(Eye pain) .

, , , , , , , , , , , ,

1.

asthenopia)

1.1 (Accommodative

(Accommodation)

2

1. (Miosis) 2. (Convergence) 3. Ciliary muscle Zonule ( Schachars theory) (Refractive error) Accommodative asthenopia ? (Myopia) Accommodative asthenopia (Hyperopia) Accommodative asthenopia (Astigmatism) Accommodative asthenopiaBlock : Ambulatory care/15 . 46

3

Amplitude of accommodation 8 Amplitude of accommodation 14 Diopter (D), 25 Amplitude of accommodation 10 D, 40 Amplitude of accommodation 6 D (Presbyopia) (Extraocular muscle) Convergence insufficiency (Near point of convergence < 10 cm) (Heterophoria) (Exophoria) (Esophoria) Convergence insufficiency ExophoriaBlock : Ambulatory care/15 . 46

1.2 (Muscular asthenopia)

4

1.3

,

, , Ultraviolet , , Melanin Macular Photoreceptor cell Ultraviolet Corneal epithelium ( ) 4-6 , Pressure patch 2. 2.1

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5

, Superior palpebral conjunctiva Fluorescein (pool) 1. 2. 3. 4. 5. 6. 20-22 1 Syringe 7. 8. (Pressure patch) (Infiltration) 4 8 Block : Ambulatory care/15 . 46

6

9. 10. , , Pseudomonas aeruginosa , , , ,, , (Chemosis) (Ciliary injection) (Mixed injection), (Corneal edema), Corneal infiltration Irregular corneal light reflex, Keratic precipitate (KP) Hypopyon level , (Miosis) Iris sphincter muscle contraction , Gram stain Block : Ambulatory care/15 . 46

2.2

(Corneal ulcer or keratitis)

7

, 1 , Cycloplegic drug 1% Atropine 2 Ciliary muscle spasm Posterior synechiae 3-6 Hypopyon Collection White blood cell Inferior anterior chamber 2.3 (Corneal ablation)

(Blepharospasm) , , Ciliary injection, Irregular corneal light reflex Corneal ablation Paracetamol NSAIDS Anterior uveal tissue (Iris) Ciliary body 2.4 (Anterior uveitis)

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8

Connective tissue disease Syphilis, CMV retinitis , , , Ciliary injection, Miosis, Keratic precipitate Hypopyon level Steroid Prednisolone 2 . Dexamethasone Cycloplegic drug 1% Atropine 2 Anterior chamber Aqueous Ciliary body Posterior chamber Pupil Anterior chamber pressure Posterior chamber Anterior bowing Iris Iris bomb Volcano effect Angle block Aqueous Trabecular meshwork-Schlemm's canal complex Pressure Anterior chamber Pupillary block vicious cycle , (Haloes) Corneal edema, (Photophobia), , Blepharospasm, Ciliary injection, CornealBlock : Ambulatory care/15 . 46

2.5

(Acute angle-closure glaucoma)

Semi-dilated Pupillary block

9

edema, Semi-dilated pupil Anterior chamber 2 Aqueous Carbonic anhydrase inhibitor Diamox (250 mg) 2 tab oral Beta-antagonist Timolol Vitreous 100% Glycerin oral 1-1.5 g/kg ( ) 20% Mannitol 1.5-2 g/kg iv drip . Steroid . 2% Pilocarpine Laser iridotomy Surgical iridectomy acute attack bypass aqueous Posterior chamber Anterior chamber Prophylactic laser iridotomy Surgical iridectomy Acute angle-closure glaucoma Orbital septum Orbital bone Tarsal plate 2.6 Preseptal cellulitis Orbit

Infection Orbit , , , Block : Ambulatory care/15 . 46

10

Orbital space Orbital fat, Tenons capsule, Muscle , Nerve Vessel

2.7

Orbital cellulitis

Sinus, , Streptococcus, Staphylococcus, Haemophilus influenzae Mucor , Chemosis, Cranial nerve III, IV, VI involvement, Cranial nerve II involvement, Leukocytosis CT scan MRI rule out Subperiosteal Orbital abscess drain Infection Cavernous sinus Septic thrombus Cavernous sinus thrombosis , , Septic fever Cavernous sinus 2 Infection 90% Nasolacrimal duct over growth Block : Ambulatory care/15 . 46

2.8

Acute dacryocystitis lacrimal sac

11

Chronic dacryocystitis Discharge Punctum Acute infection Lacrimal sac ( Drain Skin fistula ) Middle turbinate (Dacryocystorhinorhaphy) 3.

Demyelination Optic nerve Optic disc Disc edema Recurrent Multiple sclerosis , , , , Marcus Gunn pupil , Infection Sinusitis, Syphilis Toxic optic neuropathy, Papilledema, Ischemic Non-ischemic optic neuropathy Steroid Prednisolone Recurrent Block : Ambulatory care/15 . 46

3.1 Optic neuritis Optic nerve

12

Methylprednisolone Recurrent rate , Interferon 3.2 Giant cell arteritis (Temporal arteritis) Auto-immune

disease Temporal artery, 60 Polymyalgia rheumatica, Weight loss, Jaw claudication, Temporal artery

Ophthalmic artery, Central retinal artery

Ischemic optic neuropathy Anemia, ESR 100 mm Marcus Gunn pupil , Optic disc Temporal artery biopsy Corticosteroid 6 1 Aneurysm Cranial nerve III , Peripheral vasculopathy ( ) Cranial nerve III 3.4 Herpes Zoster Ophthalmicus Block : Ambulatory care/15 . 46

3.3 Posterior communicating artery aneurysm

13

(Chickenpox)

Reactivation Varicella-

zoster virus Trigeminal nerve ganglion Maculopapular rash Vesicles Pustules Ophthalmic branch Trigeminal nerve , Conjunctivitis, Dendritic keratitis Acyclovir 800 mg 5 7-10 72 Eruption Ocular complication Postherpetic neuralgia Amitriptyline Duration Postherpetic neuralgia Anterior uveitis, Optic neuritis, Cranial nerve (III, IV, VI) palsies necrosis , / Vasoconstrictive phase Vasodilative phase Attack , , , Ergotamine tartrate Block : Ambulatory care/15 . 46

Acute retinal

3.5 Migraine , ,

14

1. Vaughan D, Asbury T, Riordan-Eva P, eds. General Ophthalmology 15th ed. London: A Simon & Schuster Company; 1999 2. Albert DM, Jakobiec FA eds. Principles and practice of Ophthalmology 2nd ed. W.B. Saunders Company Philadelphia; 2000

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