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EYE EM

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EYE EM

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    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

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