20 Common Eye Diseases

Lynn E. Lawrence, CMSgt (ret), CPOT, ABOC

Course Description

• This lecture will focus on 20 common eye diseases. It will identify the disease, characteristics of the disease and the affects of the disease on the eye. The course will also discuss clinical presentations and testing associated with the disease.

20 Diseases of the Ocular System

• Lids and Lashes• Cornea• Tear Film• Conjunctiva• Lacrimal System• Crystalline Lens• Retina• Refractive System

Lids and lashes 1. Ptosis = muscles 2. Dermatochalasis = skin/fat

3. Chalazion

• Though very common, a careful inspection of the lids is still required to ensure that is the only diagnosis

• Reoccurring conditions maybe a reason for concern

(WC Posey, Diseases of the Eye, 1902)

4. Cancer

• Many different types of presentations

• During the slit lamp exam, please look for missing lashes in suspicious areas

• Story of Montana clinic

4. Bugs!

• Story from Nebraska

• Cause major eye irritation

• Often mis-diagnosed by PCP

• Caution with chemicals

5. Corneal Diseases• Fuchs' Dystrophy. Fuchs'

dystrophy is a slowly progressing disease that usually affects both eyes and is slightly more common in women than in men.

• Ulcers• Dry Eyes• Clouding• Arcus Senilus• Keratoconus *• Keratitus• Viral• Systemic Diseases

6. Dry Eyes

• Plethora of causes

• Difficult to resolve on elderly patients

• Medication induced

• Environmentally impacted

Marginal Corneal Ulcer

• Viral • Bacterial• Infections can be

difficult to treat

7. Pinguecula vs 8. Pterygium

Little Penguin Big Pterodactyl

9. Keratoconus

• Thinning and the “coning of the cornea

• This patient presents with unstable rx

• Topography will aid in confirming dx

Cornea

Herpes

Bacterial Ulcer

Fusarium Keratitis

What of the above is caused by a virus?

Lacrimal System: Tear Film Layers

oilaqueous

snot

What functions does each layer of the tear perform?

Causes of Tearing• Punctal agenesis• Poor/blocked drainage• Trichiasis • Superficial foreign bodies• Poor pump action

– Eyelid mal-positions– Eyelid disease

• Tear deficiency or instability

• Trigeminal nerve irritation

Causes of Tearing Cont…• Foreign body sensation• Hypersecretion

– Lacrimal secretion and drainage imbalance

– Primary or reflex tearing (reflex tearing is more common with ocular surface irritation)

• Lacrimal pump failure• Lacrimal drainage

obstruction• S/P Surgery

The Connections

• Connections–Lacrimal gland to

the eye–From the eye to

the lacrimal sac–From the

lacrimal sac to the nose Caniculitis can cause the blockage

Clinical Presentation

• Chief Complaint

• History of present illness

• Past medical history

• Clinical examination

• Nasal Examination

Is this possible? You be the judge

Conjunctivitis

• The “infamous” pink-eye • Numerous causes:

– Bacteria– Viruses– Allergies– Toxic Reactions (chemicals)– Often difficult to diagnose exact etiology

What is the most accurate measure of intraocular pressure?

MUSCLES

• What condition is this?

• Which is the dominate eye

• When the dominate is covered, which way will the non-dominate move?

Binocular Vision• Strabismus– Tropia-manifest deviation of the eyes. – Phoria is a latent deviation held in check by

fusional vergence– Frequency- constant/intermittent– Diplopia Eso vs Exo

What condition is this?What happens when the Right eye is covered?

Is this a Tropia or Phoria/why?

How would you document this condition?

What happens when you cover this eye?

Components of an Optical Prescription

• Prism– Prism is used to correct blurry or double

vision due to deviated eyes

A B

Label the conditions in each of these pictures

Pupil Testing• Explain test• Proper lighting• Perform direct and

consensual• Swinging flashlight• Evaluate near response• Recording accuracy

Is it required to have corrected vision for pupil testing?

Pupil Testing

• Relative Afferent Pupillary Defect

• Adie’s Tonic Pupil-slow response to light• Argyll Robertson-no reaction to light; reaction to

accommodation

How long should the light be held in front on the eye during pupil testing?

Pupil Testing

• Anisocoria- unequal pupil sizes– “cor” = pupil– “aniso”=difference

• Hippus- “jumping” pupil– Most commonly seen in younger patients

Congenital color vision defect normally impact vision in ______ eyes?

Anterior Chamber

• Iritis• Uveitis• Narrow Angle Glaucoma• Hyphema• PDS• Cells and Flare

Cataracts

What is a cataract?

Crystalline Lens

• Cataracts / Phakia

• IOL – Aphakia

• Without a IOL is Pseudophakia

HyperopiaHyperopia• A refractive condition where parallel light rays focus behind the retina when the eye is at rest

• Termed farsightedness

• Patient may have 20/20 vision at distance and near

What type of lens is used to correct hyperopia?

MyopiaMyopia• A refractive condition where parallel light rays focus in front of the retina when the eye is at rest

• Termed nearsightedness

• Patient may have 20/20 vision at near, but distance vision will be reduced

Myopia is corrected with what type of lens?

AstigmatismAstigmatism

• A refractive condition where different meridians of the eye have different powers

• Corrected by lenses which incorporate cylinder power

• Usually due to different curvatures of the cornea

TRUE/FALSE: A cylindrical lens correct for astigmatism?

Amblyopia• A condition in which reduced visual acuity with no

apparent cause and not correctable by refractive means• Often referred to as “lazy Eye”• It is generally treatable even after age eight• Scientists are exploring whether treatment for amblyopia

in older children and adults can improve vision

What is the clinical definition of amblyopia?

Presbyopia

• Reduction in the ability to accommodate

• Occurs normally with age– Reduction in lens elasticity– Reduction in strength of the

ciliary muscle

Using the Worth 4-Dot test, if only two or three lights are seen ______ is indicated?

The Retina• AMD• Retinitis Pigmentosa• ERM• Diabetic Retinopathy• Glaucoma• The ultimate

receiver

Age Macular Degeneration

• Wet – more aggressive

• Dry – can turn more aggressive without warning

POAG Glaucoma

• Increased intraocular pressure• Increased cupping (cup to disc ratio)• Decrease in peripheral/vision retina damage

What is the clinical definition of glaucoma?

POAG Case Hx Optic Nerve Head (ONH) Visual function…field testing Retinal Nerve Fiber Layer Expert interpretation of

results Corneal thickness…

pachymetry avg 500 microns

Gonioscopy POAG vs CAG

Trauma IOP (asymmetric pressure)

Goldmann (industry std) POAG Low Tension Closed or narrow angle

Acute Angle Glaucoma

• Steamy cornea• Elevated pain• Elevated IOP• Decreased vision• Irregular shaped pupil

Reinoblastoma• A white color (leukocoria) in

the center circle of the eye (pupil) when light is shone in the eye, such as when taking a flash photograph

• Eyes that appear to be looking in different directions

• Eye redness• Eye swelling• a mutation on chromosome 13,

called the RB1 gene

Diabetes• Fluctuations with vision• Bleeding in retina is called

retinopathy• Dried blood leaves

yellowish clumps in the retina called, Exudates

The white spot in this photo come from ________ deposits?

Optic Nerve Coloboma

• Coloboma of optic nerve, also called Morning Glory syndrome, is a rare defect of the optic nerve that causes moderate to severe blindness. It is extremely rare, occurring in only one person per every two million in the United States.

CRVO

• Since the central retinal artery and vein are the sole source of blood supply and drainage for the retina, such occlusion can lead to severe damage to the retina and blindness, due to ischemia (restriction in blood supply) and edema (swelling).[2]

• It can also cause glaucoma.

What do you think?

2

1

3

4

Were you correct?

Large C/D ratio

RPE

Torturous vessels

Herpetic Dendrite

What is wrong in these photos?

Extreme Blood Pressure/ retinal bleeding Papilledma

Call it

Call it

cataract glaucoma

Call it

Call it

keratoconus

neovascularization

Call it

Call it

PVD

Macular Degeneration

Call it

Call it

Farsighted Retinal detachment

Questions

• What is the purpose of the fitting triangle?• Which tonometers require an anesthetic?• What instrument is used to obtain a

prescription from a contact or ophthalmic lens?

• What is the heaviest lens material?

Questions

• What is the difference between acuity and accommodation?

• Spell the scientific name for your eyelid ______________?

• What percentage of water is in a low water content ______ or high water content _______ contact lens.

Questions

• The person who normally grinds lenses is called a(n) _________________?

• What is the difference between a mydriactic and miotic?

• What is the definition of the word “plano”?

Review Questions• The point where the upper and lower eyelids meet is called?

• The blockage of the meibomian gland is called the ___________ when it causes pain, and the _________ when it does not cause pain?

• What is a good tear break up time?

• What is amblyopia?

Review Questions• The eyelid will protect your eyes from what?• What main muscles raises the eyelid?

• Convert to spherical equivalent- 1.50 – 1.00 X 180

- 2.25 – 1.50 X 120

• What is the main layer of the eye lid?

Review Questions• What is the difference between visual acuity and accommodation?

• What is decentration?

• Name a test performed binocularly?

• Through a prism the image deviates which way?

• _________ is the merging of images from each eye into one image?

Review Questions

• What are the layers of a tear film?

• Where is tear mucin produced?

• Why is the tear film important in contact lens wear?

• What is stereopsis?

Review

• Opia means what?

• What is the difference between a tropia and a phoria?

• Avascular means what?

• How many extra-ocular muscles are oblique?

Review Questions

• Where does aqueous drain?

• What drug is used to slow aqueous production?

• What is the difference between versions and vergence?

• Analyph glasses are used with what test?