Creator ALIM

Abnormal ocular secretions
• lacrimation (tearing/welling up of tears on the ocular surface)
• epiphora (actual spilling of tears over the margin of the eyelid onto the face)
• dryness
• discharge (purulent, mucopurulent, mucoid, serous, or watery; the first 2 kinds of
discharge are associated with neutrophils and can cause true sealing of the eyelids
overnight)
Abnormal appearances
• ptosis (drooping of the eyelid)
• proptosis or exophthalmos (protrusion of the eye or eyes)
• enophthalmos (the opposite of proptosis)
• blepharitis
• misalignment of the eyes
• redness, other discolorations, opacities, masses
• anisocoria (asymmetric pupil size)
Other concerns
• “something my doctor wanted to be checked”
• the need for a second opinion regarding diagnosis, surgery, or other management
Trauma
Cases of ocular trauma in partic
ular can require very detailed reports based on a thor
-
ough history and examination, and important issues such as workers’ compensation,
disability, and medicolegal factors must be kept in mind.
• the date, time, and place (including the precise address) of the injury
• what happened, in the patient’s own words (particularly in the case of trauma, the
patient’s words are useful in the history of the present illness as well as in the chief
concern)
• what safety precautions were taken, if any, including the wearing of safety glasses
• what measures were taken for emergency treatment (treatment takes priority over
obtaining a history in a true emergency [see chapter 14], although the history remains important)
• the size, type, material composition, and roughly estimated speed of any foreign
body, and whether part or all of the object was recovered after the injury
• whether the vision has been affected
• tetanus immunity status
• time the patient last ate (in case the patient needs to be taken to the operating room
for surgical repair)
Some patients with ocular trauma may have suffered from intimate partner violence.
Screening questions are asked when the patient’s spouse is not at the bedside; referral to a social worker or alerting the emergency department physician may be lifesaving.
BS Optometry

Disturbances of vision
• blurred or decreased central vision (distance, near, or both)
• decreased peripheral vision
• altered image size (micropsia, macropsia)
• distortion of images (metamorphopsia)
• diplopia (monocular, binocular, horizontal, vertical, oblique)
• floaters (moving lines or specks in the field of vision)
• photopsia (flashes of light)
• iridescent vision (halos, rainbows)
• dark adaptation problems (nyctalopia)
• dyslexia (difficulty processing the written word)
• color vision abnormalities
• blindness (ocular, cortical, perceptual)
• oscillopsia (movement or shaking of images)
Ocular pain or discomfort
• foreign-body sensation (a feeling of scratchiness, as though a particle is present on
the surface of the eye)
• ciliary (deep) pain (an aching, often severe, pain within and around the eye, sometimes radiating to the ipsilateral temple, forehead, malar area, and even the occiput,
secondary to spasm of the ciliary muscles)
• photophobia (a less severe form of ciliary pain that is present only upon exposure
to light)
• headache
• burning
• dryness
• itching; true itching, which compels the patient to rub the eye(s) vigorously (and
which usually indicates allergy), must be differentiated from burning, dryness, and
foreign-body sensation
• asthenopia (eyestrain)

Cetirizine hydrochloride 10 mg tablet
Uses
Cetirizine is an antihistamine used to relieve allergy symptoms such as watery eyes, runny nose, itching eyes/nose, sneezing, hives, and itching. It works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction.Cetirizine does not prevent hives or prevent/treat a serious allergic reaction (such as anaphylaxis). If your doctor has prescribed epinephrine to treat allergic reactions, always carry your epinephrine injector with you. Do not use cetirizine in place of your epinephrine.
Dosage
The dosage is based on your age, medical condition, and response to treatment. Do not increase your dose or take this medication more often than directed.
Side effects
Drowsiness, tiredness, and dry mouth may occur. Stomach pain may also occur, especially in children. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
difficulty urinating, weakness.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Examination of a long case: Proptosis
Guidelines
1. Duration of the complaints should be in chronological order.
2. Elaboration of the complaint should have an onset (insidious, sudden,
etc.) and a progress mode (rapid, slow, etc.) and any relieving nature
(e.g. pain relieved with closing the eyes).
Mr M, a 57-year-old male, farmer by occupation, hailing from Madurai
presented to us with complaints of:
 Prominence of right eye of 4 months duration.
 Swelling and pain of right eye of 1 month duration.
History of present illness
The patient was asymptomatic till 4 months back when he noticed
prominence of right eye which was insidious in onset, progressive in
nature and more worse in the morning. The prominence was associated
with mild discomfort and dryness of the right eye. He consulted a local
ophthalmologist and was prescribed some eye drops which provided some
symptomatic relief.
The patient then developed swelling of right eye of both upper and lower
lid associated with pain and redness of the right eye which was progressive
in nature and worse in the morning. The pain was dull aching in nature
more of retrobulbar discomfort, typically described by the patient as
something pushing behind the eye. The pain was non-radiating, present
both at rest and with movements of the eye.
The above symptoms were associated with gritty foreign body sensation
of both eyes.
H/o loss of weight with good appetite associated with increased sweating,
tremors and palpitations since past 2 years.
He gives h/o swelling in the neck for past two years.
No h/o diplopia.
No h/o defective vision or blackouts or transient loss of vision or defective
color perception.
No h/o hyperpigmentation of lids/eyes.
No h/o postural variation (bending forwards).
No h/o variation with sneezing or coughing or straining.
No h/o photophobia, discharge or colored halos.
No h/o any other swelling in the body.
No h/o dysphagia, dysphonia, easy fatigability, drooping of eyelids.
No h/o radiation therapy or chemotherapy in the past.
No h/o skin discoloration in the past.
No h/o fever, headache, nausea, vomiting.
No h/o nasal block, frequent respiratory tract infection, epistaxis.
No h/o trauma.
Past history
H/o taking tablet Carbimazole 5 mg BD for past 2 years.
No h/o diabetes mellitus, hypertension, cardiac disease.
Personal history
Patient consumes mixed diet.
He is a chronic smoker, consumes average of 6–7 ci******es per day.
He occasionally consumes alcohol.
Family history
No h/o similar complaints in the family.
General examination
Patient is averagely built and nourished.
Pulse—90/minute, regular in rhythm and volume.
Respiratory rate was 18/minute.
Blood pressure was 130/80 mm Hg taken in left upper arm in the supine
position.
Higher functions are normal.
No pallor, cyanosis, icterus and clubbing.
No evidence of any regional or generalized lymphadenopathy.
No evidence of any skin changes or dryness.
Examination of the neck revealed small midline swelling 3 × 5 cm which
moved with deglutition and did not move with protrusion of the tongue
suggestive of a thyroid swelling.
Fine tremors were noted when the patient was asked to stretch his arms
and spread out his fingers.
Tremors were not present at rest.
There was no evidence of dysdiadochokinesia and finger.
Nose past pointing test was negative.
Central nervous system was within normal limits. There was no signs of
confusion or dementia, lethargy.
Cardiovascular system was normal without any murmurs.
Respiratory system examination revealed normal vesicular breath sounds
in both lungs on auscultation.
Per abdominal examination was normal with no evidence of any palpable
intra-abdominal mass.
ENT examination—anterior rhinoscopy was normal with no evidence of sinus tenderness
Ocular examination
Visual acuity in both eyes is 6/12p improving to 6/6 with +1.50D sphere
with 2.50D sphere for near vision.
Right eye Left eye
Axial proptosis Normal
Lids
Periorbital edema
Normal
Conjunctiva
Congestion nasally and Normal
temporally, mild chemosis,
decreased tear film height,
decreased tear film
breakup height (

1. Case Sheet Writing
The following description attempts to train a resident in describing
various abnormalities of the fundus in a case of diabetic retinopathy.
Fundus of Mr C aged 70 years.
High risk PDR with CSME (Right eye)
Fundus examination of the right eye:
Distant direct ophthalmoscopy at one arms distance showed a good red glow.
Direct ophthalmoscopy close to face revealed a clear media.
Disk was, vertically oval, normal in size, pink in color , with well-defined
margins and having a cup disk ratio of 0.3 with a healthy neuroretinal rim.
Vessels arise from the center of the disk, branching dichotomously
maintaining an arterio-venous ratio of 2:3.
Fine, lacy frond of vessels occupying one clock hour area of the disk
superiorly and 3 o’clock hours inferonasally suggestive of neovascularization
of the disk are noted.
A whitish, elevated semilunar shaped fibrous band about 1 disk diameter
inferonasal to the disk containing fine tufts of vessels suggestive of
neovascularization elsewhere is seen.
Background retina shows numerous red pinhead shaped lesions not
continuous with the blood vessels suggestive of dot aemorrhages in all
four quadrants.
A single streak shaped red lesion at the inferotemporal margin of the disk
suggestive of a flame shaped hemorrhage is seen.
A tortuosity of the vein in the superotemporal arcade suggestive of venous
looping is seen.
Localized caliber changes of the veins in the superonasal and
superotemporal arcades suggestive of venous beading is seen.
Yellowish, waxy lesions with distinct margins suggestive of hard exudates
arranged in clumps at the posterior pole, inferior, nasal and temporal to the
fovea with adjacent retinal thickening are seen.
A dark red, well defined accumulation of blood in the inferior retina obscuring
the view of the underlying retinal vasculature suggestive of a vitreoushemorrhage is seen
On slit lamp biomicroscopy with a +90D lens retinal thickening is seen at
the macular area and the above findings are confirmed. Indirect
ophthalmoscopy showed the peripheries to be normal.
Fundus examination of the left eye:
Diagnosis: Severe NPDR with CSME
Distant direct ophthalmoscopy at one arms distance showed a good red glow.
Direct ophthalmoscopy close to face revealed a clear media.
Disk was normal in size, vertically oval, pink in color, with well-defined
margins and having a cup disk ratio of 0.3 with a healthy neuroretinal rim.
Vessels arise from the center of the disk, branching dichotomously
maintaining an arterio-venous ratio of 2:3.
Background retina shows numerous pinhead shaped red lesions suggestive
of dot and blot hemorrhages in all four quadrants.
A streak shaped red lesion inferior to the fovea suggestive of a flame
shaped hemorrhage is seen.
Yellowish, waxy lesions with distinct margins arranged in clumps along the
superior and inferior temporal arcades suggestive of hard exudates are seen.
A yellowish lesion with distinct margins, 2 disk diameter (DD) from the
temporal disk margin, surrounded by an area of retinal thickening suggestive
of a hard exudates plaque is seen.
A yellowish fluffy lesion with indistinct margins inferior to the disk suggestive
of a cotton wool spot is seen.
A few atrophic hypopigmented chorioretinal scars along the inferotemporal
arcade suggestive of old laser marks are seen.
On slit lamp biomicroscopy with a +90D lens, the above findings are
confirmed. Indirect ophthalmoscopy showed the peripheries to be normal.

Know about eye DROPS
5 lubricating eye drops
1. Refresh tears eye drops
2.Systane ultra eye drops
3. Itone eye drops
4. Tear plus eye drops
5. Genteal eye drops
* Do not use any eye drops without consultation

ADDICTION

A physically based dependence on a drug, causing, craving,and tolerance for it and leading withdrawal symptoms. All of these aspects of addiction may be exacerbated or reduced by physiological factors.

Craving and tolerance may be observed as symptoms of addiction . Craving implies an uncontrollable need for drug which may also be observed as light intolerance and shivering. Craving commonly leads the addict who is involuntarily deprived of the drug to steal and even to use violence . Tolerance means that the addict needs more of the drug to achieve the desired effect. Addicts often take in one dose enough of the drug to kill the native user. Tolerance reflects a slow chemical adjustment by cells, presumably nerve cells in the brain, to the drug such that sudden deprivation seriously distorts cell function

Withdrawal symptoms may be seen, therefore , as the observe of tolerance. They can include anxiety, depression,pain, sweating,diarrhoea , weight loss, fever and even death.

लत

एक दवा पर शारीरिक रूप से आधारित निर्भरता, कारण, लालसा और इसके लिए सहिष्णुता और वापसी के लक्षण। नशे के इन सभी पहलुओं को शारीरिक कारकों द्वारा बढ़ा या कम किया जा सकता है।

तरस और सहनशीलता को नशे के लक्षण के रूप में देखा जा सकता है। तरस का मतलब है कि दवा के लिए एक बेकाबू आवश्यकता होती है जिसे हल्के असहिष्णुता और कंपकंपी के रूप में भी देखा जा सकता है। क्रैडिंग आमतौर पर नशे की लत का नेतृत्व करता है जो चोरी से और यहां तक ​​कि हिंसा का उपयोग करने के लिए दवा से अनजाने में वंचित है। सहिष्णुता का मतलब है कि वांछित प्रभाव को प्राप्त करने के लिए व्यसनी को दवा की अधिक आवश्यकता होती है। नशेड़ी अक्सर देशी उपयोगकर्ता को मारने के लिए दवा की पर्याप्त खुराक लेते हैं। सहिष्णुता कोशिकाओं द्वारा एक धीमी रासायनिक समायोजन को दर्शाती है, संभवतः मस्तिष्क की तंत्रिका कोशिकाओं को दवा के लिए, जैसे कि अचानक अभाव गंभीर रूप से विकृति कोशिका कार्य.
निकासी के लक्षणों को देखा जा सकता है, इसलिए, सहिष्णुता के निरीक्षण के रूप में। वे चिंता, अवसाद, दर्द, पसीना, दस्त, वजन घटाने, बुखार और यहां तक ​​कि मृत्यु भी शामिल कर सकते हैं।

ALOPECIA(गंजापन). Loss of hair, baldness.
Common baldness affects 40% of men and 8% of women, though most women show no sign of hair loss until after the menopause. A condition that is so wide spread can hardly be called a disease. Occasionally, however, baldness is a symptom.
# Drugs and cleanliness can cure the disease,and the hair will then usually return to normal.
# In fact boldness is a symptoms and it may occur due to illness also.
*. No treatment has been proven effective. Hair transplant perhaps the newest and certainly the most expensive,
* Must be continued for years , after which it will still look patchy.

ALOPECIA (गंजापन)। बालों का झड़ना, गंजापन।
सामान्य गंजापन 40% पुरुषों और 8% महिलाओं को प्रभावित करता है, हालांकि अधिकांश महिलाएं रजोनिवृत्ति के बाद तक बालों के झड़ने का कोई संकेत नहीं दिखाती हैं। एक ऐसी स्थिति जो इतनी व्यापक फैली हुई है, उसे शायद ही कोई बीमारी कहा जा सकता है। कभी-कभी, हालांकि, गंजापन एक लक्षण है।
# ड्रग्स और सफाई से बीमारी ठीक हो सकती है, और बाल फिर सामान्य रूप से वापस आ जाएंगे।
# वास्तव में बोल्डनेस एक लक्षण है और यह बीमारी के कारण भी हो सकता है।
*। कोई उपचार प्रभावी साबित नहीं हुआ है। हेयर ट्रांसप्लांट शायद सबसे नया और निश्चित रूप से सबसे महंगा,
* वर्षों तक जारी रखा जाना चाहिए, जिसके बाद यह अभी भी दिखाई देगा।

Know about Diseases

Abscess
A collection of pus confined within tissue. It is caused by a bacterial infection.
Abcess may occur anywhere in the body . Because they can be press against neighbouring tissue, they can cause pain. In the root of a tooth behind the eardrum,an abscess can become excruciating. The pressure from an abscess within the skull will damage the brain. Others may develop in relatively unconfined tissue , for example, between the liver and diaphragm.

फोड़ा
ऊतक के भीतर मवाद का एक संग्रह। यह एक जीवाणु संक्रमण के कारण होता है।
शरीर में कहीं भी गर्भपात हो सकता है। क्योंकि वे पड़ोसी ऊतक के खिलाफ दबाए जा सकते हैं, वे दर्द का कारण बन सकते हैं। ईयरड्रम के पीछे एक दांत की जड़ में, एक फोड़ा कष्टदायी हो सकता है। खोपड़ी के भीतर एक फोड़ा से दबाव मस्तिष्क को नुकसान पहुंचाएगा। अन्य लोग अपेक्षाकृत असंक्रमित ऊतक में विकसित हो सकते हैं, उदाहरण के लिए, यकृत और डायाफ्राम के बीच.