EYE EM

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EYE EM

• Adrian Burger

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How to approach the eye..
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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

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Two types

• Medical - red eye (infection, inflammation)
• - loss of vision
• Trauma - penetrating
• - blunt
• - chemical
• - thermal

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History

• Main symptom(s)
• Pain
• Discharge
• Vision
• Any trauma
• PMH, PSH
• Medication

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Examination

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

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Eye Movements
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Ophthalmoscopy

• Dim room
• Approach from 15cm, O magnification
• Right to Right, Left to Left
• Red reflex
• Aim nasally, small aperture, low light
• Cornea
• Lens

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Red Reflex
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Fundoscopy 1

• Optic disk
• Swelling, cupping
• Colour
• Vessels, bleeds
• Macula
• Colour
• Exudates, abnormalities

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Papilloedema
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Fundoscopy 2

• Vessels
• New vessels
• Tortuousity, segmentation
• Colour
• Rest of retina
• Pallor
• Bleeds
• Pigmentation
• Retinopathy

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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

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Rest of exam

• Visual acuity
• Visual fields
• RAPD
• Digital tonometry

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VA Pinhole
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Rest of exam
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Lids and Lashes
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Lacrimal System
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Dacryocystitis Treatment

• Acute - antibiotics
• - I D
• Chronic - DCR

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Lids and lashes
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Viral
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Viral treatment

• Check Cornea!
• Symptomatic, supportive
• Chloramphenicol
• Refer if in doubt

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Bacterial
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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

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PKC

• HS reaction
• Self resolving
• ?Steroids

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Allergic, Vernal, GPC
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Treatment

• Topical Antihistamines
• Spersallerge
• Topical Mast cell stabilisers
• Optichrom
• Topical Steroids
• Refer

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Conjunctiva - other
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Cornea
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HZO

• Refer
• Check immunity
• Treat
• Systemic antivirals
• Topical antivirals
• Analgesia

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Glaucoma
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Acute Angle Closure
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Glaucoma Post - Surgery
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Chronic OAG Cup/disk ratio
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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

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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

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Non Proliferative

• Background
• - dot and blot
• - hard exudates
• -micro aneurysms
• - macular oedema
• Pre-proliferative
• - cotton wool spots (soft)
• - IRMA
• - venous segmentation
• - large dark blots

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Proliferative

• NVD
• NVE
• Fibrovascular proliferation
• Vitreous bleeds

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Proliferative 2
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FB, Blunt and Perforating Trauma
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Blunt Trauma
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Corneal Injury
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Lens Injury
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Other trauma

• Traumatic mydriasis
• Traumatic iritis
• Vitreous bleed
• Retinal detachment
• Macula oedema
• Optic neuropathy

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Trauma management

• Analgesia
• Low light
• Gentle
• Same as all eyes
• X rays
• Topical antibiotics
• Tet Tox

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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