The document discusses various signs and symptoms related to ophthalmology, focusing on conditions affecting vision such as asthenopia, amblyopia, night blindness, and color blindness. It outlines the causes and characteristics of these conditions, including ocular surface disorders, visual disturbances, and symptoms like glare and floaters. The information serves as a reference for understanding the range of ophthalmic anomalies and their clinical implications.

1. Signs and Symptoms in Ophthalmology
Dr. Jeelkumar R Garala
Department of Ophthalmology
CU Shah Medical college and hospital

2. Anomalies of Ocular Motility
• Disturbances of the extraocular muscles may
manifest as eyestrain or asthenopia sensation
of heaviness or tirednessof the eyes, blurring
of vision after reading for a while, diplopia or
a visible squint.

3. Asthenopia
• Weakness or fatigue of the eyes commonly
following prolonged close work and may also
occur after extended viewing at a distance, such
as watching a film or television.
• The patient complains of aching or burning of the
eyes and heaviness of the eyelids, together with a
headache.
• Complaints of blurring of vision or 'doubling' of
letters after reading for about 20-30 minutes are
more specifically due to an insufficiency of
convergence.

4. Diminution of Vision
• Characterization of the loss of vision should
include its duration; progression: steadily
worsening, improving or static; pattern: constant,
intermittent, more for distance or near, episodic
or periodic; and finally, associated symptoms
such as pain, redness, watering, photophobia,
photopsia, floaters, diplopia.
• Important leading questions related to its onset
would be the age at onset, whether it was
gradual or sudden and were both eyes affected
simultaneously or sequentially.

5. Amblyopia
• Partial loss of vision, respectively, in one or
both eyes in the absence of ophthalmoscopic
or other marked objective signs.
– Unilateral
• Unilateral high refractive error
– Bilateral
• Bilateral cataract
• B/L Corneal opacities
• B/L high refractive error

6. Amaurosis fugax
• Transient monocular blindness caused by a temporary
lack of blood flow either to the brain or to the retina.
• It is related to be the result of emboli from plaques in
the carotid artery.
• This blocks an artery for a while resulting in loss of
vision for the duration of blockage.
• Onset is acute and episode may last for several
minutes.
• The sudden loss may appear like a curtain falling from
above or rising from below and recovery occur in the
same pattern.

7. Night Blindness or Nyctalopia
• Inability to see in low light
• Seen in :
– Retinitis pigmentosa
– Xerophthalmia
– Pathological myopia
• Night blindness is attributed to interference with the
functions of the retinal rods.
• In xerophthalmia, the symptom is a manifestation of a
deficiency of fat-soluble vitamin A in the diet.
• It also occurs in diseases of the liver, especially
cirrhosis.

8. Hemeralopia
• Inability to see clearly in bright light due to
poor light adaptation.
• Cone dystrophy or achromatopsia is a rare
cause of hemeralopia, which may also be due
to aniridia and albinism.

9. Colour Blindness
• Congenital colour blindness occurs in two chief forms –
– Total – Anopes
– Partial - Anomaly
• X-linked recessive
• In most cases, red and green colours are confused so
that the defect is a source of danger in certain
occupations, such as in engine drivers and sailors.
• Protanopes – Red colour perception is defective
• Deuteranopes – Green colour perception is defective
• Tritanopes – Blue colour perception is defective

10. Dyslexia
• The patients fail to recognize printed or
written words.
• The auditory memory of words is unimpaired ,
and generally numerals and music can be
read.

11. Disorders of the Ocular Surface
• Diseases affecting the cornea, conjunctiva and
eyelids, i.e. the ocular surface of the eye,
frequently present with symptoms such as
redness of the eye, a foreign body sensation,
swelling of the lid, photophobia and irritation.

12. Ocular Irritation
• A sandy or gritty sensation which is generally
worse in the morning.
• The patient may also complain of tiredness of the
eyes or a 'burning sensation.‘
• It can be due to inflammation, trauma or scars or
when there is inadequate lubrication between
the two surfaces by an abnormal tear film.
• Common causes are a 'dry eye', allergic
conjunctivitis, trachoma or blepharitis.

13. Lacrimation
• A reflex increase in the production of tears, as
opposed to epiphora, which signifies an
overflow of tears due to an obstruction to the
outflow of tears.
• Lacrimation may be caused by irritation of the
ocular surface due to the presence of a foreign
particle, inflammation, chemical injuries or
psychogenic factors .

14. Photophobia
• Discomfort caused by an abnormal sensitivity to
ambient light conditions.
• This intolerance to light may be due to pain
induced by pupillary constriction and ciliary
spasm due to inflammations of the anterior
segment or stimulation of the terminal fibres of
the trigeminal nerve in the cornea.
• It can be due to corneal abrasion , oedema,
foreign body or ulcer or evidence of anterior
uveitis.

15. Redness
• The final common response to any anterior
segment disease is redness of the eye,
irrespective of whether the basic cause lies in the
conjunctiva, cornea or anterior uvea.
• Causes:
– Conjunctivitis
– Corneal ulcer
– Episcleritis
– Scleritis
– Acute congestive glaucoma
– Subconjunctival haemorrhage

16. Glare
• When too much light either shines directly or
reflects into the eye, reducing vision, e.g. bright
light reflecting from shiny surfaces.
• Glare increases the difficulty in distinguishing
objects from their background and makes it hard
to identify faces.
• Sunlight is often a major cause.
• High gloss paper such as that used in many
magazines can also be hard co read because of
glare, as can computer monitors.

17. Floaters
• With age, the normally transparent vitreous gel
liquefies and breaks up, leading co the presence of
little particles and fibrous strands floating in the
vitreous cavity.
• This debris casts shadows onto the retina.
• Patient complains of seeing black dots, rings, strands or
‘spider like’ images that are more noticeable against a
bright background and ‘move‘ even when the eye is
stationary.
• Floaters indicate some form of vitreous degeneration
and liquefaction and are usually benign and age-
related.
• They are also common at a younger age m myopes.

18. • However, showers of dots or a sudden
increase in their numbers could indicate the
formation of a retinal tear, especially if
associated with photopsia.
• Alternatively, sometimes, the onset of new
floaters is secondary to vitreous haemorrhage,

19. Photopsia
• The patient perceives flashes of light or has a
sensation of flickering lights.
• This occurs due to vitreous shrinkage or
liquefaction, which causes a pull on
vitreoretinal attachments, irritating the retina
and causing it to discharge electrical impulses.
• Usually benign and age-related but could be
an indicator of a developing retinal tear or an
early retinal detachment.

20. Metamorphopsia
• The perceives altered, irregular contour or
shape of the object.
• It is associated with diseases affecting the
macula and retina.
• Micropsia, in which ordinary, everyday objects
look smaller than normal.

21. Coloured Halos
• They are seen as rainbow-coloured rings
around lights at night.
• These commonly occur in acute angle-closure
glaucoma, cataracts or corneal oedema.
• The halos are due to the accumulation of fluid
in the corneal epithelium and to alterations in
the refractive condition of the corneal
lamellae.

22. Visual Hallucinations
• Visual hallucinations are objects, shapes or
lights 'seen' by patients which are not visible
to other persons in the vicinity and are fairly
specific for disorders involving the cerebral
cortex.

23. Scintillating Scotomata
• Occur in migraine
• A positive scotoma appears in the field of vision.
• lt gradually increases in size until ultimately one-
half of the field is clouded.
• In the dark field, bright spots and rays of various
colours are often seen, frequently arranged in
zigzags, when they are called 'fortification
spectra' (teichopsia).
• Vision usually clears in about a quarter of an
hour, but the attack is soon followed by violent
headache.

24. Coloured Vision (Chromatopsia)
• Erythropsia - (red vision) occurs in some
patients after cataract extraction if the eyes
are exposed to bright light.
• On the other hand, some patients report an
excessive 'bluish' appearance of objects after
cataract extraction because blue light was
filtered out by the yellowish cataractous
nucleus before surgery.

25. Thank You
• Reference : Parson’s Diseases of the Eye 23rd
Edition