Cataracts and Conjunctivitis (Chapters 55 & 57)

Cataracts (Chapter 55)

• Opacification of the eye's crystalline lens
• Leading cause of blindness globally
• Non-painful, progressive vision loss
• Frequent changes in eyeglass prescriptions
• Physical exam involves a full ophthalmologic evaluation
• Typically does not cause conjunctival injection, corneal opacification, or pain (except in rare instances of trauma or hypermature cataracts)
• Hazy vision of the optic nerve and retina due to lens opacity
• Poor or absent response to the red light reflex
• Diagnostics include fundoscopic and dilated retinal exams
• Treatment is surgical cataract extraction

Conjunctivitis (Chapter 57)

• Inflammation of the conjunctiva (transparent mucosal tissue lining the eye and inner eyelid surface)
• Infectious Conjunctivitis
  • Bacterial: Thick, purulent discharge, eyes are sticky/glued shut, symptoms worse in the morning
  • 70% of cases—recent URI or exposure to sick contacts (likely adenoviral)
  • Acute onset, red eye, excessive watery discharge, usually starts in one eye, then the other a few days later
  • Viral: Artificial tears and cool compresses; contagious while tearing
  • Management:
    • Bacterial: Use discretion in topical antibiotics (trimethoprim-polymyxin B or fluoroquinolone drops, 4 times a day for 1 week); high-risk patients should always receive antibiotics
    • Acute allergic: Avoidance of triggers, oral antihistamines, preservative-free artificial tears, cool compresses, and removal of contact lenses. Severe cases may also require addition of antihistamines and vasoconstrictors, mast cell stabilizers.

Corneal Surface Defects and Ocular Surface Foreign Bodies (Chapter 58)

• Corneal surface defect: Interruption of the corneal epithelium
• Causes: Direct trauma from foreign objects (fingers, branches, makeup applicators)
• Risk factors: Prolonged lens use (contact lens wearers)
• Symptoms: Sudden onset of severe eye pain, pain typically resolves after topical anesthetic drop, foreign body sensation, blurred vision, redness, tearing, light sensitivity, eyelid swelling, blepharospasm
• Physical exam: Thorough eye exam - visual acuity, pupil, light response, eye pressure, cornea check for foreign bodies. Topical fluorescein dye.
• Management: Supportive care in most cases, ophthalmic antibiotic ointment (e.g., erythromycin or polymyxin B/bacitracin) for pain/comfort, oral analgesics, artificial tears, If visible foreign object removal, referral to ophthalmologist for other cases, immediate irrigation of chemical exposure, check pH (7-7.5)
  • If symptoms warrant ophthalmologic referral (RSVP - Redness, Sensitivity to light, Vision changes, or Pain)

Dry Eye Syndrome (Chapter 59)

• Multifactorial disorder characterized by abnormalities in tear film stability, hyperosmolarity, and ocular surface inflammation
• Symptoms: Dryness, foreign body sensation, burning/stinging pain, itching, ocular fatigue, redness, light sensitivity, transient blurred vision relieved by blinking, symptoms worsened by activities requiring concentration, excessive tearing, intolerance to contact lenses.
• Diagnostics: Schirmer test and tear breakup time to differentiate aqueous-deficient from evaporative dry eye. Autoimmune testing (SS-A, SS-B, rheumatoid factor, antinuclear antibodies) if autoimmune suspected
• Management: Stepwise management based on disease severity. Avoid windy/smoky environments, low humidity, limit uninterrupted computer work, review systemic medications, make dietary recommendations, artificial tears, high-viscosity gels, ointments

Pingueculae and Pterygia (Chapter 62)

• Pinguecula: Benign, yellow-white nodule on the bulbar conjunctiva, often located nasally to the cornea
• Pterygium: Benign growth of fibrovascular conjunctiva extending onto the cornea's surface.
• Symptoms: Dryness, irritation, foreign body sensation, itching, redness, cosmetic concerns. Advanced cases may cause persistent vision decrease
• Diagnostics : Slit-lamp exam
• Management: Symptom management (preservative-free artificial tear drops, UV protection), lower potency topical steroid drops (4-7 day course)