Common Eye Disorders

Visual disturbances can include gradual or sudden vision changes, full or partial loss of vision, blind spots, and change in visual acuity, including color vision. It is important to determine whether there was pain associated with the vision change. Did the pain occur with, occur before, or persist with the vision change? Was there any trauma associated with the vision change? Does anything make the vision change better or worse? Has this been a gradual or an abrupt change? Were there any new medications or a change in routine?

The examination should begin with your inspection of the patient’s face and, in particular, his or her eyes. Follow this with an assessment of vision acuity—the Snellen test with use of any prescription lenses (if used) is preferred. Common Eye Disorders

The next step is assessment of extraocular movement and pupil reaction. Note the red reflex and then proceed to fundoscopic examination, if possible. The patient may be extremely photophobic, or cataracts may be present that prevent full fundoscopic examination. Be alert for any changes that signify other disease processes, such as hypertension, diabetes, or neurological conditions.

The following table shows common eye disorders that may be seen in an adult patient. Keep in mind that you may have to refer the patient for further testing and evaluation on the basis of your findings.

Common Eye Disorder

Signs and Symptoms

Evaluation Treatment Plan

Cataracts Chief Complaints:

 Blurred vision.

 Haziness in the visual field.

 Gradual decrease in visual acuity. Common Eye Disorders

 Halos around light.

 Increase in glare when driving at night.

Cataracts may be visualized with a normal eye exam, but early cataracts are best detected through a dilated eye examination.

Refer the patient for ophthalmology evaluation and possible cataract extraction. Remind the patient to have an annual eye examination.

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©2016 South University Common Eye Disorders

3 Week 2 Lectures

Chronic Open-Angle Glaucoma: Chronic open-angle glaucoma is the most common form of glaucoma, or the increased intraocular pressure that compresses the optic nerve. The resulting neuropathy of the optic nerve leads to alteration in vision. African Americans, diabetics, adults aged thirty-five years and older, and those with a family history of chronic open-angle glaucoma are at higher risk of developing glaucoma.

Patient Presents:

 Gradual alteration of vision.

 Can be quite advanced before the patient notices any visual symptoms, such as peripheral vision loss.

Assess peripheral visual fields and perform fundoscopic examination. The cup-to-disk ratio is increased, as is the intraocular pressure, in a patient with chronic open- angle glaucoma.

Ophthalmology should be consulted for evaluation and initiation of a treatment plan. Remind your patient that an annual eye examination is part of health maintenance.

Acute Closed- Angle Glaucoma: Acute closed-angle Common Eye Disorders

Patient Presents:

 Abrupt onset of severe, unilateral eye pain that may

The pupil may be fixed and somewhat dilated accompanied by infection of the eye. Edema of the

Acute closed- angle glaucoma requires an immediate referral to an ophthalmologist

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©2016 South University

4 Week 2 Lectures

glaucoma often presents with acute changes in vision. There may be only a transient increase in the intraocular pressure, yet it results in significant symptoms during the time of the event. These symptoms may resolve by the time the patient is evaluated. Do not dilate the patient’s eyes if there is a history of unilateral eye pain and visual changes. The dilation of the eye may exacerbate the intraocular pressure. Common Eye Disorders

be associated with photophobia, headaches, or nausea.

 May complain of halos around lights and blurred vision.

cornea is common, with a hazy or dewdrop appearance.

for evaluation and treatment. The goal is to provide treatment as soon as possible in order to preserve vision.

Amaurosis Fugax: “It’s like a shade has been pulled down over my eye. It lasts a few minutes . . . then it’s

Chief Complaints:

 Unilateral “shade being drawn down over the eye,” this symptom may last from a few seconds Common Eye Disorders

If you are able to assess the patient during the episode, you may be able to visualize a whitening of the retina with a bright-red fovea. Fundoscopic

A referral is needed for a further workup and treatment of the patient.

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©2016 South University

5 Week 2 Lectures

gone.” This is the presentation of amaurosis fugax. This transient ischemia of the retina is a warning sign of an impending stroke. There are four general sources for amaurosis fugax: emboli, insufficient vascular supply to the retina, arterial spasms, and other idiopathic means.

to several minutes, and the resolution is the “shade going back up,” just as it descended.

 There is no pain associated with amaurosis fugax. Common Eye Disorders

examination may show you hemorrhages, tiny emboli or aneurysms, and vessel changes. These changes may be seen outside the acute episode. Assess for carotid bruits and any neurological changes or weakness. An electrocardiogram (ECG), a carotid ultrasound, and computed tomography (CT) should be considered, as well as a complete blood count (CBC), a comprehensive metabolic profile, and the erythrocyte sedimentation rate (ESR), for assistance in diagnosing the patient Common Eye Disorders