Opthalmology Flashcards
Dx: Red eye Not painful/mild pain \+/- Watering & photophobia May be bilateral
Episcleritis
Management of episcleritis
Self limiting usually
Conservative- may use artificial tears
How to differentiate episcleritis vs scleritis
Phenylephrine drops- if redness improves with drop then dx episcleritis
(phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels)
Features of age related macular degeneration
Drusen (collections of lipids/protein beneath RPE and within Bruch’s membrane)
RPE hypo/hyperpigmentation
RPE atrophy
Neovascular AMD- abnormal new blood vessels which easily bleed/leak
Risk factors for age related macular degeneration
SMOKING
Increasing age
Family Hx/Genetic factors
Possible risk factors; HTN, CV disease, excessive sunlight, cataract surgery, long sighted, high alcohol intake, obesity
AMD classification
No AMD- no/few small drusen less than 63 micrometers diameter
Early AMD- multiple small drusen, few intermediate drusen or mild abnormalities of RPE
Intermediate AMD- any one of; numerous intermediate drusen, at least 1 large drusen (125 micrometres diameter at least), or geographic atrophy not involving central fovea
Advanced AMD- Geographic atrophy involving central fovea and/or neovascular AMD
These are features of…
Painless deterioration of central vision
Usually 55yrs+
Metamorphopsia (distorted vision where straight lines appear bent)
Scotoma (black/grey patch affecting central vision)
Others: Light glare Loss of contrast sensitivity Abnormal dark adaptation Photopsia (flickering/flashing lights) Charles Bonnet syndrome (hallucinations)
AMD
What would you find on examination in a patient with AMD?
Normal or ↓ visual acuity
Drusen
Pigmentary/exudative/haemorrhagic/atrophic changes of macula
In GP if AMD suspected need to
Refer urgently to ophthalmology (within 1 week)
Investigations for AMD
Slit lamp biomicroscopy
Colour fundus photography
Ocular coherence tomography
Fluorescein angiography
Management of AMD
Slow progression by stopping smoking, healthy diet, supplements
In neovascular AMD- anti-angiogenic therapies e.g. anti VEGF drugs (ranibizumab, bevacizumab, afilbercept)
Red, swollen, painful eye- acute onset Fever Erythema and oedema of eyelids Ptosis of eye Lack of orbital signs
Preseptal cellulitis (preorbital cellulitis)
Management of preseptal cellulitis
Admit ophthalmology
Oral co-amoxiclav
Eyelid erythema and oedema Chemosis (oedema of conjunctiva) Proptosis Gaze restriction Blurred/double vision Fever
Orbital cellulitis
Management of orbital cellulitis
Admit ophthalmology
IV abx e.g. cefotaxime and flucloxacillin 7-10d
Surgery if CT shows orbital collection
Investigations for preseptal/orbital cellulitis
FBC- leukocytosis
Blood cultures
Swab any skin breaks
CT sinuses and orbit +/- brain
Itchy eyes Watery/mucoid discharge Conjunctival redness Chemosis Oedema of eyelid
Conjunctivitis
Ophthalmology red flags
Reduced visual acuity
Marked eye pain, headache or photophobia
Inability to open eye or keep it open
Red sticky eye in neonate (within 30d of birth)
Hx of trauma or possible foreign body
Copious rapidly progressive discharge (may indicate gonococcal infection)
Possible herpes virus infection (herpes simplex may present as unilateral red eye + vesicles on eyelid, herpes zoster - lesions on tip of nose)
Soft contact lens use with corneal sx e.g. photphobia/watering
Management of conjunctivitis
Avoid allergens and do not rub eyes
Cold compresses/saline/artificial tears
Topical antihistamine (Emedastine)
OR dual mast cell stabiliser + antihistamine (Azelastine, Epinastine, Ketotifen, Olopatadine)
Bilateral eye grittiness and discomfort, esp. at eyelid margins
Eyes may be sticky in the morning
Eyelid margins may be red
Blepharitis
Management of blepharitis
Hot compresses BD
Mechanical removal of debris from lid margins
Artificial tears if dry eyes/abnormal tear film
Severe pain- ocular or headache Decreased visual acuity Hard, red eye Symptoms worse with mydriasis (e.g. watching TV in dark room) Haloes around lights Semi-dilated non-reacting pupil Dull/hazy cornea May have systemic upset e.g. nausea, vomiting, abdo pain
Acute angle closure glaucoma
Management of acute angle closure glaucoma
Urgent referral ophthalmology
Patient to lie flat with face up, no pillow, to relieve pressure
Pilocarpine eye drops
Acetazolamide 500mg orally (reduces production of aqueous humour)
Analgesia
Anti-emetic
In secondary care- laser iridotomy
Increased intraocular pressure
Visual field defects
Cupped optic disc
Primary open angle glaucoma
Treatment of primary open angle glaucoma
Mild- monitoring
Reduce intraocular pressure with a topical prostaglandin analogue or prostamide, or a topical beta-blocker
Features of Horner’s syndrome
Miosis (small pupil)
Ptosis (drooping of upper eyelid)
Enopthalmos (sunken eye)
Anhidrosis (loss of sweating on one side)
