Opthalmology Flashcards
Types of strabismus
Paralytic: CN3, CN4 or CN6
Convergent = esotropia, most common in children
Divergent = exotropia, in older children, often intermittent
Complication of esotropic squint
Brain suppresses deviated image and pathway may not develop
Diagnosis of strabismus - 2
Corneal reflection - should be symmetrical
Cover test - squinting eye will move to take up fixation when normal eye is covered
Management of strabismus - 3
Optical - determine refractory state with cyclopentolate, and check for any abnormalities. Give glasses to correct refractory error
Orthoptic - patch good eye
Operation - on rectus muscles to align, or botulinum toxin
Appearance of CN3 palsy and causes
CN3 - cavernous sinus lesion, diabetes, posterior communicating artery aneurysm
Complete ptosis and down and out, fixed and dilated (unless diabetes or htn when pupil is spared)
Appearance of CN4 palsy and causes
Diplopia, head tilted - ocular torticolis
Look up in adduction and cannot look down and in
Caused by trauma, diabetes or tumour
Appearance of CN6 palsy and causes
Diplopia
Medically deviated and cannot move laterally
Caused by tumour increasing ICP and compressing nerve on edge of petrous temporal bone, trauma to base of skull, diabetes
3 requirements for good outcomes with strabismus
<7yo
Conscientious and disciplined treatment
Optimal glasses
Pupil reflex pathway
Optic nerve afferent - oculomotor nerve efferent
SNS pupil dilatation via ciliary nerves
Cause of afferent defects - 3
Optic neuritis
Optic atrophy
Retinal disease
Causes of fixed dilated pupil - 5
CN3 palsy Trauma Myriatics Acute glaucoma Coning
Condition causing delayed response to light
Tonic (Adie) pupil - lack of parasympathetic innervation. Initially uni then bilateral
What is Horner’s syndrome
Disrupted sympathetic fibres
Miotic pupil with no dilation in the dark
Partial ptosis
Anhydrosis
Causes of Horner’s syndrome - 6
Posterior inferior cerebellar artery occlusion MS Pancoast’s tumour Hypothalamus lesion Mediastinal mass Aortic aneurysm
Cause of bilateral miosis and other features
Argyll Robertson pupil - neurosyphilis and diabetes
Bilateral miosis, poor pupil dilatation, pupil irregularity
2 features that determine refraction in eye
Distance between cornea and retina
Curvature of lens and cornea
Pathophysiology of myopia and treatment
Short sighted - eyeball long, so closer to eye = focus further back and on retina
Concave glasses
Pathophysiology of hypermetropia and treatment
Long sighted - eyeball short so distant objects focus behind retina
Ciliary muscles contract to make lens more convex, which makes tiredness and convergent squint
Treat with convex glasses
What is astigmatism
Irrregularly shaped cornea
What is the age related sight change
Presbyopia - lens stiffens so ciliary muscles cannot reduce tension in it and make it more convex
When to get help in sudden loss of vision - 3
Retinal artery occlusion <6h
Visual loss <6h unknown cause
GCA
5 questions in sudden vision loss
HELLP
Headache - ESR for GCA
Eye movements hurt - optic neuritis
Like a curtain - amaurosis fugax precedes vision loss from GCA/emboli
Lights/flashes - detached retina
Poorly controlled DM - vitreous haemorrhage
Optic neuropathies - what and 4 signs
Damage to optic nerve:
Monocular vision loss with central scotoma
Afferent pupillary defect
Dyschromatopsia
Papillitis then optic atrophy on fundoscope (pale disc)
2 causes of optic neuropathy
GCA
Anterior ischaemic optic neuropathy - inflammation or atheroma block posterior vascular supply
What is GCA
Medium to large vessel vasculitis
Associated with polymyalgia rheumatica,
Mostly women >50
Sx - headache, malaise, jaw claudication, tender scalp
Eye - amaurosis fugax, blurring, dipolopia
Monocular visual loss
Management GCA
High ESR and CRP
FBC - anaemia, thrombocytopoenia
High dose prednisolone
USS, biopsy temporal artery within 1w of starting steroids - may miss as skip lesions
What is optic neuritis and 3 causes and treatment
Subacute loss of unilateral vision over hours to days
Afferent defect, pain on movement and dyschromatopsia
Caused by diabetes, syphilis, often first presentation of MS
Treat with high dose methylprednisolone then prednisolone
4 causes of transient vision loss
Vascular - microemboli from atherosclerotic plaque in heart or carotid arteries
MS
Subacute glaucoma
Papilloedema
Form of stroke affecting eye and initial investigations
Central retinal artery occlusion = sudden vision loss. Afferent pupil defect presents before retinal change (white with red spot)
Look for thromboembolic source - atherosclerosis, AF, DM, smoking, carotid bruit
Manage central retinal artery occlusion
Stroke protocol
3 causes of sudden loss of vision in 1 eye
Migraine
Acute glaucoma
Retinal detachment
RF for retinal vein occlusion - 5
Arteriosclerosis BP Diabetes Polycythaemia Glaucoma
Mechanism of visual loss in retinal vein occlusion
Thrombosed = visual loss due to ischaemia and macular oedema
Different types of retinal vein occlusion
Central - painless blurred vision, at level of optic nerve. Ischaemic or non-ischaemic
Branch - asymptomatic if macula not affected
Manage retinal vein occlusion
Manage complications - retina neovascularisation (more likely to haemorrhage) and chronic macular oedema
Intravitreal anti-VEGF if vision loss
Causes of vitreous haemorrhage - 4
Retinal neovascularisation - DM, CRVO, BRVO
Retinal tear
Retinal detachment
Trauma
Sx of vitreous haemorrhage
Vitreous floaters (black dots) No red reflex if large, retina may not be seen
Investigate VH and treat
B-scan US for course
Normally undergoes spontaneous absorption, or vitrectomy if dense or torn/detached retina
7 causes of gradual vision loss
Diabetic retinopathy Cataracts Macular degeneration Glaucoma Hypertension Optic atrophy Slow retinal detachment
Biggest cause of vision loss
Age related macular degeneration
Pathophysiology of macular degeneration
Pigment, drusen and bleeding into macula. Over time, progresses to retinal atrophy and central retinal degeneration which causes a loss of central vision
Risk factors for ARMD - 5
Family history Age Smoking CVD Cataract surgery
What are drusen? Appearance on fundoscopy
Optic nerve head axonal degeneration
= intracellular mitochondrial calcification
= some rupture and extruded into extracellular space, depositing calcium,
and drusen form
Optic disc edge irregular with lumpy yellow matter
No optic cup
Vessels have abnormal branching patterns
2 types of ARMD
Wet - exudative - choroidal neovascularisation membranes develop and leak fluid and blood = scar. Vision deterioration and distortion.
Dry - non-exudative - slow progressive visual loss from drusen and macular changes
Manage dry ARMD
Prevention
Antioxidant vitamins
Manage wet ARMD
Fluorescein angiogram then 4-6w reviews
Intravitreal anti-VEGF decreases cell proliferation and blood vessel formation and leak
Laser photocoagulation if specific signs
Intravitreal steroids
3 causes of optic atrophy and sign on opthalmoscope
Pale disc
RIOP in glaucoma
Retinal damage - choroiditis, retinitis pigementosa
Ischaemia in retinal artery occlusion
Causes of choroidoretinitis
Granulomatous reaction from toxoplasmosis, TB, sarcoidosis
What is glaucoma?
Optic neuropathy with death of many retinal ganglion cells and optic nerve axons
RF for glaucoma
RIOP Black race Family history Age Hypertension and diabetes
Why screen for glaucoma
Not symptomatic until visual fields severely impaired
Lifelong follow up in RIOP
Diagnosis of glaucoma
Intraocular pressure using tonometry
Central corneal thickness
Visual field measurement
Optic nerve assessment with fundus examination
Cup:disc ratio reduced as loss of disc substance
Who to screen for glaucoma - 5
>35yo Family history Afro-Caribbean Myopia Diabetic/thyroid eye disease
Drug treatment for glaucoma
Increase uveoscleral outflow with prostaglandin analogues, a-adrenergic agonist and miotics (pilocarpine)
Decrease aqueous production with b blockers, a-adrenergic agonists and carbonic anhydrase inhibitors
Sympathomimetics - caution in htn, heart diseases or closed angle glaucoma
Laser therapy increase aqueous outflow to decrease IOP
Trabeculectomy
What are cataracts ?
Opacity in the lens, leading cause of blindness
RF for cataracts
Age Smoking, alcohol, sunlight Trauma Radiation HIV+ Earlier in: Genetic Diabetes Steroids High myopia
Classifying cataracts
Opthalmoscopic lens appearance
Presentation of cataracts - 4 adult, 4 children
Often unnoticed if unilateral, but can lose distance judgement
Blurred, gradual painless loss of vision
Dazzle in light and haloes at night
Monocular diplopia
Children: white pupil, squint, nystagmus, amblyopia
Manage cataracts and disadvantages
Mydriatic drops, or surgery to remove cataract and replace with artificial lens (LA or GA)
Likely to still have glare, may need distance glasses, often have macular degeneration too which limits outcome
Care after cataract surgery and 7 post op complications
Antibiotics and anti-inflammatory drops for 3-6w, and change glasses
Eye irritation - require altered drops/lubricant
Post-op posterior capsule thickening/opacification - may need capsulotomy with laser
Astigmatism more noticed, correct during surgery if noticed in pre-op biometry
Enopthalmitis, anterior uveitis
Vitreous haemorrhage, retinal detachment, glaucoma (+- permanent vision loss)
Prevention for cataracts - 3
Sunglasses to decrease UV-B
Reduce oxidative stress (antioxidants eg vitamin c, caffeine)
Stop smoking
When to operate on congenital cataracts and why, and what else to do
<6w in the latent period of visual development to prevent significant deprivation amblyopia
Do TORCH screen
What is TORCH
Infection screen in newborns:
Toxoplamosis, Rubella, Cmv, Herpes, HIV
Structure of the retina
Outer pigmented layer in contact with choroid
Inner sensory layer in contact with vitreous
Macula at centre of posterior part
Causes of retinal detachment and other risk factor
Trauma: tear - fluid from vitreous space into subretinal space, between sensory and outer pigmented epithelium
Exudative: vasculitis, macular degeneration, hypertension, tumour, cause retina to detach without tear
Tractional: proliferative retinopathy pulls on retina.
Higher myopia = higher risk
Presentation of retinal detachment, and on opthalmoscope
Painless
4 Fs:
Floaters
Flashes
Field loss
Fall in acuity - like curtain Falling
Field defect indicates position and extent of detachment (superior detachment = inferior field loss)
Central vision loss = macular pulled off - doesn’t always recover
Ballooning grey opalescent retina on opthalmoscope
Prognostic factors in retinal detachment
Site and extent
Time to definitive treatment
Cause of underlying pathology
Differentials for retinal detachment - 4
Retinal artery occlusion
Posterior vitreous detachment
Vitreous haemorrhage
Migraine
Management of retinal detachment and rate of recurrence - 4
Rest - lie flat if superior detachment, or 30 degrees up if inferior
Laser photocoagulation therapy
Urgent surgery - retinopexy, vitrectomy and gas tamponade, with scleral silicone implants
Cryotherapy or laser coagulation secures retina
5-10% recurrence post-op
What is retinitis pigmentosa
Inherited degeneration in the retina
Presentation of retinitis pigementosa
Night blindness, then peripheral and central daytime vision loss
Complete blindness in late stages when photoreceptors affected
Common causes of floaters - 3
RBCs - new vessels form on retina can lead to vitreous haemorrhage, trauma, retinal detachment
WBCs - posterior choroiditis
Tumour seeding - melanoma or retinoblastoma
Manage floaters
Urgent referral as may be retinal detachment
Examine vitreous and retina and treat cause
Cause of flashing lights
Intraocular or cerebral in response to mechanical tissue disturbance
What is posterior vitreous detachment and sx
Degenerative changes in vitreous cause separation from retina
Monochromatic photopsia in peripheral temporal fields, more obvious in dim light and eye movements
Vision unchanged, no field defects, increase in floaters
Caution in posterior vitreous detachmen
Fundus check as retinal tears can happen as a consequence
Structure of macula
Lateral to optic disc
Fovea is a pit in the middle, and in the middle of this is foveola where cones are narrow, long and densely packed
Key role of macula
Visual acuity
Wha can cause blurred and distorted central vision, in relation to macula
Macular hole - break in macular region of retinal tissue, affecting fovia
>55yo
15% chance of another in other eye
Cause of macular hole - 4
Age related reduction in water in vitreous, causing traction on retinal tissue
High myopia
Trauma
Retinal detachment
Macular hole on exam
Tiny punched out area in centre of macula
Yellow-white deposits at base
Grey halo of detached retina surrounds it
Test for macular disease
Amsler grid reveals distortion
Optical coherence tomography diagnoses and stages holes
Fluorescein differentiates macular hole from cystoid macular oedema
Treat macular hole
Vitreo-retinal surgeon
Surgery - vitrectomy removes vitreous and internal limiting membrane over hole is peeled. Air bubble provides tamponade to macula back into position
1-2w post-op face down
Complications of macular hole - 3
Cataracts
Retinal detachment
Widening of hole
What is vascular retinopathy
Arteriopathic - AV nipping - arteries nip veins where they cross as they share CT sheath
Or
Hypertensive - arteriolar vasoconstriction causes superficial retinal infarction, causing cotton wool spots and flame haemorrhages. These can leak to cause hard exudates, macular oedema and papilloedema
Eye signs with infective endocarditis
Roth spots - retinal infarcts
Wilson’s disease eye sign
Keyser-Fleischer ring
Hyper and hypothyroid eye sign
Myxoedema = eyelid and periorbital oedema = exophalmos Hypothyroid = lens opacity
Eye sign with hyperparathyroidism
Corneal and conjunctival calcification
Sore eyes in gout?
Monosodium urate deposits in conjunctiva
Systemic causes of uveitis
Granulomatous diseases - TB, sarcoid, toxoplasmosis
Systemic causes of choroidoretinitis
TB, sarcoid, toxoplasmosis, syphilis, CMV
Sarcoid eye signs
Uveitis, choroidoretinitis
CN palsy and lacrimal gland swelling
Eye signs of collagen/vasculitic diseases
Conjunctivitis - SLE and reactive arthritis
Episcleritis - SLE and polyarteritis nodosa
Scleritis - RA
Uveitis - Ank spond and reactive arthritis
Orbital oedema and heliotrope rash with retinal haemorrhages - dermatomyositis
SLE eye signs
Conjunctivitis and episcleritis
RA eye signs
Scleritis
Ank spond eye signs
Anterior uveitis
Reactive arthritis eye signs
Conjunctivitis, uveitis
Dermatomyositis eye signs
Orbital oedema
Retinal haemorrhages
Heliotrope rash
Sjögren’s syndrome eye and mouth complications and test, and manage
Keratoconjunctivitis sicca
Reduced tear formation with Schirmer filter paper test, causing gritty feeling - give pilocarpine and ciclosporin if moderate/severe
Decreased salivation = dry mouth (xerostomia)
Main eye risk with HIV and treat
CMV retinitis
Retinal spots and flame haemorrhages
Asymptomatic or blindness
IV ganciclovir
Cotton wool spots in HIV? And 2 other HIV complications
HIV retinopathy - microvasculopathy not retinitis
Candidiasis of aqueous and vitreous
Kaposi’s sarcoma on lids or conjunctiva
Causes of retinopathy - 9
Vascular eg hypertensive Metabolic eg diabetes or thyroid Granulomatous disease eg sarcoid or TB Vasculitic eg SLE Sjogren’s Radiation Carotid artery disease Central or branch retinal vein occlusion Retinal telangiectasia/Coat’s disease
Eye changes in pregnancy - 7
Corneal sensitivity decreased
Lid pigmentation
Reduced tear production
Reduced IOP - good if glaucoma
Reduced AI activity - good if AI disease
Retinopathy - DM gets worse, proliferative changes
Pre-eclampsia - blurred, scotoma, photopsia, diplopia
Occlusive vascular disorders - hypercoagulable so higher risk of retinal vein or artery occlusion
Why screen for DM retinopathy in DM patients?
Not symptomatic until advanced disease when little can be done
2 structural eye changes in diabetes
Ocular ischaemia - new blood vessel formation, can block drainage of aqueous - cause glaucoma
Age related cataracts form faster
Vascular pathogenesis in diabetes in eye
Microangiopathy in capillaries:
- vascular occlusion causes ischaemia and new vessel formation (proliferative)
- retraction of fibrous tissue makes retinal detachment more likely
- occlusion causes ischaemia of nerve fibres and cotton wool spots
- microaneurysms cause oedema and hard exudates. Rupture at nerve fibre level cause flame haemorrhages, or blot haemorrhages when deep in retina
Classification of diabetic retinopathy - 3
Non-proliferative: microaneursms, haemorrhages (flame or blots), hard exudates (yellow patches)
- significant ischaemia = engorged torturous veins, cotton wool spots, large blot haemorrhages
Proliferative: neovascularisation on optic disc and retina, can cause vitreous haemorrhages
Maculopathy: oedema from vessels near macula threaten vision
Screening for diabetic retinopathy
At diagnosis, every year
With dilated fundus photography
6 things that accelerate retinopathy in diabetes
Pregnancy Raised BP Dyslipidaemia Renal disease Smoking Anaemia
Manage diabetic retinopathy - 4
Lower BP to <140/80 or <130/80 if end organ damage
Glycaemic control
Photocoagulation by laser for maculopathy and proliferative retinopathy, surgical review if pre-proliferative or haemorrhages
Anti-VEGF drugs for macular oedema
When to refer with maculopathy - 3
Exudate or retinal thickening in optic disc
Exudates in macula
Microaneurysm or haemorrhage near centre of fovea with poor visual acuity
Causes of optic disc swelling
Papilloedema Malignant hypertension SOL Cavernous sinus thrombosis Optic neuritis Central vein occlusion Opaque myelinated nerve fibres
Examining optic disc - 3 features
3Cs
Colour (pink/yellow with pale centre)
Contour
Cup (1/3 of disc diameter) - wider and deeper in glaucoma
Papilloedema associated features and investigate
Bilateral, from RICP. Present due to other features eg NV, headache
Also CN11 palsy and transient visual obscurations
Inv: MRI for SOL, LP for opening pressure and CSF analysis, BP/haemorrhages
What is pseudopapilloedema
Disc margins blurred, disc appears elevated
Benign, associated with hypermetropia and astigmatism
No true oedema and veins normal and pulsate
Papilloedema appearance
Discs swollen forward and outwards into surrounding retina
Disc margins hidden
Retinal vessels congested or concealed from oedema impairing translucency
Assess neuroretinal rim?
Pale = optic atrophy Fuzzy = swollen disc
Considering drug applications to eye- 6
Drops not retained as long as ointment, apply /2h 5m between doses to prevent overspill Ointment good for night Don’t use for >1 month Consider manual dexterity
Antibiotics for eyes?
Chloramphenicol, fusidic acid, neomycin
Drug for pupil dilation?
Mydriatics = cycloplegics - for dilating pupil and paralysing ciliary muscle, so blurred vision
Prevent adhesion formation in anterior uveitis
Can dilate for exam, lasts 3h
Drug for acute glaucoma?
Miotics - constrict pupil and increased drainage of aqueous, for acute glaucoma
Examine painful eye?
Local anaesthetic for examining painful eye with blepharospasm
Use of steroids and NSAIDs drops
Inflammation, under opthamologist guidance
For allergy, episcleritis, scleritis, iritis
Increase IOP so can precipitate glaucoma
Can induce progression of dendritic ulcer - checkwith slit lamp first
Drugs that can cause:
- dry eye
- corneal deposits
- lens opacity
Dry eye - b blocker, anticholinergics, any eye drops
Corneal deposits - amiodarone, chlorpromazine
Lens opacity - steroids
Drugs that cause glaucoma or papilloedema
Glaucoma - steroid drops, mydriatics, anticholinergics (tricyclics, Parkinson’s)
Papilloedema - steroids, OCP, tetracyclines
Drugs that cause retinopathy
Ethambutol
Isoniazid
Chloroquine
ADR of pilocarpine - 6
Parasympathetic sweating Brow-ache from spasm Urinary frequency BP increase Palpitations Visual disturbance
Infection causing entropion
Chlamydia trachomatis causes scarring of inner eye lids, damaging cornea, then distortion eyelids, so lashes ulcerate cornea
Signs on exam for allergic conjunctivitis, and treatments
Small papillae on tarsal conjunctiva
Antihistamine and mast cell stabiliser drops
Allergic eye disease that threatens vision?
Atopic keratoconjunctivitis - severe pain redness and reduced vision
Causes conjunctival papillae and scarring, and eventually corneal opacification and neovascularisation
Associated with atopic dermatitis
Conjunctivitis from foreign body? and treatment
Giant papillary conjunctivitis
Remove and treat with topical mast cell stabilisers or steroids
Managing allergic eye disorders
- Remove allergen
- General - artificial tears, cold compress, oral antihistamines
- Drops - antihistamines, mast cell stabiliser (inhibit degranulation), steroids, NSAIDs
Advantage of eye drops? - 2
Rapid action
Fewer SEs as topical
3 complications from contact lenses
Keratoconjunctivitis
Giant papillary conjunctivitis
Pseudomonas infection
Causes of dry eyes and test
= keratoconjunctivitis sicca
Reduced tear production:
- by lacrimal glands in old age
- Sjogren’s
- sarcoidosis, amyloidosis
Excess evaporation (exposure) or mucin deficiency
Schirmer’s test - strip of filter paper put overlapping lower lid, tears should soak >15mm in 5 mins
Categories of watery eyes - 3
- Decreased drainage - punctal stenosis/obstruction or canaliculitis
- Increased lacrimation - environment, injury
- Pump failure - positive and negative pressure changes in lacrimal sac on blinking suck tears in. Entropion, ectropion or CNS cause (myasthenia, CN7 palsy)
Signs of retinoblastoma - 3
Strabismus
Leukocoria
No red reflex
Retinoblastoma inheritance
Aut dom with 80% penetrance
RB gene is tumour suppressor gene
Complications of retinoblastoma extra-ocular
Secondary malignancies - osteosarcoma, rhabdomyosarocma
Manage retinoblastoma
Chemotherapy, if bilateral
Radiotherapy: external beam radiotherapy or brachytherapy
Cryotherapy and thermotherapy if small
Enucleation if large, long standing retina detachment, optic nerve invasion or extra-scleral extension
Vision 6:24 what does it mean
Acuity: they see at 6m what normal person can see at 24m
What is accommodation
Change of lens shape for distance vision using ciliary muscles
Dye in eye and what for
Fluorescein - blue, yellow when touches eye, so defect on epithelium looks green
5 top causes of blindness in developed country
ARMD, glaucoma, cataracts, diabetic retinopathy, refractive error
Orbital vs pre-septal cellulitis
Orbital - behind orbital septum
Preseptum in front of orbital septum
Manage orbital cellulitis
Cephalosporins flucloxacilin, metronidazole
CT of orbits
Carotico-cavernous fistula?
Carotid artery rupture causes reflux of blood into cavernous sinus
Pulsatile exophthalmos with bruit and eye vessel engorgement
Causes of relative afferent pupillary defect - 3
Optic neuritis
Retinal disease
Optic atrophy
4 causes of Horner’s syndrome
PICA
MS
Cavernous sinus thrombosis
Pancoast tumour
Late sign in cataracts
Loss of red reflex
Sx of cataracts 4
Glare
Diplopia
Lack of colour appreciation
Reduced acuity
3 types of cataract
Nuclear sclerotic (myopic) Cortical Posterior subcapsular (diabetes, steroids)
Early complications of cataracts surgery 5
Anterior inflammation (give steroid drops) Endophthalmitis (sight threatening) Corneal oedema Iris prolapse Wound leak
3 late complications of cataracts surgery
Posterior capsule opacification (laser surgery)
Cystoid macular oedema
Retinal detachment
IOP in open angle glaucoma
Raised in primary open angle glaucoma
Can be normal
Sx of glaucoma
Asymptomatic, late sign loses peripheral vision
RF for glaucoma - 4
Family
Afrocaribbean
Diabetes/thyroid eye disease
Myopia
Investigate glaucoma
Goldmann visual field tests - nasal and superior fields lost, then arcuate scotoma
Optic cupping
Manage glaucoma - 6
Prostaglandin analogue - increase outflow
A adrendergic agonist - increase outflow
B blockers - reduce aqueous production
Carbonic anhydrase - reduce aqueous production
Miotic - reduce resistance
Trabeculostomy/trabeculectomy
5 questions for red eye
Vision loss Pain Distribution of redness Discharge and type Photophobia
Sx and treat corneal abrasion
Pain, photophobia
Chloramphenicol
Ulcer of cornea management
Smear, scrape, gram stain
Chloramphenicol and cyclopentolate drops
3 types of corneal ulcer
Bacterial
Herpetic
Fungal
Manage acute closed angle glaucoma
Admit Lie supine for 1h and limit fluid intake Acetazolamide IV then PO Pilocarpine Surgery
Sx of scleritis
Conjunctival oedema
Deep scleral injection
Pain not relieved by NSAIDs
Scleritis bloods
ANCA ANA ESR
Treat scleritis
PO steroid
Immunosuppression
Episcleritis sx and manage
Dull ache
Tender eye
Redness localised to one area
PO or topical NSAIDs
Pus or blood in anterior chamber and association
Pus - hypopyon - anterior uveitis
Blood - hyphaema
Chronic or advanced anterior uveitis sx
Adv - hypopyon
Chronic - synechiae - adhesions
Manage ant uveitis 3
Steroid drops
Cyclopentolate
Rheum referral
inv central retinal vein occlusion
RAPD
IOP
Gonloscopy
Bloods
Central retinal vein occlusion sx and 2 types
Sudden painless loss of vision - metamoprphia
Ischaemic or non ischaemic
Manage CRVO - 2
Anti VEGF
Laser to make more ischaemic
Central retinal artery occlusion sx and sign in exam
Sudden painless loss of vision
Cherry red spot as macula spared
Associated with atherosclerosis
2 manage CRAO
Ocular massage and anterior chamber paracentesis
2 Risk factors or retinal detachment
Aphakia or pseudophakia
Myopia
Chemical injury of eye - which is worse
Alkali - liquefactive necrosis - can continue to track through eye
Acid - coagulative necrosis makes a barrier
Manage of chemical injury in eye - 5
Irrigate Topical steroids Chloramphenicol Cyclopentolate Vitamin a if limbus ischaemia
