Treatment/advice Flashcards
GPC
Replace damaged contact lens Reduce wearing time Optimum hygiene 2-4 week protein removal Different lens edge design Different lens material
Topical mast cell stabilisers can help
Interstitial keratitis
What is is?
Cause?
Tx?
Stromal inflammation without epithelial loss
Red/watery/photophobia /reduced VA if visual axis crossed
Cause..Immune reaction to trapped antigens in eye
Tx…topical steroids
Chlamydial conjunctivitis
Signs?
Referral/tx?
Follicles, more in inferior than superior fornix
Superficial punctuate keratitis
Can have irregular subepithelial infiltrates after several weeks
Systemic antibiotics..GP?
Referral to sexual health clinic..
Bacterial keratitis
Tx?
Corneal scrape, antibiotics, cycloplegia..pain
Dacryocystitis
Can be acute or chronic
Unilateral red eye, tearing, blurred vision, discharge, abyss of lacrimal sac
Chloramphenicol
Systemic antibiotics
Dacryoadneitis
Inflammation of lacrimal sac
Acute allergic conjunctivitis
Tx?
Cold compresses
Topical and systemic mast cell stabilisers
Topical antihistamines
Endophthalmitis
Tx?
Same day
Vitreous can be removed
Bell’s palsy
Tx?
Can be associated with latent virus
Most improvement seen in first 3 weeks
Photokeratitis
Painkillers Don’t pad eye Cold compresses Sunglasses Rest with eyes closed Should self resolve 24-48 hours
Review next day
Mild photophobia and blurring may last 1 week
BRVO/CRVO
Tx?
Laser photocoagulation
Steroids
Anti Vegf if CMO
CRAO
Tx?
Ocular massage
Co2 brown paper bag
AION arteritic
Tx?
Steroids, aspirin
HZO
Signs?
Hutchinson’s tip of nose…may indicate ocular involvement
Antivirals, topical steroids
Avoid elderly/children/those with depressed immune system
HSV
Tx?
Antivirals, topical steroids
Bacterial conjunctivitis
Tx?
Can self resolve
Hygiene
Chloramphenicol
Anterior uveitis
Tx.
Cyclopentolate
Topical steroids
Pre-septal cellulitis
Tx
Antibiotics oral
Adenovirus also conjunctivitis
Tx
Artificial tears Cold compresses Review 5-7 days for keratitis Hygiene Time off work 2 weeks
Refer if severe pain/visual loss but inform hospital
Allergic conjunctivitis
Tx
Cold compresses
Topical antihistamines effective in combination with vasoconstrictors
Mast cell stabilisers
Avoid allergen
Marginal keratitis
Signs
Tx
Flat or elevated Infiltrates smaller than 1.5mm just inside limbus usually 4 and 8 o clock, islands (gao btw)
Pannus possible
Refer if not sure..concerned
Topical steroids
Lid scrubs
Topical antibiotics to lid margins
Acanthoemba
Tx
Refer
Tell ox to bring cl case
Angle closure
Tx
Pilocarpine (miotic)
What defence mechanisms does cornea have?
UV
Tight cell junctions epithelium, epithelium expresses immune receptors Bowman layer and descemets membrane act as barrier
Epithelial cell quick turnover displace bacteria
Tears…immunoglobulin A and lactoferrung
P E D A L?
Pain Epithelial defect Discharge Anterior chamber reaction Location
What causes RRD and what does it stand for?
rhegmatogenous retinal detachment
Fluid from vitreous enters the space between the RPE and neurosensory retina through a hole or tear
Usually occurs superior temporally
What is exudatitive detachment?
Fluid from choroid seeps sub retina through damaged RPE or blood retinal barrier
Cause choiroidal malignant melanoma or subretinal neovascular membrane
Wet AMD tx options
VA criteria
Ranibizumab/lucentis
Aflibercept/ eyelea
PDT
Verteportin/visudyne (takes up by CNVM) and then low power laser
6/12 to 6/96
What causes AMD
Oxidative stress
Accumulation of metabolic debris and lipofusin
What questions with visual field loss?
How rapidly was the vision lost? How long did the vision loss last for? What was the extent of the vision loss? How did the vision loss appear to You? Was it in one eye or both?
What anterior conditions have pain?
Corneal infection
Acute anterior uveitis
Acute angle closure haemorrhage
What could be the causes of a red eye with no ocular pain or discomfort?
Conjunctivitis
Sub conjunctival haemorrhage
Episcleritis
Which has conjunctivitis has papillae which have follicles?
Papillae
Bacterial
GPC
Follicles
Viral
Pupils in
Angle closure
Anterior uveitis
Fixed mid dilated
Miotic
What questions to ask with red eye?
When was the onset of the symptoms? Any pain? Other sensations? Vision loss? Haloes/photophobia? History of trauma? Cl wearer? Discharge? Previous history of similar?
What questions to ask with floaters? flashes
Are they new or have they always been there?
What do the look like?
How many are there?
When do you notice them?
How long do they last?
Optic neuritis What does the nerve look like in the following Neuroretinitis? Papillitis? Retrobulbar neuritis?
Swollen, hyperamic also star shaped hard exudates around macula
Swollen, hyperaemic
Normal/pale
Why is papilloedema different to optic neuritis?
BES as due to raised intracranial pressure
What does no RAPD indicate?
Severe optic nerve disease
Severe retinal disease
What does LIPCOF stand for
Lid parallel conjunctival folds
What is normal tear meniscus nd breaks up time
0.2mm or more
10 sec
