Final Flashcards
I cant see up close HX:
Any other problems?
How far do you read?
How well can you walk/steps?
Problems with bright light?
Itchy burny eyes Hx:
When did it start?
Vision affected?
Contacts?
Affect your tasks?
Discharge?
Family with same condition?
Hayfever/GH?
Glaucoma/DM?
How do you manage a patient with idiopathic macular oedema:
VA/pinhole
VF/Amsler > confrontation
IOP > DFE/OCT
Document and compare
Reffer for FFA
anti-VEGF treatment if symptomatic
How do you manage a patient with confluent drusen in one eye:
Regular monitoring > amsler recheck
Documentation > OCT/photography
Lifestyle > smoking cessation
Supplements > AREDS
Education > return if worsening
Low vision referral
Dry AMD:
Age/oxidation > dysfunctional metabolism of rod OS (^at macula) > ^metabolic by-products:
Basal laminar deposit (RPE/basement): collagen (cell stress)
Basal linear deposit (inner portion of bruchs): lipid/lippofuscin/complement (soft drusen; pro-inflammatory)
Progression > soft drusen (>67um) > ^size/confluent > thickening/inflammation > calcification/degeneration of elastin/collagen layers of bruchs > hydrophobic barrier to fluid/nut. > loss between outer retina/choroid
Nutrient loss / Drusen reabsorbtion > RPE ischemia / lipofuscin tox > ^dysfunction > apoptosis (seen as hypo/hyperpigmentation)
Wet AMD:
RPE loss > PR/CC dysfunction > largening chorioretinal geographic atrophy
RPE-produced trophic factor (VEGF) loss > CC atrophy > altered perfusion of choroidal vessels
Choroidal BV stenosis / Drusen inflammation > CC toxicity/death > CC perfusion loss > adjacent RPE hypoxia > angiogenic compound production (VEGF) > BV growth stimulation in CC > neovascular membrane (CNV) breaking bruchs > BRB loss > serum leak > PR loss
Aquired cataract patho:
PSC from corticosteriods > dysfunctional epithelial differentiation
CC from inflammation/injury > altered cellular metabolism
Blunt trauma > mechanical water influx (rosette)
RP patho:
Mutations > altered rhodopsin/RPE/PR-structure/PTD/Visual cycle > Rod PR/RPE dysfunction
Rod apoptosis > RPE dysfunction > retinal remodelling > altered signalling to cone PRs > apoptosis > central vision loss
RP remodelling patho:
PR loss > RPE dysfunction >
RPE hyperplasia / inward migration (bony spicules)
Glial cell migration/proliferation (ON pallor)
PR loss > O2 consumption loss > BV attenuation
RPE degen. > BRB loss > intraretinal fluid leakage > macula edema
Lost vision in one eye DDX:
CRAO/CRVO > Are you hypertensive/diabetic
MS/TED/GCA > autoimmune disorders
Wet AMD > history of AMD causing a vit haemorrhage
Explain to Px they have bacterial keratitis:
You have a bacterial infection in the front portion of your eye
Causing pain and blur
Medical emergency > need intensive treatment to preserve eye health
Ciprofloxacin 0.3% ointment every 10min for an hour, then every hour for 24, ill see you after 24h to ensure effect
We continue for a day > taper to QID, or perform a culture
Explain Wet AMD refferal:
Noticed progression of AMD
Choroidal neovascular membrane formation > new BV formation in eye
This can lead to permenant blindness, you’ll need Anti-VEGF injections to prevent this
Tests to asses cataract Px:
VA w/pinhole
Colour vision test
Slit lamp w/retroillumination
Contrast sensitivity
Refraction (RI change) compare BCVA
Manage epithelial HSK/HSV keratitis:
Live virus (dendritic/geographic):
Topical aciclovir 3% 5/d for 10d
Assisted with topical lubricants
AC reaction can be assisted with cycloplegics
If corneal toxicity at risk > oral acyclovir 400mg 5/d for 10d w/specialist refferal
Metaherpetic / neuroprophic:
Topical lubricants per hour
Manage bacterial conjuntivitis:
Acute bacterial: Self limiting 2w, Clorsig 0.5% QID 1w to lessen lifespan