Ophthalmology
Acute & Chronic Eye Disorders
Ophthalmology

Acute & Chronic Eye Disorders

CRAO, glaucoma, hyphema, conjunctivitis, uveitis, retinoblastoma, retinopathies.

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◆Vision-threatening retinal/vascular

  • •CRAO: sudden painless monocular loss + pale retina + cherry-red spot at fovea → stroke workup (carotid)
  • •CRVO: 'blood and thunder' fundus; anti-VEGF
  • •Amaurosis fugax: transient 'curtain coming down' → carotid duplex
  • •Macular degeneration: distorted central vision (metamorphopsia), drusen on fundus; wet AMD → anti-VEGF
  • •Retinal detachment: flashes/floaters then 'curtain'; emergent surgery
  • •CMV retinitis: HIV CD4<50; 'pizza pie' hemorrhages + necrosis; ganciclovir/foscarnet
  • •GCA: vision loss + headache + jaw claudication + ESR>50 → immediate steroids

◆Acute angle-closure glaucoma

  • •Sudden painful red eye + mid-dilated FIXED pupil + nausea/vomiting + hazy cornea
  • •Iris blocks trabecular meshwork → ↑IOP
  • •Acute: timolol + acetazolamide + pilocarpine
  • •Definitive: laser peripheral iridotomy (usually bilateral)

◆Hyphema

  • •Blood layering in anterior chamber after blunt trauma
  • •Shield eye + elevate HOB + monitor IOP
  • •Screen sickle cell (high risk of complications)
  • •Rebleed 3–5 days

◆Conjunctivitis

  • •Viral (adenovirus): watery, follicular, preauricular LAD → supportive
  • •Allergic: itching, bilateral → antihistamines + mast cell stabilizers
  • •Bacterial: purulent, stuck eyelids → topical antibiotics (erythromycin, polymyxin)

◆Anterior uveitis

  • •Painful red eye + photophobia + constricted pupil + ciliary flush + cells/flare
  • •Associated: HLA-B27 spondyloarthropathies, sarcoid, IBD
  • •Topical steroids + cycloplegics

◆Retinoblastoma

  • •Leukocoria + absent red reflex in child
  • •RB1 gene mutation; AD heritable; bilateral/multifocal possible
  • •Increased risk of osteosarcoma
  • •Urgent ophtho + MRI

◆Optic neuritis

  • •Painful unilateral vision loss with eye movement + RAPD
  • •Often presents MS — MRI brain/spine
  • •IV methylprednisolone speeds recovery

◆Diabetic & hypertensive retinopathy

  • •DM nonproliferative: microaneurysms (earliest), hard exudates, cotton-wool spots
  • •DM proliferative: neovascularization → panretinal photocoagulation
  • •HTN: AV nicking + flame hemorrhages + cotton-wool spots + pale disc
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