Final year‎ > ‎

14.01.22 Ophthalmology

Herpes
  • Dendritic pattern
  • DON'T give steroids


Cellulitis
  • Pre-septal
    • Anterior to orbital septum
    • Oral Abx
  • Orbital
    • Posterior to orbital septum
    • Often from sinusitis
    • Clinical signs: Reduced mobility, Proptosis, Reduced vision (colour lost first), RAPD, Optic disc oedema, Painful movements
    • => Optic nerve damage, Meningitis
    • Orbital CT, IV Abx, Cultures


CRAO

  • Pale macula
  • Cherry-red spot at fovea - Blood supply from posterior ciliary arteries


Corneal abrasion

  • Pain, tears, photophobia
  • Oxybuprocaine + fluorescein
  • Try (once) to remove with cotton bud
  • 5/7 topical chloramphenicol
  • Safety net
  • Any metal - refer to ophthalmology


Subconjunctival haemorrhage

  • WHY DID IT HAPPEN??
    • Warfarin, Head injury, NAI
  • Exclude hyphaema (no blood in anterior chamber)


Burns

  • Acid => Coagulative necrosis
  • Alkali => Liquefactive necrosis
    • Much worse
    • Keeps going deeper
  • Irrigate until pH is normal (7.0 - 7.3)
  • Then refer to ophthalmology


Ruptured globe

  • Tear-drop pupil - Points to injury
  • STOP EXAMINING
  • Cover with cup + refer to ophthalmology


Orbital blowout fracture

  • Will happen before the globe ruptures
  • Check for muscle/nerve entrapment - esp. inferior rectus
    • => Can't look up
  • This is an open fracture (maxillary sinus) => Abx


Retrobulbar haematoma

  • Compartment syndrome of the eye
  • => Optic nerve pressure / Ischaemia
  • Can do lateral canthotomy


Random notes
  • Contrindications to dilation
    • Head trauma, ?Ruptured globe, Glaucoma
  • Schaffer's sign
    • Clumping of pigmented cells in anterior chamber and on corneal endothelium. Also known as "tobacco dust".
  • Upper zone fibrosis
    • B - Beryllium
    • R - Radiation
    • E - Extrinsic allergic alveolitis
    • A - Ankylosing spondylitis / Aspergillus
    • S - Silicosis 
    • T - TB
    • S - Sarcoidosis
    • C - Coal Workers pneumoconiosis
    • L - Langahans Cell histiocytosis
    • A - Ankylosing Spondylitis
    • P - Psoriasis
  • Lower zone
    • D - Drugs (AMEN: Amiodarone, Methotrexate, Ergot-derivatives, Nitrofurantoin)
    • R - Rheumatoid arthritis
    • C - Connective tissue disease 
    • I - Idiopathic Pulmonary Fibrosis
    • A - Asbestosis
    • S - Systemic sclerosis
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