EYE EXAM

How to approach the eye..

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

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

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

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

Eye Movements

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

Red Reflex

Fundoscopy 1 Optic disk Swelling, cupping Colour Vessels, bleeds Macula Colour Exudates, abnormalities

Papilloedema

Fundoscopy 2 Vessels New vessels Tortuousity, segmentation Colour Rest of retina Pallor Bleeds Pigmentation Retinopathy

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

Rest of exam Visual acuity Visual fields RAPD “Digital” tonometry

VA – Pinhole

Rest of exam

Lids and Lashes

Lacrimal System

Dacryocystitis Treatment Acute - antibiotics - I & D Chronic - DCR

Lids and lashes

Viral

Viral treatment Check Cornea! Symptomatic, supportive Chloramphenicol Refer if in doubt

Bacterial

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

PKC HS reaction Self resolving ?Steroids

Allergic, Vernal, GPC

Treatment Topical Antihistamines Spersallerge ® Topical Mast cell stabilisers Optichrom ® Topical Steroids Refer

Conjunctiva - other

Cornea

HZO Refer Check immunity Treat Systemic antivirals Topical antivirals Analgesia

Glaucoma

Acute Angle Closure

Glaucoma Post - Surgery

Chronic OAG Cup/disk ratio

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

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

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

Proliferative NVD NVE Fibrovascular proliferation Vitreous bleeds

Proliferative 2

FB, Blunt and Perforating Trauma

Blunt Trauma

Corneal Injury

Lens Injury

Other trauma Traumatic mydriasis Traumatic iritis Vitreous bleed Retinal detachment Macula oedema Optic neuropathy

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

References UCT Ophthalmology Lecture Notes htmwww.medicine.ucsd.edu/clinicalmed/eyes. htm