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External Eye diseases :eyeglasses: (Eye examination :eye: (Contrast vision…
External Eye diseases
:eyeglasses:
Basic Ophthalmology
Periocular anatomy
Eyelids
Conjunctiva
Cornea
Tear film
Eye examination
:eye:
External inspection for normal anatomy
Upper eye lid eversion
I/C
:check:: FB เข้าเปลือกตา
A/C depth assignment
Fluorescecin staining (ย้อมผิวกระจกตาที่เป็นรอยถลอก แล้วใช้สีย้อมแผลจาก accident)
Visual acuity (VA)
Visual field (VF)
Color vision
Contrast vision
eg. Chloroquine ➭ maculopathy
eg. TB drugs eg Ethambutol ➭ Macula พัง
:goat:
Interpret the findings
:fog:
Visual loss
Acute
Chronic
:red_flag:
Red eye
:candy: Hyperemic stage of
Conjunctiva
Conjunctival
injection forms
:cookie:
Conjunctival
Pericorneal
Mixed
Ciliary
Episclera
Sclera
:candy: From adjacent organ
Eye lids
Periocular tissues
ExtraOcularMuscles
EOM
Soft tissues
:rain_cloud:
Media opacities
(cornea, A/C, lens)
:closed_umbrella:
Cornea
Corneal scar
Corneal haze/cloudy
must iden. area ➭ total or localized?
Corneal edema:
ground glass
appearance
Hx should R/O
Infection
High intraocular pressure
Corneal dystrophy (โรคกระจกตาทางกรรมพันธุ์)
:closed_umbrella:
Anterior chamber
Present with
Hx Traumatic
Hx Intraocular inflammation ➭ usu. related to uveitis -- usu related to inflam (autoimmune)
Abnormal iris & pupil shape
Cells - seen as fluid level
Red cells:
Hyphema
White cells:
Hypopyon
:closed_umbrella:
Lens
Crystalloid lens (
natural
lens)
Cloudy -- usu ขุ่น 80-90% จาก Trauma
:star:
Cataracts
Displacement
Artificial lens (
got after Sx
)
Aphakia (
no lens
)
Sx
Traumatic
:fireworks:
Severity
Non-severe
Conjunctival abn.
Infection
Infectious Conjunctivitis
:yellow_heart:
Acute
(< 4 wks)
Causes
Virus (M/C!)
eg. adeno virus, herpes
1 more item...
Bacterial
(G+ staph, strep; G- gonococcal)
1 more item...
Rx
Antihistamine ED
Tear ED
ATB ED
if too many D/C ➭ ATB +- steroid ED
Chronic
(> 4 wks)
Consult จักษุแพทย์
Infection
Chlamydial trachomatis
Allergic
Contract lens related
Chronic irritation
Irritation
Eyelid
Inflammation
Infection
:star2:
Severe
:fire:Acute Angle Closure Glaucoma (
AACG
)
Triads
:Fire:
Iridocyclitis (uveitis)
Def: inflam. of the iris & ciliary body (muscles and tissue involved in focusing the eye)
:fire:
Keratitis/Corneal ulcer
(contact lens related?)
:cry:
Irritation
:arrow_down: normal tears
Dry eye syndrome
Office syndrome
Chronic exposure UV :sunny:
Pinguecula
Pterygium
:building_construction:
Eye trauma
Severity
Minor
Corneal abrasion
Foreign body: conjunctiva, cornea
เวลาเอาออกใช้ไรบ้าง :grey_question:
Eyelid speculum
0.5% Tetracaine Hydrochloride (ยาชา)
Mild acid/alkali injury
UV light keratitis
eg. Arc Welding (เชื่อมเหล็ก)
high conc. of UV
➭กระจกตา/cornea ค่อยๆหลุดรอก
➭ so 7-10 hrs later ค่อยมีอาการ
Soft tissues injury
Severe
Massive blunt injury
Penetrating injury
Projectile '
striking metal to metal' injury
must R/O
Intraocular FB
(IOFB)
Location
Bony orbit
Fx floor/medial wall
Optic canal
Eye lids
Lacerated wound
Lid margin
Lacrimal apparatus
Ocular surface
Conjunctiva
Cornea
A/C & iris tissue
Vitreous hemorrhage
:sparkling_heart:
detect abnormality
Dx steps
VA
Eyelids
Pattern of redness & D/C
Corneal clarity & surface
A/C & iris & pupil
Lens
Symptoms that R/O Danger conditions
:arrow_down: VA > 50% from normal
Severe pain
Photophobia
Halos
:arrow_up: floater & flashing