Common EYE Disease. Patcharaporn Wangvoravit
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1 Common EYE Disease Patcharaporn Wangvoravit
2 Chief complaint -> VA drop?, Eye pain?, One or two side?, Trauma? Examination -> VA!!! -> RAPD -> association Emergency eye condition >>> consult EYE True emergency => CRAO & Chemical injury
3 CRAO : central retinal artery occlusion Acute painless visual loss Unilateral, sudden onset May have Hx. of Amaurosis fugax VA drop RAPD + No sign inflamm./infection Quiet eye
4 Cilioretinal artery occlusion CRAO with sparing cilioretinal artery
5 Hollenhorst plaques
6 Timing is very importance!!! Concern in risk factor => cardiovascular risk, emboli, trauma->fat emboli, CNT dz., GCA Rx. > ocular massage > A/C paracentesis IOP lowering Carbogen inhaletion (vasodilate), hyperbaric chamber W/U : EKG, CRP/ESR(GCA), basic lab, echo?, carotid dropper U/S Poor visual prognosis & permanent VL
7 Chemical Injury : Alkali & Acid Alkali Burns Saponification of fatty acid in cell membrane Visual prognosis - extend of ocular surface injury - presence + degree of skin burn - effected on eyelid function Most unfavorable visual prognosis * extensive limbal epi. damage * intraocular chemical penetration
8 Chemical Injury : Alkali & Acid Acid Burns Denature and precipitate protein by contact Coagulation necrosis Mainly at epi.level -> less severe tissue damage
9 Emergency Check tear 5-10 min. following irrigation Pain control : topical tetracaine, analgesic Copious irrigation --> balance ph Remove particulate chemical : NSS flush, forceps Debridement of devitalized corneal epi. Cycloplegia : 1% atropine Control IOP
10 Test ph of eye Litmus test - blue litmus paper : acid --> red - red litmus paper : alkali --> blue - neutral litmus paper : purple
11 Urine strip test : - read in sec.
12 Eye exam : vision, slit lamp, extraocular injury Initial evaluation stroma may difficult due to epi. opacity - limbal involved grade IV-V Delay assessment of stromal edema at hrs. may be need
13 Corneal Abrasion Acute eye pain with tearing Hx. Trauma, rubbing, FB Topical anesthesia may help Before examination Search for FB Rx. > Lubrication : tear > topical ATB prophylaxis > if not sure for infection => Don t pressure patch
14 NOT only abrasion!!! Beware... Infection : Ulcer
15 Corneal Ulcer Eye pain, redness, tearing, FB sensation, VA, discharge Hx. Trauma, FB, CL Lid inflammation, injected conjunctiva, discharge Whitish infiltration at cornea May hypopyon Don t missed cornea!!!
16 Consult EYE *** Don t eye pad / pressure pad VA drop?? Size of infiltration cornea : central? Hypopyon?? FB??
17 Not sure corneal ulcer?? Topical ATB : poly-oph, chloram., Tobramycin ATB eye ointment : chloram. EO, terramycin EO F/U OPD EYE Advice pt. Don t eye pad/pressure pad >>> eye irrigation not necessary
18 Bacterial Conjunctivitis Eye irritation, redness, blurred VA Yellow/green discharge Mostly unilat -> may bilat. Topical ATB : poly-oph, chloram., Tobramycin ATB eye ointment : chloram. EO, terramycin EO Advice pt.
19 Gonococcal Conjunctivitis Cef mg IM single dose Consult eye ** -> topical ATB ± admit Rx. Partner & Child : beware abuse Acute onset, severe eye pain Massive mucopulurent discharge Hx. STD Young age Unilat -> may bilat
20 Viral Conjunctivitis Eye irritation, redness, FB sensation Watery discharge Unilat.-> bilat. Hx. contact pt. / Hx. URI Preauricular LN enlarge VA drop >> beware!!! EKC photophobia
21 Usually self-limited Advice eye care & hygeine Isolation at least 7 D Not eye pad *** Eye irrigation is not necessary!!! Tear => p.r.n for lubrication May ATB eye drop/ointment for 2 nd bact. prophylaxis general practice not recommend use of steroid If suspected EKC >>> consult eye or F/U OPD EYE
22 Itching, eye irritation, redness, FB sensation May mucous discharge Hx. AR Allergic Conjunctivitis Seasonal/perineal Rx. > Hista-oph q.i.d > Tear > oral in severe case > cold compress > mast cell stabilizer (EYE)
23 Pterygium & Pinguecula No symp., eye irritation, localized redness UV, wind Sun glasses >> tear for lubrication If inflammation antihistamine Ed, steroid(eye) Sx. in involved visual axis/induce astig., > 3mm.
24 Cornea/conjunctiva Eye irritation, redness, tearing, blurred VA Hx. Trauma/FB mechanism Topical anesthesia before remove Must check lid
25 Remove by needle NO. 20/21 >> bevel up in horizontal fashion beware!!! needle penetration should remove rust ring Med > topical ATB > ATB eye ointment > advice pt. > if suspect infection F/U EYE > not used steroid > aware of eye pad
26 Corneal Laceration Tearing, FB sensation, eye pain Hx. finger, nail, tree Consult EYE *** Beware infection => ATB eye drop/ointment May sx., on CL, patch Must R/O complete laceration
27 Rupture Cornea Site >>> Pupil : round?, oval?, peak iris A/C form? Uveal tissue?
28 Consult EYE!!! Only Eye shield Do not used eye drop/ointment Analgesic drug Anti emetic drug NPO time
29 IOFB Eye pain, irritation, FB sensation, tearing High velocity of FB** Metallic / non-metallic Must be R/O in every case of suspicion!!! Film moving eye ball CT orbit (non-contrast) Consult EYE
30
31 Save life first Only eye shield Consult EYE!!! NPO >> NPO time Control pain Do not use eye drop/ointment
32 IOFB : Complication Traumatic Endophthalmitis *** Siderosis bulbi(metalic) Traumatic Cataract Retinal break/rrd VH
33 Traumatic Hyphema Blunt injury Acute eye pain, photophobia, VA If > 1/3 of A/C...admit Consult EYE *** Microscopic hyphema : Rx as OPD
34 Absolute bed rest Head up 30 ⁰ Eye shield Steroid ED ( inflamm.), may prednisolone ATB for prophylaxis... In some case Cycloplegic ED => 1% atropine, Cyclogyl Analgesic drug : not NSAID/ASA IOP lowering Anxiolytic drug
35
36 Tear Canaliculi
37 Fracture Orbit ABC first VA drop?? RAPD +?? Site? Limit EOM?? Displace??
38
39 AION Decrease VA RAPD + VF loss Optic disc edema NAION & AAION
40
41
42
43 Orbital cellulitis Source - direct inoculation : trauma - direct spread : sinus, dental infection, dacryocystitis, hordeolum - hematogenous spread : sepsis, OM, pneumonia Lesion posterior to orbital septum Chemosis, axial proptosis, pain Limit EOM, VA drop, RAPD + Increase IOP, papillitis
44 Thyroid Associated Ophthalmopathy : TAO Autoimmune disease affected ocular + orbital tissue 25-50% of Graves dz onset within 6 mth after/before onset of hyperthyroidism Peak incidence : 5 th decade + 7 th decade 85-95% bilateral Lid lag Lid retraction *90% unilat/bilat Proptosis 60% Restrictive extraocular myopathy 40% Compressive optic neuropathy
45 Lab investigation Thyroid function test => TSH, FT3, FT4-6% euthyroid stage Thyoglobulin Ab : TgAb TSH Receptor Ab : TRAb Thyroid Peroxidase Ab : TPOAb
46 Thank You
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