Opthamology AKT
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Diabe tic Re tinopathy
Mild Non-prolife rative diabe tic re tinopathy
Mode rate Non-prolife rative diabe tic re tinopathy
Se ve re Non-prolife rative diabe tic re tinopathy
Prolife rative re tinopathy
Primary Ope n Angle Glaucoma
Acute angle clos ure glaucoma fe ature s
Ante rior uve itis
Mos t common caus e of blindne s s in 35-65 ye ar olds
Hype rglycae mia - incre as e d re tinal blood flow and abnormal me ta
bolis m in ve s s e l walls
Exudate s , microane urys ms , ne ovas cularis ation
>= 1 microane urys m
Microane urys m
Hard e xudate s
Blot hae morrhage s
Cotton wool s pots , ve nous be ading/looping, intrare tinal microvas cu
lar abnormalitie s le s s s e ve re than s e ve r NPDR
Blot hae morrhage s and microane urys ms in 4 quadrants
Ve nous be ading in >=2 quadrants
Intrare tinal microvas cular abnormalitie s in >=1 quadrant
Re tinal ne ovas cularis ation - vitre ous hae morrhage
Fibrous tis s ue forming ante rior to re tinal dis c
Blind in 5 ye ars
Re quire s re fe rral for panre tinal photocoagulation - las e r the rapy
Optic ne uropathy due in the majority of pe ople to rais e d IOP.
Chronic s imple glaucoma
2 % of thos e > 40 ye ars
Ris k factors - fhx, black, myopia (s hort s ighte dne s s ), hype rte ns ion,
diabe te s
Fe ature s - pe riphe ral vis ual fie ld los s , de cre as e d vis ual acuity, op
tic dis c cupping
Se ve re pain - ocular or he adache
De cre as e d vis ual acuity - patie nt s e e s haloe s
Se mi-dilate d pupil
Haz y corne a
Unilate ral pe riphe ral vis ual fie ld los s
Acute ons e t, Pain, Blurre d vis ion and photophobia, Small, fixe d ova
l pupil, ciliary flus h, lacrimation.
Ankylos ing s pondylitis , re active arthritis , IBD, Be hce t's
Mx - urge nt re fe rral, atropine + cyclope ntolate (dilate s pupils ), s te
roid e ye drops .
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Scle ritis
Macular de ge ne ration ris k factors
Early age re late d macular de ge ne ration
Late age re late d macular de ge ne ration
Age re late d macular de ge ne ration
Re tinoblas toma
Sudde n painle s s los s of vis ion
Ce ntral re tinal ve in occlus ion
Se ve re pain - wors e on move me nt and te nde rne s s
Unde rlying autoimmune dis e as e
Age > 60 ye ars
Smoking
Fhx
White
High cumulative s unlight e xpos ure
Fe male
Non-e xudative
Drus e n
Alte rations to re tinal pigme nt e pithe lium
ne ovas cularis ation
Exudative
Re duce d vis ual acuity - ce ntral vis ion is los t firs t
Ce ntral s cotomas
Drus e n, pigme ntary change s
Mx - s top s moking, be ta-carotine , vitamins E + C, z inc
Dry - no me dical tre atme nts
We t - photocoagulation, photodynamic the rapy, anti-growth factor a
nd MAB tre atme nt
Mos t common occular malignancy in childre n
Ave rage age - 18 months - 10 % he re ditary
Abs e nce of re d-re fle x, white pupil, s trabis mus , vis ual proble ms
Mx - e nucle ation, che mo, radiothe rapy, photocoagulation
> 90 % s urvive to adulthood
Is chae mic optic ne uropathy
Occlus ion of ce ntral re tinal ve in
Occlus ion of ce ntral re tinal arte ry
Vitre ous hae morrhage
Re tinal de tachme nt
Incre as ing age
More common than re tinal arte ry occlus ion
Caus e s - glaucoma, polycythae mia, hype rte ns ion
Fundos copy - re tinal hae morrhage s - piz z a.
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Ce ntral re tinal arte ry occlus ion
Pos te rior vitre ous de tachme nt
Re tinal de tachme nt
Vitre ous hae morrhage
Horne rs Syndrome
Re tinitis Pigme ntos a
Horde olum e xte rnum
Horde olum inte rnum
Due to thromboe mbolis m or te mporal arte ritis
Affe re nt pupilary de fe ct
Che rry re d s pot on a pale re tina
Flas he s of light in the pe riphe ral fie ld of vis ion
Floate rs - ofte n on the te mporal s ide of ce ntral vis ion
Flas he s of light in the pe riphe ral fie ld of vis ionFloate rs - ofte n on t
he te mporal s ide of ce ntral vis ion
De ns e s hadow that progre s s e s towards the ce ntral vis ion
Ve il/curtain ove r vis ion
Ce ntral vis ual los s
Straight line s - curve d
Diabe te s , ble e ding dis orde rs
Large - s udde n vis ual los s
Mode rate - nume rous dark s pots
Small - floate rs
Mios is - s mall pupil
Ptos is - drooping e ye lid
Enophthalmos - s unke n e ye
anhydros is - los s of s we ating on 1 s ide
He te rochromia - diffe re nce of e ye colour - s e e n in conge nital Horn
e rs Syndrome .
Fe ature s - night blindne s s , funne l vis ion, fundos copy - black pigme
ntation in pe riphe ral re tina
Infe ction - s taphylococcal of the glands of z e is (s e bum producing)
or glands of moll (s we at glands ).
Mx - hot compre s s and analge s ia - abxs only re quire d if caus ing c
onjunctivitis
Infe ction of the me ibomium glands - may le ave a re s idual chalaz io
n - me ibomium cys t
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Re te ntion cys t of me ibomium gland

Firm, painle s s lump in the e ye lid
Chalaz ion
Mx - majority s pontane ous ly re s olve - s ome re quire s urgical drain
age

Fundos copy - ve nous e ngorge me nt, los s of ve nous puls ation, blurr
ing of optic dis c margin, e le vation of optic dis c, los s of the optic cu
Papiloe de ma p.
Caus e s - s pace -occupying le s ion, malignant hype rte ns ion, ide opat
hic intrancranial hype rte ns ion, hydroce phalus , hype rcapnia

Caus e s - MS, diabe te s , s yphilis

Fe ature s - unilate ral gradual los s of vis ual acuity, poor dis criminati
on of colours , pain on e ye move me nt, affe re nt pupillary de fe ct, ce
Optic ne uritis ntral s cotoma
Mx - high dos e s te roids - 4-6 we e ks
MRI > 3 white matte r le s ions - chance of MS in ne xt 5 ye ars - 50
%.

Ris k factors - hype rme tropia (long s ighte dne s s - e ye balls are s m
Acute Angle Clos ure Glaucoma alle r), pupil dilation, le ns growth as s ociate d with age
Mx - urge nt re fe rral, ace taz olamide , pilocarpine .

Age , UV light
Sys te mic - Down's , DM, hypocalcae mia, s te roids , conge nital rube ll
Cataracts ris k factors a, galactos ae mia, myotonic dys trophy
Ocular - trauma, uve itis , high myopia, topical s te roids

Infe ction of the lacrimal s ac

Dacryocys titis Wate ring e ye , s we lling and e rythe ma at inne r canthus of the e ye
Mx - s ys te mic antibiotics - if s igns of orbital ce llulitis - IV antibiotics

Normal IOP 10-21 mmHg

Pros taglandin analogue

Incre as e s uve os cle ral outflow
Latanopros t Caus e s brown pigme ntation of the iris
Once daily application
Us e d firs t line if his tory of as thma
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Be ta blocke r
Timolol Re duce s aque ous production
Avoid in as thmatics and thos e with he art block

Sympathomime tic
Re duce s aque ous production and incre as e s outflow
Brimonidine
Avoid if taking MAOIs or TCAs
Caus e s hype rae mia

Carbonic anhydras e inhibitor

Dorz olamide Re duce s aque ous production
Sys te mic abs orption may caus e s ulphonamide -like re actions

Miotics
Mus carinic re ce ptor antagonis t
Pilocarpine
Incre as e s uve os cle ral outflow
Caus e s cons tricte d pupils , he adache and re duce d vis ion.

Pupil dilation - won't cons trict to light

Be nign. Se e n in wome n.
Holme s -Adie Syndrome Unilate ral in 80 %.
If pupil cons tricts - re mains s mall for a long time
Abs e nt ankle /kne e re fle xe s

Large ve s s e l vas culitis - PMR

> 60 ye ars , ons e t < 1 month, he adache , jaw claudication, is chae m
Te mporal Arte ritis ic optic ne uropathy - vis ual dis turbance , te nde r te mporal arte ry, a
ching and s tiffne s s in proximal limb mus cle s , le thargy, de pre s s ion
, night s we ats , low-grade fe ve r, anore xia, night s we ats .

Ix - ESR > 50, rais e d CRP, biops y - s kip le s ions , normal cre atinine
Te mporal Arte ritis Mx kinas e and EMG.
Tx - high dos e pre dnis olone and opthamology re fe rral.

Inflammation of e ye lid margins

Caus e s - me ibomian gland dys function, s e borrhoe ic de rmatitis , s t
aph infe ction, ros ace a.
Ble pharitis Bilate ral, gritty dry e ye s , s ticky, re d e ye lid margins , s tye s , chalaz i
ons , s e oncdary conjunctivitis .
Mx - hot compre s s e s , coole d boile d wate r and baby s hampoo/s odi
um bicarb, artificial te ars .
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Eme rge ncy re duction of rais e d ICP Hype rve ntilation - hypocapnia - re ducing ICP and papilloe de ma.

Pupil dilation
Caus e s - Argyll-Robe rts on s yndrome , 3rd ne rve pals y, atropine , tr
Mydrias is
opicamide , cocaine , amphe tamine s , TCAs , conge nital, phae ochrom
ocytoma.

I - Ante riolar narrowing and tortuos ity, incre as e d light re fle x, s ilve

r wiring.
Clas s ification Hype rte ns ive Re tinopathy II - AV nipping
III - Cotton-wool e xudate s , flame and blot hae morrhage s
IV - Papilloe de ma

Le s ion of optic chias m

Uppe r quadrant de fe ct>lowe r quadrant de fe ct - infe rior chias m - p
Bite mporal He mianopia ituitary s ource
Lowe r quadrant de fe ct>uppe r quadrant de fe ct - s upe rior chias m -
craniophayngioma

Accomodation re fle x pre s e nt but no re s pons e to light.

Small, irre gular pupils .
Argyll-Robe rts on Pupil
Caus e s - DM, s yphilis

Marcus -Gunn Pupil

Le s ion ante rior to the optic chias m - optic ne rve or re tina.
Affe re nt pupillary de fe ct
Optic ne rve - optic ne uritis - MS.
Re tina - de tachme nt

Glaucoma
Re tinitis pigme ntos a
Papilloe de ma
Tunne l vis ion caus e s
Coroidore tinitis
Hys te ria