Opthalmology Flashcards
Strabismus
Children don’t grow out of squints
Intraocular pathology must be excluded
Amblyopic requires early treatment
Irritable eyes DDx
Dry eyes - use tear supplements
Blepharitis - check lid hygiene, remove crusting
Chronic allergy - avoid steroids
Unilateral red eye DDx
Foreign body
Trauma
Corneal ulcer
Iritis
Acute glaucoma
Eyelid ulcer
May be BCC
Conjunctivitis
Almost always bilateral
Corneal abrasion
Treatment
Antibiotic ointment
Review daily
Should heal in 24hrs
Herpes simplex
May be painless
History of recurrence and scarring Involvement of the tip of the nose = involvement of the eye
Use antivirals only - never use steroids
Refer to ophthal
Warning symptoms of retinal detachment
Floaters
Flashes
Field defects
Steroid
Complications
Corneal perforation with herpes simplex
Open angle glaucoma
Cataract formation
Fungal infection
Foreign Body removal
Don’t remove foreign bodies that are deep central corneal, intra-ocular or intra-orbital - Refer
Sudden loss of vision
DDx
Elderly - temporal arteritis
Optic nerve ischaemia - afferent pupil defect, start high-dose oral steroids
Retinal artery or vein occlusion
Macular haemorrhage
Papilloedema
Signs/symptoms
Blurred optic disc margins
Good vision
Optic neuritis
Signs/symptoms
Blurred optic disc margins
Reduced vision
Afferent pupil defect
Transient blindness
DDx
Carotid artery disease
Migraine aura
Afferent pupil defect
Retinal artery occlusion
Optic nerve lesion
Chronic open-angle glaucoma
No early signs or symptoms - requires routine screening in adults >40
Familial
Elevated IOP causes optic disc cupping and visual field loss
Acute angle closure glaucoma
Rare in those <60 Symptoms - pain, haloes, blurred vision
Signs - shallow anterior chamber, redeye, fixed mid-dilated oval pupil
Treatment - pilocarpine drops, then YAG laser
Admission to hospital
Hypaema
Hypopyon
Penetrative eye injuries
Severe chemical burns
Acute glaucoma
Tear drop sign
Penetrating eye injury
Due to distortion of the pupil due to a perforated cornea
Entropion
The whole eyelid is inverted
Trichiasis
One or two aberrant eyelashes are turned in
Viral conjunctivitis
Unilateral redness and watering in one eye spreading to the other eye
History of viral illness or contact with red eye
Commonest cause - adenovirus
No loss of vision
Preauricular lymphadenopathy
Viral conjunctivitis Treatment
Self-limiting
Cold compress and tear supplements
Resolves in 2-3 weeks
Contagious for first 2 weeks
Bacterial conjunctivitis
Purulent discharge
Eyelashes firmly stuck together in the morning
Blurring of vision clears with blinking
Bacterial conjunctivitis
Treatment
Topic chloramphenicol or fucidic acid drops
Allergic conjunctivitis
Often associated with nasal symptoms
Acute but transient bouts of sneezing, itching eyes and redness
Seasonal or perennial
Allergic conjunctivitis
Treatment
Topical mast cell stabilisers e.g. olopatadine drops
Blepharitis
Inflammation of the eyelid margin
Common
Usually symmetrical and bilateral
Main symptom is burning and grittiness
No discharge
Chronic condition
Associated with seborrhoeic dermatitis and rosacea
Blepharitis
Management
Lid hygiene - hot compress, washing away crusting
Topical lubricants
Oral tetracycline for 2-3 months in severe cases
Subconjunctival Haemorrhage
Spontaneous
Painless
Normal vision
May be associated with HTN or heavy bouts of coughing or straining
Suconjunctival haemorrhage
Treatment
Self limiting within 2-3 weeks
Pterygium
Benign fibrovascular growth from the conjunctiva
Usually medial and can extend onto the cornea
Increased sun exposure is a risk factor
Leave alone unless encroaching onto the visual pathway
Corneal abrasion
Management
Chloramphenicol eye ointment
Review daily until healed
Oral analgesia - DO NOT USE TOPICAL ANAESTHETICS FOR PAIN RELIEF
Arc eye (Welder’s flash)
Photokeratitis - sunburn of the cornea
Pain like “sand poured into eye”
Photophobia
Tears ++
Constricted pupil
Corneal ulcer
Bulbar conjunctiva would be involved but not eh palpebral conjunctiva
Contact lenses - bacterial keratitis leading to corneal ulceration.
Always stain the cornea with fluorescein and stop contact lens use until eye condition has fully resolved
Treated with intensive topical antibiotics
Herpes simplex
Dendritic ulcer of the cornea
Recurrent infection is common
Frequently have history of oral infections with the virus
Always stain the eye with fluorescein
Treated with topical antivirals by ophthalmologist - DO NOT PRESCRIBE STEROID DROPS
Iritis
Painful eye with mild photophobia
Unilateral red eye with circumciliary injection (limbal flush)
Possibly reduced visual acuity
Half of cases are idiopathic (?autoimmune) - 50% of patients are HLA-B27 positive Investigate recurrent episodes
Iris can adhere to the anterior surface of the lens giving an irregular shaped pupil
Keratic precipitates seen on slit lamp
Iritis
Treatment
Topical steroid drops
Topical cyclopentolate drops to dilate pupil and break down posterior synechiae, also helps relieve the pain
Episcleritis
Affect young adults
Moderate ache
Milder symptoms than those experienced by patients with iritis
Conjunctival inflammation is usually localised to one sector
Episcleritis
Treatment
Benign, self-limiting
Resolves in 2 weeks
Herpes zoster ophthalmicus (HZO)
Ophthalmic division of trigeminal nerve
Can cause uveitis, keratitis, conjunctivitis
Hutchinson’s sign - if zoster involves the tip of the nose it is likely that the infection will involve the eye
HZO
Treatment
Oral and topical antivirals
Acute angle closure glaucoma
MEDICAL EMERGENCY
Acute onset of pain due to high IOP
Redness
Mid-dilated, fixed pupil
Visual loss
Slightly cloudy cornea
Abdominal pain and vomiting
Acute angle closure glaucoma
Risk factors
Age >40-50
F>M
FHx
PHx in the other eye
Hypermetropia or long-sightedness
Acute angle closure glaucoma
Mechanism
Shallow anterior chamber
Thickening of lens with age
Pupil dilatation
Acute angle closure glaucoma
Treatment
IV acetazolamide - reduce aqueous secretion
Pilocarpine drops - pupillary constriction
Surgical or laser iridotomy
Sty
Common
Small abscess forms at the base of an eyelash
Usually due to Staph. Aureus
No treatment - hot compress, pull out eyelash on that spot
Preseptal Cellulitis
Infection of subcutaneous tissues
Unilateral
Tender to touch
Normal vision and no pain on eye movements
Often seen on insect bites
Treat with oral antibiotics
Orbital Cellulitis
Superficial tissues around the eye and the deeper orbital contents
Painful and restricted eye movements
Proptosis
Abnormal vision
Systemically unwell
Sinusitis most likely cause
Potentially fatal as infection can track into the cranial cavity
Hyphaema
Due to injury
Needs urgent referral
Amblyopia
Decrease in vision with no structural pathology
Caused by a failure of visual pathway maturation during childhood
Causes include stimulus deprivation, uncorrected refractive error, uncorrected strabismus
Strabismus
Squint aka crossed eyes
Look for symmetry of the corneal light reflex
Cataract
Gradual worsening blurred vision, despite good Snellen acuity.
Glare from ongoing headlights at night
Defect in the red reflex
Lens opacity
Cataract Causes
Old age
Congenital Metabolic e.g. diabetes
Infective, e.g. rubella
Physical, e.g. trauma, radiotherapy, UV exposure
Drugs, e.g. steroids
Glaucoma
Management
PG analogues (e.g. latanoprost)
Beta-blockers (e.g. timolol)
Oral acetazolamide
Laser and surgery
ARMD
Commonest cause of irreversible visual loss in >60
Progressive steady decline in central vision
Difficulty in reading
Distortion of straight lines
Bilateral but may be asymmetrical
ARMD
Management
Modification of risk factors
Magnifying aids may help with reading
Good lighting (esp. natural light) helps with vision
Wet (abnormal new vessels grow and leak) - anti-VEGF intravitreal inections
ARMD Risk factors
Old age
Smoking
FHx
Poor diet
Diabetic retinopathy
Microvascular occlusion and leakage
Commonest cause of blindness ages 20-65
2 types - non-proliferative and proliferative
Reduced vision only occurs in advanced disease and may be irreversible
Diabetic retinopathy
Treatment
Monitor
Laser photocoagulation
Central retinal artery occlusion (CRVO)
Sudden unilateral loss of vision
Reduced visual acuity in that eye
Diffuse pallor of the retina due to retinal ischaemia
Due to an embolus
Cherry red spot
Retinal detachment
Unilateral loss of vision
Flashing lights and floaters preceding with a shadow coming across the eye
Detachment of the inner sensory retina from the pigmented epithelium of the retina
Most common cause is due to posterior vitreous detachment or ocular trauma
More common in short-sighted people
Temporal arteritis
Treatment
High dose IV steroids
Optic Neuritis
Idiopathic or associated with MS
Initially fundoscopy is normal, after a few weeks pale disc due to optic nerve inflammation
Enlarged blind spot
Slight vision loss with ache in eye, impaired colour vision
Amaurosis Fugax
Transient and painless loss of vision in one eye - “curtain passing across the eye”
Rapid onset lasting for seconds or minutes Indicates of transient retinal ischaemia
Risk for CRAO, stroke
Usually associated with stenosis of the ipsilateral carotid artery
Systemic workup needed including carotid dopplers, echo, chol/trig levels, BP monitoring
Unilateral red eye
FUGIT
Foreign body
Ulcer
Glaucoma
Iritis/uveitis
Trauma
Chemical injuries
Management
15-20mins of constant irrigation with saline
Herpes simplex
Hyphaema
Iritis
Subconjunctival haemorrhage
