Opthalmology Flashcards
List three abnormalities and the diagnosis
- Pupil mid size
- Pupil irregular
- cloudy cornea
- lateral ciliary injection
Acute close angle glaucoma
What are 3 ways of measuring intra ocular pressure
What is normal limit?
Tonopen
rebound tonometry
impression tonometry
pneumato-tonometry
Normal limit
15-22cmh20
What are the ED treatment for Acute close angle glaucoma plus supportive
ED treatments
Acetazolomide 500mg IV or oral
timolol drops
pilocarpine drops
Supportive
Analgesia - name some
Ondasetron
Post trauma - key finding?
- haemorrhage in the anterior chamber inferiorly
- pupillary distortion
With trauma to the eye what differentials need to be considered?
What would be their clinical features?
- Vitreous haemorrhage - floaters, visual haze, loss of red reflex
- Retinal detachment - floaters, markedly reduced VA, no red reflex
- Ocular globe rupture - viterous humour leak, decreased OP, loss of vision, distorted pupil
- acute glaucoma - irregular pupil, hazy vision, pain, nausea and vomiting
- lens subluxation - blurred vision and quivering of iris on movement
what is the management of eye trauma
consult opthal
analgesia
patch
nurse at 30 degrees
cycloplegics
3 causes of conjunctivits, differentiating history and exam and management
- Bacterial - unilateral with purulent discharge - treatment with drops/anbx
- Viral - bilateral, watery discharge - conservative
- Allergic - itching and oedema of eyelid - steroid drops, antihistimane drops
homeless man - four significant findings?
what are the important parts of eye exam and what will you find?
- central corneal opacity
- irregular pupil
- small hypopyon
- arcuate corneal opacity
- conjunctival erythema
Exam
1. VA - reduced
2. IOP - increased
3. flouroscein uptake on slit lam exam
Treatment?
Complications?
Treatment
* urgent opthal review
* broad specturm abx
* topical analgesia
* cycloplegics
Complications
* opacification and scarring of cornea
* increased ocular plressure and secondary glaucoma
* corneal perforation
most likely diagnosis and why?
how would you confirm?
Acute closed angle glaucoma
midsize pupil
injected sclera
hazy cornea
Confirm by measuring IOP - over 40 is suggestive
three abnormalities
extensive subconjuctival haemorrhage
dilated pupil
poptosis
periorbital bruising
chemosois
what examination features suggest orbital compartment syndrome?
- proposis
- hard eyeball when palpated with eye shut
- pressure over 40
- severe eye pain
- inability to open eye
- RAPD
- only vision on VA
what are the steps in a lateral canthotomy?
Need to have adequate LA and/or sedation. Inject 1-2 mL local anaesthetic into lateral
canthus
x Perform the canthotomy - insert needle holder from lateral canthus towards bony orbit
and compress this area to devascularise it.
x Remove needle holder and using scissors cut along the lateral canthus 1-2 cm to the
bony orbit.
x Perform cantholysis: Grasp the lateral lower eyelid with toothed forceps. Pull the lower
eyelid down to visualise the inferior canthal tendon and cut through this with scissors. If
not visualised the tendon can be identified as a rigid band, like a guitar string,
“strummed” by the forceps to help locate it.
x If IOP still high after this cut the superior canthal tendon too by lifting the upper eyelid
and locating the tendon. Use scissors to cut.
abnormalities?
What needs to be assessed
diagnosis?
irregular pupil
hyphaema
conjuctival injection and oedema
presence of fluroscein
bruise to inner upper eyelid
need to examine
pressure
acuity
light reflex
what is traumatic iritis?
occurs few days post trauma
pain, tearing
photophobia
abnormalities?
What may be the associated injuries?
Early and late complications of this?
conjuctival injection
hyphaemia
traumatic mydriasis
Injuries
globe rupture
orbital floor rupture
lens dislocaiton
retinal detachment
Early
rebleeding
raised IOP
Late
corneal blood staining
optic atrophy
mangement steps?
- analgesia - avoid NSAIDS
- patch
- bed rest at 30 degress
- topical cycloplegics
- treat associated conditions
abnormalities?
What would you look for on exam?
abnormalities
globe rupture
orbital blowout rupture
displacement inferior rectus
air in maxillary sinus
**
Exam**
VA
extra oculr movement
inferior orbital nerve sensation
pupil shape RAPD
GCS for other injuries
c spine asessment
management?
urgent opthal referral
lay flat
avoid pressure on eye
ADT
eye shield
IV abx
opiate analgesia
anti emetic
c spine
list three abnormalities
diagnosis?
hazy pupil
ciliary injection
mid size pupil
Diagnosis
acute angle close glaucoma
what are the routes for contracting orbital cellulitis
- extension from peri orbital structures eg nose, face
- inoculation from trauma or surgery
- haemategonous spread
what organisms commonly cause orbital cellulitis
s.aureus
s.pyogenes
h.influenzae
painful eye - list abnormalities
diagnosis
irregular pupil
hypopyn
conjunctival injection
cloudy cornea
diagnosis;
anterior uveitis/iritis
what is the difference between ciliary and conjuctival injection
ciliary around iris
conjunctival more doffuse
what can predispose to iritis/anterior uveitis?
crohns
SLE
ank spon
sarcoid
what is the mangement of iritis/anterior uveitis?
steroid drops
opthal referral
mydriatic instillation
symptoms of anterior uveitis/iritis
conjunctival injection
pain
distorted puptil
hypopyn
what are the causes of unilateral painless visual loss?
- TIA/stroke
- central retinal artery occlusion
- central retinal vein occlusion
- retinal detachment
- vitreous haemorrhage
- optic neutiris
- temporal arteritis
Diagnosis?
What is the main cause of this?
vitreous haemorrhage
often caused my proliferative diabetic retinopathy
what is RAPD?
What can cause it?
pupil constricts normally during cosensual reponse but not direct
retinal detachment
CRAO
CRVO
TIA
what exam features can differentiate the below causes of painless visual loss
IVDU - painless visual loss
diagnosis and why?
CRAO
Why:
cherry red spot
IVDU so high risk
white oedema
What are the management steps in CRAO?
- opthal referral
- heparin
- localised pressure to eye
- identify source of emboli
abnormalities
diagnosis?
extruded iris
irregular pupil
cloudy cornea
scleral injection
penetrating eye injury
steps in management
- elevate head
- analgesia - state
- anti emetic - state
- urgent opthal review
- abx
6 eye shield
Trauma:
three positive and two negative findings
next ix
positive
exruding iris
lacerated sclera
misshapen pupil
Negative
no hyphema
no exra ocular trauma
ix
CT/US to look for FB
what are the risk factors for retinal detachment?
myopia
previous detachment
CTD
recent eye trauma
cataract surgery
with acute painless visual loss what investigations may help and why?
ECG - ?AF in CRAO
ESR - TA
BSL - glucose in CRVO
carotid US - ?CRAO
FBC - ?hyperviscosity and platelets
coags -?coagulopathy
what are some treatments and rationale for CRAO?
- HBOT - reduce ischaemia
- anterior chamber paracentesis - reduce IOP and dislodge clot
- ocular massage - dislodge clot
- TPA - lyse clot
painful eye - list abnormalities
diagnosis
conjunctival/sclera injection
hypopyon
hazy cornea
irregular pupil
anterior uveitis/iritis
what are the complications of anterior uveitis?
glaucoma
cataracts
retinitis
band keratopathy
what are the differential for painful red eye
glaucoma
iritis
corneal abrasion
dendtritic ulcer
episcleritis/scleritis
infective conjuctivitis
