Opthal Flashcards
What is anterior uveitis also known as
Iritis
Buzz word for anterior uveitis
Acutely painful eye
Pus and inflammatory cells in the anterior chamber (hypopyon)
SMALL FIXED OVAL PUPIL WITH CILIARY FLUSH
Visual acuity initially normal then becomes impaired.
Associations of anterior uveitis
HLA B27
Ank Spond
Reactive arthritis
Behcets
Sarcoidosis
Management of anterior uveitis
Urgent opthal review
Cycloplegics (dilates the pupil which helps relieve pain and photophobia e.g. atropine, cyclopentolate)
Steroids
How does scleritis present?
SORE
Red, watering, photophobia, decreased vision
Rx = NSAIDs, steroids
Oral NSAIDS 1st line
Main risk factor for development of scleritis
Rheumatoid (main)
rheumatoid arthritis: the most commonly associated condition
systemic lupus erythematosus
sarcoidosis
granulomatosis with polyangiitis
Main cause of episcleritis and presentation?
Most cases are idiopathic.
Some caused by IBD / RA
Classically not painful / approx 50% of cases are bilateral / mild photophobia and watering
How do you differentiate between scleritis and episcleritis
Phenylephrine drops.
If the redness blanches / disappears = Episcleritis
Rx of episcleritis?
Conservative / artificial tears
Definitive Rx of acute closure glaucoma?
Laser peripheral iridotomy
Presentation of acute glaucoma?
severe pain: may be ocular or headache
decreased visual acuity
symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil
corneal oedema results in dull or hazy cornea
systemic upset may be seen, such as nausea and vomiting and even abdominal pain
SEMI DILATED NON-REACTIVE PUPIL
Rx of acute glaucoma
Parasympathomimetic - opens trabecular netroek
B Blocker (timolol) - decreases aqueous production
alpha 2 agonist (aproclonidine) - decreases aqueous production
Factors assoc with Acute glaucoma?
hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age
Primary open angle glaucoma, optic disc cupping ratio?
> 0.7
Other signs on fundoscopy:
- Optic disc pallor - indicating optic atrophy
- Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
- Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
Risk factors for primary open angle?
Increasing age
Family Hx
Afro-carribean
Myopia (short sighted)
Describe the iris in pOAG.
It is clear of the trabecular meshwork
Rx of pOAG
1) Prostaglanding eyedrops (latanoprost)
2) B Blocker (timolol)
Miotics (pilocarpine ) - cause pupil constriction, headache . blurred vision
Rx of pOAG if IOP >24?
NICE guidelines
offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg
What surgery may be considered in severe cases of pOAG?
Trabeculectomy
What is inflammation of the cornea?
Keratitis
How does keratitis present?
Red eye, photophobia, gritty, hypopyon
Causes of keratitis
Bacterial (Staph / Pseudomonas - CONTACT LENSES)
Fungal . Amoebic / Parasite
Management of keratitis ?
Topical Abx (Cipro / Levo), Cycloplegic for analgesia
How does herpes simplex keratitis present?
Dendritic ulcer - topical aciclovir
FLUOROSCEIN staining shows epithelial ulcer
Rx = topical acivlovir
