1. Painful diminution of vision
MBBS
KGMU

2. Common causes of painful diminution of vision
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

3. Common causes of painful diminution of vision (contd)
Chemical injuries.
Scleritis.
Dry eye.
Herpes zoster ophthalmicus.
Orbital cellulitis.
Neurological conditions.e.g. ophthalmoplegic migraine, temporal arteritis.
painful diminution of vision

4. 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

5. Conjunctival vs. circumcorneal congestion
Bright red.
Arborous branching.
Near fornices.
Vessels move with conjunctiva.
Blanch with phenylephrine.
Fill from fornix towards centre.
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

6. Conjunctival congestion
painful diminution of vision

7. Conjunctival vs Circumcorneal congestion
painful diminution of vision

8. Few common clinical conditions
painful diminution of vision

9. Acute angle closure glaucoma (salient features)
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

10. 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

11. Acute Iridocyclitis (salient features)
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

12. 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

13. Glaucoma Iridocyclitis
painful diminution of vision

14. Keratitis / Corneal ulcer (salient features)
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

15. painful diminution of vision
Corneal ulcer
painful diminution of vision

16. 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

17. 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

18. Post-op endophthalmitis (salient features)
Patient presents in early post-operative period
Severe pain & redness
Fall in visual acuity
Hazy cornea
Hypopyon
PR defective
painful diminution of vision

19. painful diminution of vision
Thank You
painful diminution of vision