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Watery Eyes
AJGP Vol. 53, No. 11 Supplement, November 2024 Definitions and Classification Epiphora Anatomy of the Lacrimal System Components of the Lacrimal System Pathophysiology of a Watery Eye Etiology of Epiphora Differential Diagnosis of Epiphora Pediatric Population Adult Population Common Causes of Epiphora Reflex Lacrimation: Nasolacrimal Duct Obstruction (NLDO): Facial Palsy:…
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Dry Eyes
Ocular Surface Components Tear System Anatomy Types of DED Signs and Symptoms Diagnosis Sjogren Syndrome Diagnosis Criteria Management Pharmacologic Therapy: In-office Procedures: Therapeutic Eyewear: Surgical Interventions:
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Peripheral Visual Loss
Bilateral Hemianopia: Total Blindness in One Eye: Right Incongruous Hemianopia: Homonymous Superior Quadrantanopia: Homonymous Hemianopia:
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Onychogryphosis
Definition: Onychogryphosis, also known as ram’s horn nail, is a nail disorder characterized by slow nail plate growth, opaque yellow-brown thickening, elongation, and increased curvature of the nail plate. Demographics Causes Clinical Features Complications Diagnosis Differential Diagnoses Treatment Outcome
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Presbyopia
Etiology Epidemiology Pathophysiology History and Physical Examination Evaluation Treatment / Management Non-surgical Options: Surgical Options: Differential Diagnosis
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Age Related Macular Degeneration (ARMD)
Risks Two types Symptoms Differentials Condition Signs and Symptoms Management Age-Related Macular Degeneration (ARMD) – Loss of central vision– Peripheral vision generally preserved– Gradual decrease in visual acuity – Anti-VEGF therapy– Lifestyle modifications– Low vision aids Glaucoma – Peripheral vision loss– Increased intraocular pressure– Optic nerve cupping – Medications to…
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Retinal Detachment
Refer to ophthal to differentiate causes
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Posterior vitreous detachment
most common cause of acute onset of flashes and floaters Differential Diagnosis Causes of Photopsia other than posterior vitreous detachment include the following: Causes of floaters other than posterior vitreous detachment include the following: Clinically Early Stages: Symptoms: Treatment Complications Aspect Vitreous Detachment (PVD) Retinal Detachment (RD) Definition Separation of vitreous gel…
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Flashes and floaters
OphthalmicFlashes OphthalmicFloaters OphthalmicBoth Flashes and FLoaters Non-opthalmic flashes Posterior vitreous detachment Posterior vitreous detachment Posterior vitreous detachment Migraine – scintillating scotomas, coloured lights, bilateral, evolves over 5 to 30 minutes before resolving with onset of a headache, normal visual acuity Retinal detachment Retinal detachment Retinal detachment Postural hypotension – bilateral…
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Choloboma
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Cataracts
Etiology of Cataracts Traumatic Cataracts Systemic and Endocrine Diseases Secondary Cataracts Other Causes Pathophysiology Clinical Examination findings Disease-related Complications Ophthalmology referral for Cataract Extraction Cataract Referral Criteria for Queensland Health Eligibility for Referral Additional Considerations for Referral Urgent Referral Criteria Advice for Patients with Cataracts Awaiting Surgery Symptom Management Lifestyle…
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Central Retinal Vein Occlusion (CRVO)
Overview: Central Retinal Vein Occlusion (CRVO): Non-Ischemic CRVO: Ischemic CRVO: Etiology: Epidemiology: Pathophysiology: Risk Factors History and Physical: Evaluation: Treatment / Management: Prognosis: Complications: Non-ischemic CRVO Ischemic CRVO Visual acuity >20/200 <20/200 RAPD (relative afferent papillary defect) Mild or absent Present (>0.7 log units of neutral density filter) Visual field…
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Retinal Artery Occlusion
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Diabetic Retinopathy
Hypertensive Retinopathy
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Red Eye Reflex
How to Check the Red Reflex What to Look For White reflex causes Retinoblastoma
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Optic Neuritis
Clinical Treatment / Management: Differential Diagnosis The differential diagnosis of optic neuritis includes the following conditions:
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Strabismus (squint)
Eye turning in (esotropia) Eye turning out (exotropia) Intermittent/variable turning in of the eye before 3 months of age.Do not refer – this is normal for infants. Intermittent/variable turning in of the eye after 3 months of age.Refer semi-urgently for evaluation of strabismus. Constant large turning in of the eye…
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Eye Trauma
Retrobulbar hemorrhage/ orbital compartment syndrome Pathology DDx Examination findings Management lateral canthotomy/ cantholysis The main steps in emergency ≈/ cantholysis are: Orbitozygomatic fractures/ Orbital blowout fracture Chemical Burn to eye
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Orbital Cellulitis
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sudden, painless, unilateral vision loss
Nontraumatic causes of transient (<24h) monocular vision loss Nontraumatic causes of acute persistent monocular vision loss Nontraumatic causes of acute binocular loss of vision Post-traumatic causes of loss of vision (From ‘front to back’):
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Scleritis & Episcleritis
Feature Scleritis Episcleritis Definition Inflammation of the sclera, the white outer coating of the eye Inflammation of the episclera, the thin layer of tissue covering the sclera Cause Often associated with systemic autoimmune diseases (e.g., rheumatoid arthritis, lupus) Usually idiopathic; can be associated with mild systemic conditions (e.g., dry eye…
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Uveitis/Iritis
inflammation of the uveal tract. History Investigations may not be required if: Complications Management
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Acute Closed-Angle Glaucoma
Pathology of Raised Intraocular Pressure Primary Causes: Precipitating Factors: Secondary Causes: Risk Factors: History: Examination: Management
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Painful Eye
History Physical Examination Anatomic Assessment External Structures Conjunctiva Sclera Cornea Pupil Anterior Chamber Anterior Uvea Common Conditions and Management Emergent Ophthalmologic Diseases
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Ocular rosacea
Rosacea Ocular Rosacea Clinical Management
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Conjunctivitis
Allergic conjunctivitis Age Children or adults Aetiology Local response to an allergen, including:– seasonal (typically spring and autumn)– perennial– contact hypersensitivity reactions (eg preservatives in eye drops, contact lens solutions). Clinical features In seasonal and perennial conjunctivitis- symptoms are usually bilateral. The primary diagnostic symptom– itch with watery eyes – usually…
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Keratitis
Types Common symptoms: examination Adenoviral Keratoconjunctivitis . Herpes simplex keratitis: all of which can be vision threatening. Management Contact lens wearers OR OR (if available) dendritic ulcer OR Herpes zoster ophthalmicus OR OR Adenovirus keratoconjunctivitis UV keratitis (welders Keratitis)
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Corneal foreign body/Corneal abrasion
History: Examination: Slit lamp exam and tonometry: Differentials Management: Follow up Complications
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Trichoma
Incubation period Infectious period Clinical presentation and outcome Differentials Examination WHO simplified grading system for trachoma Grade Signs Infectious TF Trachomatous inflammation- Follicular Presence of 5 or more follicles of >0.5mm in diameter on the upper tarsal conjunctiva TI Trachomatous inflammation – Intense Presence of pronounced inflammatory thickening of the…
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serious causes of a RED EYE
features on history or examination serious causes of a RED EYE Severe eye aching IritisKeratitisAcute Angle-Closure GlaucomaScleritisOrbital CellulitisCavernous Sinus Thrombosis (CST) Prominent photophobia IritisKeratitis Impaired vision IritisKeratitisAcute Angle-Closure GlaucomaOrbital CellulitisCST Cloudy cornea KeratitisAcute Angle-Closure Glaucoma Corneal opacification Keratitis – Chemical Or Infectious Circumcorneal conjunctival injection IritisKeratitis Cloudy anterior chamber Iritis…
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Eye lesions
Benign melanocytic lesions urgent referral if enlarging or suspicious Vascular lesions Infantile hemangioma/ strawberry hemangioma – usually resolve by 10yo, can cause ptosis, refractive error, amblyopia – refer to ophthalPort wine stains – if involving the eyelid can be associated with glaucoma – urgent refer SCC, BCC, actinic keratosis, keratoacnathoma,…
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Hyphaema & Hypopyon
Hypopyon causes: Hyphaema causes Rx: bedrest at 30 degrees, Topical corticosteroids If inc intraocular pressure 🡪 topical aqueous suppressants (beta-blockers and alpha-agonists)
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Pterygium & Pinguecula
Pinguecula
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Eye lid issues
Trichiasis Ectropion Entropion
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Dacrocystitis
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Nasolacrimal duct obstruction
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Blepharitis
Inflammation of the eyelids/lashes.glands and associated structures with minimal ocular involvement Risks Types Clinical Management of Blepharitis(eTG) Eyelid Hygiene: Topical Antibiotics for Anterior Blepharitis: Systemic Antibiotics for Posterior Blepharitis: Review: Special Considerations: Complications from blepharitis include:
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Red eye
Painless Painful Diffuse Localised redness Abnormal cornea Abnormal eyelid Diffuse conjunctival injection Ciliary injection/ scleral involvement Anterior chamber involvement BlepharitisEctropionEntropionTrichiasisEyelid LesionTumourStye PterygiumCorneal Foreign Body w/out abrasionOcular TraumaSubconjunctival Hemorrhage HSV KeratitisCorneal UlcerMarginal KeratitisForeign body 🡪 Corneal Abrasion ChalazionStyeAcute BlepharitisHerpes Zoster Ophthalmicus Viral ConjunctivitisAllergic ConjunctivitisBacterial ConjunctivitisDry EyesAcute Glaucoma Scleritis Acute Anterior Uveitis (Iritis)HypopyonHyphema
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Eye Exam
highly recommend: History Examination The physical examination includes measurement of visual acuity, external examination, and slit- lamp biomicroscopy. Visual Acuity Patient discomfort, photophobia, and tearing may compromise determination of visual acuity. It is important, however, to document baseline visual acuity and to ascertain that it is consistent with the anterior…
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Eye Anatomy
Exophthalmus vs proptosis proptosis Exophthalmus Enophthalmos Posterior displacement of the globe in the orbit – implies that the eye is normal
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Chalazion and Hordeolum (stye)
Pathophysiology Chalazion Etiology Management Complications Hordeolum Risk Factors Management
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Vision problems
1. Myopia (Short-sightedness) 2. Hyperopia (Long-sightedness) 3. Astigmatism 4. Presbyopia 5. Amblyopia (Lazy Eye) 6. Strabismus (Crossed Eyes)
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Visual Requirements for driving
Visual Acuity Monocular (One-Eyed) Drivers: Diplopia (Double Vision): Visual Field Requirements:
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Horner’s Syndrome
indrawn eye + small pupil + ptosis (± anhydrosis) → Horner syndrome (?lung cancer) as per Murtag Causes: Investigations
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Cranial nerve palsies
6th nerve palsy Third cranial nerve palsy “down and out” 4th cranial nerve palsy
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Herpes Zoster Ophthalmicus
VZV distributions of the fifth cranial nerve (trigeminal nerve), shared by the eye and ocular adnexa Red Flags Background Risk Factors History Examination Signs Specific Examination Components Differential diagnosis Management of Herpes Zoster Ophthalmicus (HZO) Skin Rash Treatment Ocular Treatment Antiviral Therapy Systemic/Oral Prednisolone Elevated Intraocular Pressure (IOP) Pain Management…
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Strabismus (‘squint’)
Common causes of strabismus Primary causes of strabismusRisk factors: – family history of strabismus– premature birth– low birth weight Secondary causes of strabismus often associated with neurological pathology Idiopathic strabismusCongenital syndromes Cranial nerve palsies (CNIII, IV, VI) Orbital fractureIntracranial bleedIntracranial/intraorbital/intraocular mass (benign or malignant)Intracranial infectionGrave’s diseaseMyasthenia gravisDiabetes mellitusAmblyopiaToxins and heavy metal poisoningPost-vaccination…