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GPEP Ophthalmology > Red Eye > Flashcards

Red Eye Flashcards

BPAC / Health Pathways

1
Q

Red flags for red eye

A

Significant pain
Photophobia
Reduced visual acuity
Unilateral presentation

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2
Q

Most cases of “red eye” seen in general practice are likely to be _______ or __________

A

Conjunctivitis or a superficial corneal injury

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3
Q

6 serious causes of red eye, which can result in visual loss (and should be discussed/referred with ophthalmology acutely)

A

Acute angle glaucoma
Iritis
Keratitis
Scleritis
Penetrating eye injury or embedded foreign body
Acid or alkali burn to the eye

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4
Q

What type of eye pain is typical of a serious problem?

A

Severe, constant, aching pain
Especially when associated photophobia

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5
Q

Sharp, brief, “gritty” eye pain indicates…

A

Surface irritation

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6
Q

Pain that resolves with local anaesthetic drops is usually due to…

A

Superficial disease, i.e. conjunctival or corneal

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7
Q

What is acute angle closure glaucoma

A

Occurs when there is an obstruction to drainage of aqueous humour from the eye, rapidly causing increased intraocular pressure

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8
Q

Acute angle closure glaucoma typically occurs in which patients?

A

Middle-aged to elderly
Hypermetropic (long-sighted) females
Patients of Asian ancestry

But can occur in any patient

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9
Q

Presenting features of acute angle closure glaucoma

A

Unilateral red eye
Deep achy pain
Drop in visual acuity
Halo around light sources
Unwell (nauseous, vomiting)

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10
Q

Signs of acute angle closure glaucoma

A

Ciliary injection
Fixed mid-dilated pupil
A generally hazy cornea
Decreased visual acuity

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11
Q

What is keratitis?

A

Inflammation of the corneal epithelium caused by infection (e.g. viral, bacteria, fungi or protozoa) or auto-immune processes (e.g. collagen vascular diseases)
Sight threatening

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12
Q

Microbial keratitis is usually precipitated by…

A

A change to normal corneal epithelial health e.g. by trauma, contact lens use, tear film and/or eyelid pathology.

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13
Q

Most common reason for ophthalmology admission to hospital

A

Infectious keratitis

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14
Q

Typical presentation keratitis

A

1 to 3 day acute hx
Initially with sharp pain, redness, and photophobia which progresses to severe pain and often decreasing vision

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15
Q

Signs of keratitis on exam

A

Severely red eye
Swollen eyelids
Mucopurulent discharge (hypopyon)
Corneal haze or any area of corneal opacity or thickening
Corneal infiltrate with a matching area of fluorescein staining over it

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16
Q

Management of keratitis

A

Dark glasses
Analgesia (oral or topical)
Remove contact lenses (keep to ?send for culture)
Call ophthalmology

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17
Q

What is iritis?

A

Inflammation of the iris that can be associated with other inflammatory disorders, e.g. ankylosing spondylitis, or occur as an isolated idiopathic condition

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18
Q

Iritis is also known as…

A

Anterior uveitis

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19
Q

Complications of iritis

A

Glaucoma
Cataract
Macular oedema

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20
Q

What conditions can iritis be associated with?

A

Autoimmune inflammatory and connective tissue disorders e.g., ankylosing spondylitis, RA, SLE, IBS
Granulomatous conditions e.g., sarcoidosis, TB
infections e.g., HIV, syphilis, Lyme disease, herpes.

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21
Q

Typical symptoms of iritis

A

Short hx (1-2 days) unilateral red eye + deep aching pain that is not relieved by topical anaesthetics
Significant light sensitivity
Conjunctival redness around the edge of the iris
Decreased vision

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22
Q

If someone has iritis are they likely to get it again?

A

Yes - for the first episode of uncomplicated iritis, about 20% will have a recurrence in their lifetime. It could be 20 years later

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23
Q

Typical signs on exam of iritis

A

Acutely inflamed red eye
Very small pupil, poorly reactive to light, sometimes distorted.
Hypopyon – a yellow fluid level at the bottom of the anterior chamber
Cornea usually clear, but may be cloudy
No discharge, inner lining of the eyelids not inflamed

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24
Q

Management iritis

A

Acute ophthalm referral - they oversee treatment but is usually steroid eye drops and dilating eye drops (to prevent the iris sticking to the lens)

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25
Q

History questions for red eye

A

Duration, nature and onset of sx
Dull, stabbing, throbbing or gritty pain?
One eye, both or sequential?
Exposure to chemicals or other irritants, foreign body or trauma
Photophobia
Changes to vision; reduction in acuity, haloes, other visual disturbances
Discharge from the eye; nature, volume and persistence
Past ocular hx
Occupational hx
Other sx suggesting systemic cause

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26
Q

What to ask in history of red eye about past ocular history?

A

Previous episodes?
Previous herpetic eye disease?
Previous eye surgery?
Contact lens use – hygiene practices?

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27
Q

What to ask in history of red eye about occupational history?

A

e.g. outdoor worker, metal fabricator, childcare worker
Exposure to chemicals, other irritants
Recent trauma to eye

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28
Q

What other sx should you ask about in history that might be suggestive of a systemic disease causing the red eye?

A

Recent or concurrent URTI
Skin and mucosal lesions
Muscular or skeletal pain
Joint stiffness
Genitourinary discharge, dysuria

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29
Q

Exam of red eye

A

Extent, location and nature of the redness
Any discharge? Is it purulent or clear?
Any evidence of hyphema or hypopyon?
Pupils - equal? Irregular shape? light reflex
Cornea opaque/hazy? Any localised corneal opacity representing a corneal infiltrate?
Look for foreign body incl under eyelids
Eyelids - normal position? complete closure? blepharitis? eyelashes inturned?

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30
Q

What is hyphema?

A

Blood in the anterior chamber

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31
Q

What is hypopyon?

A

Purulent exudate in the anterior chamber

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32
Q

Pattern of redness - conjunctival injection appears as…

A

A diffuse area of dilated blood vessels

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33
Q

Pattern of redness - ciliary injection appears as…

A

Injection in a ring-like pattern around the cornea

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34
Q

If the mechanism of injury and/or clinical signs suggest the possibility of a penetrating eye injury should you attempt eyelid eversion to look for foreign body?

A

No - contents of the eye may prolapse

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35
Q

What can fluorescein dye help you detect?

A

Corneal abrasions, ulcers and foreign bodies

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36
Q

Management of serious chemical eye injury

A

First priority = irrigation
Apply topical anaesthetic then irrigate with >500mL sterile water/normal saline until pH 7-8 and equal between both eyes
Then refer urgently to ophthalm

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37
Q

Management of acute angle closure glaucoma

A

Refer urgently to ophthalm
While waiting, the patient should lie flat with their face up, without a pillow. This may decrease the intraocular pressure by allowing the lens and iris to “sink” posteriorly, opening up the drainage angle.

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38
Q

What is herpes simplex keratitis

A

Reactivation of the herpes simplex type 1 virus (“cold sores”) can, in some people, result in ocular symptoms
Causes characteristic dendritic ulcers

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39
Q

Management herpes simplex keratitis

A

Refer ophthalm
Ocular anti-viral treatment is usually given (aciclovir 3% eye ointment)

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40
Q

Possible long term complications of herpes simplex keratitis

A

Corneal scarring and visual loss

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41
Q

Recurrences in herpes simplex keratitis

A

Recurrences (almost always in the same eye) are common and can occur many years after the previous episode

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42
Q

What is scleritis

A

Painful inflammation of the sclera that may also involve the cornea, adjacent episclera, and underlying uveal tract

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43
Q

What is scleritis often associated with?

A

Underlying systemic illness, e.g. rheumatoid arthritis, Wegener granulomatosis, SLE, vasculitis, inflammatory bowel disease.

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44
Q

Complications of scleritis

A

If untreated, can progress to damage eye structures and cause permanent vision loss

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45
Q

What is episcleritis

A

A local inflammation of the superficial layer between the sclera and conjunctiva.
Vision is unaffected
Majority not associated with underlying systemic disorder

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46
Q

Does episcleritis need treatment?

A

Usually self-limiting and resolves within ~ 3 weeks, but can recur.
Lubricating eye drops + NSAIDs
Consider scleritis if the symptoms worsen

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47
Q

Symptoms of scleritis

A

Severe aching pain in the involved eye (bilateral in 50% of cases), tending to develop over approximately 1 week.
Pain wakes the pt from sleep or prevents from going to sleep, may radiate to face or be exacerbated by eye movements

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48
Q

Symptoms of episcleritis

A

Irritation and mild pain only
Dilated superficial blood vessels in a localised area of the sclera
Localised tenderness

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49
Q

Signs on exam of scleritis/episcleritis

A

Redness of eyeball (not lids) - generalised or involving a sector
Eyelids are normal
Eye movements are normal, with no proptosis

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50
Q

Exam findings specific to scleritis (not episcleritis)

A

Vision can be blurred
Eye is usually severely red (either all over or in a sector of the eye), but may appear normal in posterior scleritis.
Dark areas of choroid visible through the sclera suggest necrotising scleritis – this form of scleritis needs urgent treatment and referral.
May be photophobia

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50
Q

Management scleritis

A

Acute ophthalm referral
May be advised to start immediate NSAIDs or oral pred (topical steroids not useful)

51
Q

Management of endophthalmitis

A

Urgent ophthalm referral
Treatment involves sampling of intraocular fluids, intravitreal antibiotics and possibly vitrectomy surgery

51
Q

What causes Endophthalmitis?

A

Most commonly iatrogenic, occurring after recent intraocular surgery (usually <1-2 weeks prior), but can rarely occur from endogenous causes such as septicaemia or endocarditis

51
Q

What is Endophthalmitis?

A

Sight- and globe-threatening internal infection of the eye

51
Q

Presentation of endophthalmitis

A

Worsening pain, redness and/or visual loss
A level of purulent exudate within the anterior chamber (a hypopyon) may be visible

52
Q

Types of conjunctivitis

A

Viral, bacterial or allergic

53
Q

Which types of conjunctivitis are most contagious?

A

Bacterial and especially viral conjunctivitis are often highly contagious

54
Q

As a general rule, ________ discharge indicates bacterial conjunctivitis and a ________ discharge indicates viral or allergic conjunctivitis

A

purulent discharge –> bacterial
clear or mucous discharge –> viral or allergic

55
Q

How to differentiate viral vs allergic conjunctivitis

A

The presence of pruritis, a history of atopy and exposure to a known allergen usually helps to differentiate allergic conjunctivitis from viral.

56
Q

Viral conjunctivitis is usually caused by _________

A

Adenovirus

57
Q

Typical features of viral conjunctivitis

A

Sequential bilateral red eyes
Watery discharge and inflammation around the eye and eyelids, which can produce dramatic conjunctival swelling (chemosis) and lid oedema, to the extent that the eye is swollen shut
Grittiness or stabbing pain
May have other resp sx
Enlarged, tender preauricular lymph nodes
Crusting of lashes overnight

58
Q

Treatment of viral conjunctivitis

A

Supportive
Clean away secretions from eyelids and lashes with cotton wool soaked in water
Wash their hands regularly, especially after touching eye secretions
Avoid sharing pillows and towels
Avoid using contact lenses
Lubricating eye drops if needed

59
Q

Symptoms of viral conjunctivitis can take up to __________ to resolve (timeframe)

A

3 weeks

60
Q

Complications of viral conjunctivitis

A

In severe cases, punctate epithelial keratitis may develop – seen with fluorescein staining as multiple small erosions of the conjunctiva. Can cause ongoing discomfort for several weeks, which then resolves spontaneously

Immune sub-epithelial infiltrates may develop after the conjunctivitis has settled, impairing visual acuity. These cannot be seen with fluorescein dye, and can take several weeks to resolve spontaneously.

61
Q

Bacterial conjunctivitis is usually caused by…

A

Streptococcus pneumoniae
Haemophilis influenzae
Staphylococcus aureus
Moraxella catarrhalis

62
Q

Bacterial conjunctivitis is less commonly caused by…

A

Chlamydia trachomatis
Neisseria gonorrhoeae

Sx usually more severe and persistent

63
Q

Do people with bacterial conjunctivitis need treatment?

A

Self-limiting in most people and will resolve without treatment within 1-2 weeks (although resolution may be more rapid in some people).

Advise supportive treatment (as for viral conjunctivitis)

64
Q

When to use topical abx in bacterial conjunctivitis

A

“Back pocket prescription” - delay starting treatment for a few days to see if the symptoms resolve
Antibiotics may be started immediately if symptoms are severe or distressing

65
Q

Recommended treatment for adults and children >2yrs for bacterial conjunctivitis when abx needed

A

Chloramphenicol 0.5% eye drops, 1-2 drops, every two hours for the first 24 hours, then every four hours, until 48 hours after symptoms have resolved.

Chloramphenicol 1% eye ointment can also be used at night in patients with severe infections or as an alternative to eye drops for those who prefer this formulation.

66
Q

Alternative treatment for adults and children >2yrs for bacterial conjunctivitis when abx needed (and also preferred treatment in pregnant women)

A

Fusidic acid 1% eye gel, 1 drop BD until 48 hours after symptoms have resolved

67
Q

When are investigations (i.e. swab) indicated in conjunctivitis

A

Consider in immunocompromised patients or if sx are persistent despite chloramphenicol treatment.

If gonococcal conjunctivitis is suspected in an adult, collect an eye swab (before applying any topical treatment) and test for gonorrhoea and chlamydia

68
Q

What is herpes zoster ophthalmicus

A

Shingles (reactivation of the varicella-zoster virus) in the ophthalmic branch of the trigeminal nerve (V).

All parts of the eye innervated by this nerve can be affected, causing conjunctivitis, keratitis and/or iritis, along with a periorbital vesicular rash, identical to a shingles rash seen elsewhere on the body.

69
Q

Although a shingles rash that involves the _________ (Hutchinson’s sign) is said to predict the development of herpes zoster ophthalmicus, 1/3 of patients without the sign have ocular complications

A

Tip of the nose

70
Q

In herpes zoster ophthalmicus involvement of _______ may suggest CNS involvement and patients require neurological + ophthalmological assessment

A

Other cranial nerves such as II (optic neuritis), III, IV and VI (diplopia)

71
Q

Patients with suspected herpes zoster ophthalmicus should be started on ________ if they have presented within ________ of the onset of vesicular rash.

A

oral acyclovir
72 hours

72
Q

When should patients with suspected herpes zoster ophthalmicus be referred urgently to ophthalm

A

Patients with decreased visual acuity and/or corneal epithelial defect on fluorescein examination should be referred for same-day ophthalmological assessment

73
Q

What is dry eye syndrome?

A

Deficiency or dysfunction of the tear film that normally keeps the eyes moist and lubricated

74
Q

Dry eye syndrome is more common in which patient groups?

A

Females
Incidence increases with age

75
Q

In dry eye syndrome decreased tear production is most often caused by…

A

Most often age-related
Can also be due to systemic auto-immune diseases (e.g. Sjogren’s syndrome) or some medicines.

76
Q

In dry eye syndrome tear film dysfunction is most often caused by…

A

Blepharitis
Altered lid position (e.g. ectropion)
Decreased blink rate (e.g. intense concentration, Parkinson’s disease)
Incomplete lid closure
Environmental factors

77
Q

Sx of dry eye syndrome

A

Feeling of dryness, grittiness or mild pain in both eyes, which worsens throughout the day
Eyes water, esp when exposed to the wind.
Blinking or rubbing eyes relieves symptoms

78
Q

Signs of dry eye syndrome

A

Conjunctival injection is usually mild
Fluorescein staining typically shows punctate epithelial erosions, which occur due to desiccation on the lower part of the cornea where lid coverage is least. The erosions are very small and may not be seen without magnification.

79
Q

Treatment of dry eye syndrome

A

Eyelid hygiene
Artificial tears
Managing exacerbating factors, e.g. limiting use of contact lenses, avoiding smoking, taking frequent breaks when concentrating on a screen.
In some cases, punctal plugs are inserted into the lower or upper tear drainage canals of the eye, to reduce dryness.

80
Q

Complications of dry-eye syndrome include…

A

Conjunctivitis and keratitis

81
Q

If conjunctivitis is present in a newborn infant (aged ≤ 28 days), consider _________ as the cause, usually transmitted vaginally during birth

A

Chlamydia trachomatis or Neisseria gonorrhoeae

82
Q

Management of chlamydia/gonorrhoea conjunctivitis in newborn

A

Refer the infant urgently to a Paediatrician; do not apply topical treatment
If the diagnosis is confirmed, parents will also require testing and possible treatment

83
Q

Why is chlamydia/gonorrhoea conjunctivitis in newborns serious?

A

Gonorrhoea can result in a sight-threatening eye infection and chlamydia can be associated with the development of pneumonia in young infants

84
Q

Infants who present with a “sticky eye”, without conjunctival inflammation, are most likely to have…

A

Poor drainage of the lacrimal duct rather than conjunctivitis (does not require urgent assessment)

85
Q

Allergic conjunctivitis is caused by…

A

A local response to an allergen, e.g. pollen, preservatives in eye drops or contact lens solution.

86
Q

Typical presentation of allergic conjunctivitis

A

Swollen, itching eye(s), irritation
Mild photophobia
Watery or serous discharge

Symptoms are episodic in the case of seasonal allergies

87
Q

Signs on exam of allergic conjunctivitis

A

Eversion of the lids often reveals a “cobble-stone” appearance of the tarsal (eyelid) conjunctiva

88
Q

Treatment of allergic conjunctivitis

A

Avoid the allergen
Avoid rubbing the eyes
Apply a cool or warm compress to relieve symptoms
Use artificial tear eye drops if required.

Antihistamine eye drops, e.g. levocabastine, or a mast cell stabiliser (takes several weeks for full effect), e.g. lodoxamide or cromoglicate sodium.

Olopatadine eye drops combine antihistamine and mast cell stabilisation activity and are often effective

Oral antihistamine can be considered

89
Q

Patients with severe allergic conjunctivitis should have what done as part of work up

A

Visual acuity checked and a fluorescein examination, and then be referred to an Ophthalmologist for further assessment and possible initiation of topical corticosteroids

90
Q

_____________ are two severe forms of allergic eye disease affecting children and young adults respectively, and can be associated with large epithelial defects on the cornea (shield ulcers) that can lead to…

A

Vernal and atopic keratoconjunctivitis
Can lead to scarring, and also microbial keratitis

91
Q

Patients with a foreign body in their eye or a corneal abrasion typically present with…

A

Discomfort
Watery discharge
Pain associated with movement of the eye
Blurring of vision
Photophobia

92
Q

Causes of foreign body/corneal abraision

A

May be aware of the foreign body which has entered the eye or may have occurred unnoticed during an activity such as chiselling, hammering, grinding metal or mowing the lawn
Corneal abrasion can occur due to an accidental scratch, e.g. with a fingernail or while removing or inserting contact lenses, or by rubbing the eye, e.g. in the presence of a foreign body.

93
Q

If a penetrating injury is missed, and the eye is stained, a penetrating injury will be seen as ____________, although it may be difficult to see without a slit lamp

A

A dark stream (i.e. dye diluted by aqueous) in a pool of bright green (i.e. concentrated dye); this is known as the Siedel sign

94
Q

How to remove a foreign object from the eye

A

Apply topical analgesia
Remove by irrigating eye if possible
If unsuccessful - use a sterile cotton-tipped swab

95
Q

When to refer a patient to ophthalm post attempted removal of foreign body

A

If the object is embedded and cannot be removed
If after the object is removed there is a large abrasion, corneal opacity, rust ring (after removing a metal object), a distorted pupil or reduced visual acuity

96
Q

To prevent a secondary infection, in a patient with a corneal abrasion (including after removal of a foreign object) prescribe…

A

Chloramphenicol 0.5% eye drops, 1 drop, QID, for seven days (or ointment, depending on patient preference). Fusidic acid eye gel 1%, one drop, BD, for seven days is an alternative

97
Q

Management of corneal abrasion

A

Eye patch or dressing is not necessary.
Contact lenses should be avoided until the abrasion has healed and ideally, until abx treatment has finished.
Usually no need for prescription of anaesthetic drops; prolonged use can lead to corneal damage

98
Q

When to ideally f/up patient with corneal abrasion? And when to refer to ophthalm

A

Ideally reassess in 24 – 48 hours.
Refer for an ophthalmological assessment (or consider Optometrist triage) if the abrasion is not resolving, or if visual acuity deteriorates or pain increases

99
Q

What causes subconjunctival haemorrhage

A

Blunt trauma to the eye, coughing, sneezing or straining.
In some cases, it may be associated with atherosclerosis, bleeding disorders or hypertension

100
Q

Management of subconjunctival haemorrhage

A

Usually resolves without treatment in 1-2 weeks.
Use of artificial tears may relieve any discomfort.
Check BP and INR if on warfarin

101
Q

What is blepharitis

A

Chronic inflammation of the margin of the eyelids, which can present in patients as a “red eye”, with burning, pruritis and discharge

102
Q

Who is blepharitis more common in?

A

Older people
People with rosacea and seborrhoeic dermatitis

103
Q

What is blepharitis caused by

A

Dysfunctional secretions of the Meibomian glands leading to a chronic inflammatory state within the lid, and the resultant dysfunctional tear film leads to dry eye symptoms and signs

104
Q

What are Meibomian glands

A

Oil-secreting glands in the eyelid margin which help the tears to distribute evenly across the ocular surface and decrease tear evaporation

105
Q

Ddx to consider with blepharitis

A

Consider the possibility of squamous cell, basal cell or sebaceous cell carcinoma of the eyelid margin (marked eyelid asymmetry may indicate this), dermatitis or infection (e.g. impetigo)

106
Q

Clinical course of blepharitis

A

Treatment focuses on improving the Meibomian gland secretions, but is never curative and it should be explained to patients that management needs to be ongoing. As blepharitis is a chronic condition, relapses and exacerbations can be expected

107
Q

Treatment of blepharitis

A

Warm compress to the closed eyelids for five to ten minutes
Gently massage the eyelid margin with a circular motion
Clean the eyelid with a wet cloth or cotton bud and rub along the lid margins; use a solution of 1 part baby shampoo to 10 parts water for cleaning

Do the above BD until sx start to improve then once daily

Avoid make up esp eyeliner
Can use lubricating eye drops PRN

108
Q

If sx of blepharitis are particularly severe what can be considered as part of treatment?

A

Topical abx - chloramphenicol 0.5% eye drops, 1-2 drops, QID, for 7/7 (or up to 6/52 in chronic cases). Fusidic acid eye gel 1% is an alternative.
In some cases low dose doxycycline, may be considered if topical antibiotics have not resulted in an adequate response (for 6/52 but may be needed for up to 3/12)

109
Q

Complications of blepharitis

A

Does not permanently affect vision, as long as complications are adequately managed.
Increased risk of developing conjunctivitis and keratitis.
Long-term complications include loss of eyelashes (madarosis), misdirection of lashes towards the eye (trichiasis) and depigmentation of the lashes (poliosis)

110
Q

What is ectropion

A

Lower eyelids are lax/floppy and turn outwards, with the inner surface of the lid becoming exposed, swollen, and chronically red

111
Q

What is entropion

A

Eyelid (usually lower) folds inwards and causes the eyelashes to irritate the cornea

112
Q

Common causes of ectropion

A

Increasing age
Scarring of eyelid or cheek skin
Facial palsy
History of shingles causing corneal anaesthesia
Large eyelid tumours

113
Q

Common causes of entropion

A

Increasing age
Congenital (most common in Asian children)
Scarring of the conjunctiva

114
Q

Ectropion can result in

A

Epiphora (excessive tearing) – tears cannot reach lacrimal punctum.
Exposure keratopathy – lower lid does not reach the ocular surface, resulting in poor tear film coverage.

115
Q

Management ectropion

A

Frequent application of artificial tears and a topical lubricant ointment e.g. paraffin for symptomatic relief
If the cornea becomes exposed, or there is increasing pain despite lubricants, refer ophthalmology for consideration of surgical correction.

116
Q

Management entropion

A

Refer ophthalm semi urgent
Prescribe topical lubricant and consider taping the lid down for symptomatic relief while awaiting review.

117
Q

What is Pterygium

A

Wedge‑shaped growth of conjunctival tissue
Benign and relatively harmless
Can encroach onto corneal surface nasally and affect vision

118
Q

What is Pinguecula

A

Degenerative eye condition that is often confused with pterygium.
A yellowish, slightly raised conjunctival lesion.
Remains confined to the conjunctiva without corneal involvement.
Usually space between the pinguecula and the edge of the cornea.

119
Q

Pterygium is associated with

A

Chronic sun exposure

120
Q

Differentiating conjunctival neoplastic lesion (possible malignancy) from pterygium or pinguecula

A

Not always at the 3 o’clock or 9 o’clock position
Not triangular
Growth at limbus
Gelatinous and raised
Corkscrew vessels
Can be fast growing

121
Q

Management of pterygium or pinguecula

A

Lubricant drops PRN
NSAID drop may help chronic inflammation
Decrease UV exposure (reduce rate of progression)

122
Q

When to refer ophthalm with pterygium or pinguecula

A

Aypical appearance, fast growing, and/or suspected ocular surface neoplasia
Decreased vision due to pterygium, extension onto cornea of 3 mm or greater.
Edge of the lesion is at or beyond the edge of the pupil in normal room lighting.

123
Q
A

GPEP Ophthalmology (2 decks)

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