Eyes - Primary Open Angle Glaucoma, Blepharitis, Cataracts, Conjunctivitis, Diabetic retinopathy, Macular degeneration, Preseptal cellulitis, Episcleritis Flashcards
Primary open-angle glaucoma
-risk factors
-presentation
-diagnosis
-investigations
-management
Fluid drains too slowly
Age
FHx
Short sighted - thought to be related to the increased susceptibility of the optic nerve head to IOP damage
HTN, DM, CS
Insidious
Peripheral field loss
Decreased acuity
Optic disc cupping, pallor
Diagnosis by opthalmologist
-Perimetry - visual field
-Slit lamp - optic nerve and baseline
-Tonometry - IOP
-Gonioscopy - peripheral ant chamber assessment
1st line - Selective laser trabeculoplasty => structural change to promote drainage
2nd line - eyedrops
-Bb (timolol) - reduce prod
-CAinh (dorzolamide) - red prod
-Sympathomimetics (brimondine) - red prod, increase outflow
3rd line - trabeculectomy surgery
Blepharitis
-pathophysiology
-risk factors
-presentation
-management
Inflammation of eyelid margin
-dysfunction of meibomian gland
-seborrhoeic
-staph infection
-rosacea
Bilateral, gritty discomfort around margin
Sticky in morning
Red
Hot compress TDS - soften margin
Lid hygiene - cotton bud and cooled boiled water and baby shampoo to clean debris
Cataracts
-pathophysiology
-risk factors
-presentation
-management
-complications
Opacification of the lens => reduced vision/blindness
Normal ageing process
Smoking, alcohol, DM
Trauma
Long term CS
Low Ca => damages membrane of aqueous humour
Reduced vision, faded colour vision
Glare
Halo lights
Reduced red reflex
Dilate pupil => normal fundus, optic nerve
Slit lap => visible cataract
Early => stronger glasses, brighter lighting
Definitive => surgical replacement if visual impaired/QOL low/patient choice
Endophthalmitis - inflammation of aqueous/vitreous humour
Cataracts
-types and causes
Nuclear (center of lens) - old age
Polar (in visual axis) - localised, commonly inherited
Subcapsular (back of lens) - steroid use
Dot opacities - DM, myotonic dystrophy
Infective conjunctivitis
-types and features
-management
Most common eye problem
-sore, red, sticky discharge, often unilateral
Bacterial (SAureus/Spneumonia/Hinf)
-purulent, eyes stuck together in morning, normally unilateral
Viral (adeno)
-serous discharge, recent URTI, lympadenopathy, uni or bi
Normally self-limiting within 1-2wks
-cool boiled water, wipe eyelashes with clean cotton
-cold flannel on eye to cool
-avoid contact lenses, sharing towels/pillows
If bacterial - chloramphenicol/fusidic acid if pregnant
Allergic conjunctivitis
-features
-management
Bilateral, red, swollen
Itchy
Seasonal/Hx of atopy
1st line - topical/systemic antihistamines
2nd line - topical mast cell stabilisers (sodium cromoglicate and nedcromil)
Macula degeneration
-risk factors
-types, presentation
-diagnosis
-management
Most common cause of blindness
Age
Smoking
FHx
CV risks
Dry (90%) - drusen
-gradual visual acuity loss
Wet (10%) - choroidal neovascularisation => serous fluid/blood leaks => rapid loss of visual acuity
Bilateral
Worse in dark
Fluctuating visual disturbance
Photopsia, glare
Charles Bonnet syndrome - visual hallucinations
Amsler grid - distortion of line perception
Fundoscopy - drusen/retinal fluid leaks or hemorrhage
Slit lamp
CONFIRM WET => Fluorescein angiography, OCT
Dry - Zn VitACE
Wet - antiVEGF
Preseptal cellulitis
-pathophysiology
-risk factors
-presentation
-diagnosis
-management
-complications
Infection of soft tissues anterior to orbital septum - eyelid, skin, subcut tissue of face
Children
Skin breaks in face or sinusitis/URTI
-Saureus, Sepidermidis, Strep, anaerobes
Red swollen eyelid, painful eye
Fever symptoms
High CRP
Swab discharge => find causative organism
Contrast CT - rule out orbital cellulitis
PO Abx - Coamox
2ndary care assessment
If infection spreads into orbit => orbital cellulitis
Episcleritis
-pathophysiology
-risk factors
-presentation
-how to differentiate from scleritis
-management
Inflammation of episclera
IBD
RA
Red eye
No pain, but discomfort
Watery, photophobia
When pressure applied
-episcleritis - vessels mv
-scleritis - no mv
Phenylephrine drops
-episcleritis - blanched
-scleritis - no blanching
Conservative management
Artificial tears
Diabetic retinopathy
-pathophysiology
MOST COMMON CAUSE OF BLINDNESS IN 35-65 YEAR OLDS
Hyperglycemia => CAUSES DAMAGE IN ENDOTHELIAL CELLS
Increased vascular leaking => exudates
-growth factors in response to retinal ischemia => neovascularisation
-pericytes no longer able to protect vessels => microaneurysms
Diabetic retinopathy
-classification
Non-proliferative diabetic retinopathy
-microaneurysms
-blot hemorrhages
-cotton wool spots - retinal infarction
-hard exudates - leaking lipoproteins
Proliferative
-retinal neovascularisation
Maculopathy - changes relating to the macula
-CHECK VISUAL ACUITY
Diabetic retinopathy
-management
All
-optimise glycemic control, BP, cholesterol
-regular opthal review
Maculopathy
-change in visual acuity => VEGF inh
Non-proliferative
-regular observation
-can consider panretinal laser photocoag if severe
Proliferative
-panretinal laser photocoag => reduction in visual field and decreased night vision as rods destroyed
-VEGF inh
Vitreous hemorrhage
-what is it
-presentation
-investigations
Bleeding into vitreous humor
MOST COMMON CAUSE OF SUDDEN PAINLESS VISION LOSS
Painless visual loss - reduced acuity, field if severe
Red hue in vision
Floaters, shadows, dark spots in vision
Fundoscopy
Slit lamp
US - rule out retinal detachment and if hemorrhage obscures retina
Fluorescein angio - neovascularisation?
Mild - observation and follow up for spontaneous resolution
Treat underlying cause
-laser photocoag if diabetic retinopathy
-VEGFinh if wet AMD
Severe or persistent - vitrectomy
Posterior vitreous detachment
-what is it
-presentation
-investigations
-management
Separation of vitreous membrane from retina
Sudden floaters, cobwebs - strands of vitreous casting shadows on retina
Flashers - vitreous tugging on retina
Blurred vision -
DARK CURTAIN - RETINAL DETACHMENT!
Weiss ring - detachment of vitreous membrane to form ring floater
URGENT ASSESSMENT WITHIN 24HRS TO RULE OUT RETINAL DETACHMENT
Symptoms improve over 6 months, no treatment
Repair retinal detachments
Retinal detachment
-what is it
-risk factors
-presentation
-investigations
-management
Retina detaches from underlying epithelium
-DM
-myopia
-age
-trauma
Can follow posterior vitreous detachment
-sudden, painless, progressive visual field loss (curtain)
-optic nerve involvement => RAPD
Fundoscopy
-retinal folds
-no fundal reflex
New onset flashers, floaters => URGENT REFERRAL for slit lamp
Scleral buckling
Pneumatic retinopexy
