NB topics Flashcards
6 Eye problems in HIV/ AIDS
- Abnormal conjunctival lesions
- Abnormal vernal keratoconjunctivitis
- HZ infection
- Herpes Simplex Keratitis in periphery
- Kaposi’s Sarcoma
- Orbital cellulitis
What is needed for near vision
- Convergence
- Pupillary constriction
- Accommodation
Hypermetropia
Indications for treatment
Treatment
Indications for treatment: < VA, eye exhaustion, strabismus
Treatment:
1. Convex lenses
2. Contact lenses
Myopia
treatment
- Concave lens
- Contact lenses
- Refractory surgery
Anterior Uveitis: Clinical tests
- Consensual light reflex–> Pain in contralateral eye
- Accommodation test
- Eclipse test
Posterior Uveitis Symptoms Causes Signs Complications
Symptoms: < VA
Causes: Toxoplasmosis from animals
Signs: Dull fundus, yellow/white choroid, retinal vasculitis
Complications: Chorio-retinal scar formation, exudative retinal detachment, rhegmatogenous retinal detachment, papillitis
Diagnostic drugs
• Fluorescein: orange liquid, under blue light bright green/yellow
• Midriatics: parasympathetic drugs -> paralysis of iris sphincter:
oAtropine sulphate: 7-14 days (longest) -> therapeutic
oScopolamine: 2-3 days
oTropicamide: 6-8hrs -> shortest
oCyclopentolate: 6-24 hrs
oSide-effects: nausea; vomiting; pallor
oSympathomimetics: Phenylephrine (use in combination with pSympathetic)
Side effects: Steroids, Ethambutol, Phenothiazine
- Steroids: cataracts; glaucoma
- Ethambutol: optic neuritis
- Phenothiazine: opacities in lens/corneal epithelium
Meibomian Cyst
Definition
Clinical picture
Treatment
- Definition: Lipogranulomatous inflammation secondary to the retention of meibomian due to obstruction
- Clinical Picture: firm round swelling in tarsal plate; often painless; red raised conjunctiva
- Treatment: Incision and curettage
Blepharitis treatment
- Lid hygiene
- topical antibiotic, post. Blepharitis = systemic tetracyclines
- warm compress; expression of meibomian glands
Ptosis classifications and treatment
Classification: Neurogenic, Aponeuritic, Mechanical, Myogenic
Treatment: refer to ophthalmologist, avoid amblyopia, suspect CN III palsy
Causes of mucin & lipid layer deficiency
- Chemical burns
- Trachoma
- Steven-Johnson syndrome
- Vit A deficiency
Lid Abnormalities: Causes of abnormal lid contours & disruption of lid movement
Countour: Trachoma, Trauma, Tumour
Lid Movement: fascial paralysis, Simblephara (trauma, Steven-Johnson, Trachoma)
Dacryocystitis: Definition, Signs & Treatment
Definition: obstruction of the tear flow distal to lacrimal sac leading to stasis, secondary infection can occur, filling sac with pus
Symptoms: Epiphora, Pain
Signs: Swelling, Redness, Tenderness over lacrimal sac, can break skin
Treatment: local/systemic antibiotics, drainage of abscess
Difference between pre-orbital cellulitis & orbital cellulitis
Orbital: Chemosis, Redness, Pain, Proptosis, Decrease in eye movement
Pre-orbital: opposite of above
Pterygium: Treatment & Indications for surgery
Treatment:
- artificial tears
- antihistamines
- vasoconstrictors
- antibiotics, steroids
Indications:
- medical treatment failure
- increasing astigmatism,
- growth over visual axis,
- to be able to wear contact lenses,
- cosmesis
- suspected malignancy
Classify bacterial conjunctivitis, viral conjunctivitis, allergic conjunctivitis
- Bacterial: Acute, Gonococcal, Chlamydial, Chronic blepharoconjunctivitis
- Viral: Adeno virus (pharyngo (adeno 3 & 7), epidemic keratoconjunctivitis (8 & 19)) Acute haemorrhagic; Herpes simplex; Molluscum contagiosum keratoconjunctivitis
- Allergic: Hayfever; Acute allergic blepharoconjunctivitis; Vernal conjunctivitis; Giant papillary conjunctivitis; Steven-Johnson
Adenovirus conjunctivitis syndromes: Clinical picture & treatment
Picture: acute follicular conjunctivitis with pre-auricular lymphadenopathy; red eyes; years; itches; photophobia
Treatment: no specific Mx, antibiotic & vasoconstrictor drops (steroids only if vision is affected & herpes simplex excluded)
Allergic Conjunctivitis: Treatment
- Antihistamines
- Vasoconstrictors
- Ice packs
- Topical steroids
Bacterial Keratitis: Organisms, treatment & complications
Organisms: Pneumococci, Pseudomonas, Staph. Aureus/epidermidis
Treatment:
- Cover eye
- Cycloplegic drugs
- Local antibiotics
Complication: corneal thinning, corneal opacification, corneal perforation, endophthalmitis
Phlyctenulosis: Causes, variance, treatment
Causes: usually TB, reaction against staph.cocc. organism
Variance: conjunctival phlycten (raised pink nodule close the limbus) & corneal phlycten (starts in limbus, may spread centrally, ulcerates)
Treatment: steroids
Keratoconus: Munsen’s sign, Clinical picture and treatment
Munsen sign: in keratoconus, the extra bowing of the lower eyelid caused by the misshapen cornea as the eye rotates downward.
Treatment:
- Corneal transplant
- Hard contact lenses
Optic Neuritis: Classification, Causes, Clinical Picture
Classification: Papillitis, Retrobulbar neuritis
Causes: MS most common in adults, Viral most common in children, idiopathic, autoimmune, systemic infection
Clinical Picture: unilateral loss of vision, retrobulbar pain
Optic disk clinical characteristics
- colour
- cup
- contour
- cardiovascular
Strabismus: Consequences
- Amblyopia (strabismus amblyopia, depravation, refractive)
- Suppression of image (coping mechanism)
- Diplopia
Strabismus: Commitant (refractive error) vs. Incommitant (eye movement fucked)
Incommitant: deviation will vary with direction of gaze, impairment of movement, angle of deviation maximal in affected muscle test, not present in all directions of gaze, head position is held where affected muscle is least used
Commitant: no impairment of eye movement -> angle of deviation same in all directions
CN III Palsy: Consequences & Causes
Causes: space-occupying lesions, vascular causes (ischaemia, thrombosis),
Consequences: horizontal & vertical diplopia, inability to elevate & duct, ptosis of the upper eyelid, pupil may be dilated
Horner’s syndrome: Characteristics
- Miosis
- ptosis
- pseudoenophtalmos
- anhydrosis
- heterochromia of the iris
Differential diagnosis of leucocoria (pupil displays white)
- Cataract
- Retinoblastoma
- Retinal detachment
- Post. Uveitis
- Old virteous haemorrhage
- Retinopathy of prematurity
- Persistant hyperplastic primary vitreous
- Tunica vasculosa lentis
Anterior & Posterior Uveitis: Signs, Symptoms, Complication
Anterior:
o Signs: decreased visual acuity, ciliary congestion, anterior chamber opacification, hypopion, miosis
o Symptoms: dull vision, redness, photophobia, deep eye pain
o Complications: anterior/posterior synechiae, cataracts, hypotonia, blocking of trabecular network, glaucoma
Posterior:
o Symptoms: decrease in visual acuity
o Signs: dull fundus, cotton-wool choroid and retina, vasculitis
o Complications: exudative/rhegmatoid retinal detachement, papillitis, scar formation
Glaucoma: Diagnosis, Signs & Symptoms, Treatment
Closed angle: Diagnosis: nature of pain, fixed mid-dilated pupils corneal oedema Symptoms: acute onset, unilateral pain radiating to ipsilateral hemicranium, can vomit from pain, red eyes, big decrease visual acuity, coloured halos around lights, photophobia Signs: fixated middilated pupils, ciliary congestion, corneal opacification Treatment: 1. acetozolamide (diamox) 2. emergency Mx 3. glycerol 4. topical B-blockers 5. pilocarpine 6. systemic analgesia 7. anti-emetic agent
Open Angle:
Diagnosis: optic disk indicative of disease, referral
Symptoms: almost always asymptomatic
Signs: decrease in visual acuity when terminal, loss of visual fields, increased IOP
Optic disk changes: colour pale, cup large (C/D > 0.5), vessels has nasal displacement, border has nerve fibre haemorrhage
Treatment:
1. adrenaline
2. B-blocker
Cataracts: Indications & contra-indications for surgery
Indications: impact on daily functioning, diabetic patient, pale fundus, lens-induced disease
Contra-indications: patient don’t want, glasses & other medical treatment works fine, surgery won’t improve
Cataracts: Indications & contra-indications for surgery
Indications: impact on daily functioning, diabetic patient, pale fundus, lens-induced disease
Contra-indications: patient don’t want, glasses & other medical treatment works fine, surgery won’t improve
Retinoblastoma: Clinical picture & treatment
Clinical picture:
- Leucocoria
- strabismus
- proptosis
- uveitis,
- glaucoma
Treatment:
- radiotherapy
- chemotherapy
- cryotherapy
- enucleation
- photocoagulation
Blow-out fracture: Clinical Picture & Treatment
Clinical:
- diplopia
- proptosis
- enophthalmos
- periorbital crepitus
- reduced sensation
Treatment:
- antibiotics
- don’t blow nose (eye in maxillary sinus – eye can come out!)
Hyphema: Complications & treatment
Complications: raised IOP, discolourisation of corneal stroma, secondary bleeding
Treatment:
- Topical steroids
- oral cyclocapron
- topical cycloplegics
- B-blockers
- Diamox
Acute central retinal venous occlusion: Associations, Symptoms, Signs, Treatment
Associations: hypertension, glaucoma, diabetes, phlebitis,
Symptoms: sudden unilateral loss of vision in a white eye
Signs: visual acuity & field decrease, RAPD, optic disc swelling, cotton wool spots
Complications: Neovascularisation
Treatment: photocoagulation
Differential diagnosis of painful red eyes
- Acute closed angle glaucoma
- Open eye injuries
- Chemical burn
- Corneal abscess
Differential diagnosis of painless white eyes
- Acute retinal arterial occlusion
- AION
- Acute retinal tear
- Retinal detachment that threatens macula
- Acute extra-ocular muscle paralysis with headache
Rhegmatogenous retinal detachment: Cause/Process & Treatment
Cause/Process:
retinal hole formation is caused by: vitreous traction during post vitreous detachment, vitreous traction during blunt eye trauma, degenerative holes with vitreous traction
Treatment:
- laser or cryotherapy
- drainage of fluid
Acute central retinal artery occlusion: Causes, Symptoms, Signs, Treatment
Causes: thrombosis, embolism
Symptoms: white eye and sudden unilateral loss of vision, amaurosis fugax (fleeting vision),
Signs: decreased visual acuity, decreased visual field, RAPD, milky-white retina, cherry red spot,
Treatment:
- massage
- 95% O2 + Co2
- vasodilators
- acetozolamide
Eyelid blunt trauma: Treatment
- Clean thoroughly
- topical broad spectrum antibiotics, systemic analgesia
- anti-inflammatory drugs
Contusion of eye: Complications
- Peri/retrobulbar bleeding
- Proptosis
- Limitation eye movement
Chemical burn: Treatment and complications
Complications: glaucoma, corneal scarring, simblepharon, entropion, dry eyes
Treatment:
- Rinsing of eye with water
- Sterile isotonic salt mixture in palpebral
- Wet cotton bud
- Local anaesthetic
- Systemic painkillers
Age Related Macular Degeneration: Classification, Symptoms, Treatment
• Classification: Dry and Wet • Symptoms: painless decrease in visual acuity (wet=fast)(dry=insidious), picture distortion, central scotoma •Treatment: 1. dry=non-specific 2. wet=laser photocoagulation
Diabetic Retinopathy: Microvascularopathy & treatment
Microvascularopathy: vascular leakage, microvascular occlusion
Treatment:
- Monitor blood glucose
- Argon laser photocoagulation
- Regular ophthalmologist visits
- Blood pressure control
- Aneamic control
- Infection control
Complications of neovascularisation
- Neovascular glaucoma
- Massive intra-retinal exudates
- Vitreous haemorrhage
- Vitreous traction cords
- Retinal traction detachment
Hyperthyroidism
- Fatty tissue increased inside orbit -> exophthalmos
Rheumatoid Arthritis
- Dry eyes
- Corneal thinning
- Episcleritis
- Scleritis
