 Thegradual loss of eye’s ability to focus

on nearby objects

 Is it part of normal aging?

 Yes

 TypicalGP question: Patient has difficulty

reading the newspaper and has to hold it
at arm’s length
Other signs and symptoms : eyestrains or headaches
after doing close work, symptoms are much less
noticeable in bright sunlight?
- Why is that so students?
Iris is closing to a smaller diameter
 Risk factors Treatment

• Age • Non surgical:

• Drugs (antidepressants, corrective or contact
antihistamines and lenses
diuretics) • Surgical : implantation
• Medical conditions: MS of intraocular lens
or cardiovascular (INTRACOR)
diseases-can increase
risk of premature
presby
 Clouding of the lens

 Leading cause of blindness worlwide, my grandma had it

 Can affect one or both eyes

 3 subtypes
 -subcapsular (those with diabetes and on high does steroids)
 -nuclear (the ones that are usually associated with aging)
 -cortical cataract ( wedge-like opacities that start in the
periphery of the lens and work their way to the center

**bilateral cataracts in infants**- due to ..

Congential rubella syndrome
Typical GP question:
Patient is on the beach, applying sunscreen
cant see the sunscreen properly
Advice to give patients:
 Wear sunglasses if you must go out in the
sun
 Reduce exposure to bright lights
 Do not cook or deal with fire or fireworks
 Do not do activities that require bending
down
 Treatment
: mainly surgical , it is
OUTPATIENT and performed using LA

Some complications of cataracts surgery?

 Retinal detachment
 Endopthalmitis
 Inflammation of the optic nerve
 Also knows as ,,,
Papillitis ( head of optic nerve involved)
Retrobulbar neuritis (posterior nerve)
Commonly associated with MS
Signs and symptoms: sudden loss of vision,
partial or complete, blurred or foggy vision
and pain on movement of the affected eye
- May lose colour vision in affected eye
 Treatment: IV steroids

 Patientswith MS who present with optic

neuritis have a more benign MS course
 Most common cause is carotid artery
artherosclerosis
Other causes : dissecting aneurysms, giant
cell arteritis and arterial spasms

Signs and symptoms: sudden, acute, and

painless loss of vision in one eye.
Fundoscopic examination reveals: cherry red
spot
 Treatment of central retinal artery
occlusion:
ocular massage, anterior chamber
paracentesis, and inhalation therapy of a
mixture of 5% carbon dioxide and 95%
oxygen
Approach to an eye
patient
 1. HOPC
• SOCRATES
 2. Systems review
• Floaters and flashing lights
• Transient vision loss
• Blurry vision:
• Red, painful eyes
• Chronic itching and tearing
• Headaches and scalp tenderness
• discharge
 3. PMH(diabetes, hypertension, and coronary artery
disease)
 4. POH(cataract surgeries, eye trauma, and glaucoma.)
 5.FH(glaucoma and blindness.)
 6. contact lenss use
1. needs immedeate treatment
2. needs treatment in a few days
3. does not need treatment
1. Acute glaucoma
2. Uveitis :iritis, choroiditis
3. Corneal ulcer
4. Herpes simplex keratitis
5. Herpes zoster opthalmicus
6. Penetrating injury
7. Orbital cellulits
8. Endopthalmitis
9. Scleritis
10. Episcleritis
11. Hyphaema >3mm
12. Chemical burns
13. Giant cell arteritis
 Signs and symptoms
• Blurred vision
• Halos, photophobia
• Pain
• Fixed middialated pupil
• Diffuse conjunctival injection
• Hazy cornea
 Risk factors
• Age, FH, steroid use, myopia,
 Treatment
• Emergency referal, IV acetazolamide, pilocarpine
drops or peripheral iridotomy
viral conjunctivits
 supportively with cool compresses
 Tylenol, and chicken soup.
 Warn the patient that they are contagious
• encourage them to wash their hands
• don’t share towels
• throw out their makeup.
Bacterial
 Antibiotics- chloramphenocol
 Supportive
• Warm compression
• Eye irrigation
Allergic
 Antihistamine
 NSAIDS
 Avoid allergens
Chlamydial
 Topical erythromycin or oral
azithromycin- treat partners as well.
 50% idiopathic a lot n
 50% systemic disease(RA, SLE, PAN, wegeners,

 Signs and symptoms : PTP, pain , teary, photobia

 A red or violet, slightly raised patch on the white of the

eye, usually only a fraction of an inch in diameter
 Uvea= iris, cilliary body, choroid

 Cause – HLA B27, exogenous infection,

idiopathic, malignant,

 Signsand symptoms: reduced vision,

perilimbal injection, constant eye pain,
watery , photobia
Questions
A 50 year old woman complains of
sudden pain of her right eye. She
complaints of a headache and being able
to see flashes of lights. On examination
her pupil was found to be mid-dilated
and cornea was hazy
 A. irits
 B. Conjunctivitis
 C. acute glaucoma
 D. Keratitis
 A 24 year-old medical student presents to the
emergency department with 2 days of superficial left
eye pain, mild redness, tearing and mild photophobia.
She has a history of cold sores and has been stressed
out by exams recently.
 Slit lamp examination reveals this:

A. Fungal
keratitis
B. Herpes
keratitis
C. Foreign
body
D. sarcoidosis
 A 32 y.o. female c/o redness and increasing pain in her
left eye x 3/7.
 The eye is painful to touch
 The pain has woken her from sleep over the last two
nights.
 Eye is a little watery but there is no significant discharge
 Eye examination: tenderness

Answer : Scleritis
A 20 year old man presents with a non
tender eye. On examination, the sclera is
bright red with a white rim around the
limbus. The iris, pupil , cornea and IOP
are normal

 Subconjunctival haemorrhage
 Key words : sclera is bright red with a
white rim around the limbus
 33year old woman presents with painful
red eye. The conjunctival vessels are
injected and blanch on pressure. The iris,
pupil ,cornea , IOP normal

 Conjunctivits
 Key word: blanch of pressure
 20year old man with non specific
urethritis and sero(-) arthirits is also
noted to have red eye associatead with
Reiter’s syndrome

 Anterior uveitis
 Key words: V said that if you see reiter’s ,
choose Anterior Uveitis, if not,
conjunctivitis