眼科門診常見疾病 主治醫師教學 98-03-10 眼科 譚超毅

Myopia, Hyperopia, Astigmatism

Esotropia Congenital Accommodative

Exotropia Exophoria Intermittent exotropia Constant exotropia

Cataract

Cataract Surgery

Assessment of “RED EYE” General Danger Symptoms Decreased vision Severe ocular pain Colored halos

Assessment of “RED EYE” Associated symptoms and symptom complexes Itching, seasonal exacerbation, associated rhinitis allergy Burning, foreign body sensation, tearing  blepharitis, dry eye, retained foreign body, trichiasis Localized lid tenderness  hordeolum, chalazion

Eyelid Inflammations Hordeolum Chalazion Blepharitis

Trichiasis

Preseptal Cellulitis Pain, red, swelling of lid Vision? EOM? Pupil sign? Oral antibiotic

Orbital Cellulitis

Subconjunctival Hemorrhage Can occur secondary to blunt trauma or can be spontaneous (Valsalva, bleeding disorder etc.) No pain, normal vision No treatment required resolves in 1-3 weeks Lubrication if foreign body sensation

Ultraviolet Keratitis Sources: Sunlamps, welding arcs Severe Pain and photophobia Management : Cycloplegics, antibiotic ointment, patch

Pingueculum and Pterygium

Conjunctivitis Redness, foreign body sensation, discharge Onset: acute or chronic Viral or bacterial origin?

Acute Viral Conjunctivitis History of previous contacts or URI Initially unilateral Watery discharge, follicles +/- pseudomembrane Tender preauricular node Very contagious for 7-10 days Adenovirus commonest

Chlamydial Conjunctivitis sexually transmitted: history of vaginitis, cervicitis or urethritis may be present inferior tarsal follicles, corneal pannus, preauricular node, often unilateral

Allergic Conjunctivitis

Herpes Simplex Keratitis

Herpes Zoster Ophthalmicus Pseudodendrite

Open Angle Glaucoma Elevated IOP Disc cupping enlargement Visual defect

Acute PACG: Symptoms pain in and around the eye redness of the eye nausea and vomiting blurred vision A prodrome of rainbow colored halos around lights may be reported

Acute PACG: Signs Elevated IOP Conjunctival injection Cloudy cornea (edema) Shallow anterior chamber Mid-dilated, sluggishly reactive or nonreactive pupil Flare and cells in the anterior chamber Closed angle on gonioscopy

Acute PACG

Corneal Ulcer Pain, redness, blurred vision Contact lens wearing? Trauma? Topical antibiotics

Gonococcal Corneal Ulcer

Acute Anterior Uveitis

Endophthalmitis Postoperative Traumatic Endogenous

Endogenous endophthalmitis Blurred vision, redness, pain Fungal or bacterial infections Treatments Intravitreal antibiotic injection Vitrectomy Systemic and topical antibiotics

Pressure Patch

Painless Visual Loss

CRAO

BRAO

CRVO

BRVO

Retinal Detachment Floaters, photopsia, curtain-like VF defect Fundus exam Photocoagulation or surgery

Diabetic Retinopathy BDR PDR

Acute Diplopia Traumatic Orbital wall fracture Orbital hemorrhage CN III, IV, VI palsy Nontraumatic Refractive error Optic media opacity CN III, IV, VI palsy

Oculomotor Palsy

Trochlear Palsy

Abducens Palsy

Ocular Trauma

Classification of ocular trauma Trauma of lids, orbit and adnexa Trauma of eye Closed globe injury: Wall of the eye is intact Open globe injury: Wall of the eye has been breached

Chemical Burn Grade 1 Grade 2 Grade 4 Grade 3

Chemical Burn Acid precipitates quickly Alkali continues to penetrate Therefore can progress over an extended period of time Management Continuous irrigation with saline until neutral pH Test fornices with Litmus paper Sweep fornices to remove retain debris Antibiotic ointment, cycloplegics

Corneal Abrasion

Lid Laceration

Traumatic Hyphema

Blunt Trauma: Traumatic Mydriasis

Traumatic Lens Dislocation

Blow-out Fracture Symptoms Diplopia, especially on up-gaze Eyelid swelling after nose blowing Small right “trapdoor” floor fracture Signs Enophthalmos Restricted eye movement Orbital rim step deformity Infraorbital nerve anesthesia

Traumatic Optic Neuropathy Blunt eye trauma Combined skull fracture? RAPD (+) Prognosis: initial VA Steroid pulse therapy or optic nerve sheath decompression

Carotid-Cavernous Fistula

Globe Rupture

Corneoscleral Laceration

Subluxated Corneal Flap

Conjunctival Foreign Body

Corneal Foreign Body

Corneal Foreign Body

Intracameral Foreign Body

Intracameral Foreign Body

Intraocular Foreign Body

Intraocular Foreign Body

Intraorbital Foreign Body

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