6. PERIORBITAL CELLULITIS
-
PATHOGENESIS
o S. Aureus
o Streptococuus
o Invasion of dermis and subcutaneous tissue around the eye
TREATMENT
o Antistaphylococcal penicillins (oxacillin/nafcillin)
o If allergic to penicillin
Cephalosporins (1st gen (cephazolin))
7. UVEITIS
-
PATHOGENESIS
o Inflammation of the Uveal tract (iris, ciliary body, choroid)
o Etiology systemic (psoriasis, sarcoidosis, syphilis, reiters, IBD)
PRESENTATION
o Painful red eye with marked photophobia
o Pain occurs even when the light is shining in the unaffected eye (consensual
light reflex in which the affected pupil will constrict even when the light is
shined in the normal eye)
DIAGNOSIS