EYE EXAM

How to approach the eye..

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

History

• Main symptom(s)

• Pain

• Discharge

• Vision

• Any trauma

• PMH, PSH

• Medication

Examination

• Anatomical Lymphnodes Eye movements Lids and lashes Conjunctiva Cornea Anterior chamber Iris, Pupil & Lens Fundoscopy

Eye Movements

Ophthalmoscopy

• Dim room

• Approach from 15cm, “O” magnification

• Right to Right, Left to Left

• Red reflex

• Aim nasally, small aperture, low light

• Cornea

• Lens

Red Reflex

Fundoscopy 1

• Optic disk Swelling, cupping Colour Vessels, bleeds

• Macula Colour Exudates, abnormalities

Papilloedema

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

Rest of exam

• Visual acuity

• Visual fields

• RAPD

• “Digital” tonometry

VA – Pinhole

Rest of exam

Lids and Lashes

Lacrimal System

Dacryocystitis Treatment

• Acute - antibiotics

- I & D

• Chronic - DCR

Lids and lashes

Viral

Viral treatment

• Check Cornea!

• Symptomatic, supportive

• Chloramphenicol

• Refer if in doubt

Bacterial

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

PKC

• HS reaction• Self resolving• ?Steroids

Allergic, Vernal, GPC

Treatment

• Topical Antihistamines Spersallerge ®

• Topical Mast cell stabilisers Optichrom ®

• Topical Steroids

• Refer

Conjunctiva - other

Cornea

HZO

• Refer• Check immunity• Treat

Systemic antivirals

Topical antivirals

Analgesia

Glaucoma

Acute Angle Closure

Glaucoma Post - Surgery

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

Proliferative

• NVD• NVE• Fibrovascular

proliferation• Vitreous bleeds

Proliferative 2

FB, Blunt and Perforating Trauma

Blunt Trauma

Corneal Injury

Lens Injury

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

References

• UCT Ophthalmology Lecture Notes

• www.trauma.org

• www.medicine.ucsd.edu/clinicalmed/eyes.htm

• www.atlasophthalmology.com

• www.eyecasualty.co.uk

• www.webeye.ophth.uiowa.edu/eyeforum