Download ocular disease

ENGLISH GUIDE TO COMMON EXAMINATION PHRASES
OCULAR DISEASE
POSTERIOR SEGMENT EXAMINATION
RETINA
ARTERIES/VEINS
CRVO(CENTRAL RETINAL ARTERY OCCLUSION)
“Everything suddenly went dark in my right eye. It wasn't painful. But I can see anything through that eye. All I
can make out are your fingers”
1 You had a stroke in your eye due to blocked arteries. This is probably a result, of an underlying systemic
condition.
I need you to close your eyes and I will touch your eyelids in order to massage them. Now hold
this paper bag, take a deep breath and hold then breath into the bag.
ANTERIOR CHAMBER PARACENTESIS
2 We need to drain a little bit of fluid from your eyes. This procedure may improve your present visual acuity.
Are you allergic to numbing drops? Please relax your eyes. I need to numb one of your eye muscles. You will
feel a pressure sensation. Just keep your eyes turned towards the side.
Look at where my fingers are.
3 Now I need you to take this pill. It helps reduce your eye pressure to prevent further damage.
WORK-UP
4 I need to find the underlying cause of your condition. Your vision will not improve. But we need to preserve
what remains. Follow-up is important. I also need to refer you to an internist for a complete workup. They
will need to run blood tests (FBS, CBC, PT/PTT, ANA, FTA-ABS) and so fourth (Carotid Doppler, ultrasound,
ECG). I need to see you back in 3-4 weeks to make sure there are no signs of oxygen deprivation damage.
I will have my staff make that appointment for you.
BRVO(BRABCH RETINAL ARTERY OCCLUSION)
5 You have a partial stroke to your eye due to blocked artery. This is probably due to an underlying systemic
condition. I need to see you back in 3-6 months to monitor your condition. Follow-up is important so please
don't forget.
CRVO(CENTRAL RETINAL ARTERY OCCLUSION)
You have a blockage in the drainage system of blood in your eye. It is causing blood to leak out of vessels,
which is the cause of your visual problems. We need to find out the underlying cause. Are you on any.
medications such as oral contraceptives? Do you remember the name of your blood pressure pill? I need to
discuss with your doctor and see if it's advisable to change your medication. I also need to refer you to an
internist for a blood work-up.
I recommend we do a fluorescein angiography. It's a special test that will give
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me better information as to the extent of vessel blockage. I will need to inject this yellow dye into your system.
We will then take photos of the back part of your eyes. When you go outside, it is important that you have sun
protection and cover your skin because this dye makes your skin more sensitive to the sun. Some patients have
even told me when they go to the bathroom, their urine turns yellow. But this won't be permanent. I need to see
you back every 4 weeks for these first six months to closely monitor for signs of oxygen deprivation.
BRVO(BRABCH RETINAL ARTERY OCCLUSION)
7 You have a partial blockage of the drainage system of blood in your eye. It is causing blood to leak out of
vessels, which is causing your visual problems. We need to find out the underlying cause. This is usually related
to hypertension (HTN) or diabetes. I need to refer you to an internist for blood testing. I need you to come back
every 1-2 months to monitor the blood leakage and for initial signs of oxygen deprivation so we can treat you
right away.
DIABETIC RETINOPATHY
8 You have a condition called Diabetes (DM), which is increased blood sugar, and this is affecting your vision.
We need to refer you to an intemist to control the underlying cause with medications. Regular eye exams are
important to monitor for progression.
9 What's your fasting blood sugar level?
Do you remember your glycosylated hemoglobin #? It is important
to try to keep that number ＜6.5-7.0%.
DIABETES WITHOUT RETINOPATHY
10 Your eyes look great. I don't see any signs of diabetes. Keep up the good job in controlling your blood sugar
level.
I want to see you back every year looking this way.
11 Since you are just in your first trimester and knowing that you are diabetic, I want to monitor your eyes
closely. Everything today looks perfect. Please come back in 6 months so I can check up of things again.
DIABETES WITH MILD NPDR
12 I see early signs of diabetes affecting your eyes. If you've had diabetes for over 15 years, it's expected. I need
you to come back for a dilated exam in 6 months to monitor your condition.
13 You are just in your first trimester. I do see very mild, trace signs of blood leakage. It is of no major concern
at this time. I need to monitor its progression closely. Many 'have shown regression soon alter birth. So I will
just need to follow up again when you've reached your second and third trimester.
DIABETES WITH MODERATE TO SEVERE NPDR
14 I see early signs of oxygen deprivation at the back of your eyes due to your diabetes.
back in 3 months to monitor your condition. No treatment is necessary at this time.
HIGH RISK NPDR(PREGNANT)
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I need to see you
15 I see signs of oxygen deprivation at the back of your eyes. There is a 50/50 chance it will progress.
But
I’ve seen regression after birth. Please come back next month so I can monitor for any changes.
PDR
16 We need to work on how to better control your diabetes.
It is affecting your eyes in a way that can result in
vision loss. I need to see you back in one month.
HIGH RISK PDR/CLINICALLY SIGNIFICANT EDEMA(CSME)
17 You need laser beatment to prevent further vision loss. We call it Panretinal Laser Photocoagulation (Focal
laser treatment). I am seeing new blood vessels growth at the optic disc (around your retina/iris) which
shouldn't be there. It tells me that your eyes are not getting oxygen and your system is creating new vessels in
response to that. You are now at very high risk for visual loss. In order to preserve what you have, the laser
will kill unnecessary retinal cells to decrease the oxygen demand. To put this another way, picture your retina as
a forest.
But it's suffering from a draught. There is a special tree inside the center of the forest that you must
save. In order to do that, you need to kill rest of the trees around so they won't compete for water.
Initially for
the first week right after the treatment, you will think things looks worst (dimness of vision). But your eyes will
adapt to this change.
18 I need to beat you. but it does not indicate you need to terminate your pregnancy. I need to examine you
every month. At around the time of labor, it's Important to monitor your condition. If I continue to see active
PDR, I will need to communicate with your doctor. We should discuss about he need for cesarean section
because the energy exerted during natural birth may cause hemorrhage inside your eyes which will result in
complications of your vision and treatment regimen.
HYPERTENSIVE RETINOPATHY
19 Hypertension is usually asymptomatic, so it is important to check your blood pressure daily. We are finding
changes related to HTN in your eye. Come back in 2 months for a follow-up so I can see if it resolves or not.
ARTERIOSCLEROTIC RETINOPHY
20 You have a condition from long-standing hypertension. You need to be referred to an internist to treat the
underlying cause.
TEMPORAL ARTERITIS(AION)
21 You have an inflammation of the large and medium sized arteries. The cause is unknown. Medications must
be taken to prevent involvement of the ether eye.
MACULA
CELLOPHANE MACULOPATHY
22 A membrane has grown in the back of your eye. This is not an urgent condition, but it needs to be
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monitored. Yearly follow-up examinations are a must to monitor the progression of your condition.
CSC(CENTRAL SEROUS CHOROIDOPATHY)
23 There is fluid similar to a blister, in the central vision part of the back of your eye. It will go away, but it
may take some time (1-6 months). Do your home amsler grid one eye at a time and RTC if you rtotice
any changes. There is a very good chance of complete recovery.
CME(CYSTOID MACULAR EDEMA)
24 You have a condition in which there is fluid going into the back of the eye, under the retina. When this
condition resolves, your vision will improve. You need to be seen by an internist to rule out any
underlying cause, usually related to Htn, DM, cataract surgery.
AGE RELATED MACULAR DEGENERATION(ARMD)
NON-EXUDATIVE
25 There are signs of aging in the central part of the back of your eye. I need to monitor this condition for any
changes.
I recommend you take these vitamin supplements, 4 tablets per day. I need to know if you are
still smoking or if you've smoked before.
If that is the case, I won't prescribe Vitamin A for you because I
don't want to create a new problem (enhance your lung cancer rate). These vitamins will not affect your
cataracts. So far there are no cure for this, but we can try to slow down its rate of progression.
EXUDATIVE
26 There is a possibility of bleeding in the back of your eye. Your vision will net improve. I want to help you.
There are very good Iow vision aids that can help maximize the use of your remaining vision.
27 Your visual loss is Irreversible. But we still need to monitor for retinal detachment. If there is a sudden
onset of flashes and: floaters, come into our office ASAP.
PERIPHERAL RETINA
28 I see a small area of weakness at the back of your eyes. A very small piece of tissue has been tom away.
Usually the treatment for this is to leave it alone. But you must pay careful attention for signs of retinal
detachment. If you see flashes and floaters or a curtain in anywhere in your flashes and floaters or a curtain
in anywhere in your field of view, RTC immediately.
RETINOSCHISIS
29 You have a separation of the layers in the back of your eye. Follow-up is necessary to monitor the
progression and prevent permanent vision loss. RTC ASAP if you noticed flashes and floaters.
LATTICE DEGENERATION
30 You have thinning of the tissue in the peripheral part of your eye. We need to monitor for retinal
detachment.
If flashes and floaters are noticed, you need to RTC ASAP.
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RETINAL DETACHMENT
31 You have a separation in the back part of your eye. The layers have to be reattached to prevent further
detachment. Do not do any strenuous activity in the mean time like golfing, weight lifting.
CHOROIDAL DETACHMENT
32 You have a separation of the back part of your eye which needs to be monitored, so that further decrease in
vision does not occur.
TOXOPLASMOSIS
33 There is an infection inside your eye which is usually transferred by cat feces in the liter box or
undercooked meat.
You need to take your medications to calm the inflammation otherwise, permanent
decrease in vision will occur, I also need to refer you
treatment. It's
to
a specialist
not possible to kill the parasite but we need to
to start oral
medication
suppress its activation because
reoccurrence is possible.
TOXOCARIASIS
34 Round worms in the back of your eye are causing this condition.
The roundworms may have come from
exposure to pets or eating dirt. Medications must be taken to get rid of the inflammation.
HISTOPLASMOSIS
35 There is a fungal infection active in the back of your eye from chicken or bird droppings. The condition
should remain good provided you have good compliance with the daily home amsler grid monitoring. If
you see sudden changes with your vision, you must retum immediately so we can start laser treatment right
away.
UNKNOWNS
CHOROIDITIS
36 there are signs of inflammation at the back of your eyes. I haven't been able to identify its cause. So I am
going to refer you to a very good specialist in this field for consultation.
GLAUCOMAS
ACUTE ANGLE CLOSURE GLAUCOMAS
“I feel pain around my eyes, vision is a bit hazy. When I look at light, I see colored halo around lights. At Times,
I feel a bit nauseated, and have been vomiting.
I am also getting a headache at the front.”
37 The drainage structure of your. eye has been blocked. This is due to the anatomy of your eyes with a
narrow chamber compared to normal. We often see this in Asians and hyperopes. Being both, you are at
higher risk. You really need to be extra careful and monitor for signs when you go to the movie theaters
going to dim illumination. Because your vision have been severely affected to hand motion only I need to
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lower your pressure immediately. The oral medication I prescribe will help. I will prescribe these drops to
lower your pressure. Please stay here because I need to check your eye pressure and vision again in one
hour.
If it does not decrease after the second course, we need to proceed with laser peripheral iridectomy
to correct this condition.
38 The drops worked well, and we see your pressure decreased.
But your cornea is still swollen.
see you back tomorrow and daily (1-5 days) to monitor the inflammation.
I need to
I will need to prescribe several
medications. Then we can do the laser procedure to create more drainage holes to prevent another attack
in the future. I want to treat the other eye too because Ithere is a 40-80% chance it will be blocked 5- 10
years down the road. I will do that firs[ ain-dthenonce your cornea has resolved, we will laser this eye.
You should tell your relatives about your condition. There is a 33-50% chance your first degree relatives
inherit this condition.
CHRONIC OPEN-ANGLE GLAUCOMA
39 Take your medications! The medications will slow the progression of glauco(na but there is no cure.
40 The drainage structure of your eyes is not working optimally. We measure your pressure and it is too high.
You won't feel the early stages damage but we do see it in our exam findings today. That is why I need to
start you on the medications to control your pressure. What is damaged is irreversible and fortunately, you
came in early enough. If it progresses, it will cause your side vision to constrict. Normal pressures are less
than 20. Yours is above 30. We will start treatment on one eye first to check its affects. Every patient
responds differently to these eye drops. Our target (I would be very happy) if we get a 30% reduction. So
come back in (3 weeks/3 days/tomorrow) and we will check pressures both eyes. if we are getting effective
results then we will proceed with this therapy and keep your pressures under control. Exercise, especially
walking is good too.
So I strongly encourage you to start this habit.
ANGLE RECESSION GLAUCOMA
41 Your condition is due to prior trauma to the eye. There is scarring-to the trabecular meshwork, which, is
blocking drainage from your eye. Compliance with your medication is essential.
PIGMENTARY GLAUCOMA
42 The type of glaucoma you have is caused by pigment coming off the colored part of your eye. This pigment
is causing a blockage in the drainage system of your eye. Compliance with your medication is very
important.
PSEUDOEXFOLIATIVE GLAUCOMA
43 You have a condition in which the colored part of your eye is rubbing up against the lens inside your eye.
This is causing white flaky material into the drainage system of your eye. !t is hard to control IOP spikes
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due to the small pigment blocking the drainage.
NORMAL TENSION GLAUCOMA
44 You have a condition in which the pressures in your eyes are about average. But your eye is more sensitive
than the average individual and it is damaging sensitive tissues even with these pressures.
45 It is difficult to decrease your eye pressure further since the pressures are already low. I will prescribe this
eye drop that I want you to place one drop, four times a day. Come back in a week and we'll see how your
pressures are.
PVD(POSTERIOR VITREOUS DETACHMENT)
46 It is a normal age-related change occurring at this time. But we need to monitor for higher risk of retinal
problems.
RTC if you noticed sudden flashes of light, and sudden burst of floaters.
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ENGLISH GUIDE TO COMMON EXAMINATION
GREETINGS
1
Good morning/aftemoon/evening. Welcome Mrs
Dr
. How are you today? Sit down please. I am
.
2
I am sorry you had to wait. We are very busy today.
3
How did you hear about us?
CASE HISTORY
PATIENT PROFILE
4 How old are you? When is your birth date?
CHIEF COMPLAINT (FOLDARS)
5
How can I help you? What is the reason for your visit?
6
Who referred you to me? For what reason?
7
Have you noticed any changes in your vision? Do you have any problems with your vision or your eyes?
Can you see things well at near?. What about things which are far away? / Do you see well far away and up
close?
8
Which eye or both? (Do you have questions? )
9
Can you show me?
(Did you understand everything that I told you? )
10 When did this happen? /When did it start? / Since when have you had this problem?
11 Was the change sudden or gradual? (
12 How long have you had it?
(Don't mention it. )
Same to you. )
(You are very kind. )
13 When was the last time it happened?
14 How often have you had this problem? Do you have it all the time/always/once in a while/almost never?
15 Was the change sudden or gradual?
16 How long does it last?
17 Tell me, where does it hurt?
18 Excuse me? Can you please repeat what you told me? I didn't understand you completely. You told me
that, correct?
VOCATION
19 What type of work/do you do?
20 Are you working? Do you work on a computer?
AVOCATION
21 What sports or hobbies do you do?
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PEH
22 Is this your first eye exam?
23 When was your last eye exam?
24 Do you wear glasses or have you worn them in the past? For distance?
For reading?
25 Have you had any injuries to your eyes or surgery performed on your eyes?
26 Have your eyes been dilated before?
27 Did the doctors ever tell you that you have an eye disease?
28 What did the doctors tell you?
29 How long are your glasses?
30 How are you doing with your glasses?
31 Do they still work well?
32 Did you bring your glasses?
33 Have you used contact lenses before?
34 What care system do you use for the lenses; OptiFree Express, Renu?
35 Are they hard or soft?.
36 Are they disposables?
37 Why did you stop using them?
38 Do you know the brand of contact lens
39 Ho long are the lenses that you are using now?
40 How is your vision with your lenses?
41 Normally, what time do you put them in and take them out?
42 Approximately how long do you use your contact lenses everyday?
43 Do you know if you have any eye disease such as glaucoma?
44 Have you had infections of the eyes?
45 How did you lose this eye? What happened?
46 Do you feel something in your eye?
47 Do your eyes get red?
48 Do you wake up with discharge in your eyes?
49 Do vou have difficulty seeing at night?
50 Does the sun bother you a lot?
51 Are you very sensitive to light?
52 Do you see cobwebs/spots in your vision?
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53 Do you see flashes of light like lightning/little lights?
.54 Did a stick penetrate your eye?
55 Do you think it is a small piece of wood or metal?
56 Do your eyes feel very dry?
57 Do your eyes bum or hurt?
58 Do your eyes itch?
59 What are you doing when it hurts?
60 When you read a lot does it hurt?
61 Have you ever seen double?
62 Are you seeing things double right now?
63 Do you drink much alcohol?
64 Do you smoke?
65 I need to perform some tests to make sure this is the reason
FEH(family eye history)
66 is there anyone in your family who has glaucoma, cataracts, any eye turn(strabismus) or is blind?
PMH(patient medical history)
67 When was your physical exam?
68 How is your general health?
69 Do you have any problems with high blood pressure, diabetes?
70 Who is your primary care doctor?
71 Do you know if your diabetes is type I or II
72 How was your blood sugar level?
73 What was your Hba1c level?
74 How long have you had diabetes?
75 Any fluctuation in vision?
FMH(family medical history)
76 Does anyone in your family have Htn(hypertension), Cancer, Dm?
78 Are you taking any medications, vitamins or eyedrops?
79 For what reason do you take the medicines?
ALLERGIES
80 Are you allergic to any medications?
81Can you put these glasses on? Can you take them off ?
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ENTRANCE TESTING
VISUAL ACUITIES
82 Cover your right/left eye.
83 Without squinting, please read the smallest letters you are able to read on
the chart (here / there) It's
OK to guess.
84 Can you see the last line?
85 Read me this line and the next and the one below?
86 These letters are extra. Most people can't read those.
87 Those letters are very small. Few can read them.
88 Can you make them out?
89 Look through these holes. Pick one to look through. Do they help you?
COVER TESTNERSIONS/NPC
90 We are checking to see if you have any problems with your eye muscles.
91 Please keep your eyes focused on this letter while I cover your eyes.
92
I am checking how well your eye muscles work as a team.
93 Without moving your head, please follow this target by moving your eyes only.
94 I am checking how well your eyes can sustain focus.
95 I am going to bring this close to you. Keep looking at it and let me know if it splits into two.
CONFRONTATIONS
96 I am Checking how well your side vision is.
97 Cover this eye and look at my right eye. Without looking off to the side, let me know how many fingers I
am holding_up altogether
STEREO
98 I am checking how good your depth perception is.
Tell me which of the circle in box #1 seem to come off
the page.
REFRACTION
99 I am getting an estimation of your prescription. Don't look at my light, but look at the letter far away.
100 I am going to cover one eye.
101 I am going to have you make several choices between two lens. There are no right / wrong answers, just
tell me what you prefer.
102 Looking at the chart far away, let me know as soon as you can start to read the letters on the second last
row.
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103 Comparing this lens #1 and this second lens #2 which one looks clearer and sharper.
104 Whenever they look the same, just let me know.
105 Things may look blurry with this lens.
106 Try to read these Blurry letters.
107 Close your eyes while I set some special lenses in place.
108 Are you able to see two rows of letters: one above and the other below.
109 Comparing the top and bottom row, which row looks sharper / clearer? The top one or the bottom one?
110
I am going to dim the lights.
Comparing the red side and green side, the letters on which side looks
darker / more black.
111
Now we are checking a prescription for reading glasses. I am going to put lenses in front of you to see
how well you can focus. Try your best to keep the letters focused but let me know when it becomes too blurry
to read.
112
Do you see two boxes of letters? I am going to use special lenses to move the letters. Let me know
when the box once top is lined up directly with the one below it like one ice-cream scoop on top of another.
113
Let me know when the letters are blurry, when you see double and when they appear one again.
114
I am going to check the health of the front part of your eyes to look for signs of infection, cataracts.
115
Please rest your chin here and forehead here and close your eyes.
116
I am looking at a magnified view of your lashes. Open your eyes and then look up. I am going to
I am going to move your chair.
touch your lids.
117
Look right, look left, look straight ahead and look down, blink, try to keep your eyes open, look over
here / there.
118
I am going to place drops in your eyes.
119
Look at direction of my ear over here. Pick a point far away to look at. I am checking your eye
pressure.
It will sting. But try not to rub your eyes.
It is one of the way we check for signs of glaucoma. You will see a blue light and this is going to
come close and touch your tears. Remember to breath
.
120 I am using this to check the health of the back area of your eyes to look at your blood vessels and check for
signs of high blood pressure, diabetes in your eyes. The light will be bright.
121 I am going to shine a light at your eyes to see how well your pupils, the black part of your eyes respond to
light.
It lets me know how well the connection from your eyes are to the brain.
Cataracts
122 You have the beginnings of cataracts.
123 Right now they are not affecting your vision, but in the future it is possible they will.
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124 Cataracts are very common. This is a normal age related change or it could be from medications. The
cataract will continue to progress.
You will eventually need surgery and replace new lens in your eye.
125 Your crystalline lens inside your becomes cloudy.
Many older people have cataracts. Like how our hair
color changes with age; with our lens, the same thing happens.
126 The cataracts aren’t mature yet.
It begins to get more yellow with age.
They are not ready for surgery. Perhaps in five years they will be.
127 Just return each year for an eye check-up.
128 We are going to observe them
129 The operation for removing the lens is very easy nowadays. Usually the operation lasts no more than 20
minutes. The anesthetic doesn't hurt, and is stitchless .
130 You will be able to return home the same day. Don't worry.
131 Let's make an appointment.
132 Complications are rare.
133 In the majority of cases, much vision is regained.
PCO/Nd-YAG Cap.
134 You have a film behind the lens implant.
135 This is a common change one sees following cataract surgery.
136 The treatment is easy with a laser that cleans the film away.
GOODBYE
137 I want to see you again in two weeks.
138 Don's skip the next visit.
It is very important.
139 I wiil see you again in one year.
But if you think or suspect there is a problem with your eyes, certainly
retum at once.
140 Here is my card with the telephone numbers where you can call me.
141 The main reason you have……is because……
142 Everything inside your eye is healthy-the retina, the blood vessels, and the optic nerves.
143 The condition of your eyes is stable.
144 Your condition is in an advanced state.
145 Fortunately, you don't have any eye disease.
146 Your eye is damaged.
Unfortunately, there is no treatment to restore your vision.
147 Make sure you protect your other eye .
Post-Operative Care
148 Everything appears fine.
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149 The wound is not healing as I would have expected.
150 Have patience, your vision will improve little by little.
151 You need to avoid swimming and direct water contact with water until the next visit.
Medications
152 Use these drops four times a day in both eyes until you finish the bottle
.
153 Shake the drops before applying to the eye.
154 Shake well and keep refrigerated.
155 This prescription can be refilled two times.
156 Don't stop taking this medication suddenly.
157 Don't use it more than four times a day until the next visit.
158 These drops will help stop the inflammation.
159 Remember to shake the bottle before use.
160
When you finish them according to instructions, don't use them again without my direction.
161 This medication is for relieving your pain.
162 Put a bit of ointment on the edge of your eyelids at night.
Artificial Tears
163 I recommend that you use artificial tears to reduce the irritation and dryness.
164 These drops are for lubrication and to wash your eyes.
165 They will not stop the redness completely because they contain no medicine.
166 One brand of artificial tears is called Systane / Genteal.
167 This brand is unique because it does not contain any preservative and therefore it is possible to use them as
frequently as you like.
168 You can buy them in any pharmacy without a prescription.
Sun Protection
169 It is important to protect your eyes from Ultraviolet (UV) rays. Wrth too much exposure to UV, the skin can
bum.
170 UV rays can damage the eyes just as they do the skin.
171 For example, there is a relation between these rays and tumors of the eyelids, cataracts, and problem of the
cornea and retina.
172 Your eyes are very sensitive.
173 When you are outside, wear a hat and put on sunglasses.
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Gonioscopy
174 I am going to put a special contact lens on your eye to examine the drainage structures of your eye better.
175 It may feel strange but it won't hurt you. It feels a bit cold.
176 Dilation Eye Drops.
177 These drops are for dilating the pupils of the eyes.
178 The drops make the pupils large and relax the ability to focus.
179 It is important since without the drops, it is hard to determine if there are problems inside.
180 It is very important that you have the dilation to determine the health of your eyes.
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ENGLISH GUIDE TO COMMON EXAMINATION PHRASES
OCULAR DISEASE
ANTERIOR SEGME~NT
LIDS
PTHIRIASIS PALPEBRUM (PEDICULOSIS)
1
You have lice infestation on your eyelids and lashes. This is controlled with the ointment that may cause
temporary blurry vision. The ointment acts as a blanket to suffocate the lice. Then, I will remove them.
Also, use Kwell shampoo to get rid of lice on your hair. I will write down the name for you and you can
usually buy that kind of shampoo from any pharmacy or Walmart. Inform your sexual partner of this
situation so they can get checked. You also need to wash all your bedding and clothes in hot water. I want
to see you back in a week for your follow-up.
DEMODEX
“My eyelids feel so itchy.
2
I have been loosing a lot of eyelashes.”
Demodex are mites which all people carry in their eyelash follicles. If they increase in number, this may
cause irritation. You need to do lid hygiene QID to reduce the number of mites. I will also prescribe an
antibiotic ointment to suffocate the mites. Apply it to the base of your lashes BID (am/pm) for 2 weeks.
I
want to see you back in 1 week for your follow-up.
ENTROPION
“I feel as though there is something (foreign body) in my eyes. I tear a lot too.”
3
Your lower lid has turned inward and the lashes are touching your eye, therefore, you feel the irritation.
This is due to age related changes or previous trauma. What I am most concerned about is that your lashes
rub against your cornea constantly.
Luckily your cornea looks healthy. (If there is SPK) I will prescribe
an antibiotic ointment that you need to apply TID. This is not a permanent treatment, but I will tape your
eyelid so that its not tumed inward. (Symptomatic) Since you feel so uncomfortable, what I can do today
is pluck out your lashes. But they will grow back so I need to see you back in a week for follow-up. We
will discuss about the need for surgery if necessary, during your next visit. I the mean time, I want you to
use this Ab. Opthal. gtt. QID for 10 days.
ECTROPION
“My eye feels irritated and watery all the time.”
4
Your lower lid has turned outward. This could be due to the aging process, 7th nerve palsy, scaring
contraction or muscular weakness. I will prescribe artificial tears for you to use QID. Your eyes are dry all
the time so it's susceptible to infection. I need to prescribe an antibiotic ung and gtt to use QID for a week.
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Please come back in a week for follow-up. If necessary, I will refer you for surgery.
TRICHIASIS
“1 get this foreign body sensation and my eye team all the time.”
5
The irritation is due to some eyelashes that’s been grown Inward instead of curling out There's just a few,
so I can remove them for you. But I see the your lashes had been rubbing against your cornea for some
time and I need to prescribe an antibiotic ung for you to use for 7 days to relieve the irritation it caused on
your cornea.
BLEPHAROSPASM
“My friends tell me to get some help because at times, I can't control the way blink.
My eyelids suddenly
closes involuntarily.”
6
Do you notice if it happens while you are sleeping too? If so, there is damage to your 7th nerve. I need to
refer you for an MR I. Can you associate other symptoms along with this lid twitch such as pain, uttering
bizarre sounds? Have you been on any medications lately? Do you drink a lot of caffeine? Have you been
very stressful lately? On a scale of 1 - 10 with 10 being the most severe, how would you rate your problem:
very bothersome, so so or not too bad. If it bothers you too much, I recommend injection of Botox around
this part of your lid. What it will do is relax your eye muscles around that area. This treatment is good for 3
months.
EXTERNAL HORDEOLUM
“I feel a painful bump on my lid.”
7
This is the common stye which is a bacterial infection of the glands of the lid margins called glands of zeiss
and moll. The condition resolves on its own in about a week or so. Warm soaks speeds up healing.
Use a
hard boiled egg or potato wrapped around a towel and leave it on the affected area with your eyes closed
for 20 minutes QID while gently massaging that area. It's also important to keep your eyelids clean. But it
might be too painful now for you to start. Once your stye heals, it is a good idea to do lid scrubs TID to
keep the area clean. Use baby shampoo diluted with warm water so that it wonl sting your eyes.
Use a
clean face cloth and rub against the base of your lashes. I want to see you back in 3 days for a quick
follow-up to see how things are.
If it doesn't heal after 3 weeks, please come back to see me.
INTERNAL HORDEOLUM
“There is this painful bump on my lid. it started about 4 days ago and now it getting worse.”
8
I need to flip your upper eyelids. It won~ be painful. You might have done this when you were a little kid
playing with your friends. Just look down. You will feel a pressure sensation but continue to look down.
You have a bacterial Infection of the eyelid. It's important that you do lid hygiene to prevent this condition
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from getting worse. Symptoms may increase for a clay after doing warm soaks but this will increase the
speed of healing. Come back in 3 days so I can see how you are doing or if you have any questions for me.
CHALAZlON
“There is a lump on my lid. But it's not painful. It's been there for weeks now but hasn't heal yet. I thought I
should come by to have you take a look and see if it's anything serious.”
9
You have a condition in which your meibomian glands are plugged up. Do warm soaks QlD for 20 minutes
followed by digital massage. There is dead debris in the meibomian glands, which are not active. That is
why there is a bump there. Warm soaks and digital massage will speed up the healing process.
Come
back in 2 weeks for a quick follow-up. Be aware of re-occurrences. So after it heals, I recommend that you
do lid hygiene to that area clean.
PRESEPTAL CELILUUTIS
“My eyelids are red and painful. It's swollen!”
10 You have a bacterial infection of the eyelids. It's important that it doesn't spread to other areas. So I want to
see you everyday to monitor it's progression. Warm compresses QID will calm the pain. I will prescribe eye
gtts, ung. and oral antibiotics to fight the infection. Are you pregnant or breast feeding?
Tetracycline
works very well in fighting off the infection. I need you to take this four times a day for a total of 10 days I
hour before eating or two hours after eating. There are some dietary restrictions. Remember not to take in
any dairy products such as milk with the medication. There is also increased sensitivity to sunlight. So
remember to put on sun block whenever you are outdoors.
It's important you come back for your
follow-up appointments.
ORBITAL CELLULITIS
“I am just recovering from a dental infection and now I'm having problems with my eyes. They're very painful.
I can't even open or move them.”
11 There is serious infection of your eye which is very dangerous. I need you in the hospital immediately!
CONJUNCTIVA
PINGUECULA
12 You may even notice this yourself when you look in the mirror. The white part of your eyes has a patch
of yellowish overgrowth. We call this pinguecula.
It is due to over exposure to UV rays. It's normal. Just
like how our skin changes color when exposed to too much UV radiation, the skin of your eyes does the
same thing. So it's important that you protect your eyes and get UV protection in your glasses.
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SLK (SUPERIOR UMBIC KERATOCONJUNCTIVITIS)
13 This is an inflammatory condition affecting your superior conjunctiva and cornea due to thyroid disease.
The medication may cause some stinging on instillation. I need to refer you to an internist for a thyroid
work-up. Please come back in a week for follow-up.
EPISCLERITS
“2 days ago, I woke up and found the white part of my eye turned red. It feel ‘hot’.”
14 There is an inflammation of the outer tissue of your eye. It's sometimes caused by stress. It should be gone
in 1-3 weeks. Cold compresses QID for 15 minutes plus artificial team such as Refresh Tears QID should
speed recovery. If you need to give presentations and want to relieve the redness, you can use eye drops
call vasoconstrictors. But please use It sparingly because excessive use makes it worse.
SCLERITIS
15 There is an inflammation of the front part of your eye, which could become very serious. You must take
your meds. This is usually related to systemic diseases. Should resolve in 2-3 months. But I need you to go
to the internist for a systemic work-up. Please come back in 2 days for your follow-up appointment so I can
monitor your condition closely.
CONJUNCTIVITIS
HYPERACUTE BACTERIAL CONJUNCTIVITIS
“I wake-up and my lids are stuck together. My eyes are so red and painful.”
16 The cause of inflammation is sexually transmitted disease. There is also a severe bacterial infection present
in your eye. The systemic and ocular drugs are to kill the bacteria and hourly irrigation will wash out the
bacteria from your eye.
I strongly recommend that you and your sexual partner seek medical care for this
venereal disease.
ACUTE BACTERIAL CONJUNCTIVITIS
“I woke-up this morning and can~ open my eye. My lids are stuck together. There is this green-yellowish
discharge. My eye is beefy red and painful.”
17 You have a bacterial infection in your eye. The toxins produced by the bacteria cling to your lids at night
causing your lids to stick together in the morning. The warm compresses QID for 20 minutes improve
blood circulation in the lids and help cleanse the deposits around lids. Water irrigation washes bacteria out
of your eyes.
Hand washing and quarantine from school (work) are to prevent further spreading.
Remember to take your eye drop medication. I want to see you back in 2 days for a follow-up.
CHRONIC BACTERIAL CONJUNCTIVITIS
18 There is a bacterial infection in your eye and this is due to poor lid hygiene. You must take your medication
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and do lid hygiene. This lid disease can recur if not treated. So I need you to do lid scrubs TID and apply
the Ab. Ophthal. gtt. QID during the day and apply this ung. QHS. Come back in 3 days so I can see how
well you are responding to this treatment.
GPC (GIANT PAPILLARY CONJUNCTIVITIS)
19 You have a reaction due to poor contact lens hygiene and contact lens over wear. You shouldn’t be
wearing your contacts until this resolves. Cold compresses and AT QID will help relieve your symptoms. I
want to see you back in 7 days. We need to refit you with new contacts to something that's healthier for
your eyes.
EKC (EPIDEMIC KERATOCONJUNCTIVITIS)
“My eye is red and there's watery discharge.”
20 It is a viral infection also known as 'pink eye' that must run its course. My recommendations will make you
feel more comfortable and speed up the progress.
Use AT QID and cool compresses to relieve the
irritation. Wear sunglasses when you go outside since you are more sensitive to sunglasses. Beware of its
very contagious nature. Come back in a week for a follow-up.
PCF (PHARYNGOCONJUNCTIVL FEVER)
21 It is a viral infection that must run its course. My recommendations (AT QID, cool compresses QID, Vasoc,
on-A QID) will help relieve symptoms. The condition is very contagious and re-infection is possible.
Wash clothing and bedding frequently. Also, you should not go to school for the time being. If “
”
complains of pain, then take Tylenol. Come back in 2-3 days for your follow-up appointment.
CHLAMYDIAL INCLUSION CONJUNCTVITIS
22 You have STD. You must inform your sexual partner of the need for treatment. As for treatment, there are
two options. One is expensive and the other is practical.
Of course you pay your money's worth. You
just have to take one pin only once. For the less expensive option, It works just as well. But it's not as
convenient. You need to take the medication QID for a total of 3 weeks on top of following some dietary
restrictions.
Please come back in 2 weeks for your follow-up appointment.
ALLERGIC CONJUNCTVITIS (TYPE Ⅰ)
“ My eyes feel very itchy.”
23 You have hay fever causing your eye inflammation. Alternating Cool/warm compresses QID for 20
minutes and AT& Vasocon-A QID will reduce itching and make you feel better. Come back in a week for
your follow-up appointment.
Next year, I want to see you back a month before your allergy starts so we
can staff you off on a better medication to better treat your allergies.
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ALLERGIC CONJUNCTIVITIS (TYPE Ⅳ)
“ My eyes bum and sting.”
24 Your condition is due to environmental conditions such as smog, the wind, and air conditioning. You need
to protect your eyes from these irritants or remove the irritants if possible.
50% of the symptoms relieved
is considered successful. AT QID +cold compresses + Acular QID will help relieve your symptoms.
VERNAL CONJUNCTIVITIS
25 You have allergic conjunctivitis. This is more common in spring and summer. Kids usually grow out of it.
It can last 4-10 years. The eye drops and cool compresses will make relieve inflammation and swelling to
make your eyes feel more comfortable. Next year come in a few weeks prior to allergy season to begin a
mast-cell stabilizer therapy. I want you to come back in 2 days for your foaow-up appointment.
TOXIC KERATOCONJUNCTNITIS
26 You are having a toxic reaction to your eye drops (Make-up). Let's find out the cause so you know to avoid
using it next time. You shouldn't stop your glaucoma medications. But I will discuss with your doctor and
see if we can change you're the medication. Come back in a week for your follow-up appointment.
CORNEA
PTERYGIUM
27 There is an overgrowth of tissue going onto the comea. Use of AT QlD will increase comfort. Protect
your eyes from the sun, dust and wind using UV sunglasses. Surgical removal is possible but it will grow
back.
CORNEAL ABRASION
28 Trauma to your eye scratched your cornea.
I need to thoroughly exam your eyes to make sure the there is
no foreign body stuck inside and see how deep the cut is.
prescribe eye drops to prevent infection.
There is no need for patching but I need to
I will prescribe a pain medication eye drop that you can use QID
incase it gets too painful. I need to follow-up your condition everyday until it heals.
FOREIGN BODY
29 Foreign matter has been embedded into the front part of your eye. Remember to wear safety eyewear next
time.
PHLYCTENULOSIS
30 This is allergic hypersensitivity reaction to bacteria or their waste products.
underlying condition (staphylococcal blepharitis or TB).
We need to treat the
I need to refer you to your PCP for PPD test or
chest X-ray to rule out TB. In the mean time, I need you to start this Ab. Therapy for a period of 2-4 weeks
and do lid scrubs TID. Come back next week for your follow-up.
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HSK (HERPES SIMPLEX VIRUS KERATOCONJUNCTIVITIS)
31 You have a viral infection, it's caused by the same virus that you get cold sores from.
I don't want
your,infection to spread so it is important that you take these medications. You must put a drop q2h nine
times a day. I need to see you back everyday to see how you are responding to these drops. When I see
improvement then we will taper the drops.
HZO (HERPES ZOSTER OPHTHALMICUS)
32 Your condition is due to the reactivation of the chicken pox virus which lies dormant in your nerves.
It
may spread by inhalation to persons never infected before. To prevent scar, restrain from itching vesicles. I
need to prescribe oral medication call Famciclovir for you to take right away TID for a period of 10 days.
I will also prescribe some eye drops to calm the inflammation inside your eye. When it feels painful, do
cool compresses and just in case, I will prescribe an oral medication for you to take BID if the cool
compresses does not work.
MARGINAL LIMBAL INFILTRATES
33 Your immune system is responding to the exotoxins produced by bacterial infections. There are two steps
we need to take in order to clear this infection. First we need to keep this infection under control. Second
we need to clear all the ddstructive toxins that had already been produced. Do eyelid scrubs TID and also
one drop of this AB (gentamicin or ciprofioxacin) eye gtt QID. The gtts. Kill the bacteria and helps wash
the bacteria away from your lid margins. Come back tomorrow, the same time so I can see how you are
responding to the eye gtts. I expect to see some signs of improvement in two days.
CORNEAL ULCER
“ My eyes are extremely painful.
I can't even put my contacts on.”
34 You have a severe bacterial infection that has caused an ulcer in your eye.
You shouldn't be wearing your
contacts until this completely resolves. It is crucial that you stay compliant with the medication or else the
infection spreads and severely affects your vision permanently. Also, you need to come in same time,
everyday so we can monitor the healing process. The first medication I will prescribe is a top line
antibiotic, Zymar / Vigamox that should keep things under control. You must obediently follow these
directions: 1 gtt q30 min for the first 24 hrs. That means even when you sleep, set your alarm or have
someone help you out to put your drops in. Another eye drop I will prescribe helps to improve comfort.
Put l gtt of Scopolamine TID.
Doing cool compresses helps as well. Once I see your eye responding
well to the medications, then we need to add another type of eye drop to this regimen to minimize any
scarring.
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RENCURRENT CORNEAL EROSION
35 The top layer of your cornea is loosely adhered to the other layers and in the morning your eyelids pull off
this top layer. SCL's will protect it from the lid.
I will also prescribe an eye gtt to use QID and ung to
use at night to reduce the swelling.
FICH'S DSTROPHY
36 You have a hereditary condition that affects the front part of your eyes. This front part consists of 5 layers:
epithelium, bowman's, stroma, descemet's membrane and endothelial layer.
The pump that keeps fluid out
of these layers has broken down with age and causes your cornea to swell. The progression of your
condition called Fuch's D is divided into 3 stages. You are now at the beginning stage. You don't feel
anything but I see the signs while examining your eyes. As it progresses to the second stage, you will
start to become more bothered by glare and expect your vision to drop 2-3 lines.
In its last stage, we will
need to see whether there is a need for corneal transplant. Right now, will prescribe an eye drop that helps
to control the corneal swelling. But it may sting. I also recommend using a hair dryer to help dry out the
surface.
KERATOCONUS
37 You have a condition where the front part of your eye, called the cornea is getting thinner and so it is
bulging out.
We don l know the cause but for now, glasses can still improve your vision.
In the future,
you need to be fitted with rigid contact lens to provide optimum correction.
IRITIS/UVEITIS
TRAUMATIC IRITIS
38 You have an inflammation at the colored part of your eye, your iris.
It was due to the trauma you had. It is
very important that you come back for subsequent follow-up exams. I will now prescribe eye drops that
will calm the inflammation. The drops work very well. But make sure you remember to shake the bottle
before you put it in your eye.
It is a suspension, so you really need to shake it well.
that you do not stop the medication yourself.
It is very important
If you stop it too early, it may worsen your condition and
make it very difficult to treat afterwards. Do you have any questions?
SYSTEMIC DISEASE
ILNEITIS
39 You have an inflammation of the colored part of your eye. Our goal is to calm the inflammation as well
as decrease the pain.
1 gtt of homatropine QID, and I gtt of Prd Forte q3h. Come back tomorrow. Since
this is the third time you've had this, I need to refer you for some testing to make sure it's not any systemic
condition causing the inflammation.
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OCULAR ROSACEA
40 This is a non-contagious disorder of the oil glands and blood vessels near the skin surface.
It can be
effectively treated with antibiotics, which should be taken one hour before meals or 2 hours alter.
Be
aware of sunlight sensitivity.
41 There is a break in a tissue layer in the back of your eye. We need to monitor this condition for vessel
growth, which can lead to bleeding and cause damage to the tissues of your eye, ultimately causing a
decrease in vision.
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