Eyes Brought to you

Eyes
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You are not alone!
A very popular topic
How much time at medical school?
What do the acuity numbers mean!

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Special history
One or both?
What disturbance of vision?
Rate of onset?
Any blind spots?
Any associated symptoms e.g.
floaters? flashing lights?
Exactly what is worrying the patient.
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Contact lens use?
Myopia? (increases risk of retinal
detachment 10 fold)
Any family history? (FH of glaucoma
in a 1st degree relative gives you a 1/10
lifetime risk, or squint)
Any history of diabetes, hypertension
or connective tissue disease?

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Examination
Snellan chart, 3m or 6m, simple text for near
vision,
Pinholes
Fields, remember red and the quality of the red,
simple 4 quadrant testing.
Pupils: a bright torch and magnifying glass
Squint
Movements
Opthalmoscopy: Start at 10, red reflex?, green
filter enhances blood vessels, dilate prn, risk of
acute closed angle glaucoma remote. Brought to you by


Clinical classification
 Red eye
 Lids and tears
 Slow visual loss in the quiet eye
 Trauma
 Squints, new and congenital, rare
movement disorders
 …..(then a rare specialist rag bag)
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Red eye

Conjunctivitis
Commonest, an uncomfortable red eye.
Bacterial
 Discomfort. Purulent discharge. Spreads
from one eye to the other. Vision normal.
Uniform engorgement Chloramphenicol
first choice (?)
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Conjunctivitis
Viral
 Often with an URTI. Gritty. Discomfort.
Watery discharge. May last many weeks.
 Photophobia. Small corneal opacities may
develop. Prolonged (often adenoviral) may
need specialist therapy with steroids.
Chloramphenicol to prevent 2nd infection.

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Conjunctivitis
Chlamydia
 Mucopurulent, cornea inflamed, visual loss. Often
with STD. Permanent damage possible, topical
and? systemic tetracyclines. Refer.
Infants
 Less than one month is notifiable disease - any
cause. May lead to scarring and permanent

damage. Refer most.
Allergic
 Itching and discomfort. Chemosis and visual
acuity loss possible. Papillae and if big
cobblestones. Cromoglycate may take days to
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start to work if bad.


Episcleritis / scleritis
Red sore eye. No discharge. Localised
(viz. conjunctivitis=generalised)
inflammation.
 Episcleritis usually self limiting and
idiopathic, no treatment needed.
 Scleritis often with CT diseases,
dangerous (perforation possible) Refer.
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Corneal ulcers
 Any infection, Abrasion, topical steroids, contact







lens use.

PAIN. - Except zoster
May be general or localised inflammation.
Must stain. Should evert upper lid to exclude a sub
tarsal FB
?Hypopyon - pus in anterior chamber.
Refer most (except small abrasions - but refer if
big or longer than 36 hours)
Remember recurrent abrasion syndrome.

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Anterior uveitis
 The uveal tract. So iritis, iridocyclitis and anterior

uveitis are synonyms.
 At risk: HLA-B27, CT diseases, past attacks,
juvenile arthritis, sarcoid.
 PAIN, then photophobia then visual loss.
 Ciliary flush. As it gets worse the pupil gets small
and reactions get sluggish, hypopyon, keratitis
(back of cornea). These markers of it getting
worse are bad news.
 Refer all.
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Acute closed angle
glaucoma
 Often starts in the evening. Especially in

those over 50 years.
 Severe pain first. Impaired vision and
haloes around lights. May have history of
past episodes relieved by going to sleep
(the pupil constricts during sleep).
 Refer even if attack spontaneously
resolves.
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Lids and tears
Chalazion
 = meibomnian cyst. In the lid. Warm
compresses and chloramphenicol.
Persistent - incise.
 Recurrent: ? DM, ? blepharitis, ?
roseacea.
 Can cause astigmatism from pressure.
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Stye
 An infection of lash follicle. May

be head of pus - nick with
needle. Or warm compresses
and chloramphenicol.

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Marginal cysts
 Non infected cysts from sweat or

sebaceous lid glands, if a problem
can often be simply treated with a
nick with a needle - small.

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Blepharitis
 Common, underdiagnosed. Persistently sore

eyes. Gritty. Often with chalazions or styes.
Inflamed lid margins, crusts, may have inflamed
lids.
 Associated with psoriasis, eczema and roseacea.
 Keep clean, antibiotic ointment[tetracycline],
artificial tears ? oral tetracyclines

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Acute dacrocystitis
 Medial inflammation over lacrimal

sac. Refer, systemic therapy and
topical urgently.

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Orbital cellulitis
 Life threatening and blinding. Usually from

sinuses. Especially important in children
who may become blind in hours.
 Unilateral swollen lids which may not be red.
 The patient is ill, there is tenderness over the
sinuses, restricted eye movements. ADMIT

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Ectropion
 Watery eye.. Laxity from age or nerve palsy.
Ointment and refer for LA operation to correct.
Entropion
 Common especially in the elderly. Scarring from
the lashes.
 Often results from blepharitis or chronic
conjunctivitis
 Refer

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Ingrowing lashes

 Damage to lids. May be

removed but will often need
electrolysis or cryocautery to
prevent recurrence.

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Watering eyes
 Differential diagnosis.your homework!
Dry eyes
 Common,
 Remember to treat associated blepharitis

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Sudden visual loss

An easy list really as
they all need
specialist
assessment!
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Retinal detachment
 Floaters, photopsias, the shadow or curtain across the
sight.

Optic neuritis
 More women, pain on moving the eye, central scotoma
Posterior vitreous detachment
 Aged 50+, flashing lights, floaters
Vitreous haemorrhage
 Floaters, red haze may be present. Red reflex absent.0

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Disciform macular degeneration
•Sudden disturbance of central vision.
Vascular occlusions
•Field loss. Diabetes, hypertension
Migraine
•Youth, headache, zigzag lines,
multicoloured lights.
Cerebrovascular disease
•Elderly, bilateral loss.
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