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which cause of red eye always needs to be ruled out?
acute angle closure glaucoma
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what needs to be asked in HPC about red eye?
- painful
- loss of vision
- duration of symptoms
- discharge
-
what are the symptoms of bacterial conjunctivitis?
- discomfort
- eyelashes stuck together in mornings
-
what would you see OE of bacterial conjunctivitis?
- 1. diffuse conjunctival injection (red eye)
- 2. mucopurulent DISCHARGE
- 3. papillae - red bumps on inside of eyelid
-
what is the Rx of bacterial conjunctivitis?
- topical abx drops and ointment at night
- chloramphenicol
- counsel pt: hand washing, very contagious so don't share towels
-
what are the symptoms of viral conjunctivitis?
- grittiness
- watery eye
- photophobia if keratitis
- associated URTI
-
what would you see OE of viral conjunctivitis?
- diffuse or haemorrhagic conjunctival injection - red
- watery discharge
- follicles
- lymphadenopathy - preauricular node enlargement
-
what is the Rx of viral conjunct?
- artificial tear drops - hypromellose
- may want to give topical abx to cover
- counsel pt: hand washing, very contagious so don't share towels
-
what are the symptoms of allergic conjunctivitis?
- itching
- hx of atopy or use of eyedrops
-
what do you see OE allergic conjunct?
- red watery eyes
- chemosis
- giant papillae
- bilateral
-
what is Rx of allergic conjunct?
topical antihistamine eg sodium cromoglycate - mast cell stabilisercounsel pt: hand washing, very contagious so don't share towels
-
what would make you suspect chlamydial conjunctivitis and treatment?
- GU symptoms
- tetracycline or erythromycin
-
what are the symptoms of episcleritis?
- mild ache
- recurrent episodes (but self limiting)
-
what do you see OE of episcleritis?
- sectorial redness
- nodule (can be moved over sclera)
- episcleral vessels blanch with phenylephrine
-
what is the treatment of episcleritis?
- weak topical steroid
- oral NSAIDs
-
what are the symptoms of scleritis?
- severe pain
- wakes pt at night
- watering of eye
- photophobia
-
what do you see OE of scleritis?
- sectorial or DIFFUSE redness
- immobile nodule
- scleral vessels DO NOT BLANCH with phenylephrine
- deep vessels, tortuous dilated inflamed
-
what is the treatment of scleritis?
- oral NSAD
- systemic steroids
- refer as 25% are part of vasculitis
-
who is at higher risk of bacterial corneal ulcer?
contact lens wearers
-
what are the symptoms of bacterial corneal ulcer?
- mild-sever pain
- photophobia
- discharge
-
what do you see OE of bacterial corneal ulcer?
- focal white opacity in cornea
- overlying epithelial defect that stains with fluorescing
- hypopyon
-
what is the treatment of of bacterial corneal ulcer?
- admit
- intensive abx eye drops
-
who is at higher risk of viral corneal ulcer?
cold sores
-
what are the symptoms of viral ulcer - HSV?
-
what do you see OE of viral ulcer?
- eyelid vesicles
- dendritic corneal ulcer that stains with fluorescing and rose bengal
-
what is the treatment of viral ulcer - HSV
aciclovir eye ointment
-
what is the history of corneal abrasion?
scratch to eye
-
what are symptoms of corneal abrasion?
- pain
- photophobia
- watering
- FB sensation
-
what do you see OE of corneal abrasion?
epithelial defect that stains with fluorescin
-
what is the treatment of corneal abrasion?
ointment and double pad
-
what is a typical hx of FB or rust ring in eye?
grinding metal
-
what are symptoms of FB in cornea?
- FB sensation
- photophobia
- watering
-
what do you see OE of FB?
-
what is the treatment of FB?
-
what is the other name for iritis?
anterior uveitis
-
what is iritis assoc with?
- seronegative arthropathy HLA-B27 positive eg ank spond
- IBD
- TB
- sarcoidosis
-
what are the symptoms of iritis?
- photophobia
- pain
- watering
- may have reduced visual acuity
-
what do you see OE of iritis?
- ciliary injection -red around cornea
- small pupil due to iris sphincter spasm
- irregular pupil - due to adhesion of iris to lens = posterior synechiae
- keratin precipitates (white dots)
- hypopyon if severe (pus in anterior chamber)
-
what is the treatment of iritis?
- refer to ophthalmology - don't give steroids straight away in case it is HSV!
- topical steroids: dexamethasone
- mydriatic: cyclopentolate -paralyses ciliary body to relieve pain, prevents posterior synechiae
-
which conditions can precipitate acute angle closure glaucoma?
- topical mydriatics
- dim light - dilated pupil
-
what causes acute angle closure glaucoma?
- secondary to obstruction of aq hum outflow
- closure of angle - iridocorneal angle
-
what are symptoms of acute angle closure glaucoma?
- pain
- coloured halos around lights
- frontal headache
- reduced vision
- blurred vision
- N&V
-
what do you see OE of acute angle closure glaucoma?
- corneal oedema
- pupil: fixed, semi dilated
- red eye
- increased IOP - hard on palpation
- shallow anterior chamber - eclipse sign
- reduced VA
-
what is immediate treatment of acute angle closure glaucoma?
- iv diamox acetozolamide
- topical steroids
- BB (timolol), PG (lanoprost), alpha2agonist (brimonidine), cholinergics (pilocarpine)
-
what is the definitive treatment of acute angle closure glaucoma?
- YAG laser peripheral iridotomy - make bypass
- bilateral
-
what are features of mild-mod NPDR?
- Haemorrhage
- Oedema
- Microaneurysm
- Exudates
-
what are features of severe NPDR?
- venous changes: beading, looping
- cotton wool spots
- IRMA - intra retinal microvascular abnormalities
-
what does boat shaped haemorrhage indicate?
pre-retinal haemorrhage, see in PDR
-
what is the difference between normal retinal BV and those seen in PDR?
PDR: bld vessels are fenestrated
-
what are 2 complications of untreated PDR?
- 1. fibrous component of new bv gives rise to preretinal fibrosis and tractional RD
- 2. new vessels on iris - rubeosis iridis gives rise to rubeotic glaucoma
-
which type of DM gets diabetic maculopathy?
- type 2
- get oedema and exudates at macula
-
what are the 4 main causes of blindness in DR?
- 1. tractional RD
- 2. rubeotic glaucoma
- 3. vitreous haemorrhage - sudden reduced VA
- 4. maculopathy
-
what is the treatment of mild NPDR?
no Rx, review in 6/12
-
what is the treatment of moderate NPDR?
no Rx, review in 2-4/12
-
what is the treatment of severe NPDR?
no treatment, review in 2-4/12
-
what is the treatment of macular oedema?
laser - focal or grid
-
what is the treatment of PDR?
panretinal laser photocoagulation
-
what is the treatment of vitreous haemorrhage or tractional RD?
surgery - vitrectomy
-
what are the symptoms of 4th nerve palsy?
- diplopia when looking down worse
- affected eye is higher than normal due to unopposed action of superior rectus
- head turn and face tilt to OPPOSITE side
-
what are the symptoms of 7th nerve palsy in eye?
- lid ectropion - due to loss of muscle that holds it up
- cant close eye as orbucularis oculi is paralysed - problem as cornea is expose - get dry eye and ulcer
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