Eye Conditions Flashcards
Opthalmic shingles
Must do snellen. Stain to show ulcers. N pain and preceding hypersensitiv. If lesions on top of nose then eye likely inv.
shingles- dormant vricella in sensory ganglia reactivs and spreads cross dermatome as shingles.
-RF- age, trauma, imm comprom
-px- pain and neuraglia in CN V1 dermatome precedes blistering inflamed rash
-complics- post herpatic neuralgia.
-tx- aciclovir, strong analgesia. Or famciclovir.
Blepharitis
Lid swell due to chronic infec eyelash follics.
-inflamm causes- staph, seborrhoeic dermatitis, rosacea.
-px- burnin itchy red eye margins. Lash scales.
-tx- eyelid hyg. Baby shampoo.
Erythromycin in kids with blepharokeratitis.
Stye and meibomian cyst
Inflammatory lid swelling.
Lash follic infec, us staph. May6 inv sweat and sebum glands.
-px- point outwards, can be v inflamed.
-tx- warm compress 10 mins sev times a day.
Abcess of meibomiam glands less comm. point inwards. Leave resid meibomian cyst swelling when subside. Can aff vis.
-cyst tx- incis and curretage.
Ectropion and entropion.
-ectropion-
Lower lid eversion. Causes eye irrtat, watering, and expos keratitis.
Assocs- age, facial plasy.
Tx- plastic surg, upper lid implant.
-entropion-
Lid inturning typ due to degen of lower lid fascial attachments and their muscs. Corneal irrit.
Tx- taping lower lids to cheek, botox lower lid, surg.
Giant cell (temporal arteritis)
Medium to large vess systemic vasculitis. Us in eld.
-px- new headache, malaise, jaw claudication, tneder scalp and temporal As, neck pain, monocular vis loss.
Assoc with PMR (girdle morn stiff).
-ix- ESR and CRP. Temporal A biop in 1 wk of starting prednisolone.
-tx- other eye at risk til sterpids given. Start prednisolone fast. Tail off as ESR and symps settle.
Orbital cellulitis
Sight and life threatening emerg.
Infec of soft tiss post to orbital septum.
Spread us via paranasal sinus infec, or eyelid/dental/ext ocular infec.
-px- ocular pain, eyelid swell, affs EO muscs and fatty tiss in orbit, can spread to cav sinus. Fever, reduc eye mobil, painf eye movem, conjunct swell, proptosis.
-orgs- staph aureus or strep pneum.
-complics- abcess. Extra orbit extension. Vis loss due to optic neuritis or central retinal vein or art occlus. IC inv- meningitis, brain abcess, thrombosis in dural or cav sinus.
-tx- admit, CT, ENT, AB.
Other
Dacrocystitis- tear duct abcess
Block tear duct- comm in babies
Schirmers test for dry eye
Pterygon
Keratitis (corneal inflamm white area)- ant chamber infec comm due to contact lens. Cotton wool spots.
Penet inj- can cause pupil dilat.
Fluoroscein- ulcerat shows green under blue light.
Herpes dendritic ulcers.
Anisocoria uneq pupils, often congenital.
Oval pupil in acute glaucoma, asymm in penet inj.
Papilloedema- blurr optic disc, RICP.
Red reflex- do at birth and 6 wk. Congenit cataracts. Assoc with CA. Tx fast can save some sight.
Conjunctivitis
-px- conjunctiva red and inflamed. Hyperaemic vessels may be moved over the sclera by gentle press on globe. Dx by ruling out sight threatening feats.
Eyes itch, burn and lacrimate.
Often bilat with disch sticking lids together.
Allergic- cobblestone eyelid inside. Itchy, sneeze etc. Serous disch not purulent like infec. Seasonal.
-ix- acuity, pupil resp, corneal lustre unaffected. Cultures req if susp NG/CT, neonatal, or recurr and not resp to therap.
-non infectious causes- allergic most comm, toxic, AI, neop, contact lens.
-infectious- non herpetic viral most comm (serous disch), mostly adenovir. Bacterial purulent disch more promin, esp in gonococcal infec.
-tx- us self lim in 4/5d.
Mostly viral- artif tears and topical anti hist. Hyg.
Bact also self lim. AB drops can help, and req for STI/contact lens/imm comprom/sev sys ill/excluded from school.
Chloramphenicol 0.5% drops 2-3 hourly. Or fusidic acid drops.
For allergic- anti hist drops, sodium cromoglicate drops, steroid drops.
Always remove contact lens. Dont share towels.
Retinopathy
Haemorr, microaneur, hard exudates.
Arteriopathic or hypertensive.
Arteriopathic- eg arteriovenous nipping where A nips V where they cross.
Hypertensive- art vasoconstric an leakage, prod hard exudates, macular oedema, haemorr, papilloedema.
Thick shiny A walls appear like wires. Infaraction of superfic retina causes cotton wool spots and flame haemorr.
Retinal ahemorr seen in leukaemia. Retinal new vess format and comma shaped conjunct haemorr in sickle cell. Optic atrophy in pernic anaemia. Roth spots retinal infarcts in infec endocarditis.
-causes-
Metab dis eg DM, wilsons (kayser fleischer), hyperthyr.
Granulomatous disorder eg TB, sarcoid, leprosy.
Collagen and vascultic dis.
HIV/AIDs
Keratoconjunctivitis/sjogrens.
Sudd painless loss vis
Qs to ask- headache, painful eye movem, lights/flashes preceding, curtain descending, poorly controlled DM and vitreous haemorr.
-optic neuropathies- monocular loss with central scotoma, aff pupil defects unilat, dyschromatopsia, papillitis to optic atrophy.
-ant ischaemic optic neuropathy. And non arteritic.
-temporal arteritis.
-optic neuritis
-central retinal A occlus- vis loss within secs. Often TE. Aff pupil defect. White retina with cherry red spot at macula.
Tx- ocular massage, aqueous remov. LT CVS RF reduc.
-transient vis loss causes- vasc (TIA, mig), MS, subacute galucoma not always painful, papilloedema.
-retinal V occlus- FLAME haemorr. Less sudd vis loss than artery occlus.
-central retinal V occlus- at lev of optic N. unilat sudd onset painless blurred vis. STORMY sunset hyperaemia and haemorr.
-branch retinal V occlus- asymp if macula not aff. Vis deficit corresp to area of occlus.
Non ischaemic- better acuity and prog.
Ischaemic- cotton wool, swollen ON, macular oedema, neovasc tortuous.
-vitreous haemorr- from neovasc, retinal tears, retinal detach, trauma. Extravasat of blood prods vitrous floaters.
-acute glaucoma- often painful.
Retinal detach
Migraine.
Grad vis loss
Cataract Macular degen Glaucoma DM retinop HTN Optic atrophy Slow retinal detach Choroiditis
Glaucoma
Chronic open angle
Optic neuropathy with death many retinal ganglion cells and their optic N axons. IOP may be raised. Vis field loss.
Optic disc cupping.
-ix- IOP, central corneal thickness, periph ant chamber anal, vis fields, ON ass with slit lamp and fundosc.
Screen high risk. Tonometry, vis fields, OD.
-tx- lifelong monit. Sight cant be restored once lost.
Drugs- prostaglandin analogues, BB, alpha agons, carbonic anhydrase inhibs, miotics eg pilocarpine, sympathomimetic eg dipivefrine, fixed dose combin drops.
Laser therapy.
Surg- trabeculectomy.
Cataracts
Opacity in lens
-causes- age, genet, DM, steroid, smok, alc, sun, trauma, radiotherapy, HIV.
-types-
Nuclear- changed refrac index. Dull colours.
Cortical- wedge opacities, mild aff on vis.
Post subcapsular- faster prog, cause glare.
-px- blurr vis, reduc judgem, bilat cause grad vis loss, dazzle, monocular diplopia, squint/white pupil, nystag in kids.
-surg- phacoemulsion and intra ocular lens implant.
-preven- sunglasses, reduc ox stress, stop smok.
glaucoma
Acute closed angle
-px- preceding blurr vis, haloes arnd lights, at night.
Pain, NV, vis loss, corneal oedema, redness, puil fixed and dilat, eye feels hard.
-cause- blocked aq drain from ant chamber via canal of schlemm. Worsened by pupil dilat at night. IO press rises to over 60.
-mx- pilocarpine drops plus acetazolamide IV. Analgesia, anti emetic. Monit press. Mannitol. Topic ster and anti HTN drops.
Laser periph iridectomy once IO press reduced.
