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EYE EM

EYE EM. Adrian Burger. How to approach the eye. 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.

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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. HS reaction Self resolving ?Steroids PKC

  26. Allergic, Vernal, GPC

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

  28. Conjunctiva - other

  29. Cornea

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

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

  38. NVD NVE Fibrovascular proliferation Vitreous bleeds Proliferative

  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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