Eyes Brought to you

Eyes Eyes Brought to you by You are not alone A very popular topic How much time at medical school? What do the acuity numbers mean Brought to you by Special history One or both? What disturbance of.Eyes Eyes Brought to you by You are not alone A very popular topic How much time at medical school? What do the acuity numbers mean Brought to you by Special history One or both? What disturbance of.

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You are not alone!

 A very popular topic

 How much time at medical school?

 What do the acuity numbers mean!

Special history

 One or both?

 What disturbance of vision?

 Rate of onset?

 Any blind spots?

 Any associated symptoms e.g

floaters? flashing lights?

 Exactly what is worrying the patient.

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 Contact lens use?

 Myopia? (increases risk of retinal

detachment 10 fold)

 Any family history? (FH of glaucoma

in a 1st degree relative gives you a 1/10

lifetime risk, or squint)

 Any history of diabetes, hypertension

or connective tissue disease?

Snellan chart, 3m or 6m, simple text for near

vision,

Pinholes

Fields, remember red and the quality of the red,

simple 4 quadrant testing.

Pupils: a bright torch and magnifying glass

Squint

Movements

Opthalmoscopy: Start at 10, red reflex?, green

filter enhances blood vessels, dilate prn, risk of

acute closed angle glaucoma remote. Brought to you by

Clinical classification

 Red eye

 Lids and tears

 Slow visual loss in the quiet eye

Red eye

Conjunctivitis

Commonest, an uncomfortable red eye.

Bacterial

 Discomfort Purulent discharge Spreads

from one eye to the other Vision normal

Uniform engorgement Chloramphenicol

first choice (?)

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Viral

Often with an URTI Gritty Discomfort

Watery discharge May last many weeks.

Photophobia Small corneal opacities may develop Prolonged (often adenoviral) may need specialist therapy with steroids

Chloramphenicol to prevent 2nd infection.

 Less than one month is notifiable disease - any

cause May lead to scarring and permanent

damage Refer most.

Allergic

 Itching and discomfort Chemosis and visual

acuity loss possible Papillae and if big

cobblestones Cromoglycate may take days to

start to work if bad. Brought to you by

Episcleritis / scleritis

Red sore eye No discharge Localised

(viz conjunctivitis=generalised)

inflammation.

 Episcleritis usually self limiting and

idiopathic, no treatment needed.

 Scleritis often with CT diseases,

dangerous (perforation possible) Refer.

Corneal ulcers

 Any infection, Abrasion, topical steroids, contact

lens use.

 PAIN - Except zoster

 May be general or localised inflammation.

 Must stain Should evert upper lid to exclude a sub

tarsal FB

 ?Hypopyon - pus in anterior chamber.

 Refer most (except small abrasions - but refer if

big or longer than 36 hours)

 Remember recurrent abrasion syndrome

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Anterior uveitis

 The uveal tract So iritis, iridocyclitis and anterior uveitis are synonyms.

 At risk: HLA-B27, CT diseases, past attacks,

juvenile arthritis, sarcoid.

 PAIN, then photophobia then visual loss.

 Ciliary flush As it gets worse the pupil gets small and reactions get sluggish, hypopyon, keratitis

(back of cornea) These markers of it getting

worse are bad news.

 Refer all.

Acute closed angle

glaucoma

 Often starts in the evening Especially in

those over 50 years.

 Severe pain first Impaired vision and

haloes around lights May have history of

past episodes relieved by going to sleep

(the pupil constricts during sleep).

 Refer even if attack spontaneously

resolves.

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Lids and tears

Chalazion

 = meibomnian cyst In the lid Warm

compresses and chloramphenicol

 An infection of lash follicle May

be head of pus - nick with

needle Or warm compresses

and chloramphenicol.

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Marginal cysts

 Non infected cysts from sweat or

sebaceous lid glands, if a problem

can often be simply treated with a

nick with a needle - small.

 Common, underdiagnosed Persistently sore

eyes Gritty Often with chalazions or styes

Inflamed lid margins, crusts, may have inflamed lids.

 Associated with psoriasis, eczema and roseacea.

 Keep clean, antibiotic ointment[tetracycline],

artificial tears ? oral tetracyclines

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Acute dacrocystitis

 Medial inflammation over lacrimal

sac Refer, systemic therapy and

topical urgently.

Orbital cellulitis

 Life threatening and blinding Usually from

sinuses Especially important in children

who may become blind in hours.

 Unilateral swollen lids which may not be red.

 The patient is ill, there is tenderness over the sinuses, restricted eye movements ADMIT

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 Watery eye Laxity from age or nerve palsy

Ointment and refer for LA operation to correct.

Ingrowing lashes

 Damage to lids May be

removed but will often need

electrolysis or cryocautery to

prevent recurrence.

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Sudden visual loss

An easy list really as

they all need

specialist

assessment!

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Retinal detachment

 Floaters, photopsias, the shadow or curtain across the

sight.

Optic neuritis

 More women, pain on moving the eye, central scotoma

Posterior vitreous detachment

 Aged 50+, flashing lights, floaters

Vitreous haemorrhage

 Floaters, red haze may be present Red reflex absent.0

Disciform macular degeneration

•Sudden disturbance of central vision.

Slow visual loss

Refer to optician then ? refer.

 Corneal opacities

 Refer !

 Unless really trivial

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 Refer

 Remember the orthoptist

 Can you do a cover test?

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