Ocular Conditions and Symptoms

Ocular Conditions and Symptoms

• Hyperopia (Farsightedness): Inability to see close objects clearly.
• Myopia (Nearsightedness): Inability to see distant objects clearly.
• Presbyopia: Age-related farsightedness due to lens hardening. Common and requires reading glasses.
• Diplopia (Double Vision): Double vision often caused by brainstem or cerebellum lesions.
• Red Eye (Painless): Subconjunctival hemorrhage, viral conjunctivitis are common causes.
• Red Eye (Painful): Acute angle closure glaucoma, Keratitis, foreign body, uveitis are potential causes.
• Sudden, Unilateral, Painless Vision Loss: Usually vascular in nature. Vitreous hemorrhage (often due to DM or trauma), macular degeneration, retinal detachment, retinal vascular occlusion, and central retinal artery occlusion are among the causes.
• Sudden, Unilateral, Painful Vision Loss: Often related to cornea and anterior chamber issues. Acute angle closure glaucoma, corneal ulcer, uveitis, traumatic hyphema, and optic neuritis are potential causes.
• Gradual Vision Loss: Cataracts, glaucoma, and macular degeneration are common causes of this type of vision loss.

Ocular History and Assessment

• Pain: Pain in the eye often signals issues with anterior ocular structures (cornea, anterior chamber, anterior uvea).
• Ocular History: Important to ask about known ocular disease, prior surgeries, contact lens or glasses use and past medical history.
• Medical Pre-dispositions: DM, CAD, HTN, and autoimmune disorders can increase the risk of ocular pathology.
• Reactive Media: Cornea, vitreous body, lens, and aqueous humor are the four reactive medias.

Ocular Evaluation Tools

• Wood's Lamp: Used to detect corneal abrasions and foreign bodies by emitting UV light.
• Slit Lamp: Used to examine the interior of the eye (sclera, cornea, lens, retina, and optic nerve).

Eyelid Conditions

• Entropion: Inward-turning eyelid margin and lashes often due to aging, potentially treated with artificial tears, lubricants, surgical repair, or Botox injections.
• Ectropion: Outward-turning eyelid margin, often due to aging, associated with OSA (obstructive sleep apnea) exposing the conjunctiva and cornea (leading to tearing, irritation, & redness). Treated surgically.
• Floppy Eyelid Syndrome: Both eyelids lose tone, causing conjunctivitis with discharge from mechanical trauma during sleep; treated with surgical repair.
• Hordeolum (Stye): Acute inflammation of the eyelid (tender, erythematous lump). Commonly 30-50 years old. Infection of a blocked gland (internal or external –meibomian or ciliary glands). Treated with warm compresses, massage, gentle wiping.
• Chalazion: Painless swelling of the eyelid. Inflammation/obstruction of a meibomian gland forming granuloma (can follow a stye, initially tender). Conservative management (warm compresses).
• Blepharitis: Chronic inflammation of eyelid margin (itching, burning, tearing, foreign body sensation, crusting of eyelids). Dysfunction of meibomian glands or staph infection. Treated with lid hygiene (warm compresses, baby shampoo), massage, artificial tears, and antibiotics (erythromycin or bacitracin). May require doxycycline if associated with ROSACEA/meibomian gland dysfunction

Conjunctival Conditions

• Pinguecula: Small, raised, white/yellow growth limited to the conjunctiva (fat, protein, and/or calcium deposits). Usually on nasal side. Periodic inflammation is possible. Treated with artificial tears, lubricants, decongestants, anti-inflammatories. Protection from UV, Wind, and dust.
• Pterygium: Wedge-shaped growth of conjunctiva; fleshy/triangular affecting the medial or lateral part of the cornea. Irritation, redness possible. Often on nasal side, bilateral. Treated with lubricants, artificial tears, steroid drops; potentially surgical removal if vision impaired or extraocular muscles (EOM) affected. Often associated with "surfer's eye" (UV, wind, chronic irritation)
• Dacryocystitis: Infection of lacrimal sac (located in inferomedial region). Infection of nasolacrimal duct causing obstruction (distinguish from orbital cellulitis). Common in pediatrics. Massaged to express exudates for cultures. Requires ophthalmologist. Antibiotics for treatment.

Other Ocular Conditions

• Orbital Cellulitis: Bacterial infection of orbital tissues and eye lids (often from sinus infection; potentially subperiosteal abscess in the orbit). Redness, localized soft tissue swelling, warmth, pain, fever possible. Diagnosed via CT scan. Treated with antibiotics.
• Periorbital Cellulitis: Infection of skin/tissues around the eyelid (anterior to orbital septum). Superficial compared to orbital cellulitis.
• Xanthelasma: Soft, yellow plaques on eyelids (often bilateral). Common in middle-aged/older adults. Painless, due to cholesterol build up. Treatment generally not required.
• Arcus Senilis (Corneal Arcus): Bluish/white/light grey ring around corneal edge (lipid deposits). Associated with shorter lifespans in women (Copenhagen City Heart Study), CAD, and older age. Does not affect vision; no specific treatment, treat underlying condition if present.
• Ptosis (Eyelid Drooping): Upper eyelid drooping due to congenital or acquired issue with levator muscle. May indicate serious neurological condition. Treated with surgical correction.
• Anisocoria: Unequal pupil size. Benign or indicative of a life-threatening condition like intracranial aneurysm.

Neurological Ocular Conditions

• Horner's Syndrome: Classic neurological syndrome affecting face/eye on one side. Loss of sympathetic tone, pupil constriction (miosis), eyelid drooping (ptosis), lack of sweating (anhidrosis). Due to a lesion along sympathetic pathway.
• Cranial III Nerve Palsy (Oculomotor Nerve): Impaired extraocular movements in ipsilateral eye. Dilated pupil on the affected side requires urgent aneurysm evaluation.