Transcript Painful diminution of vision [PPT]

Painful diminution of vision
MBBS
KGMU
Common causes of painful diminution
of vision
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Acute angle closure glaucoma.
Acute iridocyclitis.
Acute keratitis/ corneal ulcer.
Trauma +/-Foreign body.
Indiscriminate use of contact lenses.
Acute opic neuritis.
Endophthalmitis/ Panophthalmitis.
painful diminution of vision
Common causes of painful diminution
of vision (contd)
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Chemical injuries.
Scleritis.
Dry eye.
Herpes zoster ophthalmicus.
Orbital cellulitis.
Neurological conditions.e.g. ophthalmoplegic
migraine, temporal arteritis.
painful diminution of vision
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 vision
Conjunctival vs. circumcorneal congestion
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Conjunctival
Bright red.
Arborous branching.
Near fornices.
Vessels move with
conjunctiva.
Blanch with phenylephrine.
Fill from fornix towards
centre.
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Circumcorneal
Bluish red.
Radial arrangement.
Around limbus.
Do not move with conj.
Do not blanch with
phenylephrine.
Fill from limbus, outwards.
painful diminution of vision
Conjunctival congestion
painful diminution of vision
Conjunctival vs Circumcorneal
congestion
painful diminution of vision
Few common clinical conditions
painful diminution of vision
Acute angle closure glaucoma
(salient features)
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Attacks of severe hemicrania
Rapid diminution of vision.
Coloured haloes.
Circumcorneal congestion.
Hazy cornea.
Shallow A.C.
Semi dilated pupil.
Raised IOP.
painful diminution of vision
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 vision
Acute Iridocyclitis
(salient features)
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Rapid diminution of vision.
Circumcorneal congestion.
Marked ciliary tenderness.
Aqueous flare and cells.
Keratic precipitates.
Muddy iris pattern,
Small irregular pupil.
Posterior synechiae.
painful diminution of vision
Chronic / recurrent Iridocyclitis
(salient features)
• Frequent /recurrent ocular pain and
headache.
• Dense posterior synechiae
• Complicated cataract.
• Diminution of vision is more gradual.
painful diminution of vision
Glaucoma
Iridocyclitis
painful diminution of vision
Keratitis / Corneal ulcer
(salient features)
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Rapid diminution of vision.
Pain.
Lacrimation and discharge.
H/O FB/trauma (+/-).
Blepharospasm.
Circumcorneal congestion.
White spots/area on cornea
Corneal infiltration, tissue necrosis and sloughing.
(Picture differs with etiology).
• Iridocyclitis & hypopyon.
painful diminution of vision
Corneal ulcer
painful diminution of vision
Optic neuritis
(Salient features)
• Sudden/rapid, usually unilateral loss of vision : PL+/- or
FC.
• Relative afferent pupillary defect.
• Papillitis
– Optic disc oedema, engorged veins, superficial
haemorrhages, cells in vitreous.
– Pain +/-
• Retrobulbar neuritis
– Painful ocular movements
– Normal disc & fundus
painful diminution of vision
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.
painful diminution of vision
Post-op endophthalmitis
(salient features)
Patient presents in early post-operative
period
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Severe pain & redness
Fall in visual acuity
Hazy cornea
Hypopyon
PR defective
painful diminution of vision
painful diminution of vision