OCULAR SYMPTOMATOLOGY OCULAR COMPLAINTS 1. OBJECTIVE - what can be seen by an observer 2.

SUBJECTIVE what is felt and reported by the patient OBJECTIVE SIGNS 1. REDNESS OCULAR ADNEXAE Bheparitis redness of the lids usually associated w/ inflammation of the lid margin Internal hordeolum glands within External hordeolum glands at the root of the eyelashes Dermatitis contact / systemic allergy Dacryocystitis redness localized nasally (inflammation of the lacrimal sac) Dacryoadenitis redness in the lateral aspect (inflammation of the lacrimal gland) EYEBALL Conjunctival congestion dilatation of the superficial conjunctival blood vessel - signifies inflammation of the conjunctiva, sclera or lids. Ciliary injection localized near the limbus involving the deeper blood vessels of the anterior ciliary artery and denotes inflammation of the cornea intraocular structures / glaucoma Subconjunctival hemorrhage flood accumulated under the conjunctiva owing to ruptured blood vessel.

2. CRUST / SCALES / FLAKES Contact dermatitis - the skin of the lids may show scaling Blepharitis 3. SECRETION Watery secretion Infection of the conjunctiva mucoid, mucopurulent, purulent discharge Allergic conjunctivitis allergens produced stringy secretion Vit. A deficiency whitish foamy secretion Vicarious menstruation bloody discharge LUMPS Pre auricular masses Lymphadenopathy acute infection of the lids and orbit, granulomatous infection, vital infection of the conjucntiva Malignant tumors of the eyelids and eyeball Orbital margin masses

4.

Tumors Granuloma Hematoma Meningocoele

Eyelid masses Hordeolum Granuloma Cholesterol deposit (xanthelasma) Tumors Lacrimal sac masses Infalammation Mucocoele Tumor Eyeball masses small localized conjunctiva Phlyctenule Pinguecula Pterygium Nodule Cyst Dermoid Nevus Malignant tumor Uveal tissue

Desmetocoele corneal Staphyloma scleral

5. DISTURBANCE OF THE EYELID Malformation Coloboma Epicanthus Epiblepharon Blepharochalasis Malposition exophthalmos lid retraction pseudoptosis Malfunction Ptosis upper lid may not be elevated partially / fully due to paralysis of levator palpebrane Lagophthalmos unable to close completely due to paralysis of facial nerve, pressure of cicatricial bands or in proptis Blepharospasm toxic / clonic movement of the eyelid - duane & marcus- gunn syndrome 6. DISTURBANCE OF THE EYEBALL Abnormal size

Hydrophthalmus Buphthalmus }enlarge size Macroglobus Atropia bulbi}small size Phthisis bulbi

Malposition Proptosis anteriorly displaced Enophthalmus can follow orbital atrophy / found in sympathetic paralysis Maldirection Exotropia Esotropia Hypertropia Hypotropia Malfixation Nystagmus labyrinth nystagmus vertical, oblique, rotating rel. to untracaranial tesion horrible nystagmus tesion in the inner ear / in the brain SUBJECTIVE SYMPTOMS 1. PAIN Eye pain Foreign body sensation Itching, snorting, burning sensation Soreness / tenderness Orbital pain Anteriorly tenonitis Deep seated retrobulbar neuritis Head pain / head ache Localized temporal / frontal (EOR) Inflammation of the orbit, lids / eye & glaucoma unilateral Bilateral uncorrected EOR /muscle imbalance Migraine hemicrania 2. VISUAL DISTURBANCE Dizziness Poor distant vision ocular media, perceptive element, diabetes, retinal artery occlusion / EOR Poor rear vision presbyopia, glaucoma, anterior uveitis Spot in the center central scotoma Hemeralopia leukoma , cataract Nyctalopia optic atrophy ,glaucoma, retiritis pigmentosa, Vit A deficiency Diplopia double vision (anisometropia, wound of iris, lens dislocation, inc. cataract & mascular pathology

 Methamopphopsia distorted vision (astigmatism) choroidal lesions, mascular

dse.) Chromatopsia colored vision Painful light Floaters Flashes of light Blindness

OBJECTIVE EXAMINATION 1. OCCULAR ADNEXAE 2. EYEBALL 3. EXTERNAL EYE 4. Internal eye Anterior chamber Iris Pupil Lens Conjunctiva Sclera Cornea Eyebrow Orbit Lacrimal apparatus Eyelid

OPHTHALMOSCOPY studies the retina, choroids & optic disc objectively direct 15x magnification Indirect w/ +10 D / +20 D image is inverted 4.5 x mag. Fundus disc 1.5 mm. in diameter, slightly vertical oblong hyperope appear smaller myore appear larger astigmat oblique /elongated pinkish (temporal half in pale) disc margin (flat, well-defined)

OCULAR PATHOLOGY 1. ORBIT INFLAMMATORY CONDITIONS o orbital edema o orbital hemorrhage o orbital varices o carotico-cavernous fistula/ aneurism o acute orbital inflammation o specific chronic infection o inflammatory pseudo-tumor NON-INFLAMMATORY CONDITIONS o thyroxic exophthalmos o endocrine exophthalmos o neoplasm 2. EYELIDS INFLAMMATORY CONDITIONS o blepharitis o hordeolum / stye o chalazion o meibomianitis o contact dermatitis o phthiriasis palpebrum o herpes fibrilis o herpes zoster ophthalmicus o lid vaccinia o verruca o molluscum contagiosum NON-INFLAMMATORY CONDITIONS o developmental anomalies coloboma epicanthus blepharophimosis distichiasis blepharoptosis o neurologic anomalies myokymia

 blepharoclonus lagophthalmus blepharospasm blepharoptosis o degenerative disorder baggy eyelids blepharochalasis o neoplasm benign tumors cutaneous horn milium xanthelasma sweat gland cyst hemangioma malignant tumors basal cell carcinoma squamous cell carcinoma meibomian gland carcinoma INFLAMMATORY SEQUELAE trichiasis cicatricial entropion cicatricial ectropion symblepharon ankyloblepharon 3. LACRIMAL APPARATUS INFLAMMATORY CONDITIONS o dacryoadenitis ( gland) o fungus infection of the canaliculus (lacrimal passage) o dacryocystitis (lacrimal passage) NON-INFLAMMATORY CONDITIONS congenital anomalies neoplasm 4. CONJUNCTIVA INFLAMMATORY CONDITIONS o bacterial conjunctivitis o viral conjunctivitis o Chlamydia conjunctivitis Trachoma Inclusion blenorrhea o Allergic conjunctivitis Phlyctenular conjunctivitis Atopic conjunctivitis Contact conjunctivitis NON-INFLAMMATORY CONDITIONS Degenerations Pinguecula Pterygeum

 Nevi Melanosis

Neoplasm

5. CORNEA INFLAMMATORY CONDITIONS o Corneal ulcer Bacterial corneal ulcer Viral keratitis Phlyctenular keratoconjuctivitis Padi keratitis Idiopathic disciform keratitis Superficial punctuate keratitis Bullous keratopathy NON-INFLAMMATORY CONDITIONS Developmental anomalies Corneal degeneration Corneal dystrophy Nutritional lesion neoplasm 6. SCLERA INFLAMMATORY CONDITIONS episcleritis scleritis 7. UVEA INFLAMMATORY CONDITIONS purulent inflammation non-purulent inflammation NON-INFLAMMATORY CONDITIONS developmental anomaly neoplasm 8. VITREOUS persistent hyperplastic primary vitreous vitreous liquefaction and detachment vitreous opacity vitreous bands and membrane 9. RETINA vascular disturbance retinopathy retinal detachment retinoblastoma