• This patient's eye findings are consistent with a chalazion, a granulomatous reaction to a blocked Zeis or meibomian tear gland in the eyelid. Chalazia occur more commonly in patients with rosacea or eyelid margin blepharitis. The lesion is more common on the upper eyelid due to the increased number and length of meibomian glands in the area. Patients typically develop eyelid swelling and erythema that progress to a solitary (usually painless), rubbery, and nodular lesion. The lesions are best visualized when the eyelid is everted. Chalazia often resolve spontaneously, but larger lesions may require warm compresses to enhance drainage and speed healing. Persistent or severe lesions may require ophthalmology referral for resection or glucocorticoid injection

• This patient's eye lesion is consistent with pterygium, a superficial wedge-shaped lesion starting medially on the nasal conjunctiva and extending laterally onto the cornea. Pterygium occurs most commonly intropical regions and likely relates to chronic ultraviolet exposure.�Smaller lesions typically improve with artificial tears or ocular lubricants, whereas larger lesions affecting vision (eg, astigmatism, visual opacity, restricted eye movement) require surgical excision.

• Pinguecula is a degenerative eye condition typically presenting as a yellowish and slightly raised conjunctival lesion. Pinguecula starts in the nasal conjunctival region just as pterygium does but remains confined to the conjunctiva without corneal involvement

• This patient has acute anterior uveitis (iritis), which is characterized by a unilateral painful, red eye and photophobia. Inflammation can affect both the anterior (iris, ciliary body) and posterior (choroid) uveal tract in addition to adjacent structures such as the retina and vitreous humor. Most cases are idiopathic, but common secondary causes may include: Infections (eg, toxoplasmosis, cytomegalovirus, syphilis) Autoimmune diseases (eg, ankylosing spondylitis, sarcoidosis, Behçet's disease) Medications (eg, rifabutin, cidofovir) Gross examination may show a ciliary flush (marked erythema ringing the iris) and hypopyon (leukocytic exudate in the anterior chamber). The presence of leukocytes in the anterior chamber is diagnostic of anterior uveitis and differentiates it from other causes of red eye.

If the condition is not corrected by age 7-8, the patient could lose visual acuity permanently. Therefore,�every child age 3-5 should undergo vision screening at least once, and vision abnormalities should be�addressed immediately

• Bacterial keratitis (BK) is the most common infectious complication of contact lens use, especially in patients who use extended-wear or overnight lenses. Symptoms include pain, eyelid swelling, photophobia, and conjunctival injection. If the corneal lesion (visible under fluorescein staining) is central, vision may also be affected. An inflammatory infiltrate (hypopyon) is occasionally seen in the anterior chamber. The diagnosis of BK is primarily clinical. Treatment with empiric, broad-spectrum topical antibiotics (with Pseudomonas coverage) such as the fluoroquionolone gatifloxacin should be initiated

acute angle-closure glaucoma (ACG)

• headache, nausea, and eye pain with a non-reactive and mid-dilated pupil . ��Patients also often have diminished vision and halos around lights. ACG is characterized by an acute rise in intraocular pressure due to impaired aqueous humor drainage in the anterior chamber. The increased pressure may rapidly damage the optic nerve and potentially lead to permanent vision loss. ACG may occur spontaneously but is frequently triggered by certain medications (decongestants, anti-emetics, anticholinergic drugs).

• A definitive diagnosis can be made with slit-lamp examination and gonioscopy (use of a specialized prismatic lens to visualize the iridocorneal angle).

• hordeolum, which refers to a focal, acute, purulent inflammation at the eyelid margin. An internal hordeolum results from inflammation of a meibomian gland on the conjunctival side of the eyelid. In contrast, an external hordeolum (stye) arises from an eyelash follicle or tear gland. Treatment is aimed at encouraging drainage of the lesion with application of warm, moist compresses to the affected eye several times a day until the condition resolves. In addition, patients with styes should be instructed not to wear contact lenses or eye makeup as this can further exacerbate the inflammation. (Choice B) A hordeolum that does not resolve may harden into a chalazion (painless, rubbery, nodular lesion). Incision and drainage by an ophthalmologist is reserved for recalcitrant lesions.

• amaurosis fugax, which is characterized by painless, rapid, and transient (<10 minutes)
• monocular visual loss. The description of a curtain descending over the visual field is highly suggestive but
• is present in only about 24% of cases. The most common etiology is retinal ischemia due to
• atherosclerotic emboli originating from the carotid artery. Patients with amaurosis fugax and
• concomitant carotid artery disease have a 2%-3% per year risk of stroke. Recurrent episodes are
• associated with a higher likelihood of having complete ipsilateral carotid artery stenosis.

• Dacryostenosis is the most common cause of persistent tearing in infants due to obstruction at the distal portion of the lacrimal duct. Typical manifestations include tearing and mucoid discharge and crusting (mattering) of the eyelashes. Some infants have mild conjunctival injection. First-line treatment consists of lacrimal sac massage to force tears into the NLD, thereby bypassing the obstruction. Gentle pressure should be applied over the lacrimal sac in a downward direction 2-3 times a day. Parents should be reassured that the obstruction usually resolves spontaneously by age 6-12 months.

• Uveitis is characterized by inflammation of the uveal tract, which includes the iris, ciliary body, and choroid. Anterior uveitis (iritis) often presents with intense pain and photophobia in one eye. Consensual photophobia is seen in iritis, helping to differentiate it from conjunctivitis, in which only direct photophobia is seen. Noninfectious uveitis may be seen in isolation or in association with autoimmune diseases such as sarcoidosis, spondyloarthropathies, and inflammatory bowel disease. Infectious uveitis may be caused by a variety of organisms, including viruses (eg, herpes simplex virus, cytomegalovirus), bacteria (eg, Lyme disease, tuberculosis), and fungi (eg, Aspergillus). Patients with suspected uveitis should be referred promptly to an ophthalmologist to confirm the diagnosis. Noninfectious uveitis is usually managed with topical glucocorticoid drops (eg, prednisolone). Cycloplegic-mydriatic agents (eg, scopolamine, cyclopentolate) can relieve the associated pain. Infectious uveitis also requires expedited treatment for the underlying infection.

ABDUCENS NERVE PALSY <6^TH> .. �LATERAL RECTUS PALSY

STROKE OF THE EYE �TPA

Giant papillary conjunctivitis (GPC)�Causes: Primarily linked to mechanical irritation from contact lenses 

ANTI VEGF INJECTION FOR WET MACULAR DEGENERATION .