Opthalmology Flashcards
(40 cards)
List three abnormalities and the diagnosis
- Pupil mid size
- Pupil irregular
- cloudy cornea
- lateral ciliary injection
Acute close angle glaucoma
What are 3 ways of measuring intra ocular pressure
What is normal limit?
Tonopen
rebound tonometry
impression tonometry
Normal limit
15-22cmh20
What are the ED treatment for Acute close angle glaucoma plus supportive
ED treatments
all reduce pressure
Acetazolomide 500mg IV or oral
timolol drops - reduce pressure
pilocarpine drops - reduce pressure
Supportive
Analgesia - name some
Ondasetron
Post trauma - key finding?
- haemorrhage in the anterior chamber inferiorly
- pupillary distortion
With trauma to the eye what differentials need to be considered?
What would be their clinical features?
- Vitreous haemorrhage - floaters, visual haze, loss of red reflex
- Retinal detachment - floaters, markedly reduced VA, no red reflex
- Ocular globe rupture - viterous humour leak, decreased OP, loss of vision, distorted pupil
- acute glaucoma - irregular pupil, hazy vision, pain, nausea and vomiting
- lens subluxation - blurred vision and quivering of iris on movement
what is the management of eye trauma
consult opthal
analgesia
patch
nurse at 30 degrees
cycloplegics - paralyse ciliary muscle eg tropicamide/pilocarpine or
3 causes of conjunctivits, differentiating history and exam and management
- Bacterial - unilateral with purulent discharge - treatment with drops/anbx
- Viral - bilateral, watery discharge - conservative
- Allergic - itching and oedema of eyelid - steroid drops, antihistimane drops
homeless man - four significant findings?
what are the important parts of eye exam and what will you find?
- central corneal opacity
- irregular pupil
- small hypopyon
- arcuate corneal opacity
- conjunctival erythema
Exam
1. VA - reduced
2. IOP - increased
3. flouroscein uptake on slit lam exam
Treatment?
Complications?
Treatment
* urgent opthal review
* broad specturm abx
* topical analgesia
* cycloplegics
Complications
* opacification and scarring of cornea
* increased ocular plressure and secondary glaucoma
* corneal perforation
three abnormalities
extensive subconjuctival haemorrhage
dilated pupil
proptosis
periorbital bruising
chemosis -swelling of conjunctiva
what are the steps in a lateral canthotomy?
- Need to have adequate LA and/or sedation. Inject 1-2 mL local anaesthetic into lateral
canthus - Perform the canthotomy - insert needle holder from lateral canthus towards bony orbit and compress this area to devascularise it.
- Remove needle holder and using scissors cut along the lateral canthus 1-2 cm to the
bony orbit. - perform cantholysis: Grasp the lateral lower eyelid with toothed forceps. Pull the lower
eyelid down to visualise the inferior canthal tendon and cut through this with scissors - If IOP still high after this cut the superior canthal tendon too by lifting the upper eyelid
and locating the tendon. Use scissors to cut.
abnormalities?
What needs to be assessed
diagnosis?
irregular pupil
hyphaema
conjuctival injection and oedema
presence of fluroscein
bruise to inner upper eyelid
need to examine
* pressure
* acuity
* light reflex
Trauma
what is traumatic iritis?
occurs few days post trauma
pain, tearing
photophobia
abnormalities?
What may be the associated injuries?
Early and late complications of this?
conjuctival injection
hyphaemia
traumatic mydriasis
Injuries
globe rupture
orbital floor rupture
lens dislocaiton
retinal detachment
Early
rebleeding
raised IOP
Late
corneal blood staining
optic atrophy
mangement steps?
- analgesia - avoid NSAIDS
- patch
- bed rest at 30 degress
- topical cycloplegics
- treat associated conditions
abnormalities?
What would you look for on exam?
abnormalities
globe rupture
orbital blowout rupture
displacement inferior rectus
air in maxillary sinus
**
Exam**
VA
extra oculr movement
inferior orbital nerve sensation
pupil shape RAPD
GCS for other injuries
c spine asessment
management of orbital blowout fracture?
- urgent opthal referral
- lay flat
- avoid pressure on eye
- ADT
- eye shield
- IV abx
- opiate analgesia
- anti emetic
- c spine
what are the routes for contracting orbital cellulitis
- extension from peri orbital structures eg nose, face
- inoculation from trauma or surgery
- haemategonous spread
what organisms commonly cause orbital cellulitis
s.aureus
s.pyogenes
h.influenzae
painful eye - list abnormalities
diagnosis
irregular pupil
hypopyn
conjunctival injection
cloudy cornea
diagnosis;
anterior uveitis/iritis
what is the difference between ciliary and conjuctival injection
ciliary around iris
conjunctival more diffuse
what can predispose to iritis/anterior uveitis?
Autoimmune things:
crohns
SLE
ank spon
sarcoid
what is the mangement of iritis/anterior uveitis?
steroid drops
opthal referral
mydriatic instillation
symptoms of anterior uveitis/iritis
conjunctival injection
pain
distorted pupil
hypopyn
