OCULAR SYMPTOMATOLOGY
OCULAR COMPLAINTS OBJECTIVE - what can be seen by an observer 1. OBJECTIVE 2. SUBJECT SUBJECTIVE IVE – what is felt felt and reported reported by by the the patient 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 Dacryocystitis – redness localized nasally (inflammation of the lacrimal sac) Dacryoadenitis 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 hemorrhage – flood accumulated under the conjunctiva owing to ruptured blood vessel.
2. CRUST / SCALES / FLAKES Contact dermatitis dermatitis - the skin of the lids may show scaling scaling ♦ Blepharitis ♦ 3.
SECRETION Watery secretion
♦
♦ ♦ ♦
4.
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 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 –
♦ ♦ ♦
♦
Lacrimal sac masses Infalammation ♦ Mucocoele ♦ Tumor ♦ Eyeball masses –small localized conjunctiva ♦ ♦ ♦ ♦ ♦ ♦ ♦
5.
Meningocoele
Eyelid masses Hordeolum ♦ Granuloma ♦ Cholesterol deposit (xanthelasma) ♦ Tumors ♦
♦
Tumors Granuloma Hematoma
Phlyctenule Pinguecula Pterygium Nodule Cyst Dermoid Nevus Malignant tumor
Uveal tissue ♦
Desmetocoele – corneal
♦
Staphyloma – scleral
DIST DISTUR URBA BANC NCE E OF THE THE EYE EYELI LID D Malformation ♦ Coloboma Epicanthus ♦ Epiblepharon ♦ Blepharochalasis ♦
Malposition ♦ ♦ ♦
Malfunction ♦
♦
♦
6.
exophthalmos lid retraction pseudoptosis
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
DISTU DISTURBA RBANC NCE E OF OF THE THE EYE EYEBA BALL LL Abnormal size
♦
Hydrophthalmus
♦
Buphthalmus }enlarge size Macroglobus Atropia bulbi}small size Phthisis bulbi
♦ ♦ ♦
Malposition ♦ ♦
Maldirection ♦ ♦ ♦ ♦
Proptosis – anteriorly displaced Enophthalmus – can follow orbital atrophy / found in sympathetic paralysis
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
Eyebrow Orbit Lacrimal apparatus Eyelid
2. EYEBALL 3. EXTERNAL EYE
Conjunctiva Sclera Cornea
4. Internal eye
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-
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Anterior chamber Iris Pupil Lens
OPHTHALMOSCOPY studie studiess the the retin retina, a, chor choroid oidss & opti opticc disc disc obje objecti ctivel vely y direct 15x magnification Indirect w/ +10 D / +20 D image is inverted inverted 4.5 x mag. Fundus disc disc 1.5 1.5 mm. mm. in in diam diamete eter, r, slight slightly ly vertic vertical al oblo oblong ng hype hyperrope ope app appeear sma smalle ller myore appear larger astigmat oblique /elongated pink pinkis ish h (te (temp mpor oral al half half in pale pale)) disc disc marg margin in (fla (flat, t, well well-d -def efin ined ed))
OCULAR PATHOLOGY 1. ORBIT INFLAMMATORY CONDITIONS orbital edema o orbital hemorrhage o orbital varices o carotico-cavernous carotico-cavernous fistula/ aneurism o acute orbital inflammation o specific chronic infection o inflammatory pseudo-tumor o NON-INFLAMMATORY CONDITIONS thyroxic exophthalmos o endocrine exophthalmos o neoplasm o 2. EYELIDS INFLAMMATORY CONDITIONS blepharitis o hordeolum / stye o chalazion o meibomianitis o contact dermatitis o o phthiriasis palpebrum herpes fibrilis o o herpes zoster ophthalmicus lid vaccinia o o verruca molluscum contagiosum o NON-INFLAMMATORY CONDITIONS developmental anomalies o coloboma epicanthus blepharophimosis distichiasis blepharoptosis neurologic anomalies o myokymia
blepharoclonus lagophthalmus blepharospasm blepharoptosis degenerative disorder o 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 dacryoadenitis ( gland) o fungus infection of the canaliculus (lacrimal passage) o dacryocystitis dacryocystitis (lacrimal passage) o NON-INFLAMMATORY CONDITIONS congenital anomalies neoplasm
4. CONJUNCTIVA
INFLAMMATORY CONDITIONS bacterial conjunctivitis o viral conjunctivitis o Chlamydia conjunctivitis o Trachoma Inclusion blenorrhea Allergic conjunctivitis o Phlyctenular conjunctivitis Atopic conjunctivitis Contact conjunctivitis NON-INFLAMMATORY CONDITIONS Degenerations • Pinguecula Pterygeum
•
Neoplasm
Nevi Melanosis
5. CORNEA INFLAMMATORY CONDITIONS Corneal ulcer o Bacterial corneal ulcer Viral keratitis keratoconjuctivitis 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
