Eyeballs Flashcards
Double vision? Concerned?
Test one eye alone - do they still have double vision? Binocular double vision - This is concerning! This means one eye is not moving right
Need an urgent head scan - risk of aneurysm
Retinal detachment? Next steps?
Is their vision intact? 20/30-50 if yes this is more urgent to try and operate and preserve vision. All will need surgery in the next week or so.
Eye discomfort, jaw pain, headache, vision changes in an older person?
High index of suspicion for temporal arteritis - give oral prednisone, and get a biopsy within a week.
Vision required for driver’s license?
20/50 or better in one eye
HSV 1 in the eye?
Look for dendritic lesions - have a little bulb on the end, could also have a geographic lesion
First line treatment for HZV of the eye?
Oral anti-virals, work as well as topicals for the eye, with less risk of ototoxicity
Loss of light differentiation - concerned?
If the patient can’t see light this indicates severe compromise of the ocular tissues this is very concerning.
Classic presentation of acute angle glaucoma?
Pain, N/V, cloudy cornea, red eye, hard eye (on light palpation), decreased vision, and non-reactive dilated pupil
Steroid use is not associated with acute increased pressure more chronic
Hyperopia vs Myopia?
Farsighted - hyperopia
Nearsighted - myopia
Severe photophobia is most characteristic of?
Iritis - ciliary flush (not limbic sparing - opposite of conjunctivitis)
When can’t you dilate the pupil?
Usually use epinephrine (sympathetic agonist), tropicamide (anti-cholenergeric)
- acute angle glaucoma, neurological injury suspected, lens implant supported by the iris
- will actually help an iritis
Unilateral conjunctivitis moves from one eye to the opposite eye
Usually viral (very contagious) and weepy (not pus, pus is dead WBC)
Lingers in one eye - bacterial, chalmydial.
Allergic - both at the same time
Third nerve presentation?
Down and out eye with aniscoria, and ptosis
Horner’s?
Ptosis, anyhydrosis and miosis (small pupil)
Sections of the eye?
Anterior section (Aqueous humour) = the anterior and posterior chamber Posterior section (vitreous humour) = vitreous chamber
Layers of the eye?
Fibrous layer (sclera and cornea) Vascular layer (choroid, iris, ciliary body) Neural layer (retina - contains pigmented layer and neural layer)
What does the vitreous humour do?
Preserves shape and function, keeps retina attached to the choroid
Retinal detachment is separation of
Neural sensory layer and RPE
Dislocated lens presents
Monocular diplopia
Urgent optho consult if you see?
Corneal ulcer, retinal detachment, acute glaucoma, acute iritis
The uvea contains
The iris, the uvea and the cilliary body
Central retinal vein occlusion looks like on fundoscopy?
Blood and thunder, will be painless, monocular, possibly due to atherosclerosis of the vein in the eye
Renal artery occlusion sign?
Positive swinging flashlight, often painless, severe monocular loss of vision
Try massaging the globe of the eye, decrease IOP, call optho - this is an emergency
Glaucoma definition?
Optic neuropathy involving changes to the structure of the nerve head changing vision - commonly associated with high IOP
Usual flow of Aqueous humour
Ciliary epithelium through the trabecular mesh work, the canal of Schliemann and into the aqueous veins and out into the venous system
Normal IOP?
8-21mmHg
Open angle vs closed angle glaucoma
Open angle is most common - trouble with trabecular network, insidious.
Acute is blockage of drainage is an emergency
Sx of acute angle closure glaucoma
Severe eye pain, headaches, nausea, halos around lights. Hard eye. Can have a fixed pupil
Tx of acute angle closure glaucoma?
Increase outflow - pilocarpine, latanoprost, brimanidine
Decrease production - timolol, topical carbonic anhydrase inhibitor
Can give mannitol
Surgery is the definite solution
Retinal detachment sx?
Painless, sudden onset, flashes of light with floater and curtain of blackness
Blepharitis Patho?
Inflammation of lid margins, either due to S. aureus (crust) or seborrheic (flaky) tearing, itching, thickened red lid margins, warm compress and baby shampoo
What is a hordeolum?
Style - inflammation of an eyelid gland, or eyelash follicle, will localize to the eyelid margin, will usually resolve on own.
Chalazion?
Inflammation of the meibomian gland often preceded by an internal hordeolum, non-tender, if recurrent need to biopsy
Tends to localize to the eyelid margin in the centre and becomes non-painful (unlike a stye)
Pre-septal vs Orbital cellulitis
Pre-septal - soft tissue infection, usually after a local trauma, edema but normal ocular mobility and vision, give abx
Orbital - MEDICAL EMERGENCY - secondary to sinus or facial infections/ trauma, the eye tissues themselves are infected. Proptosis, decreased vision, mobility. IV abx, CT, and abscess drainage
Causes and presentation of conjunctivitis
Viral - one eye then the other, red itchy eye with watery tearing - adenovirus - no tax
Bacterial - more likely to be monocular, green and goopy - S. aureus - give topical abx
Allergic - both eyes at the same time, triggered by something in environment or with nasal congestion
Neonatal - chlamydial usually, this is why we give prophylactic erythromycin
Conjunctivitis always spares the limbus
Subconjuctival hemorrhage?
Don’t worry about it. It looks bad but goes away by itself - from valsalva/ pushing
Episcleritis?
Localized inflammation of the sclera, often in young people, self-limited, oral NSAIDs can help, optho if recurrent for steroids
Scleritis?
Severe destructive vision threatening inflammation of the eye, often seen in women with other inflammatory diseases, severe pain, hyperaemic patches on the eye, treat with prednisone
Pinguecula
Benign subepithelial deposit of tissue, no concerns seen in older people, lots of sun exposure.
Pterygium
Encroachment of epithelial tissue cover the cornea, excise if causing vision problems due to growth.
HSV in the eye?
Classic dendritic lesions with bulbs at the end.
HZV of the eye
Look for vesicles elsewhere, give the, valcyclvir right away.
Welder flash burns
A type of photokeratitis - very painful, but only supportive care and limited use of topical anesthetic (due to risk of corneal ulcer)
Tx for corneal abrasion?
Topical abx, patch and see - most clear within 2 days. If not then be concerned for an ulcer, which is secondary infection. Ask about contact lenses
Corneal ulcer IS AN EMERGENCY
Sx of uveitis?
Ocular aches or brow pain , redness, photophobia, decreased vision - often idiopathic or immune, refer to optho
Iritis can present with stuck pupil that is irregularly shaped
(Iritis is SEVERE)
Tx of iritis?
Use mydriatics to dilate - get pupil wide to stop the adhesions from occluding the visual field - pheynalephrine
What is a hypopyon?
Pus in the anterior chamber, will see at base of iris - see by optho in the same day
Hyphema?
Blood in anterior chamber, see at base of iris - urgent to optho
What is a cataract?
Any opacity of the lens - most common cause of reversible blindness worldwide
Features of a vitreous hemorrhage?
Look for retinal tear, or detachment, trauma, bleeding into the chamber, painless floater and visual loss
Most common location for orbital fracture
Inferior wall blowout with lateral rectus entrapment
Lateral canthotomy
For retro-orbital bleed - if proptosis
Psychogenic vision loss
Test for involuntary responses, flicking towards eyes, sometimes they will stop their proprioception too
Bilateral inter nuclear opthalmoplegia
MS
(Unilateral is indicative of a stroke
Tortuous vessels in the conjunctiva
Consider cavernous sinus carotid fistula
Risk factors for subcapsular cataract
Steroids, DM, trauma, smoking - seen in younger folks
Increased IOP?
Start with 500mg acetozolamide, then drops
High IOP - next steps?
Pain? Hx Cataract surgery?
Causes of retinal detachment
Retinal tear, watery vitreous (age), traction (shrivelled vitreous - also age)
