Opthalmology Flashcards
What is orbital cellulitis?
What is the cause?
What are the sx?
What is the treatment?
Inflammation within the oral cavity
Causes pressure on the optic nerve and blood vessels
Cause- ethmoidal sinusitis
Sx= visual involvement, opthalmoplegia
Systemic sx= pyrexia
Treatment= oral/IV abx, warm compression, +/- surgical drainage of abscess
It will be dealth with by the on call opthalmologist
What is a RAPD and what are the causes?
RAPD is tested by the swinging light test, it is where the pupil dilates instead of constricts
Two main causes= retinal problem or a problem woth optic nerve
What are the organisms associated w/ orbital cellulitis?
Staph or strep
What are the features of orbital cellulitis?
Lid- induration, warm, eryrhema, tenderness, unable to open eye
Additional features seen in orbital cellulitis- fever, proptosis, chemosis
Red flags of optic nerve compression…
- reduced vision
- reduced colour vision
- relative afferent pupillary defectv
- reduced visual fields
- opthalmoplegia (pain on eye movements)
What Ix do you want to do for orbital cellulitis?
FBC CRP ESR Blood cultures Imaging (CT head)
What is the most definitive management for orbital cellulitis?
CT head
What is the management of orbital cellulitis?
Admit patient
Broad spec abx
IV for 72 hours followed by PO for 1 week
ENT review for review of sinus drainage
What bone is most likely to be damaged in blowout fracture?
Maxillary bone
What clinical features/ investigations do you do for a blowout fracture?
Eyelid swelling Pain Reduced vision Diplopia Surgical emphysema Enopthalmos or proptosis Hypoesthesia
Management ABC Abx Tetanus if open wound Avoif nose blowing Refer to opthalmolohy and oromaxillofacial
What clinical features/ investigations do you do for a blowout fracture?
Eyelid swelling Pain Reduced vision Diplopia Surgical emphysema Enopthalmos or proptosis Hypoesthesia
Management ABC Abx Tetanus if open wound Avoif nose blowing Refer to opthalmolohy and oromaxillofacial
What should you think of with a contact lens wearer who has red eye which is itchy?
Bacterial keratitis
Keratitis can be bacterial, viral and fungal, what is the viral cause of keratitis?
Herpes simplex virus
What is the most common cause of bacterial keratitis in a contact lens wearer, what are the clinical features?
Pseudomonas aeuriginosa (most common in contact dermititis)
Clinic features... Red eye Painful eye Purulent discharge Blurred vision Hypopyon White corneal opacity= corneal ulcer
Management is to stop wearing contact lenses until healed
Start them on topical abx drops- ofloxacin
What features make you think viral keratitis?
Trearment?
Watery discharge
History of cold sores
Would see dendritic ulcer on fluorescein staining
Acyclovir drops
What is glaucoma and what are the two main types?
Optic nerve damage due to raised IOP
Two main types- open angle glaucome and closed angle glaucoma
What is glaucoma and what are the two main types?
Optic nerve damage due to raised IOP
Two main types- open angle glaucome and closed angle glaucoma
What are the risk factors for acute angle closure glaucoma?
Female
Small eyes (long sighted, hypermetrophic)
Asian ethnicity
Age
What are the features of acute angle closure glaucoma?
IOP>40mmHg Red eye Cloudy cornea Fixed, oval, irregularly dilated pupil Pain Watering Reduced vision
What are the monocular causes of vision loss?
Optic neuritis Acute cataract disease Acute corneal disease Vitreous haemorrhage Retinal vessel occlusion Retinal detachment Ischaemic optic neuropathy (GCA)
What are the binocular causes of vision loss?
CVA Pituitary tumour Optic neurinitis Severe papilloedema Migraine
What are the causes of retinal detachment?
What are the symptoms?
What is the management?
Causes=
Age, post op/trauma
Diabetic retinopathy
Symptoms= Floaters Flashes Field loss Fall in acuity \+ absent red reflexes
What is vitreous haemorrhage
What are the causes
What are the symptoms
What is the management
This is bleeding into the vitreous fluid in back compartment of the eye
The causes= proliferative diabetic retinopathy
Retinal tear
Retinal detachment
Symptoms= floaters and absence of red reflex
Management= refer to opthalmology, vitrectomy and reattachment if needed
What are the symptoms/ signs of central retinal artery occlusion?
Symptoms= Sudden, profound, entire vision loss Signs= RAPD, PD, retinal oedema, pale retina (ischaemic), cherry red spot, +/- carotid bruits Investigations= BP, FBC, ESR, glucose, carotid USS, cardiac echo
What is the treatment of CRAO?
Refer to eye casualty
Rebreathe into bag (CO2 dilates vessels)
Ocular massage
Acetazolamide (decreases IOP)
Anterior chamber Paracentesis (decreases IOP) (wont be doing this as a junior)
What are the features of CRVO?
What investigations would you do?
Blurred, widespread vision loss Wideslread retinal haemorrhages Oedema Disc swelling Tortuous veins \+/- cotton wool spots
R/O causes of HT, DM, glaucoma, blood problems therefore you would do;
BP, FBC, ESR, glucose, IOP (tonometer)
What are the causes of PAINLESS vision loss?
Retinal detachment
Vitreous haemorrhage
Retinal vessel occlusion
What are the causes of acute red eye?
Haemorrhages- subconjunctiva, or retrobulbar
Subconjunctival= blood pools behind the conjunctiva
Retro bulbar= blood pools behind eyeball
Vascular congestion= episcleritis and scleritis (localised), or generalised (conjunctivitis, keratitis, uveitis)
What is the difference between episcleritis and scleritis?
Scleritis= deeper inflammation of the sclera and episclera Episcleritis= superficial inflammation of the episcler
Scleritis= very painful Episcleritis= mild/achy pain
Episcleritis= vision not affected Scleritis= blurring of vision and photophobia
Episcleritis= blanches with phenylephrine Scleritis= no blanching with phenylephrine
How do you treat episcleritis?
How do you treat scleritis?
Episcleritis=
Steroid drops/NSAIDs
It is self limiting
Scleritis=
Oral steroids
Needs referall
What are the causes of acute generalised red eye?
Conjunctuvitis, keratitis, uveitis
What are the causes of viral conjunctivitis?
What are the sx?
What is the treatment?
Adenovirus
HSV
Molluscum
Symptoms= gritty feeling, watery discharge
Treatment= artificial tears and simple painkillers
What are the causes of bacterial conjnctivitis, what are the symptoms, what is the treatment?
Staph aureus
Strep pneumoniae
What is the treatment of bacterial conjunctivitis?
Chloramphenicol
Fusidic acid drops
What are the symptoms of keratitis?
How do you treat keratitis?
Blurry/impaired vision
Red eye which is painful
Constricted pupil
Photophobia
Treatment is with steroids (PO or topical) +/- antibiotics
Analgesia
What are the causes of keratitis?
What are the risk factors?
What is the treatment?
What is the complication?
Infection- pseudomonas, HSV (do not give steroids if HSV, give acyclovir)
Trauma- FB, post op, perforation
Inflammation- RA/SLE/ wegners
Risk factors- dry eyes and contact lenses
Treatment= steroids if not HSV (dendritic ulcers indicate this) and abx, analgesia
Complication= corneal ulcer
How do you manage someone with foreign body in eye?
They will present with sudden onset irritation and photophobia
You need to remove FB and give analgesia and prophylactic abx
How do you manage chemical injury of the eye?
Immediate irrigation with water
Determine if acid/alkali (alkali is worse!)
Careful eye inspection
Opthalmology referall: topical abx, steroids, topicak dilators, analgesia, artificial tears
What are you woried about with blunt trauma of the eye?
A blow out fracture
Will present with restricted eye movement and periorbitL swelling
You would want to investigate with CT/ xray
What are the features of thyroid eye disease?
Periorbital oedema
Eyelid retraction
Expthalmos
Diplopia
What are the causes of gradual visual loss of the eye?
Diabetic retinopathy
Age related macular degeneration
Cataracts
Glaucoma
What is the most common cause of vision loss in the UK and what type of visual loss does it cause?
Age related macular degeneration
It causes a progressive, irreversible central vision loss
What are the two types of age related macular degeneration?
Dry AMD (90%)= gradual vision loss (years) Wet AMD (10%) = sudden severe vision loss (months)- starts with distorted images
What would you see on fundoscopy of someone with Dry macular degeneration?
Drusen
What is wet/neovascular AMD characterized by?
New aberrant blood vessels underneath the retina which is driven by VEGf (a growth hormone which promotes angiogenesis and neovascularisation)
What is amslers grid used in?
Age related macular degeneration
What is a cataract?
What are the causes?
Clouded opacity on/within the lens due to liquefaction of lens content
Causes= age, trauma, metabolic (DM, wilsons), toxins (steroids, smoking), systemic disease (marfans, NFT2, atopic dermatitis)
Maternal infection
Hereditary
What are the features of cataract?
Decreased acuity and blurring
Myopia (short sided)
Faded colours
Trouble with bright lights and night vision
What is the management of cataract?
What are the complications of this management?
Phacoemulsification Complications… Retinal detachment Post capsule opacification Vitreous loss Endopthalmitis
