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Flashcards in Painful Loss of Vision + Glaucoma Deck (47)
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1

What causes painful loss of vision

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

2

What causes acute angle closure glaucoma

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

3

What are the symptoms

What are complications

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

4

What happens to pupil

Mid dilated
Non reactive / sluggish

5

What is visual loss like

Periphery
Blurring
Halo around eye due to build up of fluid

6

What are RF

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

7

What do you do if suspect

Urgent referral

8

How do you Dx

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

Do U+E

9

How do you Rx initially

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

10

What is 1st line Rx

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

11

What does prostalgnaidn eye drops do

Constrict eye and increase outflow through chamber

12

What do all the other medications do

Reduce production of AH

13

What do you do after this

Chek IOP after 1 hour
Consider IV mannitol if not responding as osmotic agent and will draw fluid out

14

When should you have caution prescribing mannitol

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

15

What happens after initial management

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

16

What are complications

Visual loss
Central retinal artery or vein occlusion

17

What is corneal abrasion

Any defect in corneal epithelium

18

What causes

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

19

What are the symptoms

Eye pain - mild / mod
Photophobia
Decreased acuity
Sensation of Fb
Conjunctival injection
Increased lacrimation

20

What occurs 2

Bacterial infection / keratitis

21

How do you Dx

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

22

How do you Rx

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

23

What Ax

Fluroquinolone = 1st line
Aminoglycoside may be needed but often delays healing but will sort infection

24

What do you avoid

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