MBBS KGMU Common causes of painful diminution of vision Acute angle closure glaucoma Acute iridocyclitis Acute keratitis corneal ulcer Trauma Foreign body Indiscriminate use of contact lenses ID: 632467
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Slide1
Painful diminution of vision
MBBS
KGMUSlide2
Common causes of painful diminution of vision
Acute angle closure glaucoma.
Acute
iridocyclitis.Acute keratitis/ corneal ulcer.Trauma +/-Foreign body.Indiscriminate use of contact lenses.Acute opic neuritis.Endophthalmitis/ Panophthalmitis.
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Common causes of painful diminution of
vision (
contd
)Chemical injuries.Scleritis.Dry eye.Herpes zoster ophthalmicus.Orbital cellulitis.Neurological conditions.e.g.
o
phthalmoplegic
migraine, temporal arteritis.
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Steps of management
Come to a probable clinical diagnosis.
Order relevant investigations.
Urgent treatment in acute phase.Definitive treatment.Proper follow up.painful diminution of visionSlide5
Conjunctival vs. circumcorneal congestion
Conjunctival
Bright red.
Arborous branching.Near fornices.Vessels move with conjunctiva.Blanch with phenylephrine.Fill from fornix towards centre.CircumcornealBluish red.Radial arrangement.Around limbus.Do not move with conj.
Do not blanch with phenylephrine.
Fill from limbus, outwards.
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Conjunctival congestion
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Conjunctival
vs
Circumcorneal congestionpainful diminution of visionSlide8
Few common clinical conditions
painful diminution of visionSlide9
Acute angle closure glaucoma
(salient features)
Attacks of severe
hemicraniaRapid diminution of vision.Coloured haloes.Circumcorneal congestion.Hazy cornea.Shallow A.C.Semi dilated pupil.Raised IOP.
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Chronic angle closure glaucoma
(salient features)
Episodic /chronic low grade pain.
Diminution of vision is more gradual and progressive.More damage to optic disc and nerve fibre layer.painful diminution of visionSlide11
Acute
Iridocyclitis
(salient features)
Rapid diminution of vision.Circumcorneal congestion.Marked ciliary tenderness.Aqueous flare and cells.Keratic precipitates.Muddy iris pattern,Small irregular pupil.Posterior synechiae.
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Chronic / recurrent
Iridocyclitis
(salient features)
Frequent /recurrent ocular pain and headache.Dense posterior synechiaeComplicated cataract.Diminution of vision is more gradual.painful diminution of visionSlide13
Glaucoma Iridocyclitis
painful diminution of visionSlide14
Keratitis / Corneal ulcer
(salient features)
Rapid diminution of vision.
Pain. Lacrimation and discharge. H/O FB/trauma (+/-).Blepharospasm.Circumcorneal congestion.
White
spots/area
on corneaCorneal infiltration, tissue necrosis and sloughing. (Picture differs with etiology).
Iridocyclitis
&
hypopyon
.
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Corneal ulcer
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Optic neuritis
(Salient features)
Sudden/rapid, usually unilateral loss
of vision : PL+/- or FC. Relative afferent pupillary defect. PapillitisOptic disc oedema, engorged veins, superficial haemorrhages, cells in vitreous.Pain +/-
Retrobulbar
neuritisPainful ocular movements
Normal
disc & fundus
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Post-op endophthalmitis
Post- operative
endophthalmitis
is one of the most dreaded complications of cataract surgery.Defective sterilization of instruments.Contaminated irrigating solutions.
Contaminated IOLs,
viscoelastics
.
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Post-op
endophthalmitis
(salient features)
Severe pain & rednessFall in visual acuityHazy corneaHypopyonPR defective
Patient presents
in early post-operative period
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painful diminution of vision
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