What is Medicine – What is Episcleritis?
Episcleritis is an inflammation of the episclera.Episclera is situated just underneath the conjunctiva. Episclera is the outermost layer of the sclera. Episcleritis is common in young and middle age adults. Episcleritis is associated with inflammatory bowel disease or rheumatoid arthritis. Episcleritis only affected one side of the eyes / unilateral. Patients with episcleritis is typically present with symptoms and signs such as watering of the eye, dilated episcleral vessels, no to mild pain,foreign body sensation and segmental redness where there is a patch of redness in the lateral scleral. In terms of management refer to ophthalmologist. The treatments include analgesia, cold compresses and lubricating eye drop (to relieve the symptoms). Topical steroid eye drops and systemic NSAIDS / naproxen are useful for severe cases of episcleritis.
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What is Medicine – What is Scleritis?
Scleritis is the inflammation of the sclera. Scleritis is more severe than episcleritis and the most serious form is necrotizing scleritis. In general, the onset of symptoms of scleritis is acute in nature .50% of scleritis affect both of the eyes ( bilateral). The common symptoms and signs of scleritis are, tenderness on palpation of the eye, severe pain, abnormal pupil reaction to light, reduced visual acuity, eye watering, photophobia and pain with eye movement. Patient with necrotizing scleritis may present with painless visual impairment which may cause perforation of the sclera. Scleritis is associated with systemic condition such as systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, inflammatory bowel disease, granulomatosis with polyangiitis. Patient with scleritis need to be referred to the ophthalmologist. The medication needed include treatments for underlying disorders, topical or systemic steroids, topical or systemic NSAIDS and immunosuppressant such as methotrexate. what is medicine- what is corneal abrasions?
Corneal abrasion happens due to the damage to the cornea or scratches to the cornea. This occurs mostly due to finger-nails, contact lenses, foreign bodies, eyelashes, inward turning of the eyelid (entropion). Pseudomonas infection is associated with corneal abrasion due to the use of contacts lenses. Herpes keratitis is commonly considered as a differential diagnosis of corneal abrasion. In terms of presentation, patients with corneal abrasion may present with red painful eye, photophobia, blurring vision, watering eye, foreign body sensation and history of foreign body in the eyes or contact lenses wearers. To diagnose the present of corneal abrasion, the diagnostic tests require are fluorescein stain and slit lamp examination. A fluorescein stain is a yellow orange colour stain which is collected in the abrasions or ulcers and highlighting them. Patient with sight threatening red eye should be referred to the ophthalmologist. The management of corneal abrasion may include lubricating eye drops; antibiotic eye drops such as chloramphenicol and simple analgesia such as paracetamol. The symptoms of photophobia is usually resolved by applying cyclopentolate eye drops. 2-3 days are needed for corneal abrasion to heal. What is Medicine- what is herpes keratitis?
In general, keratitis is the inflammation of the cornea. There are plenty of causes of keratitis. These include viral infection, bacterial infection, fungal infection, contact lens acute red eye and exposure. The most common cause of keratitis is due to herpes simplex virus infection. This is known as herpes simplex keratitis. Other forms of keratitis include bacterial causing keratitis due to pseudomonas or staphylococcal infection or fungal infection due to candida or aspergilus infection. Exposure keratitis occurs due to inadequate coverage of the eyelid. The most common keratitis is herpes simplex keratitis. This happens due to the herpes simplex infection. Hopes simplex keratitis causing the inflammation of the eye mostly the epithelial layer of the cornea. An inflammation of the stroma (the layer between epithelium and endothelium) is known as stromal keratitis. stromal keratitis is associated with necrosis of the stroma, vascularization and scarring. This may lead to corneal blindness. Herpes simplex keratitis presents with symptoms and signs such as photo phobia, painful red eye, vesicles around the eye, watering eyes foreign body sensation and reduced visual acuity. Herpes simplex keratitis is diagnosed by staining with fluorescein. This will show the dendritic corneal ulcer. Dendritic is describes as the appearance of branching and spreading ulcer. Slit lamp examination is also useful to identify the present of keratitis. Corneal swabs of scrapings are used to isolate the virus which are used for virus culture at PCR. Patient with potentially sight threatening should be refitted to ophthalmologist. Management of herpes simplex keratitis may include topical or oral aciclovir, eye gel ganciclovir. In case of stromal keratitis, the treatment includes topical steroids and antivirals. Corneal transplant is required in case of stromal keratitis to treat any scarring. What is Medicine – What is Subconjunctival Hemorrhage?
Subconjunctival hemorrhage happens when one of the small blood vessels within the conjunctiva rupture. This will lead to the release of blood into the space between the conjunctiva and the sclera. Subconjunctival hemorrhage happens after episodes of strenuous exercise such as weight lifting, trauma to the eyes, heavy coughing or even straining in case of constipation. Patient with subconjunctival hemorrhage may present with a patch of bright red blood underneath the conjunctiva and in front of the sclera. It does not affect the vision and painless. Other conditions that may be associated with subconjunctival hemorrhage may include hypertension, non-accidental injury, medications intake such as warfarin or anti platelets, whooping cough or bleeding disorders such as thrombocytopenia. Subconjunctival hemorrhage may resolve spontaneously without any treatment and approximately 2 weeks are required. What is Medicine – What is Posterior Vitreous Detachment?
The vitreous body consists of water and collagen. It is the gel inside the eye which maintains the eyeball’s structure and keeps the retina pressed on the choroid. The vitreous body becomes less firm and may not be able to maintain its shape as before.Therefore in older patients, it is very common for the detachment of the vitreous body to happen. This is known as posterior vitreous detachment. Patients with posterior vitreous detachment may present with floaters, spots of vision loss and flashing lights. There is no necessary treatment of posterior vitreous detachment Over times with brain adjustments the symptoms will improve. The common complications of posterior vitreous detachment may include the development of retinal tears and retinal detachment. The risks of developing these two conditions need to be assessed by referral to the ophthalmologist. What is Medicine – What Is Retinal Detachment?
Retinal detachment is a condition where the retina is separated from the choroid. This happens when there is a tear in the retinal which leads to the vitreous fluid to get under the retina. The vitreous fluid fill the space between the choroid and the retina. The blood vessels of the choroid supply the retina. Any retinal detachment may lead to sight threatening. The risk factors of developing retinal detachment include traumatic eye injury, diabetic retinopathy, posterior vitreous detachment, older age, retinal malignancy and family history. The retinal detachment may present with peripheral loss of vision which is sudden and present as shadow coming across the vision. Besides that, the patient may also present with flashes and floaters as well as blurred or distorted vision. The management of central retinal vein occlusion may include treatment with detailed assessment of the retina for patient presenting with painless flashes and floaters to detect the present of retinal tears and detachment. Retinal tears treatment may include cryotherapy and laser therapy. The purpose is to create adhesions between the choroid and retina to prevent detachment. Retinal detachment treatment may include vitrectomy, scleral buckling and pneumatic retinopexy to reattach the retina. The purpose of retinal detachment treatment is to reattach the retina and reduce the pressure or traction which may cause repeated detachment. Vitrectomy involves removing the relevant part of the vitreous body and replace it with oil and gas. What is Medicine – What is Central Retinal Vein Occlusion?
There are four branched veins which form the central retinal vein. The central retinal veins run through the optic nerve for draining blood from the retina. Central retinal vein occlusion is due to the formation of thrombus / blood clot in the retinal veins. The thrombus or blood clot blocks the drainage of blood from the retina. The blockage of the central retinal vein causing problem to the whole retina. The blockage of one the veins may cause problem in the area being drained by the branch of the veins. Blockage of the retinal vein cause pooling of blood in the retina. Retinal hemorrhages and macular edema may occur due to the leakage of the blood and fluid. Macular edema and retinal hemorrhages may result in the loss of vision due to the damage of the retinal tissue. A new blood vessel (neovascularization) may happen due to the release of VEGF. The risk factors of developing central retinal vein occlusion may include diabetes, smoking, hypertension, high cholesterol, glaucoma and systemic lupus erythematosus. Patient with central retinal vein occlusion may present with sudden painful loss of vision. The investigations that need to be considered are full medical history, full blood count ( leukemia) , ESR ( SLE), serum glucose and blood pressure. Fundoscopy of the examination may reveal the characteristic of retinal vein occlusion such as optic disc edema, macula edema and flame as well as blot hemorrhage In terms of management, referred the patient to the ophthalmologist. Laser photocoagulation, intravitreal steroids and anti VEGF therapies such as aflibercept or ranibizumab may be considered in treating macular edema and preventing the development of neovascularization. What is Medicine – What is Central Retinal Artery Occlusion?
Central retinal artery is a branch of ophthalmic artery. Ophthalmic artery is a branch of the internal carotid artery. The central retinal artery supplies the blood to the retina. When there is a blockage to the blood flow through the central retinal artery this will lead to the central retinal artery occlusion. The blockage is most commonly due to atherosclerosis. Another cause is giant cell arteritis. It is a form of vasculitis affecting the ophthalmic or central retinal artery which leads to reduced blood flow. This commonly happens in white female patient age 50 years of age The risk factors of developing retinal artery occlusion include, obesity, inactivity, older age, family history, poor diet, diabetes, hypertension, alcohol consumption and smoking. Fundoscopy examination may reveal pale retinal with a cherry red spot. The pale retinal is due to the lack of perfusion with blood. Patient with central retinal artery occlusion may present with symptoms and signs such as sudden painless loss of vision. The common signs include relative afferent pupillary defect. Relative afferent pupillary defect is presented with the pupil in the affected eye constricts more when light is shone in the other eye compared to when it is shone in the affected eye. Relative afferent pupillary defect occurs due to the input not being sensed by the ischemic retina when testing the direct light reflex but being sensed by normal retina due to consensual light reflex. The treatment is best on referral to thean ophthalmologist for assessment and management. In emergency scenario, the immediate management may include ocular massage, reducing intra ocular pressure by removing fluid from the anterior chamber and inhaling carbogen or sublingual isosorbide dinitrate to dilate the artery. In case of giant cell arteritis which cause retinal artery occlusion., the test includes temporal artery biopsy and treatment with high dose of steroids. Long term treatment include secondary prevention of cardiovascular disease or treatment of reversible risk factors. What is Medicine – What is Retinitis Pigmentosa?
Retinitis pigmentosa is a congenital disorders which lead to the degeneration of the cones and rods in the retina. Rods will generate more than cones. Retinitis pigmentosa may present with symptoms such as night blindness and loss of peripheral vision. This may follow with central loss. Retinitis pigmentosa may stand as an isolated disease on its own or part of the systemic disease. In term of systemic disease. Retinitis pigmentosa is part of the symptoms in Usher’s syndrome which also cause loss of hearing. Besides that Bassen Kornzweig syndrome ( disorder of fat metabolism and absorption) may also present with retinitis pigmentosa and progressive neurological symptoms. Refsum’s disease is another disease duet to metabolic disorder of phytanic acid, where the patients may suffer from hearing loss, neurological symptoms, dermatological symptoms and retinitis pigmentosa. On fundocscopy, retinitis pigmentosa is presented as bone spicule pigmentation which is more concentrated around the mid peripheral area of the retina. It appears as sharp pointed objects which is similar to network appearance of bone matrix. Retinitis pigmentosa may also be associated with pale or waxy appearance of the optic disc with narrowing of the arterioles. In terms of management, genetic counselling is very important as a preventive measure. The treatment of retinitis pigmentosa may include referral to an ophthalmologist for assessing the patients and diagnosing them. Vision aids and sunglasses protect accelerated damage of the retina. Regular check up is also essential to check for any worsen condition such as cataracts. Options of medication that may be considered include oral acetazolamide, topical acetazolamide, vitamin and antioxidant supplements, steroids injections and anti VEGF injections. |
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