Eye Flashcards
Leucokoria: Clinical Presentation (Cp)
White pupil
Leucokoria: Differential Diagnosis (DD)
Congenital cataract, Retinoblastoma
Leucokoria: First Step
Refer immediately (vvvvvvvvvvvimp)
Retinopathy : Risk Factor
Prematurity
Retinopathy of Prematurity: High Flow Oxygen
Vasoproliferative scarring and blindness
Retinopathy of Prematurity: Treatment (TTT)
Laser
Retinoblastoma: Incidence
Rare, most common malignant intraocular tumor
Retinoblastoma: Clinical Presentation (Cp)
Leukocoria, Strabismus
- most common intraocular tumor in children
- Leukocoria (white cornea or Cat’s eye)
-strabismus - initial: US (intraocular calcification)
- best dilated indirect
ophthalmoscopic examination under anesthesia
Retinoblastoma: Investigation (Inv)
CT (NO BIOPSY…SPREAD)
Retinoblastoma: Treatment (TTT)
Surgery, good prognosis
Corneal Abrasion: Symptoms
Pain, tearing, photophobia, decreased vision
Corneal Abrasion: Investigation (Inv)
Fluorescein staining
Corneal Abrasion: Treatment (TTT)
Pain relief and antibiotics
Foreign Body: First Step
Excessive irrigation with saline
Foreign Body: Metal Foreign Body
Emergent removal under anesthesia
Foreign Body: If deeply embedded
Refer
Penetrating Eye Injury: Management
Urgent referral, X-ray, Tetanus vaccine, Antibiotics
Orbital vs. Periorbital Cellulitis: Common Organism
Staph
Orbital vs. Periorbital Cellulitis: Clinical Presentation (Cp)
Erythema, Edema, Chemosis
Orbital Cellulitis: Clinical Presentation
Cannot move eye, diplopia
Periorbital Cellulitis: Clinical Presentation
Normal eye movements, no diplopia
Orbital Cellulitis: Investigation (Inv)
CT (vvvvvvvvvvvimp)
Periorbital Cellulitis: Investigation (Inv)
FBC and blood culture
Orbital Cellulitis: Treatment (TTT)
Admission and IV ceftriaxone and IV flucloxacillin
Periorbital Cellulitis: Treatment (TTT)
Mild: Amoxicillin/Clavulanate; Moderate: Flucloxacillin; Severe: Flucloxacillin and Ceftriaxone 50 mg/kg
Aniridia: Definition
Defect of the iris
Aniridia: Check for
Wilm’s tumor
WAGR Syndrome: Components
Wilms tumor, Aniridia, Genitourinary malformation, Retardation
WAGR syndrome is a rare genetic disorder that stands for:
1. Wilms Tumor: A type of kidney cancer that primarily affects children. 2. Aniridia: Absence of the iris, the colored part of the eye, leading to visual impairment. 3. Genitourinary Anomalies: Various abnormalities of the genitals and urinary tract. In males, this might include undescended testes (cryptorchidism) or hypospadias. In females, it might include streak ovaries or other genital malformations. 4. Intellectual Disability (previously referred to as “mental Retardation”): Developmental delays and intellectual disability of varying degrees.
Congenital Cataract: Most Common Causes
Rubella (cataract, deafness, PDA), Galactosemia
Strabismus: Transient
Common up to 4 months
Strabismus: Time to Correct
1-2 years
Strabismus: Correction Deadline
Before 7 years
Neonatal Conjunctivitis: First Day
Chemical (silver nitrate)
Neonatal Conjunctivitis: 2-5 Days
Gonococcal infection
Neonatal Conjunctivitis: Gonococcal Treatment
Single dose IV ceftriaxone
Neonatal Conjunctivitis: 5-14 Days
Chlamydia (more common)
Neonatal Conjunctivitis: Associated Condition
Pneumonia
Neonatal Conjunctivitis: Investigation
Swab for PCR
Neonatal Conjunctivitis: Treatment (TTT)
Chlamidya
Oral azithromycin 3 days
Nasolacrimal Duct Obstruction: Clinical Presentation (Cp)
Excessive watery secretions
Nasolacrimal Duct Obstruction: Treatment (TTT)
Massage
The appearance differs from conjunctivitis in that the child will not have any discomfort and the conjunctiva remains white. Gentle massage of the lacrimal sac may cause expression of mucus.
90% of nasolacrimal duct obstructions will spontaneously resolve by 12 months of age. Due to this, referrals should wait until the child is 1 year of age.
Nasolacrimal Duct Obstruction: Prognosis
Majority heal spontaneously
Children Conjunctivitis: Most Common Cause
Viral
Children Conjunctivitis: Most Common Virus
Adenovirus
Children Conjunctivitis: Symptoms
Running nose, red eye, clear discharge 2-3 weeks, follicular response, preauricular lymphadenopathy
Children Conjunctivitis: Management
Cool compression, no pad
Photophobia Differential Diagnosis: Look at the Pupil
Normal: Keratitis
Photophobia Differential Diagnosis: Constricted Pupil
Iritis/Uveitis
Iritis/Uveitis: Treatment (TTT)
Steroids
Photophobia Differential Diagnosis: Dilated Fixed Pupil, No Light Reflex
Acute glaucoma
Acute Glaucoma: Symptoms
Sudden onset red painful eye, halos, fixed semi-dilated pupil
Acute Glaucoma: Management
Immediate referral to ophthalmology, IV or oral acetazolamide or pilocarpine
Photophobia Differential Diagnosis: No Photophobia
Conjunctivitis (bacterial or viral)
Herpes Simplex Infection: Clinical Presentation (Cp)
Dendritic ulcer vesicles, gritty watery green, pain, photophobia, lacrimation
Herpes Simplex Infection: Treatment (TTT)
Initial management is with topical acyclovir eye ointment administered five times daily.
, refer to ophthalmology
Herpes Zoster Ophthalmicus: Clinical Presentation (Cp)
Rash involving trigeminal nerve distribution, dendritiform ulcer
Herpes Zoster Ophthalmicus: Treatment (TTT)
Acyclovir
Subconjunctival Hemorrhage: Causes
Trauma, severe cough and sneezing
Subconjunctival Hemorrhage: Symptoms
Painless, uniform redness
Subconjunctival Hemorrhage: Management
Usually none, reassure
If doesn’t cross limbus
Acute Glaucoma: Risk Factors
Old age, Female, Hypermetropia, Prolonged time in dark area
Acute Glaucoma: Clinical Presentation (Cp)
Sudden severe unilateral pain, halos around lights, dilated fixed pupil, photophobia, lacrimation, blurring of vision, eye injection
Acute Glaucoma: Investigation (Inv)
Tonometry
Acute Glaucoma: Treatment (TTT)
Emergency room: IV Acetazolamide; Long term: Iridotomy
Acute Glaucoma: Drug to Avoid
Atropine
Open Angle Glaucoma: Clinical Presentation (Cp)
Bilateral loss of peripheral vision
Open Angle Glaucoma: Risk Factors
DM, Myopia, Elderly
Open Angle Glaucoma: Fundus Exam
Cupping of optic disc
Open Angle Glaucoma: Tonometry
Increased IOP
Open Angle Glaucoma: Treatment (TTT)
Timolol; Long term: Trabeculectomy
Sudden Unilateral Loss of Vision Differential Diagnosis (DD)
CRAO, CRVO, Amaurosis fugax, Retinal detachment
Central Retinal Artery Occlusion (CRAO): Cause
Emboli
CRAO: Source
Ipsilateral carotid artery
CRAO: Clinical Presentation (Cp)
Sudden painless unilateral loss
CRAO: Ophthalmoscopy
Cherry red spot
CRAO: First Step
Breathing in a bag (increase CO2), Massage (only first 90 minutes)
Ocular massage using a contact gonioscopy lens was performed. Intravenous acetazolamide and topical medications were given to lower the intraocular pressure. An anterior chamber paracentesis was performed, in which 0.1 mL of aqueous humour was removed using a 25 gauge needle via a limbal approach.racgp
CRAO: Treatment if >3 hours
IV acetazolamide (vvvvvvvv imp)
Central Retinal Vein Occlusion (CRVO): Clinical Presentation (Cp)
Sudden unilateral painless loss of vision
CRVO: Fundoscopy
Disk swelling and venous dilatation
CRVO: Treatment (TTT)
No specific treatment
Retinal Detachment: Main Risk Factors
Myopia, DM, Macular degeneration
Retinal Detachment: Clinical Presentation (Cp)
Flashes of light (key word), curtain coming down (vvvvvvv imp), floaters, loss of vision
Retinal Detachment: First Aid
Tilt the head back (vvvv imp)
Retinal Detachment: Treatment (TTT)
Laser photocoagulation
Amaurosis Fugax: Cause
Emboli
Amaurosis Fugax: Source
Ipsilateral carotid artery
Amaurosis Fugax: Sign of
Impending stroke
Amaurosis Fugax: Clinical Presentation (Cp)
Sudden painless unilateral loss of vision, curtain falls down, then sees well again
Amaurosis Fugax: Examination
Murmur over carotid
Amaurosis Fugax: Investigation (Inv)
US for carotid
Amaurosis Fugax: Drug of Choice
Aspirin
Curtain Falling Down Differential Diagnosis (DD)
Retinal detachment (flashes of light), Retinal emboli (murmur over carotid)
Macular Degeneration: Most Common Cause of Blindness
Elderly
Macular Degeneration: Clinical Presentation (Cp)
Slowly bilateral loss of central vision, see lines wavy
Macular Degeneration: Treatment (TTT)
Better to refer
Macular Degeneration: Dry
No treatment
Macular Degeneration: Wet
Laser
Diabetic Retinopathy: Stages
Non-proliferative: control DM; Proliferative: Laser photocoagulation
Diabetic Retinopathy: Screening Frequency
Every 1-2 years
Cataract: Most Important Risk Factor
Age
Cataract: Other Risk Factors
DM, Smoking, Trauma
Cataract: Clinical Presentation (Cp)
Cannot read well at night (key word), cannot see well at daylight (vvvvvv imp)
Cataract: Treatment (TTT)
Phacoemulsion (imp)
Definite - lens
Eye Floaters Differential Diagnosis (DD)
Retinal detachment, Trauma (bleeding), DM (most common cause)
Eye Floaters: Clinical Presentation (Cp)
Black dots moving in front of him
Eye Floaters: Investigation (Inv)
Fundoscopy
Eye Floaters: Treatment (TTT)
Usually none
Pupil Abnormalities Differential Diagnosis (DD): Constricted Pupil
Morphine, Heroin toxicity, Organophosphorus, Intracranial hemorrhage (pontine), Iritis/Uveitis
Constricted Pupil: Morphine Treatment
Give naloxone
Constricted Pupil: Organophosphorus Treatment
Atropine and oximes
Constricted Pupil: Intracranial Hemorrhage (Pontine) Investigation (Inv)
CT is a must
Pupil Abnormalities Differential Diagnosis (DD): Dilated Pupil
Amphetamine toxicity, Ecstasy toxicity, Cocaine toxicity, LSD toxicity, Alcohol withdrawal
Dilated Pupil: Alcohol Withdrawal Treatment
IV diazepam
Dilated Fixed Pupil Differential Diagnosis (DD)
Acute glaucoma, 3rd cranial nerve palsy
Trachoma: Organism
Chlamydia
Trachoma: Most Common Cause of Blindness
Aboriginal people
Trachoma: Prevention
Face wash
Trachoma: Spread Prevention
<20%: treat only contact with azithromycin; >20%: treat whole community
Trachoma: Clinical Presentation (Cp)
Inflammation and scarring of the eye flees
Trachoma: Best Prophylaxis
Wash hands
Trachoma: Treatment (TTT)
Azithromycin (DOC), Surgery
Dacryocystitis: Clinical Presentation (Cp)
Infection of the lacrimal sac, pain, redness, swelling over inner aspect of lower eyelid
Dacryocystitis: Treatment (TTT)
Oral antibiotics, warm compresses; If abscess: incision and drainage
Hypopyon: Definition
Pus in the anterior chamber
Hypopyon: Cause
Post-operative
Hyphema: Definition
Blood in the anterior chamber
Episcleritis and Scleritis: Clinical Presentation (Cp)
Both conditions present with a red eye which may be painful but no discharge; Think Rheumatoid arthritis, Herpes zoster
Episcleritis and Scleritis: Management
Topical corticosteroids or oral anti-inflammatory medications
Episcleritis and Scleritis: Notable Symptom
Painful and no discharge
Sudden Loss of Vision in Elderly: First Investigation (Inv)
ESR (vvvvvvvvvvvvvvv imp, even before CT)
Stye: Clinical Presentation (Cp)
Red painful swelling on eyelid margin abscess
Stye: Management
Hot compression
Chalazion: Clinical Presentation (Cp)
Granuloma of the meibomian in eyelid, painless lump
Chalazion: Management
Hot compression with massage; If large: refer for incision
Blepharitis: Common Organism
Staphylococcus
Blepharitis: Symptoms
Feels like something is in the eye, crust or scale near baseline of eyelid
Blepharitis: Management
Hygiene
Blepharitis may be treated with a combination of antibiotic or steroid drops. Lid scrubs to remove any excess crusting will also help.