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  <head>
    <title>055-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="The eye: foundations">
      <outline text="Orientation">
        <outline text="Vision needs optics, retina, pathways, movement, cortex"/>
        <outline text="Symptoms reveal local, neurological, systemic disease"/>
        <outline text="Immediate action">
          <outline text="Sudden loss or painful red eye with poor vision"/>
          <outline text="Chemical injury and penetrating trauma"/>
          <outline text="Angle closure, occlusion, endophthalmitis, arteritis"/>
        </outline>
      </outline>
      <outline text="Optics and retinal signalling">
        <outline text="Cornea gives most power, lens fine-tunes">
          <outline text="Ciliary contraction lets the lens thicken for near"/>
        </outline>
        <outline text="Refractive errors">
          <outline text="Myopia focuses in front of retina, hyperopia behind"/>
          <outline text="Refraction cannot restore retinal or neural loss"/>
        </outline>
        <outline text="Rods for dim light, cones for colour and acuity"/>
        <outline text="Light hyperpolarises photoreceptors">
          <outline text="Alters glutamate release to bipolar networks"/>
        </outline>
        <outline text="Nasal fibres cross, giving characteristic field defects"/>
        <outline text="Pupil reflex tests afferent and parasympathetic paths">
          <outline text="Relative afferent defect: asymmetric retina or nerve"/>
        </outline>
        <outline text="Aqueous outflow resistance sets pressure"/>
      </outline>
      <outline text="History">
        <outline text="Monocular or binocular, onset, progression"/>
        <outline text="Flashes, floaters, curtains, halos, colour loss"/>
        <outline text="Diplopia with either eye covered">
          <outline text="Monocular usually optical"/>
          <outline text="Binocular reflects misalignment"/>
        </outline>
        <outline text="Drug history">
          <outline text="Steroids: cataract, glaucoma, infection"/>
          <outline text="Anticholinergic dilation may cause angle closure"/>
        </outline>
      </outline>
      <outline text="Examination">
        <outline text="Acuity in each eye first, habitual correction">
          <outline text="Pinhole improvement suggests refractive blur"/>
        </outline>
        <outline text="Fluorescein reveals epithelial defects"/>
        <outline text="Pupils, fields, movements, cover test"/>
        <outline text="Fundoscopy: red reflex, disc, vessels, macula">
          <outline text="Dilation aids view, not specialist review"/>
        </outline>
        <outline text="Suspected open globe">
          <outline text="Avoid pressure, shield rather than patch"/>
          <outline text="No tonometry, cautious ultrasound"/>
        </outline>
      </outline>
      <outline text="Red eye">
        <outline text="Conjunctivitis: discharge, vision preserved"/>
        <outline text="Corneal ulcer: pain, opacity, fluorescein uptake">
          <outline text="Urgent cultures and antimicrobials"/>
        </outline>
        <outline text="Anterior uveitis: ciliary injection, chamber cells">
          <outline text="Steroid drops can worsen herpetic keratitis"/>
        </outline>
        <outline text="Scleritis deep pain, episcleritis self-limited"/>
        <outline text="Angle closure: pain, halos, mid-dilated pupil">
          <outline text="Rapid pressure lowering protects the nerve"/>
        </outline>
        <outline text="Chemical injury: irrigate before history">
          <outline text="Alkali penetrates deeply"/>
        </outline>
      </outline>
      <outline text="Sudden visual loss">
        <outline text="Arterial occlusion: painless retinal ischaemia">
          <outline text="Assess arteritis, emboli, stroke risk"/>
        </outline>
        <outline text="Venous occlusion: haemorrhage and oedema"/>
        <outline text="Detachment: flashes, floaters, curtain">
          <outline text="Vitreous separation may tear retina"/>
          <outline text="Macula-on detachment is time-sensitive"/>
        </outline>
        <outline text="Optic neuritis: subacute, painful, colour loss"/>
        <outline text="Ischaemic optic neuropathy: sudden, disc swelling"/>
        <outline text="Giant-cell arteritis in older patients">
          <outline text="Immediate steroids protect the other eye"/>
        </outline>
        <outline text="Occipital injury: homonymous loss, pupils spared"/>
        <outline text="Never dismiss new loss as migraine"/>
      </outline>
      <outline text="Glaucoma">
        <outline text="Progressive optic neuropathy, not always high pressure"/>
        <outline text="Open-angle loss painless and peripheral"/>
        <outline text="Risks: age, family, pressure, thin cornea"/>
        <outline text="Treatment lowers pressure">
          <outline text="Prostaglandin analogues increase outflow"/>
          <outline text="Beta blockers cut production, worsen asthma"/>
          <outline text="Adherence and drop technique matter"/>
        </outline>
        <outline text="Angle closure needs anatomical management"/>
      </outline>
      <outline text="Cataract, macula, and diabetes">
        <outline text="Cataract: painless blur, glare, poor contrast"/>
        <outline text="Macular degeneration damages central vision">
          <outline text="Geographic atrophy: gradual loss"/>
          <outline text="Neovascularisation: distortion, rapid loss">
            <outline text="Anti-vascular endothelial growth factor injections"/>
          </outline>
        </outline>
        <outline text="Diabetic retinopathy: leakage to new vessels">
          <outline text="Macular oedema threatens vision at any stage"/>
          <outline text="Rapid glucose improvement can transiently worsen it"/>
        </outline>
      </outline>
      <outline text="Paediatric and neuro-ophthalmic principles">
        <outline text="Amblyopia: sensitive period, less reversible with age"/>
        <outline text="Leukocoria, strabismus, poor fixing need urgency">
          <outline text="Retinoblastoma causes leukocoria"/>
        </outline>
        <outline text="Diplopia: nerve palsy, junction, thyroid, orbit"/>
        <outline text="Painful ophthalmoplegia, proptosis, fever">
          <outline text="Orbital cellulitis, cavernous sinus, aneurysm"/>
        </outline>
        <outline text="Papilloedema: raised intracranial pressure"/>
      </outline>
    </outline>
  </body>
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