Ophthalmology Flashcards
Causes of red eye
Conjunctivitis (#1) - viral (mildly itchy), allergic (very itchy), bacterial in chlamydia (purulent DC), decreased vision and pain (severe bacterial)
Blepheritis
Corneal abrasion
FB
Subconjunctival haemorrhage
Keratitis - erosion, pain, decreased vision. Caused by dry eye, RA, infection
Uveitis/Iritis - ocular pain, miosis, decreased vision
Glaucoma - sudden onset severe pain, blurred vision, haloes, N/V, fixed mid-dilated pupil, increased IOP
Scleritis
Episcleritis
HZV ophthalmicus - Hutchinson’s sign
Red Eye - when to refer
Pain not relieved by topical anaesthesia
Purulent DC
Requiring topical steroids
Vision loss
Corneal involvement
Recent ocular surgery
Traumatic injury
Distorted pupil
Herpes infection
Recurrent infections
Acute bacterial conjunctivitis consider immediate treatment
Healthcare workers
Immune compromise
Contact lens wearers
DM
Dry eyes
Recent ocular surgery
Hospitalised
If <28 days old refer acutely to pads
Children whose schools require treatment
Consider delaying if no risk factors above, good healthcare access/literacy and not requesting ABx
VZV ophthalmicus
10-25% of shingles are ophthalmic
65% of these will develop corneal involvement
Initial finding is epithelial punctate keratitis
Dendrites appear in several days to weeks
Dendrites appear as swollen plaques in “medusa-like” patterns
Stromal keratitis appears in week two (25%) - multiple fine granular infiltrates in the stroma underlying the epithelium
Deep stromal keratitis and neurotropic keratopathy are more rare
Acute open angle glaucoma risk factors
Increasing age
Female
Asian
Hypermetropia
FHx
Use of eg anticholinergics
Acute closed angle glaucoma sx and signs
Rock hard globe on palpation
Acute severe pain/distress
HA - severe, unilateral, sudden onset
Nausea/vomiting
Vision loss/decreased acuity
Red eye
Increased IOP if able to measure
Mid-dilated sluggishly reactive pupil - pathognomonic
Cloudy/hazy cornea with indistinct iris
Signs of blunt force injury to eye/peri-orbital structures
Hyphema
Orbital blow-out # or teardrop sign on XR facial views - numbness infraorbitally, pain, restriction or diplopia with eye movements (esp upwards gaze due to involvement of inferior rectus)
Decreased vision
Traumatic iritis
Traumatic mydriasis
Retrobulbar haematoma - eye pain and proptosis
Leaking eye/positive Siedel’s test
Oedema and damage to retina (commotio retinae)
Eye trauma management
Protective shield eg styrofoam cup
Anti-emetics
Do not remove penetrating objects
Do not force eye open or push on eye
Urgent ophthalmology review
Analgesia
NBM
?tetanus
?ABx if delay to service
Corneal foreign body referral criteria
Suspicion of into-ocular FB (can be minimal pain, suspect if metal on metal hx)
Sx of corneal infection
Large abrasion post removal
Persistent sensation of FB if one not found
Concurrent contact lens use
Persisting visual loss
Persisting defect
Difficult/paediatic patient
Persisting rust ring
Loss of transparency of cornea
Amaurosis fugax definition
Transient, painless, monocular vision loss due to lack of blood flow and perfusion to the optic nerve and retina
Lasts seconds to minutes and frequently accompanied by pre-syncope
Amaurosis fugax causes
Carotid artery disease - classic
Other atherosclerotic disease
Embolic disease
Cocaine
Hypercoaguable state
GCA
Amaurosis fugax workup and treatment
Carotid artery doppler/CTA
?Echo
CVD risk assess
?GCA investigations
Urgent stroke referral
Causes of transient visual loss
Amaurosis fugax
Migraine
Vertebrobasilar artery insufficency
Papilloedema
Causes of persistent visual loss
Retinal artery occlusion - usually embolic
Retinal vein occlusion - usually atherosclerotic
Retinal detachment
Optic neuritis
Ischaemic optic neuropathy
Vitreal haemorrhage
CVA
Causes of retinal detachment
Advanced age
Previous cataract surgery
Myopia
Trauma
