D
ry
e
y
e
Hea
lth pro
b
l
e
ms
D
ry
e
y
e
s
a
r
e a d
ry st
a
t
e
of th
e c
orn
ea
surf
ace a
n
d
c
onjun
c
tiv
a ca
us
ed b
y r
ed
u
ced
t
ea
r
c
ompon
e
nt pro
d
u
c
tion
(
M
usin
,
I a
n
d L
ipi
d
).
D
ry
e
y
e
s
a
r
e
on
e
of th
e d
isor
de
rs
oft
e
n on th
e e
y
e
with
a
n in
c
i
de
nt of
a
roun
d
10
-
30
%
of th
e
popul
a
tion
a
n
d
e
sp
ec
i
a
lly
e
xp
e
ri
e
n
ced b
yw
a
nit
a
ov
e
r
40
y
ea
rs ol
d
.
A
noth
e
r r
e
j
ab
is
I
n
c
r
ea
s
ed
w
a
t
e
r
e
v
a
por
a
tion of w
a
t
e
rf
a
llings of hom
e
,
offi
ce
or
e
nvironm
e
nt
a
l
D
u
e
to
La
gophool
M
us
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
T
h
e
p
a
ti
e
nt
c
om
e
s with
e
y
e c
ompl
a
ints it
c
hy
a
n
d
lik
e
s
a
n
d
y
.
C
ompl
a
ints
ca
n
be acc
omp
a
ni
ed b
y
b
urning
,
r
ed
,
sor
e a
n
d
gl
a
r
e
s
e
ns
a
tion
.
Pa
ti
e
nts
O
ft
e
n r
ea
liz
e
th
a
t symptoms f
ee
l mor
e
s
e
v
e
r
e a
t th
e e
n
d
of th
e da
y
(
a
ft
e
rnoon
/
e
v
e
ning
).
R
isk f
ac
tor
1
.
a
g
e
>
40
y
ea
rs
2
.
Me
nop
a
us
e
3
.
S
yst
e
mi
c d
is
ea
s
e
,
su
c
h
a
s
:
S
jogr
e
n syn
d
rom
e
,
progr
e
ssiv
e
syst
e
mi
c
s
c
l
e
rosis
,
Sa
r
c
oi
d
osis
,
Le
uk
e
mi
a
,
L
ymphom
a
,
A
myloi
d
osis
,
a
n
d He
mo
c
hrom
a
tosis
4
.
U
s
e
of
c
ont
ac
t l
e
ns
e
s
5
.
U
s
e
of
c
omput
e
rs for
a
long tim
e
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
N
orm
a
l vision
2
.
T
h
e
r
e
is
a F
o
a
my
Tea
rs on th
e
forniks
c
onjun
c
tiv
a
3
.
A
ss
e
ssm
e
nt of t
ea
r pro
d
u
c
tion with
a
s
c
hirm
e
r t
e
st shows r
e
sults
<
10
mm
(
norm
a
l v
a
lu
e
≥
20
mm
).
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis is
e
nfor
ced b
y
:
1
.
A
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
2
.
S
hirm
e
r t
e
st wh
e
n n
eeded
C
ompli
ca
tions
1
.
Ke
r
a
titis
2
.
K
orn
ea de
pl
e
tion
3
.
Sec
on
da
ry inf
ec
tion
b
y
bac
t
e
ri
a
4
.
Ne
ov
a
s
c
ul
a
riz
a
tion of th
e c
orn
ea
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
Ad
minist
e
r
ed a
rtifi
c
i
a
l t
ea
rs
,
n
a
m
e
ly
d
rops of m
a
t
a
k
a
r
b
oxym
e
thyl
ce
llulos
e
or
so
d
ium
hy
a
luroni
c
.
Ad
v
a
n
ced S
upporting
Ge
n
e
r
a
lly not n
eeded
CONSELLING
&
EDUCATION
Fa
mily
a
n
d
p
a
ti
e
nts must un
de
rst
a
n
d
th
a
t
d
ry
e
y
e
s
a
r
e c
ir
c
umst
a
n
ce
s
c
hroni
c a
n
d
tot
a
l r
ec
ov
e
ry is
d
iffi
c
ult
,
e
x
ce
pt for mil
d ca
s
e
s
,
wh
e
n
E
pith
e
li
a
l
c
h
a
ng
e
s in th
e c
orn
ea a
n
d c
onjun
c
tiv
a a
r
e
still r
e
v
e
rsi
b
l
e
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Re
f
e
r
e
n
ce
to
a
n
e
y
e
sp
ec
i
a
list if
c
ompl
a
ints
a
r
e
not r
ed
u
ced a
ft
e
r th
e
r
a
py
or
c
ompli
ca
tions
a
ris
e
.
E
quipm
e
nt
1
.
LUP
2
.
Sc
irm
e
r strip
(
WHATMAN F
ilt
e
r
Pa
p
e
r
N
o
.
41
)
P
rognosis
1
.
Ad V
it
a
m
:
B
on
a
m
2
.
Ad F
un
c
tion
a
m
:
B
on
a
m
3
.
Ad Sa
n
a
tion
a
m
:
B
on
a
m
T
wilight
Hea
lth pro
b
l
e
ms
B
lin
d d
usk or twilight
,
a
lso
ca
ll
ed
ny
c
t
a
lopi
a
or h
e
m
a
rolopi
a
,
is
in
ab
ility to s
ee
w
e
ll
a
t night or on
Da
rkn
e
ss
.
T
his
c
on
d
ition is mor
e a
sign of
a
n
ab
norm
a
lity
th
e
un
de
rlying
.
T
his h
a
pp
e
ns
d
u
e
to
ab
norm
a
liti
e
s in th
e
rol
e
of r
e
tin
a
l st
e
m
ce
lls
in
da
rk vision
.
T
wilight
b
lin
d ca
us
e
s
a
r
e
vit
a
min
A de
fi
c
i
e
n
c
y
a
n
d
P
igm
e
ntos
e
r
e
tinitis
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
S
ight
dec
r
ea
s
e
s
a
t night or in
a da
rk
,
d
iffi
c
ult situ
a
tion
Ada
pting to
d
im light
.
O
n vit
a
min
A de
fi
c
i
e
n
c
y
,
b
lin
d d
usk
is th
e ea
rli
e
st
c
ompl
a
int
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
Ca
n
be
foun
d
oth
e
r signs of vit
a
min
A de
fi
c
i
e
n
c
y
:
1
.
D
rought
(
x
e
rosis
)
B
il
a
t
e
r
a
l
c
onjun
c
tiv
a
2
.
T
h
e
r
e a
r
e b
itot spots on th
e c
onjun
c
tiv
a
3
.
c
orn
ea
l x
e
rosis
4
.
c
orn
ea
l ul
ce
rs
a
n
d c
orn
ea
l
b
roth
e
r
5
.
T
h
e
skin looks x
e
rosis
a
n
d
s
ca
ly
6
.
D
iffus
e C
orn
ea
l or
Ke
r
a
tom
a
li
a Nec
rosis
S
upport
N
ot n
eeded
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis is
e
nfor
ced ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
I
n vit
a
min
A de
fi
c
i
e
n
c
y
,
vit
a
min
A
is giv
e
n high
d
os
e
.
2
.
C
orn
ea
lu
b
ri
ca
tion
.
3
.
P
r
e
v
e
ntion of s
ec
on
da
ry inf
ec
tions with
a
nti
b
ioti
c e
y
e d
rops
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Te
ll th
e
f
a
mily th
a
t
b
lin
d
twilight is
ca
us
ed b
y
ab
norm
a
liti
e
s
fun
da
m
e
nt
a
l
,
n
a
m
e
ly vit
a
min
A de
fi
c
i
e
n
c
y
a
n
d
r
e
tinitis pigm
e
ntos
a
.
2
.
I
n th
e ca
s
e
of vit
a
min
A de
fi
c
i
e
n
c
y
,
th
e
f
a
mily n
eed
s to
be
r
e
sult
ed
for
provi
de ba
l
a
n
ced
nutritious foo
d
int
a
k
e a
n
d
vit
a
min suppl
e
m
e
nt
a
tion
A
high
d
os
e
.
E
quipm
e
nt
1
.
LUP
2
.
O
f
Ta
l
M
os
c
op
e
H
or
de
olum
Hea
lth pro
b
l
e
ms
H
or
de
olum is
a
suppur
a
tiv
e
infl
a
mm
a
tion of th
e e
y
e
li
d
gl
a
n
d
.
U
su
a
lly
I
t is
a
st
a
phylo
c
o
cc
us inf
ec
tion in th
e
p
e
t
a
l s
ebaceed
gl
a
n
d
s
.
K
nown
T
wo forms of int
e
rn
a
l
a
n
d e
xt
e
rn
a
l hor
de
olum
.
E
xt
e
rn
a
l hor
de
olum
I
t is
a
n inf
ec
tion in th
e
z
e
iss or moll gl
a
n
d
.
I
nt
e
rf
a
ith
H
or
de
olum
I
t is
a
n inf
ec
tion of th
e Me
i
b
om gl
a
n
d
lo
ca
t
ed
insi
de Ta
rsus
.
H
or
de
olum
Ea
sily
a
ris
e
in in
d
ivi
d
u
a
ls who suff
e
r from
b
l
e
f
a
ritis
a
n
d c
onjun
c
tivitis
c
hroni
c
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Pa
ti
e
nts
c
om
e
with
c
ompl
a
ints of swoll
e
n p
e
t
a
ls
acc
omp
a
ni
ed b
y p
a
in
.
T
h
e
m
a
in symptom of
H
or
de
olum is
a
swoll
e
n p
e
t
a
l with p
a
in
a
n
d
b
lo
c
k
,
r
ed a
n
d
p
a
in wh
e
n pr
e
ss
ed
,
a
n
d
f
ee
lings of
d
is
c
omfort
a
n
d
b
urning s
e
ns
a
tion on
e
y
e
li
d
s
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
O
f
Ta
l
M
ologi
ca
l physi
ca
l
e
x
a
min
a
tion
F
oun
d
swoll
e
n
,
r
ed
,
a
n
d
p
a
inful
e
y
e
li
d
s
.
P
us
ca
n g
e
t out of th
e ba
s
e
of th
e
h
a
ir
(
e
xt
e
rum hor
de
olum
).
I
f
a
lr
ead
y
Ab
s
ce
ss o
cc
urs
ca
n
a
ris
e a
n un
d
ul
a
tion
.
S
upport
N
ot n
ece
ss
a
ry
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt
d
i
a
gnosis with
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
D
i
a
gnosis of
A
pp
ea
l
1
.
P
r
e
s
e
pt
a
l
ce
llulitis
2
.
Ka
l
a
zion
3
.
PI
og
e
ni
c
gr
a
nulom
a
C
ompli
ca
tions
1
.
Pa
lp
eb
r
a ce
llulitis
2
.
Ab
s
ce
ss of
Pa
lp
eb
r
a
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
Hea
v
e
nly
c
ompr
e
ss
ed e
y
e
s
4
-
6
tim
e
s
a da
y for
15
minut
e
s
eac
h tim
e
to h
e
lp
d
r
a
in
a
g
e
.
T
h
e ac
tion is
d
on
e
with th
e e
y
e
s
c
los
ed
.
2
.
T
h
e e
y
e
li
d
s
a
r
e c
l
ea
n
ed
with
c
l
ea
n w
a
t
e
r or so so
a
p or
S
h
a
mpoo th
a
t
d
o
e
s not
ca
us
e
irrit
a
tion
,
su
c
h
a
s
bab
y so
a
p
.
T
his
ca
n
S
p
eed
up th
e
h
ea
ling pro
ce
ss
.
Ac
tions
a
r
e d
on
e
with
e
y
e
s
c
los
ed
.
3
.
D
on
'
t pr
e
ss or pi
e
r
ce H
or
de
olum
,
this
ca
n
ca
us
e
M
or
e
s
e
rious inf
ec
tions
.
4
.
A
voi
d
using m
a
k
e
-
up in th
e e
y
e
s
,
beca
us
e
of th
e
possi
b
ility
bec
om
e a ca
us
e
of inf
ec
tion
.
5
.
D
on
'
t us
e c
ont
ac
t l
e
ns
e
s
beca
us
e
it
ca
n spr
ead
inf
ec
tion to
th
e c
orn
ea
.
6
.
G
iving topi
ca
l th
e
r
a
py with oxyt
e
tr
ac
y
c
lin
e e
y
e
ointm
e
nt or
C
hlor
a
mph
e
ni
c
ol
e
y
e
ointm
e
nt
e
v
e
ry
8
hours
.
W
h
e
n using
C
hlor
a
mph
e
ni
c
ol
e
y
e d
rops
1
d
rops
e
v
e
ry
2
hours
.
7
.
G
iving syst
e
mi
c
or
a
l th
e
r
a
py with
500
mg
e
rythromy
c
in in
ad
ults
a
n
d
th
e c
hil
d
is in
acc
or
da
n
ce
with
b
o
d
y w
e
ight or
c
los
e
t
ed
4
tim
e
s
a da
y
for
3
da
ys
.
Ad
v
a
n
ced S
upporting
N
ot n
ece
ss
a
ry
CONSELLING
&
EDUCATION
H
or
de
olum
ca
n r
e
p
ea
t so it n
eed
s to
be
tol
d
p
a
ti
e
nts
a
n
d
Fa
mily to m
a
int
a
in hygi
e
n
e a
n
d e
nvironm
e
nt
a
l
c
l
ea
nlin
e
ss
.
F
ollow up pl
a
n
I
f with
c
ons
e
rv
a
tiv
e
tr
ea
tm
e
nt it
d
o
e
s not r
e
spon
d
prop
e
rly
,
th
e
n
surgi
ca
l pro
ced
ur
e
s m
a
y
be
n
eeded
to m
a
k
e d
r
a
in
a
g
e
on
hor
de
olum
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
I
f it
d
o
e
s not r
e
spon
d
with
c
ons
e
rv
a
tiv
e
tr
ea
tm
e
nt
2
.
Re
p
ea
t
ed H
or
de
olum
E
quipm
e
nt
M
inor
S
urgi
ca
l
E
quipm
e
nt
C
onjun
c
tivitis
Hea
lth pro
b
l
e
ms
C
onjun
c
tivitis is
a c
onjun
c
tiv
a
l infl
a
mm
a
tion th
a
t
ca
n
be ca
us
ed b
y
M
i
c
roorg
a
nisms
(
virus
e
s
,
bac
t
e
ri
a
),
irrit
a
tion
,
or
a
ll
e
rgi
c
r
eac
tions
.
C
onjun
c
tivitis
T
r
a
nsmitt
ed
through
d
ir
ec
t
c
ont
ac
t with th
e
sour
ce
of inf
ec
tion
.
T
his
d
is
ea
s
e ca
n
A
tt
ac
k
a
ll
a
g
e
s
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Pa
ti
e
nts
c
om
e
with r
ed e
y
e c
ompl
a
ints
,
th
e
t
a
st
e
is
b
lo
c
king
,
it
c
hing
a
n
d
A
qu
e
ous
,
som
e
tim
e
s
acc
omp
a
ni
ed b
y s
ec
r
e
tions
.
C
ompl
a
ints
a
r
e
not
acc
omp
a
ni
ed
b
y
a
sh
a
rp
dec
lin
e
vision
.
R
isk f
ac
tor
1
.
Dec
r
ea
s
ed b
o
d
y r
e
sist
a
n
ce
2
.
T
h
e
r
e
is
a
history of
a
topy
3
.
U
s
e
of
c
ont
ac
t l
e
ns with not goo
d ca
r
e
4
.
P
oor p
e
rson
a
l hygi
e
n
e
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
N
orm
a
l vision
2
.
C
onjun
c
tiv
a
l inj
ec
tion
3
.
Ca
n
be acc
omp
a
ni
ed b
y p
e
t
a
l
ede
m
a
,
k
e
mosis
4
.
e
xu
da
tion
;
e
xu
da
t
e ca
n s
e
rous
,
mukopurul
e
n
,
or purul
e
nt
de
p
e
n
d
th
e ca
us
e
of
5
.
I
n th
e c
onjun
c
tiv
a
t
a
rs
a
l
ca
n
be
foun
d
folli
c
l
e
s
,
p
a
pil
e
s or gi
a
nt p
a
pil
e
s
,
flikt
e
n
,
m
e
m
b
r
a
n
e
,
or ps
e
u
d
om
e
m
b
r
a
n
.
S
upporting
c
h
ec
ks
(
if n
eeded
)
1
.
D
ir
ec
t pr
e
p
a
r
a
tion of th
e c
onjun
c
tiv
a
l sw
ab
with gr
a
m or
c
h
a
r
ac
t
e
r
G
i
e
ms
a
2
.
Sec
r
e
t
e
x
a
min
a
tion with
be
t
e
l nuts in th
e ca
s
e
gonorrh
ea c
onjun
c
tivitis
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt of
d
i
a
gnosis
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
C
onjun
c
tivitis
c
l
a
ssifi
ca
tion
1
.
Bac
t
e
ri
a
l
c
onjun
c
tivitis
:
hyp
e
r
e
mi
c c
onjun
c
tiv
a
,
purul
e
nt s
ec
r
e
tion or
M
ukopurul
e
n
ca
n
be acc
omp
a
ni
ed b
y
a
m
e
m
b
r
a
n
e
or ps
e
u
d
om
e
m
b
r
a
n
e
in th
e
c
onjun
c
tiv
a
t
a
rs
a
l
.
G
onorr
e
st
c
onjun
c
tivitis susp
ec
ts
,
e
sp
ec
i
a
lly in n
e
w
b
orns
,
if
foun
d c
onjun
c
tivitis in two
e
y
e
s with th
e
purul
e
nt s
ec
r
e
t
Ve
ry mu
c
h
.
2
.
V
ir
a
l
c
onjun
c
tivitis
:
H
yp
e
r
e
mi
c c
onjun
c
tiv
a
,
ce
r
e
mony g
e
n
e
r
a
lly
M
ukos
e
ros
a
,
a
n
d e
nl
a
rg
e
m
e
nt of pr
ea
uri
c
ul
a
r gl
a
n
d
s
3
.
A
ll
e
rgy
c
onjun
c
tivitis
:
H
yp
e
r
e
mi
c c
onjun
c
tiv
a
,
a
history of
A
topi or
a
ll
e
rgi
e
s
,
a
n
d
I
t
c
hy
c
ompl
a
ints
.
C
ompli
ca
tions
Ke
r
a
tokonjuntivitis
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
Pe
rto
d
ry
1
.
I
n
bac
t
e
ri
a
l inf
ec
tions
:
1
d
rops
c
hlor
a
mp
e
ni
c
ol
6
tim
e
s
a da
y
or
e
y
e
ointm
e
nt
3
tim
e
s
a da
y for
3
da
ys
.
2
.
A
t
a
ll
e
rgi
e
s
:
FLUMETOLON E
y
e d
rops twi
ce a da
y for
2
w
ee
ks
.
3
.
I
n
G
onorrh
ea c
onjun
c
tivitis
:
c
hlor
a
mph
e
ni
c
ol
e
y
e d
rops
0
.
5
-
1
%
a
s m
a
ny
a
s
1
e
v
e
ry hour
a
n
d
inj
ec
tions in
bab
i
e
s
a
r
e
giv
e
n
50
,
000
u
/
kg
bb e
v
e
ry
da
y
U
ntil th
e Ge
rm g
e
rm w
a
s foun
d a
t th
e APUS
pr
e
p
a
r
a
tion for
3
da
ys
a
row
.
4
.
I
n vir
a
l
c
onjun
c
tivitis
:
ac
y
c
lovir ointm
e
nt
3
%
,
5
tim
e
s
a da
y for
10
da
ys
.
Ad
v
a
n
ced S
upporting
Ge
n
e
r
a
lly it is not n
eeded
,
e
x
ce
pt for th
e
suspi
c
ion of gonorrh
ea c
onjun
c
tivitis
,
d
il
a
kuk
a
n p
e
m
e
riks
aa
n s
ed
i
aa
n
a
pus
de
ng
a
n p
e
w
a
rn
aa
n
G
r
a
m
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Ea
sy
c
onjun
c
tivitis
,
beca
us
e
it
'
s
be
for
e a
n
d a
ft
e
r
c
l
ea
ning or
a
pplying
d
rugs
,
suff
e
r
e
rs must w
a
sh
H
is h
a
n
d
w
a
s
c
l
ea
n
.
2
.
D
on
'
t us
e a
tow
e
l or l
a
p tog
e
th
e
r with r
e
si
de
nts
oth
e
r hous
e
s
.
3
.
Ma
int
a
in th
e c
l
ea
nlin
e
ss of th
e e
nvironm
e
nt
a
n
d a
roun
d
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
I
f
c
ompli
ca
tions o
cc
ur in th
e c
orn
ea
2
.
I
f th
e
r
e
is no r
e
p
a
ir r
e
spons
e
to th
e
giv
e
n tr
ea
tm
e
nt
E
quipm
e
nt
1
.
LUP
2
.
S
impl
e
l
ab
or
a
tori
e
s for gr
a
m
e
x
a
min
a
tions
B
l
e
f
a
ritis
Hea
lth pro
b
l
e
ms
B
l
e
f
a
ritis is infl
a
mm
a
tion on th
e ed
g
e
of th
e e
y
e
li
d
(
m
a
rgo p
a
lp
eb
r
a
)
th
a
t
ca
n
acc
omp
a
ni
ed b
y
a
n ul
ce
r form
a
tion
a
n
d ca
n involv
e
h
a
ir folli
c
l
e
s
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
I
t
c
hing on th
e ed
g
e
of th
e e
y
e
li
d
2
.
H
ot fl
a
vor on th
e ed
g
e
of th
e e
y
e
li
d
3
.
Red
/
hyp
e
r
e
mi
a
on th
e ed
g
e
of th
e e
y
e
li
d
4
.
Ha
r
d a
n
d c
ri
e
st s
ca
l
e
s
a
r
e
form
ed e
sp
ec
i
a
lly
a
roun
d
th
e ba
s
e
of th
e
l
a
sh
5
.
S
om
e
tim
e
s
acc
omp
a
ni
ed b
y
e
y
e
l
a
sh loss
(
m
ada
rosis
),
whit
e
on
e
y
e
l
a
sh
e
s
(
polyosis
),
a
n
d
tri
c
hi
a
sis
6
.
Ca
n
c
om
e
out of th
e de
t
e
rior
a
tion for sl
ee
p
,
so wh
e
n h
e
w
a
k
e
s up
p
e
t
a
ls
a
r
e d
iffi
c
ult
R
isk f
ac
tor
1
.
S
kin
d
isor
de
rs
,
for
e
x
a
mpl
e
s
eb
orrh
e
i
c de
rm
a
titis
2
.
H
ygi
e
n
e
p
e
rson
a
l
a
n
d e
nvironm
e
nt th
a
t is not goo
d
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
S
ku
a
m
a
or
K
rust
a
on th
e ed
g
e
of th
e
p
e
t
a
l
.
2
.
E
y
e
l
a
sh
e
s f
a
ll out
.
3
.
Ca
n
be
foun
d a
sh
a
llow ul
ce
r on th
e ed
g
e
of th
e e
y
e
li
d
.
4
.
S
w
e
lling
a
n
d
r
ed
on th
e e
y
e
li
d
s
.
5
.
Ca
n
be
form
ed b
y
a c
r
a
ft
a
tt
ac
h
ed
to th
e ed
g
e
of th
e e
y
e
li
d
.
I
f
K
rust
a
is r
e
l
ea
s
ed
,
b
l
eed
ing
ca
n o
cc
ur
.
S
upport
N
ot n
ece
ss
a
ry
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis
e
nfor
ce
m
e
nt is
ca
rri
ed
out
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d e
x
a
min
a
tion
physi
ca
l
.
C
ompli
ca
tions
1
.
B
l
e
f
a
rokonjun
c
tivitis
2
.
Mada
rosis
3
.
T
ri
c
i
a
sis
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
N
on
-
Med
i
c
m
e
ntos
a
a
.
C
l
ea
n th
e e
y
e
li
d
s with
c
otton sti
c
ks moist
e
n
ed b
y w
a
t
e
r
w
a
rm
b
r
ea
kf
a
st
.
C
l
ea
n with sh
a
mpoo or so
a
p
C
..
Wa
rm
c
ompr
e
ss for
5
-
10
minut
e
s
2
.
Med
i
c
m
e
ntos
a
I
f th
e
ul
ce
r is foun
d
in th
e e
y
e
li
d
s
,
ointm
e
nt
ca
n
be
giv
e
n
A
nti
b
ioti
c e
y
e d
rops until symptoms
d
is
a
pp
ea
r
.
CONSELLING
&
EDUCATION
1
.
P
rovi
de
inform
a
tion to th
e
p
a
ti
e
nt
a
n
d
f
a
mily th
a
t th
e
s
ca
lp
,
e
y
eb
rows
e
y
e
s
,
a
n
d
p
a
lp
eb
r
a ed
g
e
s must
a
lw
a
ys
be c
l
ea
n
ed e
sp
ec
i
a
lly in p
a
ti
e
nts
with s
eb
orrh
e
i
c de
rm
a
titis
.
2
.
Te
ll th
e
p
a
ti
e
nt
a
n
d
f
a
mily to m
a
int
a
in p
e
rson
a
l hygi
e
n
e a
n
d
th
e e
nvironm
e
nt
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Pa
ti
e
nts with
b
l
e
f
a
ritis n
eed
to
be
r
e
f
e
rr
ed
to s
ec
on
da
ry s
e
rvi
ce
s
(
sp
ec
i
a
list
d
o
c
tors
E
y
e
s
)
I
f th
e
r
e
is
a
minimum of on
e
of th
e ab
norm
a
liti
e
s
be
low
:
1
.
S
h
a
rp vision
dec
r
ea
s
e
s
2
.
Med
ium or h
ea
vy p
a
in
3
.
Hea
vy or
c
hroni
c
r
ed
n
e
ss
4
.
T
h
e
r
e
is th
e
involv
e
m
e
nt of th
e c
orn
ea
5
.
Rec
urr
e
n
ce e
piso
de
6
.
N
ot
a
r
e
spons
e
to th
e
r
a
py
E
quipm
e
nt
1
.
F
l
a
shlight
2
.
LUP
S
u
bc
onjungtiv
a b
l
eed
ing
Hea
lth pro
b
l
e
ms
S
u
bc
onjungtiv
a b
l
eed
ing is
b
l
eed
ing
d
u
e
to
b
loo
d
v
e
ss
e
l ruptur
e
un
de
r th
e c
onjun
c
tiv
a
l l
a
y
e
r
,
th
e c
onjun
c
tiv
a
l
b
loo
d
v
e
ss
e
l or
e
piskl
e
r
a
.
M
ost of th
e ca
s
e
s of su
bc
onjungtiv
a b
l
eed
ing
a
r
e ca
s
e
s
spont
a
n
e
ous or i
d
iop
a
thi
c
,
a
n
d
only
a
sm
a
ll portion of th
e ca
s
e a
sso
c
i
a
t
ed
with
tr
a
um
a
or syst
e
mi
c ab
norm
a
liti
e
s
.
S
u
bc
onjungtiv
a
is to o
cc
ur in
A
ll
a
g
e
groups
.
S
u
bc
onjungtiv
a b
l
eed
ing mostly o
cc
ur
U
nil
a
t
e
r
a
l
(
90
%
).
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
T
h
e
p
a
ti
e
nt
c
om
e
s with
c
ompl
a
ints
ab
out
b
loo
d
on th
e
s
c
l
e
r
a
or
e
y
e
s
B
right r
ed
(
thin
)
or
da
rk r
ed
(
thi
c
k
).
2
.
M
ost of th
e
symptom
a
ti
c
symptom
a
ti
c
symptoms r
e
l
a
t
ed
to
S
u
bc
onjun
c
tiv
a b
l
eed
ing
be
si
de
s
b
loo
d
looks in th
e S
kl
e
r
a
s
ec
tion
.
3
.
B
l
eed
ing will look
e
xt
e
nsiv
e
in th
e
first
24
hours
a
ft
e
r th
a
t
T
h
e
n it will
dec
r
ea
s
e
slowly th
e
siz
e
is
d
u
e
to
d
i
ab
sorption
.
R
isk f
ac
tor
1
.
H
yp
e
rt
e
nsion or
a
rt
e
ros
c
l
e
rosis
2
.
B
lunt or sh
a
rp tr
a
um
a
3
.
U
s
e
of
d
rugs
,
e
sp
ec
i
a
lly
b
loo
d
thinn
e
rs
4
.
Va
ls
a
v
a
m
a
n
e
uv
e
rs
,
for
e
x
a
mpl
e d
u
e
to
c
oughing or vomiting
5
.
A
n
e
mi
a
6
.
Be
n
da a
sing
7
.
C
onjun
c
tivitis
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Ge
n
e
r
a
lly st
a
tus
c
h
ec
k
2
.
O
ft
a
l
M
ology
c
h
ec
k
:
a
.
T
h
e
r
e a
pp
ea
r
ed
to
be b
l
eed
ing in
a b
right r
ed
s
c
l
e
r
a
(
thin
)
or
da
rk r
ed
(
thi
c
k
).
b
r
ea
kf
a
st
.
Pe
rforming
a
sh
a
rp vision of visu
a
l
6
/
6
,
if th
e
vision
<
6
/
6
th
e
n
da
m
a
g
e
is susp
ec
t
ed
oth
e
r th
a
n in
c
onjun
c
tiv
a
C
..
F
un
d
us
c
opi
c e
x
a
min
a
tion is n
ece
ss
a
ry for
e
v
e
ry suff
e
r
e
r with
S
u
bc
onjun
c
tiv
a b
l
eed
ing
d
u
e
to tr
a
um
a
.
S
upport
N
ot n
ece
ss
a
ry
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt of
d
i
a
gnosis
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
S
u
bc
onjun
c
tiv
a b
l
eed
ing will
d
is
a
pp
ea
r or
dabb
sorption in
1
-
2
w
ee
ks
without
be
ing tr
ea
t
ed
.
2
.
T
r
ea
tm
e
nt of un
de
rlying
d
is
ea
s
e
s if
a
ny
.
Ad
v
a
n
ced S
upporting
N
ot n
ece
ss
a
ry
C
ouns
e
ling
a
n
d ed
u
ca
tion
Te
ll th
e
f
a
mily th
a
t
:
1
.
N
o n
eed
to worry
beca
us
e b
l
eed
ing will look wi
de
spr
ead
in
24
hours
F
irst
,
b
ut
a
ft
e
r th
a
t th
e
siz
e
will
dec
r
ea
s
e
slowly
beca
us
e
ab
sor
bed
.
2
.
T
h
e c
on
d
ition of hyp
e
rt
e
nsion h
a
s
a
high
e
nough r
e
l
a
tionship with num
be
rs
th
e
o
cc
urr
e
n
ce
of su
bc
onjun
c
tiv
a b
l
eed
ing so th
a
t
c
ontrol is n
eeded
B
loo
d
pr
e
ssur
e
in p
a
ti
e
nts with hyp
e
rt
e
nsion
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
S
u
bc
onjungtiv
a b
l
eed
ing must
be
imm
ed
i
a
t
e
ly r
e
f
e
rr
ed
to
a
n
e
y
e
sp
ec
i
a
list if
F
oun
d a dec
r
ea
s
e
in vision
.
F
or
e
ign o
b
j
ec
ts in
c
onjun
c
tiv
a
Hea
lth pro
b
l
e
ms
F
or
e
ign o
b
j
ec
ts in
c
onjun
c
tiv
a a
r
e
o
b
j
ec
ts th
a
t
a
r
e
norm
a
l
foun
d
in th
e c
onjun
c
tiv
a Da
n
da
p
a
t
ca
us
e
s n
e
twork irrit
a
tion
.
O
n th
e
g
e
n
e
r
a
lly this
d
isor
de
r is mil
d
,
b
ut in som
e c
ir
c
umst
a
n
ce
s it
ca
n
s
e
rious
c
ons
e
qu
e
n
ce
s
e
sp
ec
i
a
lly in for
e
ign or
a
lk
a
lin
e
for
e
ign o
b
j
ec
ts
a
n
d
W
h
e
n
e
m
b
oss
ed
s
ec
on
da
ry inf
ec
tion
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Pa
ti
e
nts
c
om
e
with
c
ompl
a
ints
ab
out o
b
j
ec
ts th
a
t go into
c
onjun
c
tiv
a
or h
e
r
e
y
e
s
.
T
h
e
symptoms
ca
us
ed b
y p
a
in
,
r
ed e
y
e
s
a
n
d
runny
,
s
e
ns
a
tion of for
e
ign o
b
j
ec
ts
,
a
n
d
photopho
b
i
a
.
R
isk f
ac
tor
W
ork
e
rs in th
e
in
d
ustry th
a
t
d
o not w
ea
r prot
ec
tiv
e
gl
a
ss
e
s
,
su
c
h
a
s
:
G
rin
d
ing work
e
rs
,
w
e
l
d
ing work
e
rs
,
ce
r
a
mi
c c
utt
e
rs
,
work
e
rs r
e
l
a
t
ed
to
C
h
e
mi
ca
ls
(
ac
i
d
-
ba
s
e
).
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
B
i
a
s
a
ny
a
norm
a
l vision
.
2
.
F
oun
d c
onjun
c
tiv
a
l inj
ec
tion t
a
rs
a
l
a
n
d
/
or
b
ul
b
i
.
3
.
F
oun
d
for
e
ign o
b
j
ec
ts
a
t th
e S
up
e
rior
Ta
rs
a
l
c
onjun
c
tiv
a a
n
d
/
or
I
nf
e
rior
da
n
/
or
B
ul
b
i
c
onjun
c
tiv
a
.
S
upport
N
ot n
eeded
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis is
e
nfor
ced
through
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
D
i
a
gnosis of
A
pp
ea
l
Ac
ut
e c
onjun
c
tivitis
C
ompli
ca
tions
1
.
c
orn
ea
l ul
ce
r
2
.
Ke
r
a
titis
Ha
pp
e
ns if
a
for
e
ign o
b
j
ec
t on th
e c
onjun
c
tiv
a
t
a
rs
a
l swip
e
th
e
surf
ace
c
orn
ea a
n
d ca
us
e
s
ec
on
da
ry inf
ec
tions
.
Hea
vy infl
a
mm
a
tory r
eac
tions
ca
n o
cc
ur
I
f for
e
ign o
b
j
ec
ts
a
r
e c
h
e
mi
ca
ls
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
1
.
N
on
-
Med
i
c
m
e
ntos
a
:
r
e
mov
a
l of for
e
ign o
b
j
ec
ts
He
r
e a
r
e
w
a
ys th
a
t
ca
n
be d
on
e
:
a
.
G
iv
e
2
%
Te
tr
a
k
a
in
-
HC
l
E
y
e D
rops
1
-
2
d
rops to th
e e
y
e
who is
a
ff
ec
t
ed b
y for
e
ign o
b
j
ec
ts
.
b
r
ea
kf
a
st
.
U
s
e
th
e
m
a
gnifying gl
a
ss
(
LUP
)
in r
e
mov
a
l of for
e
ign o
b
j
ec
ts
.
C
..
L
ift for
e
ign o
b
j
ec
ts using
c
otton sti
c
ks or syring
e
s
siz
e
of
23
g
.
d
.
T
h
e d
ir
ec
tion of t
a
king for
e
ign o
b
j
ec
ts is
d
on
e
from th
e
mi
dd
l
e
to th
e ed
g
e
.
He
y
.
A
pply th
e c
otton sti
c
k to
be a
ffix
ed b
y
P
ovi
d
on io
d
in
e
in
a
us
ed
pl
ace
F
or
e
ign o
b
j
ec
t
.
2
.
Med
i
c
m
e
ntos
a
T
opi
ca
l
a
nti
b
ioti
c
s
(
ointm
e
nt or
e
y
e d
rops
),
for
e
x
a
mpl
e c
hlor
a
mph
e
ni
c
ol
d
rops
e
y
e
s
,
1
d
rop
e
v
e
ry
2
hours for
2
da
ys
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Te
ll th
e
p
a
ti
e
nt so
a
s not to ru
b
his
e
y
e
s so
a
s not
I
nvitors th
e
l
e
sion
.
2
.
U
sing
a
prot
ec
tiv
e
tool
/
gl
a
ss
e
s
a
t work or
d
riv
e
.
3
.
E
n
c
our
a
g
e
p
a
ti
e
nts for
c
ontrol wh
e
n
c
ompl
a
ints g
e
t mor
e
w
e
ight
a
ft
e
r
Ac
tions
,
su
c
h
a
s th
e e
y
e
s
a
r
e
r
ed
,
swoll
e
n
,
or
acc
omp
a
ni
ed
with
a dec
r
ea
s
e
in vision
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
I
f th
e
r
e
is
a dec
r
ea
s
e
in visu
a
l visu
a
l
2
.
I
f for
e
ign o
b
j
ec
ts
ca
nnot
be
r
e
mov
ed
,
for
e
x
a
mpl
e
:
d
u
e
to limit
a
tions
f
ac
iliti
e
s
A
stigm
a
tism
A
stigm
a
tim
e
is
a
situ
a
tion wh
e
r
e
th
e
p
a
r
a
ll
e
l light is not r
e
fr
ac
t
ed
to on
e
T
h
e
s
a
m
e
fo
ca
l point on
a
ll m
e
ri
d
i
a
ns
.
T
his is
ca
us
ed b
y
T
h
e c
urv
a
tur
e
of th
e c
orn
ea
or l
e
ns is not th
e
s
a
m
e
on v
a
rious m
e
ri
d
i
a
ns
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
Pa
ti
e
nts usu
a
lly
c
om
e
with
c
ompl
a
ints of
b
lurr
ed
vision
a
n
d a
littl
e d
istortion
whi
c
h som
e
tim
e
s
a
lso
ca
us
e
s h
eadac
h
e
s
.
Pa
ti
e
nts t
a
nk
,
or
Head T
ilt to
be ab
l
e
to s
ee
mor
e c
l
ea
rly
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
Ge
n
e
r
a
l
c
on
d
itions
a
r
e
usu
a
lly goo
d
.
E
x
a
min
a
tion of vision with th
e S
n
e
ll
e
n
C
h
a
rt will show sh
a
rply
vision is not m
a
xim
a
l
a
n
d
will in
c
r
ea
s
e
with giving
pinhol
e
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis
e
nfor
ce
m
e
nt is
ca
rri
ed
out
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d e
x
a
min
a
tion
r
e
fr
ac
tion
.
T
ho vision will r
eac
h m
a
ximum with l
e
ns giving
c
ylin
d
ri
ca
l
.
D
i
a
gnosis of
A
pp
ea
l
O
th
e
r r
e
fr
ac
tion
ab
norm
a
liti
e
s
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
U
s
e
of th
e
sungl
a
ss
e
s of th
e c
ylin
d
ri
ca
l l
e
ns with
a
ppropri
a
t
e c
orr
ec
tion
.
Ad
v
a
n
ced S
upporting
N
ot n
eeded
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
Te
ll th
e
f
a
mily th
a
t
a
stigm
a
tism is
a
visu
a
l imp
a
irm
e
nt
whi
c
h
ca
n
be c
orr
ec
t
ed
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Pa
ti
e
nts n
eed
to
be
r
e
f
e
rr
ed
to s
ec
on
da
ry s
e
rvi
ce
s if
:
1
.
C
orr
ec
tion with gl
a
ss
e
s
d
o
e
s not fix th
e
vision
,
or
2
.
T
h
e
siz
e
of th
e
l
e
ns
ca
nnot
be de
t
e
rmin
ed
(
for
e
x
a
mpl
e
s
e
v
e
r
e a
stigm
a
tism
).
E
quipm
e
nt
1
.
S
n
e
ll
e
n
C
h
a
rt
2
.
A
s
e
t of tri
a
l l
e
ns
e
s
(
tri
a
l fr
a
m
e
s
a
n
d
tri
a
l l
e
ns
e
s
)
3
.
P
inhol
e
H
ip
e
rm
e
tropi
a
Hea
lth pro
b
l
e
ms
H
yp
e
rm
e
tropi
a
(
n
ea
rsight
ed
n
e
ss
)
is
a
st
a
t
e
of imp
a
irm
e
nt
e
y
e
r
e
fr
e
shing wh
e
r
e
th
e
r
a
ys p
a
r
a
ll
e
l is f
a
r not strong
e
nough to
be
r
e
fr
ac
t
ed
S
o th
e
fo
c
us point is lo
ca
t
ed be
hin
d
th
e
r
e
tin
a
.
T
his
d
isor
de
r spr
ead
s
E
v
e
nly on v
a
rious g
e
ogr
a
phi
ca
l
,
e
thni
c
,
a
g
e a
n
d
s
e
x
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
V
ision is un
c
l
ea
r to
c
los
e
o
b
j
ec
ts
.
2
.
Headac
h
e
s
,
e
sp
ec
i
a
lly th
e
front
a
l
a
r
ea a
n
d
th
e
strong
e
r on us
e
O
l
d e
y
e
s
a
n
d c
los
e
r
ead
ing
.
N
ot goo
d
vision
(
a
sth
e
nopi
a
acc
ommo
da
ting
=
e
y
e
str
a
in
)
e
sp
ec
i
a
lly wh
e
n looking
a
t
a
fix
ed d
ist
a
n
ce a
n
d
c
l
ea
r vision is n
eeded
for
a
long tim
e
,
for
e
x
a
mpl
e
Wa
t
c
h
TV a
n
d
oth
e
rs
.
3
.
E
y
e
s
a
r
e
s
e
nsitiv
e
to light
.
4
.
S
p
a
sm
acc
ommo
da
tion th
a
t
ca
n
ca
us
e
ps
e
u
d
omyopi
a
.
S
quint
ca
n o
cc
ur
beca
us
e e
x
ce
ssiv
e acc
ommo
da
tion will
be
follow
ed c
onv
e
rg
e
n
ce
E
x
ce
ssiv
e
too
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
V
isius
c
h
ec
k with
S
n
e
ll
e
n
C
h
a
rt
Re
fr
ac
tion
c
h
ec
ks with tri
a
l l
e
ns
a
n
d
tri
a
l fr
a
m
e
s
S
upport
N
ot n
ece
ss
a
ry
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt
d
i
a
gnosis with
a
n
a
mn
e
sis
a
n
d
r
e
fr
ac
tiv
e e
x
a
min
a
tion
.
C
ompli
ca
tions
1
.
E
sotropi
a
or squint into th
e
p
a
ti
e
nt will h
a
v
e
to
d
o
acc
ommo
da
tion
2
.
Sec
on
da
ry gl
a
u
c
om
a
o
cc
urs
d
u
e
to th
e
hyp
e
rtrophy of th
e
sili mus
c
l
e
in th
e b
o
d
y
of th
e
sili
who will n
a
rrow th
e c
orn
e
r of th
e e
y
e
l
e
t
3
.
A
m
b
lopi
a
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
C
orr
ec
tion with th
e
strong
e
st positiv
e
s
e
lf
-
sofit l
e
ns th
a
t pro
d
u
ce
s sh
a
rply
Be
st vision
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
Te
ll f
a
mily if this
d
is
ea
s
e
must
be c
orr
ec
t
ed
with th
e
h
e
lp of gl
a
ss
e
y
e
s
.
Beca
us
e
if not
,
th
e e
y
e
s will
acc
ommo
da
t
e c
ontinuously
a
n
d
Ca
using
c
ompli
ca
tions
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
Re
f
e
r
e
n
ce
is
ca
rri
ed
out if
c
ompli
ca
tion
a
ris
e
s
.
E
quipm
e
nt
1
.
S
n
e
ll
e
n
C
h
a
rt
2
.
A
s
e
t of tri
a
l fr
a
m
e
s
a
n
d
tri
a
l fr
a
m
e
s
M
il
d
myopi
a
Hea
lth pro
b
l
e
ms
L
ight myopi
a
is
a
r
e
form
ab
norm
a
lity wh
e
r
e
th
e
p
a
r
a
ll
e
l light
c
om
e
s into
E
y
e
s in r
e
st
(
without
acc
ommo
da
tion
)
will
be
r
e
fr
ac
t
ed
to th
e
fo
ca
l point
in front of th
e
r
e
tin
a
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
B
lurr
ed
vision wh
e
n looking f
a
r
,
e
y
e
s
a
r
e
tir
ed
,
d
izzy
a
n
d
S
l
ee
py
,
t
e
n
d
s to squint wh
e
n looking f
a
r
.
N
ot
a
v
a
il
ab
l
e
H
istory of syst
e
mi
c ab
norm
a
liti
e
s
,
su
c
h
a
s m
e
llitus
,
hyp
e
rt
e
nsion
,
a
n
d
twilight
b
lin
d
.
R
isk f
ac
tor
Ge
n
e
ti
c a
n
d e
nvironm
e
nt
a
l f
ac
tors in
c
lu
de
th
e
h
ab
it of s
ee
ing
/
r
ead
ing
c
los
e
,
Lac
k of out
d
oor
ac
tiviti
e
s
,
a
n
d
high
e
r
ed
u
ca
tion l
e
v
e
ls
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
V
isius
c
h
ec
k with
S
n
e
ll
e
n
C
h
a
rt
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt of
d
i
a
gnosis
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d a
n
c
hrif
ac
tion
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
C
orr
ec
tion with th
e
w
ea
k
e
st n
e
g
a
tiv
e
sph
e
ri
ca
l l
e
ns gl
a
ss
e
s th
a
t pro
d
u
ce
sh
a
rp
be
st vision
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Read
in
e
nough light
a
n
d d
on
'
t r
ead
within th
e d
ist
a
n
ce
T
oo
c
los
e
.
2
.
C
ontrol
a
t l
ea
st on
ce a
y
ea
r for r
e
fr
ac
tion
c
h
ec
ks
,
if th
e
r
e a
r
e c
ompl
a
ints
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
P
rogr
e
ssiv
e
r
e
fr
ac
tion
ab
norm
a
liti
e
s
2
.
Re
fr
ac
tion
d
isor
de
rs th
a
t
a
r
e
not
ad
v
a
n
ced
with
c
orr
ec
tions or not foun
d
l
e
ns siz
e
th
a
t provi
de
s visu
a
l improv
e
m
e
nt
3
.
D
isor
de
rs th
a
t
a
r
e
not
ad
v
a
n
ced
with pinhol
e
.
E
quipm
e
nt
1
.
S
n
e
ll
e
n
C
h
a
r
2
.
A
s
e
t of l
e
ns
e
s
a
n
d
fr
a
m
e
tri
a
ls
P
r
e
s
b
yopi
a
Hea
lth pro
b
l
e
ms
P
r
e
s
b
yopi
a
is
a c
on
d
ition th
a
t is r
e
l
a
t
ed
to
a
g
e
b
lurr
ed
vision wh
e
n s
ee
ing o
b
j
ec
ts is
c
los
e
.
P
r
e
s
b
iopi
a
is
T
h
e de
g
e
n
e
r
a
tiv
e e
y
e
pro
ce
ss th
a
t g
e
n
e
r
a
lly st
a
rts
a
roun
d
40
y
ea
rs of
a
g
e
.
T
his
d
isor
de
r o
cc
urs
beca
us
e
th
e e
y
e
l
e
ns los
e
s
e
l
a
sti
c
ity
a
n
d
T
h
e ab
ility to
c
h
a
ng
e
sh
a
p
e
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
B
lurr
ed
vision wh
e
n looking
c
los
e
.
2
.
O
th
e
r symptoms
,
a
ft
e
r r
ead
ing th
e e
y
e
s f
ee
l tir
ed
,
runny
,
a
n
d
oft
e
n
Fee
l sor
e
.
3
.
Read
ing is
d
on
e b
y k
ee
ping th
e
r
ead
ing p
a
p
e
r r
ead
.
4
.
T
h
e
r
e
is
a
work
d
isruption
,
e
sp
ec
i
a
lly
a
t night
a
n
d
n
eed
s r
a
ys
L
ight
e
r to r
ead
.
R
isk f
ac
tor
O
l
d a
g
e
g
e
n
e
r
a
lly mor
e
th
a
n
40
y
ea
rs
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Re
fr
ac
tion
c
h
ec
ks for
d
ist
a
n
ce
vision
b
y using
S
n
e
ll
e
n
C
h
a
rt is
d
on
e
first
.
2
.
Re
fr
ac
tion of
c
los
e
vision
b
y using
a ca
r
d
Jae
g
e
r
.
P
ositiv
e SFCERIS Le
ns
e
s
(
C
ustomiz
ed A
g
e
-
See Tab
l
e
1
)
Added
on th
e
l
e
ns
c
orr
ec
tion vision f
a
r
,
th
e
n th
e
p
a
ti
e
nt is
a
sk
ed
for
Me
ntion th
e
s
e
nt
e
n
ce
until th
e
sm
a
ll
e
st s
e
nt
e
n
ce
th
a
t is r
ead
on th
e ca
r
d
.
C
orr
ec
tion t
a
rg
e
t of
20
/
30
.
S
upport
N
ot n
ece
ss
a
ry
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
E
nfor
ce
m
e
nt of
d
i
a
gnosis
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
P
ositiv
e
l
e
ns gl
a
ss
e
s
c
orr
ec
tion
CONSELLING
&
EDUCATION
1
.
Te
ll th
e
p
a
ti
e
nt
a
n
d
f
a
mily th
a
t
P
r
e
s
b
yopi
a
is
a c
on
d
ition
de
g
e
n
e
r
a
tiv
e e
xp
e
ri
e
n
ced b
y
a
lmost
e
v
e
ryon
e a
n
d ca
n
be c
orr
ec
t
ed
with
gl
a
ss
e
s
.
2
.
Pa
ti
e
nts n
eed c
ontrol
e
v
e
ry y
ea
r
,
to
c
h
ec
k wh
e
th
e
r th
e
r
e
is
C
h
a
ng
e
s in th
e
siz
e
of th
e
l
e
ns
c
orr
ec
tion
.
E
quipm
e
nt
1
.
Jae
g
e
r
ca
r
d
2
.
S
n
e
ll
e
n
C
h
a
rt
3
.
O
n
e
s
e
t of l
e
ns
e
s
a
n
d
tri
a
l fr
a
m
e
s
Ca
t
a
r
ac
ts in
ad
ult p
a
ti
e
nts
Hea
lth pro
b
l
e
ms
Ca
t
a
r
ac
ts
a
r
e
tur
b
i
d
ity on th
e
l
e
ns th
a
t
ca
us
e
s
a
sh
a
rp
dec
lin
e
V
ision
(
vision
).
Ca
t
a
r
ac
ts
a
r
e
most oft
e
n r
e
l
a
t
ed
to
de
g
e
n
e
r
a
tion pro
ce
ss
e
s
l
e
ns
e
s in p
a
ti
e
nts of
a
g
e
ov
e
r
40
y
ea
rs
(
ca
t
a
r
ac
ts
).
I
n
c
lu
de ca
t
a
r
ac
ts
,
Ca
t
a
r
ac
ts
ca
n
a
lso o
cc
ur
d
u
e
to gl
a
u
c
om
a
,
uv
e
itis
,
e
y
e
tr
a
um
a c
ompli
ca
tions
,
a
n
d
syst
e
mi
c ab
norm
a
liti
e
s su
c
h
a
s
d
i
abe
t
e
s m
e
llitus
,
m
ed
i
ca
tion us
a
g
e
history
st
e
roi
d
s
,
a
n
d
oth
e
rs
.
Ca
t
a
r
ac
ts usu
a
lly o
cc
ur
b
il
a
t
e
r
a
l
,
b
ut
ca
n
a
lso
A
t on
e e
y
e
(
mono
c
ul
a
r
).
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
T
h
e
p
a
ti
e
nt
c
om
e
s with
a
soft vision
c
ompl
a
int slowly lik
e
C
los
ed
smok
e
/
fog
.
C
ompl
a
ints with th
e
siz
e
of th
e
gl
a
ss
e
s
a
r
e
in
c
r
ea
sing
,
gl
a
r
e
,
a
n
d
h
a
r
d
to r
ead
.
R
isk f
ac
tor
1
.
A
g
e
mor
e
th
a
n
40
y
ea
rs
2
.
S
yst
e
mi
c d
is
ea
s
e
history
,
su
c
h
a
s
d
i
abe
t
e
s m
e
llitus
3
.
T
h
e
us
e
of st
e
roi
d e
y
e d
rops r
e
gul
a
rly
4
.
S
moking h
ab
its
a
n
d
sun
e
xposur
e
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
P
hysi
ca
l
e
x
a
min
a
tion
1
.
Dec
r
ea
s
ed
vision th
a
t
d
o
e
s not improv
e
with pinhol
e ad
ministr
a
tion
2
.
P
ositiv
e S
h
ad
ow
Te
st
E
x
a
min
a
tion
3
.
T
h
e
r
e
is
a
l
e
ns tur
b
i
d
ity th
a
t
ca
n
be c
l
ea
rly s
ee
n
b
y th
e
t
ec
hniqu
e
r
e
mot
e e
x
a
min
a
tion
(
from
a d
ist
a
n
ce
of
30
c
m
)
using th
e
ophth
a
lmos
c
op
e
so
foun
d
th
e
m
ed
i
a
th
a
t is
c
lou
d
y on pupil
.
T
his t
ec
hnology will
be ea
si
e
r
d
on
e a
ft
e
r
a
pupil
d
il
a
tion with tropi
ca
l
e
y
e d
rops
0
.
5
%
or
b
y
c
h
ec
king p
a
ti
e
nts in
da
rk sp
ace
s
.
S
upport
N
ot n
eeded
.
D
i
a
gnosti
c E
nfor
ce
m
e
nt
(
A
ss
e
ssm
e
nt
)
C
lini
ca
l
d
i
a
gnosis
D
i
a
gnosis
e
nfor
ce
m
e
nt is
ca
rri
ed
out
ba
s
ed
on
a
n
a
mn
e
sis
a
n
d e
x
a
min
a
tion
vision
a
n
d e
x
a
min
a
tion of l
e
ns
e
s
C
ompli
ca
tions
G
l
a
u
c
om
a a
n
d
uv
e
itis
C
ompr
e
h
e
nsiv
e Ma
n
a
g
e
m
e
nt
(
P
l
a
n
)
Ma
n
a
g
e
m
e
nt of
Pa
ti
e
nts with
ca
t
a
r
ac
ts th
a
t h
a
v
e ca
us
ed
visu
a
l
d
isor
de
rs
S
ignifi
ca
ntly r
e
f
e
rr
ed
to s
ec
on
da
ry s
e
rvi
ce
s th
a
t h
a
v
e e
y
e
sp
ec
i
a
lists
to g
e
t su
b
s
e
qu
e
nt m
a
n
a
g
e
m
e
nt
.
Ca
t
a
r
ac
t
de
finitiv
e
th
e
r
a
py
is
a ca
t
a
r
ac
t surg
e
ry
.
CONSELLING
&
EDUCATION
1
.
Te
ll th
e
f
a
mily th
a
t
ca
t
a
r
ac
ts
a
r
e
visu
a
l
d
isor
de
rs
ca
n
be
fix
ed
.
2
.
Te
ll th
e
f
a
mily to r
e
gul
a
r
c
ontrol if it h
a
s
bee
n
d
i
a
gnos
ed
with
ca
t
a
r
ac
ts
I
n or
de
r to
a
voi
d c
ompli
ca
tions
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
Ma
tur
ed ca
t
a
r
ac
ts
2
.
I
f th
e
p
a
ti
e
nt h
a
s
e
xp
e
ri
e
n
ced
signifi
ca
nt visu
a
l imp
a
irm
e
nt
3
.
I
f
c
ompli
ca
tions
a
ris
e
E
quipm
e
nt
1
.
F
l
a
shlight
2
.
S
n
e
ll
e
n
C
h
a
rt
3
.
Sc
hiotz
T
onom
e
try
4
.
O
f
Ta
l
M
os
c
op
e
