Eye Emergencies - Acute glaucoma, CRAO, CRVO, Keratitis, Anterior uveitis, Optic neuritis, Orbital cellulitis, Retinal detachment, Scleritis Flashcards
Eye red flags
Sudden vision changes/with pain
Infection
Foreign bodies
Trauma
Acute glaucoma
-risk factors
-pathophysiology
-presentation
-investigations
-management
Long sighted
Pupil dilated (dark)
Age-related lens growth
IOP
Severe eye/head pain
Decreased visual acuity
Worse in dark room
Hard, red eye
Halo lights
Semi-dilated non reacting
Corneal edema => hazy cornea
N+V
Tonometry - IOP
Gonioscopy - see angle
URGENT REFERRAL TO OPTHAL
Initial
-acetazolamide - reduce inflow
-pilocarpine - contract pupil
-timolol - reduce prod
-apraclonidine - reduce prod, increase outflow
Definitive
-Laser peripheral iridotomy
Central retinal artery occlusion
-pathophysiology
-presentation
-investigations
-management
-DVLA
Eye stroke - thromboembolism (atherosclerosis)/TA
Sudden painless unilateral visual loss
Eye exam - RAPD
Fundoscopy - Cherry red spot, pale retina
Immediate - reperfuse ischemic tissue
-options - ocular massage, dilate retinal arteries/increase blood O2 content/TPA if presented U24hrs
Manage underlying conditions
-arteritis => IV methylpred
-CV risk factors
DVLA notification if there is a complete loss of vision in 1 eye. May be able to drive after adaptation to vision/clinical advice.
Poor prognosis
Central retinal vein occlusion
-pathophysiology and risk factors
-presentation
-investigations
-management
-DVLA
Eye stroke
-CV risk factors
-conditions with hypercoagulability (eg. polycythemia, SLE/APS, clotting disorders)
Sudden, painless unilateral vision loss
Fundoscopy - stormy sunset, widespread hyperemia
-could also be branch retinal vein occlusion (less widespread), but due to blockage at AV crossings
Conservative
Treat if vision worsening
-antiVEGF agents - prevent formation of leaky new vessels
-laser photocoagulation - destroy neovascularisation
DVLA notification if there is a complete loss of vision in 1 eye. May be able to drive after adaptation to vision/clinical advice.
Keratitis
-causes
-presentation
-management
-complications
Inflammation of the cornea, can be sight threatening
Bacterial - Saureus, Paeruginosa in contact users
Viral - HSV
Amoebic - acanthamoebic keratitis (soil, contaminated water)
Fungal, parasitic
Red eye, pain
Photophobia
Gritty
Hypopyon (fluid level seen)
Contact lens users => refer to eye specialists to rule out keratitis (slit lamp needed)
Stop contacts
TOP ABx (quinolones)
Pain - cycloplegic
Corneal scarring
Perforation
Endophlthalmitis
Visual loss
Anterior uveitis
-pathophysiology
-presentation
-associated conditions
-management
Inflammed iris and ciliary body - HLA B27 link
Acute
Eye pain, photophobia, red eye
Blurred
Tears
Visual acuity can be affected
AS
Reactive
UC/Crohns
Bechet
Sarcoidosis
Urgent eye review
Cycloplegics - dilate pupil, relieve pain
CS eye drops
Optic neuritis
-causes
-features
-investigations
-management
-prognosis
Most common - MS
DM, syphilis
Unilateral decrease in acuity - hours/days
Red desturation
Pain worse on eye mv
RAPD
Central scotoma
MRI brain, orbit gadolinium contrast
High dose CS
If 3+ white matter lesions found on MRI => may develop MS
Orbital cellulitis
-pathophysiology
-risk factors
-how to differentiate from orbital and preseptal
-presentation
-investigations
-management
Infection of fat and muscles behind orbit septum
Children 7-12
Past sinus infection
Lacking Hibs vaccination
Recent periorbital cellulitis/ear/facial infection
NOT FOUND IN PRESEPTAL - Reduced acuity, proptosis, pain with eye mv
-eyelid edema
-red swollen eye
WBC and CRP high
Eye exam for above findings
CT contrast - inflammed orbital tissue deep to septum
Blood culture - Strep, Saureus, HiBs
Admit IV Abx
Retinal detachment
-pathophysiology
-risk factors
-presentation
-management
Retina detaches from epithelium
DM - neovascularisation scar tissue => traction
Myopia - retina stretched more
Age
Past surgery/trauma
New onset floaters/flashers
Sudden painless, progressive field loss - curtain
Macula involvement - central visual acuity lost
Peripheral involvement - peripheral visual acuity lost
Optic nerve involvement - RAPD
Fundoscopy - red reflex lost if break big
New onset flashes/floaters => urgent referral (U24hrs) for assessment
Surgery
-Replace vitreous humour
-Scleral buckling
-Pneumatic retinopexy
-Cryotherapy
Scleritis
-pathophysiology
-risk factors
-presentation
-how to differentiate from episcleritis
-management
Full thickness inflammation of sclera
RA, SLE, sarcoidosis, GPA
Red eye
Pain
Watery
Photophobia
Gradual decrease in vision
When pressure applied
-episcleritis - vessels mv
-scleritis - no mv
Phenylephrine drops
-episcleritis - blanched
-scleritis - no blanching
Same day assessment
PO NSAID
PO GC if severe
Immunosuppressants to treat underlying associated disease
