PatientPatient SymptomsSymptoms-- WhatWhat TheyThey MightMight MeanMean
Sarah Dougherty Wood, OD, MS, FAAO Heart of America, February 2011 Paraoptometric Lecture BasicBasic ocularocular anatomyanatomy andand physiologyphysiology MovieMovie projectorprojector analogyanalogy BlurBlur atat near/eyenear/eye strainstrain y Hyperopia (far sightedness) y Presbyopia (old age vision) HyperopiaHyperopia (far(far sightedness)sightedness) y Eye is not powerful enough y Focuses behind the eye y Blur at near y Needs a plus lens PresbyopiaPresbyopia (old(old ageage vision)vision) y After age 40, the lens is less flexible y Doesn’t allow for clear near vision y “Arm’s are too short” y Needs readers or a bifocal BlurBlur atat far/distancefar/distance visionvision duedue toto myopiamyopia y Eye is too powerful y Focuses image in front of retina y Needs a minus lens BlurBlur atat bothboth distancedistance andand nearnear y Astigmatism y High amounts of hyperopia AstigmatismAstigmatism Eye is not a sphere, so light rays get focused at two different points Patients note blur at distance and near Need cylindrical/toric lens (two different focusing powers in one lens) globalgallery.com FloatersFloaters WhatWhat conditionsconditions cancan causecause floaters?floaters? y Vitreous floaters (normal pieces of collagen fibers) y Retinal detachment (pigment or blood) y Vitreous hemorrhage (blood) y Vitritis (white blood cells) LightLight flashesflashes (photopsia)(photopsia) y Aura before a migraine y Tugging on the retina ◦ vitreous detachment, retinal detachment, retinal traction VisualVisual auraaura TuggingTugging onon retinaretina
www.retinatexas.com ““FeelsFeels likelike therethere isis somethingsomething inin mymy eye!eye!”” akaaka foreignforeign bodybody sensationsensation y Trichiasis y Dry eye y Actual foreign body y Corneal abnormality TrichiasisTrichiasis-- lasheslashes turnedturned inin towardstowards eyeeye
The Free Dictionary.com CornealCorneal foreignforeign body/metallicbody/metallic EpiphoraEpiphora
y Dry eye y Clogged puncta y Viral conjunctivitis y Corneal abrasion (scratch) y Ectropion (eyelid pulled away from eye, tears cannot reach puncta) CloggedClogged punctapuncta ViralViral conjunctivitisconjunctivitis CornealCorneal abrasionabrasion EctropionEctropion
w w
RedRed eyeeye y Bacterial y Viral y Allergic y Subconjunctivalhemorrhage y Keratitis y Endophthalmitis y Episcleritis/Scleritis y Uveitis y CL overwear y Pingueculitis/pterygium SubconjunctivalSubconjunctival HemorrhageHemorrhage
Tedmontgomery.com KeratitisKeratitis EpiscleritisEpiscleritis
Acuitypro.com ContactContact lenslens overwear/ulceroverwear/ulcer PingueculitisPterygium ItchyItchy
y Allergic (GPC, contact dermatitis, vernal) y Dry eye GiantGiant PapillaryPapillary ConjunctivitisConjunctivitis (GPC)(GPC)
Uveitis.org ContactContact DermatitisDermatitis
Optometry.com PhotophobiaPhotophobia-- lightlight sensitivitysensitivity y Uveitis y Corneal abrasion or other corneal abnormality y Aniridia y Migraine y Albinism y Lightly pigmented eye AniridiaAniridia AlbinismAlbinism
www.ssc.education.ed.ac.uk SuddenSudden lossloss ofof visionvision y Retinal vein or artery occlusion y Ischemia of the optic nerve (NAION, AION) y Amaurosisfugax y Retinal detachment y Migraine y Inflammation of the optic nerve (optic neuritis) y Vitreous hemorrhage y Corneal edema y Angle closure glaucoma y CVA (cerebrovascular accident- stroke) Normal,Normal, healthyhealthy retinaretina (fundus)(fundus) CRVOCRVO (central(central retinalretinal veinvein occlusion)occlusion) AmaurosisFugaxAmaurosisFugax (carotid(carotid stenosis)stenosis)
heartstrong.files.wordpress.com/ RetinalRetinal DisorderDisorder Retinal Tear and Detachment
www.tedmontgomery.com NormalNormal opticoptic nervenerve Swelling/inflammationSwelling/inflammation ofof opticoptic nervenerve VitreousVitreous HemorrhageHemorrhage
www.virginiaretina.org CVACVA (stroke)(stroke) PeripheralPeripheral visionvision lossloss y Retinal detachment y Glaucoma y Stroke y Retinitis pigmentosa PeripheralPeripheral visionvision testingtesting inin glaucomaglaucoma
normal visual field glaucoma field- superior arcuate defect RetinitisRetinitis PigmentosaPigmentosa
Pigment clumping Patient’s perspective
www.eyemdlink.com DiplopiaDiplopia (double(double vision)vision) y monocular- dry eye, uncorrected refractive error, corneal irregularity, dislocated lens, cataract y binocular- ◦ comitant- decompensatedphoria ◦ non-comitant- CN palsy, restriction (thyroid, tumor, entrapment of muscle, orbital pseudotumor), myasthenia gravis MonocularMonocular DoubleDouble Vision=blurVision=blur
www.disaboom.com CranialCranial nervenerve palsypalsy BinocularBinocular DiplopiaDiplopia (truly(truly seeingseeing two)two)
swatimidha.wordpress.com SwollenSwollen lidlid
y Contact dermatitis y Blepharitis y Hordeolum (stye)/Chalazion (long- standing stye) y Preseptalcellulitis/Cellulitis y Trauma y Insect bite BlepharitisBlepharitis HordeolumHordeolum andand ChalaziaChalazia akaaka StyeStye
Internal hordeolum Chalazion
www.basj.nl/ Preseptalcellulitis/cellulitisPreseptalcellulitis/cellulitis
emedicine.medscape.com DroopyDroopy eyelideyelid (ptosis)(ptosis) y Dermatochalasis y Levatordehiscence y Neurological (Horner’s syndrome, CN 3 palsy) y Swollen lid y Congenital y After surgery or trauma DermatochalasisDermatochalasis (DMC)(DMC)
emedicine.medscape.com NeurologicalNeurological ptosisptosis
casereports.bmj.com EyesEyes areare misalignedmisaligned (strabismus(strabismus oror tropia)tropia) y Esotropia, exotropia, hypertropia, hypotropia
EyeEye MisalignmentMisalignment (Strabismus)(Strabismus)
Eso- in
Exo- out
Hyper- up
Hypo- down GlareGlare atat night/halosnight/halos withwith carcar headlightsheadlights y Cataracts y Normal y Uncorrected refractive error y Corneal irregularity/edema CloudingClouding ofof thethe Lens=Lens= CataractCataract
Nuclear sclerotic Cortical Posterior Subcapsular
•www.drcilliers.com SymptomsSymptoms ofof CataractsCataracts Blurred vision Halos around lights and glare NightNight blindnessblindness y Retinitis pigmentosa y Vitamin A deficiency EyelidEyelid twitchtwitch y Stress/fatigue y Caffeine y Corneal irritation WavyWavy lines/metamorphopsialines/metamorphopsia y Macula problem y Cornea irregularity AgeAge RelatedRelated MacularMacular DegenerationDegeneration (AMD)(AMD)
Dry AMD Wet AMD tedmontgomery.com AMDAMD
Impaired central vision
Abnormal Amsler grid Questions?Questions?
y Feel free to contact me at: [email protected]
Thank you for your attention!