Eye pathology spot diagnosis Flashcards
What is used to measure intraocular pressure + what is a normal intraocular pressure?
- Goldmann applanation tonometry
- 10-21 mmHg
Basic surface eye anatomy
Spot diagnosis + management
- Symptoms: headache, vomiting, pain, redness, blurry vision, and halos
- Red sclera, eye is glossy/opaque, fixed dilated pupil
- Acute angle closure glaucoma (AACG)
Treatment:
1. IV acetazolamide
(+ topical pressure-lowering drops - timolol, pilocarpine)
2. Urgent referral for laser peripheral iridotomy
Open-angle glaucoma often looks like a normal eye, how would you measure the iridocorneal angle + what treatment would you give?
- Gonioscopy - to measure iridocorneal angle
Management of open-angle glaucoma:
1. Prostaglandin analogues - latanoprost
2. Topical beta-blockers - timolol
3. Surgery - 360 selective laser trabeculoplasty
Spot diagnosis + management
- Symptoms: pain, photophobia, lacrimation, blurry vision
- Stained blue with Fluorescein stain, can see green pattern
- Herpes simplex keratitis (dendritic corneal ulcer)
- Treatment: Aciclovir eye drops
Spot diagnosis + Risk factor + Management
- Symptoms: blurry vision, bloodshot eye, photophobia, lacrimation
- Opacity in cornea
- Corneal ulcer (aka. keratitis) - often in contact lens wearers
Treatment:
- Bacterial keratitis - Fluoroquinolone eye drops (levofloxacin)
- Viral keratitis (HSV) - Topical aciclovir
- +/- topical corticosteroids (for inflammation)
Spot diagnosis + Management
- Symptoms: trigeminal nerve distribution, fever, eye pain, redness, decreasing vision
- Shingles spread to eye
- Herpes zoster ophthalmicus
- Treatment: Oral aciclovir 5 times a day for 7 days
Spot diagnosis + Management
- Symptoms: cloudy vision, faded colours, can’t see well at night
- Cloudy patches over lens
- Cataracts
- Treatment: Lens removal and replacement (surgery)
Spot diagnosis + usual cause + Management
- Absent/very weak pupillary light reflex
- Pupils constrict and converge normally
- Pupils do not dilate with mydriatic drops
- Argyll-Robertson pupil - pupils are small/constricted and irregular + light-near dissociation + resistant to pharmacological dilation
- neurosyphilis is usually the cause
- Treatment: IV benzylpenicillin 10-14 days infusion (if pen allergic - ceftriaxone)
Spot diagnosis + Management
- unilateral dilated pupil
- poor/absent light reflex
- slow constriction to accommodation + redilates very slowly
- Holmes-Adie pupil
- Treatment: Pilocarpine drops (miotics) +/- tinted lenses (to reduce discomfort in bright environments.)
Spot diagnosis + Management
- Symptoms: swelling, redness, irritation
- Redness of bits of sclera
- Episcleritis
- Treatment: artificial tears/lubricating eye drops + oral NSAIDs
Spot diagnosis + Management
- very painful and tender to touch
- pain on eye movements
- Redness all over eye + pain on eye movements
- Scleritis
- Treatment: oral NSAIDs +/- oral prednisolone (for severe cases) + urgent ophthal review
Spot diagnosis + Management + anatomy of pathology (anterior or posterior to orbital septum)
- swelling, tenderness, very painful
- decreased vision, painful and restricted eye movement
- generally unwell (headache, malaise)
- Infection within the orbit (posterior to the orbital septum) / infection of soft tissue in eye socket
- Orbital cellulitis
- Treatment: IV antibiotics (broad-spectrum) +/- surgical drainage for abscesses (hospital admission)
Spot diagnosis + Management + anatomy of pathology (anterior or posterior to orbital septum)
- eyelid swelling, redness, tenderness
- no vision changes, no pain on eye movements
- Infection of tissues anterior to the orbital septum - eyelid and skin around eye
- Periorbital cellulitis
- Treatment: Oral antibiotics (co-amoxiclav 7 day course)
(if pen. allergic: clarithromycin or doxycycline)
Spot diagnosis + Management
- lacrimation, itchiness, burning, discharge
- Red eyes, yellow discharge
- Bacterial conjunctivitis
.
Management: - usually self-limiting within 5-7 days
1. Chloramphenicol eye drops (topical antibiotics) - until 48hrs after symptoms resolve
2. if allergic to chloramphenicol, give fusidic acid - useful for Staph. A infections
(chloramphenicol (until 48hrs after symptoms resolve) or fusidic acid (5 days))
Description + Diagnosis + Management
- Symptoms: sore eyelids, gritty, flakes or crusting
- Crusting of eyelids, some redness associated
- Blepharitis
Treatment:
1. Lid hygiene (warm compress) + artificial tears (for dry eye)
2. +/- topical or oral antibiotics (doxycycline) for severe cases
Spot diagnosis + Management
- hard swelling, tender, watery eyes
- Cyst on eyelid
- Meibomian cyst (chalazion) - blocked oil gland
- Treatment: Warm compress and ocular massage
Causes of red eye (painless and painful)
General management of eye conditions, what can you give if
- general eye discomfort
- relax the eye muscles/dilate pupil
- inflammation
- lubricating eye drops/artifical tears
- cycloplegic drops (e.g., cyclopentolate 1%) - pain relief and to prevent synechiae
- topical steroids (eg. prednisolone acetate 1%, dexamethasone implant)
Spot diagnosis + Management
- clear watery discharge, burning
- enlarged lymph nodes in front of ear / under jaw
Viral conjunctivitis
- Management: lubricating drops/artifical tears + cold compresses + good hygiene
Spot diagnosis + Management
- Red, itchy eyes
- Pt has atopic hx (asthma)
- experiences red eyes seasonally
Allergic conjunctivitis
Management:
- Olopadatine (antihistamines + mast cell stabiliser) eye drops
- If systemic symptoms - oral antihistamines (loratidine)
Spot diagnosis + Management
- blurred vision, photophobia, distorted pupil
Anterior uveitis - hazy cornea
Management:
- Urgent ophthal review
1. Topical steroids - Prednisolone acetate 1% eye drops
2. Cyclopentolate 1% eye drops (pain relief - dilates pupil)
Spot diagnosis + management
- pain, foreign body sensation, photophobia, tearing, blurred vision
Corneal abrasion - caused by trauma (eg. foreign object, contact lens misuse, fingernail)
Management:
- Topical antibiotic drops (eg. chloramphenicol) - to prevent infection
- lubricating drops - for discomfort
- +/- analgesia
(review if symptoms persist)
Spot diagnosis + management
- painless red eye, no visual disturbance
- happened suddenly when at gym / Valsalva maneuver / trauma
Subconjunctival haemorrhage
Management:
- Reassurance - self-limiting in (2 weeks)
- +/- artificial tears
(if recurrent –> check BP and INR)
Spot diagnosis (LEFT / RIGHT) + management
- foreign body sensation, lacrimation, photophobia, redness
- works with dust/metal
- LEFT –> corneal foreign body
- RIGHT –> conjunctival foreign body
Management:
- Irrigation with saline (1st line)
- Removal –> cotton bud (if visible and non-embedded) OR anaesthesia + needle (if superficial)
- Antibiotic drops (chloramphenicol) if corneal involvement
- Fluorescein stain to check for corneal abrasion
- Urgent review if suspected penetrating injury
Spot diagnosis + management
- severe pain, vision loss, misshapen eye
- occurred due to trauma
- RAPD
Globe rupture - peaked / teardrop-shaped pupil
Management:
- Urgent ophthal review
- DO NOT apply pressure to eye –> shield the eye
- IV broad-spectrum antibiotics + analgesia
Spot diagnosis + management
- pain, vision loss, red eye, photophobia, hypopyon
- post-cataract surgery
Endophthalmitis
Management:
- Urgent ophthal review
- Intravitreal antibiotics
