1. Overview of Common Eye Conditions
Ian Tan
MBBS VI

2. Case 1 70 year old man PC: R Sudden loss of vision Denies pain
Visual acuity – 6/9 L, CF R
Right – RAPD
Fundus Exam shows cherry red spot at macula on pale retina

3. Case 1 What is the likely diagnosis?
What investigations would you order?

4. CRAO Symptom: Sudden painless loss of vision (except in GCA)
VA Severely reduced
Profound RAPD
Fundus – cherry red spot
ESR and CRP to exclude GCA

5. Case 2 81 year old lady Sudden onset of pain in left eye
+ blurring of vision and seeing haloes.
VA – HM in left, 6/9 in right
Slit lamp exam: L eye mid-fixed dilated pupil, shallow anterior chamber, corneal oedema

6. Case 2 What is the diagnosis? What would you do next?
What is the definitive management in the acute setting?

7. Acute Angle Closure Glaucoma
Occurs when trabecular meshwork is occluded by the peripheral iris  obstructed flow
Risk factors – >60, female, race, family history, refraction
Symptoms – blurred vision, halo, pain, systemic symptoms
High IOP > 60mmHg
Visual acuity 6/60 or HM
Immediate management – acetazolamide, timolol, apraclonidine, prednisolone
Bilateral laser iridotomy
Acetazolamide 500mg PO or IV
Timolol 0.5%
Apraclonidine 0.5-1%
Prednisolone 1%
+/- Pilocarpine 2-4%
Bilateral laser iridotomy

8. Case 3 31 year old man Presents with 3 day history of L red eye
Accompanied by mild discomfort, blurred vision and excessive watering
Reduced corneal sensation
Slit exam shows diffuse conjunctival injection
What would you do next?

9. Case 3
 Slit lamp exam: Dendritic ulcer evident with fluorescein under cobalt blue light

10. Case 3 What is the diagnosis? What investigations needs to be done?
How would you manage this patient?

11. HSV Keratitis Predominantly HSV 1 Principally clinical diagnosis
Symptom – red eye + blurred vision, watering
Under fluorescein for dendritic ulcer
Treatment – topical acyclovir/ganciclovir

12. Case 4
62 year old woman
PC: Sudden L monocular painless loss of vision
Past Hx: hypertension + diabetes
VA counting fingers
L RAPD
Fundus: Diffuse haemorrhages throughout fundus, swollen optic disc.

13. Case 4
What is the diagnosis?
Diagnosis CRAO

14. CRVO Symptom – Sudden painless loss of vision Poor VA RAPD present
Risk of neovascular glaucoma
Fundus: extensive blot and flame shaped hemorrhages involving
Intravitreal anti-VEGF injection or dexamethasone implant for macular edema

15. Case 5 38 year old man Suspected foreign body in right eye
Complains of blurred vision and mild photophobia
Using angle grinder, wearing protective glasses
VA 6/6 L, 6/18 R
Slit lamp examination

16. Case 5
Slit lamp exam: rust ring foreign body evident at 9 o’clock position

17. Case 5 What is the next step in your management?
What do you do if no foreign body is found on the surface of the eye?

18. Foreign Body Superficial vs IOFB High index of suspicion for IOFB
CT if IOFB is suspected
Examination under lid
Topical Analgesia
Sterile Blunt needle vs burr
Fluorescein to assess epithelial defect

19. Case 6 25 year old man Presents with 2 day history of red eye (L)
Accompanied by pain and photophobia
Third episode
Examination – cloudy AC with cells
Small hypopyon
VA 6/6 R, 6/9 L
IOP 7 in L, 11 in R

20. Case 6 What is the likely diagnosis?
What investigations would you order?
How would you treat this patient?

21. Anterior Uveitis
Inflammation of iris and anterior part of ciliary body
Commonly idiopathic or HLA B27 related
Symptoms – Unilateral pain, photophobia, redness and watery discharge
Mildly reduced VA
Signs – hypopyon, cells in AC, posterior synechiae
Mx – 1st line topical steroids (pred 1% or dex 0.1%)

22. Common Medications Diamox (Acetazolamide) Mydriatics – tropicamide 1%
Chlosig (chloramphenicol) drops/ointment
Hypromellose drops/gel (Genteal, Polytears)

23. SUMMARY CRVO CRAO Acute Angle Closure Glaucoma Foreign body
Corneal Ulcers
Uveitis

24. References Kanski’s Clinical Ophthalmology – A systematic approach
Emergency Eye Manual – An illustrated Guide