12. Opthalmology Flashcards
What is BPPV?
Reccurent and brief attacks of positional vertigo
Canalith particles break loose and fall into the wrong part of semi-circular canals of ear
Symptoms of BPPV?
Last less than a minute
Provoked by position
Quick onset
N&V
How do we investigate BPPV?
Hallpike’s manoeuvre
- Sit up, rotate head 45 degrees and then lie patient down and hold at 20 degree at edge of bed
- Positive is nystagmus and vertigo
What is menieres disease?
Inner ear change in fluid volume in labyrinth, causing tinnitus and vertigo.
Idiopathic, menieres syndrome is secondary to another condition e.g. allergy, viral, syphilis etc.
Symptoms of menieres disease?
Minutes to hours
N&V
Tinnitus
May have hearing loss in affected ear
Fukuda’s stepping test - marching and body starts to turn toward affected side
Romberg’s test - eyes closed and body will tilt to affected side
How do we investigate and treat meniere’s?
Clinical diagnosis but sensorineural hearing loss on affected side
No cure
Vestibular suppressant drugs e.g. benzos, antihistamines
Lifestyle to prevent recurrence - limit salt, caffeine, alcohol, smoking and stress.
Exercise for balance.
What is a thyroglossal cyst?
Epithelial-lined cyst between adam’s apple and chin.
Median age 5 y/o
Thryoglossal duct should disappear after 6 weeks but if open, fluid
Thyroglossal cyst symptoms?
Lump that is compressible and moves upward when tongue protruded and on swallowing
What is cataracts?
Opacification of the lens with gradual loss of visual acuity as the lens degrades overtime
Symptoms of cataracts?
Loss of vision over years
Blurred vision
Glare in bright light
Painless
Examination and management for cataract?
Slit lamp reveals a black cataract against red reflect
Normal pupillary response
Reduced red reflex
Control risk factors
What is conjunctivitis?
Inflammation of conjuctiva
Viral most common e.g. EBV
Bacterial e.g. staph a
Symptoms of conjunctivitis?
Eye redness
Discharge
Itchy
Crust formation
How do viral and bacterial conjunctivitis differ?
Viral clear and water discharge, unilateral but then becomes bilateral with redness and conjunctival follicles.
Bacterial is thick purulent discharge, unilateral with diffuse redness
How to manage conjunctivitis?
Viral - self-limiting, antihistamine drops and maybe acyclovis if herpes
Bacterial - abx
Allergic - avoid allergen, cold compress and antihistamine drops
What is a glaucoma?
Increased intraocular pressure that causes damage to retina and optic nerve.
Glaucoma symptoms?
Open angle - bilateral, progress visual loss peripheral to central
Closed angle - sudden onset, redness, photophobia, nausea
Tonometry and fundoscopy on investigations
Gonioscopy for glaucoma
What is uveitis?
Anterior - Inflammation of iris and ciliary body, typically idiopathic or genetic e.g. RA, SLE, ankylosing spondylitis
Posterior - inflam of retina, choroid, retinal vasculaure, optic nerve typically infectious
Symptoms of uveitis?
Pain Eye redness PHOTOPHOBIA Flares Lacrimation Decrease visual acuity
Floaters and flashes in posterior!!! It’s also painless!!
Examination findings in anterior uveitis?
Slit lamp -
Keratic precipitates in anterior chamber
Protein in aquous
General inflammation signs
Examination of posterior uveitis?
Leukocytes in vitrous humour
How to manage uveitis?
Corticosteroid drops
Cycloplegic drops
Analgesia
Antibiotic or antiviral if infectious cause
What is optic neuritis?
Inflammation of optic nerve, common in young females and is associated with MS, often presenting complaint of MS.
Symptoms of optic neuritis?
Vision loss Hours to days Decreased visual acuity Pain worse on movement Reduced colour visual Usually unilateral
How to investigate optic neuritis?
Gadolinium-enhanced MRI of orbit and brain (MS diagnosis too)
How to manage optic neuritis?
High dose corticosteroids to speed up recovery
What is scleritis?
Inflammation of scleritis, underlying systemic disease in most of them e.g. RA, SLE, IBD
Symptoms of scleritis?
Dull, boring eye pain
May disturb sleep
Pain worse on eye movements
May radiate to rest of face
Eye redness with violet or blue tinge
Over several days
Photophobia
Lacrimation
DANGER TO VISION
Related to episcleritis but that is painless.
How to manage scleritis?
Urgent referral to ophth
NSAIDs
Treat underlying cause
Systemic steroids if necrotising disease
