13.03.13 Ophthalmology tutorial

Top 4 key causes

• • Acute red eye

    • Conjunctivitis

    • Keratitis

    • Uveitis

    • Acute angle closure glaucoma

  • Acute visual loss

    • CVA

    • Giant cell arteritis

    • Central retinal artery/vein occlusion

    • Retinal detachment

    • Vitreous haemorrhage

  • Chronic visual loss

    • Cataract

    • Open angle glaucoma

    • AMD

    • Diabetes

Acute red eye

Keratitis

• • AKA corneal ulcer

  • Contact lens use is highly suggestive

  • Treat with a fluoroquinolone

    • Levofloxacin

    • NB Ciprofloxacin is also in this class (cf C. diff risk)

History

• • Ask about three key things in the first 30 seconds:

    • Visual changes

    • Pain

    • Redness

  • Don't forget their AGE!

  • Photophobia?

  • Discharge?

Visual field testing

• • Cover one eye

  • Look at my nose

    • Any bits of my face blurred or missing?

  • Look at my eye

    • Hold up 1 or two fingers (clearly) in each quadrant

Notes

• • Conjunctivitis is not painful

  • Keratoconus: Degenerative disorder in which structural changes within the cornea cause it to thin and change to a more conical shape

  • Old people don't get migraines - Consider other causes

  • Vitreous haemorrhage from proliferative diabetic retinopathy

  • Rods are lost first in retinitis pigmentosa => Peripheral vision lost first

  • Small bowel resection => Vitamin A malabsorption => Visual loss

  • Optic radiations

    • Superior visual fields travel through the temporal lobe

    • Inferior visual fields travel through the parietal lobe

  • Some people have collateral supply to the foveal parts of the occipital lobe from the MCA => PCA strokes can spare central vision

  • Onset is acute if they can remember what they were doing at the time

  • Glaucoma starts with a arcuate scotoma which progresses to tunnel vision

  • Intraoccular pressure rises from 10-21 mm Hg to 60-70 mm Hg in glaucoma