DR.AGHLAB KHOURYALQUDS MEDICAL SCHOOLBASR
ABC OF EYES
HISTORY AND EXAMINATION
ABC OF EYESHISTORY AND EXAMINATION
HistoryPrevious ophthalmic historyMedical historyFamily historyDrug history
ABC OF EYESHISTORY AND EXAMINATION
Visual symptoms: details to establishMonocular or binocularType of disturbancesOnsetPresence and type of field lossAssociated symptomsEffect on lifestyle
ABC OF EYESHISTORY AND EXAMINATION
ExaminationVisionVFPupilsOcular motilityEye positionEyelids,conjunctiva,sclera and corneaIntraocular pressureOphthalmoscopy
ABC OF EYESHISTORY AND EXAMINATION
Vision test
ABC OF EYESHISTORY AND EXAMINATION
Visual field test
ABC OF EYESHISTORY AND EXAMINATION
Pupils
ABC OF EYESHISTORY AND EXAMINATION
Ocular motility
ABC OF EYESHISTORY AND EXAMINATION
Eye position
ABC OF EYESHISTORY AND EXAMINATION
Eyelids
ABC OF EYESHISTORY AND EXAMINATION
Conjunctiva
ABC OF EYESHISTORY AND EXAMINATION
Cornea
ABC OF EYESHISTORY AND EXAMINATION
Sclera
ABC OF EYESHISTORY AND EXAMINATION
Intraocular pressure
ABC OF EYESHISTORY AND EXAMINATION
Ophthalmoscopy
ABC OF EYESRED EYE
ABC OF EYESRED EYE
History
OnsetSeverityPrevious attacksOther family membersContact lenses
ABC OF EYESRED EYE
Symptoms
Blurring of visionPainPhotophobiaFB sensationItching
Sings
Type of rednessDischargeFBCorneal edemaCorneal opacityLid swellingAbnormal pupil
ABC OF EYESRED EYE
Conjunctivitis
BacterialViralChlamydial conjunctivitisConjunctivitis in infantsAllergic
ABC OF EYESRED EYE
Conjunctivitis
Bacterial
ABC OF EYESRED EYE
Conjunctivitis
Viral
ABC OF EYESRED EYE
Conjunctivitis
Chlamydial
ABC OF EYESRED EYE
Conjunctivitis
Ophthalmia neonatorum
ABC OF EYESRED EYE
Conjunctivitis
Allergic
ABC OF EYESRED EYE – Episcliritis and Scleritis
ABC OF EYESRED EYE – Corneal Ulcers
ABC OF EYESRED EYE - Uveitis
ABC OF EYESRED EYE – Acute Angle Closure Glaucoma
ABC OF EYESRED EYE – Subconjunctival Haemorrhage
ABC OF EYESRED EYE – Inflamed Pterygium & Pingueculum
ABC OF EYESREFREACTIVE
ERRORS
ABC OF EYESREFREACTIVE ERRORS
ABC OF EYESREFREACTIVE ERRORS - Myopia
ABC OF EYESREFREACTIVE ERRORS - Hypermetropia
ABC OF EYESREFREACTIVE ERRORS - Astigmatism
ABC OF EYESREFREACTIVE ERRORS – Pinhole Test
ABC OF EYESREFREACTIVE ERRORS - Presbyopia
ABC OF EYESREFREACTIVE ERRORS – Contact Lenses
Soft contact lenses Gas permeable contact lenses Hard contact lenses
ABC OF EYESREFREACTIVE ERRORS – Contact Lenses
Indications
Personal appearanceHigh refractive errorsHigh anisometropiaCorneal surface irregularitiesTherapeutic indications
ABC OF EYESREFREACTIVE ERRORS – Contact Lenses
Contraindications
AtopyDry eyesPrevious glaucoma surgeryInability to handle CLActive ocular surface infection
ABC OF EYESREFREACTIVE ERRORS – Contact Lenses
Complications
Corneal abscessCorneal abrasionsCorneal pannus
ABC OF EYESREFREACTIVE ERRORS – Refractive Surgery
RK ICR PRK LASIK CLE ICL Bioptics
ABC OF EYESEYELID, ORBITAL, and LACRIMAL
DISORDERS
ABC OF EYESEYELID DISORDERS - Lumps
Importance
May need disfiguring operation if leftMay be life threateningMay cause visual disturbanceMay cause amblyopia in childrenMay indicate systemic disease
ABC OF EYESEYELID DISORDERS - Lumps
Chalazion
ABC OF EYESEYELID DISORDERS - Lumps
Stye
ABC OF EYESEYELID DISORDERS - Lumps
Papilloma
ABC OF EYESEYELID DISORDERS - Lumps
Xanthelasma
ABC OF EYESEYELID DISORDERS - Lumps
Basal cell carcinoma
ABC OF EYESEYELID DISORDERS – Inflammatory disease
Blepharitis
ABC OF EYESEYELID DISORDERS – Inflammatory disease
Chalazion Stye Acute dacryocyctitis Allergy Herpes simplex Herpes zoster
ophthalmicus
ABC OF EYESEYELID DISORDERS – Malposition
Entropion
ABC OF EYESEYELID DISORDERS – Malposition
Ectropion
ABC OF EYESEYELID DISORDERS – Malposition
Trichiasis
ABC OF EYESEYELID DISORDERS – Malposition
Ptosis
May indicate a life threatening condition
May indicate a disease that needs systemic treatment
May cause irreversible amblyopia
ABC OF EYESORBITAL DISORDERS – Proptosis
Causes
Orbital cellulitisOrbital inflammatory
diseaseThyroid eye diseaseOrbital lymphomaLacrimal gland tumorsOrbital invasion from
adjacent sinusBig eye
ABC OF EYESORBITAL DISORDERS – Enophthalmos
Causes
Blowout fractureMicrophthalmosAtrophy of orbital
contentsCicatrizing orbital
lesions
ABC OF EYESLACRIMAL SYSTEM
ABC OF EYESLACRIMAL SYSTEM – Tear film
ABC OF EYESLACRIMAL SYSTEM – Watering eye
Excessive tears production
Punctal malposition Punctal stenosis Blockage
ABC OF EYESLACRIMAL SYSTEM – Dry eye
Symptoms
Causes
Diagnosis
Treatment
ABC OF EYESEYE INJURIES
ABC OF EYESEYE INJURIES
History
The mechanismThe circumstances
○ Injuries in children
ABC OF EYESEYE INJURIES
Examination
VAInspection
○ Lids○ Globe○ Pupil
Flurescein
ABC OF EYESEYE INJURIES
Corneal abrasions
ABC OF EYESEYE INJURIES
Foreign bodies
ABC OF EYESEYE INJURIES
Radiation damage (flash burn)
ABC OF EYESEYE INJURIES
Chemical burn
Irrigate, irrigate then irrigateRemove loose particlesBeware alkalisRefer patient to ophthalmic department
ABC OF EYESEYE INJURIES
Chemical burn
ABC OF EYESEYE INJURIES
Blunt eye injuries
ABC OF EYESEYE INJURIES
Blunt eye injuries
ABC OF EYESEYE INJURIES
Penetrating eye injuries
If suspected, the eye should be examined very gently
Special attention: history of high velocity injury
ABC OF EYESEYE INJURIES
Penetrating eye injuries
Signs to look for○ Distorted pupil
○ Cataract
○ Prolapsed uveal tissue
ABC OF EYESEYE INJURIES
Penetrating eye injuries
Protect the eye from any pressure and refer the patient immediately to the nearest eye department
ABC OF EYESACUTE VISUAL DISTURBANCE
ABC OF EYESACUTE VISUAL DISTURBANCE
HistoryOnsetOld or newPrevious ophthalmic
historyGeneral healthUnderstand the
disturbance○ VF loss○ Scotoma○ Distortion
FloatersFlashing lightsAmarosis fugaxZigzag linesHeadachePain on eye
movement
ABC OF EYESACUTE VISUAL DISTURBANCE
Examination
VAPupillary reactionRed reflexVF testingFundoscopy
ABC OF EYESACUTE VISUAL DISTURBANCE
Posterior vitreous detachment
The most common cause of floaters
Might be associated with flashes
May result in retinal hole and retinal detachment
Needs urgent referral
ABC OF EYESACUTE VISUAL DISTURBANCE
Vitreous Haemorrhage
Sudden onset of floaters and loss of vision
Common in diabeticsRefer to ophth. to clarify
the cause and treat underlying disease
ABC OF EYESACUTE VISUAL DISTURBANCE
Retinal detachmentFloaters and flashesVF lossVariable in VAMore likely to occur in
high myopic patients after trauma or intraocular operation
Common in PDR
Needs surgical intervention
ABC OF EYESACUTE VISUAL DISTURBANCE
Arterial occlusion
Occlusion of the retinal artery may be caused by Arteriosclerotic changesEmbolus (from heart or carotid artery)Inflammation (rare)
ABC OF EYESACUTE VISUAL DISTURBANCE – Arterial Occlusion
History
Sudden painless visual loss which may be complete (due to central retinal artery occlusion) or partial (due to branch retinal artery occlusion)
Patient usually have a history of hypertension or heart disease
ABC OF EYESACUTE VISUAL DISTURBANCE – Arterial Occlusion
Examination
The visual acuity is reduced in CRAO but may be normal in BRAO
Relative afferent pupillary defect is present in CRAO
The retinal arteries are narrow or collapsed. In CRAO, the fovea shows a cherry-red spot
against the white infarcted retina. In BRAO, the white infarcted retina corresponds
to the occluded retina. Emboli may be seen in the arteries if the cause
is emboli
ABC OF EYESACUTE VISUAL DISTURBANCE – Arterial Occlusion
Management
Immediate referral if the visual loss is less than 6 hours.
Intravenous acetazolamide and globe massage to lower the intraocular pressure and hopefully re-establish the arterial flow.
Cardiovascular assessment.
An ESR is usually performed in the absence of obvious embolus to exclude arteritic causes.
Long term low dose aspirin is advised to reduce the risk of occurrence
ABC OF EYESACUTE VISUAL DISTURBANCE – Arterial Occlusion
ABC OF EYESACUTE VISUAL DISTURBANCE –Venous Occlusion
Retinal vein occlusion is a common vascular disorder caused by impaired venous blood flow.
It is second only to diabetes mellitus as a vascular cause of impaired vision
Hyperviscosity of the blood and hypertension are common causes
ABC OF EYESACUTE VISUAL DISTURBANCE –Venous Occlusion
History
Sudden onset painless blurred vision The patient might experience a visual field
defect
ABC OF EYESACUTE VISUAL DISTURBANCE –Venous Occlusion
ExaminationThe visual acuity is reduced in CRVO. However,
the reduction is dependent on the severity of the occlusion.
In BRVO, the visual acuity may be normal if the fovea is not involved.
Relative afferent pupillary defect may be present in patient with severe CRVO
Ophthalmoscopy reveals extensive intraretinal and pre-retinal hemorrhage with distended retinal veins.
ABC OF EYESACUTE VISUAL DISTURBANCE –Venous Occlusion
ManagementRefer within 24 hours. Identify and treat any underlying causeAntiplatelets therapyFollow-up in the clinic is arranged so that those
at risk of neovascular glaucoma may be treated with PRP
ABC OF EYESACUTE VISUAL DISTURBANCE –Venous Occlusion
ABC OF EYESACUTE VISUAL DISTURBANCE – Disciform MD
History
Sudden onset of disturbance in the central vision
Elderly are usually affectedCaused by choroidal neovascular membrane
leak or hemorrhage
ABC OF EYESACUTE VISUAL DISTURBANCE – Disciform MD
Examination
VA depends on the extent of macular involvement
Distorted line on Amsler chartFundoscopy and FFA
ABC OF EYESACUTE VISUAL DISTURBANCE – Disciform MD
ABC OF EYESACUTE VISUAL DISTURBANCE – Disciform MD
Management
LaserPhotodynamic therapyLucentis and AvastinVitamins and mineralsSurgery
ABC OF EYESACUTE VISUAL DISTURBANCE – Optic Neuritis
History
Sudden unilateral Loss of visionCentral VF lossAge 20-40 (usually woman)Pain that worsen on eye movementH/o previous attacksSymptoms of MS
ABC OF EYESACUTE VISUAL DISTURBANCE – Optic Neuritis
ExaminationVA from 6/6 to PLAPDColor vision disturbancesCentral scotomaNormal or swollen optic nerve head
ABC OF EYESACUTE VISUAL DISTURBANCE – Optic Neuritis
Management
Usually spontaneous recovery
Steroids in selected cases
SOL should be ruled out in uncertain cases
ABC OF EYESGRADUAL VISUAL DISTURBANCE
ABC OF EYESGRADUAL VISUAL DISTURBANCE
HistoryOnsetOld or newPrevious ophthalmic historyGeneral healthUnderstand the disturbance
○ VF loss○ Scotoma○ Distortion
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Refractive errors
Longstanding historyPinhole test
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Corneal disease
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Cataract
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Age related macular degeneration
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Macular hole
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Diabetic maculopathy
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Hereditary retinal degeneration
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Compressive lesions of optic pathways
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Causes
Drugs
AlcoholSmokingChloroquineTetracyclineSteroids
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Causes of acquired cataract
AgeDiabetesInflammationTraumaSteroids
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Indications for surgery
No need to wait far a cataract to be matureNo set level of visionDepends on the patient's needs
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Surgical techniquesPhacoemulsification
ABC OF EYESGRADUAL VISUAL DISTURBANCE - cataract
Extracapsular method
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Intracapsular method
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Complications of cataract surgery
Intraoperative○ Ocular perforation○ Subconjunctival hemorrhage○ Suprachoroidal hemorrhage○ Iris prolapse○ Posterior capsular tear○ Vitreous loss
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Complications of cataract surgery
Postoperative○ Infective endophthalmitis○ Retinal detachment○ Residual refractive error○ Uveitis○ Cystoid macular edema○ Glaucoma○ Posterior capsular opacification
ABC OF EYESGRADUAL VISUAL DISTURBANCE - Cataract
Optical correction after surgery
GlassesContact lensesSecondary IOL implantation
ABC OF EYESGLAUCOMA
ABC OF EYESGLAUCOMA
A progressive damage of the optic nerve which might be associated with increased intraocular pressure
The commonest cause of irreversible blindness
ABC OF EYESGLAUCOMA
ABC OF EYESGLAUCOMA
ABC OF EYESGLAUCOMA
Symptoms & signsRaised IOP
ABC OF EYESGLAUCOMA
Symptoms & signsHaloes
ABC OF EYESGLAUCOMA
Symptoms & signsCloudy cornea
ABC OF EYESGLAUCOMA
Symptoms & signsPain
ABC OF EYESGLAUCOMA
Symptoms & signsVisual field loss
ABC OF EYESGLAUCOMA
Symptoms & signsOptic disc changes
ABC OF EYESGLAUCOMA
Symptoms & signsVenous occlusion
ABC OF EYESGLAUCOMA
Symptoms & signsEnlargement of the eye
ABC OF EYESGLAUCOMA – Primary Open Angle Glaucoma
Symptoms
No symptoms until sever damage occursBest detected by screening
ABC OF EYESGLAUCOMA – Primary Open Angle Glaucoma
Risk factors
AgeingPositive family historyBlack raceLevel of IOPMyopiaThin corneas
ABC OF EYESGLAUCOMA – Primary Open Angle Glaucoma
Signs
Optic nerve cuppingAsymmetryOptic disc hemorrhagesVF lossIncreased IOP
ABC OF EYESGLAUCOMA – Acute Angle Closure Glaucoma
ABC OF EYESGLAUCOMA – Acute Angle Closure Glaucoma
Symptoms
Red painful eye HeadachesNausea and vomitingBlurred visionHaloesH/o previous attacks
ABC OF EYESGLAUCOMA – Acute Angle Closure Glaucoma
Groups at risk
HypermetropesOld ageFemale patient
ABC OF EYESGLAUCOMA – Acute Angle Closure Glaucoma
Signs
Decreased VACorneal edemaSemidilated pupil poorly reacted to lightPalpation = eye hard and tender
ABC OF EYESGLAUCOMA – Acute Angle Closure Glaucoma
Management
Admit to hospitalAcetazolamide IV 500mgTopical Timolol drops 0.5%Pilocarpine 4% dropsManitol 20%YAG laser PISurgical PI IridoplastyDrainage procedure
ABC OF EYESGLAUCOMA – Other types of Glaucoma
Inflammatory Steroid induced Rubeotic glaucoma Post traumatic Congenital Postoperative
ABC OF EYESGLAUCOMA – Medical Treatment
The aim of the treatment is to reduce the IOP to stop the progression of optic nerve damage
ABC OF EYESGLAUCOMA – Medical Treatment
B – blockersTimololBetaxolol
Sympathomimetic agentsAdrenalinBrimonidin
Carbonic anyhdrase inhibitorsDorzolamideAcetazolamide
Parasympathomimetic agentsPilocarpine
Prostaglandin analoguesLatanoprostTravoprostBimatoprost
ABC OF EYESGLAUCOMA – Laser Treatment
Laser trabeculoplasty
Laser iridotomy
Laser iridoplasty
Laser ciliary body ablation
ABC OF EYESGLAUCOMA – Surgical Treatment
Iridectomy Drainage procedure
ABC OF EYESGLAUCOMA – Surgical Treatment
Complications
Failure ( scarring )HypotonyCataractReduction in BCVAEndophthalmitis
