Eyes

What is this? How can you tell?

Uveitis/Iritis Moderate hypopyon Conjunctival erythema with no limbic sparing Synechieae What are other fetures of uveitis?

Features of uveitis Acute vs chronic Acute – pain, phtophobia +reflex photophobia, tearing, decreased vision – onset hours to days Chronic – blurred vision, some redness, waxes and wanes Clinical exam – reflex photophobia, synechiae, cells in anterior chamber, conjunctivitis with no limbic sparing

Don’t forget Associations with other diseases: SLE IBD Sarcoid Chlamydia Syphilis TB AIDS

Treatment Seek professional help Cycloplegic Topical steroids Not usually infective – don’t give Abs unless specific reason

What is this? Why?

Acute glaucoma Clouded cornea Red conjunctiva – no limbic sparing Fixed mid dilated pupil What else?

Acute glaucoma Sudden onset eye pain with vomiting and blurred vision Halos around lights Often onset with cycloplegic or exit from dark room

Treatment Laser/OT is definitive treatment A: Alpha-adrenergic agents (apraclonidine) B: Beta blockers (timolol) C: carbonic anhydrase inhibitors (acetazolamide/other zolamides) P: Parasympathomimetics (pilocarpine) P: Prostaglandin analogs (latanoprost)

What are the complications of this?

Traumatic hyphaema Grade 1 - Layered blood occupying less than one third of the anterior chamber Grade 2 - Blood filling one third to one half of the anterior chamber Grade 3 - Layered blood filling one half to less than total of the anterior chamber Grade 4 - Total clotted blood, often referred to as blackball or 8-ball hyphema

Complications Rebleed – 25%, more if higher grade Raised IOP – more likely with large hyphaema Synechiae Corneal bloodstaining – large hyphaema with raised IOP

Outcome Worse if large bleed, rebleeding or raised IOP Vision > 6/12 in 75% of patients Only 35% in total hyphaema Worse in kids <6

How do you fix this?

You don’t This laceration involves the inferior canaliculus It should be repaired by an ophtalmologist Likewise lacerations involving the tarsal plate

What is this?

Central retinal vein occlusion Thrombotic process = the DVT of the eye May be asymptomatic or have varying amounts of visual loss and pain Look for risk factors: HTN, DM, bleeding disorders, autoimmune disorders, vasculitis, ETOH Treatment: ?aspirin ?warfarin ?lysis ?steroids ?normal saline

What is this?

Central Retinal Artery Occlusion The PE of the eye (or CVA) Embolic phenomenon Sudden painless loss of vision Risk factors: AF, endocarditis, coagulopathy, atherosclerotic disease, temporal arteritis Treatment: attempt to lower IOP, consider hyperbaric O2

How do you pick peri-orbital from orbital cellulitis?

Cellulitis near the eye Orbital = bad, periorbital = not so bad Pointers to orbital cellulitis: History facial surgery/dental work Sinus infection Decreased vision Pain on eye movements Proptosis Headache

Antibiotics Periorbital = skin, orbital = sinus Periorbital: fluclox or cephalexin or clindamycin Orbital: cefotaxime or fluclox/ceftriaxone plus ophthalmology consult