opthamology Flashcards
A patient presents with yellow discharge from the eye. On history taking the patient denies pain, photophobia, or blurring of the vision. What is the most likely diagnosis?
conjunctivitis (bacterial)
What is going to help you distinguish between viral and bacterial types of conjunctivitis?
yellow is mostly bacterial
watery is most likely viral
What features would raise a suspicion that perhaps this patient has a more atypical causative organism for their conjunctivitis?
green frothy purulent discharge
there could be corneal perforation (risk)
need to do STD screen
In a neonate, what would you suspect in a day 5-19 baby who presents with sticky discharge from the eye?
Chlamydia
treatment is tetracycline and oral abx
A patient presents with vesicles around the orbit. What is it most likely to be?
herpes simplex virus the treatment is eye drops with acyclovir 5 times per day.
What supplies the cornea of the eye with sensation?
The ophthalmic branch of trigeminal nerve (5)
What would you be concerned about in a contact wearer that presents with severe pain and a fairly normal looking eye on examination?
acanothameoba
Why do you not give steroids in a patient that presents with a red eye?
It could be a herpes simplex epithelial keratosis and make the dendritic ulcer worse. Also it may make the clinical symptoms leading to delayed diagnosis.
An elderly patient (long sighted) presents to the emergency department with vomiting. You observe she is wearing sunglasses in the february and is moaning in pain.
This could be acute angle closure glaucoma
treament is laser surgery
how can you tell the difference between episcleritis and scleritis?
episcleritis is benign and self-limiting
when asked in the history there is none of the four cardinal signs
scleritis on the other hand there is pain and tenderness on palpation (severe)
it is full thickness inflammation of the sclera
What are the other conditions associated with scleritis?
Rhuematoid arthritis
SLE
Wegeners
polyteritis nodosa
A toddler presents to the GP practice with red itchy eyes. When you look at the conjunctiva there is a cobblestone appearance.
this is most likely vernal conjunctivitis
IgE mediated
can lead to corneal ulceration if untreated
What is the treatment for vernal conjunctivitis?
topical mast cell topical steroids (only to be given by ophthalmologist) with topical steriods: 10% of people have increased eye pressure
In your examination of the eye there is inflammation fo the iris… which has a characteristic hazy appearance in the anterior chamber. what is this called?
acute anterior uveitis
What does acute anterior uveitis present with?
pain photophobia discharge
When you dilate the eye in the acute anterior uveitis what do you expect
relaxation of the ciliary muscles which will decrease the pain (spasm)
prevention of posterior synechiae (Iris adhering to the cornea)
When you are dieting the pupil in a patient with anterior uveitis, you observe that the pupil is irregularly shaped. What is this called and how does it occur?
It is called posterior synechiae and it occurs due to the Iris becoming attached to the cornea.
A patient presents to you with recurrent anterior uveitis. What are you now going to be considering in your differential?
autoimmune juvenile arthritis GI UC or chrons (ask about bowel motions) ankolsing spondylitis (MRI spine and sacroiliac joint) sarcoidosis * chest X ray
An elderly patient presents with vesicles on the distribution of the ophthalmic branch of the trigeminal nerve what are you worried about?
iritis?
There is nasal involvement in shingles what is this sign called?
Huchingsons sign need oral antiviral medication
When would you consider an interaocular foreign body?
if there is a history of hammering a nail (angle grinding)
To confirm suspicion radiological imaging at different angles to confirm a moving opacity in the eye.
When a patient presents with a subconjunctival haemorrhage what other investigations would you order?
BP (hypertension)
FBC (platelets)
Coagulopathy screen (liver function)
What does a corneal melt present with?
pain and blurry vision
active inflammation leading to auto digestion of the cornea
mangement surgical glue
What are the causes of red eye that you must think about when asking the patient a history in the ED
conjunctivitis uveitis keratitis acute angle closure glaucoma scleritis
How do you treat a conjunctival infection:
chloramphenicol drops or ointment: bacterial
viral no abx required
education about spread to their eye and hygiene should be given
What about a girl that comes into the clinic with her mother complaining of red itchy streaming eyes. She has a background history of eczema and asthma. When further questioned these happen seasonly in the spring time. What is your diagnosis and what sit he treatment?
Allergic conjunctivitis this can be treated with a 6 week course of topical sodium cromoglycate drops or with antihistamines (zirtek) for the duration of the hay fever season.
A patient comes in complaining of a red eye. On further questioning they reveal that they are in pain, they are sensitive to the light and have blurry vision. There is no discharge. What is your differential?
uvetitis, keratitis, and herpes simplex corneal ulceration.
What is your treatment for a herpes complex corneal ulcer?
need to be commenced on zovirax ointment 5 times per day and cyclopentolate 1% drops and immediate referral to the eye clinic.
A little old granny comes into the emergency deparemtn with severe headache and nausea and vomiting. On further questioning the patient has pain localized to the eyes. She also says her vision is a bit blurry. Looking at her glasses she is long sighted (hypermetropic). On eye exam, her pupils are mid ovale dilatated and cornea is hazy.
This is acute angle glaucoma until proven otherwise.
The treatment is the yag laser iridotomy
This allows fluid outflow. This is a vision preserving not curative.
A little child comes in and is rubbing his eyes. You notice as he comes in he has a erthymatous rash on his face. His mom is worried that he has red yes. On further questioning he has hay fever and a history of asthma as well. On examination of his conjunctivae he has cobblestoning.
vernal conjunctivitis this is treated with mast cell stabilizers and topical steroids
If it is not treated it can lead to punctuate epitheiopathy or epithelial macroerosions
You have a 16 year old girl walk in to your practice with her mother. Her mother explains that 5 weeks ago she had just received contacts for the first time. Now she is complaining of blurry vision, feeling like something is in her eye, and light bothering her. On eye examination you see expanding oval, yellow white dense stromatolites infiltrate and stromatolites suppurations and hypopyon.
This patient most likely has bacterial keratitis.
A 23 year old walks into your GP practice. He is a contact lens wearer and complains of severe pain. He doesn’t have any redness on eye exam and it appears normal looking. What should you do?
suspect acanthamoeba. Wa he wearing his contacts while swimming.
1. inflitrates the anterior stroma and then ulcerates and satellite lesions. can have stromal opacification.
treatment is chlorhexidine
