External layer

Middle layer

Inner layer

tough, fiborous

sclera and cornea

vascular rlayer

choroid, ciliary body, iris

nerve tissue

retina

inner corner of the eye

[image]

site of the central vision and color perception

lies lateral to the optic disc

-pt asked to fixate on an object

-one eye is covered while the other eye is observed for movement

-no movement should be detected if the eyes are properly aligned

-pt is asked to fixate on an object while examiner alternately covers and uncovers one eye then the other, back and forth

-an eye with a latent defect will shift position when it is uncovered

measures intraocular pressure

1.Shioetz

2. Tonopen

O.D

ocular dexter

O.S.

ocular sinister

O.U.

oculus uterque

conjunctivitis

corneal disorders

acute glaucoma

acute uveitis

eye pain or sensitivity to light

commonly due to corneal inflammation or iritis

viral conjunctivitis

keratitis

visual acuity for distant vision of 20/200 or less in the better eye with best correction

glaucoma

diabetic retinopathy

macular degeneration

edema

hematoma

tenderness

laceration

hematoma

edema

foreign body (with eversion)

irregularity

absolute and relative size

reactions to both light and accommodation

Argyll Robertson pupils

(prositute pupils)

idiopathic unilateral process where a pupil is large with severely reduced and slow reaction to light

Often seen with asymmetrically decreased deep tendon reflexes

unequal, limited, or decreased movement

indicating laceration or entrapment

oculomotor nerve (CN III)

innervates:

Superior rectus

Inferior rectus

Inferior oblique

Medial rectus

trochlear nerve (CN IV)

innervates:

abducens nerve (CN VI)

innervates:

sudden loss of vision

orbital cellulitis

gonococcal keratoconjunctivitis

ocular trauma

white spot on cornea (corneal ulcer)

red eye after ocular surgery (infection)

"rock hard" globe (acute angle closure glaucoma)

hyperopia

(farsightedness)

a defect in vision in which parallel rays come to a focus behind the retina as a result of flattening of the globe of the eye or of an error in refraction

corrected with plus (convex) lenses

myopia

(nearsightedness)

unaccommodated eye brings into focus images of objects closer than infinity, while objects beyond this distance cannot be seen without the aid of corrective lenses

corrected with minus (concave) lenses

natural loss of accommadative capacity with age

corrected with plus lenses for near work

small sebaceous glands located in the rim of the upper and lower eyelids which secrete sebum

common granulomatous inflammation of meibomian gland that may follow an internal hordeolum

painless, hard lesion on the upper or lower lid,deep from the palpebral margin, characterized by insidious onset with minimal irritation

blepharitis

common chronic bilateral inflammatory condition of the lid margins

anterior and posterior

conjunctivitis (pink eye)

most common eye disease

may be acute or chronic

mode of transmission is direct contact

most commonly caused by:

Staphylococcus aureus

Streptococcus pneumoniae

Haemophilus aegyptius

Pseudomonas

Moraxella

transmission: direct contact or fomites

characterized by: acute onset of copius, purulent, sticky discharge from both eyes (worse upon awakening)

Gonococcal conjunctivitis

a type of bacterial conjunctivitis

caused by Neisseria gonorrhoeae

aquired through contact with infected genital secretions

copius purulent discharge

opthalmologic emergency

dx by stained smear and culture of discharge

a type of bacterial conjunctivitis

caused by Chlamydia trachomatis

major cause of blindness worldwide

dx made by Giemsa-stained conjunctival scrapings

direct contact transmission

type of viral conjunctivitis

associated with pharyngitis, fever, malaise, and preauricular adenopathy

red palpebral conjunctiva, copious watery discharge, and scanty exudate

common in elderly women

dryness, scratchy, redness

hypo-function of the lacrimal gland

excessive evaporation

allergic eye disease

benign disease occurring usually late in childhood and early adulthood, may be seasonal

manifested as atopic asthma, atopic dermatitis, allergic rhinitis

sypmtoms: itching, tearing, redness, stringy discharge, occasional photophobia and visional loss

clinical signs: conjunctival hyperemia and edema

occurs late in childhood and early adulthood

season with predilection for spring

Pathognomionic large "cobblestone" papillae on everted upper lid conjunctiva

may be lymphoid follicles at the limbus

chronic disorder of adulthood

both upper and lower tarsal conjunctivae exhibit a fine, papillary conjunctivitis w/ fibrosis, resulting in entropion w/ trichiasis

• a degenerative lesion of the bulbar conjunctiva
• appears as a yellow-white, amorphous, subepithelial nodule adjacent to the limbus, usually on the nasal side
• usually asymptomatic

• a benign proliferation of fibro-vascular tissue within the bublar conjunctiva that extends onto the perpheral cornea
• typically assumes a triangular configuration with the apex of the lesion directed toward the pupil
• growth occurs from the apex onto the limbal cornea

• an inflammatory and ulcerative conditoin involving the cornea
• most commonly due to infection by bacteria, viruses, fungi, or amebas
• opthalmologic emergency

Corneal disorder caused by:

Pseudomonas aeruginosa

Streptococcus

Moraxella

Staphylococcus

pursues an aggressive course, thick yellow-green or blue mucopurulent tenacious exudate and ground glass edema surrounding the ulcer, hypopyon is often present as well

• Corneal disorder and important cause of ocular morbidity in adults and most common cause of corneal ulcers
• accompanied by pain, irritation, foreign body sensation, redness, photophobia, tearing and occasionally decreased visual acuity
• with fluorescein staining, cornea may manifest dendritic (branching) keratitis

• disorder of the cornea that develops secondary to activation of latent varicella zoster virus within the ophthalmic division of the trigeminal nerve
• presents with malaise, fever, headache, and periorbital burning and itching which may precede the eruption by a day or more (prodrome)
• rash is usually vesicular, quickly becoming pustular, then crusting
• pts with skin lesions on the tip of the nose (Hutchinson's sign) or lid margin are at higher risk for ocular involvement
• fluorescein stain reveals dendritic lesions

• disorder of the cornea which tends to occur after corneal injury involving plant material or in an agriculture setting in eyes with chronic ocular surface disease, and in contact lens wearers
• an indolent process, w/ the cornea having multiple stromal abscesses and little epithelial loss

• disorder of the cornea suspected in contact lens wearers with contaminated lens solution, or who swim wearing contacts
• hard to identify, diagnose and treat
• present with pain out of porportion to their clinical findings
• treatment is hampered by the organism's ability to encyst within the corneal stroma

• leading cause of blindness

• consists of a group of ocular diseases charcterized by changes in the optic disk, loss of visual sensitivity, and loss of visual field

Closed (narrow) Angle - emergency

Open Angle - most common

• Aqueous humor is initially produced by the ciliary body epithelial cells in the postior chamber
• it then flows through the pupil btwn the posterior surface of the iris and the lens to enter the anterior chamber
• after circulating within the anterior chamber, the aqueous humor leaves through the trabecular meshwork of the anterior chamber angle to enter the canal of Schlemm

• glaucoma that results of closure of pre-existing narrow anterior chamber angle, when dilation of the pupil causes the iris to touch the lens
• this obstructs the flow of aqueous humor from the post chamber through the pupil, and into the ant chamber
• the ciliary body in the post chamber continues to produce aqueous humor, which leads to a rapid rise in the IOP

seek treatment immediately bc of extreme pain, headache (or browache), photophobia, and blurred vision, though there are subacute cases

Blurred vision associated with rainbow-colored halos around lights

The pt often looks very sick

Nausea, vomiting, and abdominal pain may occur

The eye is red with per-limbical injection (ciliary flush or limbic flush)

The cornea is hazy and steamy (bc of corneal edema)

The pupil is moderately dilated and non-reactive to light

"rock hard" globe, visual acuity decreased, elevated IOP by tonometry, shallow ant chamber (cresent shadow by tangential lighting)

control of IOP by decreasing the production of aqueous humor and increasing its outflow

A topical beta-blocker (timolol solution- Timoptic)

then a cholinergic agonist used to constrict the iris and releive the obsrtuction to the flow of aqueous humor, thereby increasing aqueous humor outflow

difinitive treatment is laser peripheral iridotomy

characterized by gradually progressive excavation (cupping) and pallor of the optic disk with loss of vision varying from slight constriction of the peripheral fields to complete blindness

IOP is elevated due to obstruction of flow of aqueous humor into the ant chamber angle

• No symptoms initially
• visual fields gradually constrict, but central vision remains good until late in disease

Topical beta-adrenergic blocking agents (Timolol - Timoptic)

In addition: topical carbonic anhydrase inhibitor (dorzolamide)

Oral carbonic anhydrase inhibitor

Laser trabeculoplasty

Surgery is possible

Iris

ciliary body

choroid

iritis

inflammation of the iris

Characterized by ciliary injection (limbal flush), pupil constriction, dereased visual acuity, and tearing

presents with pain with accommodation, photophobia, headache, and pain with consensual light reflex

any combination of iritis, cyclitis, or choroiditis

(inflammation of the uveal tract)

all characteristics of iritis along with unreactive pupils

search for systemic illness such as arthritis, Sjogren's syndrome, herpes simplex virus, and herpes zoster virus

any opacity of the lens of the eye

excessive sun exposure and smoking can predispose to this development

senile is the most common type

isidious onset of decreased vision

usually, far vision acuity is affected more than near