Vision Loss
Painless
Sudden
Causes
Posterior Strauctures
Pathologies
Retinal Detachment
Vascular Occulusion
Vitreous Haemorrhage
Subretinal Haemorrhage
Cerebrovascular
Gradual
Causes
- Refractive Error
- Cataract
- Glaucoma
- Retinal Disease
- Tumour
- Myopia
Near sightedness
- Hypermetropia
Long sightednedd
- Astigmatism
- Presbyopia
Imperfection in the curvature of the eye causing blurred distance and near vision
Gradual loss of focusing power of lense with age
Opacification of the lens of the eye
- Primary Open Angle Glaucoma
Increased Intraocular pressure with no underlying condition
- Age Related Macular Degeneration
Degenerative chnge of the retinal pigment epithelium
- Hereditary retinal degeneration
Degeneration of photoreceptors
- Vitreous / subretinal haemorrhage
- Retinal Detachment
- Vascular occlusion
Procedures
Visual Acutity distance
Visual acuty near
Colour vision
Eye movement examination
Red reflex Assesment
Confrontational visual field assessment
Fundoscopy
Identified Diabetic Retinopathy
Anterior segment examination with slit lamp
Instillation of eye drops
Upper eyelid evertion
Humphrey field analysis
Removal of corneal foreign body
Subconjuctival injection
Goldmann tonometry (IOP check)
Meibomian cyst Excision
Cataract surgery
Squint surgery
Syringing of tear duct
Fluorescein angiography FFA
OCT Optical Coherence Tomography
A non-invasive diagnostic technique that renders an in vivo cross-sectional view of the retina.
OCT utilizes a concept known as interferometry to create a cross-sectional map of the retina that is accurate to within at least 10-15 microns
A technique for examining the circulation of the retina and choroid (parts of the fundus) using a fluorescent dye and a specialized camera
Trauma
Eyelid
Orbital Blow-Out Fracture
Complications of blunt trauma
Complications of penetrating traume
Management of intraocular foreign bodies
Chemical injries
Haematoma
Usually innocuous but exlude associated trauma to globe or orbit
Lid margin laceration
Must be sutured - epiphora - excessive lacrimation
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Canalicular laceration
Pathogenesis
- Herniation of Inf Rectus
- Herniation of orbital fat
- Trauma
- Orbital floor fracture
Signs
- Periocular ecchymosis
Investigations
- Oedema
Infraorbital nerve anaesth
Coronal CT
Best scan for bones
No role of X-rays
Hess Test
Tear drop sign
Surgical Treatment
No treatment in case of:
- No herniation of muscle
- No double vision
- Subciliary incision
- Periosteum elevated and entrapped orbital contentes
Medial Wall Fracture
Signs
Periorbital Subcutaneous emphysema
Opthalmoplegia - adduction and abduction
Anterior segment complications of blunt trauma
Hyphaema
Blood in the interior chamber
Between cornea and iris
Sphincter tear
Iridodialysis
Vossius ring
Cataract
Lens Subluxation
Angle recesssion
Blunt trauma
Symptoms
BLurry vision
Eye pain
Elevated IOP
Treatments
Timalol
Steroids
Contraindications
Asthma
Heart block
Normal
Round
Regular
Reacts to light
Evultion of the iris from its ??solution
Posterior segment complications of blunt trauma
Commotio retinae
Penetrating Trauma
Flat Anterior chamber
Uveal prolapse
Damage to lense and iris
Vitrous haemorrgae
Tractional retinal detachment
Endophthalmitis
Hypopyon
- Localisation with reference to radio-opaque marker
- Removal with magnet or by pars plana vitrectomy
Grading of severity
Grade I
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Duration of exposure
Amount
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Limbus regenerates cornea
Treatment
Surgical
Medical
Grade II
Grade III
Grade IV
Red Eye / Lids
Eye
Acute Angle Closure Glaucoma
Eyelids
Blepharitis
Causes
Infective bacterial - Staph
Treatment
Twice daily Lid hygiene
Clean with soapy water, apply warm compress
Artificial tears
Penetration of bowman's membrane leaves a scar
Allergic - eczema, rosacea, psorisis, dermatitis
Scleritis
Conjunctiva
Allergic Conjunctivitis
Bacterial Conjuctivitis
Risks
Kids
Treatment
Mast cell stabilisers
Topical antihistamines
Steroids drop / Inject steroids
Presentation
Red itchy eyes
Swollen lids
+/- Chemosis
Risk of cataract formation and glaucoma
Uveitis
Systemic causes
Syphilis
HIV
Sarcoma
Very Painful Eye condition
Very painful
History
Pain
Severity
Itch
Discharge
Purulent
Clear
Photophobia
Floaters
Blurred vision
Systemic Symptoms
Conjunctivitis
Bacterial conjunctivitis
Allergy / viral conjunctivitis
Uveitis
Posterior scleritis
Acute angle closure glaucoma
Keratitis / Uveitis (Iritis)
Vernal keratoconjunctivitis Sicca
Uveitis
Uveitis / Iritis
Ask about back pain
Ankylosing spondylitis
Conjunctivitis
Pain passing urine / joint pain
Reiters syndrome
Examination
- Visual Acuity
- Anterior Segment Exam
- Fundoscopy
Inflammation of the Lid Margin
Meibomianitis
Orbital Cellulitis
Primary Herpes Simplex
Herpes Zoster Ophthalmicus (HZO)
Stye
Subconjunctival Haemorrhage
Episcleritis
Keratitis
Corneal Abscess
Dendritic Ulcer
Iritis
Anterior Uveitis
Opthalmia Neonatorum
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
Fucithalmic Eye drops
Minocyclin
If chronic sever and not responding to topical tx
Topical Chloromycetin
If stye / cyst is developing
Infection of the soft tissues of the eye socket
Types
Preseptal / Periorbital cellulitus
Postseptal
An eyelid and skin infection in front of the orbital septum
An infection around the eyeball that involves tissues behind 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)
- 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
Treatment
IV Antibiotics
Complications
Abcess
Meningitis
Cavernous sinus thrombosis
Differential Diagnosis of Acute Red Eye
Painless
- Conjunctivitis
- Episcleritis
- Subconjunctival Haemorrhage
Painful
- Glaucoma
- Anterior Uveitis
- Scleritis
- Corneal abrasions or ulceration
- Keratitis
- Foreign body
- Traumatic or Chemical injury
Papillary Conjunctivitis
- 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
Treatment
Systemic valacyclovir 3x day
Topical acyclovir
Keratitis
Presentation
Red eye
Sore
Itchy
Purulent discharge
'Sticky eye'
Normal vision and clear cornea
Treatment
Swab - culture and sensitivity
Bacterial conjunctivitis is an infection of the eye's mucous membrane, the conjunctiva
Topical antibiotics
Choromycetin hourly for 2 days, then 4 times a day fro a week
- 20% of the population
- Moe common in atopic peope
Usually untreated
An inflammatory response of the conjunctiva to an allergen
Vernal Keratoconjunctivitis sicca
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 🕶
Mucoid discharge
Treatment
Topical Cyclosporine
Steroids
Topical mast cell stabilisers
Antihistamines
Subconjunctival Haemorrhage
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
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
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
An inflammation of the cornea
Presentation
Painful red eye
Photophobia 🕶
Blurred vision
Contact lense wearers - Ischaemia
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
Presentation
Painful red eye
Photophobia
Blurred vision
Treatment
Admit to ophthalmic unit
Intensive topical and systemic Antibiotics
Hypopyon
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
Inflammation of the iris
Presentation
Painfule red eye
Photophobia
Reduced vision
- Acute onset
- Keratitic precipitates
- Associated with Ank Spond
Treatment
Topical steroid
Mydriatic drops âš«
Complications
Cataracts
Glaucoma
Blindness
Acute or chronic tender eyelid abscesses due to inflammation of hair follicles
Meibomian cyst
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
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)