Ac
ut
e
gl
a
u
c
om
a
Hea
lth pro
b
l
e
ms
Ac
ut
e
gl
a
u
c
om
a
is gl
a
u
c
om
a ca
us
ed b
y pr
e
ssur
e e
l
e
v
a
tion
S
u
dde
n intr
a
o
c
ul
a
r
.
Ac
ut
e
gl
a
u
c
om
a ca
n
be
prim
a
ry or
s
ec
on
da
ry
.
P
rim
a
ry gl
a
u
c
om
a a
ris
e
s
b
y its
e
lf to th
e
p
e
rson
Ha
ving
c
ong
e
nit
a
l gl
a
u
c
om
a
t
a
l
e
nt
,
whil
e
gl
a
u
c
om
a
s
ec
on
d
s
a
s
a
noth
e
r
e
y
e d
is
ea
s
e c
ompli
ca
tion or syst
e
mi
c
.
Ge
n
e
r
a
lly suff
e
r
e
rs
G
l
a
u
c
om
a
h
a
s
bee
n
e
l
de
rly
,
e
sp
ec
i
a
lly for thos
e
who h
a
v
e
risks
.
W
h
e
n pr
e
ssur
e
this su
dde
n intr
a
o
c
ul
a
r is not tr
ea
t
ed
imm
ed
i
a
t
e
ly will r
e
sult in
L
oss of vision until p
e
rm
a
n
e
nt
b
lin
d
n
e
ss
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
Red e
y
e
s
2
.
S
h
a
rp su
dde
n f
ee
t vision
3
.
p
a
in or p
a
in in th
e e
y
e
s th
a
t
ca
n spr
ead
to th
e
h
ead
4
.
Na
us
ea a
n
d
vomiting
(
a
t v
e
ry high
e
y
eba
ll pr
e
ssur
e
)
R
isk f
ac
tor
S
h
a
llow front
c
h
a
m
be
l
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
1
.
V
isis
d
own
2
.
I
ntr
a O
kul
a
r
P
r
e
ssur
e I
n
c
r
ea
s
e
s
3
.
B
ul
b
i
c
onjun
c
tiv
a
:
c
ong
e
stion hyp
e
r
e
mi
a
,
k
e
mosis with sili
e
r inj
ec
tion
,
inj
ec
tion
th
e c
onjun
c
tiv
a
4
.
c
orn
ea
l
ede
m
a
5
.
S
h
a
llow front
c
u
b
i
c
l
e
6
.
M
i
d
-
d
il
a
t
ed
pupil
,
n
e
g
a
tiv
e
pupil r
e
fl
e
x
S
upport
N
ot
d
on
e a
t prim
a
ry s
e
rvi
ce
.
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
oft
a
lmologis
.
A
pp
ea
l
d
i
a
gnosis
:
1
.
a
nt
e
rior uv
e
itis
2
.
Ke
r
a
titis
3
.
c
orn
ea
l ul
ce
r
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
Ma
n
a
g
e
m
e
nt of gl
a
u
c
om
a ca
s
e
s on prim
a
ry s
e
rvi
ce
s
a
im
ed a
t r
ed
u
c
ing
intr
a
-
o
c
ul
a
r pr
e
ssur
e a
s soon
a
s possi
b
l
e a
n
d
th
e
n r
e
f
e
r to th
e d
o
c
tor
E
y
e
sp
ec
i
a
list in th
e
hospit
a
l
.
1
.
N
on
-
Med
i
c
m
e
ntos
a
L
imit
a
tion of flui
d
int
a
k
e
to k
ee
p intr
a
-
o
c
ul
a
r pr
e
ssur
e
not
in
c
r
ea
sing
2
.
Med
i
c
m
e
ntos
a
a
.
A
s
e
t
a
zol
a
mi
d HC
l
500
mg
,
c
ontinu
ed
4
x
250
mg
/
da
y
.
b
r
ea
kf
a
st
.
KCL
0
.
5
gr
3
x
/
da
y
.
C
..
T
imolol
0
.
5
%
,
2
x
1
d
rop
/
da
y
.
d
.
C
orti
c
ost
e
roi
d
+
a
nti
b
ioti
c c
om
b
in
a
tion
e
y
e
s
4
-
6
x
1
d
rops
a da
y
He
y
.
S
imptom
a
ti
c
th
e
r
a
py
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
Te
ll th
e
f
a
mily th
a
t
e
y
e c
on
d
itions with
ac
ut
e
gl
a
u
c
om
a a
r
e c
l
a
ssifi
ed a
s
E
y
e e
m
e
rg
e
n
c
i
e
s
,
wh
e
r
e
intr
a
-
o
c
ul
a
r pr
e
ssur
e
must
be
imm
ed
i
a
t
e
ly r
e
v
ea
l
ed
Re
f
e
r
e
n
ce c
rit
e
ri
a
I
n
ac
ut
e
gl
a
u
c
om
a
,
r
e
f
e
r
e
n
ce
s
a
r
e ca
rri
ed
out
a
ft
e
r initi
a
l h
a
n
d
ling in s
e
rvi
ce
prim
a
ry
.
E
quipm
e
nt
1
.
S
n
e
ll
e
n
C
h
a
rt
2
.
Sc
hiotz
T
onom
e
try
3
.
oft
a
lmos
c
opy
C
hroni
c
gl
a
u
c
om
a
Hea
lth pro
b
l
e
ms
G
l
a
u
c
om
a
is
a
group of
e
y
e d
is
ea
s
e
s th
a
t
a
r
e
g
e
n
e
r
a
lly m
a
rk
ed da
m
a
g
e
opti
ca
l n
e
rv
e
s
a
n
d
loss of sp
ac
ious fi
e
l
d
s th
a
t
a
r
e
progr
e
ssiv
e a
n
d
r
e
l
a
ting to v
a
rious risk f
ac
tors
,
e
sp
ec
i
a
lly intr
a
o
c
ul
a
r pr
e
ssur
e
(
TIO
)
high
.
G
l
a
u
c
om
a
is th
e
s
ec
on
d
l
a
rg
e
st
ca
us
e
of
b
lin
d
n
e
ss in th
e
worl
d
A
ft
e
r
ca
t
a
r
ac
ts
.
B
lin
d
n
e
ss
beca
us
e
gl
a
u
c
om
a ca
nnot
be c
ur
ed
,
b
ut
I
n most
ca
s
e
s gl
a
u
c
om
a ca
n
be c
ontroll
ed
.
Ge
n
e
r
a
lly suff
e
r
e
rs
G
l
a
u
c
om
a
h
a
s
bee
n
e
l
de
rly
,
e
sp
ec
i
a
lly for thos
e
who h
a
v
e
risks
.
A
lmost
h
a
lf of gl
a
u
c
om
a
p
e
opl
e d
on
'
t r
ea
liz
e
th
a
t th
e
y suff
e
r
th
e d
is
ea
s
e
.
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 th
a
t
a
r
e
v
a
ri
ed a
n
d d
iff
e
r
e
nt
de
p
e
n
d
ing on th
e
typ
e
gl
a
u
c
om
a
.
C
hroni
c
gl
a
u
c
om
a ca
n
be d
ivi
ded
into prim
a
ry
c
hroni
c
gl
a
u
c
om
a a
n
d
s
ec
on
da
ry
.
1
.
Ge
n
e
r
a
lly in th
e
initi
a
l ph
a
s
e
,
c
hroni
c
gl
a
u
c
om
a d
o
e
s not
ca
us
e c
ompl
a
ints
,
a
n
d
known to
be acc
i
de
nt
a
l if you
d
o
T
io m
ea
sur
e
m
e
nts
2
.
E
y
e
s
ca
n
be ac
h
ed
,
som
e
tim
e
s
d
izzy
3
.
U
n
c
omfort
ab
l
e
t
a
st
e
or f
a
t tir
ed e
y
e
s
4
.
T
h
e
r
e
m
a
y
be a
history of
e
y
e d
is
ea
s
e
s
,
tr
a
um
a
,
or us
e
of
d
rugs
c
orti
c
ost
e
roi
d
s
5
.
T
h
e
loss of p
e
riph
e
r
a
l sp
ac
ing gr
ad
u
a
lly in
b
oth
e
y
e
s
6
.
I
n gl
a
u
c
om
a
,
th
e c
ontinu
ed
n
a
rrowing of th
e
fi
e
l
d ca
n o
cc
ur
whi
c
h is m
ea
ningful to
ca
us
e a d
istur
ba
n
ce
,
su
c
h
a
s
c
r
a
shing
W
h
e
n w
a
lking
.
R
isk f
ac
tor
1
.
a
g
e
40
y
ea
rs or mor
e
2
.
T
h
e
r
e a
r
e
f
a
mily m
e
m
be
rs suff
e
ring from gl
a
u
c
om
a
3
.
Pa
ti
e
nts with myopi
a
,
ca
r
d
iov
a
s
c
ul
a
r
d
is
ea
s
e
,
hyp
e
rt
e
nsion
,
hypot
e
nsion
,
Va
sosp
a
sm
,
d
i
abe
t
e
s m
e
llitus
,
a
n
d
migr
a
in
e
4
.
I
n s
ec
on
da
ry gl
a
u
c
om
a
,
a
history of
d
rug us
e ca
n
be
foun
d
S
t
e
roi
d
s
a
r
e
routin
e
,
or tr
a
um
a
history in th
e e
y
e
s
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
G
l
a
u
c
om
a
is
a
n
e
y
e d
is
ea
s
e c
h
a
r
ac
t
e
riz
ed b
y
T
ri
a
s
G
l
a
u
c
om
a
,
whi
c
h
c
onsists
from
:
1
.
I
n
c
r
ea
s
ed
intr
a
o
c
ul
a
r pr
e
ssur
e
2
.
Pa
thologi
ca
l
c
h
a
ng
e
s to opti
ca
l
d
is
c
us
3
.
T
ypi
ca
l vi
e
wing fi
e
l
d de
f
ec
t
.
O
mp
a
lmologi
ca
l
e
x
a
min
a
tion
1
.
N
orm
a
l or
dec
r
ea
s
ed
vision
2
.
T
h
e
fi
e
l
d
of vi
e
w n
a
rrows on th
e c
onfront
a
tion t
e
st
3
.
I
ntr
a O
kul
a
r
P
r
e
ssur
e I
n
c
r
ea
s
e
s
4
.
A
t
F
un
d
uskopi
,
th
e C
up
/
D
is
c Ra
tio
I
n
c
r
ea
s
e
s
(
N
orm
a
l
C
up
/
D
is
c Ra
tio
:
0
.
3
)
S
upport
N
ot
d
on
e a
t prim
a
ry s
e
rvi
ce
.
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
oft
a
lmologis
.
A
pp
ea
l
d
i
a
gnosis
:
1
.
Ca
t
a
r
ac
ts
2
.
Re
fr
ac
tion
ab
norm
a
liti
e
s
3
.
D
i
abe
t
e
s
/
H
yp
e
rt
e
nsion
Re
tinop
a
thy
4
.
P
igm
e
ntos
e Re
tinitis
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
Ma
n
a
g
e
m
e
nt of gl
a
u
c
om
a ca
s
e
s on prim
a
ry s
e
rvi
ce
s
a
im
ed a
t
I
nstr
a
-
Oc
ulty
'
s inst
a
n
ce
s
a
n
d
r
e
f
e
rr
ed
to
a
n
e
y
e
sp
ec
i
a
list in
H
ospit
a
l
.
T
r
ea
tm
e
nt is g
e
n
e
r
a
lly m
ed
i
ca
lo with gl
a
u
c
om
a d
rugs
,
F
or
e
x
a
mpl
e
,
T
imolol
0
.
5
%
,
2
x
1
Te
t
e
s
/
da
y
.
O
th
e
r typ
e
s of
d
rugs
ca
n
be
giv
e
n if
with
1
kin
d
s of tio
d
rugs y
e
t
c
ontroll
ed
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Te
ll th
e
f
a
mily th
a
t tr
ea
tm
e
nt
c
ompli
a
n
ce
is v
e
ry import
a
nt for
T
h
e
su
cce
ss of gl
a
u
c
om
a
tr
ea
tm
e
nt
.
2
.
Te
ll th
e
p
a
ti
e
nt
a
n
d
f
a
mily so th
a
t p
a
ti
e
nts with gl
a
u
c
om
a
history
I
n th
e
f
a
mily to
c
h
ec
k his
e
y
e
s r
e
gul
a
rly
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
O
n
c
hroni
c
gl
a
u
c
om
a
,
r
e
f
e
r
e
n
ce
s
a
r
e ca
rri
ed
out imm
ed
i
a
t
e
ly
a
ft
e
r
e
nfor
ce
m
e
nt
d
i
a
gnosis
.
E
quipm
e
nt
1
.
S
n
e
ll
e
n
C
h
a
rt
2
.
T
onom
e
t
e
r
Sc
hiotz
3
.
O
f
Ta
l
M
os
c
op
e
T
riki
a
sis
Hea
lth pro
b
l
e
ms
T
ri
c
hi
a
sis is
a c
on
d
ition in whi
c
h
e
y
e
l
a
sh
e
s grow l
ead
into
,
th
a
t is
tow
a
r
d
s th
e
surf
ace
of th
e e
y
eba
ll
,
so it
ca
n s
c
r
a
t
c
h
c
orn
ea
or
c
onjun
c
tiv
a a
n
d ca
us
e
v
a
rious
c
ompli
ca
tions
,
su
c
h
a
s p
a
in
,
e
rosion
,
inf
ec
tion
,
a
n
d c
orn
ea
l ul
ce
rs
.
Da
t
a
on th
e
pr
e
v
a
l
e
n
ce
r
a
t
e
of this
d
is
ea
s
e
in
I
n
d
on
e
si
a
N
othing
.
D
o
c
tors in prim
a
ry h
ea
lth s
e
rvi
ce
s must h
a
v
e c
omp
e
t
e
n
ce
h
a
n
d
l
e
tri
c
hi
a
sis
ca
s
e
s
beca
us
e
p
a
ti
e
nts who
e
xp
e
ri
e
n
ce
signs
a
n
d c
ompli
ca
tions of tri
c
hi
a
sis
a
r
e
v
e
ry lik
e
ly to s
ee
k h
e
lp in
P
rim
a
ry s
e
rvi
ce
first
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
Pa
ti
e
nt
c
ompl
a
ints
ca
n v
a
ry
,
for
e
x
a
mpl
e
:
runny
e
y
e
s
,
t
a
st
e
M
itting
,
gl
a
r
e
wh
e
n
e
xpos
ed
to light
,
or
a c
om
b
in
a
tion
.
Ca
n
D
istur
bed
if th
e
ul
ce
r h
a
s
a
ris
e
n on th
e c
orn
ea
.
2
.
C
ompl
a
ints
ca
n
be e
xp
e
ri
e
n
ced
in on
e
or
b
oth
e
y
e
s
.
3
.
I
f th
e
r
e
h
a
s
bee
n infl
a
mm
a
tion
,
r
ed e
y
e c
ompl
a
ints
ca
n o
cc
ur
.
4
.
T
h
e
r
e
is
a
history of
d
is
ea
s
e
s r
e
l
a
t
ed
to th
e
pr
ed
isposing f
ac
tor
,
F
or
e
x
a
mpl
e
:
b
l
e
f
a
ritis
,
tr
ac
hom
a
,
m
ec
h
a
ni
ca
l or
c
h
e
mi
ca
l tr
a
um
a
,
h
e
rp
e
s zost
e
r
oft
a
lmik
,
a
n
d
v
a
rious
ab
norm
a
liti
e
s th
a
t
ca
us
e
th
e e
m
e
rg
e
n
ce
of
b
ri
c
ks
a
n
d
e
ntropion
.
5
.
C
ompl
a
ints
ca
n
be e
xp
e
ri
e
n
ced b
y p
a
ti
e
nts from
a
ll
a
g
e
groups
.
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
1
.
S
om
e
or
a
ll
e
y
e
l
a
sh
e
s
c
ont
ac
t
ed
with th
e
surf
ace
of th
e ba
ll
e
y
e
s
.
2
.
Ca
n
be
foun
d e
ntropion
,
whi
c
h is fol
ded b
y th
e Pa
lp
eb
r
a Ma
rgo in th
e d
ir
ec
tion
in
.
3
.
I
f th
e
r
e
is infl
a
mm
a
tion or inf
ec
tion
,
c
onjun
c
tiv
a
l inj
ec
tion
ca
n
be
foun
d
or
S
ili
e
r
.
4
.
Ab
norm
a
liti
e
s in th
e c
orn
ea
,
for
e
x
a
mpl
e
:
ab
r
a
sion
,
ul
ce
rs
,
n
eb
ul
a
/
m
ac
ul
a
r
/
l
e
ukom
a
th
e c
orn
ea
.
5
.
I
f it h
a
s
da
m
a
g
ed
th
e c
orn
ea
,
it
ca
n
ca
us
e a dec
r
ea
s
e
in th
e
vision
.
6
.
I
f th
e
r
e a
r
e
ul
ce
rs on th
e c
orn
ea
,
th
e
fluor
e
s
e
in t
e
st will giv
e
positiv
e
r
e
sults
.
7
.
E
x
a
min
a
tion must
be d
on
e
in
b
oth
e
y
e
s
,
r
e
g
a
r
d
l
e
ss of wh
e
th
e
r or not
c
ompl
a
ints
.
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
T
h
e d
i
a
gnosis of tri
c
hi
a
sis is
e
nfor
ced
through
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
a
s m
e
ntion
ed ea
rli
e
r
.
F
luor
e
s
e
ns
e
ns
ca
n show
E
rosion or
c
orn
ea
l ul
ce
r
.
D
i
a
gnosis of
A
pp
ea
l
:
O
th
e
r infl
a
mm
a
tory
ca
us
e
s in th
e e
y
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
1
.
N
on
-
Med
i
c
m
e
ntos
a
E
pil
a
tion
,
n
a
m
e
ly th
e e
xtr
ac
tion of
e
y
e
l
a
sh
e
s with tw
ee
z
e
rs
.
T
his is
a
iming
Red
u
ce
s symptoms
a
n
d
pr
e
v
e
nts
c
ompli
ca
tions on th
e e
y
eba
ll
.
H
ow
e
v
e
r
,
th
e
e
y
e
l
a
sh
e
s will grow
bac
k within
4
-
6
w
ee
ks
,
so
E
pil
a
tion n
eed
s to
be
r
e
p
ea
t
ed a
g
a
in
.
2
.
Med
i
c
m
e
ntos
a
T
opi
ca
l tr
ea
tm
e
nt is giv
e
n
acc
or
d
ing to in
d
i
ca
tion
,
for
e
x
a
mpl
e
:
ointm
e
nt or
d
rops
A
nti
b
ioti
c e
y
e
s to ov
e
r
c
om
e
inf
ec
tion
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
T
h
e
p
a
ti
e
nt n
eed
s to
be
inform
ed
to m
a
int
a
in th
e c
l
ea
nlin
e
ss of his
e
y
e
s
a
n
d
A
voi
d
tr
a
um
a
in th
e e
y
e
s th
a
t
ca
n wors
e
n symptoms
.
2
.
T
h
e d
o
c
tor n
eed
s to
e
xpl
a
in som
e a
lt
e
rn
a
tiv
e
th
e
r
a
p
e
uti
c c
hoi
ce
s
,
st
a
rting from
e
pil
a
tion
a
n
d
topi
ca
l tr
ea
tm
e
nt th
a
t
ca
n
be d
on
e b
y th
e d
o
c
tor
a
t
P
rim
a
ry h
ea
lth s
e
rvi
ce
s to op
e
r
a
tions
ca
rri
ed
out
b
y sp
ec
i
a
lists
E
y
e
s in
Sec
on
da
ry
Se
rvi
ce
s
.
T
h
e
r
a
py th
a
t will
be
liv
ed
in
acc
or
da
n
ce
with th
e
c
hoi
ce
th
e
p
a
ti
e
nt
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
1
.
I
f th
e
m
a
n
a
g
e
m
e
nt
ab
ov
e d
o
e
s not h
e
lp th
e
p
a
ti
e
nt
,
r
e
f
e
r
e
n
ce ca
n
be d
on
e
to s
ec
on
da
ry s
e
rvi
ce
s
2
.
I
f th
e
r
e
h
a
s
bee
n
a dec
r
ea
s
e
in th
e
vision
3
.
I
f th
e
r
e
h
a
s
bee
n
a c
orn
ea
l
da
m
a
g
e
4
.
I
f th
e
p
a
ti
e
nt w
a
nts
a d
ir
ec
t m
a
n
a
g
e
m
e
nt in th
e
s
ec
on
da
ry s
e
rvi
ce
E
quipm
e
nt
1
.
fl
a
shlight lights
2
.
S
n
e
ll
e
n
C
h
a
rt
3
.
T
w
ee
z
e
rs for
e
pil
a
tion
4
.
LUP
5
.
Ca
n
a
lso
be
provi
ded
fluor
e
s
e
in p
a
p
e
r
a
n
d
0
.
9
%
NaC
l solution for
TER
fluor
e
s
e
in
6
.
B
lu
e
lights
(
ca
n
c
om
e
from
b
lu
e
lights on th
e
ophth
a
lmos
c
op
e
)
E
piskl
e
ritis
Hea
lth pro
b
l
e
ms
E
pis
c
l
e
ritis is
a
r
eac
tion of infl
a
mm
a
tion in
e
piskl
e
r
a
,
n
a
m
e
ly
c
onn
ec
tiv
e
tissu
e
Va
s
c
ul
a
r lo
ca
t
ed be
tw
ee
n th
e c
onjun
c
tiv
a a
n
d
th
e
s
c
l
e
r
a
surf
ace
.
D
is
ea
s
e
T
h
e
s
e a
r
e
in
c
lu
ded
in th
e
group
"
r
ed e
y
e
s with norm
a
l vision
".
N
ot
T
h
e
r
e a
r
e
sp
ec
ifi
c da
t
a
on th
e
l
e
v
e
l of
e
pis
c
l
e
ritis in
c
i
de
nts in
I
n
d
on
e
si
a
.
E
pis
c
l
e
ritis g
e
n
e
r
a
lly o
cc
urs
a
t th
e a
g
e
of
20
-
50
y
ea
rs
a
n
d
improv
e
s in
a
f
e
w
da
ys to
a
f
e
w w
ee
ks
.
Ge
n
e
r
a
lly
,
e
pis
c
l
e
ritis is mil
d
,
B
ut it
ca
n
a
lso
be a
sign of syst
e
mi
c d
is
ea
s
e
s
,
su
c
h
a
s
T
u
be
r
c
ulosis
,
r
ea
tumoi
d a
rthritis
,
a
n
d S
yst
e
mi
c L
upus
E
ryth
e
m
a
tosus
(
SLE
).
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
Red e
y
e
s
a
r
e
th
e
m
a
in symptoms or th
e
only on
e
2
.
T
h
e
r
e
is no int
e
rf
e
r
e
n
ce
in visu
a
l sh
a
rpn
e
ss
3
.
O
th
e
r
c
ompl
a
ints
,
for
e
x
a
mpl
e
:
d
ry t
a
st
e
,
p
a
in
,
b
lo
c
k
,
or
a
qu
e
ous
.
T
h
e
s
e c
ompl
a
ints
a
r
e
lightw
e
ight
a
n
d
not
d
istur
b
ing
e
v
e
ry
da
y
ac
tiviti
e
s
.
W
h
e
n
c
ompl
a
ints
a
r
e
f
e
lt v
e
ry s
e
v
e
r
e
,
it is n
ece
ss
a
ry
T
hink of
a
noth
e
r
d
i
a
gnosis
4
.
C
ompl
a
ints usu
a
lly r
e
g
a
r
d
ing on
e e
y
e a
n
d ca
n r
e
p
ea
t th
e e
y
e
s
th
e
s
a
m
e
or
a
lt
e
rn
a
t
e
ly
5
.
C
ompl
a
ints
a
r
e
usu
a
lly
ac
ut
e
,
b
ut it
ca
n
a
lso t
a
k
e
s
e
v
e
r
a
l
w
ee
k for s
e
v
e
r
a
l months
6
.
Ca
n
be
foun
d
symptoms r
e
l
a
t
ed
to
ba
si
c d
is
ea
s
e
s
,
in
c
lu
d
ing
:
tu
be
r
c
ulosis
,
r
ea
tumoi
d a
rthritis
,
SLE
,
a
ll
e
rgi
e
s
(
for
e
x
a
mpl
e
:
e
ryth
e
m
a
no
d
osum
),
or
c
ont
ac
t
de
rm
a
titis
S
impl
e
physi
ca
l
a
n
d
supporting r
e
sults
(
o
b
j
ec
tiv
e
)
E
pis
c
l
e
ritis is
d
ivi
ded
into two typ
e
s
,
n
a
m
e
ly no
d
ul
a
r
a
n
d
simpl
e
.
I
n g
e
n
e
r
a
l
,
T
h
e
sign of
e
piskl
e
ritis is
:
1
.
Red
n
e
ss only involv
e
s on
e
p
a
rt of th
e e
piskl
e
r
a a
r
ea
.
O
n th
e
irr
ad
i
a
tion with
a
fl
a
shlight
,
looks pink lik
e
s
a
lmon m
ea
t
,
W
h
e
r
ea
s in s
c
l
e
ritis th
e c
olor is
da
rk
e
r
a
n
d
purp
a
t
ed
.
2
.
Red
n
e
ss in
e
piskl
e
ritis is
ca
us
ed b
y th
e E
pis
c
l
e
r
a P
l
e
xus
C
ong
e
sti
S
up
e
rfi
c
i
a
l
a
n
d c
onjun
c
tiv
a
l
,
whi
c
h is lo
ca
t
ed ab
ov
e a
n
d
s
e
p
a
r
a
t
ed
from th
e
l
a
y
e
r
S
kl
e
r
a a
n
d E
pis
c
l
e
r
a P
l
e
xus
P
rofun
da
in it
.
T
hus
,
I
n th
e e
pis
c
l
e
ritis
,
th
e E
f
ed
rin
2
.
5
%
ph
e
nyl look will shrink
c
ong
e
stion
a
n
d
r
ed
u
ce
r
ed
n
e
ss
;
S
om
e
thing th
a
t
d
o
e
sn
'
t h
a
pp
e
n to s
c
l
e
ritis
.
3
.
I
n no
d
ul
a
r
e
pis
c
l
e
ritis
,
it w
a
s foun
d
to
be a dec
isiv
e
r
edd
ish no
d
ul
e
in
un
de
r th
e c
onjun
c
tiv
a
.
N
o
d
ul
e
s
ca
n
be
mov
ed
.
I
f th
e
no
d
ul
e
is pr
e
ss
ed
with
c
otton or through
e
y
e
li
d
s th
a
t
a
r
e c
los
ed
on it
,
will
a
ris
e
T
h
e
p
a
in th
a
t spr
ead
s
a
roun
d
th
e e
y
e
s
.
4
.
Re
sults of vision vision within norm
a
l limits
.
5
.
Ca
n
be
foun
d a
n
a
qu
e
ous
e
y
e
,
with
c
l
ea
r
a
n
d
runny s
ec
r
e
tions
.
I
f th
e
s
ec
r
e
t
,
thi
c
k
a
n
d
runny s
ec
r
e
tions
,
it is n
ece
ss
a
ry to think of
a
noth
e
r
d
i
a
gnosis
.
6
.
Ge
n
e
r
a
list st
a
tus
c
h
ec
ks must
be
m
ade
to
e
nsur
e Ta
n
da
t
a
n
da
S
yst
e
mi
c d
is
ea
s
e
s th
a
t m
a
y un
de
rli
e e
piskl
e
ritis
,
L
ik
e
tu
be
r
c
ulosis
,
rh
e
um
a
toi
d a
rthritis
,
SLE
,
e
ryth
e
m
a
no
d
osum
,
de
rm
a
titis
c
ont
ac
t
.
S
yst
e
mi
c ab
norm
a
liti
e
s g
e
n
e
r
a
lly
ca
us
e e
piskl
e
ritis mor
e
oft
e
n
no
d
ul
a
r th
a
n simpl
e
.
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
D
i
a
gnosis
ca
n
be e
nfor
ced
with
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
A
s
e
xpl
a
in
ed
in th
e
pr
e
vious s
ec
tion
.
A
pp
ea
l
d
i
a
gnosis
:
1
.
c
onjun
c
tivitis
2
.
Sc
l
e
ritis
H
ow to
d
istinguish
e
piskl
e
ritis with s
c
l
e
ritis is to
d
o
a
t
e
st
E
frin
2
..
5
%
ph
e
nyl
(
e
y
e d
rops
),
whi
c
h is
a
v
a
so
c
onstri
c
tor
.
O
n th
e
e
pis
c
l
e
ritis
,
th
e E
frin
2
.
5
%
ph
e
nyl look will shrink
c
ong
e
stion
a
n
d
r
ed
u
ce
r
ed
n
e
ss
(
b
l
a
n
c
hing
/
p
a
l
e
);
whil
e
on s
c
l
e
ritis
Red
n
e
ss s
e
ttl
ed
.
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
.
I
f th
e
r
e
is
a c
l
ea
r history of
e
xposur
e
to
e
xog
e
nous su
b
st
a
n
ce
s
,
for
e
x
a
mpl
e a
ll
e
rg
e
ns or irrit
a
nts
,
th
e
n
a
voi
da
n
ce
n
eed
to
be d
on
e
Red
u
c
ing th
e
progr
e
ssion of symptoms
a
n
d
pr
e
v
e
nting r
ec
urr
e
n
ce
.
b
r
ea
kf
a
st
.
I
f th
e
r
e a
r
e
symptoms of s
e
nsitivity to light
,
us
e
S
ungl
a
ss
e
s
ca
n h
e
lp
.
2
.
Med
i
c
m
e
ntos
a
a
.
S
impl
e e
pis
c
l
e
ritis usu
a
lly
d
o
e
s not r
e
quir
e
sp
ec
i
a
l tr
ea
tm
e
nt
.
b
r
ea
kf
a
st
.
M
il
d
to mo
de
r
a
t
e
symptoms
ca
n
be
ov
e
r
c
om
e b
y t
ea
rs
m
ade
.
A
tt
ac
hm
e
nt
D
i
a
gnosis
(
A
ss
e
ssm
e
nt
)
D
i
a
gnosis
ca
n
be e
nfor
ced
with
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
A
s
e
xpl
a
in
ed
in th
e
pr
e
vious s
ec
tion
.
A
pp
ea
l
d
i
a
gnosis
:
1
.
c
onjun
c
tivitis
2
.
Sc
l
e
ritis
H
ow to
d
istinguish
e
piskl
e
ritis with s
c
l
e
ritis is to
d
o
a
t
e
st
E
frin
2
..
5
%
ph
e
nyl
(
e
y
e d
rops
),
whi
c
h is
a
v
a
so
c
onstri
c
tor
.
O
n th
e
e
pis
c
l
e
ritis
,
th
e E
frin
2
.
5
%
ph
e
nyl look will shrink
c
ong
e
stion
a
n
d
r
ed
u
ce
r
ed
n
e
ss
(
b
l
a
n
c
hing
/
p
a
l
e
);
whil
e
on s
c
l
e
ritis
Red
n
e
ss s
e
ttl
ed
.
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
.
I
f th
e
r
e
is
a c
l
ea
r history of
e
xposur
e
to
e
xog
e
nous su
b
st
a
n
ce
s
,
for
e
x
a
mpl
e a
ll
e
rg
e
ns or irrit
a
nts
,
th
e
n
a
voi
da
n
ce
n
eed
to
be d
on
e
Red
u
c
ing th
e
progr
e
ssion of symptoms
a
n
d
pr
e
v
e
nting r
ec
urr
e
n
ce
.
b
r
ea
kf
a
st
.
I
f th
e
r
e a
r
e
symptoms of s
e
nsitivity to light
,
us
e
S
ungl
a
ss
e
s
ca
n h
e
lp
.
2
.
Med
i
c
m
e
ntos
a
a
.
S
impl
e e
pis
c
l
e
ritis usu
a
lly
d
o
e
s not r
e
quir
e
sp
ec
i
a
l tr
ea
tm
e
nt
.
b
r
ea
kf
a
st
.
M
il
d
to mo
de
r
a
t
e
symptoms
ca
n
be
ov
e
r
c
om
e b
y t
ea
rs
m
ade
.
E
y
e c
h
e
mistry tr
a
um
a
Hea
lth pro
b
l
e
ms
E
y
e c
h
e
mi
ca
l tr
a
um
a
is on
e
of th
e ca
s
e
s of
e
y
e e
m
e
rg
e
n
c
i
e
s
,
g
e
n
e
r
a
lly
h
a
pp
e
ns
beca
us
e
of th
e e
ntry of
c
h
e
mi
ca
ls to th
e e
y
e
s of th
e e
y
e a
n
d ad
n
e
x
a a
t
a
roun
d
it
.
T
his situ
a
tion r
e
quir
e
s f
a
st
a
n
d
imm
ed
i
a
t
e
tr
ea
tm
e
nt
b
y
beca
us
e
it
ca
n l
ead
to s
e
v
e
r
e da
m
a
g
e
to th
e e
y
e
s of th
e e
y
e a
n
d
ca
us
e b
lin
d
n
e
ss
.
C
h
e
mi
ca
l
ca
us
e
s
ca
n
be ac
i
d
i
c
or
a
lk
a
lin
e
.
Ba
s
a
tr
a
um
a
o
cc
urs twi
ce a
s oft
e
n th
a
n
ac
i
d
tr
a
um
a a
n
d
Ge
n
e
r
a
lly
ca
us
e
s h
ea
vi
e
r
da
m
a
g
e
to th
e e
y
e
.
Be
si
de
s th
a
t
,
th
e
s
e
v
e
rity of
da
m
a
g
e d
u
e
to
c
h
e
mi
ca
l tr
a
um
a
is
a
lso
de
t
e
rmin
ed b
y th
e
siz
e
of th
e
a
r
ea
whi
c
h is
e
xpos
ed
to
c
h
e
mi
ca
ls
a
n
d d
ur
a
tion of
e
xposur
e
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
Red e
y
e
s
,
sw
e
lling
a
n
d
irrit
a
tion
2
.
Pa
in in th
e e
y
e
s
3
.
b
lurry vision
4
.
I
t
'
s h
a
r
d
to op
e
n your
e
y
e
s
5
.
T
h
e
f
ee
ling is
b
lo
c
king th
e e
y
e
s
R
isk f
ac
tor
E
xposur
e
to
c
h
e
mi
ca
ls th
a
t oft
e
n
ca
us
e
tr
a
um
a be
tw
ee
n oth
e
rs
de
t
e
rg
e
nt
,
d
isinf
ec
t
a
nt
,
c
h
e
mi
ca
l solv
e
nt
,
hous
e
hol
d c
l
ea
ning liqui
d
,
f
e
rtiliz
e
r
,
p
e
sti
c
i
de
s
,
a
n
d ba
tt
e
ry liqui
d
s
.
A
n
a
mn
e
sis n
eed
s to
be d
on
e
to fin
d
out th
e
su
b
st
a
n
ce
C
h
e
mi
ca
l
ca
us
e
s of tr
a
um
a
,
l
e
ngth of
c
ont
ac
t with
c
h
e
mi
ca
ls
,
pl
ace
s
a
n
d
c
hronology
E
v
e
nts
,
th
e
possi
b
ility of
acc
i
de
nts
a
t work or
C
rimin
a
l
,
a
n
d
h
a
n
d
ling th
a
t h
ad bee
n
d
on
e be
for
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
W
ith th
e
h
e
lp of
a
fl
a
shlight
a
n
d LUP
,
th
e
following
ab
norm
a
liti
e
s
ca
n
be
foun
d
:
1
.
H
yp
e
r
e
mi
a c
onjun
c
tiv
a
2
.
C
orn
ea
l
a
n
d c
onjun
c
tiv
a
l
e
pith
e
li
a
l
de
f
ec
ts
3
.
L
im
b
us
K
orn
ea
is
c
h
e
mi
a
4
.
K
orn
ea a
n
d
l
e
ns tur
b
i
d
ity
V
isus
e
x
a
min
a
tion shows th
e
r
e
is
a dec
r
ea
s
e
in sh
a
rpn
e
ss of vision
.
W
h
e
n th
e
A
v
a
il
ab
l
e
,
ca
n
be
t
e
st
ed
with litmus p
a
p
e
r to fin
d
out su
b
st
a
n
ce
s
c
h
e
mi
ca
l
ca
us
e
1
.
I
f th
e
litmus p
a
p
e
r is
c
olor
ed
r
ed
,
th
e
n th
e ca
us
a
l su
b
st
a
n
ce
is
ac
i
d
i
c
2
.
W
h
e
n th
e
p
a
p
e
r is
c
olor
ed
in
b
lu
e
,
th
e
n th
e ca
us
a
l su
b
st
a
n
ce
is
a
lk
a
lin
e
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 is
e
nfor
ced
through
a
n
a
mn
e
sis
a
n
d
physi
ca
l
e
x
a
min
a
tion
.
C
ompli
ca
tions
1
.
S
im
b
l
e
f
a
ron
2
.
H
ypotoni
e
y
eba
ll
3
.
B
ul
b
i
P
tisis
4
.
E
ntropion
5
.
Ca
t
a
r
ac
ts
6
.
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
1
.
I
mm
ed
i
a
t
e
ly
d
o
e
y
e
irrig
a
tion
a
ff
ec
t
ed b
y
a c
h
e
mi
ca
l with liqui
d
flow
a
s mu
c
h
a
s possi
b
l
e a
n
d
th
e
v
a
lu
e
r
e
turn
ed
with litmus p
a
p
e
r
.
I
rrig
a
tion
c
ontinu
e
s until th
e
r
e
is no
c
oloring of litmus p
a
p
e
r
.
2
.
Pe
rform
e
v
e
rsion on
e
y
e
li
d
s
d
uring irrig
a
tion
a
n
d
g
e
t ri
d
of
Deb
ris
whi
c
h m
a
y
be
on th
e
surf
ace
of th
e e
y
eba
ll or in th
e
forniks
.
3
.
A
ft
e
r irrig
a
tion is
c
ompl
e
t
ed
,
th
e
sh
a
rp v
a
lu
e
of vision
,
th
e
n r
e
f
e
r
I
mm
ed
i
a
t
e
ly go to
a
n ophth
a
lmologist in s
ec
on
da
ry or t
e
rti
a
ry f
ac
iliti
e
s
.
CONSELLING
&
EDUCATION
Ad
vi
ce
to us
e
prot
ec
tiv
e
(
gl
a
ss
e
s
/
goggl
e
,
glov
e
s
,
or m
a
sk
)
a
t th
e
tim
e
of
c
ont
ac
t with
c
h
e
mi
ca
ls
Re
f
e
r
e
n
ce c
rit
e
ri
a
A
ft
e
r initi
a
l h
a
n
d
ling with irrig
a
tion
,
r
e
f
e
r to th
e
p
a
ti
e
nt to
a
n ophth
a
lmologist
for
ad
v
a
n
ced
m
a
n
a
g
e
m
e
nt
E
quipm
e
nt
1
.
LUP
2
.
F
l
a
shlight
3
.
C
otton sti
c
k
4
.
La
kmus p
a
p
e
r
(
if possi
b
l
e
)
5
.
P
hysiologi
ca
l flui
d
for irrig
a
tion
Lac
k of
e
y
e
li
d
s
Hea
lth pro
b
l
e
ms
T
h
e
l
a
sn
e
l p
e
t
a
ls
a
r
e c
ut into tissu
e
on
e
y
e
li
d
s
.
T
h
e ca
us
e
of
La
sn
e
r
a
s
ca
n
be
in th
e
form of sh
a
rp o
b
j
ec
ts
,
b
lunt tr
a
um
a
(
T
r
a
ffi
c acc
i
de
nts or sports
),
a
s w
e
ll
a
s
a
nim
a
l
b
it
e
s
.
Lace
r
a
tion on
p
e
t
a
ls n
eed
to
be
tr
ea
t
ed
imm
ed
i
a
t
e
ly so th
a
t th
e
fun
c
tions
a
n
d c
osm
e
ti
c
s p
e
t
a
ls
ca
n
m
a
int
a
in
ed
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
T
h
e
r
e
is
a
s
e
ns
e
of p
e
rior
b
it
a
l p
a
in
2
.
B
l
eed
ing
a
n
d
sw
e
lling on th
e
p
e
t
a
ls
3
.
Wa
t
e
ry
e
y
e
s
4
.
T
h
e
r
e
is no sh
a
rp
dec
r
ea
s
e
in vision if th
e
injury
d
o
e
s not involv
e
e
y
eba
ll
R
isk f
ac
tor
T
h
e
r
e
is
a
sh
a
rp or
b
lunt tr
a
um
a
history
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
.
P
upil
a
n
d
sh
a
rp vision r
e
fl
e
x
e
x
a
min
a
tion
2
.
E
y
e e
x
a
min
a
tion with
LUP a
n
d
fl
a
shlight to i
de
ntify
:
a
.
E
xt
e
nsiv
e a
n
d
in it l
ace
r
a
tions on p
e
t
a
ls
,
in
c
lu
d
ing i
de
ntifi
ca
tion
T
h
e
involv
e
m
e
nt of th
e ed
g
e
of th
e
p
e
t
a
l
,
m
ed
i
a
l
c
y
a
n or l
a
t
e
r
a
l
c
y
a
nous
.
T
h
e
e
x
a
min
e
r
ca
n us
e c
otton sti
c
k
d
uring th
e e
x
a
min
a
tion
.
b
r
ea
kf
a
st
.
F
or
e
ign
C
..
E
y
eba
ll involv
e
m
e
nt
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 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
T
h
e
r
e
is no
C
ompli
ca
tions
T
r
a
um
a
on th
e
l
ac
rim
a
l syst
e
m
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
.
C
l
ea
n th
e
woun
d
if it is
be
li
e
v
ed
to
be a
n int
a
k
e
2
.
C
onsi
de
r th
e
prophyl
a
xis of t
e
t
a
nus
3
.
G
iv
e
syst
e
mi
c a
nti
b
ioti
c
s
4
.
I
mm
ed
i
a
t
e
ly r
e
f
e
r to
a
n
e
y
e
sp
ec
i
a
list to g
e
t h
a
n
d
ling
imm
ed
i
a
t
e
ly
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
Te
ll th
e
p
a
ti
e
nt th
a
t th
e
woun
d
on th
e
p
e
t
a
ls n
eed
s to un
de
rgo
S
urg
e
ry
(
c
los
e
woun
d
s
)
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 if
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
W
ith
a dec
r
ea
s
e
in vision
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
A
ft
e
r initi
a
l m
a
n
a
g
e
m
e
nt
,
th
e
p
a
ti
e
nt w
a
s imm
ed
i
a
t
e
ly r
e
f
e
rr
ed
to th
e d
o
c
tor
e
y
e
s
.
H
if
e
m
a
Hea
lth pro
b
l
e
ms
H
if
e
m
a
is th
e e
xist
e
n
ce
of
b
loo
d acc
umul
a
tion on th
e
front
e
y
e c
u
b
i
c
l
e
.
H
if
e
m
a
ca
n o
cc
ur
d
u
e
to tr
a
um
a
or spont
a
n
e
ously o
cc
urs
.
H
if
e
m
a ca
n
be acc
omp
a
ni
ed b
y
c
orn
ea
l
ab
r
a
sion
,
iritis
,
mi
d
ri
a
sis
,
or oth
e
r stru
c
tur
a
l int
e
rf
e
r
e
n
ce
in th
e e
y
e d
u
e
tr
a
um
a ca
us
e
it
.
S
pont
a
n
e
ous hif
e
m
a
is r
a
r
e
ly foun
d
.
S
pont
a
n
e
ous hif
e
m
a ca
n
Bec
om
e a
m
a
rk
e
r th
e
r
e
is iri
d
is ru
be
osis
,
c
o
a
gul
a
tion
d
isor
de
r
,
d
is
ea
s
e
He
rp
e
s
,
a
pro
b
l
e
m with intr
a
o
c
ul
a
r l
e
ns
e
s
(
IOL
),
r
e
tino
b
l
a
stom
a
,
a
n
d
l
e
uk
e
mi
a
.
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
E
y
e
p
a
in
2
.
D
istur
bed
vision
(
if
b
loo
d c
ov
e
rs visu
a
l
a
xis
)
3
.
P
hotofo
b
i
a
/
gl
a
r
e
R
isk f
ac
tor
1
.
H
if
e
m
a d
u
e
to tr
a
um
a
is oft
e
n
e
n
c
ount
e
r
ed
in young m
e
n
2
.
S
pont
a
n
e
ous hif
e
m
a
is
ca
us
ed b
y sli
ced
n
e
ov
a
s
c
ul
a
riz
a
tion
(
a
s in p
a
ti
e
nts
D
i
abe
t
e
s
a
n
d Re
tin
a Ve
in
Occ
lusion
),
C
o
a
gulop
a
thy
,
a
n
d U
s
e
of
A
nti
c
o
a
gul
a
nts
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
.
V
isius g
e
n
e
r
a
lly f
a
lls
2
.
B
loo
d
looks in th
e
front
e
y
e c
u
b
i
c
l
e
.
B
loo
d ca
n
be acc
ommo
da
t
ed
in th
e
s
ec
tion
inf
e
rior front
e
y
e c
u
b
i
c
l
e
s or
ca
n m
ee
t
a
ll front
e
y
e c
u
be
s
(
full hif
e
m
a
).
3
.
N
oti
ce
wh
e
th
e
r th
e
r
e
is tr
a
um
a
on th
e
oth
e
r p
a
rt of th
e e
y
e
S
upport
I
ntr
a
o
c
ul
a
r pr
e
ssur
e c
h
ec
k with
Sc
hiotz
T
onom
e
t
e
r
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
ced b
y
A
n
a
mn
e
sis
a
n
d P
hysi
ca
l
E
x
a
min
a
tion
1
.
A
n
a
mn
e
sis to i
de
ntify symptoms
,
tr
a
um
a
history
,
a
s w
e
ll
a
s
possi
b
l
e
oth
e
r risk f
ac
tors
.
2
.
S
h
a
rp
e
x
a
min
a
tion of vision
3
.
E
y
e e
x
a
min
a
tion with
a
fl
a
shlight
a
n
d LUP
to s
ee b
loo
d
on
e
y
e
l
e
ts
,
a
ss
e
ss pupil wi
d
th
,
a
n
d
i
de
ntify
c
orn
ea
l
d
isor
de
rs or
O
th
e
r stru
c
tur
e
s
d
u
e
to tr
a
um
a
.
4
.
E
x
a
min
a
tion of intr
a
o
c
ul
a
r pr
e
ssur
e
with
T
onom
e
t
e
r
Sc
hiotz if not
th
e
r
e
is
a DEFEG
on th
e c
orn
ea
D
i
a
gnosis of
A
pp
ea
l
T
h
e
r
e
is no
C
ompli
ca
tions
P
rognosis is g
e
n
e
r
a
lly goo
d a
t hif
e
m
a
without
c
ompli
ca
tions
.
HIFEMA c
ompli
ca
tions in
c
lu
de
:
1
.
Re
-
b
l
eed
ing
(
r
eb
l
ed
ing
),
g
e
n
e
r
a
lly o
cc
urs
be
tw
ee
n
2
-
5
da
ys
a
ft
e
r
tr
a
um
a
2
.
Sec
on
da
ry gl
a
u
c
om
a
3
.
O
pti
ca
l n
e
rv
e a
trophy
4
.
C
ornn
ea
l
B
loo
d S
t
a
ining
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
.
Re
stri
c
tions on physi
ca
l
ac
tivity
2
.
E
y
e
prot
ec
tion
(
P
rot
ec
tiv
e S
hi
e
l
d
)
3
.
A
n
a
lg
e
si
c
s th
a
t
d
o not
c
ont
a
in
NSAID
s
(
non
-
st
e
roi
da
l
a
nti
I
nfl
a
mm
a
tory
d
rug
)
4
.
Re
f
e
r imm
ed
i
a
t
e
ly to
a
n ophth
a
lmologist in
a
l
e
v
e
l h
ea
lth s
e
rvi
ce
s
ec
on
da
ry or t
e
rti
a
ry
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
N
otifying p
a
ti
e
nts th
a
t th
e
possi
b
ility of p
a
ti
e
nts n
eed
to
be
tr
ea
t
ed a
n
d
bed
r
e
st
2
.
S
l
ee
p position with h
ead e
l
e
v
a
tion
Re
f
e
r
e
n
ce c
rit
e
ri
a
A
ll p
a
ti
e
nts
d
i
a
gnos
ed
with hif
e
m
a
n
eed
to
be
r
e
f
e
rr
ed
to
a d
o
c
tor
e
y
e
sp
ec
i
a
list
D
i
abe
ti
c
r
e
tinop
a
thy
Hea
lth pro
b
l
e
ms
D
i
abe
ti
c
r
e
tinop
a
thy is
a
mi
c
ro
a
ngiop
a
thy
ab
out
P
r
e
k
a
pil
e
r
Re
tin
a
,
ca
pill
a
ri
e
s
a
n
d
v
e
nul
e
s
,
ca
using mi
c
rov
a
s
c
ul
a
r o
cc
lusion
a
n
d
Va
s
c
ul
a
r l
ea
k
a
g
e
,
d
u
e
to high
a
n
d
ol
d b
loo
d
sug
a
r l
e
v
e
ls
.
Re
tinop
a
thy
d
i
abe
ti
c ca
n
ca
us
e a dec
r
ea
s
e
in vision
a
n
d b
lin
d
n
e
ss
,
e
sp
ec
i
a
lly th
e
r
e
sult
C
ompli
ca
tions su
c
h
a
s
E
kul
a Ede
m
a
,
V
itr
e
us
B
l
eed
ing
,
T
r
ac
tion
a
l
Re
tin
a Ab
l
a
sio
a
n
d
n
e
ov
a
s
c
ul
a
r gl
a
u
c
om
a
.
D
i
abe
ti
c
r
e
tinop
a
thy is th
e
l
a
rg
e
st
5
-
glo
ba
lly
ca
us
e
s of
b
lin
d
n
e
ss
(
WHO
,
2007
).
A
t l
ea
st th
e
r
e a
r
e
171
million worl
d
r
e
si
de
nts
bea
r
d
i
abe
t
e
s m
e
llitus
,
whi
c
h will in
c
r
ea
s
e
to
d
ou
b
l
e
I
n
2030
it
beca
m
e
366
million
.
A
ft
e
r
15
y
ea
rs
,
a
roun
d
2
%
d
i
abe
t
e
s
ca
n
be b
lin
d
,
a
n
d ab
out
10
%
e
xp
e
ri
e
n
ce
Hea
vy vision
d
isor
de
rs
.
A
ft
e
r
20
y
ea
rs
,
d
i
abe
ti
c
r
e
tinop
a
thy
ca
n
foun
d a
t
75
%
mor
e d
i
abe
t
e
s
.
T
h
e
r
e a
r
e
two st
a
g
e
s of
d
i
abe
ti
c
r
e
tinop
a
thy
,
n
a
m
e
ly non
-
prolif
e
r
a
tiv
e d
i
abe
ti
c
Re
tinop
a
thy
(
NPDR
)
a
n
d
prolif
e
r
a
tiv
e d
i
abe
ti
c
r
e
tinop
a
thy
(
PDR
).
A
n
a
mn
e
sis
(
su
b
j
ec
tiv
e
)
r
e
sults
A c
ompl
a
int
1
.
T
h
e
r
e a
r
e
no
c
ompl
a
ints of vision
2
.
F
rost
ed
vision o
cc
urs
e
sp
ec
i
a
lly if th
e
r
e
is m
ac
ul
a
r
ede
m
a
3
.
F
lo
a
t
e
rs or su
dde
n visions
a
r
e b
lo
c
k
ed b
y
c
ompli
ca
tions
V
itr
e
us
b
l
eed
ing
a
n
d
/
or tr
ac
tion
a
l r
e
tin
a
l
ab
l
a
tiono
R
isk f
ac
tor
1
.
B
loo
d
glu
c
os
e
l
e
v
e
ls th
a
t
a
r
e
not w
e
ll
c
ontroll
ed
2
.
H
yp
e
rt
e
nsion th
a
t is not w
e
ll
c
ontroll
ed
3
.
H
yp
e
rlipi
de
mi
a
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
.
D
i
abe
t
e
s
Me
llitus
H
istory
(
T
yp
e I
/
T
yp
e II
).
2
.
Ca
lmy
e
y
e
s with or without
a dec
r
ea
s
e
in visu
a
l visits
.
3
.
O
n
a
pupil fun
d
us
c
opi
c e
x
a
min
a
tion wi
de
on th
e
r
e
tin
a ca
n
be
foun
d
Re
tin
a
l
b
l
eed
ing
,
h
a
r
d e
xu
da
t
,
wi
de
ning v
e
ins
,
a
n
d
mi
c
ro
a
n
e
urism
(
on
NPDR
),
whi
c
h in furth
e
r
c
on
d
itions is
acc
omp
a
ni
ed b
y n
e
ov
a
s
c
ul
a
riz
a
tion
a
t
O
pti
ca
l
d
is
c
or
e
ls
e
wh
e
r
e
in th
e
r
e
tin
a
(
on th
e PDR
).
4
.
I
n
a
h
ea
vy st
a
t
e ca
n
be
foun
d Ne
ov
a
s
c
ul
a
riz
a
tion iris
(
ru
be
osis iri
d
is
).
5
.
L
ight r
e
fl
e
x
e
s in norm
a
l pupils
,
in
b
ro
ad
r
e
tin
a
l
da
m
a
g
e ca
n
F
oun
d RAPD
(
Re
l
a
tiv
e A
f
e
r
e
nt
P
upil
a
ry
De
f
ec
t
),
a
s w
e
ll
a
s
a dec
r
ea
s
e
P
upil r
e
fl
e
x
e
s in
d
ir
ec
t
a
n
d
in
d
ir
ec
t light norm
a
l
.
S
upport
T
h
e
r
e
is no
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
,
e
sp
ec
i
a
lly
fun
d
uskopi
.
D
i
a
gnosis of
A
pp
ea
l
1
.
Re
tin
a
v
e
in o
cc
lusion
2
.
Re
tinop
a
thy hyp
e
rt
e
nsion
C
ompli
ca
tions
1
.
V
itr
e
us h
e
morrh
a
g
e
2
.
D
i
abe
ti
c
m
ac
ul
a
r
ede
m
a
3
.
T
r
ac
tion
a
l
Re
tin
a Ab
l
a
sio
4
.
Ne
ov
a
s
c
ul
a
r gl
a
u
c
om
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
.
E
v
e
ry p
a
ti
e
nt
d
i
a
gnos
ed
with
d
i
abe
t
e
s m
e
llitus n
eed
s to
be d
on
e
imm
ed
i
a
t
e
ly
E
y
e e
x
a
min
a
tion
,
e
v
e
n if th
e
r
e a
r
e
no
e
y
e c
ompl
a
ints
.
2
.
I
f th
e
r
e
is no sign of r
e
tinop
a
thy
,
th
e
p
a
ti
e
nt must
be e
x
a
min
ed
Re
p
ea
t within
1
y
ea
r
(
follow
-
up
).
3
.
W
h
e
n o
b
t
a
in
ed a
sign of r
e
tinop
a
thy
,
th
e
p
a
ti
e
nt n
eed
s to
be
r
e
f
e
rr
ed
to th
e
d
o
c
tor
E
y
e
sp
ec
i
a
list
.
C
ouns
e
ling
a
n
d ed
u
ca
tion
1
.
B
loo
d
sug
a
r
c
ontrol
a
n
d
oth
e
r syst
e
mi
c
f
ac
tor
c
ontrol
(
hyp
e
rt
e
nsion
,
hyp
e
rlipi
de
mi
a
)
is import
a
nt to slow
d
own or progr
e
ssion
d
i
abe
ti
c
r
e
tinop
a
thy
.
2
.
E
v
e
ry
d
i
abe
t
e
s p
a
ti
e
nt n
eed
s to un
de
rgo
a
n initi
a
l
e
y
e e
x
a
min
a
tion
(
s
c
r
ee
ning
),
follow
ed b
y
a
furth
e
r
e
x
a
min
a
tion of
a
t l
ea
st
1
tim
e a
y
ea
r
.
3
.
E
xpl
a
in th
a
t wh
e
n r
e
f
e
rr
ed
,
it is lik
e
ly th
a
t it r
e
quir
e
s th
e
r
a
py
La
s
e
r photo
c
o
a
gul
a
tion
,
whi
c
h
a
ims to pr
e
v
e
nt r
e
tinop
a
thy progr
e
ssion
d
i
abe
ti
c
.
I
n s
e
v
e
r
e c
on
d
itions
(
vitr
e
ous
b
l
eed
ing
,
r
e
tin
a
l
ab
l
a
tion
)
I
t is possi
b
l
e
to n
eed
surgi
ca
l
ac
tion
.
Re
f
e
r
e
n
ce c
rit
e
ri
a
E
v
e
ry
d
i
abe
t
e
s p
a
ti
e
nt foun
d
signs of
d
i
abe
ti
c
r
e
tinop
a
thy
I
t
'
s
be
st to r
e
f
e
r to
a
n ophth
a
lmologist
.
