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Eyes
What is this? How can you tell?
Uveitis/Iritis
• Moderate hypopyon
• Conjunctival erythema with no limbic sparing
• Synechieae
• What are other fetures of uveitis?
Features of uveitis
• Acute vs chronic• Acute – pain, phtophobia +reflex
photophobia, tearing, decreased vision – onset hours to days
• Chronic – blurred vision, some redness, waxes and wanes
• Clinical exam – reflex photophobia, synechiae, cells in anterior chamber, conjunctivitis with no limbic sparing
Don’t forget
• Associations with other diseases:– SLE– IBD– Sarcoid– Chlamydia– Syphilis– TB– AIDS
Treatment
• Seek professional help
• Cycloplegic
• Topical steroids
• Not usually infective – don’t give Abs unless specific reason
What is this? Why?
Acute glaucoma
• Clouded cornea
• Red conjunctiva – no limbic sparing
• Fixed mid dilated pupil
• What else?
Acute glaucoma
• Sudden onset eye pain with vomiting and blurred vision
• Halos around lights
• Often onset with cycloplegic or exit from dark room
Treatment
• Laser/OT is definitive treatment
• A: Alpha-adrenergic agents (apraclonidine)
• B: Beta blockers (timolol)
• C: carbonic anhydrase inhibitors (acetazolamide/other zolamides)
• P: Parasympathomimetics (pilocarpine)
• P: Prostaglandin analogs (latanoprost)
What are the complications of this?
Traumatic hyphaema
• Grade 1 - Layered blood occupying less than one third of the anterior chamber
• Grade 2 - Blood filling one third to one half of the anterior chamber
• Grade 3 - Layered blood filling one half to less than total of the anterior chamber
• Grade 4 - Total clotted blood, often referred to as blackball or 8-ball hyphema
Complications
• Rebleed – 25%, more if higher grade
• Raised IOP – more likely with large hyphaema
• Synechiae
• Corneal bloodstaining – large hyphaema with raised IOP
Outcome
• Worse if large bleed, rebleeding or raised IOP
• Vision > 6/12 in 75% of patients– Only 35% in total hyphaema
• Worse in kids <6
How do you fix this?
You don’t
• This laceration involves the inferior canaliculus
• It should be repaired by an ophtalmologist
• Likewise lacerations involving the tarsal plate
What is this?
Central retinal vein occlusion
• Thrombotic process = the DVT of the eye
• May be asymptomatic or have varying amounts of visual loss and pain
• Look for risk factors: HTN, DM, bleeding disorders, autoimmune disorders, vasculitis, ETOH
• Treatment: ?aspirin ?warfarin ?lysis ?steroids ?normal saline
What is this?
Central Retinal Artery Occlusion
• The PE of the eye (or CVA)
• Embolic phenomenon
• Sudden painless loss of vision
• Risk factors: AF, endocarditis, coagulopathy, atherosclerotic disease, temporal arteritis
• Treatment: attempt to lower IOP, consider hyperbaric O2
How do you pick peri-orbital from orbital cellulitis?
Cellulitis near the eye
• Orbital = bad, periorbital = not so bad
• Pointers to orbital cellulitis:– History facial surgery/dental work– Sinus infection– Decreased vision– Pain on eye movements– Proptosis– Headache
Antibiotics
• Periorbital = skin, orbital = sinus
• Periorbital: fluclox or cephalexin or clindamycin
• Orbital: cefotaxime or fluclox/ceftriaxone plus ophthalmology consult