Diseases/Disorders of the Eye & Systemic Disorders with Ocular Manifestations

• congenital (present since birth): usually secondary to abnormal brain signal
• paralytic: damage (from stroke, trauma, etc.) to the nerves controlling the muscle 
• restrictive: loss of muscle elasticity (due to scarring, inflammation, trauma, etc.)

(strabismus with) outward deviation, resulting in light reflex apparent on nasal side of cornea

(strabismus with) inward deviation, resulting in light reflex on temporal side of cornea

ocular deviation is continually manifest

misalignment is controlled by the brain and only manifest when one eye is covered

• strabismus: eyes out of alignment due to muscle imbalance
• amblyopia: uncorrectable decreased vision as a result of visual deprivation in early childhood (suppression secondary to strabismus)

• symptom: effects the pt. experiences; e.g. diplopia
• sign: abnormalities quantifiable on exam; e.g. strabismus

• proptosis
• exophthalmos

• chalazion: internal hordeolum caused by blockage of the meibomian gland
• stye: external hordeolum caused by bacterial infection of gland around eyelash follicle

• ptosis = droop of upper eyelid due to muscle or nerve damage
• blepharochalasis = folds of skin above the upper lid due to repeated eyelid edema that thins and loosens the skin

globe is not completely covered when eye is closed

inflammation of lacrimal sac, usually caused by blockage of lacrimal duct

• bacterial: thick fluid (mucus & pus "mucopurulent")
• viral: watery discharge; palpebral conjunctiva appears to have tiny bumps on it. Photophobia indicates corneal involvement.

conjunctivitis in infants (<30 days old) due to bacteria or viruses present in the birth canal

• pingueculae: small yellow-white masses (degenerated bulbar conjunctival tissue) on the sclera
• nevi: yellowish-pink or brown tumors on bulbar conjunctiva
• both are usually benign; pingueculae may cause minor irritation

inflammation of the cornea

accumulation of pus in the anterior chamber and redness of the bulbar conjunctiva secondary to corneal infection/ulcer

opacity of outer edge of cornea; degenerative; does not affect vision

accumulation of blood in the anterior chamber, usually due to trauma but can also be caused by "certain diseases" (thanks a lot for the clarity, textbook)

• primary/chronic open-angle (POAG): aqueous humor fails to drain through trabecular meshwork
• primary/acute angle-closure (NAG): increase of lens size as pt ages blocks aqueous humor from flowing out through pupil, then pushes iris forward until it blocks the outflow from anterior chamber angle
• secondary: drainage reduced due to other disease processes (inflammation, PDR, trauma, etc.)
• congenital: malformation of anterior chamber angle from birth

• severe pain
• redness
• halos around lights (rainbow-colored)
• headache
• nausea/vomiting (sometimes)

• pain
• photophobia
• blurred vision

• neovascularization (growth of new blood vessels) on iris
• may lead to reddish iris coloring
• can cause secondary angle-closure glaucoma

unequal pupils due to muscular dysfunction (in turn usually due to nerve damage)

bacterial infection of the vitreous (and possibly surrounding tissue)

• rhegmatogenous: liquid vitreous goes through a retinal tear/hole to the subretinal space
• exudative: fluid collects in subretinal space due to RPE abnormailty or defect of choroid or sclera
• tractional: fibrous growth (usually due to DM retinopathy) pulls on retina

• background (early): capillaries narrow, swell, and clog, and leak blood & exudate into the retina
• proliferative (advanced): the leaks cause new blood vessels & tissue to form (which pulls on the retina and can cause tractional detachment) and may leak blood into the vitreous

• cryopexy: surgially freezing
• photocoagulation: "welding" by laser
• pneumatoretinopexy: injected gas bubble
• scleral buckle: block of silicone to indent the wall
• posterior vitrectomy: surgical removal of vitreous

hereditary retinal degeneration

compression of optic nerve due to intracranial pressure, leading to engorged blood vessels and optic disc swelling

untreatable occlusion of blood supply to optic nerve

• infectious
• inflammatory
• allergic
• ischemic
• metabolic
• congenital
• developmental
• degenerative
• neoplastic
• traumatic

• bacterial or fungal or result of herpes simplex
• corneal epithelium becomes eroded
• cornea becomes opaque
• herpes - branch-shaped figure shows on cornea under fluorescent dye
• antibiotics (topical and/or systemic) for bacterial/fungal; antiviral (topical and/or oral) for herpes

• aging
• injury 
• disease
• congenital

• inflammatory / autoimmune
• metabolic
• vascular / ischemic
• infectious
• malignant / neoplastic

scarring of the pupil

• immune system attacks extraocular muscles' receptor cells
• swelling can lead to proptosis, which can lead to exposure keratopathy

• inflammation & granulomas throughout the body
• most commonly causes uveitis, iritis or vitritis, but can also affect choroidal and retinal vessels, optic nerve and/or lacrimal gland

• neurotransmitter deficiency in skeletal muscles
• commonly causes ptosis and diplopia, and can also cause limited ocular movement

• joint pain, inflammation, stiffness (unknown cause)
• common ocular manifestations are uveitis, scleritis, corneal ulcers, and episcleritis

• autoimmune disorder, unknown cause
• causes retinal vasculitis & cotton-wool spots on retina; can also cause dry eye, scleritis and corneal ulcers

• nervous system disease, affects white matter
• can casue optic neuritis

APD, suden loss, swelling of the ON head

• RAO: pale retina, cherry red spot. 
• RVO: tortuous veins, hemorrhages

Retinal artery occlusion

Scalp tenderness, neck pain

loss of vision due to reduced blood supply; associatedwith HTN, DM, temporal arteritis

vascular growth of malignant cells on the lid & conunctiva; usually found in HIV+ pts

most commonly found in HIV+ pts, causes retinitis

cancerous tumors metastasizing from other body parts (usually breast or lung), most commonly into choroid

• brain tumor
• visual field defect & pupillary abnormality
• can also cause headaches and lead to papilledema

sluggish pupil, circumlimbal flush, diminished red reflex, photophobia

Psoriasis, IBD, TB, sarcoidosis

red eye, unresponsive pupil, corneal edema

headache, nausea, vomiting, halos, pain

Can only gaze laterally. Vertical diplopia

vertical diplopia

Horizontal diplopia, esotropia

Tumor, temporal arteritis, diabetes, aneurysm