Most common cause of blindness in adults 35-65years?
treatment options for wet macular degeneration
anti-VEGF injections, laser photocoagulation, intravitreal steroids
Which form of macular degeneration carries the worst prognosis?
wet macular degeneration
How is orbital cellulitis diagnosed?
CT, ENT with ophthalmology review
Features of wet macular degeneration?
choroidal neovascularisation, leakage of serous fluid and blood
What causes neovascularisation in the retina?
growth factors released due to retinal ischaemia
Prevention of cataracts?
wear sunglasses, decrease oxidative stress and stop smoking
common complication of ophthalmic zoster
How is Ramsay Hunt Syndrome treated?
aciclovir and prednisolone
What is Ramsay Hunt syndrome?
herpes zoster of the facial nerve, often in the elderly
Common triad of symptoms with horners syndrome
miosis, ptosis and anhidrosis (inability to sweat on that side)
What causes microaneurysms to form in the retina?
presentation of ophthalmic zoster
pain and neuralgia in CN V1 dermatome preceding a blistering inflammaed rash
Straight lines starting to appear wavy is a sign of...
Diagnosis of cataract is best made...
with a dilated pupil and slit lamp or ophthalmascope
Risk factors for ophthalmic zoster
increasing age, trauma to the area, immunocompromise
What is the most common cause of visual impairment worldwide?
Predictors of ocular involvement with ophthalmic zoster (3)
Hutchinsons sign, around 50% HZO will have globe involvement - purulent conjunctivitis, visual loss, keratitis, episcleritis, scleritis, irititis
Horners syndrome affects the eye because of nerve impingement of which nerve roots?
Common organisms causing orbital cellulitis?
staph aureus, strep pneumoniae
Horners syndrome may affect the eye by causing...
miosis (small pupil) or ptosis (dropping eyelid)
How is surgery for cataracts carried out?
one eye at a time, ultrasound to dissolve original lens and then replaced with plastic or silicone lens...should correct refractive error
What are common risk factors for cataract development?
age, congenital, trauma, smoking, alcohol, diabetes, uveitis, systemic drugs i.e. steroids, hypocalcaemia
signs of diabetic retinopathy on fundoscopy?
blot haemorrhages, cotton wool spots, microaneurysms, neovascularisation
How does Ramsay Hunt syndrome present?
severe otalgia preceding CN VII palsy, vesicles form in the ear, deep meatus, +/- soft palate and tongue, may also have vertigo, deafness and tinitus
Risk factors for macular degeneration?
age >60 years, smoking, FHx, caucasian, high cumulative sunlight exposure, female sex
Best treatment for cataracts
surgery - although limited outcome if combined with macular degeneration (around 30% patients)
Presentation of a child with orbital cellulitis
inflammation around the orbit, fever, lid swelling and decreased eye movements and diplopia
Which group is typically affected by orbital cellulitis?
What is a cataract?
opacification of the lens
What is preseptal cellulitis?
infection of the soft tissues anterior to the orbital septum
Treatment for preseptal cellulitis
amoxicillin 1g TDS for 7-10 days
Presentation of cataracts
blurred vision, bilateral causes gradual painless loss of vision, glare/haloes around street lights, change in refractive error
What is reassuring in the presentation of ophthalmic zoster?
visual acuity and normal corneal appearance
A subtype of cataract is posterior subcapsular cataracts...how does it differ?
progresses faster and usually is from steroid use
Signs of macular degeneration?
reduced visual acuity - blurred and distorted vision, particularly the central vision
common causes of preseptal cellulitis
sinusitit or facial skin lesions
What distinguishes preseptal cellulitis from orbital cellulitis?
lack of painful eye movments, diplopia and visual impairement - however if in doubt treat as if orbital cellulitis
treatment options for dry macular degeneration
Treatment of orbital cellulitis
Surgical drainage of abscess and antibiotics
Features of dry macular degeneration?
Drusen around the macula - yellow round spots
What causes exudates in the retina?
endothelial dysfunction --> increased vascular permeability and protein leakage
What is orbital cellulitis?
infection of the soft tissues posterior to the orbital septum - sight and life threatening!
Why does Hutchinson's sign predict involvement of the globe?
nasociliary branch of CN V1 affects the globe
What is the most common cause of blindness in the UK?
age related macular degeneration
What is the main treatment for opthalmic zoster?
oral antivirals within 72 hours of rash appearing
What is proptosis?
protrusion of the orbital contents
Complications associated with orbital cellulitis
orbital abscesses, visual loss (CRVO, CRAO, optic neuritis), meningitis, brain abscess, thrombosis in the dural or cavernous sinus
When should patients with ophthalmic zoster be referred?
any pain, redness or altered vision
What are the two forms of age related macular degeneration?
dry and wet