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Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Diagnostic Tools for Dry Eye Disease
Review Ocular Surface Disease Diagnostic Tools for Dry Eye Disease Sarah Dougherty Wood and Shahzad I Mian Department of Ophthalmology and Visual Sciences, Medical School, University of Michigan, Ann Arbor, Michigan, US DOI: https://doi.org/10.17925/EOR.2016.10.02.101 ry eye disease is multifactorial in aetiology and complex in pathophysiology that makes its diagnosis clinically challenging. Although there are numerous tools for assessment of dry eye disease, no single test is sufficient for the diagnosis. Typically a combination of D subjective symptoms and objective tests are used. The aim of this article is to review the available tests, including traditional tools and emerging technologies. This review includes a description of the test methodology, type of data collected, diagnostic reliability of data, benefits and limitations of each test, expected outcomes and tips for practical application. Keywords The International Dry Eye Workshop Dry Eye Workshop (DEWS) defined dry eye as “a multifactorial Dry eye disease, dry eye diagnosis, tear film disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage of the ocular surface. It is accompanied by increased Disclosure: Sarah Dougherty Wood and Shahzad I Mian osmolarity of the tear film and inflammation of the ocular surface”.1 This condition is divided into do not have financial or proprietary interest in any materials or methods mentioned. No funding was two general types: deficient aqueous production by the lacrimal gland and increased evaporation received in the publication of this article. This study of the tear film, with the latter being more prevalent. -
Onchocerciasis
11 ONCHOCERCIASIS ADRIAN HOPKINS AND BOAKYE A. BOATIN 11.1 INTRODUCTION the infection is actually much reduced and elimination of transmission in some areas has been achieved. Differences Onchocerciasis (or river blindness) is a parasitic disease in the vectors in different regions of Africa, and differences in cause by the filarial worm, Onchocerca volvulus. Man is the the parasite between its savannah and forest forms led to only known animal reservoir. The vector is a small black fly different presentations of the disease in different areas. of the Simulium species. The black fly breeds in well- It is probable that the disease in the Americas was brought oxygenated water and is therefore mostly associated with across from Africa by infected people during the slave trade rivers where there is fast-flowing water, broken up by catar- and found different Simulium flies, but ones still able to acts or vegetation. All populations are exposed if they live transmit the disease (3). Around 500,000 people were at risk near the breeding sites and the clinical signs of the disease in the Americas in 13 different foci, although the disease has are related to the amount of exposure and the length of time recently been eliminated from some of these foci, and there is the population is exposed. In areas of high prevalence first an ambitious target of eliminating the transmission of the signs are in the skin, with chronic itching leading to infection disease in the Americas by 2012. and chronic skin changes. Blindness begins slowly with Host factors may also play a major role in the severe skin increasingly impaired vision often leading to total loss of form of the disease called Sowda, which is found mostly in vision in young adults, in their early thirties, when they northern Sudan and in Yemen. -
Cataract Surgery Co-Management Information
Cataract Surgery Co-Management Phacoemulsification, Clear-Lens Extraction, and LensX INCLUSION CRITERIA: Significant visual complaints (decreased VA, increased glare, decreased Activities of Daily Living [ADLs], etc.) Treatment of secondary ocular disease (phacomorphic glaucoma, uveitis) Management of ocular disease (diabetic retinopathy, etc.) The patient’s Snellen best-corrected visual acuity must be 20/50 or worse. They may also be eligible for surgery if their BCVA is 20/40 or better and have significant difficulty with glare. Complaints of glare should be confirmed by brightness acuity testing or another suitable diagnostic test. EXCLUSION CRITERIA: Patients who are unable to receive proper postoperative care Patients in poor overall health (Primary Care Physician will not clear patient for surgery) TYPES OF CATARACT PATIENTS: Congenital: If cataract obscures visual axis (> or equal to 3mm) or is causing secondary disease, extraction should be performed within days to weeks after diagnosis in infants and small children to prevent amblyopia. If the cataract is not causing complications, closely observe for progression. Often patients with visually-significant, unilateral, congenital cataracts have strabismus and may require muscle surgery after extraction. Acquired: Most often, senile (Nuclear sclerosis, cortical degeneration, subcapsular) Due to systemic disease: (not limited to those listed below) Diabetes Mellitus Hypocalcemia Myotonic Dystrophy Frabry’s Disease Down’s Syndrome Atopic Dermatitis Wilson’s Disease -
Slit-Lamp Examination of the Vitreous and the Fundus* by H
Br J Ophthalmol: first published as 10.1136/bjo.33.4.242 on 1 April 1949. Downloaded from 242 H. GOLDMANN REFERENCES ANGELUCCI (1905).-Encycloqedie fran9aise. BAILLIART and BIDAULT (1939).-In Traiti d'Ophtalmologie, 8. Masson. COLLE, DUKE-ELDER, P. M., and DUKE-ELDER, W. S. (1931).-Jl. Physiol., 71, 1. COLOMBO (1923).-Boll. d'Ocul., 2. ;CRISTINI, G. (1947) -Ann. d'Ocul., 80, 530. (1948).-Gior. Ital. Oftal., 1, 5. (1948).-ibid., 1, 385. DIETER (1925).-Arch. f. A ugenhesilk., 96, 179 264. DUKE-ELDER, W. S. (1938).-Text-Book of Ophthalmology, Kimpton. DUKE-ELDER, W. S. and DAVSON, H. (1948).-Brit. Ji. Ophthal., 32, 555, ELSCHNIG.-Henke Lubarsch, 11, 911. FORTIN (1929).-Arch. d'Oftal., B.A., 359, 454. (1939).-Semana Medica., 1, 1128. GALA (1939).-Quoted by Magitot in Tratt d'Ophtalmologie, 6, 264. Masson. HAMBURGER (1923).-Med. Klin., 19, 1215. (1924).-lbid., 20, 267, (1925).-Ibid., 21, 1495, IiENDERSON and STARLING (1904).-Jl. Physiol., 31, 305. v. HIPPEL and GRUENHAGEN (1868).-Arch. f. Ophthal., 14,219. KOELLNER (1916).-Arch. f. Augenheilk., 80, 245. KUESEL (1906).-Klin. Monatsbl. f. Augenheilk., 44, 80, 236. LUCIANI-Fisiologia dell'uomo, 1, 381. MAGITOT (1939).-Traite d'Ophtalmologie, 11. Masson. MICHAIL and VANCEA (1926).-Ann. d'Ocul., 126, 561, PARSONS (1902).-The Pathology of the Eye. London. Poos (1931).-Arch. f. Ophthal., 127, 489. STOCKER (1947).-Arch. Ophthal., 37, 583. THIEL (1924).-Zentralbl. f. d. ges. Ophthal., 12, 305. Kurzes Handb,f. Oihthal. (Glaukom.), 781. THOMASSEN (i947).-Acta Ophthal., 25, 221. copyright. - (1947).-Ibid., 25,252. WEBER (1877).-Arch. f. Ophthal., 23, 1. -
CAUSES, COMPLICATIONS &TREATMENT of A“RED EYE”
CAUSES, COMPLICATIONS & TREATMENT of a “RED EYE” 8 Most cases of “red eye” seen in general practice are likely to be conjunctivitis or a superficial corneal injury, however, red eye can also indicate a serious eye condition such as acute angle glaucoma, iritis, keratitis or scleritis. Features such as significant pain, photophobia, reduced visual acuity and a unilateral presentation are “red flags” that a sight-threatening condition may be present. In the absence of specialised eye examination equipment, such as a slit lamp, General Practitioners must rely on identifying these key features to know which patients require referral to an Ophthalmologist for further assessment. Is it conjunctivitis or is it something more Iritis is also known as anterior uveitis; posterior uveitis is serious? inflammation of the choroid (choroiditis). Complications include glaucoma, cataract and macular oedema. The most likely cause of a red eye in patients who present to 4. Scleritis is inflammation of the sclera. This is a very rare general practice is conjunctivitis. However, red eye can also be presentation, usually associated with autoimmune a feature of a more serious eye condition, in which a delay in disease, e.g. rheumatoid arthritis. treatment due to a missed diagnosis can result in permanent 5. Penetrating eye injury or embedded foreign body; red visual loss. In addition, the inappropriate use of antibacterial eye is not always a feature topical eye preparations contributes to antimicrobial 6. Acid or alkali burn to the eye resistance. The patient history will usually identify a penetrating eye injury Most general practice clinics will not have access to specialised or chemical burn to the eye, but further assessment may be equipment for eye examination, e.g. -
Classification of Posterior Vitreous Detachment
Clinical Ophthalmology Dovepress open access to scientific and medical research Open Access Full Text Article EXPERT OPINION Classification of posterior vitreous detachment Akihiro Kakehashi1 Abstract: Diagnosing a posterior vitreous detachment (PVD) is important for predicting the Mikiko Takezawa1 prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. Jun Akiba2 This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is deter- 1Department of Ophthalmology, Jichi Medical University, Saitama mined based on the presence or absence of a PVD. The PVD then is classified as either a complete Medical Center, Saitama, 2Kanjodori posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). Eye Clinic, Asahikawa, Japan A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. -
Immune Defense at the Ocular Surface
Eye (2003) 17, 949–956 & 2003 Nature Publishing Group All rights reserved 0950-222X/03 $25.00 www.nature.com/eye Immune defense at EK Akpek and JD Gottsch CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM the ocular surface Abstract vertebrates. Improved visual acuity would have increased the fitness of these animals and would The ocular surface is constantly exposed to a have outweighed the disadvantage of having wide array of microorganisms. The ability of local immune cells and blood vessels at a the outer ocular system to recognize pathogens distance where a time delay in addressing a as foreign and eliminate them is critical to central corneal infection could lead to blindness. retain corneal transparency, hence The first vertebrates were jawless fish that preservation of sight. Therefore, a were believed to have evolved some 470 million combination of mechanical, anatomical, and years ago.1 These creatures had frontal eyes and immunological defense mechanisms has inhabited the shorelines of ancient oceans. With evolved to protect the outer eye. These host better vision, these creatures were likely more defense mechanisms are classified as either a active and predatory. This advantage along with native, nonspecific defense or a specifically the later development of jaws enabled bony fish acquired immunological defense requiring to flourish and establish other habitats. One previous exposure to an antigen and the such habitat was shallow waters where lunged development of specific immunity. Sight- fish made the transition to land several hundred threatening immunopathology with thousand years later.2 To become established in autologous cell damage also can take place this terrestrial environment, the new vertebrates after these reactions. -
Papilledema Associated with Puberty
CPJXXX10.1177/0009922814554503Clinical PediatricsSun and Horton 554503research-article2014 Resident Round Clinical Pediatrics 2015, Vol. 54(5) 504 –506 Papilledema Associated with Puberty © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814554503 cpj.sagepub.com Lynn W. Sun, BA, PhD1 and Jonathan C. Horton, MD, PhD2 Case Report headache. Fundus examination showed slight reduction of her papilledema. Over the next 6 months her symp- A 9-year-old girl was brought by her mother to a hospi- toms gradually resolved and she stopped attending clinic tal emergency room because of severe headache and appointments. vomiting. The symptoms began 2 weeks earlier while at Two years after her original presentation, she returned summer camp. The child’s examination was benign, and to the eye clinic for a routine examination. On her own she was discharged with a diagnosis of migraine. The initiative, she had discontinued treatment with acetazol- ocular fundi were not examined. The headaches contin- amide 18 months earlier. She denied headache or blurred ued and were sometimes associated with nausea, photo- vision. The height was 152.4 cm and the weight was phobia, and tinnitus. She was evaluated 2 weeks later in 71.67 kg, for a BMI of 30.9 kg/m2 (obese). She had regu- our pediatric ophthalmology clinic because of intermit- lar menstrual periods. The visual acuity was 20/20 in tent horizontal diplopia and blurred vision. each eye without correction. Pupils, eye movements, There was no relevant past medical history. The ocular alignment, visual fields, and slit lamp examination patient did not take tetracycline antibiotics or any other were normal. -
Using Slit-Lamp Images for Deep Learning-Based
diagnostics Article Using Slit-Lamp Images for Deep Learning-Based Identification of Bacterial and Fungal Keratitis: Model Development and Validation with Different Convolutional Neural Networks Ning Hung 1,2,†, Andy Kuan-Yu Shih 3,†, Chihung Lin 3 , Ming-Tse Kuo 4 , Yih-Shiou Hwang 1,2, Wei-Chi Wu 1,2, Chang-Fu Kuo 3, Eugene Yu-Chuan Kang 1,2,* and Ching-Hsi Hsiao 1,2,* 1 Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fu-Hsin Rd, Kweishan, Taoyuan 333, Taiwan; [email protected] (N.H.); [email protected] (Y.-S.H.); [email protected] (W.-C.W.) 2 College of Medicine, Chang Gung University, No. 261, Wenhua 1st Rd., Kweishan, Taoyuan 333, Taiwan 3 Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5 Fu-Hsin Rd, Kweishan, Taoyuan 333, Taiwan; [email protected] (A.K.-Y.S.); [email protected] (C.L.); [email protected] (C.-F.K.) 4 Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd, Niaosong, Kaohsiung 833, Taiwan; [email protected] * Correspondence: [email protected] (E.Y.-C.K.); [email protected] (C.-H.H.); Tel.: +886-3-3281200 (E.Y.-C.K. & C.-H.H.) † These authors contributed equally to this work. Abstract: In this study, we aimed to develop a deep learning model for identifying bacterial keratitis Citation: Hung, N.; Shih, A.K.-Y.; (BK) and fungal keratitis (FK) by using slit-lamp images. We retrospectively collected slit-lamp Lin, C.; Kuo, M.-T.; Hwang, Y.-S.; Wu, images of patients with culture-proven microbial keratitis between 1 January 2010 and 31 December W.-C.; Kuo, C.-F.; Kang, E.Y.-C.; Hsiao, 2019 from two medical centers in Taiwan. -
Treatment of Interface Keratitis with Oral Corticosteroids
Treatment of interface keratitis with oral corticosteroids Scott M. MacRae, MD, Larry F. Rich, MD, Damien C. Macaluso, MD ABSTRACT Purpose: To describe the results of treating interface keratitis using a combination of intensive topical and oral corticosteroids. Setting: Casey Eye Institute, Portland, Oregon, USA. Methods: Thirteen eyes treated for grade 2 to 3 interface keratitis using an oral cortico- steroid (prednisone 60 to 80 mg) as well as an hourly topical corticosteroid were retrospectively reviewed. The best corrected visual acuity (BCVA) was used as an objective guide of whether to treat with intense topical and oral corticosteroids, flap irrigation, or both. Predisposing factors such as intraoperative epithelial defects or a history of severe allergies or atopy were also looked for. Results: All 13 eyes responded favorably to the combination of intensive topical and oral corticosteroids and had a BCVA of 20/20 after the keratitis resolved. In 6 eyes (46%), the patients had a history of severe seasonal allergies. One day postoperatively, 3 eyes (23%) had an epithelial defect and 2 eyes (15%), lint particles or debris embedded in the interface. With oral corticosteroid use, 3 patients (23%) noted mild stomach irritation and 2 (15%) noted nervousness. All 5 side effects resolved without sequelae. No patient developed a serious side effect. Conclusion: A short, intense course of an oral corticosteroid was an effective treatment in patients with grade 2 or higher interface keratitis when combined with a topical corti- costeroid administered hourly. The BCVA is a helpful objective measure of the severity of interface keratitis and can be used to guide the clinician in the therapeutic strategy. -
Eye60. Instrumental Eye Examination.Pdf
INSTRUMENTAL EYE EXAMINATION Eye60 (1) Instrumental Eye Examination Last updated: May 9, 2019 “BEDSIDE” EXAMINATIONS ..................................................................................................................... 1 OPHTHALMOSCOPY (FUNDUSCOPY) ........................................................................................................ 1 DIRECT OPHTHALMOSCOPY .................................................................................................................... 1 INDIRECT OPHTHALMOSCOPY ................................................................................................................. 2 OPHTHALMOSCOPIC FINDINGS ............................................................................................................... 2 Hypertensive retinopathy ................................................................................................................. 6 Diabetic retinopathy ......................................................................................................................... 7 PEDIATRIC ASPECTS ............................................................................................................................... 9 APPLANATION TONOMETRY .................................................................................................................... 9 SLIT LAMP EXAMINATION (BIOMICROSCOPY) ........................................................................................ 9 ULTRASONOGRAPHY ..............................................................................................................................