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
Retinal Detachment Vision will not recover unless intervention VS Amaurosis Fugax ( Obstruction of retinal Artery ) vision will be recovered on its own
Ballooning of the retinal
Amaurosis fugax (resolves within 15-30 minutes. ) associated with TIA / STROKE / HYPERTENSION /ARTEROSCLEROSIS / GCA is also associated
Curtain coming down
Cherry red spots and Pale retina and Carotid Bruit
amaurosis fugax is the eye version of TIA
Retinal Detachment - will have Bulging of retina ( Opalescent Retina Ballooning forward )
Tripple F: 😸 👉Flares 👉Flashes 👉Fall in visual field
💎On ophthalmoscopy: Pale retina that balloons forward
Rx: Scleral Bucling
Different types of Herpes Virus
HZO»varicella zoster virus» Trigeminal Nerve distribution» painful Rash around eye with or without actual involvement of the eye (cornea, sclera, conj, iris, retina)
HSV 1» Trigeminal N distribution…
Main symptom is Keratitis (dentritic ulcer)..
may involve other structures of the eye as well (sclera, conj, iris, retina)
Ramsay Hunt syndrome…also called Herpes Zoster Oticus..
HZO»>Varicella virus» Facial Nerve…main symptom is Facial Palsy…sometimes with rash which would be in the ear usually
HZ virus can affect the ear also »_space;Ramsay Hunt syndrome…also called Herpes Zoster Oticus..
Treatment :
HZO»>VZV» oral acyclovir , oral steroids (controversial), Eye care (for HZO if eye structures involved, Ramsay hunt as there is palsy) NO ROLE OF TOPICAL
HSV1» Topical Acyclovir
Post herpatic neuritis (Complication of VZ virus in IMMUNOCOMP)
PHN is a chronic neuropathic pain condition that persists three months or more following an outbreak of shingles Herpes zoster presents initially with a painful vesicular eruption in a single dermatome, which is what the patient is currently experiencing. If the eruption resolved but the pain continued, she would have PHN.
ACUTE DACRYOCYSTITIS
: - EXCESSIVE TEAR
- PAIN
- SWELLING AND ERYTHEMA OF **INNER CANTHUS OF EYE
TREATMENT: -CO-AMOXICLAV OR CEFA…
bacterial conjunctivitis , chloramphenicol
acute dacrocystis co-amoxiclav
ANT. UVIETIS ( IRITIS / IRIDOCYCLITIS):
My teacher once told me; Rest the tired horse;; meaning that the iris is in strain or spasm so give a dilating drug to relax it and rest it. Rx of anterior uveitis- cyclopentolate
- UNILATERAL PAINFUL RED EYE
- BLURRED VISION
- PHOTOPHOBIA
- IRREGULAR SHAPE PUPIL
- EXCESIVE TEAR PRODUCTION
- CELL IN AQUEOUS HUMOUR
ASS WITH: 1-A.S 2- R.A 3- U.C
TREATMENT:
1- PREDNESOLONE
2- CYCLOPENTOLATE
OP 1630 Old women Chronic RA taking NSAID comes to emergency department with A one Painful red eye which anatomy structure is affected VS most common eye condition in RA
The common eye conditions seen in rheumatoid arthritis are
keratoconjunctivitis sicca, episcleritis, scleritis, and steroid-induced cataract.
In the given case - Unilateral, pain, and redness point more to Scleritis than keratoconjunctivitis sicca.
Please keep in mind that the question isn’t asking for the most common eye condition in RA but the single most likely affected structure.
Keratoconjunctivitis ususally comes with Bilateral eye pain
Keratoconjunctivitis sicca can have varied presentations
but is usually **bilateral** and may include irritation or discomfort — this may be described as burning, stinging or a gritty sensation.
It gets ***painful when secondary infections occur or when there is corneal ulceration.
Alternately, scleritis is an inflammation of the sclera (the white outer wall of the eye) and is characterized by **severe pain.****
Homosexual + Fundoscopy - H’ge and Yellow white area with perivascular exudates
CMV retinitis»_space;
pizza retina:
- Hemorrhages = tomato sauce
- yellowish exudate = cheese
By the way, pizza retina is a real medical description for CMV retinitis
Stages of Hypertensive Retinopathy and Diabetic Retinopathy
Hypertensive Retinopathy
Stage 1 Silver Wiring / Arteriolar Narrowing
Stage 2 AV nipping
Stage 3 Blots Spots Flame shaped hemorrhage Cotton Wool spots
Stage 4 Papilodema
DM
Background Retinopathy
Microaneurysms (Blots )
Hemorrhages (Spots)
Hard exudates
Pre Proliferative
Addition of COTTON WOOL SPOTS
Proliferative Retinopathy
Addition of NEOVASCULAROZARION
More serious - VItrous Hemorrhage - Leads rapidly to Blindness
Floaters in Image
LASER PRO COAGULATION is NEEDED
Fundus is OBSCURED BY DENSE OPACITIES
Smoking habits
Vision is Poor At Night
Cataract
Fundus is OBSCURED BY DENSE OPACITIES
Smoking habits
Vision is Poor At Night
Cataract
Fluorescein Stain - to search for corneal ULCERS (to exclude KERITITIS )
Unilateral Red eye + Irregular Pupil (not oval) + No trauma
Main point - IRREGULAR SHAPED LEFT PUPIL (NOT OVAL )
ANTERIOR UVEITIS
OP- 0190
Review
Depressive patient on drugs
now with Acute red eye pain
OP 2020
OP 2220
Age related MAcular degeneration
OP 2001
Optic Neruitis
Optic Neuritis (Diagnosed clinically by symptoms )
Unilater
Only Visual Hallucinations without any Delusions / talking/ interaction /
Normal COGNATIVE SIGNS
Knows that its abnormal
Dont happen according to its thoughts
Seeing a man in bed
Seeing snake coming from the fingers
Seeing muds sliding form shopping shelves
Charles Bonnet’s Syndrome
Sharp decline in VISION (in DM Retino / Macular degeneration / Cataract )
Charles Bonnet Syndrome (CBS):
visual hallucinations due to eye disease,
usually associated with a sharp decline in vision.
Incidence rate: >100,000 cases in the UK
S/S:
Purely visual hallucinations (secs-mins-hr),
sudden vision deterioration.
tendency to occur in dim lighting conditions.
Rx: no cure
Pt with depressive symptoms and taking some anti-depressants
(citalopram/TCA like imipramine) + headache & red eye & pain
OP 4090
–> think of Acute angle closure glaucoma & urgent refer to opthalmologist
Not Psychiatry because of emergency and not a sucidal risk
Rare side effect of TCA(Clomipramine) IS Angle Closure Glaucoma
Chalazion…. Internal hordeolum.
Stye………….external hordeolum.
Tx - Warm compress and Reassurance
If abscess - Surgical I and D
LR6 SO4 the rest 3
Diplopia on Downward Gaze - Superior oblique of the affected side
LR6
Diplopia towards the Affected Side
Diplopia on Left Lateral gaze - Lesion on the left
Diplopia on Right Lateral gaze - Leasion on the right
keratoconjunctivitis sicca (SICCA = Dryness of the eye ) Schirmer's test 7 (Normal >10 ) Moisture of the eye
Sjogren’s Syndrome - Rose Bengal Stain = Reveals the corneal ulcerations
= itchy dry eye ,
its due to reduced lacrimation ,
found in sjogren’s ,
treated by artificial tears > hypromellose ,
NACL, NA hyaluronate
Keratoconjunctivitis sicca/Sjögren’s syndrome (OHCM p724).
There is reduced tear formation (Schirmer filter paper test),
producing a gritty feeling in the eyes.
Decreased salivation also gives a dry mouth (xerostomia).
It occurs in association with collagen diseases.
Pilocarpine and cevimeline help sicca features and topical ciclosporin helps moderate or severe dry eye.
Silicone nasolacrimal punctal plugs help maintain tears on the eye surface for longer.
