eyes
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EyesTRANSCRIPT
Eyes
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You are not alone!You are not alone!
A very popular topic How much time at medical school? What do the acuity numbers mean!
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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?
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ExaminationSnellan chart, 3m or 6m, simple text for near
vision, PinholesFields, remember red and the quality of the red,
simple 4 quadrant testing.Pupils: a bright torch and magnifying glassSquintMovementsOpthalmoscopy: 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 eyeLids and tearsSlow visual loss in the quiet eyeTraumaSquints, new and congenital, rare
movement disorders…..(then a rare specialist rag bag)
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Red eye
ConjunctivitisCommonest, 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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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.
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ConjunctivitisChlamydia 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. 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.
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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. Brought to you by
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.Brought to you by
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. Persistent - incise.
Recurrent: ? DM, ? blepharitis, ? roseacea.
Can cause astigmatism from pressure.
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Stye
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.
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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
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Acute dacrocystitis
Medial inflammation over lacrimal sac. Refer, systemic therapy and topical urgently.
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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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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
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Ingrowing lashes
Damage to lids. May be removed but will often need electrolysis or cryocautery to prevent recurrence.
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Watering eyes Differential diagnosis.-
your homework!
Dry eyes Common, Remember to treat associated
blepharitis
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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
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Disciform macular degeneration•Sudden disturbance of central vision.Vascular occlusions•Field loss. Diabetes, hypertensionMigraine•Youth, headache, zigzag lines, multicoloured lights.Cerebrovascular disease•Elderly, bilateral loss.
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Slow visual loss
Refer to optician then ? refer. Cataracts Corneal opacities Macular problems Retinal problems
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Trauma
Refer ! Unless really trivial
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Squints
Refer Remember the orthoptist Can you do a cover test?
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