12 Station: Anterior Segment Cases

Front 1

Primary Acute Angle Glaucoma

Back 1

PP: older, female, hyperope, Asian, Eskimo, cortical cataracts

Sx: pain, red eye, headache, acute blurry vision, haloes, photophobia, emesis

Test: GAT, SLE (angles <1/4), Pupils

Critical DDx: Pupils fixed in mid-dilated position, narrow/angles closed, corneal edema, GAT >40.

Front 2

Corneal Abrasion

Back 2

PP: none

Sx: trauma, pain, photophobia, FB sensation, lacrimation, red eye, blepharospasm, conjunctival injection.

Test: SLE w/ NaFL

Critical signs: central punctate staining if wearing contact lens. Defects to epithelium, FB vertical tracks, Seidel's sign

Front 3

Corneal Ulcer

Back 3

PP: EW SCL wearer, corneal trauma, dry eyes, tear film anomalies, diabetics, topical steroid use, immune conditions

Sx: pain, photophobia, lacrimation, foreign body sensation

Test: SLE w/ NaFl staining

Critical Signs: gray white lesion, green discharge hypopyon, corneal infiltrates, cells and flare and blepharospasm.

Front 4

Herpes Simplex

Back 4

PP: Children 6 months to 5 years old, direct contact, UV, trauma or temperature aggravation

Sx: watery dischage, fever, malaise, FB sensation

Test: SLE w/ NaFL staining

Critical signs: watery vesicles on lids, follicular conjunctivitis, diffuse SPK and SEI's, true dendritic ulcers with terminal end bulbs, palpable preauricular nodes, decreased corneal sensitivity, nasal or oral cold sores, genital cold sores.

Front 5

Pterygium

Back 5

PP: person spends lots of time outdoors

Sx: asymptomatic, maybe decreased vision, red eye, FB sensation, irritation, hyperemia, dry eyes

Test: SLE (conj, limbus, cornea) w/ NaFL staining

Critical signs: pink/white triangular groth on nasal/temp conj or cornea, DELLEN, SPK, decreased TBUT, irregular keratometry mires, induced astigmatism

Front 6

Trichiasis

Back 6

PP: none

Sx: red eye, FB sensation, chronic tearing, decreased VA's secondary to scarring

Test: SLE (inferior cornea) w/ NaFL

Critical signs: entropion, misdirected lashes, epithelial staining (infection, ulcers), SPK

Front 7

Recurrent Corneal Erosion

Back 7

PP: Hx of epithelial defects-- map dot dystrophy, corneal trauma or refractive surgery (flap)

Sx: sharp pain upon waking up in the morning, FB sensation, photophobia, tearing, blur.

Test: SLE (cornea) w/ NaFL

Critical Signs: NaFL pooling, microcysts, rideges of epithelial basement membrane

Front 8

Dry Eye

Back 8

PP: older, post menopausal women, lagopthalmos, associated Sjogren's syndrome, Steven Johnson, SCL wearer, medications: antihistamines, sedatives, contraceptives, diuretics, beta blockers, parasympatholytics, accutane

Sx: dry, gritty, sandy feeling, burning, epiphoria, photosensitivity

Test: SLE (cornea) w/ NaFL staining

Critical signs: inferior 1/3 NaFl staining, band pattern SPK, dry mucous membranes (filaments), decreased TBUT (3 times <10 seconds), abnormal Schirmers (<5 mm), dellen

Front 9

Herpes Zoster

Back 9

PP: older, stressed, corticosteroid user, immunocompromised

Sx: pain, HA, fever, malaise, chills, neuralgia, prodrome, FB sensation, rash on one side of face

Test: SLE (cornea), RB

Critical Signs: pseudo-dendritic corneal ulcers without terminal bulbs, + Rose bengal staining, Hutchingson's sign, diffuse SPK, petechial sub conj hemes, vesicular lesions that respect the midline

Front 10

Iritis

Back 10

PP: Systemic conditions-- respiratory, dermatologic, or joint problems

Sx: red eye, sudden onset of severe pain and VA's loss, photophobia

Test: SLE (conical beam) and GAT

Critical signs: AC reaction (cells and flare), decreased IOP

Front 11

Fuch's Dystrophy

Back 11

PP: 75 yo, hyperopia, shallow AC and family history

Sx: haziness and glare in vision, corneal edema, pain, photophobia, decreased VA upon awakening

Test: SLE w/ specular reflection

Critical signs: corneal edema, cell drop out/guttata in the endothelium, hazy cornea

Front 12

Giant Papillary Conjunctivitis

Back 12

PP: CL wearer, prosthetic patient

Sx: itching, tearing, mucous discharge, FB sensation, photophobia, CL intolerance, blur, burning

Test: SLE (superior cornea), Lid Eversion, NaFl staining

Critical signs: cobblestone papillae and mucous discharge on superior palpebral conjunctiva, stringy mucus, superior SPK

Front 13

Vernal Keratoconjunctivitis

Back 13

PP: Hx of allergies, 3-25 year old males, asthma, eczema, hay fever, warm climates, onset during spring and fall

Sx: FB sensation, itching around eyes, ropy mucus discharge in AM, photophobia, "hot lids"

Test: SLE (superior palpebral conj, cornea) w/ Lid Eversion

Critical Signs: cobblestone papillae, lid edema, possible ptosis, mucus discharge, shield ulcer, chemosis, Tranta's dots