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Ophthalmology > Painful Loss of Vision + Glaucoma > Flashcards

Painful Loss of Vision + Glaucoma Flashcards

(47 cards)

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1
Q

What causes painful loss of vision

A

Acute angle close glaucoma
Corneal abrasion
Optic neuritis
GCA
Choroditis / retinitis if immunocompromised
Posterior scleritis - pain > degree of red
Chemical or mechanical injury

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2
Q

What causes acute angle closure glaucoma

A

Angle is blocked acutely so AH cannot drain through trabecular meshwork
Due to structural change at cornea / iris
Typically in hypermetropia (long eye) so not enough room
Lens get bigger as you age
Iris bulges foreward and blocks trabecular meshwork
Causes rapid rise in IOP
Axonal death occur and optic neuropathy

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3
Q

What are the symptoms

What are complications

A 
Short history 
Sudden onset pain - headache / ocular
Hard red eye 
N+V
Photophobia 
Vision loss
HARD eye on palpation 
Opaque hazy cornea as IOP drives fluid in = oedema 
Iris / ciliary / conjunctiva vessels = injected 
Pupil 
N+V / abdo pain / headache can occur

Complications

  • Visual loss
  • Central retinal artery or vein occlusions
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4
Q

What happens to pupil

A

Mid dilated

Non reactive / sluggish

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5
Q

What is visual loss like

A

Periphery
Blurring
Halo around eye due to build up of fluid

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6
Q

What are RF

A 
Age
Female
FH
Hypermetropia
Mydratic eye drop as dilates eye 
Pupil dilation
Functional block due to large lens
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7
Q

What do you do if suspect

A

Urgent referral

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8
Q

How do you Dx

A

Slit lamp = shallow chamber
Tonometry = diagnostic as shows high pressure
Gongioscopy is only way to exclude an occluded angle

Do U+E

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9
Q

How do you Rx initially

A 
Analgesisa
Anti-emetic
Avoid dark room as encourage further dilation
Lie patient supine
URGENT OPTHAMOLOGY
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10
Q

What is 1st line Rx

A 
Prostaglandin eye drop (Latanoprost) 
IV carbonic anhydrase (Azetazolomide) 
A agonist (Apraclonidine) 
Mucarinic agonist
Mitotic eye drop to constrict and open angle 
Topical steroid eye drop 
BB if no CI
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11
Q

What does prostalgnaidn eye drops do

A

Constrict eye and increase outflow through chamber

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12
Q

What do all the other medications do

A

Reduce production of AH

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13
Q

What do you do after this

A

Chek IOP after 1 hour

Consider IV mannitol if not responding as osmotic agent and will draw fluid out

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14
Q

When should you have caution prescribing mannitol

A

Cardiac function
- draws fluid out = oedema
Renal function
- Should cause diuresis but if impaired = worsens overload

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15
Q

What happens after initial management

A

Keep on all medcation
Iridiotomy later to bypass (hole in iris)
Do other eye as prophylaxis
Trabeculostomy may be needed if adhesions have formed

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16
Q

What are complications

A

Visual loss

Central retinal artery or vein occlusion

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17
Q

What is corneal abrasion

A

Any defect in corneal epithelium

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18
Q

What causes

A 
Trauma
FB
Grit / contact lenses / finger nails
Tear insufficiency 
Keratconjunctivitis sicca
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19
Q

What are the symptoms

Study These Flashcards
A 
Eye pain - mild / mod
Photophobia 
Decreased acuity
Sensation of Fb
Conjunctival injection
Increased lacrimation
20
Q

What occurs 2

Study These Flashcards
A

Bacterial infection / keratitis

21
Q

How do you Dx

Study These Flashcards
A

Can usually see with naked eye
Look under eyelid for FB
FLuroscein angiography shows yellow stained abrasion

22
Q

How do you Rx

Study These Flashcards
A

Usually heal quick
Topical Ax to prevent bacterial infection
Topical cycloplegia for pain
Remove FB

23
Q

What Ax

Study These Flashcards
A

Fluroquinolone = 1st line

Aminoglycoside may be needed but often delays healing but will sort infection

24
Q

What do you avoid

Study These Flashcards
A

Topical analgesia as damages cornea

25
When can you miss abrasion
If chemical burn as no normal epithelium to compare
26
What is primary open angle glaucoma
``` Drainage through meshwork blocked Raised IOP Affects drainage of AH Slow and chronic Leads to optic neuropathy as pressure builds up on optic nerve or interrupts blood supply ```
27
What is normal IOP range
10-20mmHG
28
How does it present
``` Asymptomatic and picked up by screening with optometrist - Elevated eye pressure - ocular HTN - Optic disc changes - Visual field loss pattern - typical Usually bilateral May present with advanced disease as occurs slowly - Gradual visual defect - Pain - Headache ```
29
What are the visual defect
``` Peripheral loss Macular fibres usually preserved until very late which gives central vision Decreased acuity Halo Blurred Eventually all nerve fibres die = blind ```
30
What are optic disc changes
Pale and cupped as nerve fibres die
31
What are RF
``` Age Genetics FH Black Myopia - short sighted Hypertension DM Steroid Thyroid eye ```
32
Who gets screening
``` Annual from age 40 if FH African Myopia DM Thyroid eye disease ```
33
How do you assess visual field
Automated perimetry
34
How do you measure IOP and what is normal
Application tonometry | Normal = 12-22
35
What other tests
Slit lamp with pupil dilation to assess optic nerve | Fundoscopy for optic disc
36
How do you Rx
``` Prostaglandin eye drops = 1st line Carbonic anhydrase inhibitor BB if no CI Laser trabeculoplasty to allow drainage Trabeculectomy = definitie Rx May need to stop driving ```
37
How do you reassess
Exclude progression and visual field loss
38
SE prostaglandin inhibitor
Eyelash growth Eyelid pigmentation Iris pigmentation
39
SE carbonic anhydrase
Paraesthesia
40
What causes optic neuritis
MS DM Syphillis
41
How does it present
``` Unilateral decrease in acuity Poor colour discrmination Red desaturation Pain worse on eye movement Afferent pupil defect ```
42
How do you Dx
Always check pupil defect before dilate eye as may be only sign of neuritis
43
How do you Rx
Steroid
44
What is a scrotoma
Particular area of blindness in eye surrounding by relatively normal blindness Occurs due to how retinal axons are arranged
45
If lower part of nerve affected
Upper part of vision lost
46
What type of scrotoma in glaucoma
-ve which means patient is not aware Usually peripheral Can be very dangerous
47
In macula disease
+Ve scorotoma so patient is aware of defect

Ophthalmology (10 decks)

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