1. OPHTHALMOLOGY REVIEW

2. History Past Medical History –Hipertension –Diabetes –Allergy Other accompanying disease

3. Lens Equatorial diameter –6.5mm at birth –9-10mm in late life AP width –3mm at birth –6mm at 80 yrs of age

4. Retina Layers –RPE –Rods and cones –ELM –ONL –OPL –INL –IPL –Ganglion cell layer –Nerve fiber layer –INL

6. MYOPIA

7. HYPEROPIA

8. ASTIGMATISM

9. Accomodation Ciliary muscle contraction –Moves ciliary muscle mass forward and inward –Relaxes zonular tension Lens assume a globular shape, shortening the anterior curvature Lens thickening is due to change in nuclear shape

10. Presbyopia Loss of accomodative power Steady, is completed by age 50 Causes: –Increased size of lens –Altered mechanical relationships –Increased stiffness of lens nucleus secondary to changes in crystalline proteins of the fiber cytoplasm

12. PTERYGIUM Wing shaped, triangular fibrous subepithelial ongrowth of bulbar conjunctival tissue over the limbus

13. PATHOPHYSIOLOGY Strongly correlated to UV exposure Dryness, inflammation and exposure to wind and dust Collagenase up-regulation and cellular migration and angiogenesis

14. CLINICAL FEATURES Small, gray corneal opacity near the nasal limbus The conjunctivae overgrows the opacity and encroaches onto the cornea in a triangular fashion

15. In the cornea, there is destruction of the Bowman’s layer by fibrovascular ingrowth with mild inflammatory changes Nearly always preceded and accompanies pingueculae With prevalence increasing steadily with proximity to the equator

17. COMPLICATIONS Astigmatism Inflammation/ irritation due to disruption of the precorneal tear film Decrease in vision due to involvement of the visual axis

18. INDICATIONS FOR EXCISION Cosmetic reasons Limitation of EOMs Progression towards the visual axis

19. SURGICAL TECHNIQUES Bare sclera Primary conjunctival closure Rotational flap Conjunctival autografts Amniotic membrane grafts Lamellar keratoplasty

20. Conjunctivitis One of the most common nontraumatic eye complaints Inflammatory process that involves the conjunctiva. Cellular infiltration and exudation characterize conjunctivitis on a cellular level.

21. Classification Based on cause: –Viral –Bacterial –Fungal –Parasitic –Toxic –Chlamydial –Chemical –Allergic

22. VIRAL CONJUNCTIVITIS

24. Etiology Adenovirus is the most common cause Herpes simplex virus (HSV) is the most problematic. Less common: varicella-zoster virus (VZV), picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscum contagiosum, vaccinia), and human immunodeficiency virus (HIV).

25. Signs and Symptoms Ocular itching Foreign body sensation Tearing Redness Photophobia

26. Signs and Symptoms Preauricular adenopathy Epiphora Hyperemia, chemosis, subconjunctival hemorrhage Follicular conjunctival reaction Pseudomembranous or cicatricial conjunctival reaction Edematous and ecchymotic eyelids. Corneal epithelial defect.

27. Management Treatment of conjunctivitis is supportive. Cold compresses and lubricants, such as artificial tears, for comfort. Topical steroids may be used for pseudomembranes or when subepithelial infiltrates impair vision

28. Management Conjunctivitis caused by HSV are treated with topical antiviral agents, including idoxuridine solution and ointment, vidarabine ointment, and trifluridine solution. Treatment of VZV eye disease includes oral acyclovir, 600-800 mg, 5 times daily for 7-10 days.

29. BACTERIAL CONJUNCTIVITIS

31. Etiology Gram-positive cocci - Staphylococcus epidermidis, Streptococcus pyogenes,Streptococcus pneumoniae Gram-negative cocci - Neisseria meningitidis, Moraxella lacunata Gram-negative rods - genus Haemophilus, family Enterobacteriaceae Pseudomonas aeruginosa Chlamydia trachomatis. Neisseria gonorrhoeae

32. Signs and Symptoms Acute onset, minimal pain, occasional pruritus, exposure history Chlamydial conjunctivitis: chronic onset, minimal pain level, occasional pruritus, and STD history.

33. Signs and Symptoms Preauricular adenopathy sometimes occurs; chemosis is common. Discharge is copious, thick and purulent. Conjunctival injection is moderate or marked.

34. Signs and Symptoms Chamydial conjunctivitis: Occasional preauricular adenopathy Chemosis is rare. Minimal, seropurulent discharge Conjunctival injection is moderate

35. Management Antimicrobials and symptomatic therapy, including topical sulfacetamide, erythromycin, gentamicin, ciprofloxacin, or ofloxacin. Gonococcal conjunctivitis requires systemic treatment: norfloxacin, cefoxitin, ceftriaxone, cefotaxime, or spectinomycin. Treat chlamydia with tetracycline, doxycycline, azithromycin, or erythromycin

36. ALLERGIC CONJUNCTIVITIS

37. Seasonal allergic conjunctivitis (SAC) Perennial allergic conjunctivitis (PAC) Vernal keratoconjunctivitis (VKC) Atopic keratoconjunctivitis (AKC) Giant papillary conjunctivitis (GPC)

38. Seasonal and perennial allergic conjunctivitis –SAC typically have symptoms of acute allergic conjunctivitis for a defined period of time –In contrast, individuals with PAC may have symptoms that last the whole year

39. Vernal keratoconjunctivitis –Chronic bilateral inflammation of the conjunctiva –Associated with a personal and/or family history of atopy. Atopic keratoconjunctivitis –AKC is a bilateral inflammation of conjunctiva and eyelids, which has a strong association with atopic dermatitis.

40. Giant papillary conjunctivitis –“Giant" papillae, which are typically greater than 0.3 mm in diameter. –Immunologic reaction to a variety of foreign bodies: contact lenses (hard and soft), ocular prostheses, extruded scleral buckles, and exposed sutures.

41. Signs and Symptoms Itching of the eyelids Watery discharge Redness Photophobia Pain Foreign body sensation Blepharospasm

42. Seasonal and perennial allergic conjunctivitis –Classic signs of allergic conjunctivitis: injection of conjunctival vessels, chemosis eyelid edema. –Milky appearance due to obscuration of superficial blood vessels by edema within the substantia propria of the conjunctiva.

43. Vernal keratoconjunctivitis –Giant papillae, occur on the superior tarsal conjunctiva, assume a flattop appearance (cobblestone papillae) –A ropy mucus discharge –Horner-Trantas dots: degenerated epithelial cells and eosinophils. –Punctate epithelial keratopathy (PEK). –Vernal pseudogerontoxon: degenerative lesion in peripheral cornea resembling corneal arcus.

44. Atopic keratoconjunctivitis Dry, scaly, and inflamed skin. Meibomian gland dysfunction and keratinization. Blepharitis, chemosis, papillary reaction Fibrosis of conjunctiva Punctate epithelial keratopathy, neovascularization, stromal scarring, and possibly ulceration. Keratoconus, which may stem from chronic eye rubbing. Anterior or posterior subcapsular cataract formation

45. Giant papillary conjunctivitis Large cobblestone papillae Mechanical ptosis of the upper lid. 3 zones of superior tarsal conjunctiva (Allansmith). Soft CL: appear in zone 1 and progress toward zone 3, while with rigid gas permeable CLexhibit a reverse pattern Localized irritant Chronic bulbar conjunctival injection and inflammation

46. Management Systemic and/or topical antihistamines Mast cell stabilizers Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids