01 COMMONOPDPROBLEMS.pdf

COMMON OPD PROBLEMS Red Eye Syndrome COMMON OPD PROBLEMS – Most common chief complaint – Sore eyes (lay man’s term), conjunctivitis...

COMMON OPD PROBLEMS Red Eye Syndrome COMMON OPD PROBLEMS – Most common chief complaint – Sore eyes (lay man’s term), conjunctivitis – Differential dx. Uveitis, keratitis, glaucoma Department of Ophthalmology Fatima College of Medicine GLAUCOMA Circumcorneal Injection ACUTE GLAUCOMA Acute Angle Closure Glaucoma Most impt. disease of red eye syndrome Critical to the vision of patient Symptoms: severe headache (typically unilateral, nausea and vomiting, sudden visual loss, iridescent vision (haloes) P.E.: hazy cornea, shallow AC, inc. IOP Tx. Beta blocker, ACE inhibitors, laser iridotomy, trabeculoplasty, filtering sx  Conjunctivitis CONJUNCTIVITIS Inflammation of the conjunctiva Viral (watery),allergic (mucinous), bacterial (purulent) Gram stain and culture -severe bacterial infection Viral- (pre-auricular lymphadenopathy) Bacterial- (post-auricular and submandibular) Tx. Topical antibiotics UVEITIS Uveitis Inflammation of the uveal structures (iris, ciliary body and choroid) Presents with conjunctival, episcleral and scleral hyperemia Hyperemia is more on the circumlimbal area Blurring of vision, flares and cells in the AC, photophobia and eye pain Tx. Steroids and cyclopegic agent KERATITIS Keratitis Inflammation of the cornea Epithelial layer is disrupted (hazy cornea or with opacity) Vision is affected if the lesion is on the central axis Photphobia- due to ciliary spasm Tx. Cyclopegics,steroids No Steroids when epithelial defects are present Corneal Scarring PTERYGIUM Elastotic degeneration of the conjunctiva Triangular, pinkish, vascular mass encroaching on the cornea Common among outdoorsmen and pigmented races Chronic UV exposure and wind (dryness) Tx. Surgical excision Pterygium PINGUENCULA a pterygium that has not encroached on the cornea Pinguecula HORDEOLUM (Stye) infection of a hair follicle Tx. I and C (incision & curettage), topical antibiotics  Hoerdeolum CHALAZION Chronic inflammation of meibomian gland Tx. I & C (Incision & Curettage), topical antibiotics Chalazion FOREIGN BODY May come from projectile trauma Drilling, welding Tx. Removal of foreign body together with rust ring,plus topical antibiotics and corneal healing agents. Corneal Foreign Body DRY EYES Associated w/ ageing autoimmune deseases Dx. Shirmer’s test Tx. Artificial tears. lubricants Dry Eyes TEARING Due to excessive lacrimation Secondary to an autoimmune response or obstruction in the lacrmal apparatus Dx. Jones test Tx. Irrigation, DCR Tearing BLEPHARITIS Infection of the lid margin Dandruff like flakes and mattering of the eye lashes Tx. Antibiotic ointment and lid scrub Blepahritis NEVUS Accumulation of pigment in any structure of the eye Most are benign and warrant mere observation  Nevus XANTHELASMA Yellow brown pigment on the eyelid Collection of foamy histiocytes Secondary to hyperlipidemia No treatment but warrants referral to an internist Xanthelasma LID WART Verruca vulgaris Tx. Excision or cautery Verruca vulgaris ENTROPION & ECTROPION Entropion-inward turning of the eyelids Ectropion-outward turning of the eyelids Tx. Surgical repair  Entropion Ectropion TRICHIASIS Trichiasis Misdirection of the eyelashes, may poke the cornea Tx. Pulling off , cryotherapy PTOSIS Ptosis Drooping of the upper eyelid Tx. Surgical repair  LAGOPHTHALMOS Lagophthalmos Inability of the eyelids to shut Can cause exposure keratitis Seen in Bell’s palsy and tumors affecting CN VII. Tx. Tear lubrication, supportive measures, surgery Thank You