Rafik Girgis. Consultant Ophthalmic Surgeon ( Cataract & Primary Care)

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1 Rafik Girgis Consultant Ophthalmic Surgeon ( Cataract & Primary Care)

2 Blepharitis Is a very common condition which usually bilateral & symmetrical. The main types are: Anterior, posterior or mixed Complications: Stye & tear film instability which can cause dry eye symptoms

3 Blephritis

4 Treatment It s a long term treatment. Lid hygiene & tear substitutes, Hylo-tears Antibiotics Occ Maxitrol BD for 2 weeks Doxycycline 100 OD for up to 3 months

5 Causes of red painful eye Idiopathic Acute glaucoma Inflammatory, episcleritis, scleritis, iritis...etc Infective Mass as chalazion, stye, any other cysts.. Dry eyes others

6 ACG

7 How to exclude ACG Check the pupils Look at the cornea

8 Corneal oedema in ACG

9 Episcleritis/ Scleritis

10 Treatment Episcleritis: tear drops, steroid or NSAIDs Scleritis: Flurbiprofen, (Froben), mg TDS

11 Iritis

12 Computer vision syndrome Red, burning and tired eyes go hand-inhand with staring at a computer screen for too long. One reason is that you blink less when working at a computer, which dries out the surface of the eye.

13 Contact Lens Keratitis

14 Subconjunctival haemorrhage

15 Tricky pathologies Papilloedema Giant Cell arteritis

16 Aetiology of papilloedema Medical causes: Hypertensive, idiopathic intracranial hypertension,iih, optic neuritis & ischemic optic neuropathy. Surgical compressive causes pseudopapilloedema

17 Papilloedema

18 Disc swelling

19 Pseudo-papilloedema DD: Optic disc drusen. Small optic discs.

20 Optic disc drusen

21 GCA Is a medical emergency, self-limiting systemic vasculitis of unknown aetiology involving large & medium sized arteries mainly in the carotid circulation as ophthalmic, CRA & temporal arteries.

22 American College of Rheum To distinguish GCA from other vasculitis if a patient gets 3 out of these 5 criteria: 1. Age: 50 years or older. 2. New onset of headache, localised pain. 3. TA abnormalities: tenderness to palpitation or decreased pulsation but unrelated to atherosclerosis. 4. ESR above 50mm/h by the Westergren method 5. + TAB

23 Symptoms Age: > 50 is 22/ > 85ys 1100/ Female > male 6:1. Race: Caucasian esp Northern European > Asian> Black Denmark 30/ compared to Japan 1.4/ for the same age group.

24 Symptoms Two classical features: Jaw claudication & diplopia BUT their absence Can t rule out the disease. Visual loss up to 30% of cases, 20 % with visual symptoms but no other symptoms. PMR symptoms up to 50%, morning stiffness, pain and tenderness of proximal muscles, weight loss, fever, anorexia and malaise.

25 Signs Abnormal temporal artery in 50%. Absence of TA abnormalities is the only clinical sign that reduced the likelihood of the diagnosis. Swollen ON usually arteritic type of ION, CRAO, BRAO, altitudinal VF defect. Cranial neuropathy Aortic aneurysm and dissections & stroke.

26 Altitudinal VF defect

27 GCA,cont. Investigation: Urgent ESR, 8-22% of patients with GCA have normal ESR. CRP: is more specific, 99% specific. Platelet count is more specific than ESR. Anaemia TAB: should be done within a week but it may fail to confirm the diagnosis as we need to take 2.5cm of the artery, 80-90% sensitive in diagnosis of GCA.

28 Treatment Steroid for one year. No evidence that IV works better than PO. Further visual loss after starting the steroid can happen up to 15% within 5-7 days but visual loss in patients without vision loss and being treated is only 1%. Aspirin

29 Cross section of the eye

30 Cataract Is cloudy/opacity of the lens

31 Prevalence and incidence of cataracts Cataract is a common and important cause of visual impairment world-wide Overall, 30% of people of 65 years and over in this population were found to have visually impairing cataract in one or both eyes and 71% in people of 85 years or more. NHS can do 330,000 operations annually.

32 Types of cataract Nuclear sclerosis

33 Types of cataracts Posterior sub-capsular cataract

34 Types of cataracts Cortical cataract

35 Types of cataracts Posterior polar cataract

36 Xmas tree cataract

37 Monofocal Types of implants

38 Toric implants to treat astigmatism

39 Implants to treat presbyopia Multifocal or trifocal

40 Thank you