Ophthalmology Flashcards
what causes dendritic ulcers
HSV
- causes a corneal ulcer
Sx and Ix for dendritic ulcer
Sx
- photophobia and eye watering
Ix
- Fluorscein drops stain
Tx for dendritic ulcer
Acyclovir
how does orbital cellulitis present
Often children with painful inflammation of the orbit, fever, lid swelling and decreased eye movements
what are the common causative organisms of orbital cellulitis and how does it spread
Common bugs : Staphs, Strep pyogenes/pneumonia
Spread by paranasal sinus infection, eyelid infection
Risk of extension to meninges and cavernous sinus
Ix and Mx of orbital cellulitis
Ix = CT
Mx = IV antibiotics
what is ophthalmic shingles and how does it present
Ophthalmic branch of the trigeminal nerve
Sx
- Pain and neuralgia in V1 dermatome
- purulent conjunctivitis
- visual loss
- episcleritis/scleritis
- CN palsy
- optic atrophy
- blistering rash
- Corneal signs and iritis
what is Hutchinson’s sign
Involvement of nose tip
- means involvement of nasociliary branch of trigeminal nerve which supplies the globe therefore eye is likely to be affected.
Mx of ophthalmic shingles
Oral Acyclovir
- start within 4 days of onset
DDx for acute red eye
conjunctivitis
keratitis
anterior uveitis
acute glaucoma
how does conjunctivitis present
diffuse injection
gritty pain
often bilateral
normal vision, pupil size and iOP
how does keratitis present
diffuse injection gritty pain photophobia reduced vision normal pupil and IOP
how does AU present
circumcorneal injection (red eye) pain photophobia reduced vision constricted pupil in affected eye normal or raised IOP proptosis ciliary flush
HLA B27 associations – Psoriatic Arthritis, ank spon, IBD, sarcoidosis, TB
how does acute glaucoma present
diffuse injection unilateral severe pain and nausea etc mild photophobia reduced vision fixed mid dilated pupil raised IOP
what is classic triad of anterior uveitis
redness
pain
photophobia
Tx of AU
topical steroid e.g. dexamethasone
dilating the pupil e.g. cyclopentolate
what is used to treat raised IOP
Beta blockers
Lantoprost
Acetazolamide
what is a hypopyon
pus in the anterior chamber
summary of episcleritis
Relatively common / no serious associations
Association with gout
Recurrent
Nodules may occur
Self limiting
what is scleritis associated with
systemic vasculitis
- Rheumatoid arthritis
- Wegner’s
Sx of scleritis
painful
“violet-blue” hue
Phenylephrine test – redness improves in episcleritis
Tx of scleritis
Oral NSAIDs
Oral Steroids
Steroid Sparing Agents
Sx of angle closure glaucoma
Sudden onset of red painful eye with blurred vision.
Associated nausea, vomiting, headache.
Circumcorneal injection
Cornea cloudy (oedematous)
FIXED AND MID DILATED IS KEY TERM
Tx of angle closure glaucoma
IV acetazolamide to reduce IOP
Pilocarpine to constrict pupil and improve aqueous outflow.
Beta blockers and prostaglandin analogues
how does CRVO present
Sudden painless loss of vision
Can have afferent papillary defect-suggesting ischemia.
what are risk factors CRVO
increasing age hypertension and CVS disease diabetes glaucoma vasculitis
how does CRVO look on fundoscopy
retinal haemorrhage
cotton wool spots
dilated veins
leakage of fluid from vessels giving retinval oedema.
Tx for CRVO
Tx for underlying cause
Pan retinal photocoagulation if neovascularisation occurs.
anti VEGF and intravitreal steroids can be also used
how does CRAO present
Sudden painless severe loss of vision or amaurosis fugax.
An afferent papillary defect is usually present
how does CRAO look on fundoscopy
cherry red spot is seen at the fovea
Tx for CRAO
Ocular massage and iv azetaolamide to reduce ocular pressure needed.
Breathing into paper bag builds up CO2 which acts as a vasodilator to help dislodge emboli.
Start on oral aspirin if not contraindicated
Corneal paracenthesis to drain off aqueous humour and decrease pressure
how does retinal detachment present
Painless, progressive visual field loss. Shadow corresponds to area of detached retina.
Floaters
Sudden flashes of light
how does a 3rd nerve palsy present
Ptosis
proptosis
fixed pupil dilation
eye is “down and out”
how does a 4th nerve palsy present
diplopia
patient may hold head tilted (ocular torticollis)
Eye looks upwards, and cannot look down and inwards (superior oblique paralysed)
how does a 6th nerve palsy present
diplopia in the horizontal plane
A 35-year-old man presents with right eye pain which is worse on movement. Examination reveals a relative afferent pupillary defect. Which one of the following is the most likely cause of his problems?
- MG
- MND
- GBS
- MS
MS
eye features of MS
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma
mx of optic neuritis
high-dose steroids
recovery usually takes 4-6 weeks
A 75-year-old woman presents to surgery complaining of ‘blurry’ vision in her right eye for the past few months. She also notes that straight lines appear crooked or wavy. This only seem to affect the centre of her right visual field and no problems are noted with the left eye. She has never worn glasses or contact lens. On examination a central scotoma is noted in the right eye.
Which is the SINGLE most likely diagnosis?
Age related macular degeneration
- Macular degeneration is associated with central field loss
[Primary open-angle glaucoma is associated with peripheral field loss]
A 72-year-old woman presents with a vesicular rash around her left eye. The left eye is red and there is a degree of photophobia. A presumptive diagnosis of herpes zoster ophthalmicus is made and an urgent referral to ophthalmology is made. What treatment is she most likely to be given?
Oral Aciclovir
- for 7-10 days, ideally started within 72 hours
A 50-year-old man presents with red-eye associated with slight watering and mild photophobia. He reports no pain or tenderness and vision is not affected. Diagnosis?
Episcleritis
- red eye classically not painful
A 71-year-old man presents with severe pain around his right eye and vomiting. On examination the right eye is red and decreased visual acuity is noted. Which one of the following options is the most appropriate initial management?
Refer to hospital
Admit immediately
A 6-year-old boy presents to his GP with a swollen right eye. It started when he was playing outside in the garden. His mother is worried because he is struggling to read the writing in his books. He has no past medical history, and this has never happened before. On examination, the right eye lid is erythematous and warm, and the eye appears to be protruding. Eye movements are restricted in all planes. The left eye appears normal. His temperature is 37.9ºC and his heart rate 120 beats/minute. What is the most likely diagnosis?
Orbital cellulitis
- differentiated from preorbital cellulitis by presence of: reduced visual acuity, proptosis and pain with eye movements
