misc (eyelid, trauma, pupil defects) Flashcards
what can squints lead to if uncorrected
ambylopia (brain favours other eye, one eye becomes lazy eye)
what is concomitant squint
imbalance of extracocular muscles // convergent > divergent
what is paralytic squint
paralysis of extraocular muscles
invx squint
corneal light reflex (asymmetrical) // cover test (focus on subject + cover eye)
mx squint
refer to ophthalmology (maybe eye patch)
what is a RAPD
swinging light test –> when shone in bad eye both eyes dilate // when shone in good eye it contracts but bad eye stays dilated
causes RAPD
retinal detachment // optic neuritis
symptoms + signs argyll roberston pupil
small, irregular pupils // does not react when light shone in (pupil reflex absent) but does react when light in other eye (accommodation)
causes argyll Robertson pupil
diabetes // syphilis
what is a holmes-adie pupil + symptoms
benign condition in women // unilateral dilated pupil // slowly reactive to accommodation, poorly reactive to light // once pupil constricted slow to dilate again
systemic symptoms holmes-adie pupil
absent ankle + knee refelx!!!
causes of mydriasis
(dilated pupil) // CNIII palsy // holmes adie // phaemochromocytoma // congenital
drug causes mydriasis
topical mydiatics eg topicamide, atropine // sympathetic drugs eg amphetamine, cocaine // anticholinergics eg TCA
symptoms horners
small pupil (miosis) // ptosis (droopy eye) // sunken eye // no sweating one side!!! (anhidrosis)
what does anyhidrosis on face, arms, trunk in horners indicate
central lesion = stroke, syringiomyelia, MS
what does anyhidrosis on face only in horners indicate
pre-ganglionic eg pancoast tumour, thyroidectomy, trauma, cervical rib
what does no anyhidrosis on in horners indicate
carotid dissection, carotid aneurysm, cavernous sinus, cluster headache
what is seen in congenital horners
heterochromia (different coloured pupils)
invx horners
apraclonidine drops (alpha agonist) cause dilation in affected pupil, but little affect in normal pupil
what causes posterior blepharitis
meibomian gland dyfunction
what causes anterior blepharitis
seborrhoeic dermatitis / staph infection
symptoms blepharitis
bilateral // gritty + uncomfortable around eyelids // sticky eyelids // (swollen in staph infection) // can progress to conjunctivitis
who commonly gets blepharitis
rosacea
mx blepharitis
hot compress 2x day // artificial tears
what is a stye
infection of the eyelid glands
what is a chalazion
meibomian cyst (firm, painless lump)
what is orbital cellulitis
infection affecting the fat and muscles posterior to the orbital septum
what usually precedes orbital cellulitis
spreading URTI
RF orbital cellulitis
age 7-12 // sinus infection // no H influe (Hib) vaccine // recent periorbital cellulitis // ear or face infection
symptoms orbital cellulitis
redness or swelling in eye // ocular pain // visual disturbance eg decreased acuity // proptosis // opthalmoplegia // eyelid eodema
invx orbital cellulitis
FBC // CT with contrast // blood culture
mx orbital cellulitis
admit + IV abx (ceftriazone)
what is preseptal cellulitis
infection in soft tissue anterior to orbital septum eg eyelids, skin
organisms preseptal cellulitis
staph A and staph epid
difference between orbital vs preseptal cellulitis
preseptal has swollen red, painful eye, fever// orbital = reduced acuity, proptosis (bulging), pain on movement
mx preseptal cellulitis
refer + oral abx usually co-amox
what is a hyphema
blood in ant chamber (usually from trauma)
risk of hyphema
raised intraocular pressure –> sight threatening
mx hyphema
bed rest and keeping as still as possible to not redisperse blood
what is orbital compartment syndrome
secondary to trauma, retrobulbar haemorrhage, emergency
symptoms orbital compartment syndrome
eye pain and swelling // proptosis (bulging) // rock hard eyelid // RAPD
mx orbital compartment syndrome
lateral canthotomy (before imaging) to decompress
symptoms corneal foreign body
eye pain // foreign body sensation // photophobia // watery eye // red eye
referal with trauma
penetrating injury (eg drilling, lawn mowing) // sharps // chemical injury // organic material eg seeds, soil // red flags
what medications can cause cataracts
steroids
what medications can cause corneal opacity
amiodarone / indomethacin
what meds cause optic neuritis
ethambutol // amiodarone // metronidazole
what meds cause retinopathy
chlouroquinine, quinine
