Painful diminution of vision

MBBSKGMU

painful diminution of vision

Common causes of painful diminution of vision

• Acute angle closure glaucoma.• Acute iridocyclitis.• Acute keratitis/ corneal ulcer.• Trauma +/-Foreign body.• Indiscriminate use of contact lenses.• Acute opic neuritis.• Endophthalmitis/ Panophthalmitis.

painful diminution of vision

Common causes of painful diminution of vision (contd)

• Chemical injuries.• Scleritis.• Dry eye.• Herpes zoster ophthalmicus.• Orbital cellulitis.• Neurological conditions.e.g. ophthalmoplegic

migraine, temporal arteritis.

painful diminution of vision

Steps of management

• Come to a probable clinical diagnosis.• Order relevant investigations.• Urgent treatment in acute phase.• Definitive treatment.• Proper follow up.

painful diminution of vision

Conjunctival vs. circumcorneal congestion

Conjunctival• Bright red.• Arborous branching.• Near fornices.• Vessels move with conjunctiva.• Blanch with phenylephrine.• Fill from fornix towards centre.

Circumcorneal• Bluish red.• Radial arrangement.• Around limbus.• Do not move with conj.• Do not blanch with phenylephrine.• Fill from limbus, outwards.

painful diminution of vision

Conjunctival congestion

painful diminution of vision

Conjunctival vs Circumcorneal congestion

painful diminution of vision

Few common clinical conditions

painful diminution of vision

Acute angle closure glaucoma(salient features)

• Attacks of severe hemicrania• Rapid diminution of vision.• Coloured haloes.• Circumcorneal congestion.• Hazy cornea.• Shallow A.C.• Semi dilated pupil.• Raised IOP.

painful diminution of vision

Chronic angle closure glaucoma(salient features)

• Episodic /chronic low grade pain.• Diminution of vision is more gradual and

progressive.• More damage to optic disc and nerve fibre

layer.

painful diminution of vision

Acute Iridocyclitis(salient features)

• Rapid diminution of vision.• Circumcorneal congestion.• Marked ciliary tenderness.• Aqueous flare and cells.• Keratic precipitates.• Muddy iris pattern,• Small irregular pupil.• Posterior synechiae.

painful diminution of vision

Chronic / recurrent Iridocyclitis(salient features)

• Frequent /recurrent ocular pain and headache.

• Dense posterior synechiae• Complicated cataract.• Diminution of vision is more gradual.

painful diminution of vision

Glaucoma Iridocyclitis

painful diminution of vision

Keratitis / Corneal ulcer(salient features)

• Rapid diminution of vision.• Pain. • Lacrimation and discharge. • H/O FB/trauma (+/-).• Blepharospasm.• Circumcorneal congestion. • White spots/area on cornea• Corneal infiltration, tissue necrosis and sloughing. (Picture

differs with etiology).• Iridocyclitis & hypopyon.

painful diminution of vision

Corneal ulcer

painful diminution of vision

Optic neuritis(Salient features)

• Sudden/rapid, usually unilateral loss of vision : PL+/- or FC.

• Relative afferent pupillary defect.

• Papillitis– Optic disc oedema, engorged veins, superficial haemorrhages,

cells in vitreous.– Pain +/-

• Retrobulbar neuritis– Painful ocular movements– Normal disc & fundus

painful diminution of vision

Post-op endophthalmitis

• Post- operative endophthalmitis is one of the most dreaded complications of cataract surgery.

• Defective sterilization of instruments.• Contaminated irrigating solutions.• Contaminated IOLs, viscoelastics.

painful diminution of vision

Post-op endophthalmitis(salient features)

• Severe pain & redness• Fall in visual acuity• Hazy cornea• Hypopyon• PR defective

Patient presents in early post-operative period

painful diminution of vision

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