OPHTHALMOLOGY Flashcards
symptoms are usually bilateral
grittiness and discomfort, particularly around the eyelid margins
eyes may be sticky in the morning, may be swollen
can commonly also have chalazions and styes
secondary conjunctivitis also common
blepharitis
management of blepharitis
hot compress
lid hygiene
artificial tears
Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)
Itch is prominent
the eyelids may also be swollen
May be a history of atopy
May be seasonal (due to pollen) or perennial
allergic conjuctivitis
management for allergic
first-line: topical or systemic antihistamines
second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
Purulent discharge in the eyes
Eyes may be ‘stuck together’ in the morning)
bacterial conjunctivitis
Serous discharge
Recent URTI
Preauricular lymph nodes
viral conjucntivitis
management of conjunctivitis
usually self-limiting within a week or two
chloramphenicol can be offered in some severe cases. fusidic acid in pregnancy
0.5% drops, 1% ointments
red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen (milky white fluid in the iris)
keratitis
management for keratitis
stop wearing contact lenses
topical abx = quinolones - ciprofloxacin
cycloplegic for pain relief e.g. cyclopentolate
refer contact lens wearers to exclude microbial keratitis
a raised, triangular or wedge-shaped, benign growth of conjunctiva tissue.
can cause irritation, redness and tearing/watery eyes
pterygium
pterygium management
drops, ointments and topical steroids can be given to soothe the eye in minor irritation.
definitive treatment = surgery
firm painless lump in the eyelid
can be slightly erythematous but usually flesh coloured
chalazion
meibomian cyst
management of chalazion
conservative/self-resolving = hot compress advised
sometimes may require surgical drainage
infection of the glands of the eyelids
red swollen painful lump on the waterline/margin of the eyelid
stye/hordeolum
management of stye
hot compress and analgesia
chloramphenicol only given when there is associated conjunctivitis/severe or recurrent stye.
Redness and swelling around the eye Severe ocular pain Visual disturbance Proptosis Ophthalmoplegia/pain with eye movements Eyelid oedema and ptosis
orbital cellulitis
Ix of orbital cellulitis
Blood culture and microbiological swab to determine the organism
management of orbital cellulitis
admission to hospital for IV antibiotics - co-amoxiclav
Excess tears (epiphora) - almost invariably.
Pain
Redness
Swelling on the upper eyelid
dacryoadenitis
management of dacryoadenitis
abx - co-amoxiclav
and analgesia
some may require incision and drainage
misalignment of the visual axes.
strabismus/squint
management for strabismus
referral to secondary care
eye patches may help prevent amblyopia
gradual onset of... reduced vision faded colour vision glare around lights halos around lights may have a opacity of the iris
defect in red-reflex
more common in women>men
usually 65yrs +
cataracts
management of cataracts
conservative contacts/glasses to improve vision
definitive = surgery
management of congenital cataracts
usually monitoring if not causing serious impairment to vision
cataract surgery
reduced visual acuity
fluctuating visual disturbance
fundoscopy = drusen, yellow areas of pigment deposition in the macular area
older age, hx of smoking, family history
age related macular degeneration
Ix for macular degeneration
slit lamp microscopy
fluorescein angiography
ocular coherence tomography
management of macular degeneration
Vascular endothelial growth factor (VEGF) - ranibizumab, bevacizumab and pegaptanib - 4 weekly injection.
laser photocoagulation does slow progression of ARMD
Inner lining of the eyelid that droops forward may become dry and sore
eyelashes droop outwards
ectropion
management of ectropion
surgery = tighten muscle around the eyes
Irritation and pain on the front of the eye.
A watery eye.
If left untreated, the front of the eye (the cornea) may become damaged
entropion
management of entropion
Taping the eyelid to the cheek; or
Injecting the muscles of the eyelid with botulinum toxin.
Lubricating eye ointment
definitive = surgery
eye pain or headache semi-dilating non-reacting pupils haloes around lights decreased visual acuity red, hard eye
acute closure glaucoma
insidious onset of peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping
usually symptomless for a long time typically present following an ocular pressure measurement during a routine examination by an optometrist
primary open angle glaucoma
acute closure glaucoma management
prompt referral to ophthalmologist
eye drops = pilocarpine (parasympathomimetic), timolol (BB), apraclonidine (alpha-2 agonist)
IV acetazolamide
definitive management = laser peripheral iridotomy
primary open-angle glaucoma
first line: prostaglandin analogue (PGA) eyedrop - latanoprost (ending in -prost)
second line: beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eye drop
very advanced = surgery/laser may be considered
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots,
diabetic retinopathy
Ix for diabetic retinopathy
gold standard for diagnosis is dilated retinal photography with accompanying ophthalmoscopy
management for diabetic retinopathy
control of diabetes
The sudden appearance of floaters (occasionally a ring of floaters temporal to central vision)
Flashes of light in vision
Blurred vision
Cobweb across vision
The appearance of a dark curtain descending down vision
retinal detachment
Ix for retinal detachment
ophthalmologist within 24 hours to rule out retinal tears or detachment.
management of retinal detachment
surgical - vitrectomy or surgical buckling
sudden visual loss
afferent pupillary defect, ‘cherry red’ spot on a pale retina
central retinal arterial occlusion
sudden painless vision loss, usually unilateral
severe retinal haemorrhages are usually seen on fundoscopy
central retinal vein occlusion
central retinal artery occlusion management
firm occular massage
anterior chamber paracentesis
acetazolamide
central retinal vein occlusion management
refer to 24hr ophthalmologist panretinal photocoagulation (PRP) laser treatment anti-vascular endothelial growth factor (anti-VEGF) ranibizumab
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems
average age of diagnosis is 18 months.
retinoblastoma
management of retinoblastoma
surgery (including localised conservative surgical treatments), chemotherapy and radiation
reduced vision
papilloedema
raised intracranial pressure
management of raised intracranial pressure
head elevation to 30°
IV mannitol
control hyperventilation
removal of CSF
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect)
central scotoma (blind spot)
optic neuritis
common association with optic neuritis
multiple sclerosis
management of optic neuritis
high dose steroids
should resolve in 4-6 weeks
reduction in vision
loss of contrast or colour vision
pale optic disc
optic atrophy
diagnosis of optic atrophy
fundoscopy
management of optic atrophy
dependent on the underlying cause of the atrophy
exophthalmos conjunctival oedema optic disc swelling ophthalmoplegia inability to close the eyelids may lead to sore, dry eyes
thyroid eye disease
management of thyroid eye disease
topical lubricants may be needed to help prevent corneal inflammation caused by exposure
steroids
radiotherapy
surgery
restriction of extraocular movement, particularly upward gaze,
lid ecchymosis/bruising and oedema
enophthalmos (sunken eye) or exophthalmos (proptosis).
epistaxis
blow out fracture
Ix for blow out fracture
Occipitomental (Waters) view plain X rays
CT Facial views
management for blow out fracture
ophthalm referral max-fax referral antibiotics nasal decongestants, ice packs don't blow nose
Irritation, photophobia, and lacrimation occur
hx of trauma
corneal abrasion
management of corneal abrasion
Prescribe regular antibiotic ointment (eg chloramphenicol) and oral analgesia.
eye patch
cyclopentolate or diclofenac eye drops
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
horner’s syndrome
management of horner’s
treat underlying cause
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation
absent ankle/knee reflexes
holme-adie
management of holme-adie
Corrective spectacles may be prescribed; no other treatment is usually needed
fixed dilated pupil which doesn’t accommodate
eye is deviated ‘down and out’
ptosis
third nerve palsy
signs of intracranial pressure
blood in the anterior chamber of the eye
hyphema
management of hyphema
in context of trauma = urgent referral to an ophthalmic specialist for assessment and management
strict bed rest + ophthalmic review
red eye classically painful mild pain/discomfort is present watering and photophobia are common gradual decrease in vision
sclecritis
