Patient Symptoms- What They Might Mean. Sarah Dougherty Wood, OD, MS, FAAO Heart of America, February 2011 Paraoptometric Lecture
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1 Patient Symptoms- What They Might Mean Sarah Dougherty Wood, OD, MS, FAAO Heart of America, February 2011 Paraoptometric Lecture
2 Basic ocular anatomy and physiology
3 Movie projector analogy
4 Blur at near/eye strain Hyperopia (far sightedness) Presbyopia (old age vision)
5 Hyperopia (far sightedness) Eye is not powerful enough Focuses behind the eye Blur at near Needs a plus lens
6 Presbyopia (old age vision) After age 40, the lens is less flexible Doesn t allow for clear near vision Arm s are too short Needs readers or a bifocal
7 Blur at far/distance vision due to myopia Eye is too powerful Focuses image in front of retina Needs a minus lens
8 Blur at both distance and near Astigmatism High amounts of hyperopia
9 Astigmatism Eye is not a sphere, so light rays get focused at two different points Patients note blur at distance and near Need cylindrical/toric lens (two different focusing powers in one lens)
10 globalgallery.com
11 Floaters
12 What conditions can cause floaters? Vitreous floaters (normal pieces of collagen fibers) Retinal detachment (pigment or blood) Vitreous hemorrhage (blood) Vitritis (white blood cells)
13 Light flashes (photopsia) Aura before a migraine Tugging on the retina vitreous detachment, retinal detachment, retinal traction
14 Visual aura
15 Tugging on retina
16 Feels like there is something in my eye! aka foreign body sensation Trichiasis Dry eye Actual foreign body Corneal abnormality
17 The Free Dictionary.com Trichiasis- lashes turned in towards eye
18 Corneal foreign body/metallic
19 Epiphora Dry eye Clogged puncta Viral conjunctivitis Corneal abrasion (scratch) Ectropion (eyelid pulled away from eye, tears cannot reach puncta)
20 Clogged puncta
21 Viral conjunctivitis
22 Corneal abrasion
23 Ectropion w w
24
25 Red eye Bacterial Viral Allergic Subconjunctivalhemorrhage Keratitis Endophthalmitis Episcleritis/Scleritis Uveitis CL overwear Pingueculitis/pterygium
26 Subconjunctival Hemorrhage Tedmontgomery.com
27 Keratitis
28 Episcleritis Acuitypro.com
29 Contact lens overwear/ulcer
30 PingueculitisPterygium
31 Itchy Allergic (GPC, contact dermatitis, vernal) Dry eye
32 Giant Papillary Conjunctivitis (GPC) Uveitis.org
33 Contact Dermatitis Optometry.com
34 Photophobia- light sensitivity Uveitis Corneal abrasion or other corneal abnormality Aniridia Migraine Albinism Lightly pigmented eye
35 Aniridia
36 Albinism
37 Sudden loss of vision Retinal vein or artery occlusion Ischemia of the optic nerve (NAION, AION) Amaurosisfugax Retinal detachment Migraine Inflammation of the optic nerve (optic neuritis) Vitreous hemorrhage Corneal edema Angle closure glaucoma CVA (cerebrovascular accident- stroke)
38 Normal, healthy retina (fundus)
39 CRVO (central retinal vein occlusion)
40 AmaurosisFugax (carotid stenosis) heartstrong.files.wordpress.com/
41 Retinal Disorder Retinal Tear and Detachment
42 Normal optic nerve
43 Swelling/inflammation of optic nerve
44 Vitreous Hemorrhage
45 CVA (stroke)
46 Peripheral vision loss Retinal detachment Glaucoma Stroke Retinitis pigmentosa
47 Peripheral vision testing in glaucoma normal visual field glaucoma field- superior arcuate defect
48 Retinitis Pigmentosa Pigment clumping Patient s perspective
49 Diplopia (double vision) monocular- dry eye, uncorrected refractive error, corneal irregularity, dislocated lens, cataract binocular- comitant- decompensatedphoria non-comitant- CN palsy, restriction (thyroid, tumor, entrapment of muscle, orbital pseudotumor), myasthenia gravis
50 Monocular Double Vision=blur
51 Cranial nerve palsy
52 Binocular Diplopia (truly seeing two) swatimidha.wordpress.com
53 Swollen lid Contact dermatitis Blepharitis Hordeolum (stye)/chalazion (longstanding stye) Preseptalcellulitis/Cellulitis Trauma Insect bite
54 Blepharitis
55 Hordeolum and Chalazia aka Stye Internal hordeolum Chalazion
56 Preseptalcellulitis/cellulitis emedicine.medscape.com
57 Droopy eyelid (ptosis) Dermatochalasis Levatordehiscence Neurological (Horner s syndrome, CN 3 palsy) Swollen lid Congenital After surgery or trauma
58 Dermatochalasis (DMC) emedicine.medscape.com
59 Neurological ptosis casereports.bmj.com
60 Eyes are misaligned (strabismus or tropia) Esotropia, exotropia, hypertropia, hypotropia
61
62 Eye Misalignment (Strabismus) Eso- in Exo- out Hyper- up Hypo- down
63 Glare at night/halos with car headlights Cataracts Normal Uncorrected refractive error Corneal irregularity/edema
64 Clouding of the Lens= Cataract Nuclear sclerotic Cortical Posterior Subcapsular
65 Symptoms of Cataracts Blurred vision Halos around lights and glare
66 Night blindness Retinitis pigmentosa Vitamin A deficiency
67 Eyelid twitch Stress/fatigue Caffeine Corneal irritation
68 Wavy lines/metamorphopsia Macula problem Cornea irregularity
69 Age Related Macular Degeneration (AMD) Dry AMD Wet AMD tedmontgomery.com
70 AMD Impaired central vision Abnormal Amsler grid
71 Questions? Feel free to contact me at: Thank you for your attention!
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