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Common Eye

Things

Common Eye

ThingsAdapted from sourceAdapted from source

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Name of chart?

Legal drivingRequirements?

Test with or without

glasses?

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Visual field defect?

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Which is the abnormal pupil??

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Sudden Loss ofVision

Think front to back: glasses, cornea,

lens, vitreous, retina, optic nerve, brain

Examine: vision, eye, red reflex, pupils,

visual field

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Abnormality?

Typical history?

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What injury in common

do both of thesepatients have?

Initial management?

Would you pull it out?

CT or MRI?

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Penetrating eye injury

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Complications of penetrating trauma

Flat anterior

chamber

Vitreoushaemorrhage

Damage to lens and iris

EndophthalmitisTractional retinaldetachment

Uveal prolapse

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Is the Globe Open?

Poor VA

Haemorrhagic chemosis

IOP

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Penetrating eye injury

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Initial Evaluation

Past ocular history

Pre-injury acuity

Previoussurgery

His

tory of injury Projectile

Examination

Is the globe open?

IOFB?

Avoid pressure on the globe

Investigation

CT, US

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Preoperative Management

Protect the globe

Shield

Prevent infection

Drops

andsystemic

Tetanus

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Preoperative management

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Which eye splashed with battery acid, which splashed

with lime/alkali?

Immediate

management?

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Grading of severity of chemical injuries

Clear

cornea

Grade I (excellent prognosis)

Limbal ischaemia - nil

Cornea hazy but visibleiris details

Grade II (good

prognosis)

Limbal ischaemia

1/2

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Management chemical

injury

IRRIGATE

IRRIGATE

IRRIGATE

SW

EEP PARTICULATE MATTERIRRIGATE

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injuries

Division of conjunctival bands

Correction of eyelid deformities Treatment of corneal opacity by

keratoplasty or keratoprosthesis

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Amniotic membrane grafting

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Abnormality?

Likely mechanism?

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Pathogenesis of orbital floor blow-out fracture

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Periocular ecchymosisand oedema

Infraorbital nerveanaesthesia

Ophthalmoplegia -typically in up- and

down- gaze (doublediplopia)

Enophthalmos - ifsevere

Signs of orbital floor blow-out fracture

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Is it life-threatening???

Airway

Breathing

Circulation

Limbs

etc

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Orbital Blow-out Fractures

Assessment

Is

the globe damaged? VA

Ecchymosis, oedema, emphysema

Enophthalmos

Eye movements

Infraorbital nerve anaesthesia

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ManagementMedical

No nose blowing

Systemic antibiotics?

Surgical

Indications Persistent central diplopia

>2mm enophthalmos

>50% floor or wall defect

Timing debatable

Subciliary or transconjunctival

Materials

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BEWAREWHITE

BLOWOUT

Young patient

Nausea and vomiting

Restriction of or painful eye movements

Greenstick + compartment syndrome

Urgent surgery required

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Surgical treatment of blow-out fracture

(a)S

ubciliary incision

Coronal CT scan following repair ofright blow-out fracture with syntheticmaterial(b) Periosteum elevated and entrapped

orbital contents freed

(c) Defect repaired with synthetic material

(d) Periosteum sutured

a b

c d

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What is the diagnosis?

What is the treatment?

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Management hyphaema

Should all be assessed by ophthalmologist

Bedrest

Pressure control

Avoid NSAIDs, nausea

SurgeryUncontrolled IOP or bleeding

Corneal blood staining

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Anterior segment complications of blunt trauma

Sphincter tear

Cataract Anglerecession

Hyphaema

Lenssubluxation

Iridodialysis Vossius ring

Rupture ofglobe

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Macular hole Optic neuropathyEquatorial tears

Posterior segment complications of blunt trauma

Choroidal rupture and

haemorrhage

Commotio

retinaeAvulsion of vitreous base

and retinal dialysis

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The Acute Red Eye

1) What is the vision?

2) Is the eye red? fornix or limbal?

3) Is there pain? ache or foreignbody sensation?

4) Is there photophobia?

5) Is there discharge?

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What is the stain?

What is the lesion?

Treatment?When would you use

steroids?

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Both eyes, vision is

normal: 3 signs?

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Normal vision, aching

eyeLikely diagnoses?

Other investigations?

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Occasionally inflamed

Diagnosis?

Management?

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CL wearer

Concerned?

2 general advice tips for CL wearers?

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White stuff? Central lesion? Cause?

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Diagnosis?

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59 yo, pain, n&v all night, poor

vision

Diagnosis?Management?

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55yo with headache and diploplia

Which cranial nerve? What must you also

check?

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25 year hx NIDDM

3 abnormalities?

Does better control improve

outcome?

Diabetic Sign?

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Diabetic. Sign?

2 mechanisms of visual loss?

Wh t i Di b ti

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Whats new in Diabetic

Retinopathy

Risk factors: time, severity, otherdiabetic problems, smoking

Fenofibrate for pre-existing retinopathy

Avastin/ Triamcinolone

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65yo, sudden visual

loss

Diagnosis?

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65yo, sudden visual

loss

Diagnosis?

CRVO

systemic hypertension

clotting studies if

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65yo cant read

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65yo can t read

Yellow spots?

Diagnosis?

Treatment?

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Whats new in ARMD?

OCT scanning Risk factors: smoking

Macuvision or not?

Avastin/ Lucentis

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What is an average intraocular pressure?

Would it be better to have a thicker cornea or athinner one?

Glaucoma

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Medications

Prostaglandin analogues

-Blockers

Alphagan

carbonic anhydrase inhibitors

Mannitol

(neuroprotection)

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Sign?