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General lnternal Medicine Primary Open-Angle Glaucoma Primary open-angle glaucoma is characterized by decreased aqueous flow with a normal iridocorneal angle. peripheral visual field loss is the earliest symptom, but it frequently goes unreported, and progression to central vision loss occurs in untreated patients. Treatment focuses on decreasing intraocular pressure with surgery or medications. Cataracts Cataracts frequently cause glare sensitivity and vision impairment, particularly at night. Examination reveals lens opacification along with diminished or absent red reflex. Treatment for vision-impairing cataracts includes phacoemulsilication with intra- operative lens replacement. Dry Eye Dry eye (keratoconjunctivitis sicca) results from abnormal eye lubrication. Symptoms are usually bilateral and include ocular pain, foreign body sensation, light sensitivity, tearing, and irritation/redness. Treatment includes arlificial tears and, occasion- ally, punctal occlusion/plugs. Consider Sjdgren syndrome. Corneal Abrasions Corneal abrasions are superficial epithelial defects that result from mechanical trauma, loreign bodies, and contact lens use. Symptoms include severe eye pain, foreign-body sensation, light sensitivity, and tearing. Fluorescein should be performed in all patients along with visual acuity assessment; provide immediate ophthalmologz referral for vision loss. In contact lens wearers, topical antibiotics should be given. Eye patches are generally avoided. Hearing Loss Diagnosis Appropriate initial tests for hearing loss include the whispered voice test or single question screening (e.9., "Do you have dif ficulty with your hearing?"). The Weber and Rinne tests help distinguish conductive from sensorineural hearing loss.

Corneal Abrasions Corneal abrasions are superficial epithelial defects that result from mechanical trauma, loreign bodies, and contact lens use. Symptoms include severe eye pain, foreign-body sensation, light sensitivity, and tearing. Fluorescein should be performed in all patients along with visual acuity assessment; provide immediate ophthalmologz referral for vision loss. In contact lens wearers, topical antibiotics should be given. Eye patches are generally avoided. Hearing Loss Diagnosis Appropriate initial tests for hearing loss include the whispered voice test or single question screening (e.9., "Do you have dif ficulty with your hearing?"). The Weber and Rinne tests help distinguish conductive from sensorineural hearing loss. STUDY TABLE: Conductive and Sensorineural Hearing Loss Condition Weber Test' Result Rinne Testb Result Differential Diagnoses Conductive hearing loss Louder in the affected ear Decreased in the affected ear Cerumen impaction, foreign (bone conduction > air body, otitis media, otosclerosis, conduction) perforated tympanic membrane Sensorineural hearing loss Louder in the good ear As loud or louder in the Presbycusis, Meniere disease, affected ear (air conduction > acoustic neuroma, sudden bone conduction) sensorineural hearing loss 'Tuning fork to forehead. bTuning fork to mastoid then in front of ear. In patients with a conductive hearing loss, a nonmobile gzmpanic membrane may indicate fluid or a mass in the middle ear or retraction from negative middle ear pressure. Sudden sensorineural hearing loss occurs acutely, usually within 72 hours of onset, and is unilateral in 90o1, of cases. It has many causes, including viral, vascular, autoimmune, and, most commonly, idiopathic.

In patients with a conductive hearing loss, a nonmobile gzmpanic membrane may indicate fluid or a mass in the middle ear or retraction from negative middle ear pressure. Sudden sensorineural hearing loss occurs acutely, usually within 72 hours of onset, and is unilateral in 90o1, of cases. It has many causes, including viral, vascular, autoimmune, and, most commonly, idiopathic. Testing Select audiography for all patients with unexplained hearing loss. For patients with progressive asymmetric sensorineural hear ing loss, select MRI or CT to evaluate for acoustic neuroma. 164