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眼科門診常見疾病
主治醫師教學
98-03-10
眼科 譚超毅
Myopia, Hyperopia, Astigmatism
Esotropia
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Congenital
Accommodative
Exotropia
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Exophoria
Intermittent exotropia
Constant exotropia
Cataract
Cataract Surgery
Assessment of “RED EYE”
General Danger Symptoms
 Decreased vision
 Severe ocular pain
 Colored halos
Assessment of “RED EYE”
Associated symptoms and symptom complexes
 Itching, seasonal exacerbation, associated rhinitis
allergy
 Burning, foreign body sensation, tearing 
blepharitis, dry eye, retained foreign body, trichiasis
 Localized lid tenderness  hordeolum, chalazion
Eyelid Inflammations
Hordeolum
 Chalazion
 Blepharitis
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Trichiasis
Preseptal Cellulitis
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Pain, red, swelling
of lid
Vision?
EOM?
Pupil sign?
Oral antibiotic
Orbital Cellulitis
Subconjunctival Hemorrhage
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Can occur secondary to
blunt trauma or can be
spontaneous (Valsalva,
bleeding disorder etc.)
No pain, normal vision
No treatment required
resolves in 1-3 weeks
Lubrication if foreign body
sensation
Ultraviolet Keratitis
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Sources:
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Sunlamps, welding arcs
Severe Pain and
photophobia
Management :
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Cycloplegics, antibiotic
ointment, patch
Pingueculum and Pterygium
Conjunctivitis
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Redness, foreign
body sensation,
discharge
Onset: acute or
chronic
Viral or bacterial
origin?
Acute Viral Conjunctivitis
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History of previous contacts
or URI
Initially unilateral
Watery discharge, follicles
+/- pseudomembrane
Tender preauricular node
Very contagious for 7-10
days
Adenovirus commonest
Chlamydial Conjunctivitis
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sexually transmitted:
history of vaginitis,
cervicitis or urethritis
may be present
inferior tarsal follicles,
corneal pannus,
preauricular node, often
unilateral
Allergic Conjunctivitis
Herpes Simplex Keratitis
Herpes Zoster Ophthalmicus
Pseudodendrite
Open Angle Glaucoma
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Elevated IOP
Disc cupping enlargement
Visual defect
Acute PACG: Symptoms
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pain in and around
the eye
redness of the eye
nausea and vomiting
blurred vision
A prodrome of
rainbow colored
halos around lights
may be reported
Acute PACG: Signs
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Elevated IOP
Conjunctival injection
Cloudy cornea (edema)
Shallow anterior chamber
Mid-dilated, sluggishly
reactive or nonreactive
pupil
Flare and cells in the
anterior chamber
Closed angle on
gonioscopy
Acute PACG
Corneal Ulcer
Pain, redness,
blurred vision
 Contact lens
wearing?
Trauma?
 Topical antibiotics
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Gonococcal Corneal Ulcer
Acute Anterior Uveitis
Endophthalmitis
Postoperative
 Traumatic
 Endogenous
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Endogenous endophthalmitis
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Blurred vision, redness, pain
Fungal or bacterial infections
Treatments
 Intravitreal antibiotic injection
 Vitrectomy
 Systemic and topical antibiotics
Pressure Patch
Painless Visual Loss
CRAO
BRAO
CRVO
BRVO
Retinal Detachment
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Floaters, photopsia,
curtain-like VF
defect
Fundus exam
Photocoagulation or
surgery
Diabetic Retinopathy
BDR
PDR
Acute Diplopia
Traumatic
 Orbital wall
fracture
 Orbital
hemorrhage
 CN III, IV, VI
palsy
Nontraumatic
 Refractive error
 Optic media
opacity
 CN III, IV, VI
palsy
Oculomotor Palsy
Trochlear Palsy
Abducens Palsy
Ocular Trauma
Classification of ocular trauma
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Trauma of lids, orbit and adnexa
Trauma of eye
 Closed globe injury: Wall of the eye
is intact
 Open globe injury: Wall of the eye
has been breached
Chemical Burn
Grade 1
Grade 2
Grade 3
Grade 4
Chemical Burn
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Acid precipitates quickly
Alkali continues to penetrate
Therefore can progress over an extended period of time
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Management
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Continuous irrigation with saline until neutral pH
Test fornices with Litmus paper
Sweep fornices to remove retain debris
Antibiotic ointment, cycloplegics
Corneal Abrasion
Lid Laceration
Traumatic Hyphema
Blunt Trauma: Traumatic Mydriasis
Traumatic Lens Dislocation
Blow-out Fracture
Symptoms
 Diplopia, especially on upgaze
 Eyelid swelling after nose
blowing
 Small right “trapdoor” floor
fracture
Signs
 Enophthalmos
 Restricted eye movement
 Orbital rim step deformity
 Infraorbital nerve anesthesia
Traumatic Optic Neuropathy
Blunt eye trauma
 Combined skull fracture?
 RAPD (+)
 Prognosis: initial VA
 Steroid pulse therapy or optic
nerve sheath decompression
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Carotid-Cavernous Fistula
Globe Rupture
Corneoscleral Laceration
Subluxated Corneal Flap
Conjunctival Foreign Body
Corneal Foreign Body
Corneal Foreign Body
Intracameral Foreign Body
Intracameral Foreign Body
Intraocular Foreign Body
Intraocular Foreign Body
Intraorbital Foreign Body
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