Opthal Flashcards
how do we test for visual acuity?
snellen chart
6/6 means, at 6metres they can see what normal eyes can see
what are the components of the opthal history?
ask about visual acuity- usaul and at presentation - is there a reduction?
Redness
Pain - + SOCRATES
Photophobia - urgent
Visual loss:
- Transient: amarosis faux
- Persistent: cataract, most other things
Contact lense use
Tearing, Itching, Discharge
what are the components of the opthal exam
CN1 exam mainly:
visual acuity, accommodation
eye movement, pupillary reflexes
corneal reflex if can
slit lamp
what are referall pathways in optimal
urgent - same day
non-urgent - 2 weeks+
eg cataract
list the causes of redness of the eye
blepharitis conjunctivitis scleritis chemical injury - emergency acute glaucoma
painful red eye, wears contacts, next steps?
History:
are they old, use eye drops?
do they sleep in them?
any trauma whilst wearing them?
examine
see opthalmologists same day
contacts can cause corneal ulcers
give examples of vision threatining presentations that hurt
eg
acute glaucoma
corneal ulcers
chemical burns
these are emergencies
how does scleritis present?
idiopathic cause
pain very bad that wakes them at night
very red eye - deep injection
EMERGENCY - need same opthal review
episcleritis - mild discomfort. non-urgent
how do we tell difference between hayfever eye sx and conjunctivitis?
conjunctivitis - eye is not itchy but is red
season - eg presents in winter rather than summer
how do we treat conjunctivitis?
viral - usually nothing
bacterial - abx
see paeds notes
how do we identify corneal ulcers?
Slit lamp with a drop of fluoriscine in the eye
corneal sensation usually reduced
what is orbital cellulitis?
true infection of orbit
staph aureus most common cause
vision threatening, life threatening
Need admission, IV Abx
patient has cataract surgery 2 days ago, now vision has dropped, eye looks cloudy, looks buldgy and inflammed - most likely cause?
Endopthalmitis!
occurs after intraocular surgery
EMERGENCY - NEED REVEIW IN 1 HOUR
what causes IOP>40mmhg?
acute angle CLOSURE glaucoma
open angle closure with 2ndary causes
sudden catastrophic unilateral visual loss, painless.
pupil nonreactive in affected eye.
hx CVD, sickle cell, diabetes.
dilated eye exam: cherry red spot on retina
likely ddx?
central retinal artery occlusion
risk of strokes afterwards
central retinal vein occlusion looks like what on retina?
look on google
messy unlike the artery occlusion
how do we mx chemical injury of eye?
local anaesthetic drop in eye
irrigate with lots of saline to neutralise eye ph
irrigate under eye lids
recheck ph
keep irrigating
mayyy need corneal transplant
pt presents saying “something went into my eye”, what do you do?
Hx: what were you doing, hammering, welding etc?
usually extraocular foreing body
can be insect etc
can leave rust deposit on fluorescien stain
no change to visual acuity
how do we ivx blows to eye socket eg suspected fx?
which MDT should be involed?
CT Orbit - so we can look at soft tissues too
MDT: opthal, maxfax
note; when there is the fracture, eye movement in the affected eye can be restricted, usually maxfax needs to release the muscle
retinal disc swelling could indicate what?
Papilloedema - Raised ICP
Arterial ischaemia -Giant cell arthritis
how does orbital cellulitis present?
Swollen eyelid, red
sometimes shut
ptosis
what is hyphon and hyphen?
hyphon - pus within iris
hyphema - blood within iris
what do the following terms mean in visual acuity:
6/6, 6/60, 6/5
6/6: individual can see at 6metres what a normal person can see at 6metres (US equivalent 20/20 in feet)
6/60: individual can see at 6metres what a normal person can see at 60metres. meaning poorer eyesight. the bigger the denominator the worse the vision.
DVLA requires 6/12 in the good eye to drive.
6/5: individual can see at 6metres what a normal person can see at 5metres. better than average vision.
mx of background retinopathy?
inform them about changes
lifestyle changes
good diabetic control
monitor closely
most common cause of Central retinal artery occlusion?
Temporal arteritis
cataract vs acute glaucoma difference in appearance?
cataract - clouded lens
glaucoma - corneal haze
