Eyes

What is this? How can you tell?

Uveitis/Iritis

• Moderate hypopyon

• Conjunctival erythema with no limbic sparing

• Synechieae

• What are other fetures of uveitis?

Features of uveitis

• Acute vs chronic• Acute – pain, phtophobia +reflex

photophobia, tearing, decreased vision – onset hours to days

• Chronic – blurred vision, some redness, waxes and wanes

• Clinical exam – reflex photophobia, synechiae, cells in anterior chamber, conjunctivitis with no limbic sparing

Don’t forget

• Associations with other diseases:– SLE– IBD– Sarcoid– Chlamydia– Syphilis– TB– AIDS

Treatment

• Seek professional help

• Cycloplegic

• Topical steroids

• Not usually infective – don’t give Abs unless specific reason

What is this? Why?

Acute glaucoma

• Clouded cornea

• Red conjunctiva – no limbic sparing

• Fixed mid dilated pupil

• What else?

Acute glaucoma

• Sudden onset eye pain with vomiting and blurred vision

• Halos around lights

• Often onset with cycloplegic or exit from dark room

Treatment

• Laser/OT is definitive treatment

• A: Alpha-adrenergic agents (apraclonidine)

• B: Beta blockers (timolol)

• C: carbonic anhydrase inhibitors (acetazolamide/other zolamides)

• P: Parasympathomimetics (pilocarpine)

• P: Prostaglandin analogs (latanoprost)

What are the complications of this?

Traumatic hyphaema

• Grade 1 - Layered blood occupying less than one third of the anterior chamber

• Grade 2 - Blood filling one third to one half of the anterior chamber

• Grade 3 - Layered blood filling one half to less than total of the anterior chamber

• Grade 4 - Total clotted blood, often referred to as blackball or 8-ball hyphema

Complications

• Rebleed – 25%, more if higher grade

• Raised IOP – more likely with large hyphaema

• Synechiae

• Corneal bloodstaining – large hyphaema with raised IOP

Outcome

• Worse if large bleed, rebleeding or raised IOP

• Vision > 6/12 in 75% of patients– Only 35% in total hyphaema

• Worse in kids <6

How do you fix this?

You don’t

• This laceration involves the inferior canaliculus

• It should be repaired by an ophtalmologist

• Likewise lacerations involving the tarsal plate

What is this?

Central retinal vein occlusion

• Thrombotic process = the DVT of the eye

• May be asymptomatic or have varying amounts of visual loss and pain

• Look for risk factors: HTN, DM, bleeding disorders, autoimmune disorders, vasculitis, ETOH

• Treatment: ?aspirin ?warfarin ?lysis ?steroids ?normal saline

What is this?

Central Retinal Artery Occlusion

• The PE of the eye (or CVA)

• Embolic phenomenon

• Sudden painless loss of vision

• Risk factors: AF, endocarditis, coagulopathy, atherosclerotic disease, temporal arteritis

• Treatment: attempt to lower IOP, consider hyperbaric O2

How do you pick peri-orbital from orbital cellulitis?

Cellulitis near the eye

• Orbital = bad, periorbital = not so bad

• Pointers to orbital cellulitis:– History facial surgery/dental work– Sinus infection– Decreased vision– Pain on eye movements– Proptosis– Headache

Antibiotics

• Periorbital = skin, orbital = sinus

• Periorbital: fluclox or cephalexin or clindamycin

• Orbital: cefotaxime or fluclox/ceftriaxone plus ophthalmology consult