EYE EM

1. EYE EM Adrian Burger

2. How to approach the eye..

3. 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

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

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

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

7. Eye Movements

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

9. Red Reflex

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

11. Papilloedema

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

13. 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

14. Rest of exam Visual acuity Visual fields RAPD �Digital� tonometry

15. VA � Pinhole

16. Rest of exam

17. Lids and Lashes

18. Lacrimal System

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

20. Lids and lashes

21. Viral

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

23. Bacterial

24. 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

25. PKC HS reaction Self resolving ?Steroids

26. Allergic, Vernal, GPC

27. Treatment Topical Antihistamines Spersallerge � Topical Mast cell stabilisers Optichrom � Topical Steroids Refer

28. Conjunctiva - other

29. Cornea

30. HZO Refer Check immunity Treat Systemic antivirals Topical antivirals Analgesia

31. Glaucoma

32. Acute Angle Closure

33. Glaucoma Post - Surgery

34. Chronic OAG Cup/disk ratio

35. 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

36. 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

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

38. Proliferative NVD NVE Fibrovascular proliferation Vitreous bleeds

39. Proliferative 2

40. FB, Blunt and Perforating Trauma

41. Blunt Trauma

42. Corneal Injury

43. Lens Injury

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

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

46. References UCT Ophthalmology Lecture Notes www.trauma.org www.medicine.ucsd.edu/clinicalmed/eyes.htm www.atlasophthalmology.com www.eyecasualty.co.uk www.webeye.ophth.uiowa.edu/eyeforum