Ophth 2 Flashcards
Define hypopion
Pus in anterior chamber
Due to corneal ulcer
Treatment of hypopion
Hourly antibiotic drops in eye
(OFLOXACIN, bacteriocidal)
Avoid contact lenses
Send the contacts off for MC&S
What is the worst case scenario after a hypopion
Corneal ulcer perforates
Iris prolapses
Endopthlamitis and loss of eye
What is fluorescin used to diagnose?
- Corneal ulcers
- Dendritic (herpetic) ulcers
- Corneal abrasion
- Dry eye (pin pricks)
3 types of cataract
Green/yellow, common: Nuclear sclerosis
Steroid use, diabetes: Posterior subcapsular
Spokes of opacity: Cortical
Symptoms of cataracts
- May improve near sight
- Decreased contrast
- Glare
- Duller colours
Name 3 complications of cataract surgery
- Endophthalmitis
- Iris prolapse
- Uveitis
What is used to see whether someone’s vision is distorted?
Amsler chart
Grid patter
Close one eye, focus on black central dot
What is an Amsler chart?
Diagnoses distortion
Close one eye, focus on black central dot.
Grid pattern.
What does wet AMD look like on fundoscopy?
Haemorrhage and exudate (creamy) and fluid are confined to macula
No disc swelling, vessels are not tortuous
Name the bones that make up the orbit
Frontal Maxilla Zygomatic Sphenoid Palatine Ethmoid Lacrimal
Where in the orbit is most at risk from blunt trauma?
Medial wall and floor (thinner with sinuses beneath them)
If someone comes in after a tennis ball to the orbit, what do you do?
Loss of consciousness? (witness collateral history). Mechanism of injury? Other injuries? Previous ocular/medical/drug history. Tetanus prophylaxis.
• Visual acuity
• Gentle exam of lid, orbit, eye (don’t press due to perforation)
• Eye movements
• Note extent of other injuries (eg max fax)
Xrays and CT scans to identify fractures
What does an eye examination entail?
- Lid
- Conj
- Cornea
- Anterior chamber
- Iris/pupil
- Lens
- Intraocular pressure
- Vitreous
- Retina
If blood is seen in anterior chamber, where did it come from? What can it lead to? What is it called?
Hyphema
Usually from iris vessels
Can lead to ocular hypertension due to blockage of filtering system
Define iridodialysis
Disinsertion of the iris root, iris comes away from ciliary body. Pupil becomes misshapen.
What does a traumatic cataract look like?
Traumatic cataracts occur secondary to blunt or penetrating ocular trauma.
Cataracts caused by blunt trauma classically form stellate- or rosette-shaped posterior axial opacities that may be stable or progressive, whereas penetrating trauma with disruption of the lens capsule forms cortical changes that may remain focal if small or may progress rapidly to total cortical opacification.
What can happen to the retina after blunt trauma?
Commotio retinae:
Yellowish sheen on retina, sheer effect due to trauma.
Define choroidal rupture
Breaks in the choroid, the Bruch membrane, and the retinal pigment epithelium (RPE) that result from blunt ocular trauma
White concentric lines of rupture due to torsion around optic nerve
What will perforation of the eye look like?
Tear drop pupil with iris poking out
If there is hx of high velocity injury, what investigation is needed?
Xray to pick up metal in back of eye
What happens if metal is not found and stays in back of eye?
Siderosis: iris colour changes, pupil becomes sluggish. Due to metal foreign body.
What is seen in diabetic retinopathy
- Microaneurysms
- Leakage (hard exudates, haemorrhage)
- Occlusion
- VEGF-> Angiogenesis-> proliferative retinopathy
Treatment of proliferative diabetic retinopathy?
Pan retinal photocoagulation in peripheries
Anti-VEGF intravitreal injections
Steroid injections
Complications of proliferative diabetic retinopathy? (2)
- Ring of fibrous tissue grows with new blood vessels, contracts and can dislodge the retina
- Blood vessels can grow towards iris, can block drainage of fluid
What is seen in anterior uveitis?
Keratitic precipitates
Iris adheres to cornea or lens
Acute uveitis is associated with___
- Can be autoimmune (HLA B27 related, psoriatic arthritis)
- IBD
- Collection of inflammatory cells
Chronic uveitis is associated with__
- Mutton fat keratitic precipitates
- Juvenile idiopathic arthritis
- TB, syphilis, herpes, sarcoidosis
What can cause retinitis?
toxoplasmosis, CMV, candida (in immunosuppression)
Signs and causes of posterior uveitis
- Cells in vitreous: clouding
- Headlight in the fog
- Choroidal granuloma/sarcoidosis
What can corticosteroid treatment do to the eye?
Posterior subcapsular cataract
2º glaucoma
Which antimalarial drugs can cause eye problems?
Chloroquine-> maculopathy
Quinine-> Optic atrophy, arteriolar narrowing
Treatment of giant cell arteritis?
Urgent steroids
Which eye muscles adduct?
Medial rectus
Inferior and superior recti