Eye Quick Review Part 2

PAPILLAEDEMA:
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 . Transient loss of vision lasting few seconds with change in head psition.
 . caused by ++ ICT manifested by morning headaches or change in headache intensity with    head position.

. Optic neuritis:
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 . Associated with multiple sclerosis.
 . Unilateral eye pain & visual loss.

. Exrenal hordeolum = Syte :
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 . Staphylococclal abscess of the eyelid.
 . Tx: Warm compresses.
 . If not resolved within 48 hours ---> incision & drainage.

. Allergic conjunctivitis:
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 . Intense itching - hyperemia - tearing - conjunctival oedema & eye lid edema.

. CATARACT:
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 . Progressive thickening of the lens.
 . Blurred vision & glare.
 . Tx: Lens extraction.

. Acute angle closure glaucoma:
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 . Old pts 55 - 70 ys.
 . Acute severe eye pain.
 . Blurred vision , nausea & vomiting.
 . Fixed dilated pupil non reactive to light.

. Open angle closure glaucoma:
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 . Loss of peripheral vision.
 . preserved central tunnel vision.
 . More common in AFRICAN AMERICANs.
 
. Macular degeneration:
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 . Loss of central vision.
 . More common in OLD AGE.

. Post-operative ENDOPHTHALMITIS:
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 . H/O of recent ocular operation.
 . symptoms manifest within 6 weeks of surgery.
 . pain & -- visual acuity.
 . swollen eyelids, corneal edema & infection.

. Herpes Zoster Ophthalmicus:
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 . Dendriform ulcers.
 . Vesicular rash in the trigeminal distribution.

. CMV Retinitis:
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 . HIV pt with CD4 < 50.
 . Fundoscopy: Yellow - white patches of retinal opacification & hemorrhages are       diagnostic.

. Optic neuritis:
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 . Central scotoma.
 . Afferent pupillary defect.
 . Change in colour perception.
 . -- visual acuity.
 . Ass. e' Multiple sclerosis.

. Vitreous hemorrhage :
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 . Sudden loss of vision.
 . Floaters in the visual field.
 . Diabetic retinopathy is the most common cause.
 . Fundus is hard to be visualized with obscured details.

. HSV ---> dendriTIC ulcers.
. HZV ---> dendriFORM ulcers.

. Amaurosis Fugax:
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 . Curtain falling down.
 . Whitened edematous retina following the distribution of the retinal arterioles.
 . caused by retinal emboli from the ipsi-lateral carotid artery.
 
. CRAO = CENTRAL RETINAL ARTERY OCCLUSION:
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 . Sudden unilateral painless loss of vision.
 . Pallor of the optic disc + CHERRY RED FOVEA + Boxcar segmentation.

. CRVO = CENTRAL RETINAL VEIN OCCLUSION:
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 . Sudden painless unilateral loss of vision.
 . THUNDER & BLOOD appearance.

. Vitreous hemorrhage:
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 . Black curtain coming down infront of eyes = Retinal detachment.
 . Photopsia (Flashes of light).
 . Floaters (Spots in the visual field).

. Central retinal vein occlusion:
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 . Sudden monocular loss of vision.
 . Blood & thunder appearance.
 . Optic disc swelling.
 . Retinal hemorrhage.
 . Dilated veins.
 . Cotton wool spots.

. Central Retinal Artery Occlusion:
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 . Sudden painless loss of vision.
 . Pallor of the optic disc.
 . Cherry red fovea.
 . Boxcar segmentation of blood in the retinal veins.

. Diabetic retinopathy:
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 . H/O of D.M.
 . -- visual acuity in both eyes.
 . Micro-aneurysms.
 . Dot & blot hemorrhages.
 . Hard exudates.
 . Macular edema.
 . Tx ARGON laser photocoagulation to prevent complications.

. Presbyopia:
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 . Difficulty in near vision.
 . Prespyobia is due to -- in lens elasticity not due to macular degeneration !!
 . A history of middle aged individual who has to hold books at an arms length to read is    classic.

. On Tx of Acute glaucome , ATROPINE is contraindicated. . 1st line Tx: I.V. MANNITOL.

. Multiple Sclerosis :
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 . FEMALE with multiple neurological presentations.
 . Associated optic neuritis can lead to blurring of vision & retro-bulbar pain.

. Sub-conjunctival hemorrhage ---> No ttt .. Just Observation.

. CRAO Tx: ocular massage + High flow Oxygen.

. Sympathetic Ophthalmia:
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 . Damage of one eye (sympathetic eye) after a penetrating injury to the other eye.
 . Due to UN-COVERING OF HIDDEN ANTIGENS !

. In HIV pts:
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 .. HSV & HZV :
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 ... Pain-ful.
 ... Ass. with karatitis & conjunctivitis.
 ... Fundus: Peripheral pain lesions & central necrosis.

 .. CMV :
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 ... Pain-less.
 ... Not ass. e'keratitis or. conjunctivitis.
 ... Fundus: Hemorrhages & fluffy or granular lesions around retinal vessels. 

. Neuro-fibramatosis type 1 = Axillary freckling + Cafe' au lait patches + Optic glioma.
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. Diabetic pt with blurry vision:
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 . Type 2 D.M. with HYPEROSMOLAR HYPERKETOTIC state without ketoacidosis.
 . Glucose in urine with NO KETONES.
 . NKHS = Non Ketotic Hyperosmolar $
 so, the cause of blurring of vision is HYPEROSMOLARITY ! 

. Macular degeneration:
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 . Grid test: distortion of the straight lines that appear wavy !