|Conjunctivitis||Viral conjunctivitis - copious watery discharge, scant mucoid discharge. Adenovirus (most common). Self-limiting associated with URI
Bacterial conjunctivitis - will present with purulent (yellow) discharge, crusting, usually worse in the morning. May be unilateral.
Allergic conjunctivitis - red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid
Bacterial: Treatment(s) in order of suggested use - the dose is 0.5 inch (1.25 cm) of ointment (preferable in children) deposited inside the lower lid or 1 to 2 drops instilled four times daily for five to seven days.
Contact lenses use = pseudomonas tx=fluoroquinolone (ciprofloxacin / Ciloxan drops)
Viral: There is no specific antiviral agent for the treatment of viral conjunctivitis. Some patients derive symptomatic relief from topical antihistamine/decongestants. Warm or cool compresses may provide additional symptomatic relief.
Allergic conjunctivitis systemic antihistamines and topical antihistamines or mast cell stabilizers. (Naphcon-A, Ocuhist, generics)
|Cataract||Blurred vision over months or years, halos around lights. Clouding of the Lens (versus clouding of cornea = glaucoma)
Tx: Surgical removal is definitive
|Corneal ulcer||Contact lens wearers, caused by deep infection in the cornea by bacteria, viruses or fungi.
Tx: Immediate referral - if immediate referral is not possible, it is reasonable to start topical ophthalmic antibiotics without delay
||Elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in the inner corner/nasal side of the eye).
Tx: Only surgically remove when vision is affected
Tx: cannulation of the duct, stenting, surgery
Tx: systemic antibiotics: Clindamycin + 3rd gen. cephalosporin
|Blepharitis||Eyelid changes: crusting, scaling, red-rimming of eyelid and eyelash flaking along with dry eyes and associated seborrhea and rosacea
TX: Warm compresses, irrigation, lid massage, and topical antibiotics for flare-ups
|Chalazion||A chalazion is a sterile painless (non-infectious) granuloma of the internal meibomian sebaceous gland, painless "cold" lid nodule, versus hordeolum, which is a painful infectious "hot" nodule
TX: Warm compresses, and eyelid hygiene
|Ectropion||Ectropion (eversion of the eyelid) occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation
TX: Tear supplements and ocular lubricants at night
|Entropion||Entropion (inversion of an eyelid) occurs when the eyelid turns inward. It is most commonly caused by age-related tissue relaxation, surgical correction is definitive
TX: Tear supplements and ocular lubricants at night
|Hordeolum||Painful, warm (hot), swollen red lump on the eyelid (different from a chalazion which is painless)
TX: Warm compress and topical antibiotics
|Nystagmus||Involuntary, jerking movements of the eyes
TX: medications baclofen and gabapentin
|Optic neuritis||Acute inflammation and demyelination of the optic nerve leading to acute monocular vision loss/blurriness and pain on extraocular movements
TX: IV corticosteroids
|Papilledema||Optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks
TX: Treat underlying cause
|Orbital cellulitis||Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection
Tx: Hospitalization and IV broad-spectrum antibiotics
|Macular degeneration||Gradual painless loss of central vision. The macula is responsible for central visual acuity which is why macular degeneration causes gradual central field loss.
Wet age-related macular degeneration
Dry age-related macular degeneration
|Retinal detachment||Vertical curtain coming down across the field of vision may sense floaters or flashes at onset, loss of vision over several hours.
TX: Stay supine (lying face upward) with head turned towards the side of the detached retina
|Retinopathy||Leading cause of blindness most common is diabetic retinopathy.
TX: control of blood glucose and BP
|Blowout fracture||History of blunt trauma, muscle entrapment, eyelid swelling, gaze restriction, double vision, decreased visual acuity, enophthalmos (sunken eye).
TX: Prompt ophthalmic referral. Treatment with surgery
|Corneal abrasion||Sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection, fluorescein dye - increased absorption in devoid area
TX: Antibiotic eye ointment, no patching
|Hyphema||TX: Antibiotic eye ointment, no patching
Hyphema (ReelDx)Trauma causes blood in the anterior chamber of the eye (between the cornea and the iris). The blood may cover part or all of the iris (the colored part of the eye) and the pupil, and may partly or totally block vision in that eye
TX: Elevate head at night, acetaminophen for pain, patch/shield. Surgery if high pressure or persistent bleeding
|Retinal vascular occlusion||Sudden, painless, unilateral, and usually severe vision loss (Amaurosis fugax)
TX: Optho emergency. Immediate treatment is indicated if occlusion occurred within 24 h of presentation
|Amaurosis fugax||Transient partial or complete loss of vision in one eye -
TX: If it does not resolve spontaneously, treatment is recommended within an hour of the occlusion
|Amblyopia||Amblyopia (lazy eye) is reduced visual acuity is not correctable by refractive means
TX: Includes correction of refraction error as well as forced use of the amblyopic eye by patching the better eye or blurring with glasses or drops
|Glaucoma||Open-angle glaucoma: most common, aqueous outflow obstruction
Acute narrow angle-closure glaucoma: Iris against lens, dark environment, acute loss of vision, nausea, and vomiting.
Acute narrow angle-closure glaucoma
Chronic open-angle glaucoma
|Scleritis||Inflammation of the sclera associated with systemic immunologic disease, such as rheumatoid arthritis
TX: Refer the patient for prompt evaluation by an ophthalmologist.
|Strabismus||Strabismus is defined as any form of ocular misalignment
Tx: Patch exercises, if untreated after age two, amblyopia results