Anterior eye disease Flashcards
What symptoms might this patient complain of?
What test could you undertake in the absence of the slit lamp?
What is the abnormality and where is it located?
- Gradually decreasing hazy / foggy vision. Glare (particularly driving at night).
- Assess the red reflex with an ophthalmoscope (best when dilated with tropicamide 1%).
- Cataract - posterior subcapsular lens opacity. The slit-lamp here is focussed on the posterior lens surface.
This patient is suffering from increased myopia and astigmatism.
What is the diagnosis?
How is it demonstrated?
What initial treatment would you refer this young man for?
This patient is suffering from increased myopia and astigmatism.
What is the diagnosis?
Keratoconus – evident by the conical shape of the cornea.
How is it demonstrated?
(1) On downgaze, the cornea pushes the eyelid out in a V pattern (Munson’s sign). (2) Abnormal non-uniform red reflex – like a “tear drop” in the centre – best viewed following dilation with tropicamide 1%). (3) Gold standard is computed Corneal Topography, which can detect very early (forme fruste) keratoconus, even before it is symptomatic.
What initial treatment would you refer this young man for?
Glasses for very early disease, then rigid contact lenses once glasses no longer correct the astigmatism satisfactorily. Surgery (corneal grafting) is reserved for very severe disease.
This man appears after work in the Casualty department stating his eye has been “sore and watering” for most of the day.
What is the diagnosis?
What occupational hazards are likely to lead to this injury?
What is the treatment?
- Corneal foreign body.
- Grinding, welding, drilling, hammering, especially without adequate eyewear / protection.
- Full history and examination to establish nature of incident (Any high velocity potential penetrating injury/ intraocular metallic foreign body should be excluded with plain xray). Foreign body removed with needle. Topical antibiotic.
What clinical signs are present?
Which eye is this?
What is the diagnosis?
What are the indications for treatment?
What clinical signs are present?
“Wing” shaped extension of conjunctiva on to nasal side of cornea. Which eye is this?
Right.
What is the diagnosis?
Pterygium.
What are the indications for treatment?
(1) Approaching visual axis / affecting vision. (2) Inflammation / thickening of pterygium causing discomfort. Note: Recurrence of pterygium is difficult to manage, therefore primary excision is done only when necessary, excision for cosmesis is discouraged.
This man complains he awoke with a “red eye”, no history of trauma.
What is the diagnosis?
Can you offer any treatment?
Subconjunctival haemorrhage. No treatment required - resolve spontaneously. What history might you elicit and what simple investigations could you undertake? Any history of raised blood pressure, coughing, vomiting. Check blood pressure. (Note: Subconjunctival haemorrhage in the setting of ocular trauma is a ruptured globe until proven otherwise.)
What is the infective agent?
How would you describe this corneal lesion?
What is the treatment?
Do you expect recurrences?
What medication is contraindicated?
What is the infective agent?
Herpes simplex / HSV.
How would you describe this corneal lesion?
Dendritic epithelial defect of the epithelium (stained with rose bengal).
What is the treatment?
Do you expect recurrences?
Acyclovir eye ointment 5x day for 10 days. Recurrences common.
What medication is contraindicated?
Topical steroid, as the infection will expand to a geographic ulcer if used.
This man has chronically irritated eyes and experiences photophobia. Rose bengal has been instilled into the conjunctival sac.
What has the stain demonstrated?
What history, examination and investigations might you undertake?
What is the condition and how can it be relieved?
What has the stain demonstrated?
Devitalised epithelial cells in the conjunctiva and cornea in the area of the palpebral aperture indicating dry eyes.
What history, examination and investigations might you undertake?
Examine for signs of associated blepharitis, lid scarring, lid closure. History of nocturnal lagophthalmos (lids open whilst sleeping). History of systemic illnesses related to dry eyes (Collagen vascular diseases – Rheumatoid Arthritis, Sjogrens, SLE). Schirmers test (strips of filter paper in lower fornix to assess tear production).
What is the condition and how can it be relieved?
Dry eye, first line is artificial tear drops. Other avenues include optimising environment (avoiding dry places - dehumidifiers, air conditioning etc.), punctal plugging, treatment of concurrent blepharitis, dietary supplementation with flax oil and omega 3.
Child comes in with an apparent preseptal cellulitis, whats the differential and how can you tell the difference?
What else would you be thinking of?
Orbital cellulitis.
How can you tell the difference?
Careful history and examination - orbital cellulitis suggested by red eye, decreased vision, double vision, pain, fever, chemosis, proptosis, reduced ocular motility, and is usually secondary to concurrent sinusitis.
A preseptal infection leaves the eye unaffected which is white and moves and sees normally if the lid is lifted. The lid MUST be lifted to differentiate, best accomplished with two cotton buds. Treat with systemic antibiotics and careful review.
