1. Eyes

2. What is this? How can you tell?

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

4. 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

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

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

7. What is this? Why?

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

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

10. 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)

11. What are the complications of this?

12. 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

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

14. 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

15. How do you fix this?

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

17. What is this?

18. 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

19. What is this?

20. 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

21. How do you pick peri-orbital from orbital cellulitis?

22. 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

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