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Ophthalmology Mariam Conde, Esther AkinyeleAll slides are uploaded to MedAll for your personal use! Please fill in the feedbackform so we can provideyouwith access :)OphthalmologyT opics ● ●Pain unilateral or Bilateral Important negatives ● ●Unilateral/bilateral ●Diplopia ●Photopsia, floaters ● ●SOCRATES – onset, duration, ● ●progression (worsening or stable?) ●Headache, scalp tenderness, jaw ● ●Other Questions tenderness Past eye history, PMH, DH, ● ●Change in vision SH, FH ● ●Colour, acuity, global or in one specific area, ● ●Discharge , Irritations, lacrimation, “foreign body sensation ● ●Erythema ● ●Diplopia ● ●Photopsia, floaters ●DISCLAIMER: Our aim is to help with your revision and supplement/consolidate your TCD learning – use this as an additional resource, not as a replacement!Facial / Periorbital swellingOrbital and PeriorbitalCellulitisWhat + Symptoms ● What ● Orbital Cellulitis: Inflammation secondary to infection of fat and muscles posterior to the orbital septum (Acute bacterial sinusitis!) ● Periorbital Cellulitis: Superficial infection anterior to orbital septum (Chalazion, Bug bite) Symptoms ● Orbital: Pain, Proptosis, Pupillary changes/vision, Oedema, Ophthalmoplegia ● Periorbital: Pain, oedemaInvestigation Bedside -Full eye exam (?signs) -Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema. Bloods -Full blood count (raised: WBC + inflammatory markers) -Blood culture and microbiological swab (?cause) - Imaging -CT with contrast - - Inflammation DEEP into septum, sinusitis (why?)Loss of Red ReflexCataractsWhat + Symptoms ●What ●Gradual increase in opacity of the lens ●Symptoms ●A gradual reduction in visual acuity ●Glare ●Halos around lights ●Colours appear faded ●Signs: loss of red reflex ●Ix: Ophthalmoscopy, Slit lamp – visible cataract ●Mx: Definitive management w/ surgeryFlashers and Floaters SubtitleRetinal DetachmentWhat + Symptoms What -The neurosensory layer separates from the retinal pigment epithelium -Macula can either remain On or Off Symptoms -Flashers / Floaters -Unilateral Painless + progressive loss of vision ”Curtain falling” (shadow from the periphery to the centre) -Macula off -> reduced visual acuityInvestigation Swinging light test -RAPD (relative afferent pupillary defect) if optic nerve is involved -Fundoscopy -Loss of red reflex -Retina folds: wrinkled, pale -Slit lamp -Tobacco dust “Schaffer's sign” -Ultrasound -Tear -Detachment Vitreous Haemorrhage What -Bleeding into the vitreous humour -Causes -Proliferative diabetic retinopathy -Ocular trauma -Posterior vitreous detachment Symptoms -Painless loss of vision -Floaters/shadows -Red hue -Signs -Reduced visual acuityVitreous Haemorrhage Investigation -Fundoscopy – - Haemorrhage in the vitreous cavity -Slit lamp -RBC in anterior vitreous -Ultrasound -DDx: retinal tear/detachment -Fluorescein angiography -Neovascularisation -Management -Find the cause -Laser therapy: peripheral vasculopathy, retinal tear -Surgery: non-resolving, peripheral vascular detachmentEye DiscomfortAnterior Uveitis What -Inflammation of the anterior portion of the uvea (iris, ciliary bodies, choroid) -Symptoms -Painful red eye -Small irregular pupil -Intense photopsia -Hypopyon (pus + inflammatory cells in the anterior chamber) -Blurred vision -LacrimationAnterior Uveitis Investigation: Eye exam -Ciliary flush -Miosis (constricted pupil) -Abnormally shaped pupil -Hypopyon -Management -(1) Urgent assessment by ophthalmologist -(2) steroids, cycloplegics -(3) Recurrent: DMARDs, anti-TNF -Conjunctivitis What -Inflammation of conjunctiva -The conjunctiva is a mucous membrane that covers the eye + lines the eyelid -Bacterial, viral , allergic Symptoms Management -Itchy, foreign body sensation, gritty -Conservative: self limiting `(1-2 works) sensation -Hygiene control = prevents spread -Discharge: Serous if viral, Purulent if -Bacterial: Chloramphenicol of Fusicidic bacterial acid -Allergy: oedema, itching, lacrimation -Allergy: anti-histaminesSuddenChange inVision OpenAngleGlaucoma What -Optic nerve damage from raised intraocular pressure (IOP) -Chronic, gradual progression Risk Factors -Increasing age, family history, black ethnicity, myopia Presentation -Peripheral vision loss (tunnel) -May be asymptomatic -(± Headaches, halos, blurred vision)OpenAngleGlaucoma Investigations -Tonometry -Slit lamp – optic nerve cupping -Visual field testing Management -Laser therapy -Eye drops: B-blockers, prostaglandin analogues… -trabeculectomyDiabeticRetinopathy What -Retinal blood vessel damage from prolonged hyperglycaemia Causes -Chronic hyperglycaemia → microvascular damage Symptoms -Vision loss, floaters, blurry vision Signs -Microaneurysms, haemorrhages, exudates -Cotton wool spots, venous beading, neovascularisationDiabeticRetinopathy Investigations -Fundoscopy -Differentiates between background, pre-proliferative and proliferative Management -Non-proliferative: Monitor, optimise diabetic control -Proliferative: -Pan-retinal photocoagulation (PRP) -Anti-VEGF injections -Surgery (e.g., vitrectomy for severe cases) -Age-Related Macular Degeneration What -Progressive macula degeneration -Causes blindness -Wet = neovascular (10%) -Dry = non-neovascular (90%) Symptoms -Gradual central vision loss -Metamorphopsia (wavy lines) -Difficulty reading small text Signs -Scotoma, Drusen (yellow deposits)Age-Related Macular Degeneration Investigations -Fundoscopy, OCT, Fluorescein angiography Management -Dry AMD: No specific treatment, monitor, lifestyle changes -Wet AMD: Anti-VEGF injections (e.g., ranibizumab, afliberceptSuddenChange inVisionAcuteAngleClosureGlaucoma What -Iris blocks trabecular meshwork → impaired drainage of aqueous humour -Rapid rise in intraocular pressure → ophthalmological emergency Causes -Shallow anterior chamber -Certain medications (e.g., adrenergic, anticholinergics, TCAs)AcuteAngleClosureGlaucoma Symptoms -Painful red eye -Blurred vision and halos -Headache, nausea, vomiting Signs -Mid-dilated, fixed pupil -Hard eyeball Management -Analgesia -Pilocarpine, acetazolamide and timolol -Laser iridotomy What •Blood clot (thrombus) blocks retinal vein drainage, causing vision loss CROAvsCRVO Types What •Obstruction to the central retinal artery, leading to sudden vision lossaemic: Leads to neovascularisation Causes •Non-ischaemic: No neovascularisation •Atherosclerosis (most common) Causes •Giant cell arteritis (vasculitis) •Hypertension, high cholesterol, diabetes, smoking, high plasma viscosity, Symptoms myeloproliferative disorders, inflammatory conditions (e.g., SLE) •Sudden painless vision loss ("curtain coming down") Symptoms •Relative afferent pupillary defect •Painless blurred vision or vision loss, dependent on vein affected Signs Signs •Pale retina with cherry red spot (fovea) on fundoscopy •Fundoscopy: Dilated tortuous veins, haemorrhages, retinal oedema, cotton Management •Emergency referral wool spots, hard exudates •Giant cell arteritis: ESR, temporal artery biopsy, high-dose steroidsnagement •Immediate management: Ocular massage, paracentesis, carbogen inhalation,rral to ophthalmology isosorbide, acetazolamide, mannitol, timolol •Treat macular oedema and prevent neovascularisation: Anti-VEGF Manage cardiovascular risk factors, secondary prevention (ranibizumab, aflibercept), dexamethasone implant, laser photocoagulationRed Eye What •Benign, self-limiting inflammation of the episclera (outer layer of sclera) Scleritisvs Episcleritis Causes What •Often associated with inflammatory conditions (e.g., rheumatoid arthritis, inflammatory bowel disease) •Inflammation of the sclera •Presentation Causes •Acute-onset unilateral redness (localised or diffuse) •Idiopathic •Mild pain (or none) •Rheumatoid arthritis, vasculitis •Dilated episcleral vessels Symptoms •No photophobia, discharge, or visual acuity changes •Severe, boring pain Differentiation from Scleritis •Red sclera, photophobia •Phenylephrine drops blanch episcleral vessels (redness disappears), Investigation unaffected in scleritis •Assess for systemic conditions Management Typically resolves in 1-2 weeks Management •NSAIDs, steroids, immunosuppression What •Benign, self-limiting inflammation of the episclera (outer layer of sclera) Scleritisvs Episcleritis Causes What •Often associated with inflammatory conditions (e.g., rheumatoid arthritis, inflammatory bowel disease) •Inflammation of the sclera •Presentation Causes •Acute-onset unilateral redness (localised or diffuse) •Idiopathic •Mild pain (or none) •Rheumatoid arthritis, vasculitis •Dilated episcleral vessels Symptoms •No photophobia, discharge, or visual acuity changes •Severe, boring pain Differentiation from Scleritis •Red sclera, photophobia •Phenylephrine drops blanch episcleral vessels (redness disappears), Investigation unaffected in scleritis •Assess for systemic conditions Management Typically resolves in 1-2 weeks Management •NSAIDs, steroids, immunosuppressionKeratitis What -Inflammation of the cornea, caused by: -Viral (e.g., herpes simplex) -Bacterial (e.g., Pseudomonas) -Fungal (e.g., Candida) -Contact lens-related -Exposure (e.g., ectropion) -Presentation -Painful red eye -Photophobia, vesicles, foreign body sensation -Watery discharge, reduced visual acuityKeratitis Diagnosis -Slit lamp: Dendritic corneal ulcer (fluorescein staining) -Corneal scraping for viral testing - Management -Urgent referral to ophthalmology -Antiviral treatment (e.g., aciclovir, ganciclovir) -Corneal transplant for scarring or vision lossThank You Same time,same place