W8 Eye Pain

What do we ask initially?

• Reasons for visit

• Which eye

• Sudden or gradual

• Transient episodes

• Recurrent

What associated symptoms do we ask?

• Reduced vision

• Double vision

• (Double vision cease if one eye closed)

• Electric pain- trigeminal neuralgia

• Pain when you move your eyes- OPTIC NEUROPATHY

• Headaches

• Sensitive to bright light

• Flashes

• Tender scalp.. (ONLY IF PX OVER 50)- temporal arteritis

• Vertigo

• Haloes

Which tests do we conduct?

• VA

• Pinhole (distance VA reduced)

• Motility

• Pupil reactions

What do pupil reaction results indicate?

• Mid-dilated pupil on one size indicates acute glaucoma

• Irregular pupil indicates iritis

• RAPD indicates optic neuropathy (in one eye only)

What external examinations do we do?

Direct ophthalmoscopy, slit lamp, anterior chamber

Orbit, eyelid, conjunctiva, cornea anterior chamber

What do orbit results indicate?

Proptosis- orbital cellulitis or tumour

What do eyelid results indicate?

Ptosis or oedema- orbital cellulitis or tumour

What do conjunctiva results indicate?

• Redness indicates orbital cellulitis, acute glaucoma or iritis

• Oedema- orbital cellulitis

What does cornea indicate?

• Hazy Stromal oedema indicates acute glaucoma

• Endothelial keratic precipitates indicate iritis

What does anterior chamber indicate?

• Closed shallow angle is acute glaucoma

• Aqueous flare and cells indicate iritis

What internal examination methods do we do?

• Direct ophthalmoscopy

• Dilation- avoid if acute glaucoma or iritis comes with photophobia

• Indirect- only do if dilation

• Onlyexmaine optic disc

What does optic disc indicate?

• Hyperaemia- acute glaucoma

• Swelling- orbital cellulitis/optic neuropathy

• Atrophy- optic neuropathy

What tests do we do pre/post dilation?

• Refraction- hyperopic shift indicates orbital tumour

• Visual field- unilateral loss indicates optic neuropathy

• Colour vision- desaturation indicates neuropathy

When do we do immediate referral?

• Acute glaucoma

• Temporal arteritis

• Orbital cellulitis

• Acute optic neuropathy

When do we do same day referral?

• Iritis- progressive optic neuropathy with headache and optic disc swelling

• Headache with transient reduced vision and optic disc swelling (brain disease affecting trigeminal nerve POSSIBLY)

What calls for urgent 1 week referral?

• Orbital tumour

• Progressive optic neuropathy with pale optic disc

When do we do routine or advise/treat referral?

• Sinusitis if px wants something done and trigeminal neuralgia For routine

• Advise and treat- sinusitis