Eagleview Eye Clinic

Tag Eyecare

MIRROR TEST

The mirror test đŸȘž is a sneaky way to check if someone’s faking vision loss in one eye (malingering).

How it works

  1. Patient claims blindness in one eye.
  2. Place a mirror in front of them, angled to show their “blind” eye.
  3. Ask them to look straight ahead.
  4. Check if they react to their own reflection (e.g., blink, move, etc.).

What it shows

  • If they react to their reflection, it suggests the “blind” eye can see.
  • If they don’t react, could be malingering
 or really blind 😅.

Tips

  • Casual setup: Make it seem like a normal exam step.
  • Distract them: Talk about something else while doing the test.
  • Combine with other tests for stronger evidence.

FOGGING TEST

The fogging test 👀 is a clever way to uncover malingering (faking vision loss in one eye).

How it works

  1. Patient wears trial frame with +5.00 D lens over the “good” eye (blurs vision).
  2. Read the chart with “bad” eye (you’re checking if they can see better than claimed).
  3. If they suddenly read smaller lines, they’re likely malingering (using the “bad” eye all along).

Sneaky part

  • They think the “good” eye is being tested (because it’s fogged).
  • If they see better with the “bad” eye, it proves vision is actually better than claimed.

Tips

  • Don’t tip them off → act like you’re testing the “good” eye.
  • Quick switch lenses if needed to confirm findings.
  • Combine with other tests (e.g., stereoacuity) for stronger evidence.

Example

  • “Test” right eye (fogged with +5 D). Patient reads 20/20 with left eye → suggests left eye is actually seeing fine (malingering?).

Limitations

  • Not foolproof → some patients catch on.
  • Cooperation needed → won’t work if they refuse to read.

RED GLASS TEST

The red glass test 👀 is a simple way to check for diplopia (double vision) and figure out if it’s caused by a muscle weakness (like a cranial nerve palsy).

How it works

  1. Patient wears red glass over one eye (usually right eye → red lens OD).
  2. Look at a point light source (e.g., penlight) in front.
  3. Ask: “How many lights do you see? What color(s)?”

What it shows

  • Normal: Sees one pink light (colors blend).
  • Diplopia: Sees one red + one white light.
    • Horizontal separation → lateral/medial rectus issue (CN VI or CN III).
    • Vertical/oblique separation → other muscles (e.g., superior oblique CN IV, superior/inferior rectus CN III).
  • Image location → helps localize the weak muscle (e.g., red image on right → right lateral rectus weakness).

Example

  • Patient sees red light on right + white on left → right lateral rectus palsy (CN VI).
  • Image is tilted/diagonal → likely a cyclovertical muscle issue.

Tips

  • Control fixation: Make sure they’re looking straight at the light.
  • Check gaze positions: Repeat in different directions → helps map out weakness.
  • Cover-uncover test can help confirm tropia/phoria.

Limitations

  • Subjective: Relies on patient description.
  • Doesn’t pinpoint cause → need extra tests (e.g., cover test, motility).

CONTACT LENS APPLICATOR

A contact lens applicator 😎 is a handy tool that helps you put in (and sometimes take out) contact lenses, especially if you’re a newbie or have dexterity issues. Types include:

  • Sucker/plucker: A small tool with a suction cup that grips the lens.
  • Finger-tip applicator: A guide that fits on your finger to help position the lens.

They’re super useful if:

  • You’re struggling to handle tiny lenses
  • You have arthritis or finger issues
  • You’re helping someone else with lenses (like kids)
AMETROPIA

Ametropia = any refractive error where the eye can’t focus light directly on the retina without help.

Main types

  1. Myopia (nearsightedness)
    • Eye is too long or cornea too curved → light focuses in front of retina.
    • Close objects are clear, distant ones are blurry.
  2. Hyperopia (farsightedness)
    • Eye is too short or cornea too flat → light focuses behind retina.
    • Near vision is harder; distance vision can be okay (but may be strained).
  3. Astigmatism
    • Cornea (or lens) is irregularly shaped (more curved in one direction) → light focuses on multiple points.
    • Vision is blurry at all distances, often with a “stretched” look.
  4. Presbyopia
    • Age-related loss of lens flexibility (usually after 40).
    • Near focus gets tough, even if distance vision is fine.

How it’s measured

  • Spherical equivalent (SE): Combines sphere (myopia/hyperopia) + half of cylinder (astigmatism) to give one number.
  • Diopter (D): Unit of lens power. Negative D = myopia, positive D = hyperopia.

Causes & risk factors

  • Genetics: Family history strongly influences myopia/hyperopia risk.
  • Environment: Too much near work (reading, screens) + little outdoor time → higher myopia risk.
  • Age: Lens stiffens → presbyopia.
  • Eye injuries or surgeries can induce irregular astigmatism.

Correction options

  • Glasses: Simple, non-invasive.
  • Contact lenses: Directly on eye; options like toric for astigmatism, multifocal for presbyopia.
  • Refractive surgery: LASIK, PRK, SMILE (laser reshapes cornea). Lenses or implants for high prescriptions.
  • Orthokeratology (ortho-k): Wear special rigid lenses overnight to temporarily reshape cornea (often for myopia control).

Management (especially for myopia control)

  • Outdoor time: 2+ hours daily linked to slower myopia progression in kids.
  • Low-dose atropine drops: Can slow myopia worsening.
  • Multifocal/Defocus lenses: Some contact lenses or glasses designed to reduce progression.
SUB HYALOID RETINAL HAEMORRHAGE

Subhyaloid retinal hemorrhage = bleeding that sits between the retina and the vitreous gel (just beneath the thin “hyaloid” layer on top of the retina).

What it looks like

  • On fundoscopy it appears as a well‑defined, boat‑shaped or dome‑shaped red‑purple patch behind the retina.
  • The blood is usually bright red because it’s relatively fresh and sits in a pocket that doesn’t mix with the vitreous.

Common causes
Clinical clues

  • Symptoms: Sudden blurred vision, a dark “spot” or “shadow” in the visual field, sometimes a scotoma. If the bleed is large, it can cause a vitreous hemorrhage and markedly reduced vision.
  • Location: Usually posterior pole (macula‑adjacent), but can occur anywhere the retina meets the vitreous.

Management approach

  1. Identify & treat the cause – control hypertension, manage diabetes, stop/reverse anticoagulation if possible.
  2. Observe – many small subhyaloid bleeds reabsorb on their own within weeks to months.
  3. Laser or cryotherapy – may be needed if there’s an underlying retinal tear or neovascularization.
  4. Vitrectomy – indicated for large, non‑clearing hemorrhages (especially if vision is < 20/200 or there’s traction on the retina).
  5. Follow‑up – regular fundus exams to monitor resolution and check for complications (e.g., macular scar, retinal detachment).

Prognosis

  • Small bleeds → usually good visual recovery once they clear.
  • Large or recurrent bleeds → risk of permanent macular damage, especially if the hemorrhage dissects into the vitreous or causes traction.
    Bottom line: Subhyaloid retinal hemorrhage is a bleed trapped between the retina and vitreous, often caused by vascular stress, trauma, or systemic disease. Management hinges on treating the underlying cause and deciding whether observation, laser, or vitrectomy is needed based on size and visual impact.

MASKING CONTACT LENSES

Masking contact lenses (also called cosmetic or tinted lenses) are colored contacts used to change eye color or cover defects like corneal scars or irregularities.

Types:

  • Enhancement tints: Slight color to enhance natural eye color.
  • Opaque tints: Fully change eye color or cover abnormalities.
  • Prosthetic lenses: Specialized lenses for eyes with damage or disfigurement (e.g., after injury or to mask a scarred cornea).

Uses:

  • Cosmetic: Just to change how your eyes look.
  • Therapeutic: To help with light sensitivity (photophobia) or mask corneal scars.
  • Prosthetic: For eyes with irregularities to improve appearance.

They’re available with or without vision correction. Safety depends on proper fitting and hygiene — always get them from an eye care professional.

BANDAGE CONTACT LENSES

Bandage contact lenses are special soft lenses placed on the eye like a protective patch. They’re used after corneal injuries, surgeries, or infections to:

  • Promote healing: By covering the cornea, they protect it from blinking and eyelid friction.
  • Reduce pain: The lens acts as a barrier, decreasing discomfort.
  • Keep the eye moist: They help maintain a stable tear film over the cornea.

How they work:

  • Fit like a regular contact lens but are larger and more comfortable.
  • Made of high-oxygen-permeable materials so the cornea can still breathe.
  • Often used after procedures like corneal debridement, PRK, or for conditions like bullous keratopathy.

They’re usually prescribed by an eye doctor and worn for days to weeks depending on the condition.

CORNEA DEBRIDING

Corneal debridement is the careful removal of damaged, diseased, or infected tissue from the cornea. It’s a common procedure in eye care, especially for infections like fungal keratitis.

Why it’s done:

  • Improves drug penetration: Meds can reach deeper layers better.
  • Diagnostic: Tissue can be tested to identify the pathogen.
  • Therapeutic: Removes infected tissue to stop spread.

How it’s done:

  1. Numbing: Anesthetic eye drops are used to prevent pain.
  2. Sterile instruments: A spatula, blade, or cotton swab is used to gently scrape the cornea.
  3. Microscope guidance: Often done under a slit-lamp or operating microscope.
  4. Cleaning: After scraping, the area may be irrigated.
  5. Medication: Antifungal, antibacterial, or antiviral drops are applied afterward.

It’s usually quick (minutes) and done in a clinic or minor operating room.

FUNGAL KERATITIS

Fungal keratitis = infection of the cornea (the clear front part of the eye) caused by fungi. It’s less common than bacterial keratitis but can be more sneaky and harder to treat.

How it happens 🍄

  • Trauma with organic matter (tree branch, soil, plant material)
  • Contact lenses (especially if you wear them overnight or in dirty conditions)
  • Immunosuppression or chronic eye disease
  • Contaminated eye drops or solutions

Common culprits

  • Filamentous fungi: Fusarium, Aspergillus
  • Yeasts: Candida

Symptoms (often slower onset than bacterial)

  • Eye pain (can be severe)
  • Redness
  • Blurred or hazy vision
  • Sensitivity to light (photophobia)
  • Tearing or watery discharge
  • White, gray, or feathery corneal infiltrate (spot)

Diagnosis

  • Slit-lamp exam: Looks for typical fungal plaque or ulcer
  • Corneal scraping: Microscopy and culture to ID the fungus
  • Sometimes PCR testing for faster results

Treatment goals

  1. Kill the fungus
  2. Control inflammation
  3. Prevent complications (like scarring or perforation)

Treatment options

  • Topical antifungals: Natamycin 5% (gold standard for filamentous), Amphotericin B, Voriconazole drops
  • Oral antifungals: Voriconazole or Itraconazole for severe/deep cases
  • Debridement: Scrape infected tissue to improve drug penetration
  • Steroids: Controversial; used cautiously to control inflammation after fungal load is down

Complications if untreated

  • Corneal scarring → vision loss
  • Corneal perforation (hole in cornea)
  • Endophthalmitis (infection spreads inside the eye)

Prevention tips

  • Protect eyes in dusty/agricultural settings (goggles)
  • Proper contact lens hygiene (clean, replace solutions, no overnight wear unless approved)
  • Avoid rubbing eyes after injury; seek care ASAP