Please enable JavaScript.

Coggle requires JavaScript to display documents.

Oppenmology :bomb:, Penetration of bowman's membrane leaves a scar -…

- - - - Usually innocuous but exlude associated trauma to globe or orbit
    - - Must be sutured - epiphora - excessive lacrimation
  - - - Herniation of Inf Rectus
      - Herniation of orbital fat
      - Trauma
      - Orbital floor fracture
    - - Periocular ecchymosis
      - Oedema
      - Infraorbital nerve anaesth
    - - Coronal CT
        Best scan for bones
        
        Tear drop sign
      - No role of X-rays
      - Hess Test
    - - No treatment in case of:
        
        No herniation of muscle
        
        No double vision
      - Subciliary incision
      - Periosteum elevated and entrapped orbital contentes
    - - Signs
        
        Periorbital Subcutaneous emphysema
        
        Opthalmoplegia - adduction and abduction
  - - - Hyphaema
        Blood in the interior chamber
        Between cornea and iris
        
        Blunt trauma
        
        Symptoms
        
        BLurry vision
        
        Eye pain
        
        Elevated IOP
        
        Treatments
        
        Timalol
        
        Contraindications
        
        Asthma
        
        Heart block
        
        Steroids
      - Sphincter tear
        
        Normal
        
        Round
        Regular
        Reacts to light
      - Iridodialysis
        
        Evultion of the iris from its ??solution
      - Vossius ring
      - Cataract
      - Lens Subluxation
      - Angle recesssion
    - - Commotio retinae
    - - Flat Anterior chamber
      - Uveal prolapse
      - Damage to lense and iris
      - Vitrous haemorrgae
      - Tractional retinal detachment
      - Endophthalmitis
        
        Hypopyon
  - - - Grade I
      - Grade II
      - Grade III
      - Grade IV
    - - Duration of exposure
      - Amount
    - - Surgical
      - Medical
- - - - Very Painful Eye condition
    - - Inflammtion of the sclera of the eye
      - Presentation
        
        Extremely painful
        
        red
      - Investigations
        
        Rule out systemic causes
      - Types
        
        Necrotising
        
        Thinning of the sclera
        
        RA patients
        
        Treat with immunosuppression
        
        Non-necrotising
        
        Treat with Systemic Indomethacin
    - - Systemic causes
        
        Syphilis
        
        HIV
        
        Sarcoma
      - Very painful
    - - Inflammation of the tissue lying between the sclera and the conjunctiva
      - Presentation
        
        Red eye
        
        Painless
        
        No discharge
      - Associated with systemic / rheumatological conditions:
        RA / Lupus
        
        May be sectorial or diffuse
      - Treatment
        
        Topical steroids
        
        NSAIDS
    - - An inflammation of the cornea
      - Presentation
        
        Painful red eye
        
        Photophobia :dark_sunglasses:
        
        Blurred vision
      - Contact lense wearers - Ischaemia
    - - Presentation
        
        Painful red eye
        
        Photophobia
        
        Blurred vision
      - Treatment
        
        Admit to ophthalmic unit
        
        Intensive topical and systemic Antibiotics
    - - Occurs when the virus affects the cornea
      - Dentritic shaped ulcer when cornea is stained
      - Presentation
        
        Red painful eye
        
        Photophobia
        
        Blurred vision
      - Cause
        
        Herpes simplex infection
      - Treatment
        
        Topical Acyclovir 5 times a day
        
        Never givesteroids
        Ulcer may rapidly progress and ulcerate the whole cornea - blindness
    - - Inflammation of the iris
      - Presentation
        
        Painfule red eye
        
        Photophobia
        
        Reduced vision
      - Acute onset
        
        Keratitic precipitates
        
        Associated with Ank Spond
      - Treatment
        
        Topical steroid
        
        Mydriatic drops :black_circle:
      - Complications
        
        Cataracts
        
        Glaucoma
        
        Blindness
    - - An accumulation of WBCs (pus) in the lower portion of the anterior chamber
      - Presentation
        
        Yellowish exudate in lower part of anterio chamber
      - Contact lense users
        
        Ask about back pain - ank spond
  - - - Causes
        
        Infective bacterial - Staph
        
        Allergic - eczema, rosacea, psorisis, dermatitis
      - Treatment
        
        Twice daily Lid hygiene
        Clean with soapy water, apply warm compress
        
        Artificial tears
        
        Fucithalmic Eye drops
        
        Minocyclin
        If chronic sever and not responding to topical tx
        
        Topical Chloromycetin
        If stye / cyst is developing
      - Inflammation of the Lid Margin
      - Presentation
        
        Itchy
        
        Sore
        
        Watery eyes
        
        Red-rimmed lid margins
        
        Eyelash Crusts
        
        Distorted lid margins
    - - Inflammation of the meibomian glands (oil releasing glands in the eyelids
      - Presentation
        
        Stingy sore eyes
        
        Red thickened
      - Complications
        
        Meibomian Cysts
    - - Infection of the soft tissues of the eye socket
      - Types
        
        Preseptal / Periorbital cellulitus
        
        An eyelid and skin infection in front of the orbital septum
        
        Can spread posterior to orbital septum
        
        80% children
        
        More common in winter
        
        Presentation
        
        Swollen and tender eyelids
        
        White eye
        
        Eye moves fully with no impairement of vision
        
        No proptosis (protrusion)
        
        Postseptal
        
        An infection around the eyeball that involves tissues behind the orbital septum
        
        Potentially life threatening
        
        Associated with URTI and undiagnosed sinus infection from H. Influenza or Strep / staph
        
        Get ENT opinion
        
        Urgent admission
        
        Presentation
        
        Painful orbital / eyelid swelling
        
        Red and swollen conjunctiva
        
        Proptosis (Eye protrusion)
        
        Unwell and feverish
        
        May not be able to open the eye
        
        Vision may be affected
        
        Investigations
        
        Blood cultures
        
        CT scan
        Outrule abscess
        
        Complications
        
        Abcess
        
        Meningitis
        
        Cavernous sinus thrombosis
      - Treatment
        
        IV Antibiotics
      - DDxx
        
        Orbital cellulitis can be distinguished from preseptal cellulitis by the presence of the following clinical features:
        
        Restricted or painful eye movements
        
        ↓ visual acuity
        
        Diplopia
        
        Proptosis (bulging)
        
        Presence of a relative afferent pupillary defect (swinging flash test)
    - - 85-90% people get in childhood
        
        May have nonspecific symptoms
        
        Can cause secondary conjuctivitis
      - Presentation
        
        Vesicles
        
        Red eye
      - Treatment
        
        Topical Acyclovir ointment 5x day
      - Investigations
        
        Stain cornea with fluorescein to look for dentritic ulcer
        Refer to ophth if corneal involvement
    - - The viral involvement of the ophthalmic division (V1) of the trigeminal cranial nerve (V)
      - Presentation
        
        Segmental skin vesicles
        
        Erythema of the upper eyelid
      - Complications
        
        Uveitis
        
        Conjunctivitis
        
        Scleritis
        
        Optic neuritis
        
        Cranial nerve palsies
        
        Encephalitis
        
        Keratitis
      - Treatment
        
        Systemic valacyclovir 3x day
        
        Topical acyclovir
    - - Acute or chronic tender eyelid abscesses due to inflammation of hair follicles
    - - Oily secretions from the glands become too thick and can result in blockage
      - Treatment
        
        G chloromycetin drops hourly x3 days then QDS for 1/52
        
        Hot compresses
        
        Surgery if no improvement
  - - - Risks
        
        Kids
      - Treatment
        
        Mast cell stabilisers
        
        Topical antihistamines
        
        Steroids drop / Inject steroids
        
        Risk of cataract formation and glaucoma
        
        Usually untreated
      - Presentation
        
        Red itchy eyes
        
        Swollen lids
        
        +/- Chemosis
      - 20% of the population
        
        Moe common in atopic peope
      - An inflammatory response of the conjunctiva to an allergen
    - - Presentation
        
        Red eye
        
        Sore
        
        Itchy
        
        Purulent discharge
        
        'Sticky eye'
        
        Normal vision and clear cornea
      - Treatment
        
        Swab - culture and sensitivity
        
        Topical antibiotics
        Choromycetin hourly for 2 days, then 4 times a day fro a week
      - Bacterial conjunctivitis is an infection of the eye's mucous membrane, the conjunctiva
    - - Inflammation of the conjunctiva and the cornea caused by dryness resulting from a deficiency or disorder of the tear film
      - Children, boys
        
        Common in actopic patients
        
        Refer to ophth
        
        Giant papillae scrape cornea - ulceration and scarring
      - Presentation
        
        Red eyes
        
        Itchy
        
        Giant papillae on everted eyelid
        
        Photophobia :dark_sunglasses:
        
        Mucoid discharge
      - Treatment
        
        Topical Cyclosporine
        
        Steroids
        
        Topical mast cell stabilisers
        
        Antihistamines
    - - Bleeding under conjunctiva due to ruptured blood vessel
      - Causes
        
        Sponataneous
        
        Trauma
        
        Hypertention
        
        Dibetes
      - Investigations
        
        Blood pressure
        
        Fasting blood glucose
      - Bilateral in female patients - suspect bulemia
  - - - Severity
    - - Conjunctivitis
    - - Purulent
        
        Bacterial conjunctivitis
      - Clear
        
        Allergy / viral conjunctivitis
    - - Keratitis / Uveitis (Iritis)
      - Vernal keratoconjunctivitis Sicca
    - - Uveitis
    - - Uveitis
      - Posterior scleritis
      - Acute angle closure glaucoma
    - - Uveitis / Iritis
        
        Ask about back pain
        Ankylosing spondylitis
      - Conjunctivitis
        
        Pain passing urine / joint pain
        Reiters syndrome
  - - - Conjunctivitis
      - Episcleritis
      - Subconjunctival Haemorrhage
    - - Glaucoma
      - Anterior Uveitis
      - Scleritis
      - Corneal abrasions or ulceration
      - Keratitis
      - Foreign body
      - Traumatic or Chemical injury
- - - - Causes
        
        Posterior Strauctures
        
        Vitreous / subretinal haemorrhage
        
        Retinal Detachment
        
        Vascular occlusion
      - Pathologies
        
        Retinal Detachment
        
        Vascular Occulusion
        
        Vitreous Haemorrhage
        
        Subretinal Haemorrhage
        
        Cerebrovascular
    - - Causes
        
        Refractive Error
        
        Myopia
        
        Near sightedness
        
        Hypermetropia
        
        Long sightednedd
        
        Astigmatism
        
        Imperfection in the curvature of the eye causing blurred distance and near vision
        
        Presbyopia
        
        Gradual loss of focusing power of lense with age
        
        Cataract
        
        Opacification of the lens of the eye
        
        Glaucoma
        
        Primary Open Angle Glaucoma
        
        Increased Intraocular pressure with no underlying condition
        
        Retinal Disease
        
        Age Related Macular Degeneration
        
        Degenerative chnge of the retinal pigment epithelium
        
        Hereditary retinal degeneration
        
        Degeneration of photoreceptors
        
        Tumour