SYMPTOMS—It is characterized by a severe throbbing pain that radiates to the forehead and temple,   lacrimation,   photophobia,   blurring   of vision,  redness,  and  enlarged  blood  vessels  around the  cornea. TREATMENT—General  measures  consist  of bed  rest  with  subdued  light,  local  corticosteroid therapy,   and   warm   compresses.   Transfer   the patient  as  soon  as  possible  to  an  ophthalmologist. Retinal Detachment There  is  usually  partial  or  complete  separation of  the  retina  from  its  pigment  layer. SYMPTOMS—The patient may notice flashes of  light  or  stars,  followed  by  sensation  of  a curtain  moving  over  the  eyes. TREATMENT—Immobilize in bed and instill mydriatics  to  dilate  the  pupils.  Evacuate  the patient  as  soon  as  possible  to  an  ophthalmolog- i s t . Floaters A  sensation  (accentuated  in  bright  light)  of seeing spots is a common complaint in myopic and elderly patients. SYMPTOMS—The  spots  are  normally  seen when  looking  at  the  sky  and  cannot  be  focused upon.  Brown  or  red  spots  that  are  reasonably stable  often  indicate  minute  hemorrhage.  A  large, slow   moving   spot   is   normally   an   intraocular foreign   body. TREATMENT—Refer  for  routine  eye  exami- nation. DERMATOLOGICAL   CONDITIONS Contact Dermatitis This   is   an   acute   or   chronic   inflammation produced by substances coming into contact with the   skin.   Some   of   the   more   common   skin sensitizing  agents  are  poison  ivy,  poison  oak, fruits, vegetables, chemicals, therapeutic agents, cosmetics,  fabrics,  and  detergents. SYMPTOMS—The   most   common   sites   are the face, neck, hands, feet, eyelids, and genitals, The  scalp  is  not  usually  affected;  however,  any area  of  the  body  may  be  affected.  In  many instances, the site of the dermatosis is a clue as to   the   agent   involved.   The   patient’s   major complaints  will  normally  be  itching,  scaling,  rash, and  pain. TREATMENT—No  treatment  can  be  effec- tive until the causative agent is determined and eliminated.  In  acute  stages,  bland  compresses  and a drying corticosteroid loction may be indicated. If  the  dermatitis  is  extremely  uncomfortable  or disabling,  a  short  course  of  systemic  corticosteroid therapy  may  be  effective.  Antihistamines  are  of little or no value in contact dermatitis. If crusting and  scaling  occur,  substitute  bland  greases  and creams  for  compresses  and  drying  agents. Atopic Dermatitis Atopic  dermatitis  is  a  chronic,  itching, superficial  inflammation  of  the  skin,  normally associated   with   a   family   history   of   allergic disorders. Usually no single causative agent can be  located.  Patients  with  atopic  dermatitis  tend to  be  tense  and  restless;  however,  the  relationship between  the  dermatitis  and  the  psychic  state  is unknown. SYMPTOMS—The   skin   is   dry   and   the primary  complaint  is  itching.  There  are  seldom any vesicles, although scratching and rubbing may produce  excoriation.  The  face,  neck,  antecubital and popliteal spaces, hands, and wrist areas are most  often  involved.  Scratching  by  the  patient may  produce  a  secondary  infection  with  oozing and  crusting.  Many  times  the  condition  is persistent  and  tends  to  be  localized  in  one  specific area. TREATMENT—Topical  corticosteroids  are the most effective agents and should be applied in  small  amounts  and  rubbed  in  thoroughly.  If the  episode  is  severe,  oral  corticosteroids  are indicated  for  a  short  period.  Advise  the  patient to  keep  the  skin  as  free  as  possible  from perspiration  and  to  avoid  scratching.  The  skin should  be  kept  moist  by  using  oils  or  lotions. Antihistamines  often  prove  very  effective  in relieving  itching.  Advise  the  patient  to  avoid  wool clothing  or  100  percent  synthetic  fibers. Psoriasis This  is  an  acute  or  chronic  papulosquamous skin  disease  of  unknown  etiology.  In  approxi- mately   one   third   of   all   cases,   the   cause   is 2-23