Acute Closed-angle Glaucoma
features	Acute – emergency
S/S	·       Hx: halos around light, pain, red eye ·       On physical exam ·       the pupil is mid-dilated and does not react to light, ·       the cornea is cloudy with a greenish hue, ·       and the eye feels “hard as a rock.”
Dx	Clx – EMERGENCY
Tx	There are 2 issues: 1.     Pressure: we need to lower it down (open a hole in the eye) 2.     Dilation: we need to reverse that by ACTIVATING ALPHA & BLOCKING BETA a.     A-agonist b.     B-Blocker

	Open Angle Glaucoma
RFs	·       Aferican-American 👨🏾‍⚖️ ·       ⊕ FHx ·       DM
S/S	·       initially Asx ·       Loss of PERIPHERAL VISION → progress to tunnel vision
Dx	⤴️ IOP Ophthalmoscopy: cupping of optic n.
Tx	1˚ BB (timolol) eye drops 2˚ Laser 3˚ if still ⤴️ IOP: surgical trabeculectomy

	Orbital Cellulitis
features	EMERGENCY
S/S	·      Febrile ·      Restricted eye movements
Dx	CT
Tx	I/D + IV ABx

	Macular Degeneration
RF	·       ⤴️ Age ·       Smoking
S/S	·       Wet / Dry ·       Asx ·       Grid test: early signs: Straigt line appear wavy ✳️
Dx	Ophthalmoscope: drusen deposits
Tx	Dry has no tx.

	Retinal Detachment
RF	·       Myopia ·       Trauma ·       Surgery ·       DM Retinopathy (predisposing event usually occur months before Sx happens)
S/S	·       Flashes of light ·       Floaters, ·       a big dark cloud at the top of his visual field –> SEVERE
Dx	Clx Ophthalmoscopy: Grey, elevated retina
Tx	LASER (spot welding)
DDx	Amox fogas: intermittent retinal artery occlusion ·       Presents the same as above, but “comes & goes”

	Choroidal rupture
Nx	Blunt Ocular Trauma
S/S	Blurred vision following trauma
Dx	Opthalmoscopy: ·       Central scotoma ·       Edema ·       Crescent-shaped streak around optical n. ·       hemorrhage (w/ seperation of macula)

	Central Retinal A. Occlusion (CROA)
features	In about 30 minutes the damage will be irreversible
S/S	·       Sudden vision loss, ·       PAINLESS ·       Cherry red spot
Dx	·       Pale optic disc ·       Cherry red fovea
Tx	🚨 1˚ OCULAR MASSAGE + O2

	Chemical Burn of the eye
Dx	Hx + Clx
Tx	·       Irrigation with plain water has to be started as soon as possible wherever the injury happened; it cannot wait until arrival at the hospital. ·       Then to ER → saline irrigation & remove any particle ·       Before D/C: pH is tested to assure that no harmful chemicals remain in the conjunctival sac

	Anterior Uveitis
features	·       Inflammation of uveal tract, which includes ·       iris (anterior) ·       cilliary body (anterior) ·       choroid (posterior) ·       HLA-B27
S/S	·      Redness + Pain = Anterior ·      ⤵️  Vision + floaters = Posterior ·      constricted pupil with abnormal pupil response ·      Severe photophobia
Dx	Clx
Tx	Corticosteroids

	Optic neuritis
#	·       Primarily in young 👩🏻 ·       Associated with MS ·       Immune-mediated demyelination
Clx	·       Acute, peaks at 2 weeks ·       Monocular vision loss ·       Eye pain with movement ·       “Washed-out” color vision ·       Afferent pupillary defect
Dx	·       MRI of the orbits & brain
Tx	·       IV corticosteroids ·       35% of cases recur

	Optic Neuritis
features	·       👩🏻 ·       Inflammation of optic n ·       Seen w/ MS
S/S	·       ⓤ Mono-ocular LOV ·       Eye pain w/ movement ·       Washed-out” color vision ·       Afferent pupillary defect
Dx	MRI
Tx	IV Corticosteroids

	Episcleritis
features	·       may be associated w/ RA
S/S	redness
Dx	phenylphrine ⊕
Tx	Self-limited

	KERATITIS	UVEITIS	ACUTE ANGLE CLOSURE GLAUCOMA
S/S	Redness Pain Tearing Photophobia	Redness Pain Tearing Photophobia	Frontal headache, transient attach of blurred vision in the evening
Central vision	⤵️(distant+near)	Distant > blurred Near > disturbed	⤵️⤵️(distant + near)
Visual field	normal	floaters	Pt is too disturbed to evaluate it
Cornea	Lost corneal luster	Muddy cornea	Edematous, obscuring deeper signs
pupil	normal	Small + spastic	Fixed + dilated
AC	deep	Full of cells + flares	Shallow
IOP	normal	normal	High, rock-hard, acutely tender

	Viral	Bacterial	Allergic
#	ⓤ	ⓤ	ⓑ
Eye stuck in morning?	✓	✓	✓
DC?	Watery	PUS, colored, thick	Watery
dischareg comes back after wiping?	❌	✓	❌
Conjunctival appearance	Follicular	Nonfollicular	·       Follicular “bumpy” ·       Conjunctival edema “chemosis”
Other points	·       Viral prodrome ·       Sandy feeling ·       Burning	ø	·       Hx of allergy ·       Itching

Sebacous cell carcinoma	Ddx from Chalazion (chronic painless inflam of mebious glands) –> Bx lesion
Chalazion	·       chronic painless inflam of mebious glands ·       Tx: ABx + incision/drianage

	Amblyopia
features	·       Path: Cortical blindness –> lack of visual stimulation causes the brain to just shut off the cortical input –> blindness ·       Once it’s there, it’s there ·       Multiple etiologies: Strabismus, Retinopathy of prematurity, Cong Cataracts
S/S	Depends on the etiology.
Dx	Clx
Tx	Tx the underlying  cause.

	Strabismus / الحَول
features	·       Path: ·       The 2 eyes are normal, but not properly aligned the same ·       Can be devided based on etiology (easier): o   Idiopathic o   Refractive o   Restrictive –> muscular (like w/ Graves) o   Paralytic –> Neural (3rd CN palsy)
S/S	Extropia / Entropia
Dx	Clx
Tx	If at birth –> Surgery / If acquired –> Patch / Glasses.

	Strabismus (ocular misalignment)
Abnormal findings	·       Constant strabismus at any age ·       Eye deviation after 4 months of age ·       Asymmetric corneal light reflexes ·       Asymmetric intensity of red reflexes ·       Deviation on cover test ·       Torticollis or head tilt
Tx options	·       Penalization therapy: Cycloplegic ·       drops to blur normal eye ·       Occlusion therapy: Patch normal eye ·       Prescription eyeglasses ·       Surgery
Complications	·       Amblyopia ·       Diplopia

	Congenital Cataract
features	No red reflex
S/S	WHITE CLOUDY EYE AT BIRTH
Dx	Clx
Tx	Remove cataract

	Retinoblastoma
features	·       Red reflex is not there. Instead, a white reflex ·       EMERGENCY
S/S	Leukocoria
Dx	Clx, on PEx
Tx	Surgery

	Retinopathy of prematurity
features	·      Premature baby recieving high dose O2 ·      Blood vessel grows abnormally on the retina
S/S	·       PEx: growths on the eye
Dx	Clx
Tx	·       Laser ·       F/U other complications of prematurity ·       Intraventricular hemorrhage –> US w/ Doppler ·       NEC ·       Bronchopulmonary dysplasia