OPHTHALMOLOGY TiKi TaKa

------------------------. PAPILLAEDEMA:
--------------. Transient loss of vision lasting few seconds with change in head psition.
. caused by ++ ICT manifested by morning headaches or change in headache intens
ity with
head position.
. Optic neuritis:
----------------. Associated with multiple sclerosis.
. Unilateral eye pain & visual loss.
. Exrenal hordeolum = Syte :
---------------------------. Staphylococclal abscess of the eyelid.
. Tx: Warm compresses.
. If not resolved within 48 hours ---> incision & drainage.
. Allergic conjunctivitis:
-------------------------. Intense itching - hyperemia - tearing - conjunctival oedema & eye lid edema.
. CATARACT:
----------. Progressive thickening of the lens.
. Blurred vision & glare.
. Tx: Lens extraction.
. Acute angle closure glaucoma:
------------------------------. Old pts 55 - 70 ys.
. Acute severe eye pain.
. Blurred vision , nausea & vomiting.
. Fixed dilated pupil non reactive to light.
. Open angle closure glaucoma:
-----------------------------. Loss of peripheral vision.
. preserved central tunnel vision.
. More common in AFRICAN AMERICANs.
. Macular degeneration:
----------------------. Loss of central vision.
. More common in OLD AGE.
. Post-operative ENDOPHTHALMITIS:
--------------------------------. H/O of recent ocular operation.
. symptoms manifest within 6 weeks of surgery.
. pain & -- visual acuity.
. swollen eyelids, corneal edema & infection.
. Herpes Zoster Ophthalmicus:
----------------------------. Dendriform ulcers.
. Vesicular rash in the trigeminal distribution.

. CMV Retinitis:
---------------. HIV pt with CD4 < 50.
. Fundoscopy: Yellow - white patches of retinal opacification & hemorrhages are
diagnostic.
. Optic neuritis:
----------------. Central scotoma.
. Afferent pupillary defect.
. Change in colour perception.
. -- visual acuity.
. Ass. e' Multiple sclerosis.
. Vitreous hemorrhage :
----------------------. Sudden loss of vision.
. Floaters in the visual field.
. Diabetic retinopathy is the most common cause.
. Fundus is hard to be visualized with obscured details.
. HSV ---> dendriTIC ulcers.
. HZV ---> dendriFORM ulcers.
. Amaurosis Fugax:
-----------------. Curtain falling down.
. Whitened edematous retina following the distribution of the retinal arteriole
s.
. caused by retinal emboli from the ipsi-lateral carotid artery.
. CRAO = CENTRAL RETINAL ARTERY OCCLUSION:
----------------------------------------. Sudden unilateral painless loss of vision.
. Pallor of the optic disc + CHERRY RED FOVEA + Boxcar segmentation.
. CRVO = CENTRAL RETINAL VEIN OCCLUSION:
--------------------------------------. Sudden painless unilateral loss of vision.
. THUNDER & BLOOD appearance.
. Vitreous hemorrhage:
--------------------. Black curtain coming down infront of eyes = Retinal detachment.
. Photopsia (Flashes of light).
. Floaters (Spots in the visual field).
. Central retinal vein occlusion:
--------------------------------. Sudden monocular loss of vision.
. Blood & thunder appearance.
. Optic disc swelling.
. Retinal hemorrhage.
. Dilated veins.
. Cotton wool spots.
. Central Retinal Artery Occlusion:
----------------------------------. Sudden painless loss of vision.

. Pallor of the optic disc.

. Cherry red fovea.
. Boxcar segmentation of blood in the retinal veins.
. Diabetic retinopathy:
----------------------. H/O of D.M.
. -- visual acuity in both eyes.
. Micro-aneurysms.
. Dot & blot hemorrhages.
. Hard exudates.
. Macular edema.
. Tx ARGON laser photocoagulation to prevent complications.
. Presbyopia:
-----------. Difficulty in near vision.
. Prespyobia is due to -- in lens elasticity not due to macular degeneration !!
. A history of middle aged individual who has to hold books at an arms length t
o read is
classic.
. On Tx of Acute glaucome , ATROPINE is contraindicated. . 1st line Tx: I.V. MAN
NITOL.
. Multiple Sclerosis :
---------------------. FEMALE with multiple neurological presentations.
. Associated optic neuritis can lead to blurring of vision & retro-bulbar pain.
. Sub-conjunctival hemorrhage ---> No ttt .. Just Observation.
. CRAO Tx: ocular massage + High flow Oxygen.
. Sympathetic Ophthalmia:
------------------------. Damage of one eye (sympathetic eye) after a penetrating injury to the other e
ye.
. Due to UN-COVERING OF HIDDEN ANTIGENS !
. In HIV pts:
------------.. HSV & HZV :
-------------... Pain-ful.
... Ass. with karatitis & conjunctivitis.
... Fundus: Peripheral pain lesions & central necrosis.
.. CMV :
-------... Pain-less.
... Not ass. e'keratitis or. conjunctivitis.
... Fundus: Hemorrhages & fluffy or granular lesions around retinal vessels.
. Neuro-fibramatosis type 1 = Axillary freckling + Cafe' au lait patches + Optic
glioma.
--------------------------. Diabetic pt with blurry vision:
--------------------------------. Type 2 D.M. with HYPEROSMOLAR HYPERKETOTIC state without ketoacidosis.

. Glucose in urine with NO KETONES.

. NKHS = Non Ketotic Hyperosmolar $
so, the cause of blurring of vision is HYPEROSMOLARITY !
. Macular degeneration:
----------------------. Grid test: distortion of the straight lines that appear wavy !
------------------------Dr. Wael Tawfic Mohamed
-------------------------