1. Dr.Aghlab Khoury AlQuds medical school basr
ABC OF EYES
HISTORY AND EXAMINATION
Dr.Aghlab Khoury AlQuds medical school basr

2. ABC OF EYES HISTORY AND EXAMINATION
Previous ophthalmic history
Medical history
Family history
Drug history

3. ABC OF EYES HISTORY AND EXAMINATION
Visual symptoms: details to establish
Monocular or binocular
Type of disturbances
Onset
Presence and type of field loss
Associated symptoms
Effect on lifestyle

4. ABC OF EYES HISTORY AND EXAMINATION
Vision VF
Pupils
Ocular motility
Eye position
Eyelids,conjunctiva,sclera and cornea
Intraocular pressure
Ophthalmoscopy

5. ABC OF EYES HISTORY AND EXAMINATION
Vision test

6. ABC OF EYES HISTORY AND EXAMINATION
Visual field test

7. ABC OF EYES HISTORY AND EXAMINATION
Pupils

8. ABC OF EYES HISTORY AND EXAMINATION
Ocular motility

9. ABC OF EYES HISTORY AND EXAMINATION
Eye position

10. ABC OF EYES HISTORY AND EXAMINATION
Eyelids

11. ABC OF EYES HISTORY AND EXAMINATION
Conjunctiva

12. ABC OF EYES HISTORY AND EXAMINATION
Cornea

13. ABC OF EYES HISTORY AND EXAMINATION
Sclera

14. ABC OF EYES HISTORY AND EXAMINATION
Intraocular pressure

15. ABC OF EYES HISTORY AND EXAMINATION
Ophthalmoscopy

16. ABC OF EYES
RED EYE

17. ABC OF EYES RED EYE History Onset Severity Previous attacks
Other family members
Contact lenses

18. ABC OF EYES RED EYE Symptoms Sings Blurring of vision Pain Photophobia
FB sensation
Itching
Sings
Type of redness
Discharge FB
Corneal edema
Corneal opacity
Lid swelling
Abnormal pupil

19. ABC OF EYES RED EYE Conjunctivitis Bacterial Viral
Chlamydial conjunctivitis
Conjunctivitis in infants
Allergic

20. ABC OF EYES RED EYE
Conjunctivitis
Bacterial

21. ABC OF EYES RED EYE
Conjunctivitis
Viral

22. ABC OF EYES RED EYE
Conjunctivitis
Chlamydial

23. ABC OF EYES RED EYE
Conjunctivitis
Ophthalmia neonatorum

24. ABC OF EYES RED EYE
Conjunctivitis
Allergic

25. ABC OF EYES RED EYE – Episcliritis and Scleritis

26. ABC OF EYES RED EYE – Corneal Ulcers

27. ABC OF EYES RED EYE - Uveitis

28. ABC OF EYES RED EYE – Acute Angle Closure Glaucoma

29. ABC OF EYES RED EYE – Subconjunctival Haemorrhage

30. ABC OF EYES RED EYE – Inflamed Pterygium & Pingueculum

31. ABC OF EYES REFREACTIVE ERRORS

32. ABC OF EYES REFREACTIVE ERRORS

33. ABC OF EYES REFREACTIVE ERRORS - Myopia

34. ABC OF EYES REFREACTIVE ERRORS - Hypermetropia

35. ABC OF EYES REFREACTIVE ERRORS - Astigmatism

36. ABC OF EYES REFREACTIVE ERRORS – Pinhole Test

37. ABC OF EYES REFREACTIVE ERRORS - Presbyopia

38. ABC OF EYES REFREACTIVE ERRORS – Contact Lenses
Soft contact lenses
Gas permeable contact lenses
Hard contact lenses

39. ABC OF EYES REFREACTIVE ERRORS – Contact Lenses
Indications
Personal appearance
High refractive errors
High anisometropia
Corneal surface irregularities
Therapeutic indications

40. ABC OF EYES REFREACTIVE ERRORS – Contact Lenses
Contraindications
Atopy
Dry eyes
Previous glaucoma surgery
Inability to handle CL
Active ocular surface infection

41. ABC OF EYES REFREACTIVE ERRORS – Contact Lenses
Complications
Corneal abscess
Corneal abrasions
Corneal pannus

42. ABC OF EYES REFREACTIVE ERRORS – Refractive SurgeryRK
ICR
PRK
LASIK
CLE
ICL
Bioptics

43. ABC OF EYES EYELID, ORBITAL, and LACRIMAL DISORDERS

44. ABC OF EYES EYELID DISORDERS - Lumps
Importance
May need disfiguring operation if left
May be life threatening
May cause visual disturbance
May cause amblyopia in children
May indicate systemic disease

45. ABC OF EYES EYELID DISORDERS - Lumps
Chalazion

46. ABC OF EYES EYELID DISORDERS - Lumps
Stye

47. ABC OF EYES EYELID DISORDERS - Lumps
Papilloma

48. ABC OF EYES EYELID DISORDERS - Lumps
Xanthelasma

49. ABC OF EYES EYELID DISORDERS - Lumps
Basal cell carcinoma

50. ABC OF EYES EYELID DISORDERS – Inflammatory disease
Blepharitis

51. ABC OF EYES EYELID DISORDERS – Inflammatory disease
Chalazion
Stye
Acute dacryocyctitis
Allergy
Herpes simplex
Herpes zoster ophthalmicus

52. ABC OF EYES EYELID DISORDERS – Malposition
Entropion

53. ABC OF EYES EYELID DISORDERS – Malposition
Ectropion

54. ABC OF EYES EYELID DISORDERS – Malposition
Trichiasis

55. ABC OF EYES EYELID DISORDERS – Malposition
Ptosis
May indicate a life threatening condition
May indicate a disease that needs systemic treatment
May cause irreversible amblyopia

56. ABC OF EYES ORBITAL DISORDERS – Proptosis
Causes
Orbital cellulitis
Orbital inflammatory disease
Thyroid eye disease
Orbital lymphoma
Lacrimal gland tumors
Orbital invasion from adjacent sinus
Big eye

57. ABC OF EYES ORBITAL DISORDERS – Enophthalmos
Causes
Blowout fracture
Microphthalmos
Atrophy of orbital contents
Cicatrizing orbital lesions

58. ABC OF EYES LACRIMAL SYSTEM

59. ABC OF EYES LACRIMAL SYSTEM – Tear film

60. ABC OF EYES LACRIMAL SYSTEM – Watering eye
Excessive tears production
Punctal malposition
Punctal stenosis
Blockage

61. ABC OF EYES LACRIMAL SYSTEM – Dry eye
Symptoms
Causes
Diagnosis
Treatment

62. ABC OF EYES EYE INJURIES

63. ABC OF EYES EYE INJURIES
History
The mechanism
The circumstances
Injuries in children

64. ABC OF EYES EYE INJURIES
Examination VA
Inspection
Lids
Globe
Pupil
Flurescein

65. ABC OF EYES EYE INJURIES
Corneal abrasions

66. ABC OF EYES EYE INJURIES
Foreign bodies

67. ABC OF EYES EYE INJURIES
Radiation damage (flash burn)

68. ABC OF EYES EYE INJURIES
Chemical burn
Irrigate, irrigate then irrigate
Remove loose particles
Beware alkalis
Refer patient to ophthalmic department

69. ABC OF EYES EYE INJURIES
Chemical burn

70. ABC OF EYES EYE INJURIES
Blunt eye injuries

71. ABC OF EYES EYE INJURIES
Blunt eye injuries

72. ABC OF EYES EYE INJURIES
Penetrating eye injuries
If suspected, the eye should be examined very gently
Special attention: history of high velocity injury

73. ABC OF EYES EYE INJURIES
Penetrating eye injuries
Signs to look for
Distorted pupil
Cataract
Prolapsed uveal tissue

74. ABC OF EYES EYE INJURIES
Penetrating eye injuries
Protect the eye from any pressure and refer the patient immediately to the nearest eye department

75. ABC OF EYES ACUTE VISUAL DISTURBANCE

76. ABC OF EYES ACUTE VISUAL DISTURBANCE
History
Onset
Old or new
Previous ophthalmic history
General health
Understand the disturbance
VF loss
Scotoma
Distortion
Floaters
Flashing lights
Amarosis fugax
Zigzag lines
Headache
Pain on eye movement

77. ABC OF EYES ACUTE VISUAL DISTURBANCE
Examination VA
Pupillary reaction
Red reflex
VF testing
Fundoscopy

78. ABC OF EYES ACUTE VISUAL DISTURBANCE
Posterior vitreous detachment
The most common cause of floaters
Might be associated with flashes
May result in retinal hole and retinal detachment
Needs urgent referral

79. ABC OF EYES ACUTE VISUAL DISTURBANCE
Vitreous Haemorrhage
Sudden onset of floaters and loss of vision
Common in diabetics
Refer to ophth. to clarify the cause and treat underlying disease

80. ABC OF EYES ACUTE VISUAL DISTURBANCE
Retinal detachment
Floaters and flashes
VF loss
Variable in VA
More likely to occur in high myopic patients after trauma or intraocular operation
Common in PDR
Needs surgical intervention

81. ABC OF EYES ACUTE VISUAL DISTURBANCE
Arterial occlusion
Occlusion of the retinal artery may be caused by
Arteriosclerotic changes
Embolus (from heart or carotid artery)
Inflammation (rare)

82. ABC OF EYES ACUTE VISUAL DISTURBANCE – Arterial Occlusion
History
Sudden painless visual loss which may be complete (due to central retinal artery occlusion) or partial (due to branch retinal artery occlusion)
Patient usually have a history of hypertension or heart disease

83. ABC OF EYES ACUTE VISUAL DISTURBANCE – Arterial Occlusion
Examination
The visual acuity is reduced in CRAO but may be normal in BRAO
Relative afferent pupillary defect is present in CRAO
The retinal arteries are narrow or collapsed. 
In CRAO, the fovea shows a cherry-red spot against the white infarcted retina. 
In BRAO, the white infarcted retina corresponds to the occluded retina. 
Emboli may be seen in the arteries if the cause is emboli

84. ABC OF EYES ACUTE VISUAL DISTURBANCE – Arterial Occlusion
Management
Immediate referral if the visual loss is less than 6 hours. 
Intravenous acetazolamide and globe massage to lower the intraocular pressure and hopefully re-establish the arterial flow.
Cardiovascular assessment.
An ESR is usually performed in the absence of obvious embolus to exclude arteritic causes.
Long term low dose aspirin is advised to reduce the risk of occurrence

85. ABC OF EYES ACUTE VISUAL DISTURBANCE – Arterial Occlusion

86. ABC OF EYES ACUTE VISUAL DISTURBANCE –Venous Occlusion
Retinal vein occlusion is a common vascular disorder caused by impaired venous blood flow.
It is second only to diabetes mellitus as a vascular cause of impaired vision
Hyperviscosity of the blood and hypertension are common causes

87. ABC OF EYES ACUTE VISUAL DISTURBANCE –Venous Occlusion
History
Sudden onset painless blurred vision
The patient might experience a visual field defect

88. ABC OF EYES ACUTE VISUAL DISTURBANCE –Venous Occlusion
Examination
The visual acuity is reduced in CRVO. However, the reduction is dependent on the severity of the occlusion.
In BRVO, the visual acuity may be normal if the fovea is not involved. 
Relative afferent pupillary defect may be present in patient with severe CRVO
Ophthalmoscopy reveals extensive intraretinal and pre-retinal hemorrhage with distended retinal veins.

89. ABC OF EYES ACUTE VISUAL DISTURBANCE –Venous Occlusion
Management
Refer within 24 hours.
Identify and treat any underlying cause
Antiplatelets therapy
Follow-up in the clinic is arranged so that those at risk of neovascular glaucoma may be treated with PRP

90. ABC OF EYES ACUTE VISUAL DISTURBANCE –Venous Occlusion

91. ABC OF EYES ACUTE VISUAL DISTURBANCE – Disciform MD
History
Sudden onset of disturbance in the central vision
Elderly are usually affected
Caused by choroidal neovascular membrane leak or hemorrhage

92. ABC OF EYES ACUTE VISUAL DISTURBANCE – Disciform MD
Examination
VA depends on the extent of macular involvement
Distorted line on Amsler chart
Fundoscopy and FFA

93. ABC OF EYES ACUTE VISUAL DISTURBANCE – Disciform MD

94. ABC OF EYES ACUTE VISUAL DISTURBANCE – Disciform MD
Management
Laser
Photodynamic therapy
Lucentis and Avastin
Vitamins and minerals
Surgery

95. ABC OF EYES ACUTE VISUAL DISTURBANCE – Optic Neuritis
History
Sudden unilateral Loss of vision
Central VF loss
Age (usually woman)
Pain that worsen on eye movement
H/o previous attacks
Symptoms of MS

96. ABC OF EYES ACUTE VISUAL DISTURBANCE – Optic Neuritis
Examination
VA from 6/6 to PL
APD
Color vision disturbances
Central scotoma
Normal or swollen optic nerve head

97. ABC OF EYES ACUTE VISUAL DISTURBANCE – Optic Neuritis
Management
Usually spontaneous recovery
Steroids in selected cases
SOL should be ruled out in uncertain cases

98. ABC OF EYES GRADUAL VISUAL DISTURBANCE

99. ABC OF EYES GRADUAL VISUAL DISTURBANCE
History
Onset
Old or new
Previous ophthalmic history
General health
Understand the disturbance
VF loss
Scotoma
Distortion

100. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Refractive errors
Longstanding history
Pinhole test

101. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Corneal disease

102. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Cataract

103. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Age related macular degeneration

104. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Macular hole

105. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Diabetic maculopathy

106. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Hereditary retinal degeneration

107. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Compressive lesions of optic pathways

108. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Causes
Drugs
Alcohol
Smoking
Chloroquine
Tetracycline
Steroids

109. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Causes of acquired cataract
Age
Diabetes
Inflammation
Trauma
Steroids

110. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Indications for surgery
No need to wait far a cataract to be mature
No set level of vision
Depends on the patient's needs

111. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Surgical techniques
Phacoemulsification

112. ABC OF EYES GRADUAL VISUAL DISTURBANCE - cataract
Extracapsular method

113. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Intracapsular method

114. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Complications of cataract surgery
Intraoperative
Ocular perforation
Subconjunctival hemorrhage
Suprachoroidal hemorrhage
Iris prolapse
Posterior capsular tear
Vitreous loss

115. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Complications of cataract surgery
Postoperative
Infective endophthalmitis
Retinal detachment
Residual refractive error
Uveitis
Cystoid macular edema
Glaucoma
Posterior capsular opacification

116. ABC OF EYES GRADUAL VISUAL DISTURBANCE - Cataract
Optical correction after surgery
Glasses
Contact lenses
Secondary IOL implantation

117. ABC OF EYES GLAUCOMA

118. ABC OF EYES GLAUCOMA
A progressive damage of the optic nerve which might be associated with increased intraocular pressure
The commonest cause of irreversible blindness

119. ABC OF EYES GLAUCOMA

120. ABC OF EYES GLAUCOMA

121. ABC OF EYES GLAUCOMA
Symptoms & signs
Raised IOP

122. ABC OF EYES GLAUCOMA
Symptoms & signs
Haloes

123. ABC OF EYES GLAUCOMA
Symptoms & signs
Cloudy cornea

124. ABC OF EYES GLAUCOMA
Symptoms & signs
Pain

125. ABC OF EYES GLAUCOMA
Symptoms & signs
Visual field loss

126. ABC OF EYES GLAUCOMA
Symptoms & signs
Optic disc changes

127. ABC OF EYES GLAUCOMA
Symptoms & signs
Venous occlusion

128. ABC OF EYES GLAUCOMA
Symptoms & signs
Enlargement of the eye

129. ABC OF EYES GLAUCOMA – Primary Open Angle Glaucoma
Symptoms
No symptoms until sever damage occurs
Best detected by screening

130. ABC OF EYES GLAUCOMA – Primary Open Angle Glaucoma
Risk factors
Ageing
Positive family history
Black race
Level of IOP
Myopia
Thin corneas

131. ABC OF EYES GLAUCOMA – Primary Open Angle Glaucoma
Signs
Optic nerve cupping
Asymmetry
Optic disc hemorrhages
VF loss
Increased IOP

132. ABC OF EYES GLAUCOMA – Acute Angle Closure Glaucoma

133. ABC OF EYES GLAUCOMA – Acute Angle Closure Glaucoma
Symptoms
Red painful eye
Headaches
Nausea and vomiting
Blurred vision
Haloes
H/o previous attacks

134. ABC OF EYES GLAUCOMA – Acute Angle Closure Glaucoma
Groups at risk
Hypermetropes
Old age
Female patient

135. ABC OF EYES GLAUCOMA – Acute Angle Closure Glaucoma
Signs
Decreased VA
Corneal edema
Semidilated pupil poorly reacted to light
Palpation = eye hard and tender

136. ABC OF EYES GLAUCOMA – Acute Angle Closure Glaucoma
Management
Admit to hospital
Acetazolamide IV 500mg
Topical Timolol drops 0.5%
Pilocarpine 4% drops
Manitol 20%
YAG laser PI
Surgical PI
Iridoplasty
Drainage procedure

137. ABC OF EYES GLAUCOMA – Other types of Glaucoma
Inflammatory
Steroid induced
Rubeotic glaucoma
Post traumatic
Congenital
Postoperative

138. ABC OF EYES GLAUCOMA – Medical Treatment
The aim of the treatment is to reduce the IOP to stop the progression of optic nerve damage

139. ABC OF EYES GLAUCOMA – Medical Treatment
B – blockers
Timolol
Betaxolol
Sympathomimetic agents
Adrenalin
Brimonidin
Carbonic anyhdrase inhibitors
Dorzolamide
Acetazolamide
Parasympathomimetic agents
Pilocarpine
Prostaglandin analogues
Latanoprost
Travoprost
Bimatoprost

140. ABC OF EYES GLAUCOMA – Laser Treatment
Laser trabeculoplasty
Laser iridotomy
Laser iridoplasty
Laser ciliary body ablation

141. ABC OF EYES GLAUCOMA – Surgical Treatment
Iridectomy
Drainage procedure

142. ABC OF EYES GLAUCOMA – Surgical Treatment
Complications
Failure ( scarring )
Hypotony
Cataract
Reduction in BCVA
Endophthalmitis