last day Ophthal Flashcards
(25 cards)
Assessment of glaucoma
corneal thickness gonioscopy tonometry visual fields/acuity fundoscopy FHx
Management of ARMD
counselling on condition - driving, maintenance of peripheral vision
optimise cataracts, DM, other ocular issues
low vision aids
register as low sight
antioxidant can slow progression but as yet no definitive cure
If suddenly worsens need to seek help - wet ARMD can give
Retinal vein occlusion Ix/Mx
Clotting, FBC, U&Es, review of other eye, lipid and glucose
fundoscopy
can give prophylactic low dose aspirin
can lead to macular oedema and neovascularisation so follow up with OCT and laser/anti-VEGF
acute glaucoma management
refer to ophthalmology
systemic acetazolamide/beta blocker if not CI
antiemetics/analgesia as required
check for pupil block if so then pilocarpine
laser iridiotomy
corneal abrasion management
refer to ophthalmology analgesia/antiemetics LA drops and dilating drops Chlormaphenicol eye drops Visualise cornea with fluourescien occlusive padding review daily until resolved
common eye signs in NAI
periorbital bruising
lens dislocation
retinal detachment
should document findings clearly, contact child protection team, get senior help, ask accompanying adults what relation they have to child
intraocular foreign body management and compications
plain XR/ocular Us/CT
significant risk of endophthalmitis so antibiotics and red flag symptoms
repair any corneal perforation
remove foreign body - risk of sidirosis
Risk of: corneal scarring - astigmatism, cataract, retinal detachment, glaucoma, and sympathetic ophthalmitis
sudden visual loss in kids
congenital cataract, retinoblastoma, toxocaria, persistent hyperplastic primary vitreous
adult onset strabismus
neurological causes include palsies of the eye movement nerves secondary to increased ICP, haemorrhage or infarct causing INO
muscular causes: trauma of muscles, MG
ocular - intraocular tumours, orbital wall fractures, thyroid eye disease
6th nerve may be due to IC aneurysm
internuclear ophthalmoplegia
is a failure of convergent gaze, failure of adduction of the affected eye when gaze is diverted medially to the affected eye, the unaffected eye abducts with nystagmus
How does thyroid eye disease lead to visual loss
EOM inflitration with autoantibodies which leads to inflammation and ophthalmoplegia
this can also cause compression of the optic nerve causing optic nerve atrophy - visual loss
exophthalmos leads to corneal exposure which can cause ulceration -> scarring/astigmatism
6th nerve palsy mx
eye patching, prisms, exclude intracranial pathology such aneurysm and stroke
spontenous recovery over 6m
Myasthenia Gravis
Test for with a tensilon test which gives IV cholinesterase inhibitor increased availability of acetylcholine at the neuromuscular junctions
management of dry eyes
shirmers test to confirm
increase room humidity, side guards for spectacles, artifical eye lubricant - whatever the atient prefers remember ointments may blur vision, punctal plugs
fluourescein corneal examination, may see punctate erosions
atopic keratoconjunctivitis
can cause corneal ulceration and scarring, keratoconus, scarring can lead to reduced vision and astigmatism, can lead to glaucoma and cataract
treat with mast cell stabilisers, allergen avoidance, topical antihistamines, topical steroids if severe
lower motor neuron causes of facial palsy
Bells Trauma infection - ramsey hunt, otitis media malignancy - parotid tumour, acoustic neuroma Systemic - MS
3rd nerve palsy
medial, superior and inferior rectus muscles down and outward position Pupil dilated mild ptosis affected eye unable to adduct
thyroid eye disease scoring
clinical activity score based on pain, sings (chemosis, conjunctiva, redness, swelling of eyelids), acuity, proptosis, eye movements
optic neuritis
presents with eye pain, worse on movement and enlarged blind spot
investigate with - visual acuity, colour testing, RAPD, blind spot, cranial nerves - eye movement and peripheral fields, fundoscopy (optic disc may be normal), corneal examination
MRI head and orbit for demyelinating lesiosn
Manage - discuss with neuro SpR, ?IV methylprednisolone, 10-25% develop MS, ask MS questions such as gait disturbance GU disturbance, intermittent weakness
Horners Syndrome causes and Ix
Brainstem: CVA, trauma
Spinal cord: trauma, syringomyelia, tumour
Preganglionic: pancoast tumour, tumour, carotid artery dissection, thyroid issues
Postganglionic: otitis media, herpes zoster
4% cocaine eye drops
Myasthenia gravis investigaion and management
Upward eye test, fatiguability of arms IV tensilon test single muscle EMG rule out thymoma with CT chest discuss with neuro, pyridostigmine (long acting anticholinesterase, consider immunosuppresion, counselling r.e: choking/cv arrest
Treatment of GCA
IV steroids with steroid counselling
TAB within a week
refer to rheumatology
if long term steroids may need bone protection
pituitary adenoma investigation
bloods for prolactin, GH, TSH
joint care with head and neck surgeons
MRI head
causes of strabismus
idiopathic refractive error Cerebral palsy; Down syndrome; Hydrocephalus; Brain tumors; Prematurity.
