Eye Disease 1+2 Flashcards
What should you include in the history for acute red eye?
- Redness: degree, distribution
- Pain: grittiness, itchy, stabbing, throbbing
- Discharge: purulent, mucoid, watery
- Photophobia (light sensitivity)
- Flashing lights and floaters
- Blurred vision
What diagnostic tests can you do for acute red eye/loss of vision?
- Snellen’s chart best corrected visual acuity (uses glasses/ contact lenses)
- Direct ophthalmoscope, Slit lamp + Volk lens: fundus examination
- Fluorescein dye: corneal diseases
What is the differential diagnosis for acute red eye?
- Infective conjunctivitis
- Allergic conjunctivitis
- Corneal abrasion
- Acute anterior uveitis
- Scleritis
- Acute Angle-closure Glaucoma
- Orbital cellulitis
What are the clinical features of Infective Conjunctivitis?
- Gritty
- Red
- Discharge (purulent/watery)
What are the treatment of Infective Conjunctivitis?
- Topical abx
What are the clinical features of Allergic Conjunctivitis?
- Itchy
- Red
- Discharge (mucoid/watery)
- Acute
- Lid swelling
- Conjunctival swelling (chemosis)
What is the treatment of Allergic Conjunctivitis?
- Topical anti-histamine
- Avoid allergen
- Mast cell stabilisers
What are the clinical features of Corneal abrasion?
- Pain
- Watering
- Blurred vision
- Epithelial defect (fluorescein dye)
What is the treatment of Corneal abrasion?
- Topical abx
- Analgesia (ie. topical cyclopegics, oral paracetemol)
What are the clinical features of acute Anterior Uveitis?
- inflammation of iris and ciliary body*
- Pain
- Watering
- Photophobia
- +/- Blurred vision
- +/- Floaters
- May have prev. hx
- Redness
- Cells in the anterior chamber
- Hypopyon -> white fluid level in the anterior chamber of the eye
- Small, irregular pupil (posterior synechiae -> iris adherent to the anterior surface of the lens)
What is the treatment of acute Anterior Uveitis?
- Topical steroids
- Dilating drops (mydriatics)
- > prevents adherence of the lens to the pupil
What are the clinical features of Scleritis?
- VV painful
- Redness (deep scleral vessels)
- Nodule (does not move over sclera)
- VV tender
What is the treatment of Scleritis?
- Systemic steroids
What are the clinical features of acute Angle-closure Glaucoma?
- VV painful
- Redness (full eye)
- Blurred vision
- Nausea + vomiting
- Hazy cornea
- Fixed mid-dilated pupil
- Hard eyeball (on palpation)
- Raised IOP
What is the treatment of acute Angle-closure Glaucoma?
- Lower IOP
- > Acetozolamide (decreases production of aqueous humour in the eye)
- Constrict pupil
- > Pilocarpine (muscarinic agonist (miotic))
- > pulls iris away from trabecular meshwork -> allows flow of fluid in the eye
- ?Surgery
- > peripheral iridotomy
What are the clinical features of orbital Cellulitis?
- V painful
- > (not as much as scleritis and acute angle-closure glaucoma)
- Redness
- Blurred vision
- Diplopia (double-vision)
- Reduced eye movement
- Proptosis
- Malaise (unwell)
- Pyrexia
What is the treatment of orbital Cellulitis?
- REFER
- IV abx
- CT scan
- > to check if there is a sub-periosteal abscess
- Drainage of pus
What should you ask in a pt. history regarding loss of vision?
- Unilateral/bilateral?
- Onset: sudden/gradual
- Type of vision loss: blurred/distorted/black
- Any associated symptoms? (pain, redness, discharge)
What Anciliary tests are you able to do for loss of vision?
- Amsler Chart: macular pathology
- Ishihara Colour Test: colour vision
- Traditional confrontational visual field test: (cover same eye as pt., bring finger into view and ask if they can see it coming into view)
- Automated test (Autorefractor): tests for refractive errors
- Fluorescein Angiography: fundus examination
- Optical Coherence Tomography: high-resolution, cross-sectional images of the retina
What is the differential diagnosis for sudden complete loss of vision?
- Central Retinal vein or artery occlusion
- Anterior Ischaemic Optic Neuropathy:
- > giant cell arteritis
- > non-arteritic
What is the differential diagnosis for gradual loss of vision?
- Cataracts
- > clouding of the clear lens of the eye
- Glaucoma
- > damage to the optic nerve
- Age-related Macular Degeneration (dry (90%), wet (neovascular)
- Diabetic Retinopathy
What is the management of Central/Branch Retinal Artery occlusion?
Identify + treat CV risk factors
What is the management of Central retinal vein occlusion?
- Identify and treat risk factors (ie. CV, elderly)
- intravitreal anti-VEGF
- > to prevent new vessel formation
What are the clinical features of GCA (anterior ischaemic optic neuropathy)?
SYMPTOMS
- loss of vision (SUDDEN)
- headache (new or changing)
- loss of appetite
- scalp tenderness (nb. when brushing hair)
- pain on chewing (jaw claudication)
SIGNS
- tenderness of superficial temporal arteries
- raised inflammatory markers
What is the management of GCA (anterior ischaemic optic neuropathy)??
- High-dose systemic steroids
What is the treatment of non-arteritic anterior ischaemic optic neuropathy?
- Painless compared to GCA!!*
- called “non-arteritic” bc lack of blood flow is not due to inflammation of the vessels*
- identify and treat risk factors!!
What are the symptoms of Cataracts?
= gradual opacification of the lens
- loss of vision
- dazzle/glare
- > esp. from headlights when driving at night
What is the management of Cataracts?
- Surgery
phacoemulsification with intra-ocular lens implant
What are the symptoms of Glaucoma?
- asymptomatic
- gradual loss of peripheral field of vision
What is Glaucoma?
- Optic neuropathy/nerve damage typically associated with raised IOP
- Classification: open or closed angle, chronic or acute
What are the clinical features of Glaucoma?
- Raised IOP
- Visual field defects
- Optic disc damage
What is the management of Glaucoma?
- Topical treatment: Acetazolamide (reduce IOP), Pilocarpine (constrictor eye drops (miotics) -> pulls iris away from trabecular meshwork)
- Surgery (trabeculectomy) = gold standard
What are the symptoms of Age-related Macular Degeneration?
- Progressive loss of central vision
- Distorsion
What are the clinical features of Age-related Macular Degeneration?
- Distorsion on Amsler chart
- Drusen
- Pigment epithelial changes
What is the pathology of Dry Age-related Macular Degeneration?
- Drusen deposits between the pigment epithelial layer of the retina and Bruch’s membrane
- Atrophy
What is the management of Dry Age-related Macular Degeneration?
- Low vision aids
- Registration
- > (as partial or full sight impairment on CVI)
What is the pathology of Wet Age-related Macular Degeneration?
New choroidal vessel formation
-> abnormal blood vessels which are more prone to leak fluid or blood into the macula
What are the investigations for Wet Age-related Macular Degeneration?
- OCT (Optical Coherence Tomography) (gold standard) -> macular oedema
- Fluorescein Angiography
What is the management of Wet Age-related Macular Degeneration?
- Intravitreal anti-VEGF injections
- Low vision aids
- Registration
- > (as partial or full sight impairment on CVI)
What are the investigations for Diabetic Retinopathy?
- Fluorescein Angiography
- OCT
What is the management of Diabetic Retinopathy?
- Intravitreal anti-VEGF (if macular oedema)
- Laster - panretinal photocoagulation
- Low vision aids
- Registration
- > (as partial or full sight impairment on CVI)
