OPTHAL Flashcards
emergency eye conditions that need to be seen urgently by ophthalmologist
penetrating eye injury
acute post op endopthalmitis
chemical injury \
orbital cellulitis
GCA with eye symptoms
sudden vision loss <6hrs
painful red eye with visual loss
retinal detachment
diplopia with pain
corneal ulcer
corneal graft rejection
blunt trauma with raised IOP
causes of red eye
Blephoritis
conjunctivitis
keratitis
scleritis/ episcleritis
uveitis
entropion
subconjunctival haemorrhage
corneal ulcer
corneal abrasion
contact lens related problem
foreign body
chemical burns
acute glaucoma
Causes of blurred vision
irititis
redused visual acuity
cataract
optic neuritis
red flag signs with red eye (refer immediately to eye ED)
pain
reduced acuity
pupil asymmetry
loss of red reflex
photophobia
Hx of trauma
ciliary flush
corneal infiltrate
Important questions in opthal Hx
contact lens wearer?
Trauma
Pain/ photophobia
Itching- conjunctivitis/ allergy
discharge- purulant(bac) or watery (viral/allergy)
other contacts affected
mono or binocular
changes in vision
recent URTI
subconjunctival haemorrhage
fragile vessels rupture due to trauma, valsalva pressure spikes, sneezing, diving, hypertension
cornea not affected
resolves in 2 weeks
bright red- dark red- orange- green
stye (hordeolum)
usually staph aureus
hot compress
topical ABx cream
what is chalazeon
when a stye becomes a cyst
blephoritis
chronic inflammation and swelling of eyelids
associated with rosacea
Mx: warm compres s
lid hygiene
topical antibiotics/ steroid
conjunctivitis
bacterial/ allergic/ chemical/ foreign body/ viral
uni/bilateral
itchy/ gritty eye
common causative organisms of bacterial conjunctivitis
staph aureus
strep pneumoniae
haemophilus
pseudomonas
rarely chlamydia
give moxifloxacin/ levofloxacin eye drops
what is keratitis
breakdown of the corneal epithelium caused by trauma, infection, contact lens over wearing, dry eyes, over exposure
The typical presentation usually involves a red eye, photophobia, pain and gritty sensation. Wearing contact lenses is a known risk factor.
seen best with fluoroscein dye
Be careful not to miss an ulcer caused by herpes - branching epithelial dendritic ulcer
common causative organisms of keratitis
bacterial-
viral-
fungal
acanthamoeba - contact len and swimming
treatment of herpes simplex ulcer
aciclovir 400mg QDS
steroids
acute glaucoma
primary angle closure- increase in pressure causing a pupilary block
management of acute glaucoma
eye drops- bblockers, alpha agonists, carbonic anhydrase inhibitors, pilocarpine
oral or IV acetazolemide
oral hyperosmotic agenet (glycerol)
IV hyperosmotic agent (mannitol)
topical steroids
lazer therapy
what is pseudoexfoliation syndrome
Pseudoexfoliation syndrome is a chronic, age-related disorder of the extracellular matrix that results in the deposition of abnormal fibrillary (pseudoexfoliative) material within various body tissues. This condition manifests primarily in the anterior segment of the eye
episcleritis
inflammation of episclera
self limiting and mild
anti inflammatory tablets
scleritis
severe
inflammation of sclera
risk of visual loss
urgent referral and treatment required
how to differentiate between episcleritis and scleritis
most of the time scleritis is diffuse
2.5% phenylephrin, wait 10-15 minutes- if after that the eye is white then it is episcleritis as the drops are a vasoconstrictor. the vessels in scleritis are much deeper which the drops dont get to
management of periorbital/ orbital cellulitis
Major opthal emergency
can be life threatening
Admission
IV antibiotics
surgical
most common cause of orbital cellulitis
staph aureus
cause of sudden loss of vision
central retinal artery or vein occlusion
is completely painless
RFs for central retinal artery occlusion
Thrombus/ embolus
HPTN
diabetes
sickle cell
trauma
signs and symptoms of central retinal artery occlusion
sudden painless loss of vision
visual acuity limited to light reaction in affected eye
pupil reflex: dilated and nonreactive in affected eye
dry macular degeneration
90% of cases
also known as atrophic
characterised by drusen - yellow round spots in Bruch’s membrane
wet macular degeneration
sudden onset reduction of vision due to oedema and angiogenesis
also known as exudative or neovascular macular degeneration
characterised by choroidal neovascularisation
leakage of serous fluid and blood can subsequently result in a rapid loss of vision
carries the worst prognosis
Papilloedemea
can be life threatening
optic nerve swelling
due to raised ICP
features of wet macular degeneration
decreasing vision, metamorphopsia (seeing straight lines as wavy), and central scotoma (a blind spot in the middle of the field of vision) are classic signs of wet age-related macular degeneration (AMD).
features of central retinal artery occlusion
sudden, painless unilateral visual loss
relative afferent pupillary defect
‘cherry red’ spot on a pale retina
what is ectropion
outward turning of the lower eyelid, often due to age-related laxity of the tissues.
common eyelid problems
blepharitis: inflammation of the eyelid margins typically leading to a red eye
stye: infection of the glands of the eyelids
chalazion (Meibomian cyst)
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids
night blindness + tunnel vision
Retinitis pigmentosa
features of Retinitis pigmentosa
night blindness is often the initial sign
tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
Causes of ptosis
3rd nerve palsy
Horners
Aging
Myasthenia Gravis
Myopathy, e.g. chronic progressive external ophthalmoplegia
causes of an abnormally large pupil
pharmacological
acute glaucoma
3rd nerve palsy
causes of abnormally small pupil
opioids
Horners
complications of herpes zoster ophthalmicus
conjunctivitis
keratitis
uveitis
corneal blisters
extraoccular muscle palsy
what is the Hutchinson’s sign?
in herpes zoster opthalmicus, if the tip of the nose is affected then the nasociliary nerve is affected meaning the eyeball is likely to be involved
what is hyphaemia
blood in the anterior chamber
(between cornea and iris).
what is A hypopyon
collection of pus in the anterior chamber and indicates endophthalmitis, usually following cataract surgery or intravitreal injection
most common cause of hyphameia
blunt trauma to the eye
