The Red Blind Eye
THE RED EYE Periorbital / Orbital cellulitis Conjunctivitis Iritis/ Keratitis/ Corneal ulcer Glaucoma cavernous sinus thrombosis thyroid eye disease alcoholism
Periorbital / Orbital Cellulitis ORBITAL CELLULITIS PRESEPTAL CELLULITIS Location orbit eyelids Proptosis present absent Eye movements decreased normal Visual acuity decreased late normal Orbital pain present absent
Periorbital / Orbital Cellulitis (management) Exclude herpetic involvement - flouresin CT orbit swab eye Peri-orbital: PO Flucloxacillin (PO Cephalexin) Orbital: IV Cefotaxime + Flucloxacillin (gentamicin if contact lens wearer) topical chloramphenicol
Glaucoma (primary closed angle) Acute severe unilateral pain visual disturbance - fog, halo mid dilated non reactive pupil shallow ant chamber corneal haze IOP > 40mmHg
Glaucoma (management) More common - female, FHx glaucoma, old beta agonists, mydriatics acetazolamide 500mg IV stat, 250mg PO tds timoptolol 0.5% drops bd Lie flat Topical steroids pilocarpine 2% every 15min x 2 mannitol 1g/kg IV Mannitol Corneal Indentation urgent peripheral iridectomy Lie flat – lens falls away from the iris decreasing pupillary block Pilocarpine may not be effectively immediately due ischaemic paralysis of the iris so start 1 hr after initial treatment Mannitol is an osmotic agent which may decrease vitreous volume Corneal indentation : a flat soft object is pushed gently on the anaesthetised cornea in an attempt to move the vitreous to the peripheries and open the angle
ACUTE NON TRAUMATIC BLINDNESS Acute glaucoma Central retinal artery occlusion Central retinal vein occlusion Retinal detachment Optic neuritis lens dislocation vitreous haemorrhage optic n. / chiasma compression toxic / metabolic neuropathies post chiasmal - infarct, infection
Retinal detachment Immediate or delayed (months) partial field defect flashes and floaters pad eye , bed rest laser coagulation
Central retinal artery occlusion Very sudden Painless unilateral usually fundoscopy pale disc retinal white oedema cherry red macula paucity of arterial vasculature
Central retinal artery occlusion (management) At risk - AF, Carotid/Cardiac embolus, giant cell arteritis, vasculitis(lupus), sickle cell disease 90min before irreversible injury digital massage hypoventilate ( increase pCO2) decrease IOP - acetazolamide, tioptolol, mannitol, diuretics anterior chamber paracentesis retrobulbar anaesthesia (thrombolysis)
Central retinal vein occlusion Onset over minutes painless fundoscopy dilated tortuous veins diffuse retinal haemorrhage asprin 300mg monitor neovascularisation