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Management of anterior uveiitis
Urgent opthal r/v
If an infectious cause- give appropriate targeted antimicrobials plus dilating drop and glucocorticoids
If non infectious: topical glucocorticoids (prednisolone) + dilating drops (cyclopentolate) +/- systemic immunosuppression if remain symptomatic despite initial therapies
Slit lamp findings for anterior uveitis
Keratic precipitates, flares, hypopyon, posterior synechiae
Conditions associated with anterior uveitis
Ankylosing spondylitits
Reactive arthritos
UC, Crohns
Bechets
Sarcoidosis
define glaucoma
Glaucoma is defined as
an optic neuropathy involving
a characteristic atrophy of the optic nerve head,
often accompanied by typical visual field defects
define acute angle closure
closed anterior chamber drainage angle with high IOP and acute
symptoms and signs of high IOP (pain, nausea, redness, corneal
oedema etc.)
e acute elevation of IOP due to diminished
outflow of aqueous humor through the anterior chamber of the eye into the
peripherally located canal of Schlemm
define angle closure glaucoma
patient has a history of angle closure (acute or chronic) AND
glaucomatous optic neuropathy (i.e. angle closure + disc changes and
visual field loss)
Clin F of acute angle closure glaucoma
severe pain: may be ocular or headache
decreased visual acuity
symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil
corneal oedema results in dull or hazy cornea
systemic upset may be seen, such as nausea and vomiting and even abdominal pain
Acute angle closure diagnosis
At least 2 of the following symptoms:
– ocular pain
– history of intermittent visual blurring which may
include the complaint of seeing halos
– nausea or vomiting
* At least 3 of the following signs:
– IOP greater than 21 mm Hg
– corneal edema
– conjunctival injection
– mid-dilated minimally reactive pupil
– shallow anterior chamber
tonometry to assess for elevated IOP
gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle
Mng of acute angle closure
Acute: 1. decrase IOP with a combination of: PO/topical carbonic anydrase inhib (acetazolemide), topical BB (timolol), topical alpha agonists (brimonidine)
If secondary to pupillary block then pilocarpine after IOP <40mmhg
2. Hyperosmotic agents - glycerine and mannitol
Chronic: Definitive laser peripheral iridotomy 24-48 hours after resolution of acute
Management of cluster HA
Acute: SC/ intranasal triptan plus high flow oxygen for 15-20 minutes
Bridging: PO prednisolone for 5 days or greater occipital nerve block
Prophylaxis: 1. Verapamil 2. Lithium, sodium valproate, topiramate, gabapentin, melatonin
Cx of hyphema caused by blunt ocular trauma
Raised intraocular pressure
Risk factors for vitreous hemorrhage
Any condition which risks formation of retinal neo- vasculature: diabetic retinopathy and hypertensive retinopathy
Anticoag use and trauma
Clin F of vitreous hemorrhage
Dark spots obscuring vision - red hue +/- loss of red reflex
Painless unless associated with trauma
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Vitreous hemorrhage
Management of Primary open angle glaucoma
- If IOP >24 mmHg, offer selective laser trabeculoplasty
- Prostaglandin analogue eye drops - latanoprost
- Bet blocker eye drops, carbonic anhydrase inhibitor eye drops, sympathomimetic eye drops
Slit lamp examination findings consistent with diabetic retinopathy
Cotton wool spots, neovascularisation, hard exudates
Clin F of anterior uveitis
Acute
Ocular discomfort/ pain that increases with use
Small pupils
Intense photophobia
Red eye and lacrimation, ciliary flushing
Associated with: ank spond, reactive arthritis, IBD, Bechet’s disease, sarcoidosis
Progressive loss of retinal ganglion cells + excavation of optic nerve head leading to a cupped disc =???????
Glaucoma
Pt with rheumatoid arthritis with a red, painful eye
Scleritis
RF for scleritis
RA
SLE
Sarcoidosis
Granulomatosis with polyangitis
Features of scleritis
Red eye
Painful
Watering and photophobia
Gradual decrease in visual acuity
Mng of scleritits
Same day opthal assessment
PO NSAIDS
PO glucocorticoids or immunosuppresants if severe
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scleritis
Clin F of sceritis
Deep red or violet eye with boring pain, visual change and photophobia
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Vitroeous hemorrhage
Scleritis vs episcleritis
Scleritis - painful and tender
Episcleritis - painless, mild gritty sensation
Treatment of anterior uveitis
steroid + cycloplegic/ mydriatic eye drops
redness around corneal limbus = ?
Uvietis
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retinal detachment
Differentials for sudden vision loss
Ischemic/ vascular - amurosis fugax, CVO, CRAO
Vitreous hemorrhage
Retinal detachment
Retinal migraine
Differentiating posterior vitreous detachment, retinal detachment and vitreous hemorrhage
Posterior vitreous detachemnt - photopsia in the peripheral visual field, floaters often on the temporal side of hte central vision
Retinal detachment - dense shadow that starts peripherally and progresses to the center. A veil or curtain over the field, straight lines appear curved, central visual loss
Vitreous haemorrhage - small bleeds- floaters
- moderate blleds- numerous dark spots
- large bleed - sudden visual loss
