Handbook of Ocular Disease Management

Signs and Symptoms Aberrant regeneration of cranial nerve (CN) III, also known as oculomotor synkinesis, is a condition with two...

Corneal infection by Acanthamoeba is a rare occurrence. Patients are most often soft contact lens wearers, although this is not universal; additional historical elements may include recent ocular trauma and exposure to soil or contaminated water.

Signs and Symptoms The word ptosis generally describes a drooping or sagging of the upper eyelid; however, the term is...

Signs and Symptoms Ectropion represents a condition of eyelid malpositioning in which the lid margin rotates outward, away from the...

Signs and Symptoms Entropion represents a condition of eyelid malpositioning in which the lid margin rotates inward against the ocular...

Signs and Symptoms Allergic conjunctivitis is the most common manifestation of ocular allergy, affecting between 20% and 40% of the...

Signs and Symptoms Patients with acute bacterial conjunctivitis present with injection of the bulbar conjunctival and episcleral vessels. In some...

Angioid streaks are acquired irregular breaks in Bruch’s membrane (BM), appearing as meandering, dark brown-reddish radial dehiscences emanating from the optic disc. They extend from a peripapillary ring as jagged, radiating lines coursing from the region of the disc in all directions.

Signs and Symptoms Patients with angle recession glaucoma are typically asymptomatic, unless the disease is advanced with profound visual field...

Signs and Symptoms Uveitis may be noted in individuals of any age, but is most commonly encountered in those between...

Signs and Symptoms Atopy is a genetic predisposition to develop an allergic reaction.1 Systemic examples include allergic rhinitis and atopic...

Signs and Symptoms A patient with bacterial keratitis will present with a typically unilateral, painful, photophobic, injected eye. Visual acuity...

Signs and Symptoms Band keratopathy can afflict any patient regardless of age, sex or race. Early in the course of...

Signs and Symptoms Blepharospasm represents an eye-specific form of dystonia, a neurological condition marked by involuntary movements and extended muscular...

Signs and Symptoms Blunt trauma to the orbital rim is the typical cause of orbital floor and medial orbital wall...

Signs and Symptoms Blue sclera is not a diagnosis but rather a sign of imperfect connective tissue, collagen and collagen-vascular...

Signs and Symptoms Brain and orbital tumors may either be primary lesions or the result of metastasis from primary tumors...

Signs and Symptoms A relatively rare disorder, canaliculitis accounts for less than 2% of all lacrimal disease.1-4 It is typically...

Signs and Symptoms Cavernous hemangioma of the retina (CHR) and the optic disc are typically considered to be uncommon lesions....

Signs and Symptoms Chlamydial infection is recognized as the world's most common sexually transmitted disease.1-8 The spectrum of ocular sequelae...

Signs and Symptoms Choroidal folds can occur in any patient regardless of age, race or sex. Patients may report visual...

Signs and Symptoms Both choroidal nevi and choroidal melanomas represent space-occupying masses of the uveal tract. Choroidal nevi appear as...

Choroidal rupture is a possible consequence following blunt trauma directly to the eye. Patients developing choroidal rupture are often younger males who are involved in activities such as ball sports that expose them to high-speed impact to the eye or adnexa.

Signs and Symptoms Epiphora describes the spillover of tears from the eye onto the lids and ocular adnexa. It is...

Signs and Symptoms Commotio retinae, formerly known as Berlin’s edema, presents as an area of retinal pallor following direct blunt...

Signs and Symptoms A congenital hypertrophy of the retinal pigment epithelium (CHRPE) is typically discovered incidentally during routine, dilated fundus...

Signs and Symptoms A congenital optic disc pit (CODP) appears as a small, hypopigmented, yellow or whitish, oval or round...

Signs and Symptoms While corneal abrasions are among the most common presenting problems in the practice of primary eye care,...

Patients with mucus fishing syndrome (MFS) present with a chief complaint of chronic or excessive stringy discharge from one or both eyes, as well as varying degrees of accompanying ocular irritation.

Conjunctival intraepithelial neoplasia (CIN) is the most common neoplasm of the ocular surface in immunocompetent individuals. It is the precursor to conjunctival squamous cell carcinoma in situ (CIS or SCC) of the conjunctival epithelium, the most common ocular surface neoplasm in all patient populations.

Signs and Symptoms While basal cell carcinoma, sebaceous cell carcinoma and malignant melanoma are the most common malignancies of the...

Conjunctivochalasis (CCh) represents an ocular surface condition in which there is atypical redundancy and laxity of the bulbar conjunctiva, without the presence of edema. It is most commonly seen with aging, and may present with a wide range of symptoms that are usually ascribed to dry eye disease.

Contact-Dermatitis-BContact-Dermatitis-A Signs and Symptoms Contact dermatitis is an inflammatory reaction of the skin, including the eyelid(s) and periocular adnexa. The presentation...

Signs and Symptoms Corneal abrasion is one of the most common urgent clinical entities in practice.1-11 Patients present with some...

Signs and Symptoms Typically, corneal foreign body injuries present as an emergency following acute injury, making them a common urgent...

A patient with acute cranial nerve (CN) III palsy will usually present with sudden-onset unilateral ptosis (or rarely, a bilateral ptosis if the damage occurs to the third nerve nucleus) and ophthalmoplegia.

A patient with cranial nerve (CN) IV palsy (also known as superior oblique palsy, trochlear palsy and fourth nerve palsy) will typically present with complaints of vertical or diagonal diplopia, which often becomes worse as the patient tries to read.

A patient with cranial nerve (CN) VI palsy will present with horizontal, uncrossed diplopia that worsens at distance in the direction ipsilateral to the involved eye. The patient will have an abduction deficit in the involved eye and a noncomitant esodeviation.

Signs and Symptoms While subluxation of the crystalline lens can occur in any patient, there are primarily three situations in...

Signs and Symptoms Cystoid macular edema (CME), not a true diagnosis but a finding arising from numerous causes, is named...

Signs and Symptoms Patients with dacryoadenitis may be highly symptomatic or only mildly distracted by their cosmetic appearance, depending upon...

Signs and Symptoms Acute dacryocystitis (lacrimal sac mucocele) is an infection of the lacrimal sac.1-7 It can occur as result...

Signs and Symptoms Diabetic papillopathy is a unilateral or bilateral (though often asymmetric) painless optic disc edema occurring in patients...

Signs and Symptoms The word ecchymosis takes its origin from the Greek words ek (to extravasate blood from) and chymos...

Signs and Symptoms Due to its numerous potential routes of inoculation, endophthalmitis has no typical age, gender or racial predilection....

Signs and Symptoms Epithelial basement membrane dystrophy (EBMD), also known as anterior basement membrane dystrophy and Cogan’s microcystic dystrophy, is...

Signs and Symptoms Exfoliation syndrome and exfoliative glaucoma occur in high rates throughout northern Finland, Iceland, Saudi Arabia, Great Britain...

Signs and Symptoms Age-related macular degeneration (AMD) is a complex, progressive degenerative disease involving multiple genetic, lifestyle, systemic and environmental...

Signs and Symptoms Patients with eyelid lacerations will present with varying degrees of eyelid swelling, edema, ecchymosis and bleeding.1 Eyelid...

Signs and Symptoms The word myokymia is derived from the Greek words myo, meaning muscle, and kyma, meaning wave. It...

Signs and Symptoms The seventh cranial nerve (CN VII, facial nerve) is responsible for the voluntary motor innervation to the...

Signs and Symptoms Familial exudative vitreoretinopathy (FEVR) is a bilateral inherited disorder characterized by peripheral retinal nonperfusion and vitreous degeneration.1-12...

Signs and Symptoms Patients with filamentary keratitis typically present with variable reports of ocular discomfort, ranging from grittiness and mild...

Signs and Symptoms First described by Austrian ophthal-mologist Ernst Fuchs in 1910, the endothelial disorder that bears his name is...

Signs and Symptoms Patients with Fuchs’ heterochromic iridocyclitis present as young adults with variable vision loss, anterior chamber reaction and...

Giant papillary conjunctivitis (GPC) is an inflammation initiated by microtrauma to the superior palpebral conjunctiva. It is associated with mechanical stimulation from either a contact lens, sutures or a prosthesis.

Signs and Symptoms The initial precipitating event in glaucomatocyclitic crisis (GCC) is the acute onset of a mild, self-limiting uveitis...

Signs and Symptoms Granular corneal dystrophy is a bilateral condition that affects the central regions of the corneal stroma while...

Signs and Symptoms Hemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction. Patients...

Signs and Symptoms The herpes simplex virus (HSV) is a common pathogen and a frequent source of ocular infection.1-6 Nearly...

Signs and Symptoms The herpes simplex virus (HSV) is a common pathogen in developed regions of the world and a...

Signs and Symptoms The most frequently affected branch of the trigeminal nerve in herpes zoster ophthalmicus (HZO) is the ophthalmic...

Signs and Symptoms Herpetic keratouveitis, as the name implies, manifests anterior uveitis and some form of keratopathy in the presence,...

Idiopathic macular telangiectasia (IMT), formerly known as idiopathic juxtafoveolar retinal telangiectasia (IJRT), is a retinal vascular malformation. Clinical and angiographic features along with the method for classification were first described by Gass and Oyakawa in 1982.

Signs and Symptoms Idiopathic polypoidal choroidal vasculopathy (IPCV), historically known as posterior uveal bleeding syndrome, is a typically unilateral disease...

Signs and Symptoms Immune stromal keratitis (ISK), historically referred to as interstitial keratitis, may be seen as either an active...

Signs and Symptoms Internuclear ophthalmoplegia (INO) can present in either the young or old and can be due to various...

Signs and Symptoms Patients with intraocular foreign body (IOFB) may present either as a catastrophic open globe injury following significant...

Keratoconus is the most common cause of degenerative corneal ectasia worldwide and the single most common reason for keratoplasty in the developed world. It is a non-inflammatory pathology wherein the cornea aberrantly assumes a cone shape, leading to corneal protrusion, tissue thinning, myopia, irregular astigmatism, metamorphosis and vision impairment.

Signs and Symptoms Lattice degeneration of the retina is named for its resemblance to a fine, white, linear criss-cross lattice...

Signs and Symptoms Most patients affected with Leber’s hereditary optic neuropathy (LHON) are males in early adulthood with vision loss...

Signs and Symptoms Limbal dermoids, also known as epibulbar or conjunctival dermoids, are generally seen as well-circumscribed oval mass lesions...

Signs and Symptoms Malignant glaucoma, also referred to as aqueous misdirection syndrome or ciliary block glaucoma, occurs without racial or...

Signs and Symptoms Marginal keratitis is defined as a peripheral corneal inflammatory response.1-4 The condition is also known as sterile...

Signs and Symptoms Meibomian gland dysfunction (MGD) represents a chronic disorder of the lids, lid margins and preocular tear film....

Signs and Symptoms Melanocytomas (magnocellular nevus) of the optic disc are slightly elevated, typically benign, darkly pigmented tumors that classically...

Signs and Symptoms Conjunctivitis refers to any generalized inflammation of the conjunctival tissues. Numerous etiologies, including infection, toxicity, allergy and...

Signs and Symptoms Metastatic tumors of the choroid may present with an assortment of signs and symptoms. Commonly, patients complain...

Signs and Symptoms A number of corneal anomalies are present at birth. They may be caused by idiopathic genetic alterations,...

Signs and Symptoms Migraine refers to a group of related chronic episodic conditions chiefly epitomized by headache, but additionally characterized...

Signs and Symptoms Patients typically develop “milky” nuclear sclerotic cataracts at an earlier age than other forms of lens opacification....

Signs and Symptoms Mooren’s ulcer represents an idiopathic, inflammatory, marginal or peripheral ulceration of the cornea. There are two recognized...

Signs and Symptoms Morning glory syndrome (MGS) is a congenital optic disc anomaly that can be discovered at any age,...

Patients with mucus fishing syndrome (MFS) present with a chief complaint of chronic or excessive stringy discharge from one or both eyes, as well as varying degrees of accompanying ocular irritation.

Neurofibromatosis (NF) is a rare, congenital, multisystem disorder that potentially involves the skin, eyes, nerves, brain and/or bones. The two basic forms of NF include type 1 (NF1) and type 2 (NF2), although NF1 is far more common, representing more than 90% of cases encountered clinically.

Signs and Symptoms Neuromyelitis optica (NMO) was first described by Albutt in 1870, but the term was not applied until...

Signs and Symptoms While neuroretinitis can present in any age group due to several potential causative etiologies, patients are typically...

Signs and Symptoms Age-related macular degeneration (AMD) is the leading cause of acquired legal blindness in the United States for...

Signs and Symptoms Patients with nystagmus will present with a rhythmic oscillation of the eyes. Nystagmus can be pendular (equal...

Signs and Symptoms Mucous membrane pemphigoid is a heterogeneous group of autoimmune diseases.1-10 It affects primarily the mucous membranes of...

Signs and Symptoms Demodicosis refers to an infestation by mites of the genus Demodex. In humans, these mites selectively inhabit...

Signs and Symptoms Ocular melanosis represents a pigmented discoloration of the superficial ocular tissues. Patients are not symptomatic with regard...

Ocular myasthenia gravis (OMG) is a subset of general myasthenia gravis (GMG) with muscular dysfunction affecting only the levator and extraocular muscles. OMG has a slight male preponderance.

Ocular rosacea is a common, chronic inflammatory centro-facial dermatosis. The condition affects approximately 16 million Americans, with up to 7% experiencing some form of ocular surface abnormality.

Signs and Symptoms Ocular surface squamous neoplasia (OSSN) refers to a spectrum of cancerous and precancerous lesions of the conjunctiva;...

Signs and Symptoms Optic disc drusen (ODD) represent a condition involving retained hyaline bodies (products of degenerated retinal ganglion cell...

Signs and Symptoms As optic nerve head (ONH) hypoplasia is congenital in nature, it is typically diagnosed in younger patients...

Signs and Symptoms Optic perineuritis is an inflammatory pseudo-optic neuropathy that may be either unilateral (typical) or bilateral. Though optic...

Signs and Symptoms Orbital cellulitis is a vision-threatening infection of the tissues of the orbit.1-5 The condition results from direct...

Signs and Symptoms Pediatric glaucoma is a term that includes any form of glaucoma that presents between birth and age...

Signs and Symptoms Phacoanaphylaxis is a term used to describe inflammation caused by the crystalline lens. Depending upon the clinical...

Phacolytic glaucoma is a secondary glaucoma caused by an autoimmune inflammation due to a hypermature cataract that is leaking lens proteins. It typically develops in elderly patients with a history of progressively worsening vision from hypermaturing cataracts.

Patients presenting with phacomorphic glaucoma are typically elderly, female and of small stature with moderate hyperopia. Frequently, an advanced cataract will be present in the affected eye.

Signs and Symptoms Phthisis bulbi is an ocular condition defined by atrophy and disorganization of the intraocular structures that leads...

Signs and Symptoms Pigment dispersion syndrome (PDS) is an asymptomatic disorder typically discovered upon routine evaluation.1 Pigmentary glaucoma (PG), a...

Signs and Symptoms Pingueculae are characterized by yellowish, slightly raised, interpalpebral exacerbations of tissue in the nasal and temporal bulbar...

Signs and Symptoms Patients with plateau iris syndrome tend to be younger, typically ranging in age from 30 to 50...

Signs and Symptoms Posterior uveitis is an encompassing term indicating inflammation of the posterior segment. The inflammation may be posterior,...

Signs and Symptoms Posterior vitreous detachment (PVD) refers to the separation of the cortical vitreous from the internal limiting membrane...

Signs and Symptoms Preseptal cellulitis is an infection within the eyelid anterior to the orbital septum.1-5 Signs and symptoms include...

The patient with primary chronic angle closure glaucoma (PCACG) typically is older and asymptomatic. Women are more commonly affected than men. Typically patients will have moderate degrees of hyperopia.

Signs and Symptoms Patients with primary open-angle glaucoma (POAG) are typically older, with men more likely to be affected than...

Signs and Symptoms Proptosis is a non-ocular term generically meaning “to push forward.” Ocularly, it is the forward projection or...

Signs and Symptoms Pterygium (plural: pterygia) is typically discovered upon routine ocular evaluation in asymptomatic individuals, or in patients who...

Signs and Symptoms In 1910, Otmar Purtscher described the occurrence of bilateral patches of retinal whitening with intraretinal hemorrhage within...

Signs and Symptoms Pyogenic granulomas typically present as solitary, rapidly evolving papules or nodules on the skin of the face...

Signs and Symptoms Retinal arterial macroaneurysms (RAM) are acquired saccular or fusiform dilatations of the large arterioles of the retina.1-7...

Acute retinal artery occlusions (RAO) are visually debilitating events. Categorized as branch (BRAO), central (CRAO), cilioretinal or ophthalmic, depending on the location of the blockage, they are not the result of a single disease but develop from several systemic abnormalities.

Signs and Symptoms The word embolus comes from the Greek word emballein, meaning “wedge-shaped stopper.” Today, the term is used...

Retinopathy of prematurity (ROP) is a potentially blinding complication of prematurely born infants (30 weeks gestational age or younger) and small infants of low birth weight (1,500 grams [3 pounds, 3 ounces] or smaller; the threshold weight varies with sources).

Signs and Symptoms Patients with Salzmann’s nodular degeneration are often asymptomatic, particularly in the early stages of the disease. Some...

Signs and Symptoms Scleral melt—also known as scleral ischemia or scleral necrosis—is an uncommon condition that typically presents in older...

Signs and Symptoms The ocular signs of sickle cell anemia are variable and may include: comma-shaped vessels in the bulbar...

Signs and Symptoms Patients will present with a vertical ocular strabismic imbalance. There will also likely demonstrate some ocular torsion...

Solar retinopathy, photo-maculopathy, eclipse retinopathy and foveomacular retinitis are all synonymous terms connoting retinal (specifically foveal) damage resulting from direct or indirect sun gazing, possibly during a solar eclipse or even on a normal day.

Signs and Symptoms Squamous cell carcinoma (SCC) is the second most common malignant neoplasm of the eyelid (after basal cell...

Signs and Symptoms Stargardt’s disease is the most common autosomal recessive macular dystrophy, and it is on the continuum of...

Signs and Symptoms Subconjunctival hemorrhage (SCH) is a frequently seen ocular condition. Patients typically present acutely, often with great anxiety...

Terrien’s marginal degeneration is one of the peripheral corneal degenerations. The entity has been recognized for more than 90 years. It may be unilateral or bilateral, affect individuals at any age

Signs and Symptoms Terson’s syndrome was first described by the French ophthalmologist Albert Terson in the early 1900s.1-4 He did...

Signs and Symptoms Thygeson’s superficial punctate keratitis (TSPK) represents a corneal epitheliopathy of unknown etiology. It was first described in...

Signs and Symptoms Tilted disc syndrome (TDS) is a unilateral or bilateral congenital optic disc anomaly that may be discovered...

Signs and Symptoms Tonic pupils (sometimes referred to as internal ophthalmoplegia) result from damage to the parasympathetic innervation to the...

Toxic keratoconjunctivitis (TKC), sometimes referred to as chemical keratitis or toxic follicular conjunctivitis, describes a condition in which the ocular surface is exposed to a noxious substance either acutely or chronically, with resultant deleterious effects to the structure and function of these tissues.

Signs and Symptoms Due to myriad potential causes, toxic/nutritional optic neuropathy has no clearly identifiable racial, gender or age-dependent predilection.1,2...

Signs and Symptoms Toxoplasma gondii is an intracellular obligate protozoan parasite.1-15 In under-developed countries, untreated drinking water is considered a...

Signs and Symptoms Tractional retinal tears (TRT) have no specific racial, gender or laterality predilection; rather, they are produced by...

Signs and Symptoms Traumatic corneal lacerations and perforations are invariably accompanied by a recent history of ocular injury. Typically, this...

Trichiasis is defined as the misdirection of one or more eyelashes toward the ocular surface. By definition, minor trichiasis involves fewer than five cilia, while major trichiasis affects five or more.

Signs and Symptoms Uveal effusion glaucoma results in intraocular pressure (IOP) elevation from non-pupil block secondary angle closure. It arises...

Patients with uveitic glaucoma typically fall into one of two categories: those that develop acute anterior uveitis replete with pain, photophobia and lacrimation, and those experiencing lesser symptoms from chronic uveitis.

Verruca vulgaris is defined as a small, multi-lobulated, firm-but-moveable growth of the outer layers of the skin or mucus membranes. Warts, as they are commonly known, come in varied shapes and sizes.

Signs and Symptoms The two frequently encountered forms of viral conjunctivitis are pharyngoconjunctival fever (PCF) and epidemic keratoconjunctivitis (EKC).1–11 Pharyngoconjunctival...

Signs and Symptoms Vitreomacular traction (VMT) syndrome has no racial or age predilection, though there is a greater incidence in...

Vortex keratopathy, also known as corneal verticillata, describes a unique presentation of corneal deposition in a classic arborizing or whorl-shaped pattern. The condition occurs secondary to exogenous medications or systemic disease.

Signs and Symptoms The term xanthelasma is derived from the Greek xanthos (meaning “yellow”) and elasma (meaning “plate”). Xanthelasma are...