2opth Flashcards
periorbital and orbital cellulitis mx
PO coamox - periorbital cellulitis
CT, IV ceftriazone + metronidazole if sinus infection (surgical drainage if abscess to prevent meningeal involvement and cavernous sinus thrombosis) - orbital cellulitis
A 30-year-old woman presents to the eye hospital with 2 days of acute vision changes in her left eye. She describes progressively worsening vision ‘as if looking through a cloud’ and has noted that the colours around her appear less bright. In this time, she has also developed retro-orbital pain which is exacerbated when she moves her eye. Her right eye is unaffected.
She has no previous ophthalmological history and no other medical history.
Given the likely diagnosis, what feature is most likely to be elicited on examination?
optic neuritis = RAPD
The optic disc is typically normal in optic neuritis. Swelling of the optic disc, known as papillitis, is seen if the inflammation extends to this part of the optic disc. Mild swelling is seen in around one-third of patients. It is, therefore, less likely to be seen on examination than RAPD, which is seen in the majority of cases.
A 64-year-old woman was referred to ophthalmology with a vesicular rash around her right upper eyelid. The right eye is red and painful.
Based on the most likely diagnosis, what treatment should be given?
oral acyclovir
Herpes zoster ophthalmicus requires urgent ophthalmological review and 7-10 days of oral antivirals
contact lens keratitis organism
hypopyon is present and there are focal white infiltrates on the cornea.
Pseudomonas infection should be suspected in contact lens associated keratitis
dendritic ulcer would mean herpes simplex
72-year-old man presents with a painful, red eye to the Emergency Department. Due to the severity of his symptoms and reduced visual acuity he is referred on to ophthalmology who make a diagnosis of acute glaucoma. Which of the following should be the aims of treatment?
The correct answer is Reducing aqueous secretion + inducing pupillary constriction. Acute glaucoma, also known as acute angle-closure glaucoma, is a medical emergency characterised by a sudden increase in intraocular pressure (IOP) due to impaired drainage of aqueous humour. The primary aims of treatment are to reduce IOP and relieve the patient’s symptoms. This can be achieved by reducing the production of aqueous humour and constricting the pupil, which helps to open up the drainage angle and promote outflow. Medications such as topical beta-blockers, alpha agonists, and carbonic anhydrase inhibitors can be used to decrease aqueous secretion, while miotic agents like pilocarpine help in inducing pupillary constriction.
34-year-old female presents with fatigue and frequent headaches. On examination of her eyes, you notice an abnormality during the swinging light test. As the light is moved from the left to the right eye both pupils appear to dilate. The pupillary response to accommodation is normal bilaterally. Fundoscopy is also normal bilaterally. Her past medical history includes type one diabetes and hypertension. What is the most likely explanation for this patients’ signs?
Marcus Gunn pupil (relative afferent pupillary defect) is diagnosed during the swinging light test. If there is damage to the afferent pathway (retina or optic nerve) of one eye, the pupil of that affected eye will abnormally dilate when a light is shone into it. This is because the consensual pupillary relaxation response from the healthy eye will dominate. Marcus Gunn pupil can be found in patients with multiple sclerosis. Therefore, given the history, this should be ruled out in this patient.
