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Eye diagram
Eye Diagram
Cornea : powerful refracting surface, providing 2/3 of the eye's focusing power Conjunctiva is the thin, transparent tissue that covers the outer surface of the eye. It begins at the outer edge of the cornea, covering the visible part of the sclera, and lining the inside of the eyelids.
The macula is responsible for our critical focusing vision. The fovea is the very center of the macula. The macula allows us to appreciate detail and perform tasks that require central vision such reading.
The choroid lies between the retina and sclera. It is composed of layers of blood vessels that nourish the back of the eye. The choroid connects with the ciliary body toward the front of the eye and is attached to edges of the optic nerve at the back of the eye.
The light rays are bent, refracted and focused by the cornea, lens, and vitreous. The lens' job is to make sure the rays come to a sharp focus on the retina.
OCULAR
SYMPTOMS & SIGNS
More common : Blepharitis, dry-eye syndrome, conjunctivitis (discharge or eyelid sticking additionally). Less common : Corneal problem (fluorescein staining of the cornea usually), inflamed pterygium/pinguecula, episcleritis, superior limbic keratoconjunctivitis
Blepharitis
Episcleritis
Pterygium Pinguecula
More common :
Few seconds (usually bilateral): Papilledema. Few minutes: Amaurosis fugax [transient ischemic attack (TIA); unilateral] Vertebrobasilar artery insufficiency (bilateral). 10 to 60 minutes: Migraine (with or without a subsequent headache).
Less common
Impending central retinal vein occlusion Ischemic optic neuropathy Ocular ischemic syndrome (carotid occlusive disease) Glaucoma Sudden change in blood pressure Central nervous system (CNS) lesion Giant cell arteritis
Less common :
Other retinal or CNS disease.
Retinal Detachment
Painful loss
Acute angle-closure glaucoma Optic neuritis (pain with eye movements) Uveitis Corneal hydrops (keratoconus).
Red Eye
Discharge present
More common : Conjunctivitis, Ophthalmia neonatorum in infants, Blepharitis. Less common: Acute allergic reaction, Dacryocystitis, Canaliculitis.
Marginal Ulcer
Fungal Keratitis
Bacterial Keratitis
Decrease vision Pain conj. Inflammation corneal Ulcer mucopurulent exudation with stromal suppuration A/C Hypopyon
Risk factors: trauma, older age, preexisting ocular disease, contact lens wear, contaminated ocular medication, surgery and systemic disease
Red Eye
No discharge present.
More common : Subconjunctival hemorrhage, injected pterygium/ pingueculum, blepharitis, dry-eye syndrome.
Pain
Pain (orbital)
Sinusitis Dry eyes Orbital pseudotumor Optic neuritis Diabetic cranial nerve palsy.
Photophobia
More common :Corneal abnormality (e.g., abrasion or edema) or anterior uveitis. Less common: Conjunctivitis (mild photophobia), posterior uveitis, albinism, total color blindness, aniridia. With normal eye examination: Migraine, meningitis, retrobulbar optic neuritis, subarachnoid hemorrhage, trigeminal neuralgia, or a lightly pigmented eye.
Less common :
Cataract, topical eye drops (miotics), Retinal detachment Migraine (transient) CNS abnormality.
Double Vision
More common: Refractive error, corneal opacity or irregularity, cataract. Less common : Dislocated natural lens or lens implant, extra pupillary openings, macular disease, retinal detachment, nonphysiologic.
Binocular Diplopia
(double vision is eliminated when either eye is occluded.)
Typically intermittent:
Myasthenia gravis, Intermittent decompensation of an existing phoria.
Eyelid Crusting
More common: Blepharitis, meibomianitis, conjunctivitis. Less common: Canaliculitis, nasolacrimal duct obstruction, dacryocystitis.
Eyelid Swelling
Associated with inflammation (usually erythematous)
More common :Hordeolum, blepharitis, conjunctivitis, preseptal or orbital cellulitis, trauma, contact dermatitis . Less common:Ectropion, corneal abnormality, urticaria/angioedema, insect bite, dacryoadenitis, erysipelas, eyelid or lacrimal gland mass.
Eyelid Swelling
Noninflammatory: Chalazion prolapse of orbital fat laxity of the eyelid skin cardiac, renal, or thyroid disease eyelid or lacrimal gland mass.
Eyelid Twitch
Fatigue, lack of sleep Excess caffeine Habit Corneal or conjunctival irritation (especially from an eyelash or cyst) Dry eye Blepharospasm (bilateral) Hemifacial spasm Albinism
Foreign-Body Sensation
Dry-eye syndrome, blepharitis, conjunctivitis, trichiasis, corneal abnormality (e.g., corneal abrasion or foreign body, recurrent erosion, superficial punctate keratitis), contact lensrelated problem,
Itchy Eye
Conjunctivitis (especially viral, vernal, and allergic), blepharitis, dry-eye syndrome, topical drug allergy or contact dermatitis, giant papillary conjunctivitis or another contact lensrelated problem.
Flashes of Light
Retinal Detachment
Night Blindness
More common : Refractive error (especially undercorrected myopia), advanced glaucoma, small pupil (especially from miotic drops), retinitis pigmentosa, congenital stationary night blindness, drugs (e.g., pheno-thiazines, chloroquine, quinine).
Cataract Acute angle-closure glaucoma Corneal edema from another cause (e.g., corneal endothelial dystrophy, aphakic/pseudophakic bullous keratopathy)
Tearing
Adults.
Pain present : Corneal abnormality (e.g., abrasion, foreign body/rust ring, recurrent erosion, edema), anterior uveitis, eyelash (trichiasis, entropion), cyst, or foreign body rubbing against the cornea, conjunctival abnormality (e.g., foreign body, laceration).
Tearing
Adults.
Minimal or no pain present: Dry eye-syndrome, blepharitis, nasolacrimal duct obstruction, punctal occlusion or other tear drainage abnormality, ectropion, conjunctivitis (especially allergic and toxic), lacrimal sac mass or inflammation.
Children:
Nasolacrimal duct obstruction, congenital glaucoma, corneal or conjunctival foreign body or other irritative disorder.
Proptosis: Exophthalmos
Thyroid eye disease (Eyelid retraction and eyelid lag. Painless unless exposure keratopathy develops. Often bilateral. CT scan: Thickening of the extraocular muscles without involvement of the associated tendons.)
Proptosis: Exophthalmos
Orbital inflammatory pseudotumor Orbital cellulitis Orbital tumors Lacrimal gland tumors Trauma (e.g., intraorbital foreign body, retrobulbar hemorrhage; Orbital vasculitis Mucormycosis Varix
OCULAR SIGNS
Hypopyon
Infectious corneal ulcer Endophthalmitis Severe iritis Reaction to an intraocular lens or retained lens protein after cataract surgery Intraocular tumor necrosis [e.g., retinoblastoma (a pseudohypopyon)]
Band Keratopathy
Arcus senilis
Membranous Conjunctivitis
Streptococci pneumococci; chemical burn; ligneous conjunctivitis; Corynebacterium diphtheriae; adenovirus or herpes simplex virus.
Pseudomembranous Conjunctivitis
(Removal of the membrane is easy, and no bleeding results.) All of the causes of membranous
conjunctivitis, as well as ocular
Gonococcal Conjunctivitis
Symblepharon :
Fusion of the Palpebral Conjunctiva with Bulbar Conjunctiva Ocular cicatricial pemphigoid, StevensJohnson syndrome, chemical burn, trauma, drugs, longstanding inflammation, epidermic keratoconjunctivitis, atopic conjunctivitis, radiation.
Eyelid Lesion
Pseudoptosis
Dermatochalasis, Brow ptosis Enophthalmos (traumatic blow-out fracture) Phthisis bulbi, microphthalmia (small eye) Chalazion or other eyelid tumor, eyelid edema
Ptosis
More common :
Less common :
Myasthenia gravis Horners syndrome Third-nerve palsy
Age-related macular degeneration (ARMD), Stargardts disease Cone dystrophy Chloroquine retinopathy
More common Acquired immunodeficiency syndrome (AIDS) retinopathy, hypertension, diabetes, collagenvascular disease (e.g., systemic lupus erythematosus), retinal artery/arteriole occlusion.
Less common Retinal vein occlusion, cardiac valvular disease, carotid artery obstruction, chest trauma (Purtschers retinopathy), anemia, leukemia, lymphoma.
CMV retinitis
Embolus
Amaurosis Fugax, Branch Retinal Artery Occlusion or Central Retinal Artery Occlusion Platelet-fibrin [dull gray and elongated (as opposed to
round)]: Carotid disease. Cholesterol (sparkling yellow, usually at an arterial bifurcation: Carotid disease). Calcium (dull white, typically around or on the disc: Cardiac disease).
Macular Exudates
More common Diabetes, choroidal (subretinal) neovascular membrane, hypertension. Less common Macroaneurysm, Coats disease (children), peripheral retinal capillary hemangioma, retinal vein occlusion, papilledema, radiation.
Neuroophthalmic Abnormalities
Afferent Pupillary Defect
Severe (2 to 3+): Optic nerve disease (e.g., ischemic optic neuropathy, optic neuritis, tumor, glaucoma); central retinal artery or vein occlusion; less commonly, a lesion of the optic chiasm/tract. Mild (1+): Any of the above, amblyopia, macular degeneration, branch retinal vein or artery occlusion, retinal detachment, or other retinal disease. Anisocoria (Pupils of Different Sizes)
Without exophthalmos Isolated third-, fourth-, or sixth-nerve palsy; multiple ocular motor nerve palsies Superior Orbital Fissure Syndrome Myasthenia gravis; chronic progressive external ophthalmoplegia; orbital blow-out fracture with muscle entrapment; ophthalmoplegic migraine Duanes syndrome
Swollen, hyperemic disc, blurring of disc margin: Papilledema Intracranial tumor Hydrocephalus Pseudotumor cerebri Intracranial hematoma & hemorrhage Brain abscess Meningitis & encephalitis DDX: HT retinopathy, papillitis, tumor, diabetic
Orbit
Extraocular Muscle Thickening on CT Scan
More common : Thyroid orbitopathy, orbital inflammatory pseudotumor. Less common : Tumor lymphoma, metastasis, or spread of lacrimal gland tumor to muscle), carotidcavernous fistula, cavernous hemangioma (usually appears in the muscle cone without muscle thickening), rhabdomyosarcoma
Pediatrics
(White Pupillary Reflex)
Leukocoria
Nystagmus in Infancy
Congenital nystagmus, albinism, Lebers congenital amaurosis, CNS (thalamic) injury, spasmus nutans, optic nerve or chiasmal glioma, optic nerve hypoplasia, congenital cataracts, aniridia, congenital corneal opacities.
Refractive Problems
Progressive Hyperopia
Orbital tumor pressing on the posterior surface of the eye, serous elevation of the retina (e.g., central serous chorioretinopathy), posterior scleritis, presbyopia, hypoglycemia, cataracts.
Progressive Myopia
High (pathologic) myopia, diabetes, cataract, use of miotic drops, staphyloma and elongation of the globe, medications (e.g., sulfa drugs, tetracycline), childhood (physiologic).
Vitreous Opacities
Asteroid hyalosis
Synchysis scintillans
Vitreous hemorrhage Vitritis or posterior uveitis
Pars planitis
Sarcoidosis Age-related vitreous degeneration