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EYEcomplaints1DRALEXNOVAK
• 65yearoldman• PMHhypertension,coronaryarterydisease,diet-controlledtype2diabetes• Presentswithtransientvisuallossinlefteyelasting10minutes• Normalopthalmological examinationincludingVA
Amaurosis fugax
• Transientischaemiaoftheretina
• usuallyembolicorthrombotic;canoccursecondarytohypoperfusionstates,hyperviscosity orvasospasm
• DDx includesmigraine,papilloedema,giantcellarteritis,impendingcentralretinalveinocclusion,glaucoma,dissection
Amaurosis fugax
• ManageasperTIA:• Aspirin• TIAclinic• Managecardiovascularriskfactors
• NBmayneedfurtheracuteimagingandinvestigationifsuspicionOFothercausee.g.Dissection
• 62yearoldman• PMHdiabetes,angina• SuddenPainlessonsetlossofvisionReye• o/eJustAbleidentifymovementwithReye
CentralRetinalArteryOcclusion
• Urgentophthalmologyreferral• UrgentESRandCRPtoexcludeGCA• TIAandvasculitisworkupasperamaurosisfugax
CentralRetinalArteryOcclusion
• immediateocularmassage• anteriorchamberparacentesis• IOPreductionwithacetazolamide(e.g.500mgIV)ortimolol (0.5%topicaldropsbd)• Breatheintoapaperbag(respiratoryacidosisinducesretinalvasodilation)
• 56year-oldfemale• PMHdiabetes,hypertension• suddenonsetPAINLESSlossofvisioninherrighteye
CentralRetinalVeinOcclusion
• “StormySunset”/“BloodandThunder”appearance(inseverecases)• Assoc:glaucoma,oldage,hypertension,diabetes,hypercoagulablestate,atherosclerosis,vasculitis• Visualacuity— variabledependingonseverityanddurationsinceonset
CentralRetinalVeinOcclusion
• Refertoanophthalmologist—photocoagulation• treatunderlyingcauses• Screenforriskfactors• aspirin
• 65year-oldfemale• Blurredvisioninlefteye– gradualonset• Associatedleftsidedheadache• Lsidedscalptenderness
TemporalArteritis
• FormofGiantcellarteritis=systemicimmune-mediatedvasculitis• Symptoms:headache(85%),visualdisturbances(50%),jawclaudication(50%)• peakincidenceoccursinpatientsaged60-80years
TemporalArteritis
• ESR>50in85%cases• Dx 3/5criteria(Age>50,headache,abn TempArt,ESR>50,Abn biopsy)• Rx– highdosesteroids• Urgentreferralforbiopsy
• 72yearoldgentleman• PMHhypertension,diabetes• C/oflashinglightsandblackspotsinlefteyesincethismorning• OtherwiseNormalvision• Otherwisefeelswell
VitreousHaemorrhage/detachment
• vitreousgelpullsawayfromtheretina• Similarsx toretinalbreak/detachment
VitreousHaemorrhage
• Ultrasound- ‘Washingmachine’sign• Opthalmology referral• Bedrest/elevation• Screen/treatunderlyingcauses• Stopanticoagulants
• 50year-oldman• lossofvision- “curtaincomingdown”• precededby‘flashesandfloaters’
RetinalDetachment
• o/e:• Visualacuity—reducedifthemaculaisinvolved
• Redreflex— abnormal• Visualfields— reduced• mildrelativeafferentpupillarydefect
RetinalDetachment
• Directfundoscopy intheEDcannotruleoutretinaldetachment• Ultrasound…• Urgentophthalmologyreferral
• 35year-olD Lady• 5/7hx Painanddeterioratingvisionlefteye• Visionblurry• Lossofcolourvision• VA6/6R,6/9L
OpticNeuritis
• Inflammationofopticnerve• TRIAD:reducedvision,eyepain(ESPmovement)andimpairedcolourvision• AssociationwitH MS
OpticNeuritis
• URGENTophthalmologyreferral• Considerneurologyreferral• Corticosteroids-methylprednisolone
• 45yearoldmale• 6/7historylefteyepain,fever,malaise• Reducedvisualacuity• Painoneyemovement
Orbitalcellulitis
• CommoncausesincludeStaph,strep,gram–ves,mixedanaerobes• Appearanceasperimage• Reducedeyemovements• Maybesystemicallyunwell
Orbitalcellulitis
• Ophthalmologyreferral• Labbloods• CTtoinvestigateextent/thrombosis• IVabx – microadvice
• 7yr-oldboyc/opainandrednesslefteyeforlast5/7• Normalvisionbutincreasingdifficultyonopeningeye• NormaL eyemovements
Preseptal Cellulitis
• Infectionanteriortoorbitalseptum• Similarcausativeagentsasorbitalcellulitis(staph/strep/etc)• Normalocularexam– noproptosis,nopainonmovement,normalVA
Preseptal Cellulitis
• Cantreatwithoralabx– flucloxacillin (adults),Augmentin(<5yrs)• ConsiderCT+/- IVABXifextentuncertainorifsystemicallyunwell