Red Eye 4 Flashcards
Endophthalmitis!
Inflammation of the internal tissue of the eye! ! About 70% of cases occur as a direct complication of intraocular Sx! ! Hypopyon with vision loss
Temporal arteritis!
Important cause of vision loss in the
elderly!
! Symptoms:!
! Sudden, unilateral loss of vision!
! Headache, scalp tenderness (temporally),
wt loss, malaise!
! Vision loss may result from arteritis or
associated central retinal artery occlusion!
! Elevated ESR
Often associated Polymyalgia
rheumatica (PMR) (Cecil, 1693-5)!
! Inflammatory disorders of unknown
etiology!
! Spectrum of proximal aches and pains!
! Shoulder > hips!
! Constitutional symptoms to an occlusive
granulomatous vasculitis of medium and large
vessels that can lead to permanent blindness!
! Occur solely in pts over 50, women > men,
Optic Neuritis
Papillitis
Painful monocular vision loss
! Optic disc swollen with vision loss and pain!
! Common finding in MS!
! Patient can’t see, Dr can see swollen disc!
! Inflammation between back of optic disc and the
area where the central retinal vein leaves the optic
nerve!
! Retrobulbar neuritis!
! Optic disc may or may not be swollen, with vision loss,
variable pn!
! Patient can’t see, Dr MAY see swollen disc!
! Inflammation in optic nerve behind where the central
retinal vein leaves the optic nerve
Causes of Neuritis
Demyelination ! Viral or bacterial infection! ! Sarcoid! ! Syphilis! ! Lyme disease
Papilledema!
Most commonly results from increased intracranial pressure! ! Need to rule out tumor! ! No change in visual acuity until late! ! Patient can see, Dr can see swollen disc! ! Space occupying lesion compresses the arachnoid granulation so decreases resorption of CSF, leading to increased CSF pressure (increased intracranial pressure)!
Central Retinal Artery
Occlusion
Sudden painless monocular loss of vision • May have history of previous transient episodes. “Amaurosis fugax”
• Retina infarction => pallor, edema, less transparency • Irreversible damage begins at 90 mins
• Macula, thinnest portion, chorea is visible thru retina • Cherry red spot may take 24 h to develop • Visual acuity may be normal if cilioretinal vessel patent
Causes of Central Retinal Artery Occlusion
Embolic (carotid, cardiac)! ! Thrombosis! ! Temporal arteritis! ! Vasculitis (eg. lupus)! ! Sickle cell disease! ! Trauma
Treatment of Central Retinal Artery Occlusion
Attempt moving embolus distally:! ! Digital massage ! ! Firm steady pressure x 15 seconds, release, repeat! ! IOP lowering drugs! ! Beta-blockers/CAI/alpha-agonists…! ! +/- Vasodilation techniques! ! Rebreathing to increase PaCO2!
Consult ophthalmology immediately! ! Paracentesis anterior chamber! ! thrombolytics! ! Locate source ! ! ESR for temporal arteritis! ! ECG for atrial. fib! ! Medicine consult (Carotid doppler, ECHO?…)!
How to Tap an Eye
Anterior Chamber Paracentesis
Anterior Chamber Paracentesis
1. Administer local anesthesia
2. Use a 30-gauge needle on a tuberculin syringe
3. Enter the eye at the limbus with bevel up
4. Ensure that the needle does not damage the lens
5. Withdraw fluid until the anterior chamber
shallows slightly (0.1-0.2 cc)
6. Administer a topical antibiotic post-procedure
Complications of Central Retinal Artery Occlusion!
Complications ! Vision loss! ! Prognosis poor in most! ! But up to 10% retain central vision! !(acuity improves to 20/50 or better in 80% of those)! ! Recurrent thromboemboli! ! CVA! ! Further visual loss to same or contralateral eye! ! Progression of temporal arteritis!
Case 2
PARTIAL LOSS, ONE EYE ! ! A 60 yo M with HTN and DM complains of progressive loss of vision in one eye over the last 2 days. ! ! No other symptoms! ! Painless uniform dulling of vision. ! ! Findings: ! ! (N) External eye and EOM! ! Acuity 20/25 OD, 20/200 OS! ! (N) Fundoscopy unaffected eye
Unmistakable fundoscopy:! ! “Blood and Thunder” or ! !“Ketchup fundus”! ! Dilated tortuous veins! ! Flame hemorrhages! ! Disc edema
Key Facts of Central Retinal Vein Occlusion
10 times more common than CRAO! ! Painless monocular loss of vision over hours to days! ! Vision may improve through the day! ! ? CRV impingement by lamina or atherosclerosis of CRA ! ! Ischemic vs. non-ischemic types
Risk Factos of Central Retinal Vein Occlusion
Age > 50! ! Diabetes! ! HTN! ! Hyperviscosity syndromes! ! Glaucoma! ! Recurrent amaurosis fugax
Non-Ischemic
Good vision! ! RAPD absent! ! Fewer retinal hemorrhages! ! Cotton-wool spots! ! May resolve fully or progress to ischemic type
! Severe visual loss!
! Extensive retinal
hemorrhage and
cotton-wool spots!
