Ocular discomfort

Question 1

Causes of ptosis?

Answer 1

3rd nerve palsy
Myasthenia gravis
Age

Question 2

Presentation of corneal abrasion?

Answer 2

Sudden onset eye pain on blinking
Foreign body sensation - feels ‘gritty’, ‘scratching’
Lacrimation/tearing
Photophobia
Blurred vision/reduced vision
Conjunctival redness
Abnormal contraction of eye lid

Question 3

Examinations/ Investigations for corneal abrasions?

Answer 3

Z2F = fluorescien stain to highlight abrasion. Slit lamp

Visual acuity w/ Snellen chart
Pupillary light reflex and RAPD
Visual field testing
Amsler grid
Colour vision testing using Ishihara colour plates
Ophthalmoscopy and slit lamp examination

Question 4

Management for corneal abrasions?

Answer 4

• Immediate referral to eye casualty
• Irrigate immediately if chemical injury
• If organic foreign body - need to be urgently managed as higher risk of infection.
• surgery to remove foreign body.
• infection control - topical abx e.g. chloramphenicol
• antinflammatories
• ocular lubricants
• analgesia
• avoid contact lenses whole recovering

Question 5

Differential diganosis for corneal abrasions?

Answer 5

V serious:
- Penetrating eye injury
- Acute angle closure glaucoma
- Uveitis
- Optic neuritis
- Iritis
- Infective keratitis
- Corneal ulcer

Less serious:
- Conjunctivitis
- Dry eye syndrome
- Trichiasis
- Keratoconjunctivitis

Question 6

Complications of corneal abrasions?

Answer 6

Corneal ulceration
Infective Keratitis
Iritis
Recurrent erosion syndrome

Question 7

What is a corneal abrasion?

Answer 7

Defect in epithelial surface of the cornea following injury

Question 8

Causes of corneal abrasions?

Answer 8

Mechanical trauma
Foreign bodies - dust, glass, rust
Chemical, radiation or flash burns
Contact lenses
Recurrent erosions

Question 9

Differentials for ocular discomfort/ eye pain?

Answer 9

The list is endless!!!

Allergies
Blepharitis
Chalazion
Cluster headache
Complication of eye surgery
Contact lens problem
Corneal abrasion and foreign body injury
Corneal herpetic infections (herpes)
Dry eyes (decreased production of tears)
Ectropion + Entropion
Eyelid infection
Glaucoma
Iritis
Keratitis
Optic neuritis
Pink eye
Scleritis
Stye
Uveitis

Question 10

What is Ectropion?

Answer 10

Outward turning of eyelids

Question 11

What is Entropion?

Answer 11

Inward turning of eyelids

eNtropion = iNward

Question 12

Presentation of stye?

Answer 12

Acute, unilateral eyelid pain - especially on lid margin
Pustule at eyelid margin or tarsal conjunctiva
No constitutional Sx
No pain of eye globe

Question 13

Investigations for stye?

Answer 13

Clinical Dx

Question 14

Management for stye?

Answer 14

Self limiting - resolve in 5-7 days.
Warm compress
Topical abx therapy if necessary (bacitracin or erythromycin)

Question 15

Complications of stye?

Answer 15

Chalazion
Cellulitis - orbital and peri-orbital
Cosmetic deformity - affect eyelash growth and can get fistulas on eyelid.

Question 16

Ddx for stye?

Answer 16

Orbital cellulitis - if have eye globe pain too.

Question 17

RF for having stye?

Answer 17

Age 30-50
Blepharitis + ocular rosacea in PMH
Seborrhoeic dermatitis in
DM
Hyperlipidaemia

Question 18

Risk factors for orbital cellulitis?

Answer 18

Age - childhood - 7-12 yrs
Previous sinus infection
Not having Haemophillus influenza type b vaccine
Recent eyelid infection / peri orbital cellulitis
Ear or facial infection

Question 19

Location of periorbital cellulitis?

Answer 19

Anterior to orbital septum

Question 20

Presentation of orbital cellulitis?

Answer 20

Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis
Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)

Question 21

What is present in orbital cellulitis that is not present in periorbital cellulitis?

Answer 21

Orbital cellulitis has:
- reduced visual acuity
- proptosis
- pain with eye movement /ophthalmoplegia

These are not present in periorbital cellulitis

Question 22

What investigations to do for suspected orbital cellulitis?

Answer 22

FBC, inflam markers like CRP
Complete ophthalmological assessment
CT with contrast
Blood cultures and microbiological swab

Question 23

What would we find in FBC results for orbital cellulitis?

Answer 23

Elevated WBC and raised inflam markers

Question 24

What is seen in ophthalmological assessment of patient with orbital cellulitis?

Answer 24

Decreased vision
Afferent pupillary defect
Proptosis
Dysmotility
Odema
Erythema

Question 25

What is seen on CT with contrast in patient with orbital cellulitis?

Answer 25

Inflammation of the orbital tissues deep to the septum
Sinusitis

Question 26

Common organisms causing orbital cellulitis?

Answer 26

Streptococcus
Staphylococcus aureus
H. Influenzae B

Question 27

How is orbital cellulitis managed?

Answer 27

Admit to hospital
IV abx

Question 28

Presentation of preorbital cellulitis (preseptal)?

Answer 28

Symptoms:
Acute onset
Red, swollen, painful eye
Fever, malaise

Signs:
Erythema and Odema of eyelid can spread to surrounding skin
Partial or complete ptosis due to swelling

Question 29

Ddx for preorbital cellulitis?

Answer 29

Orbital cellulitis
Allergic reaction

Question 30

Investigations for preorbital cellulitis?

Answer 30

• Bloods - raised inflammatory markers
• Swab of any discharge present
• Contrast CT of the orbit may help to differentiate between preseptal and orbital cellulitis. It should be performed in all patients suspected to have orbital cellulitis

Question 31

Management of preorbital cellulitis?

Answer 31

Oral abx - usually co-amoxiclav.

Question 32

Complications of preorbital cellulitis?

Answer 32

Orbital cellulitis