Ophthalmology Flashcards
Conjunctivitis
Sx 2; Types with Mx 4
Sx:
Conjunctival injection (dilated conjunctival vessels)
Conjunctival oedema
Types:
- Allergic
- Itching ++
- Allergen avoidance (e.g. mould, animal dander), surface lubricants
- Can try topical antihistamine/mast cell stabiliser (e.g. azelastine) - Viral
- Usually self-limiting within 1-2 weeks
- Separate towels, wash hands regularly, no school exclusion
- If recurrent consider herpes simplex conjunctivitis - Bacterial
- Usually self-limiting within 5-10 days
- Most common strep pneum, staph aureus, haem influenza
- Swab if initial treatment fails
- 1st line: Chloramphenicol drops/ointment (5d)
- 2nd line: Fusidic acid drops (7d)
- No school exclusion - Irritant
Sight abnormalities
3
Myopia = short-sighted (concave lens)
Hypermetropia = long-sighted (convex lens)
Astigmatism = abnormal lens curvature
Basic sight tests
2
Snellen chart - visual acuity
Ishihara chart - colour vision
Sight impairment
Severity 2; with parameters 3
SEVERELY sight-impaired
(Previously = registered as blind)
- VA <3/60
- VA <6/60 with contraction of visual field
- VA >6/60 with significant contraction of visual field impairing function, e.g. bitemporal hemianopia
SIGHT impaired
(Previously = registered as partially sighted)
- VA between 3/60 and 6/60
- VA between 6/60 and 6/24 with moderate contraction of visual field
- VA >6/18 with marked visual field defect
Squint
=; Types 2; —> 2; Refer 1; Rx 4
= one eye is not in alignment with the other, occurs e.g. due to refractive error
Types:
Eso (inwards)
Expo (outwards)
-tropia
May —>…
- Diplopia in adults
- Amblyopia in children
Refer…
All squints over 2 months as untreated will likely become permanent
Treatment options…
- Correct refractive error
- Occlusion therapy
- Surgery (extra-ocular muscle insertion point)
- Inject botulinum toxin
Subconjunctival haemorrhage
5
- Bleeding from conjunctival /episcleral vessels into subconjunctival space
- Asymptomatic red eye
- Spontaneous/trauma/sneezing/bleeding disorders
- Think Blood Pressure
- Benign, self-limiting
Blepharitis
=; Adm 2; Mx 4
= inflammation of eyelid margins
Same day admission if…
Visual loss
Or
Symptoms of corneal disease
Mx:
- Eyelid hygiene
- Warm compresses (5-10 mins)
- Massage
- May need antibiotics - topical (chloramphenicol) or oral (tetracycline) if evidence of infection
Eyelid abnormalities
Types 2; with Mx 2
- Entropian = eyelid turned in (lubricants/surgery)
2. Ectropian = eyelid turned out (lubricants/tape/surgery)
Chalazion & Stye
For each =; Mx; Refer
CHALAZION = meibomian cyst
- Chronic eyelid granuloma (firm swelling)
- Warm compressions 10-15 mins, then massage, regularly
- Refer if persists (.e.g 4 weeks) or discomfort
STYE = hordeolum
- Localised infection/inflammation of eyelid —> pain
- Most are self-limiting, Abx if infected
- Refer if persists or discomfort
Acute glaucoma
=; Sx 5; Mx 3; Refer
= ocular hypertension >21mmHg (NICE recently increased to 24mmHg) —> damage to optic nerve head
Sx:
- Severely painful red eye
- Nausea
- Blurred vision
- Oval pupil
- Stony hard eyeball
Mx:
- Laser iridotomy (allows fluid from posterior to anterior chamber)
- Pilocarpine/B blocker/steroid drops
- Acetazolamide orally/IV
ADMIT!
Uveitis
=; causes 4; Sx 4; Mx 1
= iritis = inflammation of uveal tract (iris, ciliary body, choroid)
Causes:
Usually idiopathic, but can be infectious, autoimmune, neoplastic
Sx:
- Pain
- Red eye
- Flashes/floaters
- Blurred vision
Mx:
Steroids (oral/topical) IF NOT INFECTIVE - secondary care.
ADMIT!
Orbital cellulitis
Cause; Sx 4; Mx 2
Infection spreading from local infection, e.g. sinusitis, skin infection
Sx:
- Pain
- Swelling
- Proptosis
- Oedema
Mx:
Abx, surgical drainage in secondary care
Retinal artery occlusion
Types 2; Cause 2; Sx; Fundo 1; Mx 2
- embolic or thrombotic
Can be central or branch occlusion
—> painless vision loss
Cherry red spot on fundoscopy
Rapid reduction in IOP may dislodge an embolus (globe pressure, IV acetazolamide, etc)
Think CVD assessment
ADMIT!
Retinal vein occlusion
Causes 2; Sx 1; Fundo 1; Mx
Can be central or branch occlusion
—> painless vision loss
‘Stormy sunset’ appearance on fundoscopy
Various secondary care options including medications/implants
ADMIT!
Retinal detachment
Sx 3; Fundo 1; Mx 2
Floater, flashes, painless vision loss
May see grey/pale background on fundoscopy
Mx:
Laser therapy
Vitrectomy
ADMIT!
