ALTERATIONS IN REFRRACTION c. Important!!

Refer to ophthalmologist
 Most common Cause:
 Causes:  Unequal curvature of cornea/ lens
o Irregularities of the corneal curvature Types:
o Focusing power of lens 1. Regular- either cornea/ lens (toric lens)
o The length of the eye 2. Irregular- corneal scar (contact lens)
 Major sx: blurred vision and headache
 3 types: Tests:
o Hyperopia  Snellen chart
o Myopia  Keratometer
o Astigmatism  Corneal topography
*Keratometer-Cornea  Autorefractor/ retinoscopy
 Jachson cross cylinders in a phoropter
1. HYPEROPIA “longsightedness/ hypermetropia” Dx:
a. Light rays focused behind retina Myopia & Hyperopia
Classification:  Examination by ophthalmologist, optometrist /
1. Simple orthoptist
2. Pathological  Snellen chart “Hermann Snellen. 1862”
3. Functional Visual acuity= distance of person/ distance of
Causes: smallest optotype. 20/20
 Eyeball too short  Corrective lenses (shatterproof)
 Cornea too flat  Refractive Eye Surgery
Sx: o LASIK/ Lasik (laser-assisted in situ
 Asthenopia (strain) keratomileusis) performed by
 Accommodative dysfunction ophthalmologist
 Amblyopia
*Visual acuity- affected STRUCTURAL PROBLEMS OF THE EYE

2. MYOPIA “nearsightedness” 1. COLOBOMA “cat eye syndrome”

a. Light rays focused in front of retina a. Hole in the eye
b. Genetic & environmental b. Refer to ophthalmologist
Causes: 2. HYPERTELORISM “Wide spaced eye”
 Eyeball too long a. Increased distance between the eyes
 Cornea too steep “orbital hypertelorism”
Sx: b. Chromosomal abnormalities:
 Rubbing Waardenburg’s sydnrome
 Tearing c. Congenital condition
 Red-rimmed eye d. Wide epicanthal folds
 Pressing the eye 3. PTOSIS “falling, a fall”
Age at onset: a. Droopiness of eye
 Congenital “infantile myopia” b. Injury of 3rd cranial nerve (neurologic)
 School “the use of eyes for close work” c. Types:
 Youth i. CONGENITAL (bilateral)
 Adult ii. ACQUIRED (unilateral)

3. ASTIGMATISM “Murdoch Syndrome”

a. Lights rays are bent unevenly
b. May coexist c myopia, hyperopia &
presbyopia (sa tigulang na)
ALTERATIONS IN OCULAR MOVEMENTS 3. AMBLYOPIA “lazy eye”
 Cranial nerve dysfunction a. Other eye “wanders”
o Oculomotor (n3) b. Constantly looking in 2 separate images
o Trochlear (n4) rather than fused image
o Abducens (n6) c. Leads to suppression of central vision in
 3 types: that eye
o Strabismus Meds:
o Nystagmus  Levodopa, atropine (blocks acetylcholine
o Amblyopia making the pupil dilated)
 Causes:
o Stroke ALTERATIONS IN COLOR VISION
o Brain injury
o Diabetes (neuro, retino, nephro) 12 Color wheel
o Tumors  Primary (BRY)
 Secondary (OGV)
1. STRABISMUS  Tertiary
a. Alignment
b. May be disorder of brain/ eye muscle/ 1. COLOR VISION DEFICIT “Color blindness”
cranial nerve lesion Cause:
c. Causes:  Genetic
i. Neuromuscular d/o  Eye, nerve, brain damage
ii. Cerebral hemisphere disease  Exposure to certain chemicals
iii. Thyroid disease Common in:
d. Classified:  Children c haemophilia, congenital
i. Congenital nystagmus/ glucose-6-phosphate
ii. Acquired/ secondary to pathologic dehydrogenase deficiency
e. Types:  Dx:
i. Esotropia (in) o ISHIHARA COLOR TEST (Shinovo
ii. Exotropia (out) Ishihara)- dx of red-green color
iii. Hypertropia (up) deficiencies
iv. Hypotropia (down)  Congenital types:
f. Best to assess: infant 3-6 mos o MONOCHROMACY
g. Requires intervention to prevent  Complete inability
Amblyopia Types:
h. Primary sx: Diplopia 1. Rod monochromacy
i. Pseudostrabismus- false. Detect through “achromatopsia”- no cones
“Hirschberg test” *Cerebral achromatopsia/
j. Cover test- tests ocular deviation color agrosia”- brain ang
dli ka distinguish
2. NYSTAGMUS 2. Cone monochromacy- only
a. Rapid eye movement: vertically/ 1 kind of cone
horizontally o DICHROMACY- 1 of 3 basic color
Types: is absent, 2D
 Physiologic nystagmus- vestibule-ocular o ANOMALOUS TRICHROMACY- 1
reflex cone pigment is deficient/
 Pathologic nystagmus- damage to 1 / anomalous but not absent
more components of vestibular system: TOTAL COLOR BLINDNESS- gray only
semicircular canals, otolith organs,
vestibulocerebellum
 b. Antibiotic eye drops, lubricant
INFLAMMATION OF EYE 7. ORBITAL CELLULITS
1. STYE “Hordeolism” a. Emergency case
a. Staphylococcus  Proptosis
b. 1-2 wks; 4 days c treatment  Ophthalmoplegia
c. Erythromycin  Loss of vision
 Small, yellowish spot @ center of bump 8. DACRYOSTENOSIS
 Painful a. Nasolacrimal duct blockage
Complication: b. Common in newborn
 Chalazion 9. DACRYOCYSTITIS
 Lid fistula a. Nasolacrimal duct infection
 Eyelid cellulitis b. Pus out punctum
2. CHALAZION “meibomian gland lipogranuloma) c. Dacryocystorhinostomy
a. Cyst
b. Blocked meibomian gland
c. Corticosteroid- inflammation of cyst
 Painless TRAUMATIC INJURY OF THE EYE
Complication:  Primary cause of vision d/o
 Astigmatism
 Deformed cornea 1. FOREIGN BODIES
 Blepharitis 2. CONTUSION INJURY “black eye”
3. BLEPHARITIS MARGINALIS “seborrheic  Hyphema- lacrimal drainage
dermatitis” 3. EYELID INJURIES
a. (cradle cap) a. dacryostenosis
b. 2-3 wks
c. Antibiotic ointment (Chloramphenicol,
Erythromycin, Ocular Antihistamines)
d. Sulfacetamide- to r/o seborrhoeic INNER EYE CONDITIONS
dermatitis 1. CONGENITAL GLAUCOMA
 Itching a. Blockage of schlemm canal
 Irritation *tonometer- measure pressure (12-20mmHg)
 Foreign body sensation 2. CATARACT
4. CONJUNTIVITIS "pink eye“ a. Crystallized lens
a. Gonococcus Bacillus (newborn b. Mydriatic agent-dilate pupil
ophthalmia neonatorum) Types:
b. Viral allergy reaction  Nuclear
c. 2-5 days  Cortical
 Hyperaemia  Posterior subcapsular
 Chemosis Lens replacement:
 Epiphora  Aphakic lens- duol 25%
5. KERATITIS  Contact lens
a. Impaired eyesight  IOL implants (Intra Ocular Lens)
Types:  ECCE
 Superficial keratitis Cause:
 Deep keratitis  Steroid use
 Tearing  Radiation exposure
 Photophobia  Galactosemia- inability to metabolize
 Acute pain lactose
6. PERIORBITAL CELLULITIS  Leukocoria
a. Subcutaneous tissue Anterior- birth injury
 Posterior- rickets/ hypocalcemia
3. GLAUCOMA
Types:
 Open-angel
 Angle-closure
Classification:
 Primary & secondary
 Acute & chronic narrow
 Open & closed narrow
a. Primary open-angle
i. Occasional halo
ii. Peripheral vision loss
iii. Painless
iv. Progressive vision loss
v. Early stage is asymptomatic
vi. Enlargement of optic cap
vii. Not an emergency
b. Open-angle
i. Tunnel vision
c. Angle-closure
Surgical:
 Laser trabeculoplasty
 Trabeculectomy
 Fittering procedure
 Iridotomy
 Cyclodestructive procedure