Classic Presentations Flashcards
A red eye with sticky discharge
Bacterial conjunctivitis
A red eye with watery discharge
Viral conjunctivitis
Bilateral red eyes in a young adult with follicles under the eyelid
Chlamydial conjunctivitis
Red eyes with string discharge and itch
Allergic conjunctivitis
Focal white infiltrates on the cornea and/or hypopyon (thick white line at the bottom of the cornea caused by inflammatory cells in the anterior chamber of the eye)
Bacterial keratitis
Watery/gritty/red eye, pain, reduced corneal sensation and dendritic ulcer
Herpetic keratitis
Bilateral white subepithelial infiltrates
Adenoviral keratitis
Red eye with pain and discharge in a farm worker with history of trauma from vegetation to the eye
Fungal keratitis
Red swelling around the eye + painful eye movements
Orbital cellulitis
A very red eye post-surgery that is painful with decreasing vision
Endophthalmitis
A patient with a cat experiences mild flu like symptoms. A protozoa is seen in the retina
Toxoplasmosis
A patient with a dog forms granulomas in their eye
Toxocara
Inflamed eyelids with scale and dandruff
Seborrhoeic (anterior) blepharitis
Inflamed eyelids with loss of lashes/ingrowing lashes/tepee sign +/- styes, ulcers of lid margin, corneal staining and marginal ulcers
Staphylococcal (anterior) blepharitis
A patient with rosacea has swollen meibomian glands, dried secretions at the gland openings +/- meibomian cysts
Posterior blepharitis
Eye pain, redness, reduced vision and photophobia + cells and flare in anterior chamber on examination
Anterior uveitis
Red, irritated eye with the inflammation limited to a specific area of the globe
Episcleritis
A patient with a serious systemic condition (eg Rh arthritis, Wegener’s etc) has an extremely painful red eye (sometimes with purple hue), photophobia and decreased visual acuity. Ocular pain radiates to temple or jaw
Scleritis
Trauma to one eye causes inflammation in both eyes
Sympathetic ophthalmia
A patient is hit with blunt force to the eye with an object larger than the eye socket. Teardrop sign is seen on MRI.
Blowout fracture
A patient is hit with blunt force to the eye with an object larger than the eye socket. Teardrop sign is seen on MRI. The patient is also unable to look up
Blowout fracture + inferior rectus muscle trapped in the sinus below
Microaneurysms / dot + blot haemorrhages, hard exudate, cotton wool spots and new vessel formation
Diabetic retinopathy
Copper or silver wiring, cotton wool spots, hard exudates and flame hemorrhages
Hypertensive retinopathy
Sudden, painless, profound loss of vision with RAPD, pale odematous retina, poor optic disc contour (fluffy and blending into surrounding area) and cherry red spot on the macula on examination
Central retinal artery occlusion
Sudden painless visual loss (moderate-severe) with flame hemorrhages, dilated tortuous veins and disc and macular swelling
Severe central retinal vein occlusion
Transient visual loss characteristically worse on waking and improves during the day. On examination there is flame hemorrhages, dilated tortuous veins and disc and macular swelling
Mild central retinal vein occlusion
Sudden, painless vision loss + scalp tenderness, headache and jaw claudication
GCA
Unilateral (mainly) progressive visual loss over 24-48hrs, pain behind eye exacerbated by movement, colour desaturation and central scotoma
Optic neuritis
Eye cannot abduct + horizontal diplopia worse on distance vision and looking to the affected side + esotropia
CN VI (abducens nerve) palsy - affects lateral rectus
Vertical double vision worse on downgaze + compensatory head tilt (down and to the side opposite the affected eye) + hypertropia on cover test that worsens on downgaze
CN IV (trochlear) nerve palsy - affects superior oblique muscle
Eye looks ‘down and out’ with drooping eyelid, large pupil and diplopia
CN III (oculomotor) nerve palsy - affects superior, inferior, and medial recti and inferior oblique (eye muscles), levator palpebrae superioris (upper eyelid) and sphincter pupillae (pupillary constriction)
Painful CN III nerve palsy
Aneurysm
Impairment of adduction in a patient with MS etc
Inter-nuclear ophthalmoplegia
Headache, enlarged blind spot, blurring of vision, loss of vision and bilateral swollen disks on ophthalmoscopy
Papilloedema
Loss of vision, floaters, loss of red reflex +/- haemorrhage on fundoscopy
Vitreous haemorrhage - can be caused by retinal tear, diabetic retinopathy or retinal vein occlusion
A short-sighted person experiences a painless partial loss of vision ‘like a curtain coming down’ + sudden onset of flashes/floaters
Retinal tear
Rapid central visual loss, metamorphopsia (curved distortion of linear objects) and haemorrhage/exudate on fundoscopy
Wet age-related macular degeneration
Gradual decline in vision, central scotoma (missing central vision) + drusen (white dots) in macula area and atrophic patches of retina
Dry age-related macular degeneration
Reduced visual fields, cupped disc (large cup to disk ratio) and increased IOP
Open angle glaucoma
Painful red eye, visual loss, headache, nausea, vomiting, halo around lights, cloudy cornea and stony hard eye
Closed angle glaucoma
Gradual decline in vision that cannot be corrected with glasses, vision is hazy/blurred +/- glare
Cataract
