EYE Flashcards
**Acute Angle Closure Glaucoma
Normal value?
Glaucoma value?
CF: KEY SIGN
Management:
- ↑Intraocular pressure (IOP) > 30mmHg
(norm = 15-20)
a) Primary = anatomical predisposition e.g. narrow angle (Asians), thin iris, thick lense
b) Secondary = traumatic haemorrhage→ pushes post chamber anteriorly
CF: Onset occurs over hours-days, SEVERE painful eye, blurred vision, coloured haloes around lights
- PUPUL FIXED AND DIALATED
Headache
IVX: Slit lamp, shallow anterior chamber, semi detached and non-reactive pupil.
Management: URGENT REFERAL OPTHALMOLOGY
Avoid eye patches and dark rooms
- 1st IV Acetazolamide 500mg - decrease aqeuous formation - carbonic anhydrase
+ maybe steroids - Topical B blocker Timolol
- 2nd Topical Pilocarpine (miosis opens closed drainage angle)
Cataracts
Leading cause of Blindness worldwide
RF:
CF:
Treatment: which drops
- Opaque protein deposits onto lens
Leading cause of blindnes worldwide
RF: over 80s, smoking, increased UV exposure
CF: gradual onset, blurred vision, decreased acuity, faulure to recognise faces, trouble with nocturnal vision
- Haloes = opacity
Children may get white pupil and lazy eye
IVX: fundoscopy and slit lamp Red light reflex absent if late Lens appears brown or white - Tx: Mydriatic drops or sunglasses -> refer to optho Surgery: Measure curvature of corena and then --> Phaecoemulsion and replaced with Intra-ocular lens implant.
If congenital must act within 4 weeks
Stop smoking + use sunglasses
Corneal Ulcers Aka Ulcerative Kernatitis
RF:
CF:
IVX:
Management:
Inflammation of cornea
Causes: Bacterial Herpitis, Fungal or Vasculitis
RF: contact lenses, trichiasis (abnormally position eye-lash), ectropian (droopy eye lid), steroid eye drops
CF: Very painful eye –> squint
Red eye, tearing and watery eye, decreased visual acuity, photo-phobia
IVX: Refer to opthal
HIV TESTING
Slit lamp with fluorescence
Management: Chloramphenicol eye drops gram +ve
Ofloxacin gram -ve
Cefuroxime drops with Gentamicin
Complications: Herpes Simplex Dentritic corneal ulcers (can cause blindness) - tx with Aciclorvir
Stye
1. Chalazion
- Hordeolum
- Chalazion: Non-infective meiobomian cyst, most common lid lump
- Gradually enlarging round firm lesion, yellow and immobile when lid inverted.
Non-tender. - Horsdeolim: Infective abscess
TENDER on palpation, yellow swelling at base of eye-lash
Diagnosis: Refer if lump causes visual disturbances or cellulitis
TX: Chalazion: warm compress and massage lids
Hordeolum: Abx Top chloramphenicol or flucloxacillin if cellulitis
Conjunctivitis
- Allergic
- Infective
Viral: Adenovirus, Bacterial: Staph
Non-infectious - allergic or irratitive
CF: Red eye, bilateral, irritation, gritty, sticky
Exam: assess for orbital cellutitis and discharge
Opthalmascope
Refer if severe prurulant discharge
Culture if neonatal or STI suspected
Management:
Viral: TOP artificial tears
Bacterial: Chloramphenicol topical = antibiotic
Allergic: Cold press and antihistamines and Sodium Chromoglicate
Occular Foreign bodies
- Red painful eye- watery
WORSE ON MOVEMENT
Blurred vision, photophobia, signs of abraision (rust ring)
Penetrating corneal injury: Sudden onset of pain after truama and air bubbles seen under cornea + leaking humor
IVX: Functional eye exam, slit lamo, Evert eyelids and look for abrasions
Fluroscien shows any lacerations
URGENT REFER TO OPTHAL for high risk
Abraision: Abc topical chloramphenical
Remove foreign body with topical anaesthetic
Occular trauma
Penetrating corneal injury: Sudden onset of pain after truama and air bubbles seen under cornea + leaking humor
Penetrating injury: give tetanus shot and REFER URGENT
Diabetic Retinopathy
Non Proliferative: Micro-aneurysms (dots) and haemorrhages (flames) and hard exudate (yellow patch)
Proliferative: Fine new vessels appear
Maculopathy: Oedema
Develops from mild non-proliferative disease –> Severe–> Proliferative with neurovascularisation and –> Maculopathy
Management: Address DM, aim for BP <130/80, lipid control, stop smoking
Refer to opthal for laser treatment + Vitrectomy
Hypertensive retinopathy
- BP accelerates atherosclerosis in retinal vessels → chronic HTN then leads to retinal changes.
- Ateriole narrowing or tortuosity = silver wiring
- AV nipping
- Cotton-wool exudate
- Papilloedema
TX: control BP
Acute Anterior uveitis
HLAB27?
Key clinical Feature:
- Uvea = iris, ciliary body and choroid (pigmented area of eye)
HLAB27 = Anky spond, reachtive arth, UC/CF. bechets
CF: Acute onset red eye, blurred vision and photophobia- small pupil then becomes IRREGULAR and DIALATES
Painful consensual reaction
+ Headache
IVX: Slit lamp + leukocytes visible in anterior chamber
Management: Refer Urgently to Opthal, Cyclopegics to dialate pupil
Topical Atropine
Steroid eyedrops 1% prednisolone
Ectropian
-Eyelid goes outwards
Causes: involution or cicatricial, secondary to ocular irritation
TX: lubricating eye drops, botox injections and surgery
Entropian
Eyelid goes inwards Problems occur due to conjunctival & corneal exposure and irritation
Appearance:
Asymptomatic or
Itchy, irritated red watery eye.
Patient may complain of DRY EYE (exposure keratopathy
Surgery only corrective measure
Blepharitis
- Blepharitis occurs when glands near the base of the eyelashes become clogged, causing irritation and redness
treat with hot compress and drops
Epislceritis
- Red eye a/w tearing and photophobia (mild)
Classically NOT PAINFUL
TX: NSAIDS
Sleritis
white bit
- Inflamed red sclera
- PAIN and photophobia
- Autoimmune eg arthritis or sleeping or infective
