أرشيفات التصنيف: Student_Ophthalmology

Struck in the Eye (Acase study

Struck in the Eye

A 36-year-old man with presents to the emergency department 15 minutes after being struck in his right eye (OD) while playing basketball. He has loss of vision and pain in his right eye but not in his left eye (OS). He no other facial or head trauma and no other complaints.
His visual acuity is recorded as OS 20/20 and OD 20/400, without pinhole improvement. The left pupil is 2 mm and reactive, whereas the right pupil is 6 mm and minimally reactive. The patient has red discoloration over 30% of the inferior aspect of the right anterior chamber (top image). No afferent pupillary defect is observed, though the cornea of the affected eye has a hazy appearance. Intraocular pressures (IOPs) measured on tonometry are OS 12 and OD 42 mm Hg. On fluorescein examination, no corneal abrasions are observed and the slitlamp examination reveals cells in the OD anterior chamber. The fundi are within normal limits.
What is the diagnosis and pharmacologic treatment? Why is checking for an afferent papillary defect (APD) important?

***** HINT *****
The red discoloration of the anterior chamber and the corneal haziness are abnormal
***** ANSWER *****

Hyphema with traumatic iritis and increased IOP: The patient has a hyphema with traumatic iritis and an acute increase in IOP. Postinjury accumulation of blood in the anterior chamber can be a sign of major intraocular trauma with associated damage to vascular and other intraocular tissues. Blunt trauma to the globe results in tears to the ciliary body, iris, and other anterior segment structures. These tears cause shearing of blood vessels, including those that make up the major arterial circle of the anterior segment and are responsible for hyphema formation. The potential for secondary hemorrhage and persistent elevations in IOP can result in poor final visual result.

Symptoms of hyphema include pain and photophobia. The patient’s visual acuity can be affected as a result of obstructing cells and blood. Initially, the IOP can markedly rise, as in this case, because of the disruption of the normal egress of aqueous humor into the trabecular meshwork from clogging by red blood cells and their byproducts or from direct trauma to the meshwork itself from the initial trauma.

Regarding the management of acute traumatic hyphema, first assess for concomitant injuries (eg, globe rupture, intraocular foreign body) that require emergency consultation with an ophthalmologist. If no emergency associated injuries exist, the goal of acute management is minimizing the risk of rebleeding and decreasing any pathologic increase in IOP. Rebleeding can occur with any activity that places additional shear forces on the affected blood vessels. Patients should avoid activities such as reading, tasks requiring excessive eye movements, or moving between different lighting conditions, which may cause papillary play (ie, the normal constriction and dilation of the iris in response to light). A long-acting cycloplegic agent, such as atropine or cyclopentolate (ophthalmic) can eliminate accommodation and dilate the pupil to desired effect. Topical steroids can help with associated iritis.

IOP above 24-30 mm Hg should be treated. The hyphema should be allowed to layer. Pharmacologic therapy with a topical beta-blocker (which decreases the production of aqueous humor) should be initiated. Use of carbonic anhydrase inhibitor agent, which rapidly decreases the production of aqueous humor, should be considered in patients who do not have sickle cell disease, as should an osmotic diuretic agent, such as intravenous mannitol or oral glycerol. Activities that increase IOP (eg, coughing, vomiting) should be avoided.

This patient was treated by ordering bed rest, elevating the head of the bed, and administering a topical beta-blocker and a carbonic anhydrase inhibitor. The hyphema decreased in volume and became layered by gravity (bottom image). In addition, his posttherapeutic IOP was 19 mm Hg, which made surgical washout of the anterior chamber unnecessary. A hard eye patch was placed, and follow-up with an ophthalmologist was arranged for the next morning.

Hyphema or glaucoma does not usually result in an APD unless the optic nerve is damaged as a result of persistent or marked elevations in IOP. Reducing this pressure on an emergency basis can help preserve the vision of patients with a hyphema and associated elevations in IOP.

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محاضرات فيديو رمد..د.سيف …القصر العيني

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Eye examination

Eye examination

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Nystagmus examination

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Ocular movement (basic examination)

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Prism cover test (right esotropia)

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Video lectures by Doctor Saif-Ophthalmology

Video Lectures By Doctor Saif


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>2nd concomitant squint
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Ophthalmology Examination Videos

Ophthalmology Examination Videos

Facial nerve synkinesis – 446KB ( The patient develops a right facial nerve synkinesis after recovering from Ramsey-Hunt’ s syndrome. Note the winking of the right eye with mouth movement.


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2. Hemifacial spasm – 183KB ( This patient develops a left hemifacial spasm after recovering from a left facial nerve palsy. She is also known to suffer from sarcoidosis. Note the contraction of the facial muscles and eyelid closure. The patient has difficulty in opening the right eye.


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3. Blepharospasm – 1,488KB ( This patient complains of a two-year history of recurrent spasmodic contraction of both eyelids which has got worse over the year. Slit-lamp examination of the anterior segment is normal. The spasm is reduced with pre-tarsal botulinum toxin injection.)


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4. Mobiussyndrome – 608KB ( The patient has expressionless face and is unable to blow her cheeks or frown. There is poor eyelid closure despite lateral tarsal strips and medial canthoplasties in both eyes. The horizontal eye movement is restricted as shown by the need of the patient to move her
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Cataract

Cataract


A cataract is a cloudy or opaque area in the normally clear lens of the eye. Depending upon its size and location, it can interfere with normal vision. Most cataracts develop in people over age 55, but they occasionally occur in infants and young children. Usually cataracts develop in both eyes, but one may be worse than the other.

The lens is located inside the eye behind the iris, the colored part of the eye. The lens focuses light on the back of the eye, the retina. The lens is made of mostly proteins and water. Clouding of the lens occurs due to changes in the proteins and lens fibers.

The lens is composed of layers like an onion. The outermost is the capsule. The layer inside the capsule is the cortex, and the innermost layer is the nucleus. A cataract may develop in any of these areas and is described based on its location in the lens:

* A nuclear cataract is located in the center of the lens. The nucleus tends to darken changing from clear to yellow and sometimes brown.
* A cortical cataract affects the layer of the lens surrounding the nucleus. It is identified by its unique wedge or spoke appearance.
* A posterior capsular cataract is found in the back outer layer of the lens. This type often develops more rapidly.



Normally, the lens focuses light on the retina, which sends the image through the optic nerve to the brain. However, if the lens is clouded by a cataract, light is scattered so the lens can no longer focus it properly, causing vision problems.

Cataracts generally form very slowly. Signs and symptoms of a cataract may include:

* Blurred, hazy, or vision
* Reduced intensity of colors
* Increased sensitivity to glare from lights, particularly when driving at night
* Increased difficulty seeing at night
* Change in the eye’s refractive error

While the process of cataract formation is becoming more clearly understood, there is no clinically established treatment to prevent or slow their progression. In age-related cataracts, changes in vision can be very gradual. Some people may not initially recognize the visual changes. However, as cataracts worsen vision symptoms tend to increase in severity.


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MCQ program

MCQ program

Medexam is a new free MS Windows based software program containing over 700 questions each with 5 parts allowing students to test their knowledge and learn medical information in a clear and concise way. It is not an attempt to recreate any particular exam, the information learned will help any candidate get through Medical school, USMLE and MRCP and many other medical exams. Subjects included are both basic sciences as well as clinical sciences. The questions are a mixture of MCQs and MEQs and each one comes with an explanation and images and links to other reliable sources of medical information on the internet.

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Top 20 Principal Ophthalmic Conditions

Top 20 Principal Ophthalmic Conditions

Topics:

Basal Cell Carcinoma

Central Retinal Artery

Central Retinal Vein Occlusion

Vitreous Detachment

Retinal Break

Retinal Detachment

Age-related Macular Degeneration: Retinal Drusen

Age-related Macular Degeneration: Submacular Hemorrhage

Swollen Optic Disc

Glaucoma

Choroidal Melanoma

Iris Melanoma

Ischemic Optic Neuropathy

Retinoblastoma

Retinopathy of Prematurity

Strabismus: Accommodative Esotropia

Amblyopia

Optic Neuritis

Refractive Disorders

Cataract

Principal Ophthalmic Conditions.htm