Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

No, no, no, I'm keeping it off here. Cool. Let's see. Um Right. How can I tell if people have joined you? Ok, fine, cool. Um Right. Hi guys. Um Welcome to our session on acute ophth ophthalmic conditions. Um So um I'm gonna aim to keep this like a quick, we will talk about um the main acute stuff that you guys need to be aware of and I'll be giving you guys a couple of heads up as to things that frequently come in, MC Qs, things that maybe you should look out for or that give you hints um to a condition. There is a couple of like cheat points as to how you can distinguish one from another. Um And then obviously we're gonna be stopping frequently for questions. Um Out of obviously, you have also sat fine. So if you wanna pitch in at any point, please, um please feel free to just um pitch in whenever you want. Um Right. So, oh, sorry, very re very briefly to introduce myself. Um I, I'm one of the ones based in Birmingham Central. I'm currently based in Midlands Metropolitan Hospital. Um Right, and I have a who is based in Birmingham South. Um And yeah, um anyway, so today we'll be covering very quickly a red eye what causes it? We're gonna be quickly be touching on loss of vision, more specifically sudden loss of vision as this is more of an acute session. Um and then we'll be covering um trauma, ok, starting with the acute red eye. So, um there's many possible a allergies that could result in in acute red eye um ranging from trauma to inflammation, infection, glaucoma hemorrhage with obviously uh many different things that can cause them in many different resulting circumstances. In terms of um whether it could could, it could be just an acute or temporary change in your vision or have more detrimental effects. Uh um the main causes of red eye that we see um generally presenting that are maybe um not as um that maybe sorry are a bit more common. Um Your classic one is conjunctivitis. Um So very, I'm gonna get into each of these in a bit more detail, but I just thought we'll quickly talk about each of them. Um Your classic one is conjunctivitis. It was just an in infection of your conjunct. Uh you get redness um of the entire surface of the eye, it just looks kind of red and um you have a normal pupil, clear cornea. So no change in pupil size, nothing in your anterior chamber. People, they will often present with um different extents of stickiness or grittiness, they might also present with discharge depending on what caused the conjunctivitis. Um You also have piitis, which is basically um as you can see, it's not the whole eye isn't as red as you would in conjunctivitis. It's more so the blood vessels are a bit more uh prominent. Um and visual acuity would be normal in comparison to other cases um of red eye. Um they will present with irritation. However, the vision again will not be affected. Um Another one that you would urgently referral to ophthalmology is anterior uveitis cause a lot of the times it's associated with systematic etiology. Um This one would be more so around your pupil, you'll get this con cer of circumcorneal redness, you'll get a bit more of a constrictive pupil appearance. People will come with pain, photophobia, pain on the eyesight and then um they'll also have a bit of a watery discharge and their vision. Um a lot of the times is reduced. It might also cause might be a corneal abscess, which is which you will kind of see most of the times without having to look at the microscope. But if you put it in the more in the microscope, be even more um out there. It's basically, again, generalized redness, very similar to conjunctivitis except you'll see the thein abscess either either under ei either under the microscope or with your naked eye, you'll also get scleritis. Another cause of red pain. It's very different from episclera, much more serious. Again, it could be so associated with more systematic features. Um We'll talk about how you can do them because that's a very common M CQ question. We also have very common acute angle closure, glaucoma, another ophth up another ophthalmic emergency. Um and this one is very classically known for a mid dilated pupil comes on suddenly really bad pain. Um It might also present with other systematic features like vomiting, right? So what I think is really easy um is if you split the eye into compartments, if we quickly revise or um eye anatomy. So, conjunctiva where you'd get. So where you think about red eye, you think about, usually it will be in your anterior compartments cause it appears red. So it could be any of these features that's affected and depending on which feature is affected, you'll get the name. So if it's your conjunctiva, conjunctivitis, sclerus, pitti, and so on so forth. Um With uveitis, what's important to know is that while anterior uveitis is the more is the main focus, there is different forms of uveitis, which we'll also talk about in a bit more detail, like posterior uveitis or panuveitis, right, going into the less severe end of the spectrum. Um We're gonna be talking about blepharitis, blepharitis is in simple terms, just an inflammation of your eyelids um or any of the associated structures in your eyelids. So that would be your eyelashes, the skin around the area or even um, the glands um, around your eyelashes. And um, it's has a very common association with Seborrhoic dermatitis. So, a guy with Seborrheic dermatitis presents to presents with a red eye. Make sure you rule out blepharitis cause a, it's an easy one to treat that you don't need to worry about. And um, it's a very easy one to treat that you don't need to worry about. And um you just wanna get it out of the way. Um Again, a lot of the times it will be um bilateral as well, you will have that discomfort and stickiness. And um they love asking you how to treat it for some reason. This one is just conservative management. So a lot of the times they'll give you a hot compress and they'll ask you to maintain the hygiene. So a lot of the times what that will mean is just having cotton pods and just kind of basically brush brushing this off, making sure that it stays clean. Um Something that's really interesting. That kind of stuck with me is when I was attending an ophthalmology clinic, they asked one of the patients to maintain that hygiene, losing baby shampoo. Um I don't know if that's gonna help you guys remember that li hygiene is something, but if it helps, it helps, then we have um also artificial tears. Um and then uh moving on to conjunctivitis. So there's many different causes. There's many different causes. Um, the two main ones that we're focusing on is, um, splitting it into allergic or infective, right? Uh, it's allergic, it's usually systematic, obviously. So it will be bilateral, it be red. Um, it can present with hemos or basically swelling. Um, it will be very itchy and a lot of times as we know allergy comes, um, in packs. So it won't just be, that's, um, allergic conjunctivitis. They'll come with hay fever with an asthma. Um, basically, um, a history of, for example, for girls or, um, others might make you think. Hm, this is more of an allergic picture rather than an infected one. that being said also, we need to know that with infected one, it's more likely usually to be one sided because it's an infection. However, it can present bilaterally as well. If it's an aller, if it's an allergic conjunctivitis, you'd manage it. It for most allergies except a lot of the time, it's just a bit more topical. So your muscle stabilizers, um, with, in fact, you can split it into your classic bacteria. I won't ask you to distinguish between both. Uh, um, sorry. Um, there's other, there's other causes but these are, are the two main ones and, and a very important thing to say, uh which I'll get into in a bit more detail is a lot of the contact lens. Um, if they wear contact lens and they like to see you split, especially in ay, they like to see you split it into lifestyle medication and surgical. Lifestyle wise. You can say I checked. Yeah, they're wearing contact lenses. I'd give them contact lens. Uh, even if they're not using contact lens, just general like eye allergies. That kind of thing is something that is really appealing to them because it shows them that you're looking at the bigger pictures and that you genuinely understand what a all could be, right? Scleritis and epis sclerosis, this came up in my ay. Um So we'll quickly talk about and I'll tell you guys um what questions came. Uh um So in very episclera is inflammation of episclera, the lar right above and then sclera is the sclera, which is a bit deeper. Um So using a phenyl efferent test um and basically what happens is this. So um if you put phenylephrine and the uh vessels blanch then and it's epis scleritis cause if you think about it, it's more superficial. So it's more affected by the drops. Um However, a lot of features can tell you can make a distinguished between both hands, why they don't need the test as much. Um So with much more red, it would be more painful. They'll have a lot of photophobia, they could have a reduction in their visual acuity. Um Both of them can be associated with systematic features, but a classic link they like to make in MCQ S is um scleritis with either um sle lupus or with rheumatoid arthri. Um And with, and obviously, because they can both present very, very similarly, if you're unsure between both, both of them, just send them for urgent ophthalmological assessment um to make sure you rule out scleritis. And then as with most inflammation, you'd give nsaids and if needed, you can give immunosuppressants.