Ophthal Flashcards
How to manage bacterial conjunctivitis
Mild: saline irrigation, antiseptic eye drop
Severe: chloramphenicol eyedrops 1-2hrly first 4 days, then 4x a day for 7 days
Managing vital conjunctivitis
Limit cross infection by hygiene Cool compress Topical lubricants Naphazoline Vasoconstrictors Saline bathing Watch for secondary infection NO steroids or padding
What is a very important feature of vital conjunctivitis
Subconjunctival hemorrhage
Managing allergic conjunctivitis
Topical antihistamines/vasoconstrictors Chromoglycate 2% eye drops Combination of 1 and 2 Topical steroids Artificial tear prep
How to treat herpes simplex keratitis
Eye hygiene
Acyclovir 3% ointment, 5x a day for 14 days
Atropine 1% drop 12 hourly for duration of treatment
Debriedement by consultant
How to manage blepharitis
Anterior:
- Wash eyelashes frequently with baby shampoo
- If infected, antibiotic ointment chloromycetin
Posterior:
- eye hygiene also but with eye massage
- Ocular lubricants of dry eyes
- control scalp seborrhoea
- If persists, topical corticosteroid
- antibiotic ointment like chloramphenicol
- avoid makeup and contacts
Tests for acute glaucoma
Full eye Examination Fundoscopy Slit lamp tonometry Gonioscopy Optic nerve imaging
Management of acute glaucoma
Refer to ophthal urgently
Analgesia
Acetazolamide/pilocarpine
Need to do iridotomy, under local anesthesia
What to rule out when taking history for red painful eye
Glaucoma Uveitis Conjunctivitis Corneal ulcer Herpes simplex keratitis Herpes zoster Penetrating injury Orbital cellulitis Foreign body Blepharitis Sclerosis Drugs/hyperthyroid
Questions to ask for eye presentation
- itch
- irritation
- pain
- loss of vision
- eye movements
- discharge
- contact
- URTI
- contact lenses
- trauma to the eye
- drops/ointments/cosmetics
- photophobia (uveitis, keratitis)
Clinical features of chronic glaucoma
no early signs and symptoms
central vision usually normal
progressive restriction of visual field resulting in tunnel vision
do tonometry
Treatment for chronic glaucoma
Timolol/betaxolol drops
Pilocarpine
Acetazolamide
Surgery/laser if failed pharmaco
Corneal ulcer diagnosis and treatment
Slit lamp and fluorescein stain, check for foreign body
Chloramphenicol 1% +/- homatropine 2%
Double eye pad if not infected
Review in 24 hours
Refer early if not healed
Causes of corneal ulceration
Trauma Contact lens Infection Neurotrophic Immune-related Spontaneous Chronic blepharitis Overexposure
Keratitis management
Refer urgently to ophthal
Can destroy cornea very fast with perforation
Give topical ciprofloxacin 0.3%
What to do if eye struck with a fragment/doubt about trauma
X-ray the eye
What to do if eye struck with a fragment/doubt about trauma
X-ray the eye
Retinal detachment clinical features and management
Sudden onset of floaters/flashes/black spots
Blurred vision in one eye becoming worse
Curtain coming down over the eye
Partial or total loss of visual field
Immediate referral for sealing of retinal tears, if true detachment need surgery
Clinical features of macular degeneration and management
Sudden fading of central vision
Distortion of vision
Straight lines seem wavy and objects distorted
Amsler chart shows distorted lines
Central vision eventually completely lost
Peripheral vision normal
Wet - refer urgently for treatment for injection of VEGF
Dry - treatments with vit A C E zinc, and stop smoking
Features and investigation of cataracts
Reading difficulty Difficulty recognizing faces Problem driving esp at night Reduced ability to see in bright light Haloes around lights
Absence of red reflex on fundoscopy and diminished visual acuity
Features of iritis/anterior uveitis
Dull aching painful eye Mild photophobia Red eye (limbal flush) Constricted pupil Posterior synechiae
Management of anterior iritis/uveitis
Topical steroid drops to reduce inflammation
Topical atropine to dilate pupil and break down posterior synechiae
Episcleritis is
Segmental redness of eye, moderate ache can treat with topical steroids
Scleritis features and management
Diffuse pattern, severe deep pain, loss of vision, tender
Urgent referral, corticosteroids/NSAIDS
