Week 2 - C Ophthamology 2 - (pre)Orbital cellulits, endopthalmitis, papilloedema etc Flashcards
Is orbital or preseptal cellulitis life threatening?
Orbital cellulitis is life threatening
In pre septal cellulitis, what is infected?
Infection of the eyelids and structures anterior to the septum (septum merges with tarsal plates)
What is a key factor in orbital cellulitis vs preseptal cellulitis? (movement of eye)
* In orbital cellulitis movement of the eye is associated with severe pain
* In preseptal cellulitis movement of the eye is not associated with pain
Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) must be absent in preseptal cellulitis - their presence would indicate orbital cellulitis
In a patient presenting with a rapid onset of temperature, per-ocular swelling and pain, What do you think?
Orbital cellulitis
Patient presents with diminished vision, extreme pain and temperature with eyeball proptosis, What is this?
Orbital cellulitis
Patient presents with eye lid swelling and redness, low grade fever and malaise. What is the diagnosis? A – Orbital cellulitis B – Orbital bruising C – Sinusitis D – Meniere’s syndrome E – Pre-septal cellulitis
E - Preseptal cellulitis
Usually no pain with eye movement but eyelid swelling is present
What type of scan do you take in orbital cellulitis to identify any orbital abscess from sinus?
CT scan
What are the most common types of causes of orbital cellultiits?
Streptococcus species,
staphylococcus species and
haemophilus influenza B
are the most common causative organisms
What is the most likely cause of orbital cellulitis?
Direct extension from the paranasal sinuses (particularly the ethmoidal air cells)
What is the treatment of pre-septal cellulitis?
Oral antibiotics are frequently sufficient - usually co-amoxiclav
What is the antibiotic treatment of orbital cellulitis?
Ceftriaxone IV 2g bd + Flucloxacillin IV 2g qds + Metronidazole IV 500mg tds
• Devastating infection inside of the eye • Post-surgical or endogenous • Painful +++, with decreasing vision • Very red eye • Sight threatening What is this?
This is endophthalmitis
What surgery most commonly can cause endophthalmitis as it gives opportunity for conjunctival commensals to enter the inner eye? What is the main commensal which is the main cause of endophthalmitis?
Cataract surgery is the most common surgery
Main cause of endophthalmitis is staph epidermis
What is the treatment of endophthalmitis?
Intravitreal amikacin and vancomycin or Intraviteral ceftazidime and vancomycin
What type of drug is amikacin and what type of drug is vancomycin?
Amikacin - aminoglycoside
Vancomycin - glycopeptide
Name one other glycopeptide apart from vancomycin
Teicoplanin
Toxoplasmosis chorioretinitis (more commonly known as toxoplasmosis) is caused by what organism?
Caused by toxoplasmosis gondii
Undercooked meat or cat faeces
Usually the immune system can deal with toxoplasmosis but it can affect the immunocompromised What other condition can chorioretinitis be associated with in AIDS?
Assoicating with Cytomegalovirus (CMV)
What is inflammation of the lacrimal sac known as?
This is known as dacrocystitis
What is the usual cause of dacrocystitis?
Nasolacrimal duct obstruction
What may dacrocytitis predispose to?
May predispose to orbital cellulitis
Which Le Fort fracture may interrupt the nasolacrimal duct?
Le Fort fracture 1 may interrupt the nasolacrimal duct by damaging the opening into the inferior meatus
If there is a nasolacrimal duct obstruction, this may cause the infection to gather at the corner of the eye This could cause a swelling What is this dacrocystitis known as here?
Canaliculitis - where the infection is at the canaliculi
What is optic nerve swelling due to raised intracranial pressure known as?
this is papilloedema
• All patients with bilateral optic disc swelling should be suspected of having raised ICP should be suspected of what? When looking with ophthalmoscopy, what do you see on the fundus in papilloedema?
Suspected of a space occupying lesion (SOL)
Swollen optic disc, not well circumscribed with undefined margins
Loss of major vessels coming from the disc
Subarachnoid space (SAS) around optic nerve (ON) continuous with subarachnoid space surrounding the brain When intracranial pressure increases, this is transmitted to the SAS then to the ON What are symptoms of papilloedema?
Patient presents with blurred vision, loss of colour vision and headaches
Cranial nerve II is assessed with a fundoscopy as one of the examination ways How else is it assessed?
Visual acquity - snellen chart
Pupil reflex - direct, accomodation and swinging light reflex
Visual fields - all 4 quadrants
Colour vision - using ischira plates
Why must blood pressure be checked in somebody presenting with papilloedema?
As papilloedema can be caused due to malignant hypertension
