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Diabetes
• Refractive changes due to glucose, correct when
glucose stable
• Extraocular muscle paralysis CnIII and CnVI
• Retinopathy
– Background – microaneurysms, dot haemorrhage,
hard exudates
– Pre-Proliferative – cotton wool spot, blot
haemorrhage, venous loops
– Proliferative – neovascularisation, traction retinal
detachment, glaucoma.
Investigation / Management
Retinopathy
• Ix – Digital photographic screening and Fundal
Fluorescien angiography.
• BP/Lipid/Glycaemic control
• Photocoagulation – retinal/macular, argon
laser or xenon.
• Vitrectomy – clear vitreous haemorrhage,
allows laser, relieve traction
Background retinopathy
Background
Pre Proliferative
Pre Proliferative
Proliferative
Proliferative Retinopathy
Laser
Photocoagulation
Hypertension
• Keith Wagner Classification
• Grade I – minimal constriction and irregularity of
arterioles
• Grade II – AV nipping
• Grade III – Flame haemorrhages and soft
exudates
• Grade IV – papilloedema, collection of hard
exudates radiating in a star shaped formation
• Fundal changes reflect severity of HTN, reversal
shows control
Hypertensive Retinopathy
Grade IV Malignant Phase
Red Eyes
Conjunctivitis
• Conjunctivitis
– Grittiness sensation
– Normal Vision
– Purulent discharge
– Crusting of lid margins
– History of contact
– Redness of conjunctiva
– Mx Hygiene, swab, prescribe topical Abx
chloramphenicol or fusidic acid
– Bilateral consider chlamydia
– Opthalmia neonatorum – newborns under 1 month,
reportable disease
Corneal Ulcer/Keratitis/Abscess
• Painful red eye
• Contact lenses, FB, facial cold sores???
• Photophobia
• Purulent discharge in bacterial cases
• Fluorescein staining reveals area of epithelial
defect under cobalt blue light
• Immediate opth opinion, corneal scrape,
– antivirals for herpes simplex dendritic ulcer
– Intense Abx for bacterial ulcer
Corneal Ulcer
Keratitis
Uveitis
• Inflammation of the Uveal tract – iris, ciliary body and choroid
• Painful red eye
• Photophobia
• Blurred vision or floaters
• Cilicary circumcorneal injection
• Reduced acuity
• Sluggish or irregular pupil
• Iris details may be hazy
• Inflam cells on corneal endothelium
• Raised intraocular pressure
• Cataract in recurrent or chronic uveitis
• Rx reducing regimen of topical steroid (dexamethasone 0.1%)
• Cycloplegic and dilating drop (cyclopentolate 1%) for pain
relief and prevention of synechiae
Uveitis
Acute Angle Closure Glaucoma
• Older hypermetropic people
• Sudden onset severly painful red eye
• Blurred vision
• Halos around lights
• Headache
• Nausea and vomiting
Scleromalacia
Chalazion
Exopthalmos
Stevens Johnson
Syndrome
Pterygium
Pinguecula
Corneal Dystrophy
Iridocyclitis (deformed
pupil)
Toxoplasma
Chorioretinitis
Chorioretinitis
Histoplasma infection
Macula Dystrophy
Retinoblastoma
Retinopathy of prematurity
Dragging of the optic disc
Tuberous sclerosis
Lens Dislocation