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Flashcards in Masters in Surgery Deck (76)
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1

Peripheral flashing lights and 'floaters'
Patient may also complain of 'black curtain' or 'shadow'

Rhegmatogenous retinal detachment
-may have reduced visual acuity
-may have field defect
-may have RAPD

2

What might the retina look like if it has been detached?

Anteriorly placed, slightly pale retina may be seen ballooning forwards
-treatment is surgical

3

Posterior vitreous detachment

Floaters and peripheral floating
Symptoms normally settle after a few months

4

Opthalmoscopy shows pigmentary mottling in the macular region around areas of pale atrophic-looking retina
Well demarcated yellow deposits may be seen in association with these deposits

Dry ARMD
-in wet ARMD, haemorrhage or grey subretinal neovascular membrane may be seen

5

Patients complain of disortion

(wet) ARMD

6

Treatment for ARMD

Magnifiers
Photodynamic therapy
anti-VEGF

7

Amaurosis Fugax

Visual disturbance/loss but lasts less than 24 hours

8

Swollen pale retina with a 'cherry red spot'

Retinal artery occlusion

9

CRVO treatment

Based on treatment of systemic or ocular causes (eg hypertension, diabetes, glaucoma)

Monitor : may develop complications due to development of new vessels (laser treatment may be required to avoid complications from these vessels eg vitreous haemorrhage)

More recently, anti- VEGFs used (VEGF = vascular endothelial growth factor)

10

Ischaemic optic neuropathy?

Sudden, profound visual loss with swollen disc

11

Sudden, profound visual loss with swollen disc

Ischaemic optic neuropathy

12

Arteritic ION?

Medium to large size vessels

13

Vitrous haemorrhage

Symptoms
Loss of vision
‘Floaters’
Signs
Loss of red reflex
No RAPD – unless associated with other pathology
Management
Identify cause
Vitrectomy for non-resolving cases

14

Red reflex and RAPD in vitreous haemorrhage?

Loss of red reflex but no RAPD (unless associated with other pathology)

15

Vitreous haemorrhage and bleeding? Where does the bleeding come from?

Bleeding occurs from abnormal vessels
Associated with retinal ischaemia and new vessel formation eg after retinal vein occlusion or diabetic retinopathy

Bleeding occurs from retinal vessels
Usually associated with a retinal tear

16

Retinal detachment

Symptoms
Painless loss of vision
Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)

Signs
May have RAPD
May see tear on ophthalmoscopy

17

Signs and symptoms of wet ARMD

Symptoms
Rapid central visual loss
Distortion (metamorphopsia)

Signs
haemorrhage/exudate

TREATMENT = anti-VEGF

18

Causes of gradual visual loss? (CARDIGAN)

Cataract
Age related macular degeneration (dry type)
Refractive error
Diabetic retinopathy (covered in other lecture)
Inherited diseases e.g. retinitis pigmentosa
Glaucoma
Access (to eye clinic) Non-urgent

19

Management for cataract

Management is surgical removal with intra-ocular lens implant if patient is symptomatic

20

Symptoms and signs of dry ARMD

Symptoms
Gradual decline in vision
Central vision ‘missing’

Signs
Drusen – build up of waste
products below RPE
RPE changes – atrophy/
hyperplasia

21

Refractive error

Myopia (‘short-sighted’)
Hypermetropia (‘long- sighted’)
Astigmatism (usually irregular corneal curvature)
Presbyopia (loss of accommodation with aging)

22

Open angle glaucoma

Symptoms
Often NONE
Optician screening important

Signs
Increased intraocular pressure
Cupped disc
Visual field defect

23

Arcuate field defect

Glaucoma
Increased cup

24

Open angle glaucoma treatment

Treatment - pressure-lowering eye drops or occasionally surgery

Patients need regular monitoring in eye clinic

25

Chronic inflammation of the lid margins and associated meibomian glands

Blepharitis
-eyes are persistently gritty and sore

Lid hygiene – daily bathing / warm compresses
Supplementary tear drops
Oral doxycycline for 2-3 months

Very difficult to eradicate

26

Ptosis causes

Neurogenic
-third nerve cranial palsy
-horners syndrome
Myogenic
-weakness of levator muscle (e.g. senile ptosis)
Neuromyogenic
-myasthenia gravis
Mechanical
-cysts or swelling of upper eyelid

27

Acute-onset, red, gritty eyes with a purulent discharge that characteristically causes eyelids to be stuck together on wakening

Bacterial conjunctivits
-Most common causative pathogens are staph, strep and haemophilus influenzae

28

Treatment for bacterial conjunctivits

Chloramphenicol topical drops

29

Difference between anterior and posterior blepharitis

Anterior
Seborrhoeic (squamous) scales on the lashes
Staphylococcal – infection involving the lash follicle
Lid margin redder than deeper part of lid
Posterior
Meibomian gland dysfunction
( M.G.D.)
redness is in deeper part of lid
lid margin often quite normal looking

30

Staphylococcal blepharitis

lid margin red
Lashes distorted, loss of lashes, ingrowing lashes - trichiasis
Styes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)