Eye problems

DACRYOCYSTITIS
• Infection of lacrimal sac
• Usually in infants and adults >40
• Acute: sudden onset redness and pain in medial
canthal region
• Sometimes, purulent discharge is noted from punctum.
• Few present with fever, prostration and ↑ leukocyte
count
• Causative organisms: S. aureus and β-hemolytic
streptococci
 Conjunctivitis
• Conjunctivitis literally means "inflammation of
the conjunctiva."
• The conjunctiva is the mucous membrane that
lines the inside surface of the lids and covers
the surface of the globe up to the limbus (the
junction of the sclera and the cornea). The
portion covering the globe is the "bulbar
conjunctiva," and the portion lining the lids is
the "tarsal conjunctiva."
Cont..
 Bacterial conjunctivitis
• Is commonly caused by Staphylococcus
aureus, Streptococcus pneumoniae,
Haemophilus influenzae, and Moraxella
catarrhalis.
• S. aureus infection is common in adults; the
other pathogens are more common in
children
 Cont..
• Patients with bacterial conjunctivitis typically
complain of redness and discharge in one eye,
although it can also be bilateral.
 Cont..

VIRAL CONJUNCTIVITIS
• Most cases due to adenovirus—usually in late
summers and early fall
• outbreaks common in children and caregivers
• - Last several days and usually self-limited and
usually preceded by typical nasopharyngeal
symptoms
 ALLERGIC CONJUNCTIVITIS
• Acute hypersensitivity reaction
• - Causes: exposure to environmental allergens
like animal dander, dust, dust and mold
spores. Reagin (i.e.
• IgE) mediated
• - Usually FH or personal h/o atopic disorders
such as asthma or seasonal allergies
 KERATITIS
• Keratitis is an inflammatory condition that
affects the cornea of your eye.
• The cornea is the clear part that covers both
the iris and the pupil. Keratitis can be caused
by an infection or injury to the eye.
• Keratitis is a common condition
 Cont..
• Most cases are due to Gram –ve organisms
such as Pseudomonas and Serratia, but can be
due to Gram +ve organisms as well as fungi
and amoebas
• Medical emergency
• Can lead to corneal perforation, scarring and
permanent vision loss if not addressed
promptl
 UVEITIS
• Uveitis is a form of eye inflammation. It affects
the middle layer of tissue in the eye wall
(uvea)
 EPISCLERITIS
• Episcleritis refers to inflammation of episclera
• Common cause of red eye
• - Distinguished by its localized or patchy
distribution
• -Generally mild associated pain and discharge
• May be associated with rheumatoid arthritis
and other autoimmune disorders, but many
cases areidiopathic
 DIABETIC RETINOPATHY
• Can occur in both, insulin-dependent and non-insulin
dependent DM
Has 3 types
• 1 Background or simple retinopathy or non-proliferative-
consists of dilation of veins,
• microaneurysms, dot and blot hemorrhages, hard exudates,
and retinal/macular edemaÆ
• blurred vision
• 2. Pre-proliferative retinopathy- with cotton wool spots
• 3. Proliferative or malignant retinopathy- consists of newly
formed vessels.
 HYPERTENSIVE RETINOPATHY
• There is initially focal spasm of arterioles,
followed by progressive sclerosis and
narrowing
• Funduscopy: copper or silver wiring, findings
depend on the severity of retinopathy
 RETINAL DETACHMENT
• Retinal detachment occurs when the
multilayer neurosensory retina separates from
the underlying retinal pigment epithelium and
choroid.
• This separation can occur passively due to
accumulation of fluid between these two
layers, or it may occur actively due to vitreous
traction on the retina, such as with diabetic
traction retinal detachment.
CENTRAL RETINAL ARTERY OCCLUSION

• It occurs when a severe, abrupt diminution of

blood flow through the central retinal artery
causes ischemia of the inner retina
• Fundoscopy: diffuse ischemic retinal
whitening, pale optic disc, cherry red fovea
(typical but not specific) and boxcar
segmentation of blood in retinal veins
CENTRAL RETINAL VEIN OCCLUSION (CRVO)

• Must be kept on differentials in pts with acute or

subacute u/l visual loss but usually not as acute as CRAO
• Characterized by sudden, unilateral visual impairment
that is usually noted upon waking in the morning
• Caused by thrombosis
• Risk factors: patients with coagulopathy, hyperviscosity,
chronic glaucoma, and atherosclerotic risk factors (eg,
age, diabetes, hypertension).
• Ophthalmoscopy: disc swelling, venous dilation and
tortuosity, retinal hemorrhages and cotton wool spots
 VITREOUS HEMORRHAGE
• Typically presents as a sudden loss of vision and
onset of floaters.
• Most common cause: diabetic retinopathy—
most commonly occurs in proliferative diabetic
retinopathy
• Ophthalmoscopic evaluation: fundus is hard to
visualize, and even if it is visualized, details may
be obscured, floating debris and dark red glow
may be seen
 CATARACT
• Vision-impairing opacification of the lens.
• Oxidative damage of the lens occurs with aging
• Risk factors: advancing age, diabetes, smoking,
chronic sunlight exposure, and glucocorticoid use.
• Usually bilateral, but patients may become
symptomatic in one eye before the other.
• C/F: Painless blurred vision, glare, and often halos
around lights. Loss of night time vision is very
characteristic
 GLAUCOMA
• Glaucoma is a group of eye diseases
traditionally characterized by elevated
intraocular pressure (IOP).
 Open-angle glaucoma
• is an optic neuropathy characterized by
progressive peripheral visual field loss
followed by central field loss, in a
characteristic pattern.
• This is usually but not always in the presence
of elevated intraocular pressure (IOP), perhaps
in part related to increased aqueous
production and decreased outflow
 Angle-closure glaucoma
• Is characterized by narrowing or closure of the
anterior chamber angle.
• The normal anterior chamber angle provides
drainage for the aqueous humor (the fluid that
fills the eyeball).
• When this drainage pathway is narrowed or
closed, inadequate drainage leads to elevated
intraocular pressure and damage to the optic
nerve
 Ear disease
Otitis externa (swimmer’s ear)
• refers to inflammation of the external auditory
canal or auricle.
• Swimming or other water exposure is a well-
documented risk factor for external otitis.
• Excess moisture leads to skin maceration and
breakdown of the skin-cerumen barrier,
changing the microflora of the ear canal to
predominantly gram-negative bacteria
 Otitis media (OM)
• Otitis media (infection or inflammation of the
middle ear) is one of the most common
infections, and acute otitis media (AOM) is
among the most common diseases that lead
to treatment with antibiotics
 Cont..
• Acute otitis media (AOM) — Acute otitis media
(AOM) is an acute illness marked by the presence of
middle ear fluid and inflammation of the mucosa
that lines the middle ear space
• The infection is often caused by obstruction of the
eustachian tube, which results in fluid retention and
suppuration of retained secretions.
• AOM may also be associated with purulent otorrhea
if there is a ruptured tympanic membrane..
 Cont..
• Otitis media with effusion —is defined by the
presence of middle ear fluid without acute signs of
illness or inflammation of the middle ear mucosa.
• OME usually follows AOM but can result from
barotraumas or allergy.
• OME typically leads to a conductive hearing loss and
can be a precursor to retraction and perforation of the
tympanic membrane.
• Eustachian tube dysfunction is often a predisposing
factor.
 Cont..
• Acute mastoiditis — The mastoid is that portion of
the petrous temporal bone that lies superior to the
middle ear cavity
• The mastoid antrum serves as an air space connecting
the middle ear to the mastoid air cells. Thus, most
cases of AOM are associated with some degree of
mastoid inflammation or infection ("mastoiditis").
• However, the incidence of clinically significant
mastoiditis is low since the introduction of
antibacterial drugs.
 Cont..
• chronic otitis media — Chronic otitis media (COM) is
diagnosed in an ear with a tympanic membrane perforation
in the setting of chronic ear infections, such as an ear with
chronic purulent drainage despite appropriate antibiotic
treatment.
• COM may be benign and is often characterized by a dry
tympanic membrane perforation.
• Continuous serous drainage (typically straw-colored) is
termed chronic serous otitis media, and chronic purulent
drainage through a perforated tympanic membrane is
termed chronic suppurative otitis media. (See "Chronic
 Nose problems
• Choanal atresia
• Foreign body
• Epistaxis
• Polyps
 Rhinosinusitis
• Acute rhinosinusitis (ARS) is defined as
symptomatic inflammation of the nasal cavity
and paranasal sinuses lasting less than four
weeks
• the most common etiology of ARS is a viral
infection associated with the common cold
 tonsillopharyngitis
• Tonsillopharyngitis is acute infection of the
pharynx, palatine tonsils, or both. Symptoms
may include sore throat, dysphagia, cervical
lymphadenopathy, and fever. Diagnosis is
clinical, supplemented by culture or rapid
antigen test.