A patient presents with a bilateral homonymous quadranopsia involving the right upper visual field. Which of the following represents the MOST likely anatomic location of the abnormality?
(A) Prechiasmal, right side
(B) Optic chiasm
(C) Postchiasmal, prethalamic, left side
(D) Occipital lobe, right side
(E) Occipital lobe, left side
The answer is E.
Homonymous visual field cuts imply a postchiasmal location of the abnormality because this is the first point where fibers from the same visual field of both eyes join. Fibers further divide between the thalamus and occipital lobe into upper and lower quadrant visual fields. The most common location for quadranopsia defects is the occiptal lobe. Stroke, tumor, and atypical migraine may present with quadranopsia.
Visual fields are named from the perspective of the patient, i.e., the right visual field corresponds to the left side of the retina. Therefore, a right-sided visual field cut involves the left-sided neurologic tracks.
Which of the following statements is TRUE regarding acute traumatic retinal detachments?
(A) Most detachments can be visualized on standard fundoscopy
(B) Eighty percent of detachments occur within 24 h of the traumatic event
(C) Most detachments originate in the inferotemporal quadrant
(D) Visual outcome depends on the extent of involvement of the optic disc
(E) Sudden onset of pain is a prominent feature
The answer is C.
The typical retinal detachment is heralded by painless flashes of light, floaters, and a shade across the visual field. Interestingly, most detachments follow a latent period, up to 8 months posttrauma in 50 percent of cases.
Detachments begin as small tears in the ora serrata (called dialysis), most frequently affecting the inferotemporal quadrant, followed by the superonasal quadrant. Because most detachments are very peripherally situated on the retina, standard fundoscopy is typically inadequate for visualization. Although a number of techniques have been developed to correct the detachment, visual outcome remains largely determined by the degree of macular involvement.
Pterygium is a raised, wedge-shaped, non-cancerous growth of the conjunctiva onto the cornea, characterized by elastotic degeneration of and fibrovascular proliferation
Pterygium has a characteristic shape as it is triangular, with the base of the triangle located in the conjunctiva and the apex of the triangle encroaching onto the cornea.
With corneal involvement, even if arrested surgically, a pterygium can affect vision by warping the surface of the cornea and inducing astigmatism, and/or by actually growing over in front of the pupil and obstructing the entering light.
Triangular, thin, transparent conjunctival fold in the palpebral fissure. Its head is yellow, avascular and pints toward the corneal center. The body of the pterygium extends to the semilunar fold(this image for a 32-year-old man).
Treatment :
Pterygia seem to occur more frequently in people who spent much time outside, and is especially common in the southern lattitudes "Some consider pterygium as an occupational disease" So protecting the eyes from sun, dust and wind and use of lubricating drops is the standard treatment.
If the pterygium is still troublesome it can be removed surgically under local anaesthetic ,with high rate of recurrence. Once the pterygium is removed, the bare sclera is covered with conjunctiva
In patients with Retinal Detachment "RD" ,Approximately 8-10% will develop Proliferative vitreoretinopathy (PVR) as a most common complication. Proliferative vitreoretinopathy is known simply as scar tissue formation that grows on the surface of the retina and pulls on the retina, causing it to redetach. The scar tissue also puckers the retina into stiff folds, like wrinkled aluminum foil.
Click on photo for enlargment
Unfold and reattach the retina is by removal the scar tissue with vitrectomy surgery and then reattach the retina. The lens of the eye almost always has to be removed during the surgery. If an intraocular lens implant is in the eye, it can be left alone.
PVR - Endoscopic Membranectomy
PVR or Proliferative Vitreo-Retinopathy (with video of Endoscopic Membranectomy)
Von Hippel-Lindau disease is an autosomal dominant disorder that consists of some combination of retinal angioma, cerebellar or spinal cord hemangioblastoma, renal cell carcinoma, pheochromocytoma, and visceral cysts. About 25% of patients with retinal angiomas will have at least one non-ocular manifestation. About 60% of patients with non-ocular manifestations will have retinal angiomas.
Thus any patient who has Von Hippel-Lindau disease must undergo periodic ophthalmologic examination. Conversely, any patient found to have a retinal angioma should be evaluated for non-ocular manifestations.
The yellow mound fed by a large arteriole and drained by an even larger vein is a capillary hemangioma. It is located in the retinal periphery, beyond the view of the direct ophthalmoscope.
Patients often have many such lesions. If untreated, they will gradually grow, bleed, and leak serous fluid that will finally detach the retina.
Fortunately, laser photocoagulation destroys small lesions. Larger lesions are harder to extinguish; they are treated with a freezing probe placed on the outside of the globe.
A hordeolum is an acute inflammation and/or abscess involving the glandular structures of the eyelid and presents as an acute, tender swelling of the eyelid or eyelid margin. An internal hordeolum involves the meibomian glands, while an external hordeolum (stye) involves the glands of Zeis or Moll at the base of the eye lashes. When bacterial etiology is present, S aureus is the most frequently implicated pathogen. A chalazion is a firm, nontender lump that arises from obstruction of a meibomian gland. Tenderness, when present, occurs during lid swelling and cyst formation. Both hordeola and chalazia are associated with blepharitis, inflammation of the lid margins associated with plugging of the glandular ducts, and crusting around the lashes. Conditions such as seborrheic dermatitis of the eyelids, rosacea, or rarely eyelash infestation with lice can cause blepharitis and resultant blockage of the meibomian glands.
Hordeolum. Focal swelling and erythema at the lid margin are seen in this hordeolum.
Chalazion. This chalazion shows nodular focal swelling and erythema from meibomian cyst formation. Pain is present during swelling and cyst formation.
Wolfflin spots are the whitish clumps of connective fibers found in some irides (mostly blue) near the periphery. These are somewhat distinct from Brushfield spots. Wolfflin described it as elevated nodules (witish or light yellow ), usually situated in the periphery of the iris, and occuring in about 10% of all normal individual.
Which of the following statements is true regarding corneal injuries?
A) Patients should have the affected eye patched for 24 hours.
B) Topical antibiotics are recommended to prevent superinfection.
C) Foreign bodies should not be removed because of potential further injury to the cornea.
D) Topical anesthetics should be g...iven to treat the discomfort.
E) None of the above.
Answer and Discussion
The answer is B. Controlled studies have not found patching to improve the rate of healing or comfort in patients with traumatic or foreign body abrasions. Patients should be treated with topical antibiotics to prevent superinfection. If a corneal foreign body is detected, an attempt can be made to remove it by irrigation. Topical anesthetics should never be administered or prescribed for pain relief because they delay corneal epithelial healing.
-Which of the following is considered a risk factor for retinal detachment? A) Glaucoma B) Diabetic retinopathy C) Hyphema D) Myopia
Answer and Discussion
Retinal detachment is a preventable cause of vision loss. It is relatively common after the age of 60. There are three types of retinal detachments: exudative, tractional, and rhegmatogenous.The most common type is rhegmatogenous, which results from retinal breaks caused by vitreoretinal traction.
Exudative (or serous) retinal detachment results from the accumulation of serous and/or hemorrhagic fluid in the subretinal space because of hydrostatic factors (e.g., severe acute hypertension), or inflammation (e.g., sarcoid uveitis), or neoplastic effusions. Exudative retinal detachment generally resolves with adequate treatment of the underlying disease, and restoration of normal vision is often excellent. Tractional retinal detachment occurs via centripetal mechanical forces on the retina, usually mediated by fibrotic tissue resulting from previous hemorrhage, injury, surgery, infection, or inflammation.
Risk factors for retinal detachment include advancing age, previous cataract surgery, myopia, and trauma. Other eye conditions including hyphema, glaucoma, and diabetic retinopathy are not considered risk factors for retinal detachment. Patients typically present with symptoms such as light flashes, floaters, peripheral visual field loss, and blurred vision. Retinal tears may occur without symptoms, but often photopsia (light flashes) is noted. Photopsia results from vitreoretinal traction. When the retina tears, blood and retinal pigment epithelium cells may enter the vitreous cavity and are perceived as “floaters.” Immediate intervention can prevent retinal detachment. Patients with the acute onset of flashes or floaters should be referred to an ophthalmologist. The answer is D.
Defined as Low grade infection on top of abnormal secretions of the lid glands ,a kind of nonulcerative blepharitis .As a Part of a dermatologic condition that includes the scalp, face, and eyebrows; So it also called Seborrheic Blepharitis .
Clinical signs include greasy, small white scales presents between the lashes. Inflammation is usually minimal.Removal of this scales dosen`t reveals ulceration.
Treatment:
"usually take 2-3 weeks" and includes: • Treatment of seborrhea. • Removal of scales: Using 3% sodium bicarbonate or diluted baby shampoo. • Local antibiotic ointment.
Most corneal transplants performed in the U.S. involve replacing the entire thickness of the diseased cornea with a healthy donor cornea (called penetrating keratoplasty or PK). In partial-thickness corneal transplants (LK), only the anterior (surface) layers of the cornea are removed. The donor cornea is then attached to the host corneal bed, containing only posterior (deeper) layers. LK is less risky, but tends to result in somewhat inferior vision vs. PK and cannot be performed if the disease process (e.g. scar) involves the deeper layers of the cornea.
Sectorial heterochromia, heavily pigmented nevus, and melanoma must be considered. The eye and its lesion must be reevaluated periodically - slit-lamp examination, gonioscopy, and intraocular pressure.
This case of a very small pupil, previous uveitis, total posterior synechia, with +6 black nuclear cataract with very shallow anterior chamber. Subincisional single Iris retractor/hook with Pupil expansion ring and VisionBlue capsule staining made the case a safer. Haelon5 was used tp break the synechia and dilate the pupil to implant the Mortcher pupil expansion ring. A Subincisional single Iris retractor/hook was put to avoid the iris prolapse due to the very shallow chamber. A Tecnis Acrylic AMO IOL was implanted.
Diagram of right orbit that shows the relationship of entering nerves and vessels to the annulus of Zinn.
The four recti muscles arise from a short funnel-shaped tendinous ring called the annulus of Zinn which encloses the optic foramen and a part of the medial end of the superior orbital fissure. There are 2 tendons.
The Lower Tendon (of Zinn) is attached to the inferior root of the lesser wing of the sphenoid between the optic foramen and the superior orbital fissure. The lower tendon gives origin to part of the medial and lateral recti and all of the inferior rectus. The Upper Tendon (of Lockwood) arises from the body of the sphenoid, and gives origin to part of the medial and lateral recti and all of the superior rectus muscle. The superior and medial recti muscles are much more closely attached to the dural sheath of the optic nerve. This fact may be responsible for the characteristic pain which accompanies extreme eye movements in retro-bulbar neuritis.
The patient may complain of eye pain or a foreign body sensation after being poked in the eye with a finger or twig. The patient may have abraded the cornea inserting or removing contact lenses. Removal of a corneal foreign body produces some corneal abrasion, but corneal abrasion can even occur without identifiable trauma. There is often excessive tearing and photophobia. Often the patient cannot open his eye for the exam. Abrasions are occasionally visible on sidelighting the cornea. Conjunctival inflammation can range from nothing to severe conjunctivitis with accompanying iritis.
What to do:
* Instill topical anesthetic drops (to permit exam). * Perform a complete eye exam (visual acuity, funduscopy, anterior chamber bright light, conjunctival sacs for foreign body). * Perform the fluorescein exam by wetting a paper strip impregnated with dry orange fluorescein dye and touching this strip into the tear pool inside the lower conjunctival sac. After the patient blinks, darken the room and examine the patient's eye under cobalt blue or ultraviolet light (the red-free light on the ophthalmoscope does not work). Areas of denuded or devitalized corneal epithelium will fluoresce green. * If a foreign body is present, remove it and irrigate the eye. * If iritis is present (evidenced by photophobia, an irregular pupil or meiosis, and a limbic blush in addition to conjunctival injection) consult the ophthalmologic followup physician about starting the patient on topical mydriatics and steroids (e.g., cyclopentolate or homatropine and prednisolone). * Instill antibiotic ointment (e.g., erythromycin, tobramycin) in the lower sac. A small, superficial, non-painful abrasion may be left uncovered. # For large, deep, and painful abrasions, patch the eye with enough pressure to keep the lid closed by folding one eyepatch double to rest against the lid, covering it with a second unfolded eyepatch, and taping both tightly with several strips of 1" tape running from the cheek to mid forehead. # Prescribe analgesics (e.g., oxycocone, ibuprofen, naproxen), and give the first dose. # Warn the patient the pain will return when the local anesthetic wears off. # Make an appointment for ophthalmologic followup to reevaluate the abrasion the next day.
What not to do:
* Do not be stingy with pain medication. Patching alone will not eliminate the pain. * Do not give patient any topical anesthetic for continued instillation. * Do not patch a patient with a bacterial conjunctivitis or ulcer. * Do not tape an eye patch up and down or across the nose.
Blepharospasm is an abnormal tic, spasm, or twitch of the eyelid. It is sometimes referred to as Benign Essential Blepharospasm. Focal dystonia is another phrase for this condition, which involves a involuntary muscle contraction around the eyes. The cause can be fatigue, irritant or caffeine. The symptoms can last for a few days, but commonly disappear without treatment. Severe cases can be chronic.
Besides the tic, symptoms of blepharospasm are eye dryness, excessive blinking, twitching, sensitivity to the sun and bright lights. Blepharospasm occurs spontaneously with no indicators. Patients who experience blepharospasm usually have a history of dry eyes and photo sensitivity. Other syndromes such as Meige’s syndrome have been associated with blepharospasm. Drugs used to treat Parkinson’s disease have also been known to cause blepharospasm. Rarely, blepharospasms can be caused by concussions.
A patient presents with a bilateral homonymous quadranopsia involving the right upper visual field. Which of the following represents the MOST likely anatomic location of the abnormality?
(A) Prechiasmal, right side
(B) Optic chiasm
(C) Postchiasmal, prethalamic, left side
(D) Occipital lobe, right side
(E) Occipital lobe, left side
The answer is E.
Homonymous visual field cuts imply a postchiasmal location of the abnormality because this is the first point where fibers from the same visual field of both eyes join. Fibers further divide between the thalamus and occipital lobe into upper and lower quadrant visual fields. The most common location for quadranopsia defects is the occiptal lobe. Stroke, tumor, and atypical migraine may present with quadranopsia.
Visual fields are named from the perspective of the patient, i.e., the right visual field corresponds to the left side of the retina. Therefore, a right-sided visual field cut involves the left-sided neurologic tracks.
Read More
Which of the following statements is TRUE regarding acute traumatic retinal detachments?
(A) Most detachments can be visualized on standard fundoscopy
(B) Eighty percent of detachments occur within 24 h of the traumatic event
(C) Most detachments originate in the inferotemporal quadrant
(D) Visual outcome depends on the extent of involvement of the optic disc
(E) Sudden onset of pain is a prominent feature
The answer is C.
The typical retinal detachment is heralded by painless flashes of light, floaters, and a shade across the visual field. Interestingly, most detachments follow a latent period, up to 8 months posttrauma in 50 percent of cases.
Detachments begin as small tears in the ora serrata (called dialysis), most frequently affecting the inferotemporal quadrant, followed by the superonasal quadrant. Because most detachments are very peripherally situated on the retina, standard fundoscopy is typically inadequate for visualization. Although a number of techniques have been developed to correct the detachment, visual outcome remains largely determined by the degree of macular involvement.
Read More
Pterygium is a raised, wedge-shaped, non-cancerous growth of the conjunctiva onto the cornea, characterized by elastotic degeneration of and fibrovascular proliferation
Pterygium has a characteristic shape as it is triangular, with the base of the triangle located in the conjunctiva and the apex of the triangle encroaching onto the cornea.
With corneal involvement, even if arrested surgically, a pterygium can affect vision by warping the surface of the cornea and inducing astigmatism, and/or by actually growing over in front of the pupil and obstructing the entering light.
Triangular, thin, transparent conjunctival fold in the palpebral fissure. Its head is yellow, avascular and pints toward the corneal center. The body of the pterygium extends to the semilunar fold(this image for a 32-year-old man).
Treatment :
Pterygia seem to occur more frequently in people who spent much time outside, and is especially common in the southern lattitudes "Some consider pterygium as an occupational disease" So protecting the eyes from sun, dust and wind and use of lubricating drops is the standard treatment.
If the pterygium is still troublesome it can be removed surgically under local anaesthetic ,with high rate of recurrence. Once the pterygium is removed, the bare sclera is covered with conjunctiva
Read More
In patients with Retinal Detachment "RD" ,Approximately 8-10% will develop Proliferative vitreoretinopathy (PVR) as a most common complication. Proliferative vitreoretinopathy is known simply as scar tissue formation that grows on the surface of the retina and pulls on the retina, causing it to redetach. The scar tissue also puckers the retina into stiff folds, like wrinkled aluminum foil.
Click on photo for enlargment
Unfold and reattach the retina is by removal the scar tissue with vitrectomy surgery and then reattach the retina. The lens of the eye almost always has to be removed during the surgery. If an intraocular lens implant is in the eye, it can be left alone.
PVR - Endoscopic Membranectomy
PVR or Proliferative Vitreo-Retinopathy (with video of Endoscopic Membranectomy)
Von Hippel-Lindau disease is an autosomal dominant disorder that consists of some combination of retinal angioma, cerebellar or spinal cord hemangioblastoma, renal cell carcinoma, pheochromocytoma, and visceral cysts. About 25% of patients with retinal angiomas will have at least one non-ocular manifestation. About 60% of patients with non-ocular manifestations will have retinal angiomas.
Thus any patient who has Von Hippel-Lindau disease must undergo periodic ophthalmologic examination. Conversely, any patient found to have a retinal angioma should be evaluated for non-ocular manifestations.
The yellow mound fed by a large arteriole and drained by an even larger vein is a capillary hemangioma. It is located in the retinal periphery, beyond the view of the direct ophthalmoscope.
Patients often have many such lesions. If untreated, they will gradually grow, bleed, and leak serous fluid that will finally detach the retina.
Fortunately, laser photocoagulation destroys small lesions. Larger lesions are harder to extinguish; they are treated with a freezing probe placed on the outside of the globe.
Read More
A hordeolum is an acute inflammation and/or abscess involving the glandular structures of the eyelid and presents as an acute, tender swelling of the eyelid or eyelid margin. An internal hordeolum involves the meibomian glands, while an external hordeolum (stye) involves the glands of Zeis or Moll at the base of the eye lashes. When bacterial etiology is present, S aureus is the most frequently implicated pathogen. A chalazion is a firm, nontender lump that arises from obstruction of a meibomian gland. Tenderness, when present, occurs during lid swelling and cyst formation. Both hordeola and chalazia are associated with blepharitis, inflammation of the lid margins associated with plugging of the glandular ducts, and crusting around the lashes. Conditions such as seborrheic dermatitis of the eyelids, rosacea, or rarely eyelash infestation with lice can cause blepharitis and resultant blockage of the meibomian glands.
Hordeolum. Focal swelling and erythema at the lid margin are seen in this hordeolum.
Chalazion. This chalazion shows nodular focal swelling and erythema from meibomian cyst formation. Pain is present during swelling and cyst formation.
Wolfflin spots are the whitish clumps of connective fibers found in some irides (mostly blue) near the periphery. These are somewhat distinct from Brushfield spots. Wolfflin described it as elevated nodules (witish or light yellow ), usually situated in the periphery of the iris, and occuring in about 10% of all normal individual.
Read More
Which of the following statements is true regarding corneal injuries?
A) Patients should have the affected eye patched for 24 hours.
B) Topical antibiotics are recommended to prevent superinfection.
C) Foreign bodies should not be removed because of potential further injury to the cornea.
D) Topical anesthetics should be g...iven to treat the discomfort.
E) None of the above.
Answer and Discussion
The answer is B. Controlled studies have not found patching to improve the rate of healing or comfort in patients with traumatic or foreign body abrasions. Patients should be treated with topical antibiotics to prevent superinfection. If a corneal foreign body is detected, an attempt can be made to remove it by irrigation. Topical anesthetics should never be administered or prescribed for pain relief because they delay corneal epithelial healing.Read More
-Which of the following is considered a risk factor for retinal detachment? A) Glaucoma B) Diabetic retinopathy C) Hyphema D) Myopia
Answer and Discussion
Retinal detachment is a preventable cause of vision loss. It is relatively common after the age of 60. There are three types of retinal detachments: exudative, tractional, and rhegmatogenous.The most common type is rhegmatogenous, which results from retinal breaks caused by vitreoretinal traction.
Exudative (or serous) retinal detachment results from the accumulation of serous and/or hemorrhagic fluid in the subretinal space because of hydrostatic factors (e.g., severe acute hypertension), or inflammation (e.g., sarcoid uveitis), or neoplastic effusions. Exudative retinal detachment generally resolves with adequate treatment of the underlying disease, and restoration of normal vision is often excellent. Tractional retinal detachment occurs via centripetal mechanical forces on the retina, usually mediated by fibrotic tissue resulting from previous hemorrhage, injury, surgery, infection, or inflammation.
Risk factors for retinal detachment include advancing age, previous cataract surgery, myopia, and trauma. Other eye conditions including hyphema, glaucoma, and diabetic retinopathy are not considered risk factors for retinal detachment. Patients typically present with symptoms such as light flashes, floaters, peripheral visual field loss, and blurred vision. Retinal tears may occur without symptoms, but often photopsia (light flashes) is noted. Photopsia results from vitreoretinal traction. When the retina tears, blood and retinal pigment epithelium cells may enter the vitreous cavity and are perceived as “floaters.” Immediate intervention can prevent retinal detachment. Patients with the acute onset of flashes or floaters should be referred to an ophthalmologist. The answer is D. Read More
Defined as Low grade infection on top of abnormal secretions of the lid glands ,a kind of nonulcerative blepharitis .As a Part of a dermatologic condition that includes the scalp, face, and eyebrows; So it also called Seborrheic Blepharitis .
Clinical signs include greasy, small white scales presents between the lashes. Inflammation is usually minimal.Removal of this scales dosen`t reveals ulceration.
Treatment:
"usually take 2-3 weeks" and includes: • Treatment of seborrhea. • Removal of scales: Using 3% sodium bicarbonate or diluted baby shampoo. • Local antibiotic ointment.
Read More
Most corneal transplants performed in the U.S. involve replacing the entire thickness of the diseased cornea with a healthy donor cornea (called penetrating keratoplasty or PK). In partial-thickness corneal transplants (LK), only the anterior (surface) layers of the cornea are removed. The donor cornea is then attached to the host corneal bed, containing only posterior (deeper) layers. LK is less risky, but tends to result in somewhat inferior vision vs. PK and cannot be performed if the disease process (e.g. scar) involves the deeper layers of the cornea.
Sectorial heterochromia, heavily pigmented nevus, and melanoma must be considered. The eye and its lesion must be reevaluated periodically - slit-lamp examination, gonioscopy, and intraocular pressure.
Read More
This case of a very small pupil, previous uveitis, total posterior synechia, with +6 black nuclear cataract with very shallow anterior chamber. Subincisional single Iris retractor/hook with Pupil expansion ring and VisionBlue capsule staining made the case a safer. Haelon5 was used tp break the synechia and dilate the pupil to implant the Mortcher pupil expansion ring. A Subincisional single Iris retractor/hook was put to avoid the iris prolapse due to the very shallow chamber. A Tecnis Acrylic AMO IOL was implanted.
Diagram of right orbit that shows the relationship of entering nerves and vessels to the annulus of Zinn.
The four recti muscles arise from a short funnel-shaped tendinous ring called the annulus of Zinn which encloses the optic foramen and a part of the medial end of the superior orbital fissure. There are 2 tendons.
The Lower Tendon (of Zinn) is attached to the inferior root of the lesser wing of the sphenoid between the optic foramen and the superior orbital fissure. The lower tendon gives origin to part of the medial and lateral recti and all of the inferior rectus. The Upper Tendon (of Lockwood) arises from the body of the sphenoid, and gives origin to part of the medial and lateral recti and all of the superior rectus muscle. The superior and medial recti muscles are much more closely attached to the dural sheath of the optic nerve. This fact may be responsible for the characteristic pain which accompanies extreme eye movements in retro-bulbar neuritis.
Read More
The patient may complain of eye pain or a foreign body sensation after being poked in the eye with a finger or twig. The patient may have abraded the cornea inserting or removing contact lenses. Removal of a corneal foreign body produces some corneal abrasion, but corneal abrasion can even occur without identifiable trauma. There is often excessive tearing and photophobia. Often the patient cannot open his eye for the exam. Abrasions are occasionally visible on sidelighting the cornea. Conjunctival inflammation can range from nothing to severe conjunctivitis with accompanying iritis.
What to do:
* Instill topical anesthetic drops (to permit exam). * Perform a complete eye exam (visual acuity, funduscopy, anterior chamber bright light, conjunctival sacs for foreign body). * Perform the fluorescein exam by wetting a paper strip impregnated with dry orange fluorescein dye and touching this strip into the tear pool inside the lower conjunctival sac. After the patient blinks, darken the room and examine the patient's eye under cobalt blue or ultraviolet light (the red-free light on the ophthalmoscope does not work). Areas of denuded or devitalized corneal epithelium will fluoresce green. * If a foreign body is present, remove it and irrigate the eye. * If iritis is present (evidenced by photophobia, an irregular pupil or meiosis, and a limbic blush in addition to conjunctival injection) consult the ophthalmologic followup physician about starting the patient on topical mydriatics and steroids (e.g., cyclopentolate or homatropine and prednisolone). * Instill antibiotic ointment (e.g., erythromycin, tobramycin) in the lower sac. A small, superficial, non-painful abrasion may be left uncovered. # For large, deep, and painful abrasions, patch the eye with enough pressure to keep the lid closed by folding one eyepatch double to rest against the lid, covering it with a second unfolded eyepatch, and taping both tightly with several strips of 1" tape running from the cheek to mid forehead. # Prescribe analgesics (e.g., oxycocone, ibuprofen, naproxen), and give the first dose. # Warn the patient the pain will return when the local anesthetic wears off. # Make an appointment for ophthalmologic followup to reevaluate the abrasion the next day.
What not to do:
* Do not be stingy with pain medication. Patching alone will not eliminate the pain. * Do not give patient any topical anesthetic for continued instillation. * Do not patch a patient with a bacterial conjunctivitis or ulcer. * Do not tape an eye patch up and down or across the nose.
Blepharospasm is an abnormal tic, spasm, or twitch of the eyelid. It is sometimes referred to as Benign Essential Blepharospasm. Focal dystonia is another phrase for this condition, which involves a involuntary muscle contraction around the eyes. The cause can be fatigue, irritant or caffeine. The symptoms can last for a few days, but commonly disappear without treatment. Severe cases can be chronic.
Besides the tic, symptoms of blepharospasm are eye dryness, excessive blinking, twitching, sensitivity to the sun and bright lights. Blepharospasm occurs spontaneously with no indicators. Patients who experience blepharospasm usually have a history of dry eyes and photo sensitivity. Other syndromes such as Meige’s syndrome have been associated with blepharospasm. Drugs used to treat Parkinson’s disease have also been known to cause blepharospasm. Rarely, blepharospasms can be caused by concussions.
