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Ophth - Coggle Diagram

- - - - Micoraneurysms
      - Dot haemorrhages
      - Hard exudtaes
      - Cotton wool spots
    - - Deep haemorrhage
      - Venous changes
      - Irma - Intraretinal microvascular abnormalities
    - - Proliferation of new vessels
        Optic disc
        Elsewhere
      - Vitreous haemorrhage
    - - Maculopathy - clinically significant macular oedeama
      - Exudate / oedema which threatens foveo and therfore central vision
  - - - Flourescein angiographiy
        
        Generally not required
        
        Assess ischaemia
        
        Localising leakage
        
        Photography for documentation
      - Dilated fundus photogarphy
  - - - Absorption of high energy light by rpe produces thermal burn to RPE and retins
      - Maculopathy - closure of leaking vessels
      - Proliferative disease - distry ischaemic retina, decrease angiogenic growth factors
      - Types
        
        Focal
        
        Grid
        
        Panretinal photocoagulation
      - Side effects
        
        Inadvertent foveal burn
        
        Central field defects
        
        Burn spreas
        
        PRP
        
        Loss of field, night vision,driving license
        
        Macular oedema
        
        Pain
- - - - Persistent hyperlastic primary vitreous
      - Coats disease
      - Posterior pole toxocara granuloma
      - Retinoblastoma
    - - Advanced retinopathy of prematurity
    - - Congenital cataract
      - Inflammatory cyclitic membrane
  - - - Unilateral
      - Leukocoria
      - Decreased vision
      - Stabismus
      - Retinal findings
  - - - Leukocoria
      - Nystagmus
      - Strabismus
      - Poor visual tracking in infants
    - - Ophthalmic exam
        
        Lens opacity
      - Red reflex test
        
        Abscent / assymetry
      - US
        
        Evaluate posterior segment if fundusis obscured
      - Genetic testing
        
        Hereditary
        
        Syndrome cause - Down's
      - Lab test
        
        TORCH screen
    - - Surgical
        
        Cataract extraction without intraocular lens implantation - aloow eye to grow
      - Medical
        
        Monitoring
        
        Corrective lenses
- - - - Definition
        
        Collection of blood soft tissue of eyelid
      - Aetiology
        
        Orbital roof fracture
        
        Subconjuctival haemorrhage without visible posterior limit
        
        Basal skull fracture
        
        Bilateral ring haematomas - panda eyes sign
        
        Management
        
        CT of basal skull area
        
        Check for CSF leak
      - Usually innocuous but xclude axx trauma to globe or orbit
    - - Aetiology
        
        Glass injury
        
        Child : dog or glass injury
      - Treatment
        Surgery
        
        Align with 6-0 black silk suture
        Carfully align to avoid notching
        
        Close tarsal plate with fine absorbale suture
        
        Place additional silk sutures
        
        $. Close skin with multiple interrupted 9-0 black silk sutur
      - Definition
        
        Laceration through the portion of the upper or lower lid medial to the punctum often damages the lacrimal duct or the medial canthal ligament
    - - Definition
        
        A canalicular laceration is a tear or cut in the lacrimal canaliculi, which are small ducts that drain tears from the eyes to the nose
      - Treatment
        
        Surgical repair within 24hr or will be very difficult to locate distal part of cannulicus
        
        Locate and approximate ends of laceration
        
        Bridge defect with silicone tubing
        
        Leave in situ for 3 mnths
  - - - Epidemiology
        
        Commone presenttation to MaxFax
      - Aetiology
        
        Blunt object such as tennis / foot ball
      - Pathology
        
        To protect the eye the floor bone is very thin - prevents globe rupture
      - Muscle entrapped
        
        Inferior rectus
      - Signs
        
        Periocular ecchymosis and oedema
        Around eye bleeding / swelling
        
        Infraorbital nerve anaethesis if bruised
        Loss of sensation cheeks/gums
        
        Ophthalmoplegia and vertical dipliopia
        Limitation in movement
        
        Enophthalmos
        Posterior displacement of eyeball
      - Investigations
        
        Coronal CT
        
        Right blow out fracture with tear drop sign
        
        May see fluid level of blood in sinus
        
        Hess Test
        
        Diaphragmatic test allowing to see if muscles improve over time
        
        Restriction of right upgaze and dowgaze
        
        Secondary overation of left eye
      - Treatment
        
        Surgery
        
        Subciliary incision
        
        Periosteum elevated and entrapped orbital contents freed
        
        Defect repair with synthetic material
        
        Periosteum sutured
        
        CT following repair
    - - Epidemiology
        
        Less common
      - Muscle entrapped
        
        Medial Rectus
      - Signs
        
        Periorbital subcutaneous emphysema (trapped air) due to connection of orbit to ethmoidal sunus and nose
        
        2.Ophthalmoplegia and horizontal diplopia
        Adductionand abduction if medial rectus muscle is entrapped
      - Treatment
        
        Release of entrapped tissue
        
        REpair of bony defect
  - - - Anterior Segment
        CHIRAL
        
        Cataract
        
        Hyphema
        
        Bleeding in the anterior chamber of the eye between the iris and the cornea
        
        Iris
        
        Sphincter tear
        
        Iridodialysis
        
        Vossius ring
        
        Rupture of globe
        
        Angle recession
        
        Lens subluxation
        
        Displacement of normal location
      - Posterior Segement
        CCAMEO
        
        Commotio retinae
        
        Retinal bruising
        
        Choroidal rupture and haemorrhage
        
        Avulsion of vitreous base and retinal dialysis
        
        Macular hole
        
        Equatoral tears
        
        Optic neuropathy
    - - Ophthalmic Emergency
      - Flant anterior chamber
      - Damage to lens and iris
      - Uveal prolapse
      - Vitreous haemorrhage
      - Endophthalmitis
        
        Inflammation of interior eye
      - Tractional retinal detachment
      - Epidemiology
        
        RTA
        
        Hammer / contruction equipment
      - Management
        
        Localise with reference to radio-opaque marker
        
        Removal with magnet or by pars plana vitrectomy
  - - - Grade I
        Exellent prognosis
        
        Clear cornea
        
        Limbal ischaemia - nil
      - Grade II
        Goog prognosis
        
        Cornea hazy but visible
        
        Iris details
        
        Limbal ischaemia <1/3
      - Grade III
        Gaurded prognosis
        
        No iris detail
        
        Limbal ischaemia 1/3 - 1/2
      - Grade IV
        Very poor Prognosis
        
        Opaque cornea
        
        Limbal ischaemia >1/2
    - - Medical Treatment
        
        Copious irrigation
        
        Restore pH
        
        15-20 min
        
        Topical steroids
        
        7-10 days
        
        Reduce inflammation
        
        Topical and systemic ascorbic acid
        
        Enhance collagen production
        
        Topical citric acid
        
        Inhibit neutrophil activity
        
        Topical and systemic tetracycline
        
        Inhibit collagenase and neutrophil activity
      - Surgical
        
        Division of conjunctival bancds
        
        Correction of eyelid deformities
        
        Treatment of corneal opacity by keratoplasty or kratoprosthesis
- - - - Non Vascular
        
        Posterior vitrous detatchment
        
        Retinal detatchment
        
        Vitrous haemorrhage
      - Vascular
        
        CEntral / Branch retinal vein occlusion
        
        Central / branch retinal artery occclusion
        
        Amaurosis Fugax
        
        Ischaemic optic neuropathy
        
        Cerebral vascular accident
        
        Acephalgic Migraine
    - - Giant cell arteritis
      - Optic neuritis
      - Retrobulbar neuritis
      - Benign / idiopathuc intracranial hypertension
      - Acute angle closure glaucoma
      - Migraine
      - Haemorrhage ass pituitary tumour
  - - - Myopia
        
        Short sighted
      - Hypermetropia
        
        Long sited
      - Astigmatism
        
        Refractive error in 1 plane
      - Presbyopia
        
        Insufficiency of accommodation associated with the aging of the eye
      - Emmetropia
        
        Normal vision
      - Treatment
        
        Prescription glasses
    - - Definition
        
        Any opacity in the crystalline lens
      - Presentation
        
        Symptoms GGMM
        
        Gradual onset of difficulty with daily visual function (g driving)
        
        Aquired myopia Frequent spectacle changes
        
        Glare when looking at lights
        
        Monocular diplopia
        
        Signs RR PP
        
        Reduced visual acuity
        
        Altered red reflex
        
        No change to pupil response
        
        Improves with Pinhole
      - Epidemiology
        
        Leading cause of treatable blindness
        
        75% >65 yrs
        
        20% between 45-64
      - Aetiology
        
        Senile / age related
        
        Congenital
        
        Idiopathic
        
        Inherited
        
        Systemic disease
        
        Metabolic
        
        Diabetes
        
        Galactosaemia
        
        Hypocalcaemia
        
        Infection
        
        TORCHeS -especially rubella
        
        Pre-senile
        
        Systemic
        
        Diabetes
        
        Steroids
        
        Phenothiazines
        
        Heavy metals
        
        Myotonic dystrophy
        
        Eye Disease
        
        Inflammation
        
        Trauma
        
        Radiation
        
        IR exposure
        
        Electric shock
      - Children
        
        Refere immediately due to risk of:
        
        Amblyopia
        
        Loss of binocular function
        
        Squint
      - Management
        
        Complications
        
        Endophathalmitis
        Endophthalmitis is inflammation of the interior cavity of the eye
        
        Blinding operation
        
        Hemorrhage, ruptured posterior capsule during surgery, dropping lens
        
        Cataract surgery: Phacoemulsification and IOL
    - - Presentation
        
        Symptoms
        
        Ocular pain
        
        Awareness of visual field loss
        
        Usually Asymptomatic
        
        Signs
        
        Criteria for diagnsis: 2 of following
        
        Raised IOP > 21mmHg
        
        Cupping of optic disc
        cup-disk ratio greater than 0.5
        
        Glaucomatous field defect
        
        Open angle on gionscopy
      - Investigations
        
        Goldman tonometer
        
        Measures IOP
        
        Fundoscopy
        
        Investigates cupping
        
        Visual Field
        
        Measures visual field loss
      - Definition
        
        Glaucoma refers to the optic nerve damage caused by a rise in intraocular pressure
      - Risk Factors
        
        Ocular
        
        High myopia
        
        Retinal detachment
        
        Retinitis pigmentosa
        
        Fuchs' endothelial dystrophy
        
        Systemic
        
        Diabetes mellitus
        
        Drugs
        
        Steroids
        
        FHx
        
        Primary relatives
      - Treatment
        
        Medical
        
        Beta blockers
        
        MOA
        
        Prevents activation of Sympathetic receptors on ciliary epithelium
        
        Reduces aqueous production and IOP
        
        Drugs
        
        Non selective:
        Timolol
        Levobunolol
        Carteolol
        
        Selective B1: Betaxolol
        
        Sympathoimetics
        
        MOA
        
        Reducs aqueous humour production
        
        Increases uveoscleral outflow
        
        Brimonidine tartrate 0.2%
        
        Prostaglandin analogue
        
        Latanoprost
        
        MOA
        
        Increases Uveoscleral outflow
        
        Miotics
        
        Pilocarpine
        
        MOA
        
        Increases uveoscleral outflow
        
        Muscarinic receptors on sphinter muscles of iris causing contriction + ciliary muscle constriction
        Opens angle more allowing drainage
        Pupil contriction → Parasympathetic action
        Miotic agent
    - - Age related macular degeneration (ARMD)
        
        Presentation
        
        Often bilateral
        
        May be asymmetrical
        
        Gradual loss of central vision
        
        Disorted vision (of straight liens) - metamorphopsia
        
        Drusen
        yellowish deposits of proteins and lipids between the retinal pigment epithelium and Bruch’s membrane
        
        Pathophysiology
        
        Degenerative change of the retinal pigment epithelium - supports meatbolic functions of photoreceptors
        
        Types
        
        Dry ARMD
        
        Drusen: fluffy white spots around the macula
        
        Degeneration of macula
        
        Slow visual decline over 1-2 yrs
        
        Geographic Atrophy
        
        Wet / Exudative ARMD
        
        Subretinal Neovascularisation
        
        Aberrant vessels grow into retina from choroid and haemorrhage
        
        Rapid visual decline
        
        Fundoscopy shows haemorrhage or scarring
        
        Amsler grid detects distortion
        
        Metamorphopsia
        
        Requires urge clinical attention
        
        Invx with fluorescin angiography
        
        Risk Factors
        
        Smoking
        
        Age
        
        Genetics
      - Hereditary Retinal degeneration
        
        Definition
        
        Characterised by photoreceptor degeneration -
        
        Types
        
        Rod photoreceptor degeneration - retinitis pigmentosa
        
        Various inheritence patterns and variable severity
        
        Light intolerance
        
        Night blindness
        
        Cone Photoreceptor Degeneration
        
        Affects visual acuity and colour vision
    - - Diagnose and treat reversible causes
        Monitor
      - Good lighting
      - Low vision aids
      - Registration as partiall-sighted or blind
      - Special ed and training
      - Organisations and Support Groups
      - Genetic Counselling
- - - - Most common primary malignant intraocular tumour of childhoos
      - Presents before 3yrs old
      - 40% heritablle
        60^ non heritable
      - Gene : RPE1 on 13q14
    - - Leukocoria - 60%
      - Strasbismus
      - Secondary glaucoma
      - Anterior segment invasion
      - Orbital inflammation / invasion
      - Unilateral or bilateral vision loss
      - Bulging of one eye (unilateral retinoblastoma)
      - Red and painful eye
    - - CT
        
        Asses optic nerve involvment
        
        Orbital and CNS extention
        
        Pinealoblastoma
      - Bloods - RB1 gene mutation
      - Imaging
        
        Funus photography
        
        Ultrasound imaging
    - - Small tumours
        
        Laser photocoagulation
        
        Transpupillary thermotherapy
        
        Cryotherapy
      - Medium tumours
        
        Brachytherapy
        
        Chemotherapy
        
        External beam radiotherapy
      - Large tumous
        
        Chemo followed by local treatmetn
        
        Enucleation
      - Extraocular extension
        
        External beam radiotherapy
      - Metastatic disease
        
        Chemo
      - Complications
        
        Sensorineural hearing loss from chemotherapy
        
        Retinoblastoma recurrence
        
        Retinal detachment post cryotherapy
        
        Retinopathy post radiation
      - Images
    - - Optic nerve involvement
      - Choroidal invasion
      - Large tumour
      - Anterior location
      - Poor cellular differentiation
      - Older children
    - - Cataracts
      - Retinopathy of prematurity
      - Vitreous haemorrhage
      - Other retinal tumours (such as astrocytic hamartoma)
    - - Retinal detachment
      - Retinal necrosis
      - Optic nerve invasion
      - Blindness
      - Cataracts
      - Subsequent malignant neoplasms
    - - Germline / hereditary
        
        Bilateral
      - Non-hereditary /Sporadic
        
        Unilateral
- - - - Acute Angle Closure Glaucoma
        
        Very Painful Eye condition
      - Scleritis
        
        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
      - Uveitis
        
        Systemic causes
        
        Syphilis
        
        HIV
        
        Sarcoma
        
        Very painful
      - Episcleritis
        
        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
      - Keratitis
        
        An inflammation of the cornea
        
        Presentation
        
        Painful red eye
        
        Photophobia :dark_sunglasses:
        
        Blurred vision
        
        Contact lense wearers - Ischaemia
      - Corneal Abscess
        
        Presentation
        
        Painful red eye
        
        Photophobia
        
        Blurred vision
        
        Treatment
        
        Admit to ophthalmic unit
        
        Intensive topical and systemic Antibiotics
      - Dendritic Ulcer
        
        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
      - Iritis
        Anterior Uveitis
        
        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
      - Opthalmia Neonatorum
      - 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
    - - Blepharitis
        
        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
      - Meibomianitis
        
        Inflammation of the meibomian glands (oil releasing glands in the eyelids
        
        Presentation
        
        Stingy sore eyes
        
        Red thickened
        
        Complications
        
        Meibomian Cysts
      - Orbital Cellulitis
        
        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)
      - Primary Herpes Simplex
        
        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
      - Herpes Zoster Ophthalmicus (HZO)
        
        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
      - Stye
        
        Acute or chronic tender eyelid abscesses due to inflammation of hair follicles
      - Subconjunctival Haemorrhage
      - 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
    - - Allergic Conjunctivitis
        
        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
      - Bacterial Conjuctivitis
        
        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
      - Papillary Conjunctivitis
      - 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 :dark_sunglasses:
        
        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
    - - Pain
        
        Severity
      - Itch
        
        Conjunctivitis
      - Discharge
        
        Purulent
        
        Bacterial conjunctivitis
        
        Clear
        
        Allergy / viral conjunctivitis
      - Photophobia
        
        Keratitis / Uveitis (Iritis)
        
        Vernal keratoconjunctivitis Sicca
      - Floaters
        
        Uveitis
      - Blurred vision
        
        Uveitis
        
        Posterior scleritis
        
        Acute angle closure glaucoma
      - Systemic Symptoms
        
        Uveitis / Iritis
        
        Ask about back pain
        Ankylosing spondylitis
        
        Conjunctivitis
        
        Pain passing urine / joint pain
        Reiters syndrome
    - - Visual Acuity
      - Anterior Segment Exam
      - Fundoscopy
    - - Painless
        
        Conjunctivitis
        
        Episcleritis
        
        Subconjunctival Haemorrhage
      - Painful
        
        Glaucoma
        
        Anterior Uveitis
        
        Scleritis
        
        Corneal abrasions or ulceration
        
        Keratitis
        
        Foreign body
        
        Traumatic or Chemical injury