Ophthalmology Flashcards
Management of Macular degeneration (prior to seeing ophthal)
- Monitoring with Amsler grid at home
- Smoking cessation
- 5-10% weight loss
- Nutritional supplementation: Copper, vitamin c, vitamin E & zinc
- vigorous exercise daily
Gradual vision loss in the elderly ddx
- Aged related macular degeneration
- Glaucoma
- Diabetic retinopathy
- Hypertensive retinopathy
- refractive error
- Cataract
NOTE:
To differentiate refractive error: pinhole helps? then refractive
Abmormal red reflex: Cataract
Most common cause of monocular vision loss (transient)
Amaurosis Fugax
(embolic from plaque in carotid artery)
Most common cause of binocular vision loss
Migraine
Causes of monocular vision loss
(and symptom clues)
- Central retinal vein or artery occulsion
- GCA
temporal tenderness, jaw claudication - Tumor compressing optic nerve
gaze-evoked - Acute angle- closure glaucoma
Pain, redness - Papilloedema
Postural changes - Internal carotid artery dissection
Neck trauma
horners syndrome - Amaurosis Fugax
Binocular vision loss
Migraine
Occipital tumour /AV malformation
- Blurred vision after headache onset
Papilloedema
-Valsalva or postural
Vertebrobasillar insufficiency
- Neurology: vertigo, balance, dysphagia
Allergic Conjunctivitis pharmacology
Azelastine 0.05% 1 drop BE up to QID
or
Olopatadine (patanol) 0.1% 1 drop BE BD
Syte management
Warm compresses QID
Simple analgesia
Gentle cleaning with soap and water
Giant cell arteritis / Temporal arteritis Signs and symptoms
- Jaw claudication (pathognomonic)
- Visual loss or diplopia
- Scalp tenderness
- Malaise
- PMR (50%)
- Severe headache
Initial investigations for Temporal Arteritis ?
ESR
CRP
Temporal artery physical findings
Temporal artery tenderness, enlarged or difficult to compress, nodular
PULSELESS
Temporal arteritis management (if visual loss)
HINT: Think acute and longer term
1) Methylprednisolone 0.5-1g IV
Then:
2) Oral prednisolone 50mg daily for 4 weeks then taper
ADD
Aspirin 100mg daily
Temporal arteritis management if no visual loss
Prednisone 40-60mg daily for 4 weeks
AND
Aspirin 100mg daily
Then very slow taper (by 10mg every 2 weeks to 20mg, then by 2.5 every 2-4 weeks to 10 then reduce by 1mg every 4-8 weeks
Long term management of temporal arteritis
- Serial ESR/CRP monitoring (monthly for 3 months then 2-3 monthly)
- Slow wean of prednisone to avoid relapse
- Monitor for signs of proximal limb weakness (PMR)
- Monitor for vision change (recurrence)
- Educate on side effect of prednisone
(bone density, weight gain) - Review for side effects of prednisone
Signs/Symptoms of Cataracts
- Cloudy vision
- Low light issues
- Halo around lights
- Fading colours
Signs/Symptoms of Macular Degeneration
- Decreased central vision
- Visual distortion
- Scotoma (blind spot)
Signs/Symptoms of Diabetic retinopathy
Usually asymptomatic until severe
- Floaters (due to micro haemorrhages),
- Reduced VA
Signs/Symptoms of Vitreous Detachment
- Sudden flashes, floaters
- VA usually NORMAL
Strabismus (namely esotropia - turning in),
What is normal?
Intermittent/variable before 3 months
Strabismus (namely esotropia or turning in)
When to refer?
- Intermittent but >3MONTHS
(semi-urgent) - Constant any age
semi-urgent) - Acute onset –> Urgent referral
Differentials for Posterior Vitreous Detachment
- Retinal tear or detachment
- Vitreous haemorrhage
- Diabetic vitreous detachment
- Migraine
Blepharitis management
- Warm compresses 2-5 mins with eyes closed
- Gentle scrubbing of the lashes with sodium bicarb solution
- Chloramphenicol 1% ointmentBD 2 weeks (anterior)
- Doxycycline 100mg for 8 weeks (posterior)
What is this?
Occular rosacea
Orbital fracture: signs of severe eye injury
- Tear shaped pupil
- Afferent pupillary defect
- Proptosis
- Painful extraocular motility
- Reduced visual acuity
- Evidence of orbital compartment syndrome
- Signs of reduced level of consciousness
Orbital bone management (no red flags)
- CT orbital bones
- No nose blowing for 2 weeks
- Ice to the area 10 mins every 1-2 hours
- Sleep with head of bed elevated
- no air travel for 2 weeks
Pupil behaviour in Acute Glaucoma
Fixed mid dilated pupil
Iritis features (one is a medical condition)
- Ciliary flush (Redness in a ring around the iris)
- Small pupil
- history of ulcerative colitis
Acute Glaucoma features
- Fixed semi-dilated pupil
- +/- N&V
- Hazy cornea
- Haloes around lights
- Pain
- Impaired vision
Acute Glaucoma exam findings
***Indicate which side
- Fixed mid dilated pupil
- Poor pupillary reaction to light
- Reduced VA
- Conjunctival injection
- Clouded cornea
- Rasied IOP
Acute anlge- closure glaucoma Immediate emergency management
- TRANSFER
- Supine
- NBM
- Morphine IV/IM
- Ondansetron (sublingual)
- Avoid patching eye
A) What am I
B) What do you treat this with?
Dacryocystitis
Cephalexin 500mg QID
Pharacological management to reduce progression of Diabetic retinopathy
Fenofibrate 145mg PO daily
Trachoma treatment
Azithromycin 1g (20mg/kg up to 1g) stat
Anterior uveitis same as….
Iritis
Temporal arteritis (GCA) physical findings
Tender temporal artery (side)
Pulseless temporal artery (side)
Reduced VA (side)
Proximal limb weakness
Risk factors for open angle glaucoma
Fam hx
age >65
Myopia
Vasospastic conditions (migraine or reynauds)
OSA
Diabetes
HTN
Risk factors for angle closure glaucoma
Asian
Age (middle age or older)
Fam hx
Women
Hypermetropia
Cataracts
Classes of drugs used for Glaucoma (4)
Prostaglandin analogues: Latanoprost
Beta blockers: Timolol
Alpha-2 agonists: Brimonidine
Carbonic anhydrase inhibitors: Dorzolamide
What is this (minimal discomfort)
Episcleritis
(painful) what am I?
Scleritis
Eye down and out…. which CN palsy?
(plus ptosis & enlarged pupil)
3rd
What am I ?
Marginal keratitis
What am I & what to do? (bluish hue)
Dacrocystocoele
Ophthal emergency- refer to ophthal via ED
