Emergency

Question 1

What is acute angle closure glaucoma?

Answer 1

Angle of anterior chamber narrows
Leads to acute obstruction
Rapid ↑IOP

Question 2

What is normal IOP?

Answer 2

15-20

HIGH >30

Question 3

What are the causes of angle closure glaucoma?

Answer 3

PRIMARY: Anatomical predisposition- thin iris, thick lens
SECONDARY: Traumatic haemorrhage- pushes post chamber anteriorly

Question 4

How does the normal eye produce & remove aqueous humour?

Answer 4

Ciliary body produces aqueous humour
Drains into trabecular meshwork
Between iris & cornea - anterior chamber

Question 5

What are the Sx of acute angle closure glaucoma?

Answer 5

Hours-days
SEVERE eye pain
Blurred vision
Coloured halos
Red eye- injected
Pupil fixed & dilated- NON REACTIVE
Hard globe on palpation
Headache
Systemic: Malaise, N&V

Question 6

How is acute angle closure glaucoma investigated?

Answer 6

Slit lamp: 
IOP >21
Shallow anterior chamber
Closed iridocorneal angles
Corneal oedema

Question 7

How is acute angle closure glaucoma treated?

Answer 7

• URGENT REFERAL TO OPHTHALMOLOGY
• Admit to monitor IOP

Take all 3:
1) BB: Timolol 0.5%
2) TOP Pilocarpine 2-4% drops: 2hourly 
3) IV Acetazolamide: 500mg
Other: Prednisolone 15mg every 15mins

Surgery: Peripheral iridectomy

Question 8

What should be avoided in acute angle closure glaucoma?

Answer 8

Eye patches & dark rooms

Pupillary dilatation = WORSENS angle closure

Question 9

What is papilloedema?

Answer 9

Swollen optic disc

As a result of ↑ICP

Question 10

What are the causes of papilloedema?

Answer 10

Space occupying lesion
Idiopathic ICP increase
Drugs
Intracranial infection

Question 11

What Sx might be associated w/papilloedema?

Answer 11

SEVERE throbbing headache: First thing in the morning, lying down, refractory to paracetamol
N&V
Pupils normal & reactive to light

Question 12

What features would be seen in papilloedema when using an opthalmoscope?

Answer 12

Venous engorgement
Blurring of disc contours
elevation of optic disc
Loss of optic cup
Paton's lines- Concentric lines cascading from optic disc

Question 13

What are the causes of pre-septal cellulitis?

Answer 13

Infection occurs from a superficial site: insect bite, chalazion, epidermal inclusion cyst, folliculitis
Kids: Sinusitis

Question 14

What are the causes of orbital cellulitis?

Answer 14

Local spread of URTI: Sinusitis

Organisms: Staph Aureus, Staph epidermidis , Strep, anaerobes

Question 15

How can orbital cellulitis lead to visual loss?

Answer 15

Eyelid oedema results from obstructed venous & lymphatic drainage
Sx develop as a consequence of the inflammatory exudates extending into the orbit
Leads to soft tissue swelling resulting in ↑orbital pressure

Question 16

What are the Sx of orbital cellulitis?

Answer 16

Eyelid oedema
Chemosis
Tenderness
Fever
Erythema
Orbital Signs: Proptosis, gaze restriction, blurred/double vision
↑Intra-Ocular pressure
Headache

Question 17

How is pre-septal/orbital cellulitis investigated?

Answer 17

CT sinus & orbits w/contrast

Question 18

How is pre-septal/orbital cellulitis treated?

Answer 18

Co-Amox

IV Ceftriaxone

Question 19

Where is pre-septal cellulitis located?

Answer 19

Anterior to the orbital septum

Eyelid oedema in the absence of orbital signs

Question 20

What are the causes of painful visual loss?

Answer 20

Acute glaucoma
Chemical/mechanical injury
Acute uveitis
Endopthalmitis

Question 21

What are the causes of painless visual loss?

Answer 21

Central retinal artery/vein occlusion
Retinal detachment
Massive vitreous haemorrhage
Alcohol induced
Optic neuritis