ophthalmology Flashcards
RED eye/Conjunctiva (unlike what?!?!?!?!?!?)
Sore EYELIDS
Gritty-Foreign Body / Sticky / Burning
O/E: Conjunctiva =
- diffusely injected -> transient blurring
- crusted eyelids
- SWOLLEN conjunctivae #chemosis=oedema
1a. Dx? Muco-PURULENT discharge Stuckkkk @MORNING --Noooooot itchy --usually no Pre-Auric LNopathy
- Tx?
- Tx @preg?
- Re-attender mx?
-Refer when?
1b -Muco-PURULENT d/c +
Pre-Auric LNopathy +
?STD Hx =
Dx?
_____________
2. Dx? SEROUS discharge Recent URTI Pre-AURICULAR lymph NODES PRURITIS -Chemosis=Conjunc-Oedema/erythema
- what organism? -> Epidemic KeratoConjunctivitis -> -pseudo?
- severe PAIN
- Subconjunctival Haemorrhage
- visual changes/photophobia.
-Ax? Bact Pre-auric LNs Ax?!
-Tx?
-Re-attender mx?
___________
- Dx?
sticky RED @neonate
5–14 days after birth
2 presentations:
- Copious purulent dischargeand eyelid swelling - Ax?
- petechial/subconjunctival haemorrhages, lymphadenopathy - Ax?
Tx?
-Mild = presentation?
-Severe = Ix?
___________
- Summer time, itchy eyes - Dx? Tx?
_____________
- Non-resolving i.e. chronic conjunctivitis despite top chloramphenicol - Dx?
RED eye (unlike blepharitis/dry eye synd)
Conjunctivitis: CFR-HOOMP-sCDT-AAA
1a. Bacterial conjunctivitis: CFR-HOOMP
- Chloramphenicol-Top
- FUSIDIC @pregggg-Top
- Re-attends = SWAB:
- -viral PCR #adeno/HSV
- -bacteria #top ABx
- Refer: HOOMP
- HSV #ulcer/keratitis
- Ophthalmia neonatorum #STD:CT/GC NAAT
- Ocular surgery
- Molluscum-contagiosum #pox-virus
- Periorbital OR orbital #cellulitis
1b. Muco-PURULENT d/c + Pre-Auric LNopathy + STD Hx =
GONORRHOEA
_____________
- Viral - sCDT
- ADENO -> Epidemic KeratoConjunctivitis -> -pseudoMEMBRANES
- severe pain
- subconjunctival haemorrhage
- visual changes / photophobia
Ax:
- Adeno
- Chlam/Gon present w/ Pre-AURIC NODES!!!!!
Tx: self-limit (towel/handwash) 1-2w COOL comp Debris removal Tears/lube @dry-eyes = Hypromellose -Re-attends = SWAB: ---viral PCR #adeno/HSV ---bacteria #top ABx \_\_\_\_\_\_\_\_\_\_\_
- Neonatorum-Ophthalmicus
- Copious purulent discharge + eyelid swelling #Gonococcal
- petechial/subconjunctival haemorrhages, lymphadenopathy #Viral - adeno/HSV
Tx = REFER
-Mild = Encrusted Eyelid
-Severe = Bloods, CT/GC NAAT
___________
- Allergic = AAA
Avoid allergens
AHist/Mast-cell stab Cromoglic
-Artifical tears/lube @dry-eyes = Hypromellose
______________
- Orbital Lymphoma
________
Refer for bottom causes suspected:
- Ddx:
1. Corneal abrasion - Yellow/green focal uptake Top ABx
2. Corneal ulcer - discrete/focal area of upake - Top ABx
3. Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
- HSV Keratitis- Feathery Dendritic Top Aciclovir
- HZO urgent admit PO aciclovir - U+E
red eye ddx: ACAG A.Uveitis Scleritis/EPainlesScleritis Conjunctivitis Subconjunc haemorrhage Chorioretinitis-CMV/Toxo HZO Intra-occ surg / pre/orbital cellulitis / Molluscum
NOOOOOO red eye unlike WHAT?!
-EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS
Burn / Itchy @eyeLIDS
Sore eyeLIDDDD - #CRUST
Gritty / Sticky
-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING
-Recurrent STYE !!!!!!!!!!!
O/E: EyeLIDDDD margins = RED
-NOT swollen
Assoc w/
- Meibomian dx
- A. Rosacea
- Parkinsons
- Seborrh Derm / Staph infection
- EyeLID margins Red + Swollen @?infection?!?!
- Dx? Tx?
-Posterior blepharitis w/ meibomian gland dx + rosacea
-> Tx??
___________
Pathphys of posterior blepharitis -> dry eye synd
? glands = secrete what? ->
which forms what? ->
-stop what?
-improve what?
@Meibomian blepharitis – ? reduced -> ?
NOOOOOO red eye unlike CONJUNCTIVITIS
_____________
BLEPHARITIS = EyeLID dx - WMDA ALI
O/E:
-Eyelid margins red AND swollen
@S.Aureus Blepharitis
- Warm compression
- Massage @post-bleph
- Debris removal*
- Ax tx / ?ABx: Chloramphen
- Artifical tears/lube @dry-eyes = Hypromellose
- Lens-wear = reduce/change
- Incr humidity / Lower comp screens = lower lid aperture
- Posterior blepharitis w/ meibomian gland dx + rosacea
- > DOXY
*cooled boiled water w/cotton buds /
Na HCO3-
___________
-POSTERIOR blepharitis -> dry eye synd Meibomian tarsal glands = oily secretion -> form outer part of tear-film -> -stop tear EVAP -improve tear stability/spreading
@Meibomian blepharitis – oily secretion reduced -> tear EVAP
NOOOOOO red eye unlike WHAT?!
Usually B/L
-Fluoroscein Exam: PUNCTATE stain PHOTOsensitive Mucous d/c Occular FATIGUE -WORSEN/Tearing @WIND -WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day
Burn / Itchy @EYE
?Bluuuuurring = ?INTERMITTENT
Gritty / Sticky
- Meibomian orifices on bilateral lids = plugged with OILY material
- EyeLids/Conjuntiva = crusted/Red
- Margins = irregular.
NORMAL acuity/pupils/sclera
NORMAL ant slit: cornea/chambers
PMH: Bell’s palsy - not compliant w/ taping eyelid b4 sleep
- Dx? Tx?
2.
If pt use > ? drops/day –>
consider ?-free drops
-cos preservatives= ???
@mod-severe ?? potential = is higher due to
? dosing and
? tear secretion.
@severe - use what?
?what @tear ducts –>
dos what???
3.
Pathphys of posterior blepharitis -> dry-eye synd:
-Meibomian tarsal glands = secrete what? ->
which forms what? ->
-stop what?
-improve what?
NOOOOOO red eye unlike CONJUNCTIVITIS
_____________
- DRY eye - WMD ALI
- Warm compression
- Massage @post-bleph
- Debris removal*
- Ax tx / ?ABx-Chloramphen
- Artifical tears/lube @dry-eyes = Hypromellose
- Lens-wear = reduce/change
- Incr humidity / Lower comp screens = lower lid aperture
*cooled boiled water w/
-cotton buds
-Na HCO3-
_____________
- Dry Eye WMD ALI
If pt use > 6 drops/day –>
consider PRESERVATIVE-free drops
-cos preservatives = FURTHER damage cornea/conjunctiva-epith
@mod-severe, PRESERVATIVE TOXICITYpotential = is higher due to
MORE frequent dosing and
REDUCED tear secretion.
-@severe:
PUNCTAL plugs @tear ducts –>
increase tear film
_____________
3. POSTERIOR blepharitis -> Dry Eye Synd Meibomian tarsal glands = OILY secretion -> form OUTER part of tear-film -> -stop tear EVAP -improve Stability/Spreading of tear
@Meibomian blepharitis – oily secretion reduced -> tear EVAP
Fluorescein:
- Punctate stain
- YELLOW/green stained abrasion #?surface
- discrete/FOCAL area of yellow/green
-FEATHERY Dendritic ULCER
_______________
ACUTE Local TRAUMA
PAIN, Photophobia
FOREIGN BODY sensation
LOCAL TRAUMA
After removing contact lens -
?nail scratch-self
Fluorescein exam =
YELLOW/green stained abrasion
Corneal UPTAKE
Fluorescein:
- Punctate stain – Dry eye
- YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
- discrete/FOCAL area of yellow/green – C. Ulcer
-FEATHERY Dendritic ULCER – HSKeratitis
________________
Corneal abrasion
-Top chloramphenicol
_____________________
Ddx:
- Corneal abrasion - Yellow/green focal uptake Top ABx
- Corneal ulcer - discrete/focal area of upake - Top ABx
- Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
- HSV Keratitis- Feathery Dendritic Top Aciclovir
- HZO urgent admit PO aciclovir
Fluorescein:
- Punctate stain
- YELLOW/green stained abrasion #?surface
- discrete/FOCAL area of yellow/green
-FEATHERY Dendritic ULCER
_______________
Contact lens users (CLARE)
-Red eye
Pain, Photophobia
Tearing
Pupils normal
Fluorescein exam =
discrete/FOCAL area
of yellow/green fluorescence
under a blue light
- Tx?
- Can present as?
- Avoid what?
Fluorescein:
- Punctate stain – Dry eye
- YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
- discrete/FOCAL area of yellow/green – C. Ulcer
-FEATHERY Dendritic ULCER – HSKeratitis
________________
Corneal Ulcer -Top chloramphenicol -CAN Presents as Dendritic Feathery Herpes Simlex Keratitis -AVOID top anaesthetic drops \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Ddx:
- Corneal abrasion - Yellow/green focal uptake Top ABx
- Corneal ulcer - discrete/focal area of upake - Top ABx
- Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
- HSV Keratitis- Feathery Dendritic Top Aciclovir
- HZO urgent admit PO aciclovir = U+E
ACAG A.Uveitis Scleritis/EPainlesScleritis Conjunctivitis Subconjunc haemorrhage Chorioretinitis-CMV/Toxo HZO
Fluorescein:
- Punctate stain
- YELLOW/green stained abrasion #?surface
- discrete/FOCAL area of yellow/green
-FEATHERY Dendritic ULCER
_______________
CLARE: Contact Lens Acute Red Eye -Climber/skiers -Welders (arc eye) -Sunbed users NOT USED PROTECTIVE goggles \+ FOREIGN BODY sensation #GRITTY BLEPHARO-SPASM #eyelid-spasm PAIN, PHOTOphobia RED eye - hyperaemia
O/E: ?Hypopyon Cornea = HAZY ant slit lamp NORMAL pupils Punctate lesions
Dx?
Which Bacteria @contact-use ?
Still bact most common?
Tx?
Fluorescein:
- Punctate stain – Dry eye
- YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
- discrete/FOCAL area of yellow/green – C. Ulcer
-FEATHERY Dendritic ULCER – HSKeratitis
________________
Keratitis - corneal inflamm - ACTS
- Contacts - P. Aerug #CLARE
- but still S.Aureus > P.Aerug
- Admit ASAP for Ant slit lamp to r/o Microbial Keratitis
- CycloPlegicPentolate = Analgesia #mydriasis
- Top ABx - quinolone
- Stop contact lens
Ax:
-HSV / Staph > P.Aerug #ContactsLARE)
-Fungal/ AmoebaSoil/ ParasiteRiverBlindness
_____________________
Ddx:
- Corneal abrasion - Yellow/green focal uptake Top ABx
- Corneal ulcer - discrete/focal area of upake - Top ABx
- Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
- HSV Keratitis- Feathery Dendritic Top Aciclovir
- HZO urgent admit PO aciclovir - U+E
_____________________
ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
Fluorescein:
- Punctate stain
- YELLOW/green stained abrasion #?surface
- discrete/FOCAL area of yellow/green
-FEATHERY Dendritic ULCER
_______________
RED eye
PAIN, Photophobia
Tearing
?decreased acuity
Fluorescein exam =
small, area of abnormal uptake @epithelium
-FEATHERY Dendritic ULCER
Tx? Avoid? Can presents with?
Fluorescein:
- Punctate stain – Dry eye
- YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
- discrete/FOCAL area of yellow/green – C. Ulcer
-FEATHERY Dendritic ULCER – HSKeratitis
________________
Herpes Simples KERATITIS
- Urgent OPHTHAL
- Top ACICLOVIR
- AVOID top steds
- Can present w/ Dend Corneal Ulcer
_____________________
Ddx:
- Corneal abrasion - Yellow/green focal uptake Top ABx
- Corneal ulcer - discrete/focal area of upake - Top ABx
- Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
- HSV Keratitis- Feathery Dendritic Top Aciclovir
- HZO urgent admit PO aciclovir - U+E
ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
Marco Tropical Scam in Pak:
Marcus-Gunn RAPD CN2 Ax
-M.ARCO
Tunnel vision Ax
-T.ROPIC
Scotoma Ax
-S.CAM
___________
Hypopyon Ax
-PAK
Squint strabismus:
- Up till when is it normal?
- When to start worrying?
- Types? Which one more common in concomitant?
- Ix?
Tx: Refer - eye patch @ > age ?
________
Aciclovir: when Top/PO?
Marco Tropical Scam in Pak:
Marcus-Gunn RAPD
- AION
- RVO/RAO-central
- CRVO/CRAO
- Optic Neuritis: MS/DM/Syph
TTTunnel Vision:
- Ret pigmentosa
- Optic Atrophy @TTTabesDorsalisSyph
- POAG-ACAG
- ICP high i.e. pappilooedema
- ChorioRet-CMV/Toxo
Scotoma: -CRVO -ARMD -Migraine - scintillating \_\_\_\_\_\_\_\_\_\_\_\_\_
Hypopyon: -Post-op endophthalmitis, -Ant uveitis, -Keratitis \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
- Intermittent squint in NEWborn <3 months = NORMAL - underdeveloped eye muscles
- > 3m ?start worrying #refer
Concomitant: Convergent In > Divergent Out
Paralytic: muscle paralysis
Ix:
Corneal light reflection
Cover test
Tx: Refer - eye patch @ >3months
________
Aciclovir:
Top @HSV Keratitis
PO @HZO
SUDDEN ocular irritation;
-ABERRANT lash OR
-CLUSTER of lashes seen;
_____________
Eyelid turned out
Eyelid turned in
What does 6/12 vision mean?
__________
Fluorescein:
- Punctate stain
- YELLOW/green stained abrasion #?surface
- discrete/FOCAL area of yellow/green
- FEATHERY Dendritic ULCER
______________
Marfan’s - SuddenUnilatPainless vision loss
Blue sclera @paed condition
__________
Valsalva manoeuvre, coughing, sneezing, or heavy lifting;
- asymptomatic;
PMH: HTN or Anticoagulants
O/E: well-circumscribed area of confluent haemorrhage underneath conjunctiva
Trichiasis
_____________
Ectropion
Entropion
6/12 vision = METRES!!!!!! = Pt V Normal
-PT can see X at 6m
-That a NORM person would see at 12m
________
Fluorescein:
- Punctate stain – Dry eye
- YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
- discrete/FOCAL area of yellow/green – C. Ulcer
-FEATHERY Dendritic ULCER - HSKeratitis
____________
Lens dislocation - Marfan Scoliosis SCLERA blue Lens UPWARD dislocation ARm:Height >1.05 AOrtic sinus dilation ADom PCavus / Excavatum
Blue sclera = Osteogen IMPERFECTA
__________
Non-traumatic subconjunctival haemorrhage
Keith Wagener HTN retinopathy classification:
SABP
________
Non-Proliferative BACKGROUND Diabetic Retinopathy: -mild -mod -severe \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Proliferative retinopathy DM ? > ?
-Pathphys?
-Tx?
_______________
Blurrrrrring vision, DM2,
HARD exudates @fovea
‘BG’ changes on macula
-vessels @macula = leaky / blocked
Keith Wagener HTN retinopathy classification:
-SABP
1
Silver wiring - INCR light reflex
Tortuous/narrow arteries
- AV nipping
3.
Blot Flame hamorrhages
Cotton-wool exudates
4.
Papilloedema
___________
Non-Proliferative Diabetic Retinopathy: 1/+ MBChB BMI
Mild - 1 or more microaneurysm
Mod - MBChB:
- Microaneurysms
- Blot hemorrhages
- Cotton wool spots
- hard exudates / IRMA
- BEADING/LOOOOP=venous
Severe: BMI -BEADING=venous 2 quadrants -Blot haemorrhages 4 quadrants -Microaneurysms 4 quadrants -1RMA 1 quadrant \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Proliferative retinopathy DM 1 > 2
- Ret NEOvasc –> Vit Haemorrh (veil-like periph->central)
- Fibrous tissue ANT to retinal disc
-LASER Tx
_______________
Maculopathy:
Hard exudates
‘BG’ changes on macula
ACUTE
RED eye Photophobia Blurrrrrrrrrrrrring vision Tearing - Lacrimation --PainLESSSSS
Apply gentle pressure:
-vessels = MOBILE
PainLESSSSS
PhenylEphrine --> redness IMPROVE -Why?? PainLESSSSS \_\_\_\_\_\_\_\_\_\_\_
*Dx Related: PauciArth / Asymm / OP E.Nodosum Episcleritis C>UC
Dx UNrelated: PolyArth / P - Symm / Clubbing = PSCholang P.gangrenosum Uveitis Smoking UC>C
Episcleritis PainLESSSSSSSSSS motherfuckrr!!!
PhenylEphrine –>
blanches the SUPERFICIAL conjunctival and episcleral vessels –>
redness IMPROVE
_____________________
ddx: ACAG A.Uveitis Scleritis/EPainlesScleritis Conjunctivitis Subconjunc haemorrhage Chorioretinitis-CMV/Toxo HZO
ACUTE
RED eye Photophobia Blurrrrrrrrrrrrring vision Tearing - Lacrimation --PAIN
Apply gentle pressure:
-vessels = DEEPER so NOT mobile
PAIN
PhenylEphrine –>
redness NOT IMPROVE
PAIN
Rhem arthiritis assoc more with what?
Scleritis PainFULLLLLL motherfuckrr!!!
RhemArth = assoc MORE with
KeratoConjuncitivitis Sicca > Scleritis!! #passmedQ
ACUTE
RED eye
PAIN and Photophobia
Blurrrrrrrrrrrrring vision
Tearing - Lacrimation / Ciliary flush
Pupil = FIXED OVAL (as opposed to DILATED)
- misshapen OVAL
- irregular OVAL
- small OVAL
- HYPOPYON in the Anterior Chamber
PMH:
- HLA-B27 BACK pain
- Can’t see, can’t pee, can’t climb tree
- Painless Genital ulcers/VTE/Uveitis
- black man, HyperCalc, high ACE, SOB, BHL
- LUQ pain, blood @stool
Tx?
Dx Related: PauciArth / Asymm #OP E.Nodosum Episcleritis -C > UC
Dx Unrelated: PolyArth-Symm-Clubbing #PSC P.Ganrenosum Uveitis -Smoking --UC > C
Anterior uveitis
- ank spond / reactive arth
- behcets
- sarcoid/ UC > C
C.steds TOP
Mydriatics - CycloPlegPent/ Atrop/ PhenylEph TOP
_____________________
ddx: ACAG A.Uveitis Scleritis/EPainlesScleritis Conjunctivitis Subconjunc haemorrhage Chorioretinitis-CMV/Toxo HZO
PAIN
Reduced acuity - HALOES
Semi-FIXED-DILATED pupil (as opposed to OVAL)
Hazy cornea
-watching TV @dark-room
-LONG-sighted #HyperMetropia
Mydriatic use CAP
-AntiMuscs = CycloPlegicPentate / Atropine
-Adr = PhenylEphrine
Those with a POS FHx of glaucoma should be screened ?HOW OFTEN from aged ? years
- LONG-sighted # ?opia = ?GLAUCOMA
- Short-sighted # ?opia = ?GLAUCOMA
_____________
- Myopia-Near-Sightedness
- black/HTN/DM/c.steds
Features:
- ? vessels
- Cup:Disc >0.? #?
- Disc issues?
- Visual dx?
What’s normal pressure?
____________
Tx?
ACAG
-halo in Cataract + ACAGA
ddx: ACAG A.Uveitis Scleritis/EPainlesScleritis Conjunctivitis Subconjunc haemorrhage Chorioretinitis-CMV/Toxo HZO \_\_\_\_\_\_\_\_\_\_\_\_ Those with a POS FHx of glaucoma should be screened ANNUALLY from aged 40 years
- LONG-sighted #HyperMetropia = ACAG
- Short-sighted #Myopia = POAG
POAG
- Bayonetting vessels
- Cup:Disc >0.7 #notching
- Disc Haemorrhages/ Pallor #Atrophy
- FOVL -> tunnel vision
-normal pressure 10-21
____________
Tx:
Surg: Laser Iridotomy / Trabeculo -plasty -ectomy -shunt
Meds: ALBAMA
AIM = Inc UveoScleralFlow + Lower Aqueous Production
-Lantoprost = Inc USF #BrownPigmentation #Blepharitis #LashLengthen
-Beta-Timolol - Lower AP - Asthma/HB CI
_________
Alpha AGONIST - Brimonidine = FOVL / Inflamm - itch/Red / TCA-MAOi CI
-inc USF + lower AP
Musc AGONIST - Pilocarpine = HA / Blurry / Ciliary Constriction Spasm
-inc USF
_________________
-Acetazmol - lower AP = sulfa-like rxns
50M SAM the THIN GORA SMOKER
Scotoma - central LOV
Acuity fucked
Metamorphopsia #PulfrichPhenomenon #AmslerGrid
- age >50 years;
- smoker; thin; white
a) Yellow-Drusen @Brusch-Membrane -> Gradual
Tx?
b) Choroidal Neo-Vascularisation + Haemorrhage -> Acute
Tx?
-Why avoid smoking in Beta-Carotene?
c) Mac-Degen + Hallucinations
a) DRY age-related macular degeneration
PT/OT/Education #NO-cure
-SVN: Smoking-cessation, Visual rehab, Nutrition
b) WET age-related macular degeneration
PT/OT/Education #NO-cure
-BV: Beta-carotene/ VEGF ointment/ Vit C+E
-Photo -coag -dynamic
- Why avoid smoking in Beta-Carotene? LUNG CANCER
c) Mac-Degen + Hallucinations = Charles-Bonnet Syndrome
- Gradual
vision = deteriorated + BLURRED
SHADOW in the red reflex
HALOS surrounding light source
PMH: DM2 / steroids / LOW Ca
_________________
- RED eye
PAIN
Sudden Vision LOSS
RECENT hx of /glaucoma INTRAOCCULAR Surgery
Inflammation =
hyperaemia / hypopyon
-Chemosis=Conjunc-Oedema
________________
- DAYS/WEEEEEEKS after Cataract SURGery Inflammation –> blurring
_________________ - A/W painLESS, BLURRING
Prev B/L cataract surgery
YEEEEARS agoooooo
- Cataract
-halos in cataract + ACAG ffs
____ - Post-op Endophthalmitis - urgent ophthal referral
________ - CMO: Cystoid Macular Oedema - days-weeks after
_______ - Post Capsule Opacification YEEEARS later
DISTANCE vision WORSEN
-I.e. Now short-sighted
blurred vision
-improve with use of a PINHOLE
NEAR vision > DISTance vision
-LONG-sighted #HyperMetropia = ?Glaucoma
-Short-sighted #Myopia = ?Glaucoma
______________
-poor glycaemic control HbA1c 48/+
DISTANCE vision WORSEN
blurred vision
-improve with use of a PINHOLE
NEAR vision > DISTance vision
Myopic lens shift #Myopia
- NEAR vision best
- pinhole helps
- LONG-sighted #HyperMetropia = ACAG
- Short-sighted #Myopia = POAG
Those with a POS FHx of glaucoma should be screened ANNUALLY from aged 40 years \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Diabetic Myopic lens shift
-NEAR vision best
Flashes @periph #photopsia
Floaters @temporal side
-? ring @fundoscopy
____________
** PMH: DM, Bleeding dx, APlts/ACoags **
?Von Hippel Lindau
SUP-VL
- ? - small bleed
- ? - mod bleed
- ? - large bleed
- —red hueeee in the vision
@Fundoscope = ?GONE -Ix = B-USS
Tx?
____________
-Periph --> central #VEIL-LIKE-Dense SHADOW
** PMH: Features of
Post-Vit-Detach PRECEDE:
-Spider-‘Spindley’-Flashers/Floaters **
O/E
- grey-opalescent @fundoscopy
- ?RAPD
?Straight lines = CURVY!!
Tx? Types?
Post Vit Detachment
–Weiss ring @fundoscopy
____________
Vitreous haemorrhage
- Floaters - small bleed
- Dark spots - mod bleed
- SUP VL - large bleed
- @Fundoscope = Red Reflex GONE
Tx: Bedrest 30 to 45° head Lazer –> Vitrectomy \_\_\_\_\_\_\_\_\_\_\_\_
RETinal Detachment = HOLE-BB-Pull
- Buckling retinopexy vitrectomy
- similar to Mac Degen
-Rhegmatogenous = HOLE
retina hole @degen -> fluid accum
-Exudative = B-B-B
Blood-Retina-Barrier Breakdown -> fluid accum
-Tractional = Pull
Pull retina off
SUP-VL
O/E:
1. FLAME-shaped Blot HAEMORRHAGES - #PIZZAAAAAAA
- RAPD
- Optic disc = ?
- Anterior slit lamp NORMAL
Ax:
Polycythemia
Inc Age / AF
Glaucoma / HTN
- BRVO – SUP-VL @?
- CRVO - SUP + ?
-Surg? Prev? Rubeoid glaucoma?
CRVO
- BRVO – SUP-VL @ OCCLUSION area
- CRVO - SUP + SCOTOMA
Optic disc = SWOLLEN
- Surgery = Vitrectomy
- Prevention = decrease cardiac RFs
- Rubeoid glaucoma - Photocoag/Lucentis/Dexa implant
_________
SUP-VL: -BRVO - @ OCCLUSION area -CRVO - SCOTOMA Tx = Vitrectomy Prev cardiac RFs Photocoag, Lucentis @Rubeoid
SUP-VL:
-BRAO= altitudinal
-CRAO= central
Tx = MATH
SUP-VL
- Pale retina /
- Cherry red spot
- RAPD
Pupil = POORly constrict 2 light Consensual = FINE
Ax: VTE / Atheroscl / GCA
- Tx?????????????
- BRAO= ? SUP-VL
- CRAO= ? SUP-VL
Central Retinal Arterial Occlusion
- Tx = MATH
- BRAO= altitudinal
- CRAO= central
Tx RAO: AIM=dec IOP Massage– >paracentesis Mannitol Acetazolamide Thrombolytics Hyperbaric chamber \_\_\_\_\_\_\_
SUP-VL: -BRVO - @ OCCLUSION area -CRVO - SCOTOMA Tx = Vitrectomy Prev cardiac RFs Photocoag, Lucentis @Rubeoid
SUP-VL:
-BRAO= altitudinal
-CRAO= central
Tx = MATH
- Redness and swelling around eye
- Eyelid oedema and ptosis
Normal acuity, no proptosis, no eye pain, no eye-movement pain i.e. no ophthalmoplegia
________________
Recent cold...................... -Redness and swelling around eye -Eyelid oedema and Ptosis \+ PAIN @ eye Ophthalmoplegia/Pain @ eye-movement Reduced ACUITY Proptosis
- COMMONEST cause of orbital cellulitis in kids?
- Which sinus?
- Why
- Cx and how to Ix?
Pre-Septal Cellulitis
_____________
Orbital cellulitis
-SINUSITIS of the ETHMOIDAL sinus
-THIN MEDIAL wall of the ORBIT =
COMMONEST cause of orbital cellulitis in kids
- CT-sinuses for SUB-periosteal abscess
- meningitis
Old person, circular ring @eye
AKA annular……?
___________
UNILAT decrease in acuity
over HOURS/DAYS - graaaadual
Poor discrim of colours, ‘red desat’
pain WORSE on eye MOVEment
RAPD
central SCOTOMA - missing area of the visual field
Dx? Ax? Tx?
Corneal Arcus = Annnular Senilis
________
Optic neuritis
-MS/DM/Syph
HIGH dose steroids @MS
HA @valsava - cough/early Morning DOUBLE vision Vision LOSS -FOVL -COLOUR vision
Optic disc:
-Swell / Blurrr / Elevation
-Concentric/Radial ? lines =
? from optic disc
-Optic cup ?
What used in emergency to reduce ICP?!
Papilloedema
- SLOW PROG vision loss
-Concentric/Radial RET lines =
CASCADE from optic disc
–Optic cup LOSS
HyperVentilation –> HYPOcapnia –>
vasoCONSTRICTION
Reduce ICP @emergency
6m neonate/infant
Recurrent STICKY left eye.
- Constant TEARING
- Chloramphenicol = FAIL
- Visual development Fine
- NOTT muco-purulent yellow/green,
- no Pre-Auric LNopathy
- Eye swab = negative
- (hence r/o NOphthalmicus #STD)
Dx?
- self-resolves by ? year of age
Congenital
tear (lacrimal) duct
obstruction
- self-resolves by 1 y/o
