Interactive Ophthalmology Quiz

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Interactive Ophthalmology Quiz

• Mr Behrooz Golchin
• Consultant Ophthalmic Surgeon

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10 minutes

• Section 1

• Section 2

• Case presentations

• Spot diagnosis

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• Please participate
• Dont be embarrassed
• Shout out the answers

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Case presentations

• Section 1

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Case 1

• 35 year old man
• C/O watery Rt eye
• Eye becoming progressively painful
• Photophobic
• The vision is a little blurred

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• O/E VA is 6/12.
• His right eye is photosensitive.
• The redness is diffuse but more pronounced around
  the cornea.
• The cornea appears a bit hazy and his pupil is
  miosed.

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• If you dilate the pupil, you will notice that the
  pupil now has a scalloped appearance.
• What is the diagnosis?

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Anterior Uveitis

• Anterior uveitis refers to inflammation of the
  iris and/or ciliary body and
• Usually presents with a painful, red eye.
• Patients often c/o decreased vision and a watery
  discharge.

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Anterior Uveitis

• Photophobia is 2 to spasm of inflamed iris and
  ciliary muscles.
• Visual acuity varies depending on the severity of
  the inflammation.

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Anterior Uveitis

• The pupil is often miosed
• if untreated, the pupil margin may adhere to the
  lens due to the formation of posterior synechiae.

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Anterior Uveitis

• Corneal precipitates may occur on the endothelium
  
• hypopion (pus in the anterior chamber) may be
  present in severe cases.

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Treatment

• Dilating drops
• relieve ocular discomfort by reducing ciliary
  muscle spasm
• prevent the formation of posterior synechiae.
• Topical corticosteroid drops to treat the
  inflammation
• Periocular steroid injections or even systemic
  corticosteroids may be required in more severe
  cases.

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Case 2

• 30 y.o lady
• 5 day Hx of FB sensation and redness Lt eye.
• c/o reduced vision and watery
• No previous eye Hx

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• O/E VA is 6/9
• Mild diffuse conj injection.
• A whitish area seen in the pupillary zone
• What would you do next?

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• Instillation of 2 fluorescein shows a branching
  ulcer on the lateral side of the cornea.
• What is the Dx?

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Herpes simplex Keratitis

• Dendritic ulcer
• Confined to epithelium but deeper tissues may
  become involved.
• Stained with fluorescein and rose bengal
• Rx topical aciclovir

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Dendritic ulcer
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Geographic Epithelial keratitis

• Dendritic ulcers coalesce and enlarge to form
  this larger ulcer.
• Can occur as a result of inappropriate steroid
  use.
• Do not treat a red eye with steroid unless HSK is
  ruled out.

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Case 3

• A 9 y.o. boy c/o sever itching in both eyes.
• his mother says that he is constantly rubbing his
  eyes.
• The eyes water a lot and bright light hurts them.
• Not sticky, no discharge.
• He is currently on treatment for asthma.

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• O/E , his VA is 6/9 in both eyes
• He is very photophobic.
• His eyelids are red.
• The conjunctiva is mildly injected.
• His corneas are clear and do not stain with
  fluorescein.
• What do you do next?

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• Upon everting his upper eyelids, you notice
  several raised, fleshy lesions on the
  conjunctival surface of the upper lids.
• What is the diagnosis?

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Vernal keratoconjunctivitis

• Vernal keratoconjunctivitis
• most commonly occurs in young boys
• often have a history of atopy.
• Symptoms include
• severe, chronic ocular itching
• photophobia,
• blepharospasm,
• mucoid/watery discharge
• blurred vision also occur frequently.

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Vernal keratoconjunctivitis

• Signs include giant papillae under the upper
  eyelid
• they have a typical cobblestone appearance.

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Vernal keratoconjunctivitis

• Limbitis
• a fleshy, gelatinous ring around the limbus,
• contains whitish spots called Trantas dots.

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Treatment

• Mild cases respond to
• topical antihistamines and artificial tear drops
  
• topical mast cell stabilisers
• oral antihistamines is often required in cases of
  moderate severity.
• Severe cases frequently require
• short courses of topical corticosteroids, such as
  fluorometholone or dexamethasone
• intraocular pressure need to be monitored.
• In very severe cases
• topical immunomodulatory drugs, such as
  cyclosporine or tacrolimus, may be needed to
  control the inflammation.

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Case 4

• A 32 y.o. female c/o redness and increasing pain
  in her left eye x 3/7.
• The eye is painful to touch
• The pain has woken her from sleep over the last
  two nights.
• Eye is a little watery but there is no
  significant discharge
• visual acuity has not changed.

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• O/E VA is 6/6 and her eyelids are normal.
• large area of redness, temporal to the cornea.
• The eye is very tender to touch.
• looking at the eye in natural daylight, the
  underlying sclera has a purplish hue.
• The rest of the examination is unremarkable.
  
• What is the likely Dx?

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Scleritis

• Scleritis may be either diffuse or nodular.
• Pain is a prominent feature.
• Often wakes the patient from sleep during the
  night.
• Visual acuity is often not affected in the early
  stages.

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Scleritis

• Etiology
• Collagen vascular disease RA, SLE, gout, syphilis
  
• Complications
• Peripheral ulcerative keratitis with corneal
  perforation
• Secondary glaucoma
• Scleral melting and perforation
• Exudative retinal detachment

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Treatment

• Scleritis often responds adequately to oral
  NSAIDs.
• gt 50 of patients with scleritis have an
  associated systemic disease.
• They require specialist referral for systemic
  workup
• May need potent immunosuppressive therapy.

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Spot Diagnosis

• Section 2

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Thank you for your attention