Eye Conditions

Causes of Red Eye:

  • Closed Angle glucoma
  • Anterior uveitis
  • corneal ulcers
  • conjunctivitis
  • scleritis & episcleritis
  • subconjunctival haemorrhage

Scleritis

  • acutely painful red eye
  • vision normal
  • globe is tender
  • no blanching of vesels
  • classically disturbs sleep

Associated with:

  • Rheumatoid
  • Wegners
  • Polyarteritis
  • SLE
  • Sarcoidosis
  • Inflammatory Bowel

To tell the difference between episcleritis and scleritis you can put in topical phenylephrine 2.5% which will blanch the vessels in episcleritis but not in scleritis

 

 

Leucocoria

  • commonly picked up when looking at photos – white pupil reflex
  • usually when seen in photos it’s camera flash reflecting off the optic nerve and nothing to worry about
  • Differnetial diagnosis in a child:
    • Congenital cataract (sight threatening)
    • Congenital ocular toxoplasmosis (sight threatening)
    • Retinoblastoma (life threatening)

Retinoblastoma

  • 1 in 20,000 risk in the UK
  • Almost exclusively found in young children
  • 80% 3 year survival if diagnosed before 2yrs and unilateral (less if bilateral or after 2 years)

 

Retrobulbar Neuritis

Classic triad

  • Pain on eye movement
  • Loss of colour vision
  • No fundal signs

When the lesion is in the nerve head you might see disc swelling but when the lesion is behind the disc fundoscopy will be normal.

Retrobulbar neuritis: the patient sees nothing, the doctor sees nothing.

 

Retinal detachment

  • Sensory and pigment separate
  • Time critical ophthalmic emergency

Symptoms:

  • Floaters
  • Grey curtain or veil moving across visual field
  • Sudden decrease in vision

Associations:

  • Congenital malformations
  • Metabolic disorders
  • Trauma – including eye surgery
  • Vascular disease
  • High myopia
  • Vitreous Disease & degeneration

 

 

Chemosis

  • Swelling or odema of the conjunctiva
  • Usually due to excess rubbing
  • Often caused by allergies or viral infections

 

Central Retinal Artery Occlusion

  • Sudden painless vision loss in one eye
  • Occlusion usually caused by an atherothrombitic embolus.
  • Causes pallor of disc and retina
  • Cherry red spot at the macula – this is actually macula sparing as the macula receives branches from the post-cillary artery.

Central Retinal Vein Occlusion

  • different presentations but most commonly blurred vision
  • on fundoscopy there’s vascular dilation, tortuosity of vessels and vascular dilation, and arc of haemorrhage like the trail left behind a cartoon shooting star

Age related macula degeneration

  • Commonest cause of blindness in the UK
  • Degeneration of central vision
  • Presence of drusen (multiple yellow dots pictured below) precedes ARMD picture

  • Thats drusen – above those little white dudes,
  • That preceeds the appearance of pigment, exudate and  bleeding at the macula

Chronic Open Angle Glaucoma

  • Scotoma (partial alteration of the visual field) near the blind spot
  • Then nasal and superior fields are lost
  • cupping of the disc and nasalation of the arteries

Diabetic Retinopathy

 

Papilloedema

 

Kayser-Fleisher Rings

  • Deposition of copper in the periphery of the iris
  • Associated with Wilson’s disease (autosomal recessive) – abnormal copper metabolism

Argyll-Robertson Pupil

  • Miosis (excessive construction of pupil)
  • Pupil accomodates but does not react to light
  • Classically associated with syphillis

Holmes-Aide Pupil

  • Reacts slowly to light and on convergence
  • Unilateral in 80%
  • Associated with absent ankle and knee reflexes

Uveitis

  • More information here: Uveitis / Iritis
  • Uveitis is uveal tract
  • The Uveal tract is divided into
    • anterior compartment – containing the iris and ciliary body
    • and the posterior compartment – containing the choroid

  • Uveitis may include infection of any of these
  • And may cause infection of the sclera, retina and optic nerve