1. 眼科門診常見疾病
主治醫師教學
眼科 譚超毅

2. Myopia, Hyperopia, Astigmatism

3. Esotropia
Congenital
Accommodative

4. Exotropia
Exophoria
Intermittent exotropia
Constant exotropia

5. Cataract

6. Cataract Surgery

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

8. 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

9. Eyelid Inflammations
Hordeolum
Chalazion
Blepharitis

10. Trichiasis

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

12. Orbital Cellulitis

13. 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

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

15. Pingueculum and Pterygium

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

17. 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

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

19. Allergic Conjunctivitis

20. Herpes Simplex Keratitis

21. Herpes Zoster Ophthalmicus
Pseudodendrite

22. Open Angle Glaucoma Elevated IOP Disc cupping enlargement
Visual defect

23. 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

24. 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

25. Acute PACG

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

27. Gonococcal Corneal Ulcer

28. Acute Anterior Uveitis

29. Endophthalmitis
Postoperative
Traumatic
Endogenous

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

31. Pressure Patch

32. Painless Visual Loss

33. CRAO

34. BRAO

35. CRVO

36. BRVO

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

38. Diabetic Retinopathy
BDR
PDR

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

40. Oculomotor Palsy

41. Trochlear Palsy

42. Abducens Palsy

43. Ocular Trauma

44. 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

45. Chemical Burn
Grade 1
Grade 2
Grade 4
Grade 3

46. 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

47. Corneal Abrasion

48. Lid Laceration

49. Traumatic Hyphema

50. Blunt Trauma: Traumatic Mydriasis

51. Traumatic Lens Dislocation

52. 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

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

54. Carotid-Cavernous Fistula

55. Globe Rupture

56. Corneoscleral Laceration

57. Subluxated Corneal Flap

59. Conjunctival Foreign Body

60. Corneal Foreign Body

61. Corneal Foreign Body

62. Intracameral Foreign Body

63. Intracameral Foreign Body

64. Intraocular Foreign Body

65. Intraocular Foreign Body

66. Intraorbital Foreign Body

67. THANK YOU