Evaluation and Management of Eye Disorders PDF

Part 6 Evaluation and Management of Eye Disorders  Cataracts (Chapter 55) Opacification of the crystalline lens of the eye The leading cause of blindness worldwide Nonpainful, progressive loss of visual acuity, frequent changes in eyeglass prescription Physical...

Part 6 Evaluation and Management of Eye Disorders  Cataracts (Chapter 55) Opacification of the crystalline lens of the eye The leading cause of blindness worldwide Nonpainful, progressive loss of visual acuity, frequent changes in eyeglass prescription Physical exam—Perform a full ophthalmic examination. Normally a cataract will not cause injection of the conjunctiva, corneal opacification, or pain, except in rare instances of traumatic or hypermature cataracts Hazy visualization of the optic nerve and retina due to the lens opacity Poor absent response to red light reflex Diagnostics Fundoscopic exam Dilated retinal exam Treatment Surgical cataract extraction  Conjunctivitis (Chapter 57, Slide 1 of 2) Inflammation of the conjunctiva, the transparent mucosal tissue that lines the eye and inner surface of the eyelids Infectious Bacterial Thick, purulent discharge; both eyes are sticky or glued shut. These symptoms are worse in the morning. Viral 70% of all infectious cases, a recent URI or exposure to sick contacts (Dx of adenoviral conjunctivitis) Acute onset of a red eye with excessive watery discharge, usually starts in one eye, then the other eye becomes symptomatic a few days later. Noninfectious Caused by allergy, atopy, or exposure to toxins  Conjunctivitis (Chapter 57, Slide 2 of 2) Management Viral conjunctivitis Artificial tears and cool compresses. Advise considered contagious as long as they are still tearing or for at least 1 week. Bacterial conjunctivitis Use discretion in topical antibiotics. Antibiotics indicated if suspect high infectivity rate (high-risk patients should always receive antibiotics) trimethoprim–polymyxin B or fluoroquinolone drops, 4 times a day for 1 week. Acute allergic conjunctivitis Avoidance of trigger, oral antihistamine preservative-free artificial tears, cool compresses, and removal of contact lenses. For severe cases addition of antihistamine-vasoconstrictor, mast cell stabilizers. Vernal and atopic conjunctivitis Avoidance of triggers, mast cell stabilizers initiated 2 weeks before known allergic symptoms develop. Medication toxicity Eliminate the toxic source, treatment with preservative-free artificial tears should be provided. Short course of topical steroids. Ophthalmologic referral based on assessment of sight-threatening risk, no improvement with treatment  Corneal Surface Defects and Ocular Surface Foreign Bodies (Chapter 58, Slide 1 of 2) A corneal surface defect occurs when the corneal epithelium is interrupted. Direct trauma from foreign objects (e.g., fingers, tree branches, makeup applicators) typically causes these injuries. Contact lens wearers are particularly susceptible to corneal problems. Prolonged use of lenses can result in injury and corneal epithelial breaks. Symptoms Sudden onset of severe eye pain in the affected eye Pain typically resolves after application of a topical anesthetic eye drop. May present with a foreign body sensation Blurred vision Redness Tearing Light sensitivity Eyelid swelling Blepharospasm  Corneal Surface Defects and Ocular Surface Foreign Bodies (Chapter 58, Slide 2 of 2) Physical exam Thorough eye exam, visual acuity, pupillary light response, eye pressure, cornea. Check for foreign bodies in the conjunctiva or cornea, topical fluorescein dye. Management Most cases are treated with supportive care. An ophthalmic antibiotic ointment (e.g., erythromycin or polymyxin B/bacitracin (Polysporin) aids in pain/comfort management. Oral analgesics Artificial tears RSVP—Redness, Sensitivity to light, Vision changes, or Pain (warrants ophthalmologic referral) If visible, remove foreign object on cornea, or refer to ophthalmology. For chemical involvement, immediately irrigate eyes, check pH (7 to 7.5), and repeat if pH not met.  Dry Eye Syndrome (Chapter 59, Slide 1 of 2) Dry eye syndrome is a multifactorial disorder characterized by abnormalities in the tear film. Tear film instability, hyperosmolarity of the tear film, and ocular surface inflammation Symptoms Dryness, foreign body sensation (a scratchy or gritty feeling in the eyes), burning or stinging pain, itching, or ocular fatigue Redness, light sensitivity, or note transient blurred vision that is relieved by blinking Symptoms are worsened by activities that require visual concentration (e.g., reading or computer use) or by low-humidity environments. Some patients may demonstrate excessive tearing. Intolerance to contact lenses  Dry Eye Syndrome (Chapter 59, Slide 2 of 2) Diagnostics Two basic tests help distinguish aqueous-deficient from evaporative dry eye. Schirmer test can be performed to assess aqueous production, tear breakup time. If autoimmune (rheumatoid arthritis or Sjögren’s syndrome) is suspected: Serologic evaluation including SS-A (anti-Ro), SS-B (anti-La), rheumatoid factor, and antinuclear antibodies should be obtained. Management Stepwise management according to the severity of disease Avoid windy, smoky, or low-humidity environments, drying effects of air conditioning and fans, limit the uninterrupted time spent reading or working on the computer without a break. Review systemic medications and make dietary recommendations. Artificial tears, high-viscosity gels, and ointments (nighttime use)  Pingueculae and Pterygia (Chapter 62) Pinguecula—Benign, yellow-white nodule on the bulbar conjunctiva, most often located nasal to the cornea Pterygium—Benign growth of fibrovascular conjunctival tissue that extends onto the surface of the cornea Symptoms—Complaints include dryness, irritation, foreign body sensation, itching, redness, and a bothersome cosmetic appearance. In advanced stages of disease, a pterygium may cause persistently decreased vision. Diagnostics—Slit-lamp Management—Mainly symptom management, preservative free artificial tear drops, UV protection, lower potency topical steroid drops (4–7-day course)