Ocular Health and Eye Exam

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Questions and Answers

What is a significant consequence of proliferative diabetic retinopathy?

Indistinct optic disc margins

Neovascularization near the optic disc (correct)

Thickening of the retinal walls

Increased visibility of blood vessels

Which feature is NOT associated with hypertensive retinopathy?

Neovascularization (correct)

Copper-silver wiring

A/V nicking

Flame hemorrhages

What year should diabetics have their ophthalmologic exam?

Only when symptoms arise

Every two years

Every five years

Every year (correct)

Which of the following is a characteristic symptom of senile macular degeneration?

Bilateral central field vision loss Signup and view all the answers

What could be indicated by the presence of papilledema in the retina?

Possible brain tumor Signup and view all the answers

What symptom is characterized by a hemorrhage in the anterior chamber caused by trauma?

Hyphema Signup and view all the answers

Which sign is associated with a dark spot in the field of vision indicating potential hemorrhage or detachment?

Negative scotomas Signup and view all the answers

What type of discharge is typically associated with an eye condition lasting all day?

Yellow-green discharge Signup and view all the answers

Which symptom may cause issues when exposed to bright lights?

Photophobia Signup and view all the answers

What is the term for benign, visual disturbances that appear as moving luminous patches?

Positive scotomas Signup and view all the answers

Which symptom is described as a feeling of irritation from an object in the eye?

Pain Signup and view all the answers

What phenomenon is commonly seen with retinal detachment but usually benign?

Floaters Signup and view all the answers

What type of vision disturbance is often clear upon blinking but constantly disturbed otherwise?

Blurred vision Signup and view all the answers

What primarily affects the apex of the inner ear, leading to altered perception of low frequency sounds?

Increase in pressure Signup and view all the answers

Which diagnostic test is used to identify sensorineural hearing loss associated with inner ear issues?

Weber test Signup and view all the answers

What is a characteristic symptom of vestibular neuronitis?

Abrupt onset of vertigo Signup and view all the answers

What is the impact of nystagmus in cases of peripheral vertigo?

It may fatigue with time Signup and view all the answers

In vestibular neuronitis, how is the Romberg test typically affected?

Patient falls toward the affected side Signup and view all the answers

What is a significant feature that characterizes benign positional vertigo (BPV)?

Intermittent episodes that are short in duration Signup and view all the answers

Which is true regarding the diagnostic imaging for vestibular disorders?

MRI can help identify central nervous system causes of vertigo. Signup and view all the answers

How do dietary changes affect Meniere’s disease management?

Lowering salt intake can help prevent exacerbations. Signup and view all the answers

What is a characteristic feature of Cholesteatoma?

Chronic negative pressure in the middle ear Signup and view all the answers

What type of hearing loss is associated with Otosclerosis?

Conductive hearing loss Signup and view all the answers

Which condition is typically indicated by the presence of vesicles on the tympanic membrane?

Bullous Myringitis Signup and view all the answers

What is a common consequence of untreated Acute Mastoiditis?

Facial muscle paralysis Signup and view all the answers

What is the recommended treatment approach for Cholesteatoma?

Surgical intervention to remove the sac Signup and view all the answers

What distinguishes Otitis Media with Effusion from other types of otitis media?

Retracted and immobile tympanic membrane Signup and view all the answers

Which symptom is commonly seen in individuals with Bullous Myringitis?

Severe ear pain without infection awareness Signup and view all the answers

What age group is typically affected by Otosclerosis?

Young adults aged 15-35 Signup and view all the answers

What is a common complication of sinusitis that can lead to death within 2-3 days?

Cavernous sinus thrombosis Signup and view all the answers

Which characteristic distinguishes erythroplakia from other oral lesions?

Marked erythema Signup and view all the answers

Which type of leukoplakia is considered the most common?

Homogenous oral leukoplakia Signup and view all the answers

Which condition involves white patches that can be scraped off?

Candidiasis Signup and view all the answers

What risk factor is commonly associated with the development of leukoplakia?

Chronic irritation from smoking Signup and view all the answers

Which of the following is true about glossitis?

It involves loss of papillae on the tongue. Signup and view all the answers

Which demographic is most at risk for oral candidiasis?

Infants and immunocompromised patients Signup and view all the answers

What is the typical appearance of homogenous oral leukoplakia?

Uniform white plaques Signup and view all the answers

Which of the following is a non-infectious cause of keratitis?

Corneal burn Signup and view all the answers

What symptom is NOT typically associated with keratitis?

Fever Signup and view all the answers

What finding is observed using a slit lamp exam in herpetic keratitis?

Dendritic ulcers Signup and view all the answers

Which of the following is an important management step for keratitis?

Refer to ophthalmologist Signup and view all the answers

What is a potential consequence of a pterygium if left untreated?

Expansion onto the cornea affecting vision Signup and view all the answers

Which statement about herpetic keratitis is true?

There is a 25% chance of recurrence. Signup and view all the answers

What occurs when the anterior iris becomes stuck to the trabecular meshwork?

Acute glaucoma Signup and view all the answers

Which condition is associated with a lack of tears?

Keratoconjunctivitis sicca Signup and view all the answers

What is the term used to describe pus that may be present in the anterior chamber during keratitis?

Hypopyon Signup and view all the answers

Which of the following is a symptom that may indicate keratitis?

Intolerance to light Signup and view all the answers

What is the primary cause of a pinguecula?

Mild scar tissue from environmental exposure Signup and view all the answers

Which of the following is a potential cause of acute glaucoma?

Plateau iris Signup and view all the answers

What symptom is typically associated with acute glaucoma?

Severe eye pain with vomiting Signup and view all the answers

What does a positive fluorescein stain indicate in the context of keratitis?

Damaged epithelium Signup and view all the answers

What characterizes corneal arcus?

Opaque whitening around the cornea Signup and view all the answers

Which type of blepharitis is characterized by red scales and crusts?

Bacterial blepharitis Signup and view all the answers

Which condition can lead to a large and fixed pupil not reacting to light?

Acute glaucoma Signup and view all the answers

What is a significant range of intraocular pressure (IOP) that indicates a possible acute glaucoma emergency?

40-80 mmHg Signup and view all the answers

What underlying conditions are commonly associated with keratoconjunctivitis sicca?

Rheumatoid arthritis and Sjogren’s syndrome Signup and view all the answers

What symptom is most commonly experienced with blepharitis?

Foreign body sensation Signup and view all the answers

What is a common medication type that may induce acute glaucoma by causing dilation of the pupils?

Sulfa derivatives Signup and view all the answers

Space-occupying lesions of which bodily organ can lead to acute glaucoma?

Brain Signup and view all the answers

Which statement accurately describes arcus senilis?

It results from hyperlipoproteinemia or aging. Signup and view all the answers

What is an initial management step for acute glaucoma?

Referral to an ophthalmologist Signup and view all the answers

What is one of the primary causes of gradual vision loss?

Proliferative diabetic retinopathy Signup and view all the answers

Which symptom is specifically associated with cataracts in children?

Squinting and amblyopia Signup and view all the answers

What is a common manifestation found in chronic (open angle) glaucoma?

Blind spots in vision Signup and view all the answers

What type of hemorrhage occurs within the deeper layers of the retina due to ruptured microaneurysms in background retinopathy?

Blot hemorrhages Signup and view all the answers

Which is a characteristic feature of soft exudates in background retinopathy?

Increased permeability of blood vessels Signup and view all the answers

Which risk factor is NOT associated with chronic (open angle) glaucoma?

Decreased red reflex Signup and view all the answers

What condition is characterized by the retina becoming pearl-grey and forming retinal folds?

Retinopathy of prematurity Signup and view all the answers

What is a potential consequence of macular edema in background retinopathy?

Decreased visual acuity Signup and view all the answers

Which of the following is a characteristic symptom of acute non-allergic rhinitis?

Profuse watery discharge Signup and view all the answers

What is a common cause of atrophic rhinitis?

Rhinoplasty Signup and view all the answers

Which condition is characterized by unilateral clear nasal drainage and a history of trauma?

Foreign body obstruction Signup and view all the answers

What underlying condition can cause fetid odor in the nasal passage?

Atrophic rhinitis Signup and view all the answers

What differentiates choanal atresia from other forms of nasal obstruction?

It results from a congenital defect in septal development. Signup and view all the answers

How does the prevalence of allergic rhinitis impact the economy annually?

It leads to millions of lost days at work and school. Signup and view all the answers

What is a characteristic feature of the nasal mucosa in atrophic rhinitis?

Thinning and dry membranes Signup and view all the answers

What is a potential serious implication of clear nasal drainage resulting from trauma?

It may be cerebrospinal fluid, signaling a possible skull fracture. Signup and view all the answers

Which symptom is indicative of conjunctivitis?

Discharge with slight purulence Signup and view all the answers

What is a common characteristic of subconjunctival hemorrhage?

May result from severe febrile illness Signup and view all the answers

Which statement is true regarding the use of fluorescein staining?

It helps rule out corneal abrasions or ulcerations. Signup and view all the answers

In the context of acute red eye, what does a negative fluorescein stain indicate?

No corneal abrasions or ulcerations present Signup and view all the answers

What is the primary function of the iris in the anatomy of the eye?

To regulate the amount of light entering the eye Signup and view all the answers

Which factor is NOT a known cause of conjunctivitis?

Fluorescein staining Signup and view all the answers

Which structure in the eye is responsible for focusing the lens?

Ciliary body Signup and view all the answers

What is a notable characteristic of the cornea in the human eye?

It is responsible for two thirds of the eye's refractive power Signup and view all the answers

In the anatomy of the eye, how does the pupil change size?

Through dilation and constriction by the iris Signup and view all the answers

Which component of the eye is continuous with the conjunctiva?

Cornea Signup and view all the answers

In benign paroxysmal positional nystagmus (BPPN), what direction does the fast phase of nystagmus take when gaze is directed toward the undermost ear?

Horizontal-rotary toward the undermost ear Signup and view all the answers

Which of the following best describes the initial symptom of acoustic neuroma?

Tinnitus Signup and view all the answers

What type of nystagmus is characterized in central vertigo associated with acoustic neuroma?

Vertical nystagmus that worsens with gaze fixation Signup and view all the answers

What is the primary diagnostic method used to identify acoustic neuroma?

Audiogram Signup and view all the answers

Which structure in the inner ear is responsible for detecting fluid movement to determine head rotation?

Crista ampullaris Signup and view all the answers

In which condition can particles known as otoliths cause dizziness and vertigo?

Benign paroxysmal positional nystagmus Signup and view all the answers

What type of otitis media involves fluid accumulation without infection in the middle ear?

Otitis media with effusion Signup and view all the answers

Which symptom is typically seen years later after the onset of acoustic neuroma?

Hearing loss Signup and view all the answers

Which of the following middle ear diseases is most likely to be characterized by a severe infection of the bone surrounding the ear?

Acute mastoiditis Signup and view all the answers

What is the nature of the nystagmus fast phase when the eyes are in the central orbital position during BPPN?

Vertical upward toward the forehead Signup and view all the answers

Study Notes

Eye Exam

Pupil Size, Reaction to Light and Accommodation - This is a standard component of an eye exam, which assesses the pupil's ability to constrict in response to light and its ability to focus on objects at different distances.
Fundoscopic Exam - This allows the doctor to examine the back of the eye (retina and optic nerve) to assess for any abnormalities.

Common Signs and Symptoms of Ocular Issues

Pain - Pain in the eye can be described in various ways:
- Knife-Like Pain Indicates a sharp, intense pain.
- Itching - Can be caused by allergies or a foreign object.
- Foreign Body Sensation - A feeling of something being in the eye.
Erythema (Redness) and Edema (Swelling) - These can be signs of inflammation or infection.
Discharge - A discharge, especially yellow-green, lasting all day could be a sign of infection.
Blurred Vision - Can be a sign of various issues, including eye strain, dry eye, refractive errors, or more serious conditions.
- Check if the vision clears after blinking, as this may indicate a temporary issue like dry eye.
Eye Strain - Can be caused by prolonged use of electronic devices, reading for long periods, or other activities.
Photophobia (Sensitivity to Light) - Can be a symptom of several conditions, including migraines, eye infections, and corneal abrasions.
Hyphema - Hemorrhage in the anterior chamber of the eye, commonly caused by trauma.
Scotomas - These are blind spots in the field of vision:
- Negative Scotoma - A dark spot in the field of vision, which can be a sign of retinal hemorrhage or retinal detachment.
- Positive Scotoma - Moving luminous patches in the field of vision, typically experienced in just one eye and lasting for a few seconds to minutes. They are usually not dangerous and are considered benign.
Floaters - These are small dots or specks that appear to move in the field of vision. They are generally benign, but can be a sign of retinal detachment.

Diabetic Retinopathy

Background Retinopathy - Early stage of the disease, characterized by microaneurysms and dot hemorrhages.
Proliferative Diabetic Retinopathy - A more severe stage, where new blood vessels grow near the optic disc. These new vessels bleed easily and can lead to retinal detachment.
- This stage can also cause blindness.

Hypertensive Retinopathy

Copper-Silver Wiring - Blood vessels appear this way instead of their normal red hue due to engorged blood vessels.
A/V Nicking - This occurs due to thickened arterial walls.
Flame Hemorrhages and Soft Exudates - These are characteristic findings of hypertensive retinopathy.
Papilledema - Indistinct optic disc margins, also seen in conditions other than hypertensive retinopathy, such as brain tumors.
- Retinopathy with papilledema should be a red flag for a potential brain tumor.

Senile Macular Degeneration

Affects Central Field of Vision - Typically causes distortion or blurring of the central part of the field of vision.
Usually Bilateral - It is most commonly seen in both eyes.
Pigmented Macula and Exudates - These are characteristic findings on eye examination.

Meniere's Disease

Affects Inner Ear - This disease affects the balance and hearing of the inner ear.
Fluctuation of Symptoms - Symptoms can be unpredictable and change intensity over time.
Vertigo - Episodes of dizziness and imbalance.
Tinnitus - Ringing or other sounds in the ears.
Hearing Loss - This can be temporary or permanent and often fluctuates.
Diagnosis - A thorough neuro exam including the Weber and Rinne tests are crucial.
- Inner ear sensorineural hearing loss can be identified with these tests.
Other Tests - Thyroid studies, electrolyte levels, and blood sugar levels are recommended.
Other Investigations - CBC, ESR, ANA, fluorescent treponemal antibodies (for syphilis) and an MRI of the brain (to rule out acoustic neuroma) are needed.
Management - Includes dietary changes (reducing salt intake, avoiding caffeine), reducing tobacco use.

Vestibular Neuronitis

Viral Etiology - The inflammation of the vestibular division of the eighth cranial nerve is often associated with a viral infection.
Peak Incidence in 30s and 40s - While it can occur at any age this age group appears to be more susceptible.
Abrupt Onset of Vertigo - The onset of debilitating vertigo is sudden.
First Attack Often Most Severe - Initial attacks are often the most intense and can last 7-10 days.
Nausea and Vomiting - Common symptoms associated with vertigo.
Nystagmus - Involuntary movements of the eyes, which can be vertical, horizontal, or rotational.
No Hearing Loss or Tinnitus - Vertigo is the primary symptom and is not accompanied by tinnitus or hearing loss.
Labs and Imaging - Include CBC, glucose levels, and MRI if a CNS cause of vertigo is suspected.

Benign Positional Vertigo (BPV)

Short Duration - The vertigo episodes are usually short-lasting, lasting around 30 seconds.
Caused by Certain Head Positions - Triggered by specific head movements.
Episodes Occur Intermittently - Episodes can occur sporadically lasting days to weeks.
Usually Well Between Attacks - Patients typically feel normal between vertigo episodes.
Romberg Test (+) - Suggests a loss of balance and the patient tends to fall towards the affected side.
Dix-Hallpike Maneuver - A specific diagnostic test where the patient is quickly moved from a sitting to lying position.
- The presence of nystagmus, particularly multi-directional and prolonged nystagmus that is not relieved by fixation, suggests BPV.

Otitis Media with Effusion (OME)

Conductive Hearing Loss - Affects sound transmission to the inner ear.
Retracted Tympanic Membrane - The eardrum is pulled inward and appears immobile.
Bubbles and Air-Fluid Levels - Can be seen behind the eardrum.
No Antibiotics or Prophylaxis - Typically managed with observation and avoiding antibiotics.

Bullous Myringitis

Sudden Onset of Severe Pain - Pain is typically intense.
Vesicles on Tympanic Membrane - Blisters filled with clear watery fluid are present on the eardrum.
Viral Etiology - Caused by viruses, often presenting acutely and resolving quickly.

Cholesteatoma

“Glue Ear” - A term describing a build-up of fluid in the middle ear.
Associated with Chronic Otitis Media - Often occurs as a complication of chronic ear infections.
Chronic Negative Pressure in Middle Ear - This can cause the eardrum to retract and form a sac that gradually fills with debris and may lead to bone erosion, hearing loss, facial paralysis, and even meningitis.
Prevention is Key - Prompt treatment of ear infections is important.

Acute Mastoiditis

Sequelae of Acute Otitis Media - A serious complication of ear infections.
Subperiosteal Abscess - An accumulation of pus located beneath the periosteum (a membrane covering bone) causing inflammation.
High Fever and Discharge - Common symptoms.
Labs - Leukocytosis (an increase in white blood cells), elevated ESR, and blood culture (to rule out bacteremia) are recommended.
MRI - May be needed to plan surgical treatment if necessary.

Otosclerosis

Hardening of the Ear - The bone surrounding the middle ear becomes abnormally hard.
Periosteal Bone Replaces Endochondral Bone - A change in the type of bone tissue.
Ankylosis of Stapes - Stiffening of the stapes bone in the middle ear, reducing its movement and causing hearing loss.
Onset 15-35 Years Old- Typically appears in this age range.
Familial - Tends to run in families.

Sinusitis

Homeopathic Medicine and Vitamin C Therapy - Can be helpful in both prevention and recovery from sinus infections.
Complications - Can include:
- Orbital/Periorbital Cellulitis - Inflammation of the tissue around the eye.
- Cavernous Sinus Thrombosis - A serious condition where a blood clot forms in the cavernous sinus (a vein that drains blood from the brain), and can lead to life-threatening complications.

Disorders of the Mouth and Throat

Leukoplakia

White Plaque or Patch - A white, thickened area that cannot be scraped off.
Chronic Irritation - Can be caused by smoking, alcohol, or other irritants.
Peak Age 40-60 Years Old - This condition is most commonly seen in this age range.
Usually Asymptomatic - Many individuals with leukoplakia don't experience any symptoms.
Potential for Malignancy - A small percentage (2-6%) can develop into squamous cell carcinoma.

Homogenous vs. Verrucous Leukoplakia

Homogenous Oral Leukoplakia - The most common type, characterized by uniform white plaques on the buccal mucosa.
Verrucous Oral Leukoplakia - Exhibit white plaques on an erythematous (red) base.

Erythroplakia

Marked Erythema - Characterized by a distinct red patch.
Usually Asymptomatic - Often does not cause any symptoms.
High Risk of Malignancy - A significant percentage (90%) are early squamous cell carcinomas.

Candidiasis (Thrush)

Infection with Candida Albicans - Caused by a type of yeast.
White Patches - Easily scraped off.
Painful and Raw at Base - When the white patches are removed, the underlying tissue can be painful and red.
Common Locations - The tongue, pharynx, and buccal mucosa are common areas affected.
Predisposing Factors - Individuals with weakened immune systems, infants, denture wearers, and those taking broad-spectrum antibiotics are more susceptible to Candida infections.
KOH Prep Shows Pseudohyphae - A microscopic examination can confirm the diagnosis.

Glossitis

Loss of Papillae (Slick Tongue) - A smooth tongue due to the loss of taste buds.
Painless - Typically does not cause pain.

Glossodynia

Pain/Burning of the Tongue - A burning sensation or pain on the tongue.

Eye Conditions

Excessive tearing or redness of the eye: Can be a sign of various eye conditions.
Pinguecula: A mild scar tissue on the conjunctiva due to wind or sun exposure.
Pterygium: Conjunctival thickening that can grow onto the cornea, affecting vision. Also caused by wind and sun exposure.
Keratoconjunctivitis sicca: Lack of tears, potentially associated with autoimmune diseases like Rheumatoid Arthritis (RA), Sjogren's syndrome, or Systemic Lupus Erythematosus (SLE).
Corneal arcus: Opaque whitening around the cornea, can be seen in elderly people (arcus senilis) or individuals with hyperlipoproteinemia.
Blepharitis: Inflammation of the eyelids.
- Bacterial blepharitis: Characterized by red, scaly eyelids and crusts (usually caused by staphylococcus).
- Allergic blepharitis: Shows no inflammation, but presents with greasy scales.
- Symptoms: Itching, burning, foreign body sensation; may cause eyelashes to fall out.

Keratitis (Corneal Inflammation)

Infectious causes: Bacterial, viral (Herpes simplex and zoster), and fungal.
Non-infectious causes: Contact lens wear, trauma, corneal burns.
Symptoms: Persistent and severe pain, photophobia, blurred vision, minimal or no discharge.
Diagnosis: Fluorescein stain reveals damaged epithelium, and hypopyon (pus in the anterior chamber) may be present.
Referral: It's crucial to refer patients with keratitis to an ophthalmologist immediately.

Herpetic Eye Diseases

HSV-1 (Herpes Simplex Virus Type 1): Starts on the cornea with keratitis.
- Dendritic ulcers with terminal bulbs: Observable during slit-lamp examination.
- High recurrence rate: 25% chance of recurrence.
- Common symptoms:
  - Pain
  - Photophobia
  - Redness
  - Teary eye
- Anterior uveitis: The anterior iris becomes stuck to the trabecular meshwork, closing the angle.
- Increased intraocular pressure: Can happen after cataract surgery or spontaneously.

Acute Glaucoma

Causes:
- Angle closure glaucoma: Iris becomes stuck to the trabecular meshwork, blocking drainage.
- Plateau iris: A genetically narrow angle that becomes occluded with pupil dilation.
- Medications: Sulfa derivatives, bronchodilators (can dilate pupils).
- Space-occupying lesions of the brain.
Symptoms:
- Severe pain: With nausea and vomiting.
- Unilateral vision loss: Or halo vision due to corneal edema.
- Diffuse redness: With a hazy cornea.
- Pupil dilation: Large and fixed, not reactive to light or accommodation.
- Hard eye: Increased intraocular pressure.
- IOP: 40-80 mmHg.
Urgent referral: Acute glaucoma is an emergency, requiring immediate referral to an ophthalmologist.

Sudden Vision Loss Overview

Painless sudden vision loss: Has multiple causes.
Four primary causes:
- Arterial occlusion: Blockage of an artery supplying the retina.
- Venous occlusion: Blockage of a vein in the retina.
- Vitreous hemorrhage: Bleeding into the vitreous humor.
- Retinal detachment: Separation of the retina from the underlying choroid.

Arterial Occlusion

ROP (Retinopathy of prematurity): In premature infants, excessive oxygen exposure can be toxic to the retina.
Causes:
- Hypertension: Severe or uncontrolled high blood pressure.
- Arteriosclerosis: Hardening and narrowing of the arteries.
- Emboli: Blood clots travelling from heart to the eye.
- Trauma: Injury or direct impact to the eye.
Symptoms:
- Sudden pain: In the affected eye.
- Vision loss: Can range from mild to complete blindness.
- Redness: Of the eye.
- Pupillary abnormalities: The pupil may be dilated and unresponsive to light.

Venous Occlusion

Can occur in central retinal vein or branch retinal vein.
Causes:
- High blood pressure: Can damage the veins.
- Diabetes: Can cause damage to blood vessels throughout the body.
- Glaucoma: Increased intraocular pressure can affect blood flow.
Symptoms:
- Vision loss: Can be in one area or the entire visual field.
- Blurred vision: May be gradual or sudden.
- Floaters: Tiny dark specks in the field of vision.
- Flashing lights: Brief flashes of light, especially in the peripheral vision.

Vitreous Hemorrhage

Bleeding into the vitreous humor: The jelly-like substance that fills the inside of the eye.
Causes:
- Diabetic retinopathy: Damage to the blood vessels in the retina due to diabetes.
- Hypertensive retinopathy: Damage to the blood vessels in the retina due to high blood pressure.
- Retinal tears: Tears in the retina can cause bleeding.
- Trauma: Injury to the eye can cause bleeding into the vitreous humor.
Symptoms:
- Floaters: Tiny dark specks that float in the field of vision.
- Blurred vision: May be gradual or sudden.
- Loss of central vision: If the hemorrhage is located in the macula.

Retinal Detachment

Separation of the retina from the underlying choroid: The layer of blood vessels that nourishes the retina.
Causes:
- Eye trauma: Any injury to the eye that can cause tears in the retina.
- Glaucoma: Increased intraocular pressure can damage the retina.
- Diabetic retinopathy: Damage to the blood vessels in the retina can lead to detachment.
- Age: As people age, the vitreous humor can become more liquid and pull away from the retina.
Symptoms:
- Floaters: Tiny black specks that drift across the field of vision.
- Flashing lights: Brief flashes of light, especially in the peripheral vision.
- Curtain-like vision: A dark shadow or curtain that appears in the field of vision.
- Blurred vision: Can be gradual or sudden.
- Loss of peripheral vision: The first sign of retinal detachment is often a loss of peripheral vision.

Gradual Vision Loss

More common than acute vision loss.
Six main causes:
- Cataracts: Opacity of the lens.
- Chronic (open angle) glaucoma: A gradual increase in pressure inside the eye that damages the optic nerve.
- Diabetic retinopathy: Damage to the blood vessels in the retina due to diabetes.
- Proliferative diabetic retinopathy: Abnormal blood vessels grow in the retina.
- Hypertensive retinopathy: Damage to the blood vessels in the retina due to high blood pressure.
- Senile macular degeneration: A condition that affects the central part of the retina, called the macula.

Cataracts

Opacity of the lens: Causes blurred vision and decreased Red Reflex (light reflection)
Symptoms:
- Blurred vision: Difficulty seeing clearly.
- Double vision: Seeing two images of an object.
- Glare: Sensitivity to light.
- Halos: Seeing rings around lights.
Children: Present with squinting and amblyopia (crossing of the eyes).

Chronic (Open Angle) Glaucoma

Can occur without sudden increases in intraocular pressure (IOP).
Atrophic changes to the optic nerve: Due to increased aqueous humor in the anterior chamber.
Risk factors: Diabetes, family history, hypothyroidism, age.
Symptoms:
- Blind spots in vision: Negative scotomas, meaning patients are not aware of the blind spot.
- Pale optic disc with cupping: The optic disc appears pale and cupped.

Background Retinopathy

Decreased circulation with endothelial damage: Leads to retinal ischemia.
Microaneurysms: Develop and rupture as capillaries weaken.
- Flame hemorrhages: Bleeding into the retina.
- Blot hemorrhages: Bleeding deeper into the retina.
Soft and hard exudates:
- Soft exudates: Due to increased permeability of blood vessels.
- Hard exudates: Fatty deposits on the retina.
Cotton wool spots: Areas of nerve fiber ischemia.
Macular edema: Causes decreased visual acuity.

Nasal Conditions

Non-allergic rhinitis: Inflammation of the nasal lining not caused by allergies.
- Acute rhinitis: Common cold (URI).
  - Watery discharge:
  - Profuse discharge:
  - Sneezing:
  - Malaise:
  - Swelling of nasal mucosa:
- Atrophic rhinitis: Thinning of the nasal mucosa and crust formation.
  - Idiopathic: No known cause.
  - Secondary to rhinoplasty: Surgery to reshape the nose.
  - Thinning of the nasal mucosa:
  - Nasal crust formation:
  - Fetid odor:
  - Stuffiness:
  - Painful nasal passage:
  - Dry/shiny membranes:

Differential Diagnosis for Rhinorrhea

Trauma: A concerning sign of potential skull fracture. May cause cerebrospinal fluid (CSF) leakage.
- Benedict's test: Detects sugar in the discharge, indicating CSF.
- Clear nasal drainage: With history of skull fracture.
Foreign body:
- Discharge:
- Odor: Unilateral.
Neoplasm: May cause bloody discharge.
Choanal atresia: Congenital defect in septal development, obstructing the nasopharynx on one or both sides. - Bilateral obstruction: Infant unable to breathe through nose while eating. - Crying: Allows for air inhalation. - Nose breathing: Infant's preferred breathing method.

Allergic Rhinitis

Affects 20-40 million people annually: One of the most prevalent chronic illnesses in children under 18.
Economic Impact: Leads to 3.8 million lost work/school days and $2.7 billion in direct costs annually.
Seasonal or perennial: Occurring during specific seasons or year-round, respectively.
Pathogenesis:
- IgE-mediated reaction: Allergens are recognized by IgE antibodies.
- Mast cell degranulation: Release of histamine and other inflammatory mediators.
- Symptoms: Sneezing, watery eyes, runny nose, nasal congestion.

Normal Nasal Mucosa

Respiratory epithelium: Contains ciliated cells and goblet cells.
Ciliated cells: Move mucus and debris toward the pharynx.
Goblet cells: Secrete mucus.
Blood vessels: Dilate in response to inflammation.
Lymphoid tissue: Part of the immune system.
Nerves: Provide sensation and control blood vessel dilation.

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Test your knowledge on eye exams and common ocular issues. This quiz covers pupil reactions, signs of eye pain, and symptoms of eye conditions. Enhance your understanding of ocular health with these key concepts.