LECTURE SERIES NCM 104 BY: Richard Benedict S. Roxas, RN, MD General Opthalmology Basics: OCULAR SYMPTOMATOLOGY: Objective Signs: 1.

Redness of the ocular adnexae Inflammation, Allergy, or Physiological 2. Jaundice of the Eyeball Hepatitis, Inborn errors metabolism of bilirubin, Hemolysis etc. 3. Redness of the eyeball (Conjunctival/Ciliary), Congestion, Inflammation, Trauma 4. Crust, or Flakes Contact Dermatitis 5. Secretions a. Watery lacrimation, tearing (EPIPHORIA), crying, foreign bodies b. Discharges (Mucoid/Mucopurulent) Allergic conjunctivitis, Vitamin A deficiency 6. Lumps swellings, tumor, granuloma etc. Subjective Signs: 1. 2. 3. 4. 5. 6. Pain Foreign body, Inflammation, Trauma Itching, Burning Allergic, Inflammation, Foreign body Soreness or Tenderness Frontal or Temporal Headache Refractive errors, visual aura migraine Visual Disturbance General & Common symptom they visit physician Dizziness Swaying, whirling sensation (muscle palsy, disturbance vergence, visual field defects, or vestibular origin (cochlear), Hypertension 7. Poor Distant Vision Disturbance in ocular media (CORNEA, LENS, VITREOUS), DM, Retinal Detachment 8. Poor Near Vision Presbycusis 9. Spot in the Center spot on the center of visual field (macular diseases) 10. Day Blindness HEMARALOPIA (there was a formation corneal opacity at bright light), nuclear lens cataract 11. Night Blindness NYCTALOPIA (peripheral vision is contracted seen in optic atrophy, glaucoma, vitamin A deficiency) 12. Double Vision DIPLOPIA 13. Multiple Vision POLYPSIA 14. Distorted Vision METAMORPHOSIA (Astigmatism, Choroidal lesion, macular Disease)

Amsler Grid used geometric lines grid to check macular degeneration. Colored Vision CHROMATOPSIA (glaucoma. Rabies 17. vitreous hemorrhage: (could be congenital X-linked Male 8% vs 0. Slit-Lamp Examination or BINOCULAR MICROSCOPE 4.4% Females) & acquired such as cataract & glaucoma) a. Indirect Ophthalmoscopy 3. 7. Floaters Small dark particles floating in the air 19. Tenometry (Schiotz) checks IOP (Applanation & Teno-Pen) 12. & RETINA. Ultrasonography. MRI Lesions in Globe or orbit. OPTIC NERVE) remember the room should be darkened.15. Xanthopsia. FUNDUS. Total Blindness b. LENS. red vision. Perimetry Testing Evaluates Field of Vision . BLINDNESS a. Partial Blindness Visual filed defect DIAGNOSTICS COMMONLY USED: 1. Gradual Progressive Blindness c.) 9. and on the sitting position both parties should be on eye level. Yellow Vision Jaundice. if pair of glasses are needed should wear it. Fluorescein Angiography Neovascularization check-ups in macular degeneration 10. White Vision seen in Digitalis Toxicity c. optic edema. Carbon Monoxide Poisoning b. VESSELS. retinal detachment) 18. cataract. Direct Ophthalmoscopy uses Opthalmoscope device with battery & light (CORNIA. Indocyanide Green Angiography evaluates choroidal vasculature that uses a per IV dye (INDOCYANIDE GREEN) 11. Violet Vision IANTHENOPSIA (chorio retinal pathology) 16. 2. Flashes of Light PHOTOPSIA (Seeing Streaks of lights when eye is pressed. Optical Coherence Tomography for macular diseases 8. mydriasis. Color Vision Testing (RED & GREEN TESTING) Polychromatic Plates 5. Retinal detachment etc. Blue Vision CYANOPSIA (after cataract extraction) d. 6. Painful light (Photophobia) Seen in Inflammation conjunctivitis. Color Fundus Photography Retinal lesions (the pupil should be dilated that can make the visual acuity impairment for 30 min. ARTERIES. tumors.

RODS) 2. Visual Acuity (Snellen¶s Chart Near Vision) Pictures/Numbers/Letters. RETINAL ARTERIES storage of glucose (GLYCOGEN) that supplies the retina SYMPTOMATOLOGY RELATED TO RETINAL PATHOLOGIES: 1. MICROPSIA (small image) there are misalignment of the position of the visual fields 5. Sector Field Defects LOSS FIELD OF VISION .13. MACROPSIA (large image). located at the fovea centralis (ACUTE VISION) MULLER CELLS BLOOD SUPPLY: 1. Visual Layer (PHOTORECEPTOR ± CONES. Visual Blurring (visual loss accompanied with macular damage) Impairement in the peripheral visual field 2. Nyctalopia Impairement vision at night (Vitamin A Deficiency) READ SOMETHING ABOUT: DIABETIC RETINOPATHY . CHRORIOCAPILLARIES 2. 1. Epithelial Layer anteriorly to the vitreous body FUNCTION OF THE RETNA: The Visual Layer a. RODS (Scotopic vision) night vision (influenced by vitamin A) (PERIPHERAL VISION) b. CONES (Photopic vision) daytime vision (PHOTORECEPTOR for color vision). sensation of CURTAIN or FOG covering 4. Jaeger Test card RETINAL PATHOLOGY: RETINA Located in the innermost part of the eye and situated posteriorly with the optic nerve. Photopsia FLASHES OF LIGHT (not the same with blow in the eye) or MOORE¶s LIGHTNING STREAKS 3. Disturbance of the image shape & size METAMORPHOSIA (distorted).

b. TYPES: a. TRAUMA. Teaching about COMPLICATIONS 1. color grayish. NURSING MANAGEMENT: a. exudates (HARADA DISEASE) in the vitreous body. PAINLESS 5. Target the cause of damage if SECONDARY TYPE 2. ( THESE SPOTS ARE THE EXACT SITE OF DAMAGE) 4. Tumors . SURGERY PROCEDURES: a. Scleral Buckle uses silicon band b. MANAGEMENT 1. (Affected retina only) 2. Pars Plana Vitrectomy uses vitrectomy instrument c. Promoting SAFETY b. Blood vessels are constricted. Promoting LESS FURTHER RETINAL DETACHMENT c. Sensation of CURTAIN or SHADOW in part of the field of vision. Promoting COMFORT d. SECONDARY caused by other than the retina or diseases caused the detachment (trauma. etc) DIAGNOSTICS: 1. Increase IOP 2. Vision of Shower of black floaters caused by hemorrhage in the vitreous or retinal arteries. Pneumatic Retinoplexy Repair of Rhegmatogenous retinal detachment . or hole that leads to the inflow of vitreous fluid causing tension & pressure leads to breaking up detachment. PRIMARY (Idiopathic) usually associated with retinal tearing.RETINAL DETACHMENT or RHEOMATOGENOUS RETINAL DETACHMENT: IS AN EMERGENCY Separation of the Retinal Epithelial layer to the Inner Sensory Layer. Further Retinal Detachment . OPTHALMOSCOPIC EXAM elevation of the retina and with wavy in-foldings. SUDDEN (Can be accompanied with stressful event like HPN. Sensations of flashes of light (PHOTOPSIA) Because of the mechanical separation stimulates in a way the Photoreceptors 3. least invasive 3. etc) SYMPTOMS: 1.

Deficiency of Vitamin. Distortion of Images (SECOND SIGHT makes to remove the eye glasses able to read news paper prints on PRESBYOPTIC Elderly) there are changes in the index refraction of the cataractous lens MANAGEMENT: 1. Endophthlmitis 4. Cortical c. CAUSES OF CATARACT: a. Miotic) f. SITE OF OPACITY (Nuclear. Hypocalcemia) c. AGE OF ONSET (Congenital. Discission . Developmental (Congenital. Traumatic SYMPTOMS: 1. DESCRIPTION (Punctate. Radiation Exposure in the Head) e. Subcapsular 3. Cataract & Glaucoma LENS PATHOLOGIES 1. OPACITY OF THE LENS (CATARACT) Opacity of the lens accompanied with visual impairement May occur in any place in the eye ANATOMICAL SITES: a. Rubella. Corticosteroids. Monoocular Diplopia 3. Toxoplasmosis. Complicated (Uveitis. Immature. Control & Treat the underlying cause 2. Senile. Inherited. Metabolic (Diabetic. Nuclear b.3. CLASSIFICATION OF CATARACT: a. Osmotic d. Infantile) b. Cortical. Mature. Anterior Capsular e. SURGERY Remove the Cataract a. Lamellar. Posterior Capsular d. Hypermature) d. Etc) c. CLOWDINESS OF VISION 2. Hyperthyroidism. Maternal-illness related) b. Coralliform) 4. Retinal detachment.Senile. Toxic (Poisons. MATURITY OF OPACITY (Incipient. 2.

Providing Postoperative Care c. Inferior) 3. f. errors in vision ) 3. c. 4. 6. e. 2 Oblique Muscles (Superior & Inferior) CN III (OCULOMOTOR NERVE) ALL MUSCLES (NOT LATERAL RECTUS) IV (TROCHLEAR) SUPERIOR OBLIQUE CN VI (ABDUCENS) LATERAL RECTUS ONLY 2 CILIARY ARTERIES SUPPLY EACH MUSCLES (1 only in Lateral Rectus) CN OCULAR MOVEMENTS: 1. ABDUCTION MEDIAL RECTUS ADDUCTION LATERAL RECTUS ELEVATION SUPERIOR RECTUS DEPRESSION INFERIOR RECTUS EXTORTION INFERIOR OBLIQUE + MEDIAL RECTUS INTORTION SUPERIOR OBLIQUE + MEDIAL RECTUS ORTHOPHORIA NORMAL MUSCLE BALANCE (no deviation) OCULAR DEVIATION (STRABISMUS) Disorders Related to Motility Problems: 1. Medial) 2. 5.b. 2. SELF CARE TEACHING STRATEGIES (home care checklist) OCULAR MOTILITY 3 Pairs Types of Extraocular Muscles that connects with GLOBE/EYE BALL 1. Heterophoria failure of fusion mechanism that alignment of both eye parallel is not achieved 2. Paralytic or Non-comitant strabismus (Infectious cause) . NURSING MANAGEMENT: a. Providing Preoperative Care b. d. 2 Vertical Rectus Muscles (Superior. 3. Needling Capsulectomy Phacoemulcification Lensectomy Intracapsular Cataract Extraction Extracapsular Cataract Extraction Absence of Crystalline lens must wear APHAKIC GLASSES APHAKIC PATIENT 3. g. Esotropia Most common (congenital. 2 Horizontal Rectus Muscles (Lateral.

while shorter in solution Time Duration: Ointment 6 ± 8 hours. b.EFFECTS of DEVIATIONS: 1. Diffusion Rate: Ointment has slower effect. while none in solution . Correction of Causative Factor (Trauma. Vision are not aligned & can cause double vision lead to accidents Diagnostics: 1. Covering 1 eye prevents diplopia 3. Surgery Correcting the paralyzed muscle (HUMMELSHEIM OPERATION) OCULAR THERAPEUTICS: COLOR CODING on the Caps: Blue White Yellow Green Red Antimicrobials Steroids Anesthetic Miotic Mydriatic Difference Between Solution & Ointment Topical Medications a. 2. Position of the eyeball are not aligned that could disfigure appearance 2. while Solution has rapid effect Effectivity Rate: Ointment has prolonged action . d. 3. while Solution has 1-3 hours Visual Disturbance: Produces visual disturbance in ointment . 4. Infections) Paralytic Type 2. Visual Acuity (E-chart & or Picture Chart) Prism Reflex test Hirschberg Test Ambyoscope Treatment: 1. c.

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