Eyes and Vision Flashcards
Who is eligible for diabetic eye screening?
Diabetic patients
>12 years
Letter every year (unless last 2 have been normal in which case every 2 years).
What is uveitis?
Inflammation of the iris, choroid or ciliary body. There may also be secondary inflammation of the retina and optic nerve.
Anterior uveitis: (most common)
Iris / ciliary body
Intermediate uveitis:
Vitreous, ciliary body, retina
Posterior uveitis:
Choroid, retina, optic nerve
Panuveitis:
All parts of the eye
What causes uveitits?
50% idiopathic
50%: infection, neoplasia, autoimmune, trauma
What is the difference between acute and chronic uveitis? How does uveitis present.
Acute <3 months
Red, aching, watery eye with blurred vision and photophobia. Pain is worse on pupil constriction (near objects/bright light - direct and consensual photophobia).
Chronic > 3 months
Blurred vision and mildly red
Pain and photophobia are milder
Intermediate uveitis may present with floaters and blurred vision. Does’t present with pain or redness typically.
Panuveitis presents as a combination of the above.
What is the difference between direct and consensual photophobia?
Direct photophobia is pain in an eye when light is shone into it directly
Consensual photophobia (“True photophobia” is when pain is experienced in the other eye when light is shone into one eye. Occurs in iritis
How is uveitis diagnosed?
Slit lamp examination of the anterior segment + dilated fundus exam
Done in secondary care. Uveitis should be managed by an ophthalmologist.
How does diabetic retinopathy present?
Gradual progression:
Blurring, patchy vision loss, difficulty seeing in the dark, floaters, fluctuating vision.
What do you expect to see on fundoscopy of an eye with glaucoma?
Pathological cupping or pallor of the optic disc
What is the difference between occular hypertension and glaucoma?
Occular HTN is simply raised IOP but without signs of glaucoma. It occurs in about 5% of >40 year olds and requires monitoring, as it may progress to glaucoma.
How is glaucoma classified?
Age: Congenital, infantile, juvenile, adult
Cause: Primary (unknown), secondary (known)
Rate of onset: Acute, subacute, chronic.
Angle between iris and cornea: open or closed
What is the most common form of glaucoma?
Primay, open angle glaucoma (POAG) - usually chronic. Affects 2% of people over 40 years old
How does acute angle closure present?
Acutely painful red eye
May also exhibit headache, impaired vision, lights surrounded by haloes, semi-dilated or fixed pupil.
What two conditions are associated with seeing haloes around lights?
Glaucoma
Cataracts
How do cataracts present?
Cloudy vision
Haloes around lights
Poor night vision
Sensitivity to light
True or false, asian females are more likely to develop acute angle glaucoma?
True
Especially if long-sighted and older
True or false, if a patient with acute angle glaucoma cannot be seen same day in secondary care, primary care can administer treatment?
True
How might you manage acute angle glaucoma in primary care if there is a delay in being seen by secondary care?
Lie the patient flat, facing up, with no pillows
Pilocarpine drops - 1 drop 2% in blue eyes and 4% in brown eyes
Acetazolamide 500mg PO
Antiemetic + Analgesia
True or false, different doses of pilocarpine are required when treating acute angle glaucoma in blue and brown eyed patients?
True
1 drop 2% for blue
1 drop 4% for brown
Pilocarpine takes longer to work in brown eyes so higher dose is needed
How do pilocarpine and acetazolamide work in the treatment of acute angle glaucoma?
Pilocarpine - constructs the pupil (miosis) facilitating drainage of fluid from the eye
Acetazolamide inhibits aqueous humour production thus reducing IOP. It also promotes urinary excretion of salts.
How might you recognise orbital cellulitis (post-septal)?
Proptosis
Blurred vision
Chemosis (swelling of conjunctiva)
Eye lif oedema
Double vision
Systemic signs e.g. fever
Needs urgent treatment in secondary care
Pre-septal cellulitis is more common and benign. It will have no proptosis or visual change.
What is a Chalazion? How are they treated?
Meibomian cyst
Chronic, non-infectious, inflammatory granuloma of the meibomian gland ducts (oil gland) of the eye lid.
Most self-limit in weeks to months
Apply warm compress
Lid massage
How are Styes different from Chalazions?
Styes (hordeola) are infected eye-lid hair follicles (apocrine/sebaceous gland)
Chalazions are non-infectious inflammatory granulomas of meibomian oil ducts.
What is macular degeneration?
Degeneration of the central part of the retina (macula) in people aged 50 and over
