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EYE diseases

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EYE diseases Powered By Docstoc
					   Eyes
Dr Bruce Davies
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.
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?
Examination
  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.
Clinical
classification
   Red eye
   Lids and tears
   Slow visual loss in the quiet eye
   Trauma
   Squints, new and congenital, rare
    movement disorders
   …..(then a rare specialist rag bag)
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 (?)
Conjunctivitis
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.
Conjunctivitis
Chlamydia
 Mucopurulent, cornea inflamed, visual loss. Often
   with STD. Permanent damage possible, topical and?
   systemic tetracyclines. Refer.
Infants
 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.
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.
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.
Lids and tears
Chalazion
 = meibomnian cyst. In the lid. Warm
  compresses and chloramphenicol.
  Persistent - incise.
 Recurrent: ? DM, ? blepharitis, ?
  roseacea.
 Can cause astigmatism from pressure.
Stye
 An infection of lash follicle. May be head
  of pus - nick with needle. Or warm
  compresses and chloramphenicol.
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.
Blepharitis
 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
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
Ectropion
 Watery eye.. Laxity from age or nerve palsy.
  Ointment and refer for LA operation to correct.

Entropion
 Common especially in the elderly. Scarring from the
  lashes.
 Often results from blepharitis or chronic conjunctivitis
 Refer
Ingrowing lashes
 Damage to lids. May be removed but
  will often need electrolysis or
  cryocautery to prevent recurrence.
Watering eyes
 Differential diagnosis.-
           your homework!
Dry eyes
 Common,
 Remember to treat associated
  blepharitis
Sudden visual
loss
An easy list really as
 they all need
 specialist
 assessment!
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.
Disciform macular
degeneration
•Sudden disturbance of central vision.
Vascular occlusions
•Field loss. Diabetes, hypertension
Migraine
•Youth, headache, zigzag lines, multicoloured lights.
Cerebrovascular disease
•Elderly, bilateral loss.
Slow visual loss

Refer to optician then ? refer.
 Cataracts
 Corneal opacities
 Macular problems
 Retinal problems
Trauma

 Refer !
 Unless really trivial
Squints

 Refer
 Remember the orthoptist
 Can you do a cover test?

				
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posted:11/1/2011
language:English
pages:28