Download the power point presentation from the following site
Neuro Ophthalmology Presentation
Wednesday, September 15, 2010
Orbit SEQs
The Orbit
Preseptal Cellulitis
• infection of soft tissue anterior to orbital septum
Etiology
• usually follows periorbital trauma or dermal infection
Clinical Features
• tender, swollen and erythematous lids
• may have low-grade fever
• normal visual acuity, pupils, extraocular movements (EOM)
• no exophthalmos or RAPD
Treatment
• systemic antibiotics (Suspect H. influenza in children; S. aureus or Streptococci in adults)
• warm compresses
Orbital Cellulitis
• inflammation of orbital contents posterior to orbital septum
• common in children, but also in the aged and immunocompromised
Etiology
• usually secondary to sinus/facial/tooth infections or trauma
Clinical Features
• decreased visual acuity, pain, red eye, headache, fever
• lid erythema, tenderness, and edema with difficulty opening
• conjunctival injection and chemosis (conjunctival edema)
• proptosis, limitation of ocular movements (ophthalmoplegia) and pain with
movement
• RAPD, optic disc swelling
Treatment
• admit, IV antibiotics, blood cultures, orbital CT
• surgical drainage of abscess
• follow closely
Complications
• orbital apex syndrome, cavernous sinus thrombosis, meningitis, blindness
Finding Preseptal Cellulitis Orbital Cellulitis
Fever May be present Present
Lid edema Moderate to severe Severe
Chemosis Absent or mild Moderate or marked
Proptosis Absent Present
Pain on eye movement Absent Present
Ocular mobility Normal Decreased
Vision Normal Diminished ± diplopia
RAPD Absent May be seen
Leukocytosis Minimal or moderate Marked
ESR Normal or elevated Elevated
Additional findings Skin infection Sinusitis, dental abscess
Preseptal Cellulitis
• infection of soft tissue anterior to orbital septum
Etiology
• usually follows periorbital trauma or dermal infection
Clinical Features
• tender, swollen and erythematous lids
• may have low-grade fever
• normal visual acuity, pupils, extraocular movements (EOM)
• no exophthalmos or RAPD
Treatment
• systemic antibiotics (Suspect H. influenza in children; S. aureus or Streptococci in adults)
• warm compresses
Orbital Cellulitis
• inflammation of orbital contents posterior to orbital septum
• common in children, but also in the aged and immunocompromised
Etiology
• usually secondary to sinus/facial/tooth infections or trauma
Clinical Features
• decreased visual acuity, pain, red eye, headache, fever
• lid erythema, tenderness, and edema with difficulty opening
• conjunctival injection and chemosis (conjunctival edema)
• proptosis, limitation of ocular movements (ophthalmoplegia) and pain with
movement
• RAPD, optic disc swelling
Treatment
• admit, IV antibiotics, blood cultures, orbital CT
• surgical drainage of abscess
• follow closely
Complications
• orbital apex syndrome, cavernous sinus thrombosis, meningitis, blindness
Finding Preseptal Cellulitis Orbital Cellulitis
Fever May be present Present
Lid edema Moderate to severe Severe
Chemosis Absent or mild Moderate or marked
Proptosis Absent Present
Pain on eye movement Absent Present
Ocular mobility Normal Decreased
Vision Normal Diminished ± diplopia
RAPD Absent May be seen
Leukocytosis Minimal or moderate Marked
ESR Normal or elevated Elevated
Additional findings Skin infection Sinusitis, dental abscess
Ocular Emergencies
Urgent referal to an Ophthalmologist
- intraocular foreign body
- lid/globe lacerations
- corneal ulcer
- gonococcal conjunctivitis
- orbital cellulitis
- chemical burns
- acute iritis
- acute angle-closure glaucoma
- entral retinal artery occlusion (CRAO)
- retinal detachment
- endophthalmitis
- temporal arteritis (AION)
- Any case of severe ocular trauma
- Any case of acute visual loss
Important Examination Topics
Referactive errors (myopia, hypermetropia astigmatism presbyopia)
Lids (entropion, ectropion, ptosis, Chalazion, stye, Basal cell ca Blepharitis)
Conjunctiva (conjunctivitis bacterial, viral, phylectenular, vernal catarrah, trachoma, pterygium pingecula)
Cornea (corneal ulcer, bacterial , viral, fungal, acanthamoebic, trophic, exposure, disciform keratitis keratoconus)
uvea (causes signs, symptoms and treatment of uveitis acute and chronic)
lens ( cataract, subluxation)
Glaucoma ( POAG PNAG causes of secondary glaucoma congenital glaucoma)
Dry eye (causes and treatment)
proptosis (causes, treatment options)
blunt trauma eye (effects, blow out fracture )
Chronic dacryocystitis causes of watering diagnosis treatment
central retinal venous oclusion
disc odema papllodema causes features
optic neuritis causes features treatment
retinal detachment
effects of diabetes on the eye
effects of hypertension on the eye
age related macular degeneration
central serrous retinopathy
retinitis pigmentosa
retinoblastoma
causes of leukocoria
episclerits/ scleritis causes treatment
causes of diplopia
squint (definition, classification, cover uncover test, alternate cover test investigations treatment amblyopia treatment of amblyopia)
Nerve palsies (causes features teatment)
optic atrophy causes
light reflex pathway
vitamin a deficency
orbital cellulitis
orbital pseudotumor
painful red eye
causes of reduced vision sudden and gradual
Red Eye Differential Diagnosis
| Acute Conjunctivitis | Acute Bacterial Keratitis/ Ulcer | Acute Anterior Uveitis | Acute Congestive Glaucoma | |
| Chief complaints | Redness,discharge,foreign body sensation | Redness, watering, pain, photophobia, reduced vision if central | Redness,Pain, photophobia,reduction in vision | Redness, Pain, photophobia, gross reduction of vision nausea/vomiting |
| Vision | Normal | Normal (reduced if lesion central) | Mild to moderately reduced | Severely reduced |
| Conjunctiva | conjunctival congestion | circumcorneal congestion | circumcorneal congestion | circumcorneal congestion |
| Cornea | Clear | Opacity | Generalized Haze (KPs) | Very Hazy (Epithelial Odema) |
| Anterior Chamber | Normal Depth | Normal depth (in severe cases aqueous Cells, aqueous Flare, Hypopyon ) | Normal depth or Shallow (if Iris Bombe) Aqueous Cells, Aqueous Flare, Hypopyon, | View hazy due to corneal edema Shallow anterior chamber |
| Iris | Normal | Normal | Muddy Iris Iris Bombe, Peripheral anterior synechae(PAS) | Congested |
| Pupil | Round, Regular, Normal reaction, | Round, Normal reaction | Miosed, Irregular, Sluggish Reaction Posterior Synechae, seclusio pupillae, Oclusio pupillae, | Mid-dilated, vertically oval, Non Reacting |
| IOP | Normal | Normal | Normal (High in secondary angle closure glaucoma or low in cilliary shut down) | Very High (stony hard) |
| Treatment | Broad spectrum Antibiotic eye drops analgesics dark glasses | Strong Antibiotic eye drops and Sub conjunctival injections to cover both gram positive and gram negative organisms Atropine Analgesics Dark glasses | Strong Steroid eye drops Atropine eye drops t.i.d Analgesics orally Dark glasses | Inj Mannitol 300 ml i.v. in 40 mts stat Tab Acetazolamide 2 stat then q.i.d Pilocarpine eye drops q.i.d Anti-emetics i.v. Analgesics orally Beta Blocker eye drops b.i.d. Mild steroid eye drops q.i.d.
|
Viva Questions Neuro Ophthalmology
what are the causes of disc odema
what is papilledema
what are the stages of papilledema
what are the earliest signs of papilledema
what is pseudo-tumor cerebri
what are the causes of optic atrophy
what are the causes of III Nerve palsy
what are the features
what are the causes of IV nerve palsy
what are the features
what are the causes of VI nerve palsy
what are the features
What are the causes of optic neuritis
what are the features
what are the visual field defects on ON
what are the MRI sign in ON
what is RAPD
what is the treatment
What are the causes of pain in and around the eye
what is migraine
what are the features of classical migraine
what is the treatment
what is trigeminal neuralgia
treatment
Viva Questions Orbit
what is proptosis
what are the causes
what is the most common cause
name few orbital tumours
what is pseudo tumor orbit
what are causes of orbital cellulitis
how can you differentiate between orbital and pre-septal cellulitis
what are the features of thyroid ophthmopathy
Viva Questions Lids
What are the causes of lid swelling
What is chalazion
What is the treatment of chalazion
What is stye and its treatment
What is hordeolum internum
What is hordeolum externum
What is entropion
Causes of entropoion
What is the treatment
What are the complications
What is ectropion
What are the causes
What is the treatment
What is trichasis
What is poliosis
What is madarosis and it is causes
What is disthiasis
What epiblepharon
What is ptosis
What are the causes
What is the treatment of ptosis
What is MRD
What is the grade of ptosis
What are the surgeries for ptosis
What are the indications of surgery
Viva Questions Glaucoma
Give a good definition of glaucoma
What is the normal IOP
Where is the aqueous produced
Pathway of production and drainage
What is the angle of the eye
Why it is not visible with naked eye
Which instrument one uses to view the angle
What structures are present in the angle
What are the grades of angle
What is a slit angle
Which grades are narrow
Which grades are called open
Which grades are safe
What is a visual field
How do yo plot it
Give the extents
What is blind spot of marriotte
What is scotoma
What is positive scotoma and causes
What negative scotoma and causes
What is the earliest field defect in POAG
Wat are the characterstic visual field defects in POAG
What is cupping of the disc
What is the physiological cup
What is bayoneting sign
What is the lamellar dot sign
What is the splinter haemorrhage
What are the nerve fible defects in glaucoma
How can on see the nerve fibre layer
POAG
What is the definition of POAG
What is the incidence of POAG
What is the cause of POAG
What is the site of obstruction
What are the symptoms of POAG
What are the signs of POAG
What is the treatment of POAG
What id ALT
What ire the complications of ALT
Name few anti-glaucoma drugs and their complications
How do you assess the adequacy of management
What are the indications of surgery
What are the operations
What are the complication of trabeculectomy
Name different kinds of blebs
What is normal tension glaucoma
What are the special feature of NTG
Viva Questions Lens
what is the definition of cataract
what is mature cataract
Mature cataract is one in which the lens is completely opaque
what is immature cataract
Immature cataract is one in which the lens is partially opaque
what is iris shadow test
what is hyper mature cataract
Hypermature cataract has a shrunken and wrinkled anterior capsule due to leakage of water out of the lens
what is hyper mature morgagnian cataract
Morgagnian cataract is a hyper-mature cataract in which liquefaction of the cortex has allowed the nucleus to sink inferiorlywhat is Emsley Fincham test
What is intumescent cataract
what is the medical management of cataract
what are causes of cataract
congenital
acquired
what are the indications of cataract surgery
visual
diagnostic
therapeutic
medical
cosmetic
what are the names of cataract surgery
What are the complications of cataract surgery
what is endophthalmitis
It is an inflammation involving all intraocular tissues except the sclera
What is pan ophthalmitis
It is an inflammation that involves the entire globe, often with orbital extension
How can you differentiate between end and pan ophthalmitis
what is the treatment of endophthalmitis
what are the causes of dislocation of lens
what is subluxation
what are the complications of a dislocated lens
what is luxation
What are the causes of congenital cataract
what are the morphological types of congenital cataract
what are the morphological types of acquired cataract
what laboratory investigation will you perform in cases of congenital cataract
- Serology for intrauterine infections (TORCH = toxoplasmosis, rubella, cytomegalovirus and herpes simplex).
- Urinalysis for reducing substance after drinking milk (galactosaemia) and chromatography for amino acids (Lowe syndrome).
- fasting blood glucose,
- serum calcium and phosphorus,
- red blood cell GPUT and galactokinase levels
Viva questions gemeral ophthalmology
WHO definition of blindness
- When the vision is reduced to less than 3/60 in the better eye and/or the visual field is less than 30 degrees in the better eye
What is the definition of visual acuity
how it is measured
method of taking visual acuity
what is pin hole test
what is stenopic slit
how pin hole improves vision
causes of reduced vision sudden
causes of reduced vision sudden
causes of blindness in the world
Refractive errors
what is refractive error
what are the refractive errors
what is the def of myopia
what re the types
what is pathological myopia
what are the complications/features of myopia
what is the treatment of myopia
how can you differential between concave and convex lenses
what is a retinoscope and its uses
what is an ophthalmoscope and its uses
what is distant direct ophthalmoscopy how it is done what are the uses
How can you differentiate between corneal, lenticular or vitreous opacity
what is a keratoscope and its uses
what is a keratometer and its uses
what is auto-referactor
what is visual field
how it is measured
what are the normal extents of visual fields
what is scotoma
what is positive scotoma and its causes
what is negative scotoma and its causes
what is a perimeter
what is a visual field analyser
what is placido's disc
what are the dark room test way are they now not necessary
what is refraction
what is cycloplegic refraction
what are the types of contact lenses
what are the complications of contact lenses
what the the latest surgeries for myopia
what is PRK
what is LASIK
What is mini RK
what are the complications of refractive surgery
What are is the definition of Hypermetropia
what is the treatment
What is refractive surgery
what are the complications of refractive surgery
what is astigmatism
what is strums conoid
what are the types of astigmatism
what is regular astigmatism
what is irregular astigmatism
what are the causes of irregular astigmatism
what is the treatment of astigmatism
what is with the rule astigmatism
what is against the rule astigmatism
In old age which astigmatism is common
how cataract surgery affects astigmatism
what is presbyopia
what is the treatment
name the surgeries for presbyopia
what is accommodation
what is the mechanism of accommodation
Subscribe to:
Comments (Atom)