Conjunctivitis, also called pink eye, is inflammation of the conjunctiva, the membrane lining the eyelids and covering the sclera (Fig.
Conjunctivitis causes pain, redness, swelling, itching, and sometimes purulent discharge (pus). Blepharitis, inflammation of the eyelid, is caused by excessive dryness of the eyes, excessive oiliness of the skin, or infection. Treatment includes applying warm, moist compresses and a topical antibiotic ointment to the area to help localize the infection. A chalazion (meibomian cyst) is an accumulation of lipid (fatty) material from a chronically obstructed meibomian (sebaceous) gland found on the eyelid.
Keratitis is an inflammation of the cornea caused by bacterial, viral, or fungal infections, often after trauma.
Symptoms include pain, photophobia (sensitivity to light), blurred vision, purulent drainage, and redness of the sclera. When symptoms occur, they include eye discomfort, temporary blurring of vision, reduced peripheral vision, and headaches. Acute-angle, acute closed-angle, acute narrow-angle, or angle closure glaucoma is an emergency requiring immediate recognition and treatment to prevent irreversible visual changes and blindness. In acute-angle glaucoma, the aqueous humor is blocked by a bulge of the iris at the anterior chamber before it filters through the trabecular meshwork. In some cases, the cause of acute-angle glaucoma may be iatrogenic (caused by medical interventions), such as when dilating the pupils with medications for routine eye examinations.
Early surgical intervention is indicated; it consists of an iridectomy (removal of a portion of the iris).
Client education is important because the prescribed eye medications should be instilled as ordered. Cataracts may be congenital, may be caused by injury to the eye, or may occur as part of the aging process. Dry macular degeneration progresses slowly and there is no cure for it; all forms of AMD begin with the dry form. Wet macular degeneration is a formation of fragile blood vessels behind the macula that can leak and cause vision problems. Testing for wet AMD may include a fluorescein angiogram, which involves a peripheral injection of a specific dye and monitoring of the photos looking for blood vessels leaks in the eye.
A blunt injury to the eye may cause swelling and bleeding into the soft tissues surrounding the orbit, resulting in a contusion or hematoma, also known as a “black eye.” Apply cold packs for the first 24 to 48 hours to decrease bleeding and edema.
A hyphema, a hemorrhage into the anterior chamber of the eye, is usually caused by blunt trauma and can lead to glaucoma and vision loss. After this initial irrigation, the person should immediately report to an emergency department or an ophthalmologist’s office for further treatment. Nursing Alert Extreme caution is necessary when instilling any type of medication into the eye. Corneal abrasions, which involve the outer (epithelial) layer of the cornea, are often caused by tree branches, fingernails, paper, and contact lens injuries.
If severe visual impairment results from irreversible changes in the cornea, vision might be restored by corneal transplantation (keratoplasty). To help manage any eye inflammation (iritis) a child may develop, her doctor might prescribe eye drops, such as steroids or pupil dilators. If the child is using more than one type of drop, wait 20 to 30 seconds between each kind of drop if possible. Sometimes eye drops are not enough to control a child's eye inflammation. Her doctor may prescribe oral steroids or other medicines such as methotrexate, infliximab, or etanercept. During the eye exam, the ophthalmologist may put special drops in the child's eye to temporarily make her pupil larger. The frequency of the eye exams will depend on the child's risk of developing eye problems. Her eye doctor and rheumatologist will decide how frequently she should have her eyes checked. 74-year-old female with a history of pseudophakia OU andA  primary open angle glaucoma OU that was treated in the past with trabeculectomy surgery OU (right eye 5 months prior, uncomplicated).
Her slit lamp exam showed a slightly elevated diffuse bleb and a deep anterior chamber, without significant inflammation.
Serous choroidal detachments (or choroidal effusions) describe an abnormal accumulation of fluid in the suprachoroidal space.
It is a common complication of glaucoma surgery, but may arise from other intraocular surgeries or eye conditions (e.g. Hypotony is the main cause of fluid accumulation, although the choroidal effusion in itself exacerbates hypotony by reducing aqueous humor production. Age-related macular degeneration (ARMD) is the most common cause of irreversible vision loss in Americans over the age of 60.
Macular degeneration is a disorder of the retina, the light-sensitive inner lining of the back of the eye.
The majority of people with macular degeneration have an early form of the condition and experience minimal visual loss. If macular degeneration progresses to visual loss, 90% of the affected people will develop the dry, or atrophic form of the disease.
The other 10% of people will develop a more serious condition known as the Wet, or exudative, form of macular degeneration. DRUG THERAPY’S In the search for better methods to combat wet age-related macular degeneration, drug therapy is emerging as one of the most promising weapons of choice.
ANTI-VEGF Abnormal blood vessel growth (neovascularization) is set off by a complex series of interactions in the cell. MACUGEN (pegaptanib) This is the first anti-VEGF ophthalmic drug approved by the Food and Drug Administration, Macugen became available in clinical practices last January. LUCENTIS (ranibizumab) This VEGF antibody is on the final phase of clinical trials and may receive FDA approval in 2006. This data is very compelling because, for the first time, there is a potential treatment which has been shown to improve vision in a significant number of patients with wet AMD as opposed to just slowing progression of vision loss.
AVASTIN (bevacizumab) This drug, from which Lucentis is derived, is being explored as a therapy for wet AMD.
EVIZON (squalamine lactate) Evizon is the first clinical drug candidate in a class of naturally occurring molecules know as aminosterols.
KENALOG (triamcinolone acetate) This anti-inflammatory drug is being used to minimize blood vessel growth.
RETAANE (acecortave acetate) This steroid compound, delivered behind the eye using a blunt-tipped, curved tool, continues to be studied. The Amsler Grid (see figure below, for a further explanation and printed copy, see the Amsler Grid page) is used to screen for macular degeneration. Today’s advances in medicine means that more and more older Americans will be able to maintain good vision as they age.
In people who suffer from uncontrolled diabetes, the blood vessels supplying blood to the eyes get damaged. This will make the eyes seem hazy or blurred, directly affecting the retina’s ability to process light, leading to partial blindness. By far one of the earliest symptoms that could indicate diabetic blindness, blurred vision is also the most easily detectable symptom that you must be cautious about. Haziness in vision could be due to damaged blood vessels that supply blood and other nutrients to the optic region. Inability to see or adjust one’s vision in dim or darkly lit rooms could indicate the possibility of you developing diabetic retinopathy that causes diabetic blindness.


In this condition, the blood vessels supplying blood to the retina swell and leak under pressure. If you notice black spots or dots appearing in your vision when you look at anything, you could be suffering from initial symptoms of diabetic blindness. Some people also complain about floating spots that are red in color, when there is no such spot present in reality.
Retinal swelling, cataract formation, inability to read books or newspapers and inability to focus on the road at night time are some of the other important symptoms of diabetic blindness you need to look out for. Since diabetic blindness develops after considerable damage has already occurred in the eye region, the safest way to prevent eye damage is to maintain healthy blood glucose levels after being diagnosed with diabetes. Our comprehensive eye health examinations also check your eyes inside and out for glaucoma damage, cataracts and all other eye diseases as well as high blood pressure, diabetes and other systemic diseases.
A dilated pupil examination allows us to provide the best assessment of your eye health giving the doctor a  more optimal view of the internal structures of your eyes. For patients who are at risk or are being treated for glaucoma or macular degeneration, we use the advanced technology Zeiss Cirrus Spectral Domain OCT Scanner to more thoroughly examine patients and track for potential change over time. The Zeiss HFA Visual Field Analyzer is also instrumental in the diagnosis and treatment of our patients with glaucoma. After performing your examination, your doctor will discuss your results, explain your prescription and discuss your overall eye health. The landmark Ocular Hypertension Treatment Study (OHTS), sponsored by the National Institute of Health (NIH), determined that patients with thin corneas and elevated eye pressure are at greater risk of having advanced visual field loss. We use Ultrasonic Pachymetery for patients at risk for glaucoma based on this OHTS study to measure corneal thickness so we can better profile our patients level of risk for progression to glaucoma related nerve damage. If eye drops are used, teach the client not to touch the eye with the dropper (which will contaminate the solution). Herpes simplex keratitis is the most common cause of unilateral visual loss from infectious keratitis in the United States. The lower lashes turn inward and are often not visible, but they irritate the conjunctiva and cornea.
Ptosis may result from muscular weakness, damage to the oculomotor nerve, or interference with the sympathetic nerves that maintain the lid’s smooth muscle tone.
In this condition, drainage of the aqueous humor through the trabecular (supporting) meshwork (located in the angle of the anterior chamber of the eye) is inadequate.
Open-angle glaucoma may be treated with eye drops, to increase aqueous outflow; or oral medication, such as acetazolamide (Ak-Zol, Dazamide, Diamox), to decrease production of aqueous humor.
Treatment of acute-angle glaucoma consists of miotic eye drops (which constrict the pupil). This procedure involves making a hole in the iris so that the aqueous humor can flow uninhibited from the posterior chamber to the anterior chamber. Instruct the client to avoid excessive fluid intake and all medications containing atropine.
However, the main indication for surgery is when the client complains that vision loss interferes with activities of daily living. An extracapsular cataract extraction involves removal of the anterior capsule of the lens, followed by intact removal of the lens nucleus through a larger incision. The macula is the central portion of the retina that surrounds the optic disc, which is responsible for sharp, central vision.
Signs of the disease include needing more light to read, increased difficulty with reading, and noted blurred vision in the middle of the vision field. One of the first signs of the disease is wavy lines noted in the vision field as can be tested on an ocular testing grid.
Treatment options include laser therapy, photodynamic therapy, eye injections, and medications that inhibit growth of retinal blood vessels. When the swelling has stopped, usually after 24 to 48 hours, use warm packs on the site to hasten the absorption of the blood from the tissues. Corneal abrasions and ulcerations with subsequent cataract formation may lead to permanent vision loss.
If any accidental substance comes in contact with a person’s eye, the eye should be irrigated with water for a minimum of 5 minutes. Treatment of corneal injuries includes instillation of antibiotic drops or ointment and pressure patching. Keratoplasty involves the replacement of damaged corneal tissue with human donor tissue that is obtained within 6 hours after death. This is why it is really important that a careful eye examination is done by an ophthalmologist. It is estimated that 10 million Americans will experience this age-related visual impairment during their retirement years. Ultimately, deposits called drusen appear under the retina and can be seen during an eye examination and on photographs of the retina . For many of these people, macular degeneration will not progress to a more serious condition. In this situation, abnormal blood vessels grow beneath the retina and result in bleeding and leakage of fluid.
A protein molecule called vascular endothelial growth factor (VEGF), signals cells to produce these misguided vessels.
Early study results of Avastin, which is injected directly in the eye, have been encouraging. It is a potent molecule that blocks the action of a number of angiogenic growth factors, including VEGF. It is being studied in conjunction with photodynamic therapy (PDT) to reduced the persistence or growth of abnormal blood vessels. In an effort to detect loss of vision associated with macular degeneration, eye care providers across the country are recommending this test to their patients. Since many serious eye conditions are treatable when detected at an early age, it is important to have periodic eye examinations from an eye care provider, especially as one approaches the sixth decade of life. Being extremely delicate and thin, these vessels cannot tolerate a rising increase in pressure.
If left untreated, this condition can spiral into permanent blindness, making the condition irreversible.
Since most of the symptoms develop when the diabetic condition has become extremely serious, looking out for mild changes in your vision is recommended. Any kind of damage will lead to unwanted blood leakage making the retina and cornea appear blurred and hazy. A serious side effect of diabetes, diabetic retinopathy will develop in people whose retina has been considerably damaged due to increasing blood glucose levels.
In some patients, unwanted blood vessels may also grow on the retina’s surface, leading to decreased retinal functioning. These signs could indicate the unusual phenomenon of blood leakage in the eye region and signal an imminent diabetic blindness attack.
Validated by decades of research and clinical experience, HFA is the accepted gold standard of care in glaucoma diagnosis and management.  HFA has the widest range of testing protocols on any perimeter. Options such as glasses, contact lenses, eye medications, or even eye surgery will be reviewed with you. Following a culture study, antibiotic eye drops or ointments are prescribed for bacterial infections, and antiviral medications for viral infections. Its cause is the organism Chlamydia trachomatis, which may also cause the infection inclusion conjunctivitis.


However, if it becomes infected or interferes with vision or eyelid closure, incising and draining the area may be necessary. The result is the accumulation of aqueous fluid in the anterior chamber, which causes an increase in IOP.
They consist of blurred vision, halos around lights, severe eye pain, headaches, and occasionally nausea and vomiting. These eye drops are given immediately, to allow drainage of the aqueous humor and decrease IOP. Because light entering the eye must pass through the lens to reach the retina, vision is impaired when the lens loses its transparency. Another alternative is ultrasonic fragmentation (phacoemulsification) of the lens nucleus through a smaller incision. The macula is necessary for seeing fine detail or to see objects clearly, as is needed for reading or driving.
Wet macular degeneration progresses quickly and medical attention must be sought or blindness can occur.
Multiple laser or photodynamic treatments may be required, as they are not a cure for the disorder. Internal foreign bodies may penetrate the cornea or sclera and enter the inside of the eye. During irrigation of the eye, direct the flow of water so the solution does not come in contact with the other eye.
This prolonged irrigation removes acids and alkalis that can continue to melt the eye, even after it seems that thorough irrigation has been performed. If a child has no active eye inflammation, she should still have screening checks done by an optometrist.
About 30 to 40 minutes later, the drugs will take effect. She will have large pupils, blurred vision especially for things that are up close, and maybe some sensitivity to bright light. Most of the drugs being developed for wet AMD are designed to target VEGF one way or another to inhibit this unwanted blood vessel growth and reduce leakage and bleeding. Patients typically receive injections every sex weeks for two years and show minimal side effects. The substance is a modified version of the drug Avastin (see below), which is used to treat colorectal cancer.
In addition, the cost of this treatment is significantly less than the other anti-VEGF drugs. The drug, which is given by intravenous infusion, has been tested for several types of cancers, in addition to wet AMD. If you answered yes to the above questions, you could be suffering from initial stages of diabetic blindness.
It is important to realize that nearly 80 percent of blindness cases that result from diabetes are completely preventable if the concerned individuals take proper care. This condition is easily reversible if immediate and appropriate preventive measures are adopted to prevent unwanted rise in blood glucose levels.
Proper handwashing, use of gloves, and proper cleaning of the client’s linens are essential to prevent the spread of infection. Trachoma is highly communicable and is one of the world’s leading causes of preventable blindness. A disturbance in the normal balance between production and drainage of eye fluid causes glaucoma, leading to an increase in IOP. A majority of cataracts, however, are associated with changes in the eye related to aging and develop slowly.
Macular degeneration is a painless disorder that generally commences in the fifth decade and is the leading cause of vision loss in clients over the age of 60. Studies have shown that cholesterol-lowering agents may interfere with the development of drusen.
Advanced AMD does not respond to treatment, which means that early recognition and treatment are necessary to prevent or delay vision loss.
In some cases of wet macular degeneration, laser treatment can be effective at destroying the abnormal vessels, thus preventing or slowing further visual loss. Phase III clinical trials of Macugen have found that treated patients has a 27% greater chance of avoiding moderate visual loss. Phase II trials of Evison for AMD showed positive results, with the patients experiencing stable or improved vision. Diabetes causes several types of complications affecting various vital organs in your body including eyes, brain, heart, kidneys and liver. It can develop in one eye and easily be transferred to the other eye when the eye or face is touched. Conjunctivitis can also be related to environmental allergies and not be considered an infection. An antibiotic ophthalmic ointment may be prescribed to resolve infection and prevent recurrence. To prevent damaging internal ocular structures, never attempt to remove a penetrating object from the eye. A serious complication is corneal destruction, which often requires corneal transplantation. Vision may also be affected when there are disturbances in the layer of cells below the retina called the retinal pigment epithelium. Wet macular degeneration cannot always be treated successfully by laser, however, some experimental drugs and new surgical procedures (photodynamic therapy) are being tested.
While wearing eye glasses normally worn when reading, the individual covers one eye at a time. Causative agents include the formation of yellow cellular deposits or debris called drusen that accumulate between the retina and the choroid. If an object is embedded in the cornea, a topical anesthetic may be ordered for severe ocular pain until the object can be removed.
Treatment of allergy-related conjunctivitis includes avoiding the offending allergen, taking antihistamines, and undergoing desensitization.
Ultrasound may be used to locate an embedded foreign body, and an electromagnet or surgery may be necessary for removal. All four corners of the grid should be visible, and the lines of the grid should appear to be straight and continuous from top to bottom and side to side.
In the early stages, some individuals may not notice the visual changes or rationalize the changes by thinking, “I’m just getting older.” Signs and symptoms include blurred vision, difficultly seeing faces or discerning colors, distorted vision, drastically decreased visual acuity, and the presence of drusen.
If there appear to be any holes or blurry spots, or the lines look wavy, fuzzy, crooked, distorted or broken, the individual should call their eye doctor immediately. Baby shampoo or saline solution irrigations or warm soaks may remove discharge, reduce swelling, and decrease pain and itching. Risk factors include tobacco smoking, aging, family history, hypertension, elevated cholesterol, obesity, and female gender.
There are two forms of age-related macular degeneration (AMD, ARMD): dry macular degeneration and wet macular degeneration (Fig.



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