Orbital disease

Question 1

What are the key features of proptosis?

Answer 1

proptosis, pain, visual loss or double vision

Question 2

What are some things that can cause proptosis?

Answer 2

Thyroid disease - Grave's disease
Orbital cellulitis 
trauma 
tumours 
vascular abnormalities
idiopathic inflammatory disorders

Question 3

What are some causes of a red eye?

Answer 3

acute glaucoma
uveitis
infective conjuctivitis
trauma 
episcleritis
allergic conjunctivitis 
corneal problems

Question 4

What are the signs and symptoms of bacterial conjunctivitis?

Answer 4

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.

Question 5

treatment for bacterial conjuctivitis?

Answer 5

nothing or chloramphenicol/fusidic acid topically

Question 6

what are the signs and symptoms of chlamydial inclusion conjuctivitis?

Answer 6

acute or subacute follicular conductivity

urethral or vaginal sx may occur

Question 7

treatment for chlamydial inclusion conjuctivitis?

Answer 7

microscopy, immunofluroscence and culture of conjuctival scrapes aid diagnosis
oral antibiotics - tetracycline or erythromycin

Question 8

what are the signs and symptoms of chlamydial trachomatis conjuctivitis?

Answer 8

chronic conjunctivitis leading to conjunctival changes, ingrowth of eyelashes, dry eye and corneal ulceration and scarring.

Question 9

What are the signs and symptoms of viral conjunctivitis?

Answer 9

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.

Question 10

What are the signs on funduscopy of glaucoma?

Answer 10

large optic disc:cup ratio.

dilated vessels?

Question 11

What is a differential for glaucoma seen on fundoscopy?

Answer 11

optic chiasm tumour
syphillis
ischeamic optic neuropathy
retinal degenerative disease

Question 12

what do thin vessels on fundoscopy usually mean?

Answer 12

optic atrophy

Question 13

differential diagnosis for optic atrophy?

Answer 13

compressive optic neuropathy
postoptic neuritis
optic nerve tumors 
congenital optic atrophy
hereditary optic neuropathies.

Question 14

‘The disc is pale, swollen with flame shape haemorrhages, the contralateral eye is unaffected’ what is this likely to be?

Answer 14

unilateral = giant cell arteritis

Question 15

‘the disc is hyperemic, swollen with blurring of the margins and obscured blood vessels. and occurs bilaterally’ is likely to be>

Answer 15

papilloedema since it is bilateral.

Question 16

what visual sx will someone with giant cell arteritis have?

Answer 16

Will have profound loss of vision down to counting fingers or hand movement

Question 17

what visual sx will someone with papilloedema have?

Answer 17

May not experience visual loss, or experience short periods of decreased vision (transient obscuration) often precipitated by head posture.

Question 18

what systemic sx will someone with giant cell arteritis have?

Answer 18

May have headache, jaw claudication, scalp tenderness, polymyalgia rheumatica, anorexia, weight loss, fever (and be older than 70)

Question 19

what systemic sx will someone with papilloedema have?

Answer 19

May have headache, double vision, nausea and vomiting.

Question 20

What investigations would you undertake if you suspected giant cell arteritis?

Answer 20

ESR, CRP, Platelets, and temporal artery biopsy suspecting Giant Cell (Temporal) Arteritis.

Question 21

What investigations would you undertake if you suspected papilloedema?

Answer 21

neuro-imaging (CT, MRI), as bilateral optic disc swelling due to raised ICP is papilloedema.

Question 22

what might someone with a blockage of their retinal artery have as visual sx?

Answer 22

transient visual loss (amaurosis fugax) or sudden painless onset of visual field defect.

Question 23

What are some common causes of gradual vision loss?

Answer 23

glaucoma
catarcact
armd
diabetic retinopathy/maculopathy

Question 24

Define glaucoma

Answer 24

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

Question 25

WHat are the 4 key components to Glaucoma assessment

Answer 25

1. IOP
   
   2. Angle assessment
   3. Cup to disc ratio - optic nerve
      
      4. Visual fields

Question 26

s/e of beta blockers

Answer 26

• 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

Question 27

What are the glacuoma surgery options?

Answer 27

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.