Download 20 Eye Diseases

20 Common Eye Diseases
Lynn E. Lawrence, CMSgt (ret),
CPOT, ABOC
Course Description
• This lecture will focus on 20 common eye
diseases. It will identify the disease,
characteristics of the disease and the affects
of the disease on the eye. The course will also
discuss clinical presentations and testing
associated with the disease.
20 Diseases of the Ocular System
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Lids and Lashes
Cornea
Tear Film
Conjunctiva
Lacrimal System
Crystalline Lens
Retina
Refractive System
Lids and lashes
1. Ptosis = muscles
2. Dermatochalasis = skin/fat
3. Chalazion
• Though very common, a
careful inspection of the
lids is still required to
ensure that is the only
diagnosis
• Reoccurring conditions
maybe a reason for
concern
4. Cancer
• Many different types of
presentations
• During the slit lamp
exam, please look for
missing lashes in
suspicious areas
• Story of Montana clinic
4. Bugs!
• Story from Nebraska
• Cause major eye
irritation
• Often mis-diagnosed by
PCP
• Caution with chemicals
5. Corneal Diseases
• Fuchs' Dystrophy. Fuchs'
dystrophy is a slowly progressing
disease that usually affects both
eyes and is slightly more common
in women than in men.
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Ulcers
Dry Eyes
Clouding
Arcus Senilus
Keratoconus *
Keratitus
Viral
Systemic Diseases
6. Dry Eyes
• Plethora of causes
• Difficult to resolve on
elderly patients
• Medication induced
• Environmentally
impacted
Marginal Corneal Ulcer
• Viral
• Bacterial
• Infections can be
difficult to treat
7. Pinguecula vs 8. Pterygium
Little Penguin
Big Pterodactyl
9. Keratoconus
• Thinning and the
“coning of the cornea
• This patient presents
with unstable rx
• Topography will aid in
confirming dx
Cornea
Bacterial
Ulcer
Herpes
Fusarium Keratitis
What of the above is caused by a virus?
Lacrimal System: Tear Film Layers
oil
aqueous
snot
What functions does each layer of the tear perform?
Causes of Tearing
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Punctal agenesis
Poor/blocked drainage
Trichiasis
Superficial foreign bodies
Poor pump action
– Eyelid mal-positions
– Eyelid disease
• Tear deficiency or
instability
• Trigeminal nerve irritation
Causes of Tearing Cont…
• Foreign body sensation
• Hypersecretion
– Lacrimal secretion and
drainage imbalance
– Primary or reflex tearing
(reflex tearing is more
common with ocular
surface irritation)
• Lacrimal pump failure
• Lacrimal drainage
obstruction
• S/P Surgery
The Connections
• Connections
–Lacrimal gland
to the eye
–From the eye to
the lacrimal sac
–From the
lacrimal sac to
the nose
Caniculitis can cause the blockage
Clinical Presentation
• Chief Complaint
• History of present
illness
• Past medical history
• Clinical examination
• Nasal Examination
Is this possible? You be the judge
Conjunctivitis
• The “infamous” pink-eye
• Numerous causes:
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Bacteria
Viruses
Allergies
Toxic Reactions (chemicals)
Often difficult to diagnose exact etiology
What is the most accurate measure of intraocular pressure?
MUSCLES
• What condition is this?
• Which is the dominate
eye
• When the dominate is
covered, which way will
the non-dominate
move?
• Strabismus
Binocular Vision
– Tropia-manifest deviation of the eyes.
– Phoria is a latent deviation held in check by
fusional vergence
– Frequency- constant/intermittent
– Diplopia Eso vs Exo
What condition is this?
What happens when the
Right eye is covered?
Is this a Tropia or Phoria/why?
What happens when you
cover this eye?
How would you document this condition?
Components of an Optical Prescription
• Prism
– Prism is used to correct blurry or double
vision due to deviated eyes
Label the conditions in each of these pictures
A
B
Pupil Testing
• Explain test
• Proper lighting
• Perform direct and
consensual
• Swinging flashlight
• Evaluate near response
• Recording accuracy
Is it required to have corrected vision for pupil testing?
Pupil Testing
• Relative Afferent Pupillary Defect
• Adie’s Tonic Pupil-slow response to light
• Argyll Robertson-no reaction to light; reaction to
accommodation
How long should the light be held in front on the eye during pupil testing?
Pupil Testing
• Anisocoria- unequal pupil sizes
– “cor” = pupil
– “aniso”=difference
• Hippus- “jumping” pupil
– Most commonly seen in younger patients
Congenital color vision defect normally impact vision in ______ eyes?
Anterior Chamber
• Iritis
• Uveitis
• Narrow Angle
Glaucoma
• Hyphema
• PDS
• Cells and Flare
Cataracts
What is a cataract?
Crystalline Lens
• Cataracts / Phakia
• IOL – Aphakia
• Without a IOL is
Pseudophakia
• A refractive
condition where
parallel light rays
focus behind the
retina when the eye
is at rest
• Termed
farsightedness
• Patient may have
20/20 vision at
distance and near
What type of lens is used to correct hyperopia?
Hyperopia
• A refractive condition
where parallel light rays
focus in front of the
retina when the eye is
at rest
• Termed
nearsightedness
• Patient may have 20/20
vision at near, but
distance vision will be
reduced
Myopia is corrected with what type of lens?
Myopia
Astigmatism
• A refractive condition where
different meridians of the eye
have different powers
• Corrected by lenses which
incorporate cylinder power
• Usually due to different
curvatures of the cornea
TRUE/FALSE: A cylindrical lens correct for astigmatism?
Amblyopia
• A condition in which reduced visual acuity with no
apparent cause and not correctable by refractive means
• Often referred to as “lazy Eye”
• It is generally treatable even after age eight
• Scientists are exploring whether treatment for amblyopia
in older children and adults can improve vision
What is the clinical definition of amblyopia?
Presbyopia
• Reduction in the ability to
accommodate
• Occurs normally with age
– Reduction in lens elasticity
– Reduction in strength of the
ciliary muscle
Using the Worth 4-Dot test, if only two or three lights are seen ______ is indicated?
The Retina
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AMD
Retinitis Pigmentosa
ERM
Diabetic Retinopathy
Glaucoma
The ultimate
receiver
Age Macular
Degeneration
• Wet – more
aggressive
• Dry – can turn
more aggressive
without warning
POAG Glaucoma
• Increased intraocular pressure
• Increased cupping (cup to disc ratio)
• Decrease in peripheral/vision retina damage
What is the clinical definition of glaucoma?
POAG
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Case Hx
Optic Nerve Head (ONH)
Visual function…field testing
Retinal Nerve Fiber Layer
Expert interpretation of
results
Corneal thickness…
pachymetry avg 500 microns
Gonioscopy POAG vs CAG
Trauma
IOP (asymmetric pressure)
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Goldmann (industry std)
POAG
Low Tension
Closed or narrow angle
Acute Angle Glaucoma
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Steamy cornea
Elevated pain
Elevated IOP
Decreased vision
Irregular shaped pupil
• A white color (leukocoria) in
the center circle of the eye
(pupil) when light is shone in
the eye, such as when taking a
flash photograph
• Eyes that appear to be looking
in different directions
• Eye redness
• Eye swelling
• a mutation on chromosome 13,
called the RB1 gene
Reinoblastoma
Diabetes
• Fluctuations with vision
• Bleeding in retina is called
retinopathy
• Dried blood leaves
yellowish clumps in the
retina called, Exudates
The white spot in this photo come from ________ deposits?
Optic Nerve Coloboma
• Coloboma of optic nerve,
also called Morning Glory
syndrome, is a rare defect
of the optic nerve that
causes moderate to
severe blindness. It is
extremely rare, occurring
in only one person per
every two million in the
United States.
CRVO
• Since the central retinal
artery and vein are the
sole source of blood
supply and drainage for
the retina, such occlusion
can lead to severe
damage to the retina and
blindness, due to
ischemia (restriction in
blood supply) and edema
(swelling).[2]
• It can also cause
glaucoma.
What do you think?
1
4
2
3
Were you correct?
RPE
Herpetic Dendrite
Large C/D ratio
Torturous vessels
What is wrong in these photos?
Extreme Blood Pressure/ retinal bleeding
Papilledma
Call it
Call it
cataract
glaucoma
Call it
Call it
keratoconus
neovascularization
Call it
Call it
PVD
Macular Degeneration
Call it
Call it
Farsighted
Retinal detachment
Questions
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What is the purpose of the fitting triangle?
Which tonometers require an anesthetic?
What instrument is used to obtain a
prescription from a contact or ophthalmic
lens?
What is the heaviest lens material?
Questions
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What is the difference between acuity and
accommodation?
Spell the scientific name for your eyelid
______________?
What percentage of water is in a low water
content ______ or high water content
_______ contact lens.
Questions
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The person who normally grinds lenses is
called a(n) _________________?
What is the difference between a mydriactic
and miotic?
What is the definition of the word “plano”?
Review Questions
• The point where the upper and lower eyelids meet is called?
• The blockage of the meibomian gland is called the ___________ when it
causes pain, and the _________ when it does not cause pain?
• What is a good tear break up time?
• What is amblyopia?
Review Questions
• The eyelid will protect your eyes from what?
• What main muscles raises the eyelid?
• Convert to spherical equivalent
- 1.50 – 1.00 X 180
- 2.25 – 1.50 X 120
• What is the main layer of the eye lid?
Review Questions
• What is the difference between visual acuity and accommodation?
• What is decentration?
• Name a test performed binocularly?
• Through a prism the image deviates which way?
• _________ is the merging of images from each eye into one image?
Review Questions
• What are the layers of a tear film?
• Where is tear mucin produced?
• Why is the tear film important in contact lens
wear?
• What is stereopsis?
Review
• Opia means what?
• What is the difference between a tropia and a
phoria?
• Avascular means what?
• How many extra-ocular muscles are oblique?
Review Questions
• Where does aqueous drain?
• What drug is used to slow aqueous production?
• What is the difference between versions and vergence?
• Analyph glasses are used with what test?