opth Flashcards
differentials for a male presenting with visual field loss in the centre, general blurring, and difficulty reading and night driving due to glare
Age related macular degeneration (older age, gradual onset, absence of pain, difficulty reading and recognising faces)
macular hole, less likely if bilateral, presents with wavy vision
cataracts, although these would cause more general vision reduction (but do cause blurred vision and difficulty reading)
glaucoma (although this usually presents with peripheral vision loss initially progressing to tunnel vision and may be associated with eye pain or headache)
diabetic retinopathy presentation
history of diabetes, floaters, blurred vision, fluctuating vision, impaired colour vision, vision loss, not just central vision loss
glaucoma presentation
peripheral vision loss initially progressing to tunnel vision and may be associated with eye pain or headache
cataracts presentation
cataracts, these would cause more general vision reduction (but do cause blurred vision and difficulty reading)
AMD examination findings
reduced visual acuity particularly central, scotoma (blind spot) ancestral visual field
fundoscopy- drusen in early stages, late dry AMD = atrophy of retinal pigment epithelium (wet = choroidal neovascularisation such as haemorrhages or exudates)
Amsler grid- metamorphosia (distortion of vision), common symptom in wet AMD
AMD management
Dry: no cure, but stop smoking, eat leafy greens and fish, regular exercise and eye check ups
Wet: anti VEGF medication, photodynamic therapy and laser surgery
Aids to help with low vision - magnifying glasses, large print books, software. Manage HTN and DM
never forget to ask with eyes
aggravating and relieving factors and allergies
sudden loss of vision a week ago, with blurring and pain on eye movements in one eye. Mild headache. History of MS. Differentials
optic neuritis: MS history, sudden onset, pain on eye movement and loss of vision. Common first symptom of MS or relapse
retinal detachment: although would expect flashes and floaters, and should not be painful
AAC glaucoma: though would normally be red eye as well as pain and N and V
Migraine: although visual disturbances are usually transient and resolve completely
Stroke: would not cause eye pain or be affected by movement. Would usually have other neurological symptoms
things to ask in vision loss
flashes, floaters, like a curtain, blurred, or completely lost
AACglaucoma presentation
AAA glaucoma: would normally be red eye as well as pain and N and V. acute loss of vision.
optic neuritis examination findings
reduced visual acuity, RAPD, colours appear washed out, fundus may be normal (retrobulbar) or may be swollen after 1-2 weeks, pain on eye movement, central scotoma or other visual field defect
key finding in unilateral optic neuritis (can get in glaucoma, tumour, retinal detachment, optic nerve damage)
RAPD
management for sudden vision loss and a history of MS
urgent referral to ophthalmology for further assessment- suggestive of optic neuritis which can cause vision loss
High dose corticosteroids - reduce inflammation and speed up recovery (IV methylpred)
DMARDs (e.g. Avonex (interferon beta-1a)
Information and support psychologically, MS nurse
Analgesia - paracetamol ibuprofen
painless sudden loss of vision (curtain) with preceding flashes and floaters, history of HTN, differentials
Retinal detachment: most likely given curtain coming down and flashes and floaters. Sudden painless LOV
Vitreous haemorrhage: not usually curtain though
CRAO: usually not floaters or flashes, and not curtain
CRVO: caused by TIA, less likely as vision loss in amaurosis fugax is typically transient
Examination findings in retinal detachment
LOV/blurring, loss of visual fields/curtian, Normal pupil reactions,
Fundus exam: raised billowing retina, greyish discolouration of detached retina, retinal tears or holes
May see flashes of light or floaters
Definitive diagnosis of retinal detachment
indirect opthalmoscopy or retinal imaging
management of pt with sudden loss of vision in one eye query retinal detachment
urgent ophthalmologist referral
Avoid strenuous activity, stay still until seen by a specialist
May need: pneumatic retinopexy, scleral buckling or vitrectomy
Reassure the patient that it can be possible to restore or preserve vision, but untreated can lead to permanent vision loss
differentials for red swollen eyelids, crusting around eyelashes, irritation, itchiness, mild light sensitivity and occasional blurred vision. Worst in mornings. Differentials
Blepharitis most likely: affects eyelids especially base, often chronic and worse in morning due to accumulation of debris
Dry eye syndrome: usually would be gritty and XS tearing
Conjunctivitis: usually has watery discharge, and acute
Stye or Chalazion: painful lump
Meibomian cyst: cyst in eyelid caused by a blocked gland, painless lump
examination findings in blepharitis patient
Red and swollen eyelids, crusting around eyelashes, grittiness or a foreign body sensation in the eyes, mild photophobia, possible blurred vision due to discharge,
Telengiectasia and hyperaemia of lid margin due to chronic inflammation, loss of eyelashes or misdirected eyelashes
Meibomain glands blocked as small white spots, conjunctiva may show papillary reaction
management for blepharitis
Lid hygiene: warm compress to loosen crust, clean flannel for 10 mins on closed eye. then clean lid margin with baby shampoo and warm water gently
Artificial tears if dry eyes, topical Abx such as chloramphenicol if associated bacterial infection.
Education for regular cleaning as long term management. referral to ophthalmologist if severe
always enquire about
visual impairment history
if painful, always ask
VISION
if they have UC inquire about
acute flare and maintenance control
presentation of young male with moderate pain and redness in right eye for 6 hours, sharp pain, progressively worsened, photophobia and blurred vision. UC history. Differentials?
Anterior uveitis: unilaterally or bilaterally, presents like this
Acute angle closure glaucoma: usually older, and associated with myopia (short sighted)
Scleritis: inflammation with severe pain, local radiation, tenderness, pain on eye movements, photosensitivity and eye watering (this patient had moderate pain and not on eye movement)
infections- though often bilateral, not so rapidly progressive, not blurred vision
trauma although not reported
