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Summary

Summary Ophthalmology Notes
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  • Course
  • Medicine
  • Institution
  • Queens University Belfast (QUB)

Ophthalmology notes detailing pathologies and conditions of the eye. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines. Look at specialty section and content list for the summary contents of this file.

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Document information

  • September 5, 2022
  • 34
  • 2022/2023
  • Summary

Subjects

  • ophthalmology
  • eyes
  • ocular medicine
  • eye medicine
  • ophthalmology notes
  • medical notes
  • med notes
  • medical school
  • medicine
  • eye surgery

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  • Queens University Belfast (QUB)
  • Unknown
  • Medicine
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Ophthalmology

Seán Keenan

2022

,Pathologies of the External Eye


Styes
Hordeolum externum
- Sx: Abscess or infection in the Lash follicle; Glands
of Moll (sweat); Glands of Zeis (sebum)
- Cx: Usually Staphylococci
- Dx: Area affected should point outwards
- Mx: Warm compress for 5-10 mins
Hordeolum internum
- Sx: Abscess of Meibomian glands
- Cx: Usually Staphylococci
- Dx: Area affected should point inwards
- Mx: Treat Cc with incision + cutterage
- Cc: Chalazion / Meibomian (tarsal) cyst; ↓ vision

Blepharitis
Description
- Sx: Burning, itching red margins on eyelid; Scales on lashes
- Cx: Staphylococci; Seborrhoeic dermatitis; Rosacea
- Mx: Hygiene; Consider PO Erythromycin in children
- NB: May present with seborrheic dermatitis

Pinguecula
Description
- Sx: Degenerative vascular yellow-grey conjunctival nodules
- Cx: ↑ Hair / Skin pigment; Sun damage
- Mx: Pingueculitis – Topical steroids; Pterygium – Surgery
- Cc: Pterygium – Invades cornea (exposure to wind ↑ risk)

Entropion
Description
- Sx: Lid in-turning; Usually affects >40 YO; Irritates cornea
- Cx: Degeneration of lid fascial attachment (usually lower lid)
- Mx: Relief – Tapping or Botox; Long-term – Surgical

Ectropion
Description
- Sx: Lower lid eversion; Eye irritation; Eye watering ± Keratitis
- Cx: Old age; Facial palsy
- Mx: Surgery corrects defect + upper lid implant aids closure

Upper-Lid Malposition
Description
- Sx: Hypotropic position (Pseudoptosis); Intrinsic Levator muscle
weakness (true ptosis)
- Cx: Congenital (↓ Nerve / ↓ Muscle tone); Myogenic (MD/MG);
Mechanical (xanthelasma / oedema); CNS (CNIII Palsy/Horner’s)
- Mx: Congenital – Surgical correction

Lagophthalmos
Description
- Sx: Difficulty closing eyelid; Corneal ulcer
- Cx: Exophthalmos; Mechanical impairment of eyelid; Paralysis of
Orbicularis oculi; Leprosy
- Mx: Lubricate eyes with paraffin ointment; Eye lid stich if ulcer

,Blepharospasm




Description
Blepharospasm is involuntary contraction of orbicularis oculi. Commonly occurs in response to ocular pain and can
worsen when stressed. Repetitive blepharospasm, is a focal dystonia (see abnormal movements in neurology notes).
Can often occur with other dystonias (e.g. oro-mandibular dystonia). The condition affects females 1.8x more often
than males.


Presentation Management
- Precipitates: Often preceded by exaggerated blinking - Botox: Quarterly orbicularis oculi injections
- Relieved: May be relieved by tapping eyelid - Anticholinergics: Trihexyphenidyl
Causes - Dopamine agonists: Levodopa; Bromocriptine
- Commonest: Idiopathic
- Iatrogenic: Neuroleptic drugs
- Neuro: Parkinson’s; Progressive supranuclear palsy
- Onco: Paraneoplastic syndromes (e.g. Lung ca)

, Tears and Lacrimation




Description
Tears have an important role in refraction. Most tears are produced by the lacrimal apparatus consisting of the lacrimal
gland, lacrimal lake, lacrimal sac ad nasolacrimal duct which carries the tears into the nasal cavity. Tears are composed
of a lipid layer, aqueous layer and mucin layer. The volume of tears in the eye is usually ~6 μL with a turnover rate of
1.2 μL/min. Tears are similar in electrolyte concentration to plasma, but highly rick in IgA. Tears may also contain
lysozyme and beta-lysin which aids in antibacterial qualities. Meibomian glands, conjunctival glands, goblet cells and
lacrimal glands produce tear fluids also. Reflex secretion occurs only from the lacrimal gland and occur via PsNS
stimulus from the trigeminal nerve.


Keratoconjunctivitis Sicca (Dry Eyes)
Causes Investigations
- ↓ Tear production by lacrimal glands - Schirmer’s Test: Filter paper <15 mm in 15 mins
o Commonest: Old age Management
o AID: Sjögren’s syndrome; Sarcoid - Replace: Artificial tears
o Infx: Mumps
o Onco: Lymphoma; Leukaemia
o Other: Amyloidosis; Haemochromatosis
- Excessive evaporation of tears
o ↓ Blinking: Post-exposure keratitis
- Mucin deficiency in tears
o Deficiency: Avitaminosis A
o Derm: SJS; Pemphigoid; Chemical burns

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