EYE complaints 1i3em.yolasite.com/resources/Presentations/ED Eye... · 2017-03-07 · eye pain (ESP movement) and impaired colour vision •Association witHMS. Optic Neuritis •URGENT

EYEcomplaints1DRALEXNOVAK

• 65yearoldman• PMHhypertension,coronaryarterydisease,diet-controlledtype2diabetes• Presentswithtransientvisuallossinlefteyelasting10minutes• Normalopthalmological examinationincludingVA

Amaurosis fugax

• Transientischaemiaoftheretina

• usuallyembolicorthrombotic;canoccursecondarytohypoperfusionstates,hyperviscosity orvasospasm

• DDx includesmigraine,papilloedema,giantcellarteritis,impendingcentralretinalveinocclusion,glaucoma,dissection

Amaurosis fugax

• ManageasperTIA:• Aspirin• TIAclinic• Managecardiovascularriskfactors

• NBmayneedfurtheracuteimagingandinvestigationifsuspicionOFothercausee.g.Dissection

• 62yearoldman• PMHdiabetes,angina• SuddenPainlessonsetlossofvisionReye• o/eJustAbleidentifymovementwithReye

CentralRetinalArteryOcclusion

• Urgentophthalmologyreferral• UrgentESRandCRPtoexcludeGCA• TIAandvasculitisworkupasperamaurosisfugax

CentralRetinalArteryOcclusion

• immediateocularmassage• anteriorchamberparacentesis• IOPreductionwithacetazolamide(e.g.500mgIV)ortimolol (0.5%topicaldropsbd)• Breatheintoapaperbag(respiratoryacidosisinducesretinalvasodilation)

• 56year-oldfemale• PMHdiabetes,hypertension• suddenonsetPAINLESSlossofvisioninherrighteye

CentralRetinalVeinOcclusion

• “StormySunset”/“BloodandThunder”appearance(inseverecases)• Assoc:glaucoma,oldage,hypertension,diabetes,hypercoagulablestate,atherosclerosis,vasculitis• Visualacuity— variabledependingonseverityanddurationsinceonset

CentralRetinalVeinOcclusion

• Refertoanophthalmologist—photocoagulation• treatunderlyingcauses• Screenforriskfactors• aspirin

• 65year-oldfemale• Blurredvisioninlefteye– gradualonset• Associatedleftsidedheadache• Lsidedscalptenderness

TemporalArteritis

• FormofGiantcellarteritis=systemicimmune-mediatedvasculitis• Symptoms:headache(85%),visualdisturbances(50%),jawclaudication(50%)• peakincidenceoccursinpatientsaged60-80years

TemporalArteritis

• ESR>50in85%cases• Dx 3/5criteria(Age>50,headache,abn TempArt,ESR>50,Abn biopsy)• Rx– highdosesteroids• Urgentreferralforbiopsy

• 72yearoldgentleman• PMHhypertension,diabetes• C/oflashinglightsandblackspotsinlefteyesincethismorning• OtherwiseNormalvision• Otherwisefeelswell

VitreousHaemorrhage/detachment

• vitreousgelpullsawayfromtheretina• Similarsx toretinalbreak/detachment

VitreousHaemorrhage

• Ultrasound- ‘Washingmachine’sign• Opthalmology referral• Bedrest/elevation• Screen/treatunderlyingcauses• Stopanticoagulants

• 50year-oldman• lossofvision- “curtaincomingdown”• precededby‘flashesandfloaters’

RetinalDetachment

• o/e:• Visualacuity—reducedifthemaculaisinvolved

• Redreflex— abnormal• Visualfields— reduced• mildrelativeafferentpupillarydefect

RetinalDetachment

• Directfundoscopy intheEDcannotruleoutretinaldetachment• Ultrasound…• Urgentophthalmologyreferral

• 35year-olD Lady• 5/7hx Painanddeterioratingvisionlefteye• Visionblurry• Lossofcolourvision• VA6/6R,6/9L

OpticNeuritis

• Inflammationofopticnerve• TRIAD:reducedvision,eyepain(ESPmovement)andimpairedcolourvision• AssociationwitH MS

OpticNeuritis

• URGENTophthalmologyreferral• Considerneurologyreferral• Corticosteroids-methylprednisolone

• 45yearoldmale• 6/7historylefteyepain,fever,malaise• Reducedvisualacuity• Painoneyemovement

Orbitalcellulitis

• CommoncausesincludeStaph,strep,gram–ves,mixedanaerobes• Appearanceasperimage• Reducedeyemovements• Maybesystemicallyunwell

Orbitalcellulitis

• Ophthalmologyreferral• Labbloods• CTtoinvestigateextent/thrombosis• IVabx – microadvice

• 7yr-oldboyc/opainandrednesslefteyeforlast5/7• Normalvisionbutincreasingdifficultyonopeningeye• NormaL eyemovements

Preseptal Cellulitis

• Infectionanteriortoorbitalseptum• Similarcausativeagentsasorbitalcellulitis(staph/strep/etc)• Normalocularexam– noproptosis,nopainonmovement,normalVA

Preseptal Cellulitis

• Cantreatwithoralabx– flucloxacillin (adults),Augmentin(<5yrs)• ConsiderCT+/- IVABXifextentuncertainorifsystemicallyunwell