Patient Symptoms- What They Might Mean Sarah Dougherty Wood, OD, MS, FAAO Heart of America, February 2011 Paraoptometric Lecture
Basic ocular anatomy and physiology
Movie projector analogy
Blur at near/eye strain Hyperopia (far sightedness) Presbyopia (old age vision)
Hyperopia (far sightedness) Eye is not powerful enough Focuses behind the eye Blur at near Needs a plus lens
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
Blur at far/distance vision due to myopia Eye is too powerful Focuses image in front of retina Needs a minus lens
Blur at both distance and near Astigmatism High amounts of hyperopia
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)
globalgallery.com
Floaters
What conditions can cause floaters? Vitreous floaters (normal pieces of collagen fibers) Retinal detachment (pigment or blood) Vitreous hemorrhage (blood) Vitritis (white blood cells)
Light flashes (photopsia) Aura before a migraine Tugging on the retina vitreous detachment, retinal detachment, retinal traction
Visual aura
Tugging on retina www.retinatexas.com
Feels like there is something in my eye! aka foreign body sensation Trichiasis Dry eye Actual foreign body Corneal abnormality
The Free Dictionary.com Trichiasis- lashes turned in towards eye
Corneal foreign body/metallic
Epiphora Dry eye Clogged puncta Viral conjunctivitis Corneal abrasion (scratch) Ectropion (eyelid pulled away from eye, tears cannot reach puncta)
Clogged puncta
Viral conjunctivitis
Corneal abrasion
Ectropion w w
Red eye Bacterial Viral Allergic Subconjunctivalhemorrhage Keratitis Endophthalmitis Episcleritis/Scleritis Uveitis CL overwear Pingueculitis/pterygium
Subconjunctival Hemorrhage Tedmontgomery.com
Keratitis
Episcleritis Acuitypro.com
Contact lens overwear/ulcer
PingueculitisPterygium
Itchy Allergic (GPC, contact dermatitis, vernal) Dry eye
Giant Papillary Conjunctivitis (GPC) Uveitis.org
Contact Dermatitis Optometry.com
Photophobia- light sensitivity Uveitis Corneal abrasion or other corneal abnormality Aniridia Migraine Albinism Lightly pigmented eye
Aniridia
Albinism www.ssc.education.ed.ac.uk
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)
Normal, healthy retina (fundus)
CRVO (central retinal vein occlusion)
AmaurosisFugax (carotid stenosis) heartstrong.files.wordpress.com/
Retinal Disorder Retinal Tear and Detachment www.tedmontgomery.com
Normal optic nerve
Swelling/inflammation of optic nerve
Vitreous Hemorrhage www.virginiaretina.org
CVA (stroke)
Peripheral vision loss Retinal detachment Glaucoma Stroke Retinitis pigmentosa
Peripheral vision testing in glaucoma normal visual field glaucoma field- superior arcuate defect
Retinitis Pigmentosa Pigment clumping Patient s perspective www.eyemdlink.com
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
Monocular Double Vision=blur www.disaboom.com
Cranial nerve palsy
Binocular Diplopia (truly seeing two) swatimidha.wordpress.com
Swollen lid Contact dermatitis Blepharitis Hordeolum (stye)/chalazion (longstanding stye) Preseptalcellulitis/Cellulitis Trauma Insect bite
Blepharitis
Hordeolum and Chalazia aka Stye Internal hordeolum Chalazion www.basj.nl/
Preseptalcellulitis/cellulitis emedicine.medscape.com
Droopy eyelid (ptosis) Dermatochalasis Levatordehiscence Neurological (Horner s syndrome, CN 3 palsy) Swollen lid Congenital After surgery or trauma
Dermatochalasis (DMC) emedicine.medscape.com
Neurological ptosis casereports.bmj.com
Eyes are misaligned (strabismus or tropia) Esotropia, exotropia, hypertropia, hypotropia
Eye Misalignment (Strabismus) Eso- in Exo- out Hyper- up Hypo- down
Glare at night/halos with car headlights Cataracts Normal Uncorrected refractive error Corneal irregularity/edema
Clouding of the Lens= Cataract Nuclear sclerotic Cortical Posterior Subcapsular www.drcilliers.com
Symptoms of Cataracts Blurred vision Halos around lights and glare
Night blindness Retinitis pigmentosa Vitamin A deficiency
Eyelid twitch Stress/fatigue Caffeine Corneal irritation
Wavy lines/metamorphopsia Macula problem Cornea irregularity
Age Related Macular Degeneration (AMD) Dry AMD Wet AMD tedmontgomery.com
AMD Impaired central vision Abnormal Amsler grid
Questions? Feel free to contact me at: swood@tuftsmedicalcenter.org Thank you for your attention!