Anterior disorders Flashcards
Define cataracts
Opacity of the lens due to deposits of proteins by epithelial surface.
Risk factors/ associations for cataracts
- Demographics
- Diseases/ conditions
- Lifestyle
- medications
Demographics:
- Increasing age
Diseases:
- Diabetes
- Uveitis
- Down’s syndrome
- Retinal pigmentosa
- High myopia
Lifestyle:
- Smoking
- Alcohol
Medication
- Steroids
Types of cataracts and their associations [3]
Nuclear
- Central, typically due to aging
Cortical
- Affects outer layer and moves inwards
- Associated with diabetes
Posterior subcapsular
- Affects posterior lens
- Associations: younger age, steroids, diabetes, trauma,
Complications of cataract surgery
Lens displacement
Endophthalmitis
- Infection of the inner eye contents
- Management: intravitreous injection of antibiotics.
Presentation of cataracts
- Gradual onset
- Reduction of visual acuity
- Discolouration of vision= yellow/ brown hue
- Starbursts/glare around lights, particularly at night
Signs
- Reduced visual acuity (Snellen)
- Reduced/ absent red reflex
- Opacification of lens in slit lamp
Management of cataracts
Mild cataracts
- Correct visual acuity with lens
More severe cataracts= surgery
- Removal of opaque lens and implant of new lens.
Causes of corneal abrasions
Foreign bodies
Contact lens
Fingernails
Eyelashes
Entropion
Presentation of corneal abrasion
Red, painful eye
Watering eyes, no purulent discharge
Grittiness to eye/ foreign body sensation
Blurred vision
Photophobia
First line examination for corneal abrasion
Slit lamp ophthalmoscopy with fluorescein stain
- Shows yellow/orange lesions of abrasion
- Can show foreign bodies.
First line examination for corneal abrasion
Slit lamp ophthalmoscopy with fluorescein stain
- Shows yellow/orange lesions of abrasion
- Can show foreign bodies.
Contact lens corneal abrasion is associated with infection by…
Pseudomonas
Management of corneal abrasions
Pain management= simple analgesia
Infection prevention
- Chloramphenicol drops
Lubricating drops
Photophobia relief= cyclopentolate
Features of herpes keratitis
Dendritic corneal ulcers seen via fluorescein stain
Presentation
- Red, painful, watery eye.
- Blurred vision
- Grittiness, foreign body sensation
- Photophobia
- Vesicles
Management of herpes keratitis
Topical antivirals
- Aciclovir topical
- Ganciclovir gel
Steroids for stromal keratitis
Corneal transplant for scarred cornea.
Anterior uveitis
- Definition
- Causes
Inflammation of the iris, typically due to systemic autoimmune/ inflammatory disorders.
Causes:
- Acute= ankylosing spondylitis, IBD, reactive arthritis.
- Chronic= Sarcoidosis, TB, Lyme disease
Anterior uveitis
- Presentationc
Acutely= painful, red eye
Reduced visual acuity/ blurred vision
Floaters/ flashes (cells in anterior chamber)
Photophobia
Lacrimation/ watery eye
Anterior uveitis
- Diagnosis
Slit lamp examination of anterior eye
- White cells in anterior chamber
- Hypopyon (accumulation of cells, forming white fluid)
- Posterior synechiae (adhesion of iris to lens)
- Ciliary flush (redness from cornea outwards)
Management of anterior uveitis
Topical/ oral steroids
Cycloplegic-mydriatic drops
- Cyclopentolate/ atropine
- Dilates pupils, reduces pain from ciliary spams
Treatment of underlying disease via immunosupressants
Causes of acquired ptosis
NMJ:
- Myasthenia gravis
Demyelination
- Multiple sclerosis
Nerve lesions
- Horner’s syndrome
- Bell’s palsy
- Cerebrovascular accident
Anatomical
- Exophthalmos
- Meibomian cyst
- Atopic dermatitis
Vortex keratopathy (corneal verticillata)
- Definition
- Causes
Deposition of asymptomatic grey opacities in a vortex pattern on the corneal epithelium
Causes
- Fabry disease
- Medications
Medications that cause vortex keratopathy
Amiodarone
Chloroquines (malaria)
Indomethacin (NSAID)
Phenothiazine (D2-receptor action)
_______ is given in anterior uveitis to for pain and to treat muscle spasms
Cyclopentolate/ atropine (cycloplegic-mydriatic)
First line imaging for orbital cellulitis
CT with contrast
Orbital cellulitis presentation
Painful, red eye
- Painful eye movements
- Ophthalmoplegia
Reduced acuity
Proptosis
Abnormal pupil light reflex
Contact lens users have an increased risk of keratitis caused by…
P. aeringosa
