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What do we need?
• Snellen chart • Magnifier - preferably X8 • Torch with a blue filter • Fluoroscine drops or paper • Topical anaesthesia • Topical short acting mydriatic preferably
tropicamide• Hand held ophthalmoscope • A Systematic approach
Two types
• Medical - red eye (infection, inflammation)
- loss of vision
• Trauma - penetrating
- blunt
- chemical
- thermal
Examination
• Anatomical Lymphnodes Eye movements Lids and lashes Conjunctiva Cornea Anterior chamber Iris, Pupil & Lens Fundoscopy
Ophthalmoscopy
• Dim room
• Approach from 15cm, “O” magnification
• Right to Right, Left to Left
• Red reflex
• Aim nasally, small aperture, low light
• Cornea
• Lens
Fundoscopy 1
• Optic disk Swelling, cupping Colour Vessels, bleeds
• Macula Colour Exudates, abnormalities
Fundoscopy 2
• Vessels New vessels Tortuousity, segmentation Colour
• Rest of retina Pallor Bleeds Pigmentation Retinopathy
Fundoscopy 3
• Tips
Both eyes open – yours and theirs!
Stand to side
Peripheral retina
Dilate pupils - if safe, after RAPD test and
VA test
Polarised filter
Lids and Lashes
Lacrimal System
Bacterial Treatment
• Simple - chloramphenicol - drops day, ointment nocte’• Gonococcal - admit - swabs - IV cefoxitin 1g QID - Topical Gentamycin• Neonatal - IV and topical Pen• Chlamydia - occ. Tetracycline QID four weeks - Oral doxycycline or erythromycin for six weeks
Treatment
• Topical Antihistamines Spersallerge ®
• Topical Mast cell stabilisers Optichrom ®
• Topical Steroids
• Refer
Cornea
HZO
• Refer• Check immunity• Treat
Systemic antivirals
Topical antivirals
Analgesia
Glaucoma
Acute Angle Closure
Chronic OAG Cup/disk ratio
Acute Angle Closure Mx
• Recognise
• Risk or reality
• Meds - diamox 500mg stat, 250mg QID
- glycerine/mannitol 1-2g/kg
- pilocarpine 1-2% QID
- B-blockers BD
• Referral for Laser or Surgery
Diabetic retinopathy
• Background - dot and blot - hard exudates
• Pre-proliferative - cotton wool spots - IRMA - venous segmentation - large dark blots
• Proliferative - NVD or NVE - vitreous bleeds - fibrous proliferation and retinal detachment - neovascular glaucoma
Non Proliferative
• Background - dot and blot - hard exudates -micro aneurysms - macular oedema
• Pre-proliferative - cotton wool spots (soft) - IRMA - venous segmentation - large dark blots
Other trauma
• Traumatic mydriasis
• Traumatic iritis
• Vitreous bleed
• Retinal detachment
• Macula oedema
• Optic neuropathy
Trauma management
• Analgesia
• Low light
• Gentle
• Same as all eyes
• X rays
• Topical antibiotics
• Tet Tox