Ophthalomogy Flashcards
Acute Angle Closure Glaucoma
Acute Closed Angle or Angle Closure Glaucoma
(Ischemia/ Hypo perfusion of Optic nerve/ Irreversible vison loss )
The angle between the Iris and the Drainage area become Very small
because in the Glaucoma
there is loss of Peripheral vision (Tunnel vision )
As the Outer half of vision become dark The eye thinks Its need more light to see
it Dilates the pupil by Constriction the IRIS and this led to thick IRIS which block the Drainage pathway at the Base
Sudden pain in the Eye / Headache / Photophobia / N n V
↓Visual acuity - AH Pushed into Cornea - Cloudy Cornea
↑ Pressure - Rock Hard eye ball
Physiologically massage the eye ball
Pupil Dilated - Tx is Use Pilocarpine 2% to Constrict the Iris (Miosis)(Make it more thinner and flat) - Release of the blockage
Diuretics of eye - Carbonic Anhydrate with or without Mannitol (Ophthalmologist )
If all fail - TRABECULOPLASTY - Laser to open the Duct (Trabecular Mesh Work )
-IRIDOTOMY - Laser to cut the iris and open the channel and release the pressure
SHUNT tx - By passing the TRABECULAR MESHWORK
Dx is Tonometry
GLUCOME (OAG)
GLUCOME (OAG):
-R.F: 1- Fx 2- BLACK 3- MYOPIA -OLD PATIENT - PERIPHERAL VISUAL LOSS -NASAL SCOTOMA >TUNNEL VISION -DECREASED VISUAL ACUTIY -OPTIC DISC CUPPING MYOPIA > GLUCOMA
HYPERMYTROPIA > CLOSED ANGLE GLUCOMA
Different TYPES OF EYE CONDITIONS
◙ Myopia →
♠ Open-angle Glaucoma(90% cases),
(Lifelong SLOW ONSET / SYMPTOMS NOT NOTICED/ PUPIL LESS DILATED )
“Progressive ↓ visual acuity and peripheral filed vision in an elderly ± disc cupping”
♠ Cataract
“Glare, Dazzling – halos-,
Hx of long steroid intake”,
♠ Retinal detachment “Floaters and Flashes ± Curtain falling over vision”.
◙ Hypermetropia →
♠ Acute Angle Closure Glaucoma (RAPID ONSET / Pupil MORE DILATED)
(Headache, Halos, pupil is semi-dilated, Hard globe, Corneal Oedema)
Different TYPES OF EYE CONDITIONS
◙ Myopia →
♠ Open-angle Glaucoma(90% cases),
(Lifelong SLOW ONSET / SYMPTOMS NOT NOTICED/ PUPIL LESS DILATED )
“Progressive ↓ visual acuity and peripheral filed vision in an elderly ± disc cupping”
♠ Cataract
“Glare, Dazzling – halos-, / Myopia
Absent Red Reflex (on Fundoscopy Normal color of Retina is red / Absent in Cataract)
Hx of long steroid intake”,
♠ Retinal detachment “Floaters and Flashes ± Curtain falling over vision”.
◙ Hypermetropia →
♠ Acute Angle Closure Glaucoma (RAPID ONSET / Pupil MORE DILATED)
(Headache, Halos, pupil is semi-dilated, Hard globe, Corneal Oedema)
Central Retinal Vein Occlusion VS
Central Retinal Artery Occlusion
Vein = Flame Artery = Cherry
CRAO- Arterial obstrution (Amaurosis fugax )
- No blood supply
- Pale retina
- Cherry spots
CRVO-Venous obstruction-
No venous return-
Dialated tortuous vein n Hge
• CRVO & CRAO
o Both have sudden painless loss of vision
o No redness, or abnormal pup dilation
o CRVO – OPTIC Disc swelling, veins are dilated & tortuous, & flame shaped retinal hemorrhages.
o CRAO – No retinal hemorrhages, Pale retina with cherry red spots on macula.
CRAO
Inflammation - Painful LOV - Giant cell arteritis
Dislodged Embolus - Painless LOV
Different Managements
Firm Ocular Massage—- Central retinal artery occlusion
Corticosteroids ————-Optic Neuritis (Associated with Systemic Sclerosis)
Scleral Bulking ————–Retinal Detachment.
Panretinal Procoagulation –'’Proliferative’’ Diabetic Retinopathy, when there is Neovascularization
Surgical exertion of LENS - Cataract.
Peripheral Iridotomy: For Closed Angle Glaucoma, of course
after stabilizing with eye drops: Pilocarpine, timolol, prednisolone, IV Acetazolamide
Bacterial Conjuntivits
<3 day
3-7 days
>7 days
<3 days - self- care (Clean discharge using cotton wool soaked in warm water )
> 7 days - Start topical antibiotics
Chloramphenicol - Drug of choice for bacterial conjunctivitis.
Also the drug of choice in patients with MENINGITIS who are allergic to Penicillin.
Keratitis extend deep into the stoma
Keratitis = inflammation of Cornea
Tx is only Topical Steroid if Herpes Simplex Keratitis
Fluorescent light - Can see Ulcers on the cornea
Degenerative Macular Diseases
K T B P
degenerative eye disease :
kill The Blue Parrot:
Keratoconus
Terrien Marginal Degeneration
Terrien marginal degeneration is a noninflammatory, unilateral or asymmetrically bilateral, slowly progressive thinning of the peripheral corneal stroma.
Band Keratopathy
Pellucid Marginal Degeneration
Treatment of thyroid eye disease:
1) Artificial eye drops
2) Selenium supplements
3) Decompression surgery to create more space behind the eyes
4) Eye muscle surgery for the fibrosis of the inferior rectus muscle
5) Eyelid surgery for the lid lag
Dendritic Ulcer on the Cornea on FLUROCENT STAIN (HSK)
VS
Rash on Half of Forehead with Eyelid swelling (HZO)
Herpes Simplex Keratitis(Tx TOPICAL acyclovir )
Unilateral / Painful / Photophobia /
Blurred vision
Red Eye
Sensation of a foreign Body
Herpes Zoster Ophthalmicus (Tx IV OR ORAL acyclovir ) NO ROLE OF ORAL
Mucopurulent conjunctivitis
To Prevent Postherpatic Neuralgia - GIve quickly ACICLOVER to control the VIRUS and prevent dmg to the VISION (72hr)
In Immunocompromised - Reactivation in the Area of Ophthalmic Division of Trigeminal
Associated with Hutchinson’s Sign (Involvement of Tip of NOSE )
Preorbital cellulitis Vz Orbital cellulitis (OCULAR EMERGENCY)
Preorbital = Structures in front of Orbit (eye lids / GLands)
Orbital Cellulitis = inflammation of all the Fats and Muscles in the ORBIT (Emergency )
Both will come with FEVER
Orbital Cellulitis
FEVER + PAIN ON MOVEMENT + SWELLING OF THE EYE AREA
The eye is pushed forward = Ptoptosis
All eye movements are REDUCED
Eye is diffusely red dt the inflammation of the conjunctiva and episclera vessels dilatation
Tx - Admit and give oral Co-amoxiclav initially and then IV Antibiotics (to prevent Optic nerve damage )
- Ct to see if there is an ABSCESS
if + - Surgery to drain the abscess
Orbital cellulitis…….
presence of orbital signs like proptosis and gaze restrictions
Periorbital cellulitis……..absence of orbital signs.
DIFFERENT Inv
Orbital cellulitis - CT
to exclude abscess / abscess inside the brain
oculomotor palsy.
Posterior communicating cerebral artery.
GIANT CELL ARTERITIS – ESR
RVAO —- US Doppler
OP 0601
Lady Comes to doctor for regular check up of EYE and return
then come to emergency SEEING COLOURED HALOES
with severe pain and redness
Which structure was effected
Doctor dilate the IRIS for examination (Mildly dark ophthalmic room and dilatation of pupil exacerbate the symptoms )
which precipitated the Acute closure angle Glaucoma
The answer is ANTERIOR CHAMBER is affected
