Opthalmology

Diabetes
• Refractive changes due to glucose, correct when
glucose stable
• Extraocular muscle paralysis CnIII and CnVI
• Retinopathy
– Background – microaneurysms, dot haemorrhage,
hard exudates
– Pre-Proliferative – cotton wool spot, blot
haemorrhage, venous loops
– Proliferative – neovascularisation, traction retinal
detachment, glaucoma.
 Investigation / Management
Retinopathy
• Ix – Digital photographic screening and Fundal
Fluorescien angiography.

• BP/Lipid/Glycaemic control
• Photocoagulation – retinal/macular, argon
laser or xenon.
• Vitrectomy – clear vitreous haemorrhage,
allows laser, relieve traction
Background retinopathy
Background
Pre Proliferative
Pre Proliferative
Proliferative
Proliferative Retinopathy
Laser
Photocoagulation
 Hypertension
• Keith Wagner Classification
• Grade I – minimal constriction and irregularity of
arterioles
• Grade II – AV nipping
• Grade III – Flame haemorrhages and soft
exudates
• Grade IV – papilloedema, collection of hard
exudates radiating in a star shaped formation
• Fundal changes reflect severity of HTN, reversal
shows control
Hypertensive Retinopathy
Grade IV Malignant Phase
Red Eyes
 Conjunctivitis
• Conjunctivitis
– Grittiness sensation
– Normal Vision
– Purulent discharge
– Crusting of lid margins
– History of contact
– Redness of conjunctiva
– Mx Hygiene, swab, prescribe topical Abx
chloramphenicol or fusidic acid
– Bilateral consider chlamydia
– Opthalmia neonatorum – newborns under 1 month,
reportable disease
 Corneal Ulcer/Keratitis/Abscess
• Painful red eye
• Contact lenses, FB, facial cold sores???
• Photophobia
• Purulent discharge in bacterial cases
• Fluorescein staining reveals area of epithelial
defect under cobalt blue light
• Immediate opth opinion, corneal scrape,
– antivirals for herpes simplex dendritic ulcer
– Intense Abx for bacterial ulcer
Corneal Ulcer
Keratitis
 Uveitis
• Inflammation of the Uveal tract – iris, ciliary body and choroid
• Painful red eye
• Photophobia
• Blurred vision or floaters
• Cilicary circumcorneal injection
• Reduced acuity
• Sluggish or irregular pupil
• Iris details may be hazy
• Inflam cells on corneal endothelium
• Raised intraocular pressure
• Cataract in recurrent or chronic uveitis
• Rx reducing regimen of topical steroid (dexamethasone 0.1%)
• Cycloplegic and dilating drop (cyclopentolate 1%) for pain
relief and prevention of synechiae
Uveitis
 Acute Angle Closure Glaucoma
• Older hypermetropic people
• Sudden onset severly painful red eye
• Blurred vision
• Halos around lights
• Headache
• Nausea and vomiting

• Reduced visual acuity

• Brick red eye
• Hazy cornea
• Vertically mid dilated fixed pupil
 Acute Angle Closure Glaucoma
• URGENT
• IV carbonic anhydrase inhibitor –
acetazolamide 500mg
• Oral acetazolamide for 24h
• Pilocarpine
• Timolol or Iodipine to reduce IOP
• Laser Iridotomies as permanent prevention
• Trabeculectomy
Acute
Glaucoma
Sudden Painless Loss of Vision
 Retinal Detchment
• Sudden Painless Loss of vision
• Usually preceeded by symps of flashing lights
• Floaters and visual field defects may occur
• Visual acuity may be normal if the macula is
not involved
• Once macula involved central vision is lost
• Manage – laser to retinal hole or retinal
surgery with or without vitrectomy
 Central Retinal Vein Occlusion
• Aetiology
– Systemic Hypertension
– Raised intraocular pressure
– Hyperviscosity syndromes
– Vessel Wall disease (diabetes, sarcoidosis)
• Check
– IOP
– BP
– Viscosity
• Flame shaped Haemorrhages
• Tortuous vessels
 Central Retinal Artery Occlusion
• Aetiology
– V high IOP ? Glaucoma
– Arterial Embolus
– Atheroma or inflammation (Giant cell arteritis)
• Check
– BP
– Pulse ?AF
– Carotids ?bruit
– Heart ?murmur
– Refer to Cardiology
• Cherry red spot at origin of artery
Central Retinal Artery
occlusion
Gradual Loss of Vision
 Cataract
• Blurred vision
• Glare
• RF: DM, steroids, chronic uveitis, FH,
Congenital
• Congenital risk amblyopia
• Rx Phacoemulsification and
Lens implantation
Age Related Macular Degeneration
• Commonest cause of blindness in the elderly
• Causes loss of central vision
• Macula has fine pigmentory clumps and patches of
atrophy
• White round spots – drusen, usually large and
confluent
• Neovascularisation may occur
• Manage – urgent fundal fluorescein andgiographic
tests to treat neovasc with photocoagulation
• Peripheral vision is not affected
Some Randoms
Papilloedema

Scleromalacia
 Chalazion

Exopthalmos
Stevens Johnson
Syndrome

Pterygium
 Pinguecula

Corneal Dystrophy

Iridocyclitis (deformed
pupil)
 Toxoplasma
Chorioretinitis

Chorioretinitis
 Histoplasma infection

Macula Dystrophy

Sickle cell Retinopathy

 Optic Atrophy

Retinoblastoma
 Retinopathy of prematurity
Dragging of the optic disc

Tuberous sclerosis

Siderosis Bulbi – retained Fe Particle

Iridodialysis
Iris torn at root

Hyphaema – blood in anterior

chamber

Lens Dislocation