Ophthalmology Flashcards
Causes of sudden, painless vision loss
Central retinal artery occlusion
Central retinal vein occlusion
Vitreous haemorrhage
Retinal detachment
TIA/Stroke
Temporal arteritis
Optic neuritis
What is a relative afferent pupillary defect (RAPD)?
Suggests retinal or optic nerve pathology
Pupil constricts normally during consensual response but not during direct light (gives appearance of
paradoxical pupil dilation)
Seen in:
* CRAO
* CRVO
* Retinal detachment
* Stroke/TIA
45F with sudden-onset, painless vision loss. Diagnosis and cause.
Vitreous haemorrhage
Due to proliferative diabetic retinopathy
65M progressively painful eye with temporal headache. Description and likely diagnosis
Conjunctival injection with peri-limbal (ciliary) flush, constricted irregular pupil and hypopyon
Anterior uveitis
Clinical findings in anterior uveitis
Conjunctival injection with perilimbal flush
Direct and consensual photophobia
Aching pain, may involve temporal region
Pupil may be small, normal or irregular
Muddy iris
Slit lamp - cell and flare in anterior chamber
Posterior synechiae
Hypopyon (develops over days)
Orbital vs periorbital cellulitis - Differentiating signs and symptoms
- Loss of vision
- Ophthalmoplegia
- Pain on eye movement
- Proptosis
- Conjunctival oedema
Orbital cellulitis - Routes of contraction and common organisms
Extension from peri-orbital structures: sinuses, face, globe, lacrimal sac
Direct innoculation of orbit from trauma or sugery
Haematogenous spread
Strep pneumo, pyogenes
Staph aureus
Haemophilus influenzae
Features of orbital compartment syndrome
x Proptosis
x Rock hard eyeball palpated with eyelid closed
x Visual acuity. Significantly decrease, rapidly dropping to light perception only
x Inability to open eye
x Severe eye pain
x Limited eye movements
x Raised IOP >40 mm Hg. Rock hard eye ball to palpation compared to the other side
x RAPD
Indications for lateral canthotomy
Blunt eye trauma with suspected retrobulbar haematoma
PLUS any of:
Decreased VA
Raised IOP >40 mmHg
RAPD
Proptosis
OR
CT findings of orbital compartment syndrome:
- Stretching of optic nerve
- Tenting of glob
- Retrobulbar haemorrhage with proptosis
Methods of tonometry
Tonopen (electronic indentation)
Impression (Schiotz) tonometry
Applanation tonometry with slit lamp (Goldmann)
Rebound tonometry
Pneumato-tonometry
Conditions associated with anterior uveitis
Inflammatory bowel disease
Ankylosing spondylitis
Sarcoidosis
Psoriasis
Reiter syndrome
SLE
Infectious
Trauma/post-surgical
Drug-induced e.g. sulfonamides
Complications of anterior uveitis
Synechiae
Glaucoma
Cataracts
Retinitis
Band keratopathy
Vision loss
Treatment of globe rupture
- Urgent referral to Opthalmology
- Lie patient flat
- Avoid external pressure on the eye
- Tetanus update
- IV antibiotics (cephazolin 2gm IV +/- gentamicin)
- Eye shield – not pad
- Analgesia – appropriate opiate-based analgesia
- IV anti-emetic
- Sinus precautions
28M struck in eye with cricket ball. Description of findings
Haemorrhage in anterior chamber inferiorly
Iridodialysis (iris separation from ciliary body) inferiorly
Pupillary distortion - damage to sphincter ?traumatic mydriasis
Management of traumatic hyphema
- Analgesia (avoiding NSAIDs, aspirin)
- Eye patch
- Bed rest and head elevated 30 deg to aid settling of hyphema
- Topical cycloplegics - homatropine/tropicamide
- Seek and treat complications
- Raised IOP - acetazolamide/topical timolol
- Traumatic iridocyclitis - steroids, cycloplegics
- Seek and treat assoc. injuries incl.:
- Lens dislocation
- Globe rupture
- Orbital wall fracture
- Retinal detachment
