Opthal Flashcards
A 58-year-old man develops a sudden bright red patch on the white of his left eye. He has had a chest infection recently. There is no pain in his eye and his vision is unaffected. OE Pupils NAD Dx? Mx?
Subconjunctival haemorhhage
Will resolve by itself
24 Female complains of difficulty opening eyes on waking, with purulent discharge & discomfort left eye.
OE
Hyperaemic
Normal pupillary light response
Normal Acuity
Dx?
Sx?
Ix?
Mx?
Bacterial conjunctivitis RID Red eye ocular Irritation Discharge (Purulent) Pre-auricular lymph nodes
Swabs [only in severe disease or if fails to resolve]
Chloramphenicol (topical)
every hour for 1 day
then qds for 1 week
A 45-year-old man with a preceding sore throat complains of a gritty and red left eye initially, now in both. His vision is slightly blurred and has watery discharge. There is no past ocular or medical history
OE Hyperaemia of eye whites Watery discharge VA is normal painful eye movements Periauricular lymphadenopathy
Dx?
Sx /signs?
2 causes?
Mx?
Viral conjunctivitis
Adenovirus
Coxsackie
RID
Red eye
ocular Irritation
Discharge (watery)
Signs: conjunctival Follicles Pre-auricular lymph nodes lid oedema excessive lacrimation
Mx
Hygiene (minimise spread as V contageous)
-frequent hand washing
-using separate towels
Differentiate allergic conjunctivitis from others
Very itchy
No lymph nodes
45y female happened to notice redness on the lateral part of her eye. There was a bit of discomfort associated, but no pain, watering or discharge. No loss of vision.
The redness was confined to the lateral globe, and the blood vessels in the affected area were slightly dilated but not obscured by the redness.
Dx?
Sx?
Mx?
Episcleritis
Symptoms
Acute or gradual onset
Often unilateral, localized eye redness
+/- discomfort, photophobia, tenderness
Management
NSAIDS - Diclofenac (topical) if symptoms are tiresome
NSAIDS - oral useful in (rare) severe disease
Scleritis vs epi?
Sx?
Symptoms
Intense Pain
Blurred vision
Swollen sclera Choroidal effusions (if affecting posterior part of globe)
Scleritis assoc?
Connective tissue
RheumA
PAN
SLE
2 Scleritis comps
Scleral thinning (scleromalacia) Scleral perforation Keratitis Uveitis Cataract formation Glaucoma
Scleritis Mx
Referral to Ophthalmology Steroids (high dose, systemic Indomethacin) Cytotoxic therapy (in severe disease)
45 year old female, presented with painful right eye, FB sensation, with tearing and reduced vision. He is a contact lens wearer but has no other ocular history.
OE
Pupils NAD
Reduced Visual Acuity
Dx?
Sx?
Ix?
Mx?
Bacterial keratitis
Symptoms
Pain (usually severe unless cornea is anaesthetic)
Ciliary injection
Discharge (purulent)
Blurred vision
Hypopyon
White corneal opacity
Scrapes
-gram-staining and culture
Management dual therapy Antibiotics (topical) -Cefuroxime (against gram-pos) and -Gentamicin (gram-neg) hourly for first 2 days, then reduced
2 RFs for bacterial keratitis
contact lens
Prolonged topical steroids
Dry eyes
Trauma to eye
Viral keratitis usually? Where dormant? Sx? Ix? Mx?
HSV 1
Trigeminal ganglion
Sx
Asymptomatic
Dendritic ulcer Fever Vesicular lid lesions Follicular conjunctivitis pre-auricular Lymph nodes Anaesthesia of cornea
Ix - Fluorescein stain
Mx - Topical acyclovir
A 56-year-old lady presents with photophobia, redness of the eye and blurred vision. She has no previous eye history. She has been diagnosed with sarcoidosis and is currently on systemic prednisolone
OE Diffuse Redness Abnormal Pupil Photosensitivity & Pain on accommodation White spots in the cornea
Dx?
Sx?
Signs?
Mx?
Uveitis
Pain (less in posterior uveitis)
Photophobia
Redness of eye
Poor vision
Signs Keratitic Precipitates [white spots] Hypopyon - [Exudate in eye ] dilated Iris vessels Posterior synechiae - [Strange shaped pupil]
Mx -Steroids (Dexamethasone 0.1%) Topical -Mydriatics (topical - dilate eye) Atropine -Immunosuppression (azathioprine or ciclosporin)
A 78-year-old hypermetropic (hyper = long-sighted) lady presents to the main casualty unit one evening with severe pain in her right eye which came on suddenly, associated with N&V. It feels like she’s looking through frozen glass and notices glaring rings around bright lights.
OE
injected eye
dilated pupil
blurred vision
Dx?
Sx?
3Ix?
3Mx?
Closed Angle Glaucoma
Raised intra-ocular pressure Red eye Rainbow halos around lights Photophobia Pain (and headache) Discharge (watery) Blurred vision
Systemically upset:
Nausea
Abdominal Pain
Ix - Ophthalmoscope (optic disc cup)
Tonometer (ocular pressure)
Gonioscopy (irido-corneal angle)
Mx- Immediately
- Acetazolamide ‘Diamox’ (IV then Oral)
- Pilocarpine (topical) x3 every 5m
- β-blockers (topical)
Surgery (YAG laser)
Iridotomy
Treat second eye prophylactically
80 year-old lady
sudden vision loss in her left eye
described “a curtain came down over her eye”
vision came back within 12 hours.
PMHx of IHD & poorly managed hypertension. She also suffered a TIA a year ago
OE
Retinal exam – to left
Acuity 6/12 in left eye, 6/6 in right
Carotid bruit
Dx Ix Mx -Embolic -Carotid stenosis -Hypercoag -Vsculitis GCA -Vasospasm
Amaurosis fugax
Ix
Cardiac work up
Carotid Doppler studies
Risk Factors
Mx
-treat the underlying risk factors (hypertension or diabetes)
Embolic
Aspirin (75mg/day)
Carotid Stenosis Carotid Endarterectomy (if >70% carotid stenosis)
Hypercoagulability
Warfarin
Vasculitis (GCA)
Steroids
Vasospasm
Nifedipine
36 yeard old patient presents with 3-day history of floaters, flashing lights and then a dense, curtain-like field loss in his left eye. He’s known to be myopic, but has no other PMHx.
OE
Visual Acuity left eye 6/60, right eye 6/9
Dx?
Retinal detachment
Retinal detachment
3RFs?
Sx?
Mx?
Myopia
Cataract surgery
recent severe eye Trauma
previous Detachment in other eye
Sx Floaters Flashing lights progressive Field Defect (‘shadow’ or ‘curtain’) reduced Visual Acuity
Mx
Refer to ophthalmology for surgical opinion
Key advice to give with conjunctivitis ?
Hygiene - very contagious
Absent red reflex key DDx
retinoblastoma
Type 2 diabetic - name 3 things you might see in eye?
Mx if you see these?
Cotton wool spot micro aneurysms flame haemorrhages tortuous veins V severe HTN - AV nipping, papilloedema
Panretinal photocoagulation
diabetic loss of central vision called?
maculopathy
2 eye conditions increased risk in diabetes
cataract glaucoma retinal detachment vitreous haemorrhage infection
2 RFs for cataracts
diabetes trauma long term steroids smoking uveitis Rubella in utero
2 signs OE of cataract
clouding of lens
absent red reflex
[Hx may talk about - difficulty reading / recognise face / halos]
Surgery for cataract?
Main early / late comp
phacoemulsification
Early - posterior capsule rupture
Late - posterior capsule opacification [Mx Laser therapy]
what do you use to measure IOP, what is upper limmit?
Tonometer - <21
What is gonioscopy?
measurement of the angle
-distinguish between open and closed
vision gets worse with open angle glaucoma - who do you need to tell Pt to tell?
DVLA
Medical Mx of open angl glaucoma
Prostaglandin analouges
B-blockers
carbonic anhydrase inhibitors
miotics
Elderly lady - acute visiual change "door frames look wiggily" Dx 2Ix 2 things found on retina 2Mx options Advice?
wet age-related macular degeneration
amsler chart, slit lamp fundoscopy, fluorescein angiography
-> Drussen, atrophic change, leaky vessles, neovascularisation
laser photocoagulation, intravetreal vascular endothelial growth factor inhibitors
Inform DVLA, stop smoking, good diet (green veg)
-likely only central vision affected
2 key RFs for closed glaucoma
DHx, Female, age, hypermetropia
3 OE closed glaucoma
decreased acuity
dilated fixed pupil
raised IOP
Red
Why do you get blurred vision in acute glaucoma
corneal oedema
Myopia or hypermetropia - who has a higher risk of retinal detachment? why?
myopia - thinning of the retina as stretched over a larger area
4 things you’d check OE for visual loss in 1 eye
Acuity pupil response eye movement fundoscopy corneal sensation visual fields external eye
BP
Carotid bruis
AF
classic finding of central retinal artery occlusion on fundoscopy
pale retina
cherry-red spot at the macula
ophthalmic shingles Virus? name 2 Sx? lesions on nose called and significance? dye to view ulcer/shape? what do you need to test in eye and why?
Varicella zoster
Burning, itching, paraesthesia, headache, fever, myalgia
Nasolacrimal nerve -> corneal involvement -> loss of sensation -> vulnerable to abrasion
[Hutchinson’s sign {absense of blink reflex with cotton wool)]
fluorescein / dendritic
corneal sensation - as may be affected - risk of corneal ulceration
