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Hi I am sharing ophthalmologist slides which will be helpful for a quick review .
Typology: Schemes and Mind Maps
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1. Optic nerve damage : complete loss of vision in one eye (e.g., untreated glaucoma) 2. Optic chiasm damage : bitemporal hemianopsia (pituitary adenoma) 3. Optic tract damage : (left) homonymous hemianopia (stroke)
By The original uploader was Nunh-huh at English Wikipedia. - Transferred from en.wikipedia to Commons., CC BY- SA 3.0, https://commons.wikimedia.org/w/index.php?curid= Optic nerve damage Optic chiasm damage Optic tract damage
Far-sightedness (i.e., can’t read fine print in magazines anymore) that comes with age (due to decreased elasticity in the lens ). Treatment: glasses
(Pres- means “old” in Greek)
Glaucoma refers to an increase in pressure in the eye causing damage to the optic nerve; in AACG, it is due to the inability of aqueous humor to drain; ↑ posterior pressure leading to acute closure that further ↓ drainage; this causes damage to the optic nerve. sudden onset EMERGENCY! there is EXTREME pain in the eye, which appears red and is hard to palpation; Eye will also be
CC-BY-3.0, https://commons.wikimedia.org/ wiki/File:Acute_angle_closure_glaucoma.JPG fixed and dilated, with tears; patient may see “halos” around lights; headache, nausea, vomiting; walking into a dark room can precipitate AACG b/c of pupillary dilation (same thing with anti-cholinergic medications); family history, Asians Diagnosis : tonometry (measures eye pressure); Treatment : IV acetazolamide; mannitol (to draw fluid out); pilocarpine, BB’s, and apraclonidine to constrict the pupil & ↑ drainage (BB’s also ↓ aqueous humor production); laser iridotomy
OPEN glaucoma (the more common form) is often asymptomatic and is diagnosed via routine screening (confirmed via tonometry showing increased intraocular pressure). PERIPHERAL VISION affected first , followed by central if not treated. Develops slowly. Can presents with headaches, blurred vision, and halos around lights (especially at night). Risks : blacks, family hx. Fundoscopy: enlarged optic cup; i.e., cup/disc ratio > 0.6)
Treatment : prostaglandin analog eyedrops even if asymptomatic (e.g., latanoprost) to increase uveoscleral outflow (AE: long eyelashes and eyelid/iris pigmentation); Also, topical BB’s (timolol), Carbonic anhydrase inhibitors (dorzolamide), apraclonidine, pilocarpine; if no response: laser trabeculoplasty https://www.myupchar.com/en, CC BY-SA 4. https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons
Retina pulls away from tissues supporting it ; patient sees floaters (“I see black floaty things in my left eye!”), flashing lights, and progressive visual field defect; fundoscopy shows vitreous hemorrhage and elevation of retina; risk factors: age (> 50), severe myopia!!! (due to stretching forces on the sclera, choroid, and retina), trauma/surgery Treatment : surgery usually required (retinopexy, photocoagulation, vitrectomy) to get the retina back in place!
CC-BY-4.0, https://commons.wikimedia.org/ wiki/File:Retinal_detachement_.jpg floaters
Characterized by blood spilling into the vitreous humor ; hazy vision, may be a red hue or vision loss; floaters and shadows; red reflex decreased or absent; risk factors: eye trauma and diabetic retinopathy Treatment : bed rest, elevation of bed head, photocoagulation or vitrectomy in some cases
Modified from: Häggström, Mikael (2014). "Medical gallery of Mikael Häggström 2014". DOI:10.15347/wjm/2014.008. ISSN 2002-4436. Public Domain
Infection of the cornea ; can be caused by bacteria (esp. pseudomonas ; also S. aureus), viruses (e.g., HSV), fungi, and parasites. causes a painful red eye When caused by pseudomonas (or other bacteria), it leads to acute onset mucopurulent discharge. EMERGENCY! get topical antibiotics fast to prevent permanent blindness! Also, give empiric FQ (e.g., moxifloxacin). Don't use contact lens until ulceration heals. In HSV keratitis, look for “branched linear lesions”; treat with oral/topical antiviral (e.g., acyclovir)
By Eddie314 at the English-language Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid= DOI:10.1051/parasite/2015010. PMID 25687209. ISSN 1776 - 1042., CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid= Viral keratitis (no ulceration) Keratitis ( with ulceration) By Imrankabirhossain - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=
Shingles with eye involvement (i.e., trigeminal nerve distribution, esp. the V1 branch); severe pain! Treatment : oral acyclovir (IV may be required if severe or patient is immunocompromised)
Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center Licensing, CC-BY, https://commons.wikimedia.org/wiki/File:Trigeminal_herpes_with_uv eitis_and_keratitis.jpg
Conjunctivitis refers to inflammation of the conjunctiva (membrane that lines the eyeball)
Microrao, CC BY-SA 4. https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons Gzzz, CC BY-SA 4. <https://creativecommons.org/licenses/by- sa/4.0>, via Wikimedia Commons Viral conjunctivitis Bacterial conjunctivitis
Diabetic retinopathy is caused by chronic hyperglycemia that results in changes in permeability, occlusion/ischemia, and neovascularization; may see blurry dark areas on fundoscopy; one of the leading causes of irreversible blindness Treatment : diabetes control; VEGFi’s, laser therapy, surgery
Shaofeng Hao, Changyan Liu, Na Li, Yanrong Wu, Dongdong Li, Qingyue Gao, Ziyou Yuan, Guanyan Li, Huilin Li, Jianzhou Yang, and Shengfu Fan., CC BY 4. https://creativecommons.org/licenses/by/4.0, via Wikimedia Commons
Causes ocular pain, photopia, red eye, CILIARY FLUSH! and decreased visual acuity; may see hypopyon; exam shows pupillary constriction Associated with sarcoidosis, HSV, toxoplasma, syphilis, IBD (esp. Crohn's), ankylosing spondylitis, reactive arthritis Evaluate with slit-lamp exam Treatment : eye dilators (e.g., cyclopentolate), topical steroids
Imrankabirhossain, CC BY-SA 4. https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons By Rakesh Ahuja, MD - Own work, CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid= Anterior uveitis w/ ciliary flush ciliary flush hypopyon Jonathan Trobe, M.D., CC-BY, https://commons.wikimedia.org/wiki/File:Ciliary-flush.jpg
Bleeding underneath the conjunctiva ; can occur after a sudden sneeze or cough, with heavy lifting, or with rubbing eyes (also occurs to babies as they are born!) Usually asymptomatic ; benign condition Treatment: reassurance
Daniel Flather, CC BY-SA 3. https://creativecommons.org/licenses/by-sa/3.0, via Wikimedia Commons
Chemical (<1 day): mild conjunctival irritation and tearing after silver nitrate or erythromycin ophthalmic prophylaxis Gonococcal (days 2-7): severe eyelid swelling, profuse purulence, corneal edema and ulceration (prevent with ointments, treat with IM ceftriaxone); contracted as baby passes through vaginal canal Chlamydia (days 5-14): mild eyelid swelling, watery discharge; not effectively prevented by prophylactic antibiotics; treat with oral azithromycin or erythromycin
By CDC/ J. Pledger - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), Public Domain, https://commons.wikimedia.org/w/index.php?curid=
An inflammatory demyelination of the optic nerve. Seen mostly in women 20-40, strongly associated with MS (and 25% of the time it is the first presenting symptom). Acute monocular vision loss with painful eye movement and "washed out" color vision.
Optic Neuritis in a patient with MS CC BY-SA 3.0, https://en.wikipedia.org/w/index.php?curid= Fundoscopy is normal because the inflammation occurs behind the optic nerve head!!! Diagnosis: MRI of the orbit and brain (to find other areas of inflammation); Treatment : IV steroids ; vision usually improves (only 3% become completely blind)
