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Eight

Eight. An 80 year old women complains of a very painful eye along with a feeling of nausea of 2 days duration. On examination the eye is red. What condition do you want to exclude ? How do you do this ?. Acute Angle Closure Glaucoma. Digital Tonometry. Examination of Fundus.

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Eight

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  1. Eight An 80 year old women complains of a very painful eye along with a feeling of nausea of 2 days duration. On examination the eye is red. • What condition do you want to exclude ? • How do you do this ?

  2. Acute Angle Closure Glaucoma • Digital Tonometry

  3. Examination of Fundus • Requires practice and confidence. • More accurate with dilated pupil. • Knowledge of A&P to interpret findings. • Limited view with direct ophthalmoscope.

  4. RAPD (relative, afferent, pupillary, defect) • RAPD is testing the nerve pathways to the brain. Inflammation, damage, or pressure on the nerves will cause a defect. • Light shone into a healthy eye causes constriction in both eyes. Swing light to other healthy eye and same reaction will occur. Repeat 3 or 4 times. • In a damaged eye – on swinging light to damaged eye neither pupil will constrict and damaged eye will start to dilate.

  5. Ophthalmoscope Practice • Find tops tips for using ophthalmoscope in hand out • Get into small groups • Practice !!!!!

  6. Nine A 75 year man complains of sudden loss of vision in one eye. Visual acuity is ‘hand movements’ only. • What are the likely causes? • What condition do you want to exclude ? • How do you do this ?

  7. Central Retinal Artery Occlusion • Milky white Retina with Cherry Red spot at the macula. • Can present with sudden loss of vision or have transient vision loss a few days before.

  8. Central Retinal Vein Occlusion • Central vein which drains blood from the retina becomes blocked, causing a back flow of blood, hence the vessels leaking into the retina causing swelling. • Ischemic causes of a blockage increases complications. Abnormal growth of blood vessels occur. • Some can be treated with Laser

  9. Optic Neuritis/Papilloedema

  10. Diabetic Retinopathy • Known as Background or Non-proliferative • Hard exudates – yellow flecks deep in the retina reflecting leakage of incompetent pre capillary retinal arterioles • Haemorrhages – ‘red dots’ show mini blow outs of the diseased pre capillary arterioles

  11. Proliferative • This shows the tangling of blood vessels at the optic disc & nearby retina. • The vessels are weak walled & break easily. They bleed into the retina & vitreous jelly & can cause retinal detachment & blindness. • Treatment with argon laser is helpful

  12. Glaucoma • As a rule optic disc assessment is difficult as there is an infinite variety of normal optic discs. • The main visible sign is thinning of the neuroretinal rim causing a larger central cup. As the disease progresses the rim is eroded until there is little or no rim left. Cuppeddisc Normal disc

  13. Disc Oedema with Hypertension • Disc oedema with splinter haemorrhages • Caused from severe hypertension

  14. Other presenting problems

  15. Basal cell Carcinoma • Papilloma • (removed for cosmetic purposes)

  16. Cyst of Moll • Cyst of Zeis

  17. Pinguecula • Pterygium

  18. Entropian • Ectropian

  19. Xanthelasma • Milia

  20. Corneal Foreign Body • Rust Ring

  21. Pigmented Lesion • Conjunctival Melanoma

  22. Questions The End

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