Transcript Ohpthalmology Quiz - Bon Secours Hospital

Interactive
Ophthalmology Quiz
Mr Behrooz Golchin
Consultant Ophthalmic Surgeon
10 minutes
Section 1
• Case presentations
Section 2
• Spot diagnosis
• Please participate
• Don’t be embarrassed
• Shout out the answers
Section 1
CASE PRESENTATIONS
Case 1
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35 year old man
C/O watery Rt eye
Eye becoming progressively painful
Photophobic
The vision is a little blurred
• O/E VA is 6/12.
• His right eye is
photosensitive.
• The redness is diffuse
but more pronounced
around the cornea.
• The cornea appears a
bit hazy and his pupil is
miosed.
• If you dilate the pupil,
you will notice that the
pupil now has a
scalloped appearance.
• What is the diagnosis?
Anterior Uveitis
• Anterior uveitis refers to inflammation of the
iris and/or ciliary body and
• Usually presents with a painful, red eye.
• Patients often c/o decreased vision and a
watery discharge.
Anterior Uveitis
• Photophobia is 2’ to spasm of inflamed iris
and ciliary muscles.
• Visual acuity varies depending on the severity
of the inflammation.
Anterior Uveitis
• The pupil is often miosed
• if untreated, the pupil margin may adhere to
the lens due to the formation of posterior
synechiae.
Anterior Uveitis
• Corneal precipitates may occur on the
endothelium
• hypopion (pus in the anterior chamber) may
be present in severe cases.
Treatment
• Dilating drops
– relieve ocular discomfort by reducing ciliary muscle
spasm
– prevent the formation of posterior synechiae.
• Topical corticosteroid drops to treat the
inflammation
• Periocular steroid injections or even systemic
corticosteroids may be required in more
severe cases.
Case 2
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30 y.o lady
5 day Hx of FB sensation and redness Lt eye.
c/o reduced vision and watery
No previous eye Hx
• O/E VA is 6/9
• Mild diffuse conj
injection.
• A whitish area seen
in the pupillary
zone
• What would you do
next?
• Instillation of 2%
fluorescein shows a
branching ulcer on
the lateral side of
the cornea.
• What is the Dx?
Herpes simplex Keratitis
 Dendritic ulcer
 Confined to epithelium
but deeper tissues
may become involved.
 Stained with
fluorescein and rose
bengal
 Rx topical aciclovir
Dendritic ulcer
Geographic Epithelial keratitis
 Dendritic ulcers coalesce
and enlarge to form this
larger ulcer.
 Can occur as a result of
inappropriate steroid use.
 Do not treat a red eye with
steroid unless HSK is ruled
out.
Case 3
• A 9 y.o. boy c/o sever itching in both eyes.
• his mother says that he is constantly rubbing
his eyes.
• The eyes water a lot and bright light hurts
them.
• Not sticky, no discharge.
• He is currently on treatment for asthma.
• O/E , his VA is 6/9 in
both eyes
• He is very photophobic.
• His eyelids are red.
• The conjunctiva is
mildly injected.
• His corneas are clear
and do not stain with
fluorescein.
• What do you do next?
• Upon everting his upper
eyelids, you notice
several raised, fleshy
lesions on the
conjunctival surface of
the upper lids.
• What is the diagnosis?
Vernal keratoconjunctivitis
• Vernal keratoconjunctivitis
– most commonly occurs in young boys
– often have a history of atopy.
• Symptoms include
– severe, chronic ocular itching
– photophobia,
– blepharospasm,
– mucoid/watery discharge
– blurred vision also occur frequently.
Vernal keratoconjunctivitis
• Signs include giant
papillae under the
upper eyelid
• they have a typical
cobblestone
appearance.
Vernal keratoconjunctivitis
• Limbitis
• a fleshy, gelatinous ring
around the limbus,
• contains whitish spots
called Trantas dots.
Treatment
• Mild cases respond to:
– topical antihistamines and artificial tear drops
– topical mast cell stabilisers
– oral antihistamines is often required in cases of moderate
severity.
• Severe cases frequently require:
– short courses of topical corticosteroids, such as
fluorometholone or dexamethasone
– intraocular pressure need to be monitored.
• In very severe cases
– topical immunomodulatory drugs, such as cyclosporine or
tacrolimus, may be needed to control the inflammation.
Case 4
• A 32 y.o. female c/o redness and increasing
pain in her left eye x 3/7.
• The eye is painful to touch
• The pain has woken her from sleep over the
last two nights.
• Eye is a little watery but there is no significant
discharge
• visual acuity has not changed.
• O/E VA is 6/6 and her
eyelids are normal.
• large area of redness,
temporal to the cornea.
• The eye is very tender to
touch.
• looking at the eye in natural
daylight, the underlying
sclera has a purplish hue.
• The rest of the examination
is unremarkable.
• What is the likely Dx?
Scleritis
• Scleritis may be either
diffuse or nodular.
• Pain is a prominent
feature.
• Often wakes the patient
from sleep during the
night.
• Visual acuity is often
not affected in the early
stages.
Scleritis
 Etiology:
Collagen vascular disease
RA, SLE, gout, syphilis
 Complications:
 Peripheral ulcerative
keratitis with corneal
perforation
 Secondary glaucoma
 Scleral melting and
perforation
 Exudative retinal
detachment
Treatment
• Scleritis often responds adequately to oral
NSAIDs.
• > 50% of patients with scleritis have an
associated systemic disease.
• They require specialist referral for systemic
workup
• May need potent immunosuppressive therapy.
Section 2
SPOT DIAGNOSIS
THANK YOU FOR YOUR ATTENTION