Opthalmo Flashcards
1
Q
What are the differentials for a painless red eye
A
- Blepharitis
- Ectropion/ Entropion
- Pterygium
- Subconjunctival hemorrhage
- Episcleritis
2
Q
What are the differentials for a painful red eye
A
Eyelid problem
- Chalazion
- Blepharitis
- Herpes Zoster
Cornea problem
- HSV keratitis
- Corneal ulcer/abrasion
- Arc eye
- Foriegn body
Diffuse Conjunctival injection
- Acute angle glaucoma
- Conjunctivitis
- Dry eyes
Cilliary injection/Scleral involvement
- Scleritis
Anterior Chamber
- Uveitis/iritis
- Hypopyon/Hyphaema
3
Q
Red Eye Ddx
A
- Painful
- Eyelid
a) chalazion
b) blepharitis
c) herpes zoster - Cornea
a) HSV keratitis
b) Corneal ulcer
c) Arc eye
d) Foreign body - Conjunctiva
a) Conjunctivitis (bacterial, viral, allergic)
b) Dry eyes - Other
a) Acute angle closure glaucoma
b) Anterior uveitis (keratitis)
c) Scleritis
- Painless
1. Blepharitis
2. Ectropion
3. Entropion
4. Pterygium
5. Subconjunctival haemorrhage
6. Episcleritis
4
Q
Visual Loss Ddx
A
- Painful
1. Acute glaucoma
2. Optic neuritis - Painless
1. CRAO
2. CRVO
3. Retinal detachment
4. Vitreous haemorrhage
5
Q
Eyelid laceration
A
- Penetrating eye injury until proved otherwise
- Ophthalmology referral for repair if:
1. associated ocular trauma
- laceration medial to either upper or lower eyelid punctum due to risk of damage to nasolacrimal drainage system
- Extensive tissue loss or distortion of anatomy
- Full thickness laceration or involving lid margin
- ADT +/- systemic antibiotics
6
Q
Corneal foreign body
A
- Check under eyelid
- Remove with 25/27G needle with bevel facing away from patient with slit lamp
- Antibiotic drops/ointment
- Avoid contact lens use, PO analgesia
- Review in 24-36 hours
- Ophthalmology referral if
- unable to be removed
- worsening/recurrent symptoms
- rust ring
- plant scratches (risk of fungal infection)
7
Q
Corneal abrasion
A
- Conjunctival erythema and fluorescein uptake
- Rx ADT, oral analgesia, topical antibiotics
- Review daily until healed
- Avoid contact lens use
- Ophthalmology review if:
- plant scratches
- extensive central epithelial defects
8
Q
Corneal ulcers
A
- Usually Gram negative and Gram positives
a) especially Pseudomonas in contact lens wearers
b) can blind in 1 day - RF: contact lens, diabetics, immunocompromised
- White or grey spot on cornea, central area of lobulated mass with surrounding fluorescein uptake, hypopyon
- Rx:
- ophthalmology review
- fortified topical antibiotics
- Systemic antibiotics if severe
9
Q
Flash burns Eye
A
- Arc welding, snow blindness, sun lamp, UV keratitis
- Intense pain, red eye, blepharospasm, tearing
- Widespread superficial epithelial loss (often pin point) with fuoroscein
- Rx
- topical antibiotics QID
- cycloplegic (homatropine 5% BD)
- PO analgesia
- represent if doesn’t improve after 24 hours
10
Q
Chemical injuries eye
A
- Alkali worse than acid burns as causes liquefactive necrosis and penetrate deeper
- Remove particulate matter with cotton bud
- Irrigate with normal saline until pH 7.4 - 7.5
check after each litre of fluid - Amount of limbic blanching proportional to severity of burn
- Same day ophthalmology referral
11
Q
Tissue adhesives eye
A
- Can cause chemical keratitis
- Do not force eyelashes open
- Irrigate
- Rub with petroleum based antibiotics
- If unable to open, refer
12
Q
Blunt ocular trauma
A
- Often have orbital wall fractures
- Closed globe injury
- Open globe injury
- ruptures at areas of thinnest sclera
a) limbus (visible on slit lamp)
b) behind insertion of rectus muscle (decreased eye movements, loss of red reflex, vitreous bleeding) - Look for hyphaema, limbic tears, abnormal pupils, iridodialysis (detached iris - D-shaped pupil), lens damage, raised IOP
- CT scan if fracture suspected
- Refer to ophthalmology
- Rx:
- reduce IOP
- head up
- eye shield
- antiemetics
- analgesia
13
Q
Penetrating eye injury
A
- Increased risk with small high-velocity projectiles (hammer-chisel > grinding)
- Decreased visual acuity, shallow anterior chamber, irregular pupil, small subconjuctival haemorrhage, decreased IOP, Seidels sign
- Ix CT or US
- Rx
- minimal examination
- shield (not pad) eye
- anti-emetics
- analgesia
- no topical treatment
- IV cephazolin and gentamicin
- ADT
- Ophthalmology referral
14
Q
Hyphaema
A
- Blood in anterior chamber
- Usually associated with trauma, but may occur spontaneously in sickle cell and other blood disorders, NAI in children
- Grading:
a) Grade 0: no layering, but red cells in anterior chamber
b) Grade 1: layered, <1/3 anterior chamber
c) Grade 2: <1/2 anterior chamber
d) Grade 3: <100% anterior chamber
e) Grade 4: total filling of anterior chamber - Rx
- Ophthalmology referral
- Eye shield (not pad)
- Bed rest with head elevated 30 degrees
- Cycloplegics (atropine 1% or homatropine 2-5% BD)
- Acetazolamide or timolol 0.5% BD if raised IOP
- Avoid aspirin and NSAIDs - Complications
- Glaucoma in 7%
- Rebleeding in 10% (3 -5th day)
- Corneal staining
- traumatic iritis
- Synechiae formation
- Visual loss rare
- Associated injuries
15
Q
Blowout fracture
A
- Most commonly through medial or inferior walls
- lateral wall more solid so tends to occur with extensive facial damage
- does not extend to rim - Signs:
- bruising and oedema
- Subcutaneous emphysema with medial wall
- Inferior rectus entrapment:restriction of upward gaze and diplopia
- Infraorbital nerve injury (lower lid, cheek, side of nose, upper lip/teeth/gums)
- Retrobulbar haematoma
- Enopthalmos may suggest globe rupture
- Epistaxis, ptosis, trismus - Ice pack, PO/IV antibiotics, ADT, NBM, avoid blowing nose, nasal decongestant, soft diet
- Plastics/opthalmology review
- usually delayed surgical repair > 1 weeks
