Ophthalmology 3 Flashcards
What are the signs of a retrobulbar haemorrhage? And what are the investigations? What is the treatment?
Severe pain
Proptosis
Reduced visual acuity
Subconjunctival haemorrhage
- Periorbital ecchymosis and eyelid haematoma may also be seen if trauma related.
investigation:
- usually clinical diagnosis
- CT head
- Bloods - coagulation studies as this may be the cause
Treatment:
- lateral canthotomy with cantholysis
What are the signs of orbital cellulitis, what are the investigations and management?
Proptosis Restricted movement Reduced visual acuity RAPD Diploia
Investigation:
- CT sinus and orbits with contrast
Management:
- Ophthalmology referral
- IV antibiotics
- surgical drainage by ENT
Describe the management of corneal abrasions:
irragation
Check pH 20mins later to ensure no caustic damage
Discharge with chloramphenicol
Following an acid burn to the eye - what may be seen?
White patch over the area affected - instead of it being red as you would expect. this is because the vessels have been damaged along with the stem cells.
- needs follow up in ophthalmology
If there is a foreign body in the eye - where else should always be checked?
Under the eyelids
What important question should always be asked in the setting of a corneal ulcer and if the answer is yes, what should be asked for:
If they wear contact lenses
- if yes you should ask for them to bring it in so the lenses can be sent off for analysis
On examination what can differentiate an ulcer from an abrasion?
An ulcer can be seen as a white pale patch on the eye, whereas abrasion needs fluorescein to be seen
In the setting of a painful red eye, which symptom is always correlated with closed angle glaucoma?
Vomiting
What is the immediate management of endophthalmitis?
Intra-vitreous injection of antibiotics within the hour of onset
What are the risk factors for retinal detachment?
Myopia Trauma Family history Marfan's syndrome and other connective disorders Previous surgery
Why is there a cherry red spot on pale retina in central retinal artery occlusion?
The cherry dot is the fovea which is non- vascularised and thus appears relatively normal
What is the management of central retinal artery occlusion?
Require Head CT
*referral to TIA clinic
300mg Aspirin for 2 weeks:
then: aspirin + Clopidogrel
Ocular massage
- this is a TIA and should be treated as such
- treat within 6 hours.
What is the antibiotics used for corneal ulcers?
Ciprofloxacin drops
+ / -
PO drops
How is pre-septal cellulitis treated in children?
IV ceftriaxone
This differs from adults which are usually treated with PO floxacillin.
this is because the septal orbit hasn’t fully formed in children.
Name some of the intracranial complications of orbital cellulitis:
Brain abcess
Meningitis
Cavernous sinus thrombosis
Retinal artery/ vein occulusion
What is the part of the conjunctivia which sits over the sclera and what is called when it swells?
Bulbar conjunctivia
Chemosis
What tests are needed in keratitis?
corneal scrapings
Fluorescein staining
Contact lens cultering
In contact wearers which infectious organisms should you suspect when keratitis is not improving?
Acanthamoeba
*should be thought about whenever someone wearing contacts goes swimming as well
What is the most common cause of blindness in the UK, what are some signs and what investigations are done?
ARMD
Signs:
- reduced central vision loss
- distortion of lines (seen with Amsler grid testing)
- Drusen spots on fundoscopy
Investigations:
- slit lamp examination
- Fluorescein angiography (if suspected wet ARMD)
- OCT
What are some risk factors for orbital cellulitis?
Childhood
Sinus infection
Non- vaccination of Hib
Facial infection
If a contact lens wearer presents with symptoms of keratitis, how should they be managed?
Referral same day for assessment
- they can develop pseudomonas infection which can be sight threatening
What are some risk factors for vitreous haemorrhage?
Diabetes - neovascularisation can cause bleeding Trauma Anti-coagulation Bleeding disorders Retinal tears
*vitreous haemorrhage is what it says, bleeding into the vitreous compartment which can obscure vision - not strictly a vitreous detachment
How do you diagnose a tropia?
Cover test:
Cover the contra lateral eye and the problematic eye should move into position to take focus
What are some of the complications of VZV infection of the eye and what is the classic sign?
Sign:
- Hutchison’s sign
Complications:
- anterior uveitis
- keratitis
- ptosis
How is visual acuity assessed in a baby/ toddler?
Gratings - 10 weeks old
*lines on a baord which a child will follow when compared to a grey board
Kay pictures
- 3 years old
How is retinoblastoma inherited? how does it present? and how is it investgiated if suspected?
Autosomal dominant
Presentation:
- Leukocoria
- Strabismus
Eye examine under anaesthetic
RETcam + fluorescein
B scan
Treatment:
- enucleation of eye
How are the zones of retinopathy of prematurity classified?
By the circumference they make moving into towards the macula
- the closer the higher the zone
Which three people should be contacted when there is a case of orbital cellulitis?
Paediatrician
ENT
Ophthalmology
What are the differences between pre-septal and orbital cellulitis?
Orital:
- reduced visual acuity
- exophthalmos
- reduced movement
- RAPD present
When is the synaptic pathways from the optic nerve to the brain said to be finsihed by?
6-8 years old
What are the causes of Uveitis?
Idiopathic
TB
Trauma
Autoimmune
- seronegative arthritis
Inflammatory bowel disease
VZV - herpes zoster opthalmicus
What examinations do you want to do into someone presenting with a painful red eye?
Visual acuity test
Pupil examination
- equal
- RAPD
- reactive to light
Fundoscopy
Measure IOP
Slit lamp examination
What sign are seen in anterior uveitis?
Keratic precipitates
Posterior synechiae
Hypopyon
Conjunctival injection
White cells in the anterior chamber
What is the treatment of anterior uveitis?
Topical steroids
Mydriatic eye drops
- cyclopentolate
- breaks the posterior synechia
What does the uvea consist of?
iris, ciliary choroid
*choroid is bit between the sclera and retina
What are the differentials for seeing flashing lights?
Posterior vitreous attachment
Retinal Tear
Retinal detachment
Ocular Migraine
What sign may be seen if there has been a retinal break?
Shafer’s sign
What is a sign that may be seen in the back of the eye which is suggestive that there may be a retinal detachment about to come in following weeks?
Weiss ring
- type of floater
What type of refractive error is associated with retinal detachment?
Myopia
- eyeball is large
What is the treatment for retinal tear?
- *this is for a tear not a detachment
- Laser Retinopexy
creates a scar around the tear preventing further from detaching
Which sex is more likely to develop acute angel closure?
Females
What sign may be seen on fundoscopy of acute angle closure?
Hazy to see
- due to cornea
High cup to disc ration
Prior to giving Mannitol or carbonic anhydrase medication for acute angel glaucoma what do you want to check?
There is no renal issues.
What is the general management of acute angle closure?
Break the attack: - systemic Acetazolamide or - Mannitol \+ - Timolol \+ - Pilocarpine
**treat both sides
Prevent further attack - Laser iridotomy or - Cataract surgery (remove the bulky lens) or - Trabeculectomy (creates a pleb)
