Increased IOP

Common Causes Corneal dystrophies

Dulling of the normally crisp reflection of
incident light off the cornea due to sudden Cataract surgery
CORNEAL EDEMA
opacification; ground-glass appearance of
the cornea Visual loss accompanying an attach of angle-
Ocular Emergency
closure glaucoma

Blunt trauma
Common Causes
Presence and leakage of abnormal vessels

HYPHEMA Blood in the anterior chamber Bed rest

Mild May not affect visual acuity
Ocular antihypertensive drugs
Severity Significant Reduced visual acuity
Treatment Topical corticosteroid
Complete VA Light Perception
Cycloplegic drops

Oral aminocaproic acid

Aging

Trauma
Media Opacities
Toxins
Common Causes
Systemic disease

Smoking
CATARACT Any opacity in the lens
Heredity

Based on clinical judgement + Patient's

Treatment visual acuity and assessment of interference Cataract Surgery
of ADLs

Trauma

Conditions that lead to retinal

Common Causes
neovascularization

Aneurysm rupture

Severe loss of vision with - RAPD

VITEROUS HEMORRHAGE Bleeding into the vitreous Common Findings VA never NLP

Opaque upon fundoscopy

Hemorrhage + Mobile vitreous + Attached

Observation
retina + No foreign body
Treatment
Hemorrhage + Vitreous contraction indicated
Vitrectomy
by decreased motility

7-10 days after initial wound repair

After posterior separation occurs

Requirements
After active bleeding subsides

After cornea is clearer

Chief Complaint: Flashing lights followed

by large numbers of floaters and then a
shade over the vision in one eye

RETINAL DETACHMENT Retinal tear leads to separation of retina

Rhegmatogenous
from epithelium

Fibrosis or fibrovascular proliferation leads

Types Traction
to scar tissue that pulls off retina

Accumulation of subretinal fluid leads to

Serous
retinal detachment

Reduced visual acuity

Retinal Disease Disease causing deterioration of the central
MACULAR DISEASE Common Findings +/- RAPD Treatment Laser Surgery
portion of the retina

Preceded by metamorphopsia

Sudden, painless loss of vision in one eye;

CRAO Cherry-red spot on fovea centralis
described as a "descending curtain"

Sudden onset of visual field defects (

BRAO
scotomas)
Occlusion of the central retinal artery or its Differentiate using RAPD and
RETINAL VASCULAR OCCLUSION Ophthalmoscopy
branches resulting to retinal ischemia NON-ISCHEMIC Subacute to mild-moderate loss of vision
CRVO
ISCHEMIC Sudden, severe loss of vision

BRVO Usually asymptomatic

Idiopathic
Common Causes
ACUTE VISUAL Inflammation of the optic nerve OPTIC NEURITIS
Multiple Sclerosis

Refer to an ophthalmologist
LOSS Common Findings Hyperemic and swollen optic disc

Chief Complaint: Monocular vision loss Inflammation of the orbital portion of the No abnormalities on ophthalmoscopic
that has developed over hours to days + Reduced VA and + RAPD RETROBULBAR OPTIC NEURITIS
optic nerve examination
Pain on movement of the eye
Swollen disc with blurred margins

Inflammation of the optic nerve papilla PAPILLITIS Common Findings Hyperemic disc

Usually unilateral

Elevated optic disc with indistinct margins

Microvascular congestion on disc

Common Findings Dilated retinal veins

Presence of flame-shaped hemorrhages

Usually bilateral

Signs of increased ICP

Swelling of the optic disc due to increased

Normal VA and - RAPD PAPILLEDEMA Pulsatile tinnitus
ICP

Loss of vision for a few seconds

Optic Nerve Disease
Orthostatic changes in vision

History Worsening headache when supine

Bilateral CN VI nerve palsies

Transient or persistent? With associated malaise, headache, fever,

weight loss, pain, polymyalgia rheumatica,
Monocular or binocular? Patient > 60 years old GIANT-CELL or TEMPORAL ARTERITIS Refer to an ophthalmologist
scalp tenderness or discomfort, jaw
claudication; ESR > 60 mm/hr
Timing and duration?
Common Causes
Vascular event
Patient's age?

Patient's comorbidities?
VISUAL LOSS ISCHEMIC OPTIC NEUROPATHY
Infammation

Pale, swollen disc

Did the patient have documented normal
vision in the past? Common Findings Splinter hemorrhages

Reduced VA and VF Altitudinal visual field loss

Direct or Penetrating trauma

CT Scan
TRAUMATIC OPTIC NEUROPATHY For neuroimaging
Diagnostics Indirect or Blunt trauma
Transmission of the shearing force to the
MRI
optic nerve

Vascular events
HEMIANOPSIA Common Causes
Visual Acuity Tumors

Confrontation Field Test Visual Pathway Disorders Extensive bilateral damage to the cerebral
visual pathways resulting in complete loss of
Pupillary Light Reaction vision
CORTICAL BLINDNESS

Ophthalmoscopy Normal PLR

Penlight Examination Special Tests for

Functional
Disorders
Tonometry

Tangent Screen Test

Slit-lamp Examination

Functional Disorders Visual loss without organic basis Mirror Test

Optokinetic Drum Test

Acute Discovery of Chronic Visual

Loss

CHRONIC VISUAL
LOSS
Impaired outflow of aqueous resulting from
abnormalities within the drainage system of GLAUCOMA CATARACT MACULAR DEGENERATION
the anterior chamber angle

Acquired chronic optic neuropathy Any opacity in the lens Age-related macular degeneration (AMD) is a Beckman Initiative for Macular Research
Open-angle glaucoma characterized by optic disc cupping and complex multifactorial progressive disease Classification Committee staging based on
visual field loss and usually associated with characterized initially by accumulation of lesions within two disc diameters of the
raised intraocular pressure all of lens substance is opaque Mature Cataract material (drusen) beneath the RPE fovea in either eye
Impaired outflow of aqueous resulting from
impaired access of aqueous to the drainage Angle-closure glaucoma some regions of the lens are transparent Immature Cataract
system Prophylactic Therapy to prevent progression No apparent aging changes
Diagnostics to Late AMD: Oral vitamins (Vit C and Vit E),
lens takes up water Intumescent Cataract Ophthalmoscopy
Antioxidants (Beta-carotene), Zinc, Copper
Digital Palpation Normal aging changes No drusen and no pigmentary abnormalities
cortical proteins have become liquid Hypermature Cataract

RAPD Treatment of Neovascular AMD:

hypermature cataract in which the lens
Morgagnian Cataract Bevacizumab, Ranibizumab, Aflibercept Early AMD Only small drusen (drupelets) and no
nucleus floats freely in the capsular bag
Visual acuity pigmentary abnormalities

Color vision Intermediate AMD Medium drusen and no pigmentary

Treatment abnormalities
Moderate or high-risk patient Visual field testing
Late AMD Large drusen and/or any pigmentary
IOP > 21 mmHg Ophthalmoscopy Based on clinical judgement + Patient's abnormalities
visual acuity and assessment of interference
IOP not elevated, but a difference of 5 of ADLs Neovascular AMD and/or geographic atrophy
mmHg or more between both eyes
Optic disc color

Optic cup diameter one half or more of the Refer to an ophthalmologist if Cataract Surgery
Optic disc size
disc diameter (cup:disc ratio of 0.5 or
greater)
Vessel displacement
One cup significantly larger in one eye than
in the other Glaucomatous cupping

Symptoms of acute glaucoma Temporal pallor of the ON

Papilledema

Reduced or obliterated cup

Tonometry

Perimetry

Gonioscopy