Disease of the eye, infections, inflammation, allergy and sensitivity tumors, structural abnormalities mass and eye ulcers

1. F R O N T I E R University
Lect 12. Eye and Ear
Disorder:
Dr: Ayub Abdulkadir Abdi
26/12/2021

3. Arcus senilis:
• Most often occurs in elderly Gray-opaque ring at
the corneal margin (periphery of cornea}
• Cholesterol deposits in corneal stroma; may
indicate hypercholesterolemia if the patient is <50
years old and a smoker.

4. Ophthalmia neonatorum:
• Conjunctivitis in newbom.
• Pathogens: Neisseria gonorrhoeae (first week; 2-4
days), Chlamydia trachomatis (second week; 3-10
days).
• Treatment:
• N gonorrhea: ceftriaxone.
• Chlamydia trachomatis: erythromycin.
• Erythromycin eye drops (chemical irritation)

6. Bacterial conjunctivitis:
• Purulent conjunctivitis; pain but no Blurry vision
• Pathogens: Staphylococcus aureus (most common),
pneumoniae, Haemophilus infivenzae
(Haemophilus aegyotius, pinkeye).
• Treatment: gatifloxacin ophthalmic solution.

8. Viral conjunctivitis:
• Watery exudates.
• Adenovirus: viral cause of pinkeye, painful preauricular
lymphadenopathy.
• No treatment.
• HSV-1: keratoconjunctivitis with dendritic ulcers noted
with fluorescein staining.
• Treatment: trifluridine ophthalmic.

10. Allergic conjunctivitis:
• Seasonal itching of eyes.
• Treatment antihistamine ophthalmic solutions;
olopatadine (mast cell stabilizer).

11. Acanthamoeia infection:
• Severe keratoconjunctivitis in patients who do not
clean their contact lenses properly.
• Treatment:
• Propamidine + polymyxin/neomycin/gramicidin
ophthalmic.

12. Stye:
• Infection of the eyelid.
• Most commonly due to S. aureus.
• Treatment:
• Hot packs + dicloxacillin.

13. Chalazion:
• Granulomatous inflammation involving the
meibomian gland in the eyelid; usually disappear
on their own within 2 months.
• Treatment:
• They do not disappear,
• Use an intralesional corticosteroid Injection.
• Remove it surgically.

16. Orbita cellulitis:
• Pentorbital redness and swelling that is often
secondary to sinusitis (e.g., ethmoiditis in children).
• Pathogens: S. pneumonia, H. influenza.
• Clinical feature: Fever, proptosis (eye bulges out),
periorbital swelling, ophthalmoplegia (eye
movement impaired).
• Normal retinal examination.
• Treatment:
• Naftcillin + ceftriaxone + metronidazole.

18. Orbital fracture:
• Most often associated with blunt trauma to the
eye that produces an orbital floor fracture.
• Often associated with edema and ecchymoses of
the eyelids and periorbital region ("RACCAON"
EYES).
• Clinical feature: Vertical diplopia, prolapse of
orbital contents into the maxillary sinus (sunken
eye), damage to infraorbital nerve may occur in
severe fractures.
• Treatment:
• Varies according to degree of severity.

20. Pterygium:
• Raised, triangular encroachment of thickened
conjunctiva on the nasal side of the conjunctiva;
may grow onto the cornea.
• Due to excessive exposure to wind, sun, and sand.
• Treatment:
• Surgical removal.

21. Pinguecula:
• Yellow-white conjunctival degeneration at the
junction of cornea and sclera on the temporal side
of the conjunctiva.
• Does not grow onto the cornea like a pterygium
does.
• Usually requires no treatment.

22. Optic neuritis:
• Inflammation of optic nerve.
• Causes: multiple sclerosis (most common),
methanol poisoning.
• Clinical feature: Blurry vision or loss of vision, may
cause optic atrophy.
• Treatment:
• Corticosteroids

24. Central retinal artery occlusion:
• Causes: embolization of plaque material from
ipsilateral carotid or ophthalmic artery; giant cell
temporal arteritis involving the ophthalmic artery.
• Clinical feature: Sudden, painless, complete loss of
vision in one eye, pallor of optic disk due to narrowed
arteries, "boxcar" segmentation of Blood in retinal
veins, and cherry red macula.
• Treatment:
1. Acetazolamide to lower intraocular pressure.
2. Carbogen (CO, dilates + O2).
3. Hyperbaric 0, therapy.

27. Central retinal vein occlusion:
• Causes: hypercoagulable state (e.g. polythemia
vera).
• Clinical feature: Sudden, painless, unilateral loss of
vision, swelling of optic disk, and engorged retinal
veins with hemorrhage ("blood and thunder"
appearance).
• Treatment:
1. Intravitreal injections.
2. Laser photocoagulation.

29. Glaucoma:
• Increased intraccular pressure.
• Chronic open-angle type:
• Decreased rate of aqueous outflow into the canal
of Schlemm.
• Common in persons with severe near-sightedness;
bilateral aching eyes; pathologic cupping of the
optic disks; night blindness and gradual loss of
peripheral vision leading to tunnel vision and
blindness.

30. • Treatment:
• Drugs_
1st: B-blockers (e.g., timolol; decrease rate of flow into eye).
2nd: prostaglandins, α-adrenergic agonists, pilocarpine,
carbonic anhydrase inhibitors.
• Laser trabeculoplasty if the drugs fail.

31. • Acute angle-closure type:
• Narrowing of anterior chamber angle; medical
emergency; precipitated by mydriatic agent,
• Clinical feature: uveitis, lens dislocation; severe
pain associated with photophobia and blurry vision;
red eye with a steamy cornea; pupil fixed and
nonreactive to light.
• Treatment:
• Pilocarpine + systemic carbonic anhydrase inhibitor
to lower pressure to allow for laser surgery.

32. Optic nerve atrophy:
• Pale optic disk.
• Most commonly due to optic neuritis or glaucoma.
• No effective treatment

33. Uveitis:
• Inflammation of the uveal tract (iris, ciliary body,
choroid).
• Causes: sarcoidosis, ulcerative colitis, ankylosing
spondylitis.
• Clinical feature: Pain with Blurry vision, miotic pupil,
circumcorneal ciliary body vascular congestion, normal
intraocular pressure, adhesions between iris and
anterior lens capsule.
• Treatment:
1. Corticosteroids (oral or topical).
2. Atropine.

35. Macular degeneration:
• Most common cause of permanent visual loss in the
elderly.
• Disruption of Bruch membrane in the retina.
• Dry type: thinning of the retina and formation of
yellowish white deposits called drusen.
• Wet type: extension of the dry type; vessels under the
retina hemorrhage causing retinal cells to die, creating
blind spot or distorted central vision.
• Treatment:
• Antioudants may decrease risk.
• Antiangiogenics (drugs that block vascular growth
factors).
• Insertion of special intraocular lens.

38. Cytomegalovirus ‘CMV’ retinitis:
• Most common cause of blindness in AIDS; usually
occurs when the CD4 T helper cell count is <50µl
usually painless.
• But in case of varicella/zoster virus retinitis is
usually painful.
• Cotton-wool exudates and retinal hemorrhages .
• Treatment:
• Oral, IV intraocular ganciclovir or foscarnet.

40. Cataracts:
• Opacity in the lens.
• Causes: advanced age (most common), diabetes
mellitus (osmotic damage), infection (e.g., rubella),
corticosteroids.
• Common in congenital infections (e.g. CMV, rubella).
• Treatment:
• Cataract extraction.

41. Malignant tumors:
• Retinoblastoma in children ("white eye reflex).
• Malignant melanoma in adults.
• Treatment:
• Enucleation.

42. •Retinoblastoma:
• It is an uncommon neoplasm.
• Incidence in the United Kingdom of around 1 per
20 000 live births.
• 5-10% of cases are familial.
• It demonstrates homozygous deletion of the Rb
gene (located on chromosome 13 at band q14).
• The tumor is the prototype of the “two-hit”
hypothesis of Knudson:
• 1st germ line and 2nd somatic mutation.
• Both deletions are required for tumor
development.

45. Meniere disease:
• Increased endolymph in inner ear and boss of
cochlear hairs.
• Clinical feature: Dizziness, vertigo, tinnitus,
sensorineural hearing loss.
• Treatment:
1. Hydrochlorothiazide + triamterene.
2. Surgery in resistant cases.

49. Sensonneural defect:
• Weber test:
• Lateralizes to normal ear (contralateral ear is
affected).

50. Conduction defect:
• Weber test:
• Lateralizes to affected ear.
• Due to degeneration of cochlear hairs.
• Treatment:
1. Amplification devices.
2. Cochlear implants.

51. Otosclerosis:
• Most common cause of conduction deafness in elderly.
• Due to fusion of middle ear ossicles.
• Other causes of conduction defects:
a) Impacted cerumen in outer ear canal.
b) Otitis media.
• Treatment:
1. Amplification devices.
2. Surgery.

52. Otitis media:
• Most common cause of conduction deafness in
children.
• Usually due to Streptococcus pneumonia.
• Other causes: Haemophilus influenzae, Moraxeila
catarrhalis.
• Treatment:
• Antipyrine and benzocaine ear drops for pain.
• Controversy regarding antibiotics; those that use
antibiotics most frequently use amoxicillin-clavulanate

54. External otitis:
• Inflammation of outer ear canal
• "Swimmer's ear”: due to Pseudomonas aeruginosa,
Staphylococcus aureus, Aspergilius species.
• Treatment:
• Ear drops-polymyxin B + neomycin + hydrocortisone +
selenium sulfide shampoo.
• Malignant external otitis: severe infection of outer ear
canal in patients with diabetes mellitus; Pseudomonas
aeruginosa most common cause.
• Treatment:
• Imipenem-cilastatin.