Grand rounds Flashcards
what is the management of phacoemulsification?
- hallow needle vibrates at ultrasonic frequencies
- lens material emulsified
- IOL inserted
What are the changes in the optic disc progression?
- enlargement of the optic disc
- notching at the superior and inferior poles
- distortion of pores in the lamina caribrosa
- pallor
- violation of ISNT rule
END PV
what is the referral value of IOP?
The guidance confirms that patients with IOPs measured at greater than 21 mmHg with any tonometer, including NCT, should be referred, except for patients over the age of 65, for whom there is more specific advice in the guidance.
what are the functions of xalatan (latanoprost)?
- prostaglandin analogue
- increase drainage of aqueous humour
- iris pigmentation changes
- lengthening and thickening of eyelashes
- conjunctival hyperaemia
- blepharitis
- transient epithelial erosions
Patients should be referred if the optometrist identifies one or more of the following:
a. There are optic disc signs consistent with glaucoma in either eye.
b. The IOP in either eye exceeds 21mmHg (note referral in specific scenarios below).
c. A visual field defect consistent with glaucoma is detected in either eye.
d. A narrow anterior drainage angle on van Herick testing consistent with a significant risk of acute angle closure within the foreseeable future (refs 3 and 4).
e. Signs often associated with glaucoma (e.g. pigment dispersion or pseudoexfoliation).
What are the signs of POAG?
- IOP>21mmHg at some point in course of disease
- Open angle of normal appearance
- glaucomatous damage to ONH
- vf loss
What are the managements of POAG?
1) referral
Routinely via GP if not previously diagnosed
2) treatment:
- pharmacological therapy
- laser therapy (trabeculoplasty)
- —-laser burns applied to trabeculum to increase aqueous outflow
- surgery (trabeculectomy)
- —–creation of drainage channel between angle and sub-tenon space
- ——drainage bleb under superior lid
Give example of pharmacological therapy as management of POAG?
- PGA: increase aqueous drainage; xalatan (latanoprost)
- Beta blockers: reduce the aqueous production; timolol
- Alpha 2 agonists: dual action eg. alphagan
- Miotics: increase drainage eg. Pilocarpine
What are the symptoms of ACG?
- nausea and vomiting
- periocular pain
- sudden monocular vision loss
What are the investigations that should be carried out for the detection of ACG?
- Gonioscopy or van-herick
- Goldmann tonometer
- OCT
- pupil testing
- corneal examination
What are the management if ACG?
- Emergency referral to HES
- Pharmacological intervention:
- –acetazolamide: CAI; decrease aqueous production
- – pulocarpine: miotics that increase aqueous drainage - YAG peripheral laser iridotomy:
Reestablish communication between anterior and posterior chambers by making an opening in the peripheral iris
What are the possible causes of red eye?
If come with pain:
- subconjunctival haemorrhage
- scleratis
- keratitis
- ACG
- anterior uveitis (iritis)
- foreign body
Others:
- chronic dry eye
- blepharitis/MGD
- episcleritis
- conjunctivitis
- CLs complications
What are among the investigation of red eye?
- slit lamp ant eye exam
- fluorescein
- TBUT
- lid eversion
- AC assessment
- tonometry
- pupils
- volk/ophthamoscopy
What are the management of allergic conjunctivitis?
- topical antihistamine/ mast cell stabiliser: sodium cromoglicate
- oral antihistamine eg.loratadine
- identify and avoid allergen
- cease CL wear until resolved
What are the sign, symptom, and treatment of bacterial conjunctivitis?
Symptom:
Burning
Grittiness
Discharge (muco-purulent)
Sign:
Acute eyelid redness
Crusted lid margins
Treatment:
Chloramphenicol (usually resolves 7-14 days)
