Aoc Flashcards
Entropion
Sign- rolling inwards of lid margin Redness of Bulgaria conjunctiva
Symptoms- none - eyelashes rub against conjunctiva/cornea could cause pain and lacrimation Reduce va
Pathogenesis- spasm of obicularis oculi mainly
occurs in elderly, can be caused by scar tissue on conjunctiva
Treatment- referral to GP - urgency based on symptoms Bandage cl surgery to remove eyelashes
Ectropian
Signs- lower lid rolls away from globe, palpabral conjunctiva exposed= dry eye and red
Symptoms - painless
Pathogenesis- loss of muscle tone in obicularis oculi cx wipes tears down increasing issue &contact dermatitis scar tissue can cause ectropion
Treatment - refer to GP surgery to eyelid margin. Bandage CL to protect cornea drying exposure keratitis advise to wipe up
Blepharitis
Signs- Redness & scaling, crusty lid margin debris in eyelashes(dandruff) reduction in lashes. In chronic cases ulcers can form along lid margin. Posterior - obstruction of meibomain. Thick cloudy meibomain hyperaemia- lid margin
Symptoms tired, itchy, sometimes worse on morning greasing of CL due to sebaceous secretion - none in mild cases
Pathogenesis- long term chronic inflammation of lid margin, usually older cx, poor diet, systemic illness, dandruff scalp eyebrows can be seborrhoeic/ associated with chronic staphylococcal infection/ demodex mites
Treatment lid hygiene warm compress, demodex wipe tree tree oil referral to optom/ gp if chronic, artifical tears for comfort cease CL wear
Pinguecula
Signs- raised yellow lump, para Limbaugh areas bulbar conjunctiva, more prominent and yellow with age
Symptoms- generally none CL can cause irritation
Pathogenesis- degeneration of conjunctiva collagen can be senile expose to sunlight and hot, dry conditions
Treatment- if cosmetically unacceptable then surgery, UV protection
Pterygium (silent p)
Signs- wing shaped triangle, growth on conjunctiva, can invade cornea, usually nasally (often bilateral) pink/yellow colour
Symptoms- FB sensation, mild irritation- irritation if wear CL, astigmatism produced if cornea becomes distorted, reduced VA
Pathogenesis- degeneration of conjunctiva collagen, arises from fibrous vascular connective tissue with epithelium, hot dry dusty climates
Treatment- referral to GP, urgency based on presentation, surgery before encroaches pupil/ cause corneal distortion, regrowth Common, radiation to prevent re growth
Arcus
Signs - grayish white band in peripheral cornea commences as an arc in Upper & lower cornea 1mm annulus around cornea, clear separation from limbus
Symptoms - none
Pathogenesis- fat deposits in the limiting lamellae - not sight threatening
Treatment patient reassured if cx below 50 = routine referral to GP for health check
Hordoleum externum (stye)
Blockage of gland moll & zies
Signs- red swelling of lid margin, associated with lashes may develop a yellow centre or point
Symptoms- painful
Pathogenesis- bacterial infection of eyelashes follicle usually staphylococcus
Glands of moll = sweat, zies =sebaceous
Treatment- hot compress to accelerate the pointing Pus evacuated by removal of eyelash, advise improve hygiene, recurring =GP referral for health check possible antibiotics
Chalazion (tarsal gland)
Signs- swelling inside eyelid, hard gradually enlarges, localised grayish area on tarsal conjunctiva on lid emersion
Symptoms- painless, if growth continues can put pressure on and distort cornea
Pathogenesis- swelling of tarsal gland, due to blockage of duct or infection, recurs with blepharitis
Treatment
Patient reassured, referral to GP for surgical removal if required
Hordoleum Internum (infection)
Signs- same as chalazion but infection, red swelling of eyelid, red inflammation of tarsal conjunctiva on generalised inflammation of surrounding area
Symptoms- painful
Pathogenesis- infection of tarsal gland, usually staphylococcal bacteria
Treatment- refer to optometrist/GP if acute, hot compress, may need GP for antibiotics and surgical drainage
Dacrocystis
Blocked tear duct lacrimal sac
Signs - inflammation of lacrimal sac below inner canthus localised inflammation and mucopurulent discharge, nasal conjunctiva can also be reddened
Symptoms- painful in acute form, painless in chronic, epiphora (over spill of tears)
Pathogenesis- acute due to infection of lacrimal sac, usually bacterial, chronic due to blockage of nasalacrimal duct injury or infection
Treatment- referral to GP, HES urgent if acute (under 16 rules apply), systemic antibiotics, hot compress,possible surgery to release content of sac or re open lacrimal passages
Dacryoadentis
Inflammation of lacrimal gland
Signs- swelling beneath lateral end of upper eyelid inflammation
Symptoms- very painful
Pathogenesis- bacterial infection occasionally occurs in mumps & glandular fever. Chronic dacryoadentis may accompany iritis (anterior uveitis) in systemic diseases such as tuberculosis
Treatment antibiotics- local/ systemic are given for acute, treatment for any underlying systemic co diction is also required
Ptosis
Signs- abnormally low position of upper lid reduction in size of palpebral aperture, pupil can be covered, cx elevate eyebrows to counter drooping of lid unilateral/bilateral
Symptoms - none (unless pupil covered) if other symptoms the ptosis is due to underlying cause dipoles, anisocria, strabismus anhydrous of face
Pathogenesis- most common cause by defect of levator palpebral superioris (or its innervation) can be congenital or acquired, result from trauma, associated with myasthenia gravis, honers syndrome results in triade miosis/ptosis/ anhindrosis 3rd nerve palsy
Treatment - refer to GP emergency/ urgent if other symptoms surgical intervention, surgery not normally carried out on young people unless risk of amblyopia
Xanthelasma
Signs- flat yellowish makes of fat deposited below the skin
Symptoms- none
Pathogenesis- indicate a high level of blood cholesterol more common in diabetics
Treatment- referral to GP for health check & cholesterol check can be removed if cosmetically unacceptable
Contact dermatitis
Signs- localised allergic reaction, inflammation of conjunctiva & eyelids, eyelids red & puffy may extend down cheeks
Symptoms- severe itching and discomfort
Pathogenesis- reaction to cosmetics fluids
Treatment - refer to GP, cool compress to soothe irritation, steroid drops or cream to reduce inflammation
Epicanthus
Signs- vertical fold of skin covering the inner canthus, usually bilateral & gives the appearance esotropia
Symptoms- none
Pathogenesis- normal feature that gradually disappear in the first few years of life
Treatment- none parents reassured sight test to ensure no BV issues
Keratoconus
Signs- bulging of the cornea into a conical shape usually bilateral irregular astigmatism on examination, munsons sign in servere cases corneal oedema
Symptoms acuity progressively reduces due to irregular astigmatism, monocular diplopia can occur in severe cases sudden drop in acuity if oedema occurs
Pathogenesis- reduced corneal thickness, more common in males usually onset 10-20 years, usually gradual onset
Treatment- refer to optometrist/ opthalmology RGP CL which form a tear prism reducing effects of irregular astigmatism, piggy back CL used if RGP not tolerated, corneal graft if severe or collage crosslinking
Retinoblastoma
Signs- unilater/bilateral, white pupil reflex (leukocoria) caused by pale tumour at eye posterior white reflex shows in flash photography squint can occur with reduced VA, can cause iris colour to change
Symptoms due to age of child acuity reduction (often none) is not identified, occasionally painful and redeye
Pathogenesis- most common paediatric malignancy of the eye 1/2000 births. Mostly sporadic, but can be inherited arises from foetal retinal development usually presents 8 months if inherited, 25 month if sporadic,
Treatment - urgent referral enucleation to avoid metastasis tumour can spread to orbit and optical canal so early detection paramount, radiotherapy/ phototherapy/ chemotherapy 50% of children will present with second tumour
Naevus
Signs- augmented area on surface of iris, equivalent to frexkle/ mole flat or raised, usually regular in shape
Symptoms- none
Pathogenesis- accumulation of pigmented cells on anterior of the iris
Treatment- none reassure cx naevi should be monitored (pictures) change in size, character could indicate malignant melanoma
Coloboma
Signs- section of inferior part of the iris missing, keyhole shape pupil usually bilateral
Symptoms- photophobia glare, reduced VA due to poor retinal image aberrations
Pathogenesis- failure of the optic fissure to close, occurs 5th week of embryonic life, may effect choroid and retina
Treatment- no Treatment, more focused on improving cosmetics/ va cosmetic CL
Iris melanoma
Signs-area of iris is a different colour of surrounding area maybe thicker & cause distortion of pupil, can bleed causing hyphaema
Symptoms- none, unless blockage of angle
Pathogenesis- uncontrolled growth of melanocytes . Usually develops from pre existing naevi,more common 60+
Treatment-refer to GP/HES depending on presentation surgery if advanced enucleated
Orbital cellulitis
Signs- red swollen, eyelids closing the palpebral aperture, conjunctiva swollen inflamed
Symptoms- moderate/ severe pain more so on movement, reduced acuity, diplopia, feverish
Pathogenesis-bacterial infection spread from infected tooth/sinus, milder form presentation cellulitis can occur following infected wound/ insect bite on or near eyelid
Treatment- systemic antibiotics, orbital emergency HES possibility of inflammation of the optic nerve possible surgery
Aqueous flare
Tyndall phenomena
Scattering of light in the anterior chamber due to the pressure of white blood cells and other proteins in the aqueous
Indicates inflammation in the eye
Keratitis precipitates
Kps
White blood cells can become attached to the endothelium back of cornea
Normally form a triangle shape
Subconjunctival Haemorrhage
Signs- pooling blood in the conjunctiva bright red blood obscures sclera accumulates between the conjunctiva and tenons capsule
Symptoms - often no symptoms looks more dramatic than prognosis occasionally slight discomfort/ soreness
Pathogenesis- small amount of bleeding occurs beneath the conjunctiva. Appears bright red as conjunctiva is transparent
1. Sporadic strain/ exertion 2. Hypertension/ systemic issue 3. Trauma
Do advice 1 sporadic not happend before tell when resolve cx reassured no referral- drops
2 recurring routine referral to gp
3 trauma - emergency referral to hes
Scleritis
Diffused mixed injection
Signs- generalised deep inflammation of the sclera seen through conjunctiva diffuse Bulgaria injection and hyperaemia of sclera tissue
Anterior chamber response ( aqueous flare)
Symptoms deep intense pain also can effect forehead and jaw, photophobia, epiphora, if posterior sclera involved or anterior chamber response may cause reduction in acuity
Pathogenesis- associated with collagen vascular diseases rheumatoid arthritis hepes zoster
Accompanied by Uveitis glaucoma and cataract
Posterior - can affect optoc nerve vause RD
Do advice - emergency referral treated with steroid drugs systemic and topical systemic immunsuppressants
Generally unsuitable for CL wear
Episclearitis
Super facial inflammation
Signs- mild inflammation/ injection of the superficial layers of the sclera can be localised or segmented, slight Oedema
Symptoms - irritation minor lacrimation
Pathogenesis- inflammation of the vascular connective tissue that lies between sclera and conjunctiva 1/3 cases associated with systemic disorders collagen vascular disease
Do Treatment- cx reassured ocular lubricants can ease irritation, self limiting rarely associated with systemic issues if recurring then referral to optometrist /GP warranted
Anterior Uveitis (iritis)
Signs inflammation of iris, Limbal (ciliary) injection
Iris nodules
Anterior chamber response/ infiltrates, iris bombe can form
Symptoms- sudden or insidious (slowly), in chronic - none,
In acute servere pain lacrimation photophobia
Reduced acuity
Pathogenesis- white blood cells block trabecular mesh work- secondary glaucoma, Uveitis related to systemic diseases such as aid,TB, sarcoidosis, behects, psoriasis, secondary condition to keratitis or viral ulcer, in children juvenile chronic arthritis if untreated optic nerve issues and sight loss
DO Treatment- emergency referral to GP
Treatment is focused on preventing damage to ocular structures suppressing inflammation topical steroid treatment
Use mydriatic drugs dilating pupil reduces pain associated with ciliary spasm
Keratitis (bacterial)
Signs - white corneal opacity (ulcer) visible under slit lamp (sometimes with naked eye) , mucus discharge, inflammation, ciliary injection can be diffuse, hypopyon KP ( severe cases)
Symptoms- servere pain lacrimation, photophobia in early stages FB sensation reduced VA
Pathogenesis- bacterial infection of the cornea, dry eye or breaches in corneal epithelium by trauma or contact lens wear can allow ingress of bacteria, bacteria types include staphylococcus aureus if acute can lead to iritis/ secondary glaucoma
DO Treatment- emergency referral assessed by optom if symptoms allow immediately available
Scrapes are taken to culture and identify bacterium, so that ab effective antibiotic can be prescribed, topical application
Viral keratitis
Signs- dendritic ulcer visble under slit lamp, inflammation of the cornea, ciliary injection hypopyon/KP ( severe cases)
Symptoms- pain, photophobia, lacrimation acuity loss if ulcer central
Pathogenesis- viral infection of the cornea, dry eye or breaches in corneal epithelium by trauma, or CL wear can allow ingress of virus, usually caused by herpes simplex more at risk
Do Treatment emergency referral
Keratitis ( acanthamoeba)
Signs- diffuse red eye,one or more white patches on cornea ring shaped ulcer if advanced, epiphora
Symptoms- severe pain, blurred vision, photophobia
Pathogenesis- inflammation of the cornea due to infection by the protozoa acanthamoeba, can penetrste an intact corneal epithelium can be caused by swimming in CL or washing CL case with water
Systemic conditions Uveitis
Juvenile chronic arthritis
Ankylosing spondylosis
Psoriatic arthritis
Systemic causes of cataract
Diabetes Metabolic disorders Systemic drugs steroids X radiation Infection congenital rubella Syndrome downs lowe
Classification of the glaucoma
Primary
Chronic open angle
Acute and chronic closed angle
Classification of glaucoma
Congenital
Primary
Secondary to maternal rubella infection
Secondary to inherited ocular disorders eg aniridia absence of the iris
Classification of glaucoma
Secondary glaucoma causes
Trauma Ocular surgery Ocular disease eg Uveitis Raised episcleral venous pressure Steroid induced
Primary chronic open angle glaucoma
Increase resistance to the outflow of aqueous = elevated ocular pressure
The causes of outflow obstruction include - thickening of the trabecular lamellae which reduces pore size
Reduction in the number of lining trabecular cells
A form also exists- field loss loss and cupping of optic disc not high IOP - optic nerve head usually susceptible to the IOP and has a low blood supply
Closed angle glaucoma
Occurs in small eyes hypermetropic- shallow anterior chamber
Pupil dilation when the peripheral iris may be bunched up in the angle
Resistance increased, increased pressure gradient bows the iris forward and closes the drainage angle, aqueous cannot drain through trabecular mesh work
IOP rises usually abruptly
Deprives whole cornea of nutrition, posterior of oxygen supply = corneal Oedema and clouding
