an 80 year old women complains of a very painful eye along with a feeling of nausea of 2 days...

An 80 year old women complains of a very painful eye along with a feeling of nausea of 2 days duration. On examination the eye is red.

1. What condition do you want to exclude ?

2. How do you do this ?

Eight

• Acute Angle Closure

Glaucoma

• Digital Tonometry

Examination of Fundus• Requires practice and confidence.• More accurate with dilated pupil.• Knowledge of A&P to interpret findings.• Limited view with direct ophthalmoscope.

RAPD (relative, afferent, pupillary, defect)

• RAPD is testing the nerve pathways to the brain. Inflammation, damage, or pressure on the nerves will cause a defect.

• Light shone into a healthy eye causes constriction in both eyes. Swing light to other healthy eye and same reaction will occur. Repeat 3 or 4 times.

• In a damaged eye – on swinging light to damaged eye neither pupil will constrict and damaged eye will start to dilate.

Ophthalmoscope Practice

• Find tops tips for using ophthalmoscope in hand out

• Get into small groups

• Practice !!!!!

A 75 year man complains of sudden loss of vision in one eye. Visual acuity is ‘hand movements’ only.

1. What are the likely causes?

2. What condition do you want to exclude ?

3. How do you do this ?

Nine

Central Retinal Artery Occlusion

• Milky white Retina with Cherry Red spot at the macula.

• Can present with sudden loss of vision or have transient vision loss a few days before.

Central Retinal Vein Occlusion

• Central vein which drains blood from the retina becomes blocked, causing a back flow of blood, hence the vessels leaking into the retina causing swelling.

• Ischemic causes of a blockage increases complications. Abnormal growth of blood vessels occur.

• Some can be treated with Laser

Optic Neuritis/Papilloedema

Diabetic Retinopathy

• Known as Background or Non-proliferative

• Hard exudates – yellow flecks deep in the retina reflecting leakage of incompetent pre capillary retinal arterioles

• Haemorrhages – ‘red dots’ show mini blow outs of the diseased pre capillary arterioles

Proliferative

• This shows the tangling of blood vessels at the optic disc & nearby retina.

• The vessels are weak walled & break easily. They bleed into the retina & vitreous jelly & can cause retinal detachment & blindness.

• Treatment with argon laser is helpful

Glaucoma

• As a rule optic disc assessment is difficult as there is an infinite variety of normal optic discs.

• The main visible sign is thinning of the neuroretinal rim causing a larger central cup. As the disease progresses the rim is eroded until there is little or no rim left.

Normal disc

Cupped disc

Disc Oedema with Hypertension

• Disc oedema with splinter haemorrhages

• Caused from severe hypertension

an 80 year old women complains of a very painful eye along with a feeling of nausea of 2 days...

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