Orbital disease Flashcards
What are the key features of proptosis?
proptosis, pain, visual loss or double vision
What are some things that can cause proptosis?
Thyroid disease - Grave's disease Orbital cellulitis trauma tumours vascular abnormalities idiopathic inflammatory disorders
What are some causes of a red eye?
acute glaucoma uveitis infective conjuctivitis trauma episcleritis allergic conjunctivitis corneal problems
What are the signs and symptoms of bacterial conjunctivitis?
sticky red eye acute onset mild itching burning or grittiness little or no effect on vision unilateral or bilateral lid swelling purulent discharge pupil round and normally reactive
if visual acuity is significantly reduced then a corneal problem should be considered.
treatment for bacterial conjuctivitis?
nothing or chloramphenicol/fusidic acid topically
what are the signs and symptoms of chlamydial inclusion conjuctivitis?
acute or subacute follicular conductivity
urethral or vaginal sx may occur
treatment for chlamydial inclusion conjuctivitis?
microscopy, immunofluroscence and culture of conjuctival scrapes aid diagnosis
oral antibiotics - tetracycline or erythromycin
what are the signs and symptoms of chlamydial trachomatis conjuctivitis?
chronic conjunctivitis leading to conjunctival changes, ingrowth of eyelashes, dry eye and corneal ulceration and scarring.
What are the signs and symptoms of viral conjunctivitis?
similar to bacterial, but discharge is watery.
often occurs with runny nose and fever and viruses such as measles, and chickenpox
corneal dendritic ulceration should be looked for to exclude herpes simplex keratitis.
What are the signs on funduscopy of glaucoma?
large optic disc:cup ratio.
dilated vessels?
What is a differential for glaucoma seen on fundoscopy?
optic chiasm tumour
syphillis
ischeamic optic neuropathy
retinal degenerative disease
what do thin vessels on fundoscopy usually mean?
optic atrophy
differential diagnosis for optic atrophy?
compressive optic neuropathy postoptic neuritis optic nerve tumors congenital optic atrophy hereditary optic neuropathies.
‘The disc is pale, swollen with flame shape haemorrhages, the contralateral eye is unaffected’ what is this likely to be?
unilateral = giant cell arteritis
‘the disc is hyperemic, swollen with blurring of the margins and obscured blood vessels. and occurs bilaterally’ is likely to be>
papilloedema since it is bilateral.
what visual sx will someone with giant cell arteritis have?
Will have profound loss of vision down to counting fingers or hand movement
what visual sx will someone with papilloedema have?
May not experience visual loss, or experience short periods of decreased vision (transient obscuration) often precipitated by head posture.
what systemic sx will someone with giant cell arteritis have?
May have headache, jaw claudication, scalp tenderness, polymyalgia rheumatica, anorexia, weight loss, fever (and be older than 70)
what systemic sx will someone with papilloedema have?
May have headache, double vision, nausea and vomiting.
What investigations would you undertake if you suspected giant cell arteritis?
ESR, CRP, Platelets, and temporal artery biopsy suspecting Giant Cell (Temporal) Arteritis.
What investigations would you undertake if you suspected papilloedema?
neuro-imaging (CT, MRI), as bilateral optic disc swelling due to raised ICP is papilloedema.
what might someone with a blockage of their retinal artery have as visual sx?
transient visual loss (amaurosis fugax) or sudden painless onset of visual field defect.
What are some common causes of gradual vision loss?
glaucoma
catarcact
armd
diabetic retinopathy/maculopathy
Define glaucoma
Glaucoma is an optic neuropathy with a specific pattern of axonal loss which may be associated with elevated intraocular pressure and a typical pattern of visual field loss
WHat are the 4 key components to Glaucoma assessment
- IOP
- Angle assessment
- Cup to disc ratio - optic nerve
- Visual fields
s/e of beta blockers
• Bradycardia, heart block, asystole • Heart failure (may interact with others) • Shortness of breath and bronchospasm • Apnoea in infants • CNS - confusion, delerium, depression • Reduced exercise tolerance • Impotence and loss of libido Masks symptoms of hypoglycaemia
What are the glacuoma surgery options?
Surgery - trabectulectomy - has infection risk. Creates a connection/tunnel from sclera to outside world to get rid of flow. Adverse effect is low IOP which is emergency.
Cyclodestruction - destroy ciliary body - use it for people with low vision hope such as diabetics. For pain releif mainly!! But can cause eye to shrink and a bad cosmetic effect.