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