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Common eye conditions
1. The document discusses common eye conditions seen in primary care including symptoms, signs, causes and treatment approaches. 2. Conditions covered include refractive errors, conjunctivitis, dry eye syndrome, cataracts, glaucoma, uveitis, retinal disorders and others. 3. For each condition, the summary provides key presenting symptoms, likely causes, examination findings and typical treatment pathways.
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Common eye conditions
- 1. Dr. Chamath Fernando MBBS(Sri Jayewardenepura) Lecturer Department of Family Medicine FMS USJP
- 3. Common Symptoms Blurringof vision Redness Pain Loss of vision Photophobia Discharge
- 4. Refractive Errors Disorders of the lids Conjunctivitis Corneal disorders Episcleristis / Scleritis Sub Conjunctival Haemorrhages Dry eye syndrome Cataracts Glaucoma Uveitis Disorders of the retina Loss of vision Amarausis Fugax Temporal arteritis Hypertensive changes in the retina Diabetic eye disease Strabismus
- 7. Eye Condition Treatment(spectacles, contact lenses or excimer laser) Emmetropia Normal refraction of the cornea and lens Myopia Short sightedness Corrective– Concave lenses Hypermetropia Long sightedness Convex lenses Presbyopia The ability of the lens to change the convexity is lost after the fourth decade of life – causing difficulties with near vision Bifocals Astigmatism The eye is not the same curvature of radius for refraction. (e.g. myopic in one plane and emmetropic in the other) Cylindrical lenses corrected according to the axis
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- 12. Conditions Treatment Entropion Inwardrolling of the lid margins Rubbing of the eye lashes against the globe Irritation Mimics conjunctivitis Surgical Correction Ectropion The eyelid margins are not apposed to the globe Lacrimal puncta cannot drain tears Causes a watery eye Surgical treatment Dacrocystitis Inflammation of the lacrimal sac Presents as a painful lump by the side of the nose Broad spectrum antibiotics Ophthalmologist referral for surgical treatment Blepharitis Inflammation of the eyelid margin Stye- Inflammation of the eyelashes and lash follicles Chalazion -Inflammation and blockage of the Meibomian glands Lid toilet Topical antibiotics – Chloramphenicol or Fusidic acid If orbital cellulitis – Broad spectrum antibiotics If residual lump – Incision and
- 19. Commonest causeof Red eye Causes: Viral, Bacterial, Chlamydial, Allergic Clinical features: ◦ Redness ◦ Soreness (sandy gritty sensation) ◦ Discharge ◦ Vision not impaired ◦ Usually bilateral involvement
- 20. Aetiology Dischar ge Preaur icular node Corneal Involve ment Comment Treatment Bacterial(5%) (Gonococcus - copious H. Influenzae S. Pneumoniae Staphylococcu s Moraxella) Mucopurule nt -ve except gonococc i +ve Gonococcu s Rapid onset Gonococcal infection in the neonate – symptoms occur within 2 days of birth Gonococcal – Conjunctival swab shows diplococci Treated with Oral and Topical Penicillin Chloramphenicol Viral Adenovirus HSV 1 commonly Molluscum Contagiosum Watery +ve +ve Adenovirus 50% Unilateral Cold and / or sorethroat Ass. With chemosis, lid oedema May cause blurring of vision due to corneal involvement Adenoviral – Very contagious Dendritic corneal ulcer HSV – Vesicles around the eye Molluscum – umbilicated lesions on eyelids Adenoviral – Self limiting Lubricants Cold compress Prevent cross infection If intense – may require steroids HSV – Self limiting Some may use Aciclovir topically Molluscum- Ophthalmologist referral for surgical treatment If severe - Steroids
- 21. Aetiology Discharge Preauricular node Corneal Involvem ent CommentTreatment Chlamydial (Chlamydia trachomatis) Watery + ve +ve GU discharge Slow onset of symptoms Sexually transmitted (in active individuals) Neonatal – with maternal reproductive tract secretions (2 weeks) Trachoma –blindness Topical erythromycin bd Adolescents and adults to GU surgeon Neonates to paediatrician to exclude associated pneumonitis or otitis Allergic Seasonal Perinnial Stringy/ sticky -ve +ve Itchy Avoidence of allergens Topical anti- histamines like azelastine Topical mast cell stabilizer like Na Chromoglicate Steroids avoided generally
- 24. 1. Trauma 2. Keratitis
- 25. Condition Features Treatment CornealAbrasions – a focal area of the epithelium gets rubbed away Intense pain Inability to open the eye (blepharospasm) Lacrimation Visual acuity reduced Ex: may require topical anaesthetic (Tetracaine) Use Florescin (orange) dye with a blue lamp examination to identify the abrasion (in green colour) G. Chloramphenicol qds X 5 days Pad the eye X 24 hours Corneal Foreign body e.g. flies Lacrimation Photophobia Remove gently with copious amounts of saline Topical antibiotics (Choramphenicol and Fusidic acid) Direct Trauma FB may be visible Flat anterior chamber Hyphaemia (Blood in anterior chamber) SCH Brusing if associated blunt trauma Instill no drops Refer to an ophthalmologist urgently
- 27. Corneal inflammation Causes: HSV infection, Contact lens, blepharitis Cilnical features: Redness, Pain, Lacrimation, Sensation of a foreign body, photophobia HSV- Dendritic ulcer ◦ The Virus remains dorment in the CN V ◦ Gets activated in immunosuppression ◦ Can lead to a geographical ulcer
- 28. Contact LensKeratitis ◦ Can be life threatening ◦ Urgent referral to an ophthalmologist Blepharitis ◦ Staphelococcus aureus is responbible for most of the cases ◦ Rx: with Chloramphenicol
- 29. Episcleritis (between theconjunctiva and the sclera) Localized, deep redness Tender area +/- Not painful No discharge Normal vision No photophobia Normal pupils and cornea Rx: topical/oral steroids Scleritis Symptoms are intense Painful loss of vision Severe form associated with Rheumatoid arthritis causes Scleromalacia perforans Urgent referral
- 30. Symptoms –A bright red eye due to a bleed beneath the conjunctiva caused by rupture of a small blood vessel Causes – ◦ Raised intracranial pressure (Coughing, sneezing) ◦ Trauma ◦ Violent rubbing ◦ Bleeding disorders or anticoagulants (recurrent) ◦ Hypertension Management ◦ Control of the cause ◦ Mild analgesics ◦ Eye lubricants ◦ Reassurance of resolution within weeks ◦ Make sure the line doesn't extend beyond the visible sclera (may be associated with orbital fracture)
- 31. Loss ofvision?
- 32. Symptoms Severe Pain Photophobia Reduced vision Colouredhalos around the point of light in patient’s vision Proptosis Smaller pupil On Examination Raised IOP Shallow anterior chamber depth Corneal Epithelial disruption
- 33. Cause Conjunct iva Injection Unilater al/Bilater al Pain Photoph obia VisionPupil Intraocul ar pressure Conjunctiv itis Diffuse Bilateral (in Bacterial) Gritty Occasiona lly with Adenoviru s Normal Normal Normal Anterior Uveitis Circum- corneal Unilateral Painful Yes Reduced Constricte d Normal or raised Acute Glaucoma Diffuse Unilateral Severe Mild Reduced Mild dilated Raised
- 34. Associated withKeratoconjunctivitis Sicca / Sjogren’s syndrome Clinical Features: ◦ FB sensation/ gritty feeling in the eye ◦ Mucoid discharge ◦ Photophobia ◦ Blurred vision Management ◦ Artificial tears ◦ Eye lubricants ◦ Moisture chambers glasses at night ◦ Secretogogues e.g rebamipide ◦ Punctal plugs ◦ Ophthalmologist referral
- 35.
- 37. Commonest causeof reversible blindness The commenest surgical procedure so far Aetiology ◦ Senile (legal blindness <6/12) ◦ Congenital – Maternal infection, Familial ◦ Metabolic – Diabetes, galactosaemia, Wilson’s disease, hypocalcaemia ◦ Drug induced – Corticosteroids, amiodarone ◦ Traumatic ◦ Inflammatory – Uveitis ◦ Disease associated – Down’s, Dystrophia myotonica
- 38. Clinical features– ◦ Gradual painless deterioration of vision is the commonest symptom ◦ Problems with night vision ◦ Glare – Common with posterior subcapsular cataract Investigations ◦ Diabetes ◦ Hypocalcaemia Management ◦ Early detection and ophthalmologist referral is essential in the infants to prevent development of amblyopia later on in life ◦ Correction of the aetiological factor ◦ Mild cases – spectacles ◦ If opacified – Extraction of cataracts and intra ocular lens insertion Most popular – Phacoemulsification
- 39. Elevation ofthe internal pressure of the eye >21mmHg ◦ (Normal : 10-21mmHg) Second commonest cause of blindness – via optic nerve damage ◦ Mainly visual field defects
- 40. Primary open angleGlaucoma Acute angle closure glaucoma Commonest Ophthalmic emergency – Acute rise of pressure >50mmHg Aetiology Due to blockage of the trabecular meshwork, drainage of aqueous humor is impeded Pushing of the lens anteriorly pressing against the meshwork Commonly when the pupil is maxiamaly dilated Risk factors Elderly Black race Family history Myopia Elderly – Shallow anterior chambers in Women and Hypermetropics Clinical features Gradual painless loss of peripheral visual field Red painful eye Headache Nausea, Vomiting Eye is injected, hard and tender Haziness of cornea Diagnosis Ophthalmoscopy – Cupping of the fundus IOP measurement is the definitive IOP measurement or clinically Treatment Reduction of AH production – Topical Timolol and Acetozolamide (Topical and Oral) Increasing the drainage of AH - Prostaglandin analogues (Travoprost) Emergency referral to an ophthalmologist Analgesic Antiemetics (IV Acetozolamide Pilocarpine to constrict pupils Prostaglandin analogues, Beta blockers IV Mannitol if resistant
- 41. Uveal Tract– ◦ Iris – Iritis/ Anterior Uveitis ◦ Cilliary body – Intermediate Uveitis ◦ Choroid – Posterior uveitis ◦ Entirely – Pan uveitis
- 42. Symptoms ◦ Blurredvision ◦ Redness ◦ Photophobia ◦ Pain – Mainly anterior symptom ◦ Floaters – Mainly posterior symptom Associated diseases ◦ Ankylosing spondilitis ◦ Arthritis ◦ Inflammatory Bowel disease ◦ Sarcoidosis ◦ TB ◦ Syphilis ◦ Toxoplasmosis ◦ Behcets syndrome ◦ Lymphoma ◦ Viruses – CMV, HSV, HIV ◦ Idiopathic
- 43. Classical Triad ◦Redness (genaralized) ◦ Pain ◦ Photophobia Signs ◦ Cells with keratic precipitates in the anterior chamber, pus ◦ IOP may be raised due to the cells clogging up the There may be posterior synechiae ◦ trabecular meshwork Treatment ◦ Ophthalmologist referral ◦ Dexamethasone 0.1% topically ◦ Cyclopentolone to prevent posterior synechiae also allowing fundoscopy ◦ Mx of raised IOP
- 45. Central Retinal Vein Occlusion CentralRetinal Artery Occlusion Retinal detachment Age related macular degeneration Symptoms Sudden profound painless loss of vision of one eye Sudden profound painless loss of vision of one eye Painless progressive visual field loss Floaters and flashes prior to detachment Progressive loss of central vision Pathogenesis Obstruction of venous outflow and increased intravascular pressure leading to dilated veins, retinal haemorrhages, retinal oedema and cotton wool spots Results in infarction of the inner 2/3 of the retina 90 minutes Oedema of the retina thinning Cherry red spot The area of visual field loss corresponds to the area of detachment of the retina Lipofucin deposits can be seen deposited under the retina Risk Factors DM, HT, Cardiovascular disease, Glaucoma, Vasculitis and Blood dyscrasias DM, HT, Cardiovascular disease, Glaucoma, Vasculitis and Blood dyscrasias Elderly Smoking HT Hypercholestera emia UV exposure are suggested Treatment Rx underlying condition Refer to ophthalmologist Emergency referral Ocular massage Breathing into a bag CO2 Vasodilatation Dislodging of Emboli Iv Acetazolamide Paracentesis Urgent referral to the ophthalmologist Referral to the ophthalmologist Modification of risk factors
- 50. Sudden TransientLoss of Vision in one eye. Due to thromboembolism Embolus may be visible at ophthalmoscopy during an attack Implications: ◦ May be the first evidence of internal carotid artery stenosis ◦ Hamiparesis may follow ◦ DD: Migraine, GCA
- 51. Common inelderly Presentation: Sudden painless loss of unilateral vision (May have preceded by Amaurosis fugax) ◦ May proceed to bilateral disease Associations: ◦ Severe unilateral temporal headache (along the distribution of the artery with features of inflammation). The artery is thickened and pulseless ◦ Severe facial pain in chewing ◦ IHD, microangiopathic neuropathy Management ◦ Ix: ESR elevated ◦ Diagnosis confimed by : Bx ◦ Rx: High dose steroids
- 53. Painless Painful Cataract Acuteangle closure glaucoma Open angle glaucoma Giant cell arteritis Retinal detachment Optic neuritis Central retinal vein occlusion Uveitis Central retinal artery occlusion Scleritis Diabetic retinopathy Keratitis Vitreous Haemorrhage Shingles Age related macular degeneration Orbital cellulitis Optic nerve compression Trauma Cerebrovascular disease
- 54. Keith WagenerClassification of Hypertensive Retinopathy ◦ Grade 1 – Tortuosity of the retinal arteries with increased reflectiveness “Silver wiring” ◦ Grade 2- Grade 1+ “Arteriovenous nipping”
- 55. ◦ Grade 3– Grade 2 + Flame shaped haemorrhages and Cotton wool spots ◦ Grade 4 - Grade 3 + Papilloedema (blurring of the optic disc margin
- 56. The significanceof Grade 3 and 4? ◦ Malignant Hypertension
- 57. Diabetic retinopathy– A microvascular complication Cataract External Ocular palsies Sixth and third cranial nerve palsies ◦ CN III palsies recover within a period of 3-6 months
- 58. Progression ofthe disease is rapid in type 1 >type 2 diabetics Types I. Background retinopathy II. Preproliferative and proliferative retinopathy III. Maculopathy IV. Mixed retinopathy
- 59. ◦ Dot haemorrhages- Microaneurysms ◦ Blot hamemorrhages - Intra retinal haemorrhages ◦ Cotton wool spots – Micro infarcts (lasts longer than those due to HT)
- 60. Retinal ischaemia Neovascularization fibrous tissue forming around the new vessels
- 61. Exudates aroundthe macula within one optic disc’s width
- 62. Many featuresmentioned above present together Rx: ◦ Aggressive control of glycaemia ◦ Ophthalmologist referral (surgical procedures e.g laser photocoagulation)
- 63. Mal alignmentof the two eyes/ visual axi Cause : Poor coordination of the extra ocular muscles groups Due to: e.g. CP, syndromes like Noonan, stroke, botulism, diabetes Implications: ◦ Cosmesis ◦ Diplopia ◦ Amblyopia (Lazy eye) Tests: Corneal light reflex, Cover-uncover test (read) Treatment: ◦ Spectacles ◦ Cover the better eye to improve the amblyopic eye ◦ Ophthalmologist (Muscle surgery)
- 66. Kumar andClark – Clinical Medicine Medscape Download the presentation: e-learning ◦ http://lms.sjp.ac.lk/med/blog/index.php?userid=1268