Miscellaneous Flashcards
Optic Neuritis
Inflammatory, demyelinating condition
Acute, monocular visual loss
High association with multiple sclerosis
Features - Vision loss with central scotoma developing over hours to days, eye pain, afferent pupillary defect, photopsias (flickering of light with eye movement, loss of colour vision
Fundoscopy
- Papillitis with hyperemia and swelling of optic disc, distended veins
- 2/3rds will have normal fundoscopy (retrobulbar neuritis)
Anterior Uveitis
Inflammation of the Uvea
Symptoms - Pain, red eye, vision loss
Causes
- Infection
- Inflammatory diseases (Spondyloarthritis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis, IBD, sarcoidosis, Behcet Syndrome, Juvenile idiopathic arthritis)
- Multiple sclerosis
- Medications
Entropion
Chronic inflammation from blepharitis can lead to inward turning of the eyelid.
Ectropion
Outward turning of eyelid
Pingueculum
Yellow-white fatty deposition adjecent to the limbus (junction between cornea and sclera)
Can become inflamed.
Excision if large and craggy
Pterygium
Wedge-shaped area of fibrosis of conjunctiva that may grow onto the cornea
Always on nasal side of eye.
Removal if encroachment onto pupil affecting vision or frequent inflammation,.
Episcleritis
Localised ocular redness from inflammation of episcleral vessels.
70% no underlying condition.
- When present, could be - RA, IBD, Vasculitis, SLE, Herpes Zoster, Lyme disease
- Typically not related to pain.
- Episodes last for a few weeks.
Treat with PO NSAIDS
Scleritis
Sx - Intense ocular pain worse in morning and at night, deep-red or purplish scleral hue.
Associated with headache, lacrimation, photophobia
Medical emergency. Present to ED
Herpes simplex keratitis
Ocular manifestation of HSV
- Dendritic ulcer viewable with flourescein staining.
Invetigation
- Swab for PCR HSV1 & 2
Treatment
- Aciclovir 3% eye ointment 5 times daily for 10-14 days
- Valaciclovir 500mg PO BD x 7-10 days.
Photokeratitis
Acute syndrome causing severe eye pain beginning 6-12 hours after exposure to UV light.
Desquamated corneal epithelium, exposing subepithelial nerve endings.
Resolution of symptoms within 72 hours.
Flourescein will show punctate corneal staining
Eye injection and oedema.
Facial and lid erythema
Treatment
- Prophylactic topical chlorsig
- PO NSAIDS
- Future use of protective eyewear for welding / UV exposure.
Hyphaema
Bleeding from iris collects in anterior chamber
Risk of secondary glaucoma
Treatment
- Eye shield
- Elevate head to 30 degrees
- Complete bed rest for 5 days(Exertion could cause ruptured blood vessel to bleed further, blocking escape of aqueous humour and causing severe secondary glaucoma)
- Avoid any blood thinners (Aspirin) avoid NSAIDS.
- Analgesia - Oxycodone, Paracetamol.
- Prevent vomiting to reduce likelihood of further bleed or expansion of air into the eye.
Retinal Vein occlusions
Sunset pictures in eye
Branch - Small area in eye
Central - Complete sunset
Central retinal artery occlusion
Cherry red spot around fovea and pale retina.
Diabetic retinopathy
- Haemorrhage
- Microaneurysms
- Cotton wool spots - Accumulations of axoplasmic material within the nerve fibre layer
- Exudate
Retinitis Pigmentosa
Hereditary condition.
Degeneration of rods and cones associated with displacement of melanin-containing cells from the pigment epithelium.
- Night blindness in childhood
- Concentrically narrowed visual fields
- Blind by adolescence
- May delay course with vitamin A
Fundoscopy
- Irregular patches of dark pigment especially at periphery
- Optic atrophy
Marginal keratitis
Inflammation of the cornea
- Usually due to blepharitis
- Small white ulcers may develop around the edge of the cornea. Due to meibomiam gland blockage causing loss of sebaceous secretion onto eyelid.
Treatment
- Warm compresses to closed eyelids for 2-3 minutes at a time.
- Lid massage
- Lid scrubs - Cotton bud to clean inside edge of eyelids
Consider chlorsig or PO doxycycline if symptoms not controlled despite adequate eyelid hygiene.
- Chloramphenicol 1% ointment BD applied to eyelid margin
- Doxycycline 100mg PO OD x 8 weeks. Reduce to 50mg after clinical improvement.
Bacterial Keratitis
Bacterial infection of keratin of eye
- risk - Contact wearer, laser eye surgery.
- Sx - Pain, photophobia. Small white spot on cornea.
- Ix - Corneal scraping for MCS
If referral to opthal delayed, commence treatment
- Ciprofloxacin 0.3% eye drops Q15minutely for 6 hours, then hourly for 48 hours, then every 4 hours until healed.
- Ofloxacin
- Cefalotin
Dacrocystitis
Infection of lacrimal sac secondary to obstruction
- Usual history of watery eye for months prior
- Infection normally by S. aureus, GAS or gram -‘ve bacteria.
Management
- Heat (steam or moist compress_
- Massage sac and duct in mild cases
- Acute? PO Abx Cefalexin 500mg (12.5mg/kg) PO QID
Dacrocystocoele
- Bluish swelling of skin overlying lacrimal sac with upward displacement of medial canthal tendon
- Seen shortly after birth
- Urgent referral to opthal because of risk of infection or nasal obstruction from localised pressure.
Dacryostenosis
Congenital nasolacrimal duct stenosis resulting in intermittent tearing and debris on eyelashes.
Manage with lacrimal duct massage
Should resolve by 6-10 months in 90% of cases
- If no resolution, can be cleared by opthal by probing of lacrimal duct.
Blepahritis
Chronic inflammatory condition of eyelid margins
Associated conditions - Seborrhoeic dermatitis, rosacea, acne, dry eyes.
Anterior
- Inflammation of anterior eyelid margin.
Posterior
- Dysfunction of meibomiam glands.
-Frothy discahrge along eyelid margins. Can have associated chalazia
Management
- Warm compresses to eyelids 2-5minutes daily
- Gentle scrubbing of lashes with either sodium bicarbonate solution or baby shampoo solution.
If symptoms are not controlled with eyelid hygiene, consider adding either
- Chloramphenicol 1% TOP BD * 1-2/52
- PO Doxycycline 100mg OD for minimum 8 weeks. Can reduce to 50mg after clinical improvement.
Acute Chlamydial Conjunctivitis
Investigation
- Swab PCR Chlamydia.
Rx
- Azithromycin 1g PO OD (20mg/kg up to 1g)
Trachoma
- Chronic Chlamydia infection
- Leading cause of preventable infectious blindness globally.
- Scarring of eyelids, corneal ulceration, corneal scarring.
- Suspect trachoma in endemic areas.
Risk-reduction
- regular face washing
- treatment of household contacts
Gonococcal conjunctivitis
Sx - Acute onset, copious purulent exudate.
- opthalmic emergency (Can cause corneal ulceration and perforation.
Ix - Swab PCR, Swab MCS
Rx
- Ceftriaxone 50mg/kg to 1g IM Once only
+
- Azithromycin 20mg/kg to 1g PO Once only.
Periorbital Cellulitis
Soft tissue infection of eyelids anterior to orbital septum.
Causes - localised spread of infection (Hordeolum, stye, dacrocystitis) or trauma
Patient < 4yo? Higher risk of orbital cellulitis as developmental presence of incomplete orbital septum.
Vision and eye movements are normal and patient is systemically well. If not true, consider orbital cellulitis.
Pathogens
- S. Aureus, Streptococcus, HiB in unvaccinated, HSV & HZV
Rx
- Flucloxacillin 500mg (12.5mg/kg) PO QID x 7 days or dicloxacillin
Orbital Cellulitis
Causes
- Infection of paranasal sinuses.
Sx - Reduced vision, painful eye movement, diplopia, proptosis, chemosis (swelling of eye surface membranes due to accumulation of fluid).
Acute angle closure of glaucoma Primary Care Treatment
- Urgent referral to hospital via ambulance for opthalmology review
- Analgesia - Morphine IM 5mg
- Do not patch the eye (attempt to keep iris constricted to reduce possibility of angle closure.
- Lie supine
- PRN metoclopramide if nauseous.
Opthalmologist will treat with IV Acetazolamide, TPO timolol 0.5%, TOP pilocarpine 2%
Subconjunctival Haemorrhage
Haemorrhage of blood vessel under conjunctiva, leaving large area of haemorrhage over sclera
Causes
- Blunt trauma
- Minor trauma from contact lense use
- History of elevated venous pressure (Valsalva manoeuvre, coughing, vomiting)
- HTN
- History of DM
- Coagulopathy (Anticoagulant use)
Retinal Detachment
History
- Painless loss of vision
- Increased number of flashes (traction on the retina) and floaters (haemorrhage and debris in the vitreous humour)
- Dark shadow or curtain moving over visual field of affected eye.
Fundoscopy - Detached retina appears corrugated and partially opaque and out of focus.
6th Nerve Palsy
Binocular horizontal diplopia due to palsy of abducens nerve affecting function of lateral rectus unilaterally.
Causes
- Trauma
- Tumours
- Raised ICP
- Congenital
Differential Diagnosis
- Orbitopathies
- Thyroid disease
- Myasthaenia gravis.
- Childhood esotropia
Neuroimaging with MRI recommended in most patients.
3rd Nerve Palsy
Signs
- Lateral and Down
- Ptosis
- Midriasis (Enlarged pupil)
Cataracts
Opacity in lense of eye.
Clinical Symptoms
- Distorted vision
- Glare
- Can lead to blindness
- Difficulties with driving at nighttime intitially.
Usually bilateral.
Risk factors
- Smoking
- Age
- Poor lifestyle habits
- Alcohol consumption
- sunlight exposure
- DM
- HIgh dose corticosteroids
Herpes Zoster Opthalmicus
V1 Shingles infection involving eye.
- Start treatment as soon as possible within 72 hours of development of rash.
- Consult opthalmologist in all cases
- Valaciclovir 1g PO TDS x 7 days
- 2nd - Famciclovir 500mg PO TDS x 7 days, Aciclovir 800mg PO 5 times daily for 7 days.
Contact Lens care and Use
- soft lenses accumulate surface deposits that can affect surface quality
- Use for prescribed schedule.
- Use during waking hours.
Risks
- Microbial keratitis (Pain, redness, blurred vision, photophobia)
- Corneal ulcers
- Corneal abrasions
Posterior vitreous detachment
Gel-like structure at back of eye break through vitreous face and detach vitreous from retina.
- Can occur over 1 week but up to 3 months of progressive symptoms.
- Occurs normally in 50-75yo range
- Associated with diabetes
Clinical features
- Photopsias (flashing light from tugging on optic nerve)
- Cobweb-like Floaters
