8 - Ophthalmology Anatomy, History and Examination Flashcards
What are some examples of opthalmic pathologies that need urgent review?
- Sudden blurring or loss of vision e.g GCA, CRAO, retinal detachment, TIA
- New onset diplopia e.g first sign of GCA, PCA aneurysm
- Headache with eye pain: e.g Anterior uveitis, Acute angle closure glaucoma
- Orbital cellulitis
- Chemical trauma
What is the definition of the following ophthalmological words:
- Agnosia
- Amblyopia
- Aniridia
- Anopthalmos
Agnosia: Inability to recognise common objects despite an intact visual apparatus e.g dementia
Amblyopia: Reduced vision due to disuse of the eye with no organic defect
Aniridia: Congenital absence of an iris
Anopthalmos: Absence of a true eyeball
What is the definition of the following opthalmological terms:
- Aphakia
- Binocular vision
- Blindness
Aphakia: Absence of the lens
Binocular vision: Ability of the eye to focus on one object and fuse the two images together
Blindness: In the UK it is defined as the level of visul impairment such as to prevent any work for which vision is essential, usually 3/60 or worse
What is the definition of the following opthalmological terms?
- Bupthalmos
- Chemosis
- Coloboma
-
Bupthalmos: large eyeball in infantile glaucoma
Chemosis: Conjunctival swelling of any cause
Coloboma: Congenital cleft due to the failure of some portion of the eye or the lids to complete growth
What is the definition of the following opthalmological terms:
- Keratoplasty
- Cycloplegic
- Ectropion
- Entropion
Keratoplasty: Surgery where opaque cornea is replaced with transparent cornea
Cycloplegic: Drug that relaxes the cilliary muscle, paralysing accomodation and dilating the pupil
Ectropion: Turning out of the eyelid so the conjunctival lining the inside of the lid is exposed to the exterior
Entropion: Opposite of above, eyelashes may come into contact with cornea. Can be caused by trachomatous conjunctivitis causing scarring and contraction of conjunctivae. Common cause of blindness in Africa
What is the definition of the following opthalmological terms:
- Enucleation
- Esophoria
- Esotropia
- Exenteration
Enucleation: Complete surgical removal of the eyeball
Esophoria: Tendency of the eyes to turn inwards when binocular reflexes are disrupted by covering one eye
Esotropia: Inward deviation of the eye
Exenteration: Removal of all of the orbit including the eyeball and the eyelids
What is the definition of the following opthalmological terms:
- Exophoria
- Exotropia
- Macula Lutea
- Miotic
- Mydriatic
Exophoria: Tendency of the eyes to turn outwards when binocular reflexes are disrupted by covering one eye
Exotropia: Outward deviation of the eyes
Macula Lutea: Avascular area of the retina surrounding the fovea
Miotic: A drug causing pupillary constriction
Mydriatic: An agent causing pupil dilatation
What is the definition of the following opthalmological terms:
- Myopia
- Ophtalmia Neonatorum
- Optic Atrophy
- Pannus
Myopia: Near-sighted. Refractive error where the focal point for light rays from a distant object are anterior to the retina
Opthalmia Neonatorum: Conjunctivitis in the newborn usually due to gonococcus or chlamydia
Optic Atrophy: Optic nerve damage characterised by optic disc pallor
Pannus: Infiltration of the cornea with blood vessels
What is the definition of the following opthalmological terms:
- Photocoagulation
- Pterygium
- Strabismus/Squint/Tropia
- Sympathetic Opthalmia
Photocoagulation: Method of causing multiple areas of localised destruction of the retina for treatment of certain retinal disorders e.g diabetic retinopathy
Pterygium: Pathological fold of triangular tissue that extends from the conjunctiva over the cornea
Strabismus: Misalignment of the eyes
Sympathetic Opthalmia: Inflammation in one eye following traumatic inflammation in the other eye
What is the definition of the following opthalmological terms:
- Synechia
- Trachoma
- Uvea
- Zonule
- Tarsorrhaphy
- Tonometer
Synechia: Adhesion of the iris to the cornea (anterior synechia) or lens (posterior synechia)
Trachoma: Infectious keratoconjunctivitis due to repeated chlamydial infections in hot dry climates where flies are present. WORLDWIDE COMMONEST CAUSE OF BLINDNESS!!!!!!
Uvea: Iris, Cilliary body, Choroid
Zonule: Numerous fine tissue strands that stretch from the ciliary muscles to the lens and hold the lens in place
Tarsorrhaphy: A surgical procedure for uniting upper and lower lids
Tonometer: A device for measuring intraocular pressure.
What are mydriatic and cyclopegic drops and what are they used for?
Mydriatic: Dilate the pupil
Cycloplegic: Paralyse the cilliary muscles so can no longer accomodate and focus. All cycloplegics are mydriatics
Uses: dilate pupil to look at retina, management of amblyopia, refraction of children for the prescription of glasses
What are four examples of mydriatics/cycloplegics, how long do they act for and what are the contraindications of these?
- Atropine
- Cyclopentolate
- Tropicamide
- Phenylephirine
ALL DROPS SHOULD BE AVOIDED IN UNTREATED NARROW ANGLE GLAUCOMA
What are the side effects of mydriatics/cycloplegics?
- Cannot drive until blurring effect has warn off
- Mydriatics will sting for a few seoconds after instillation
- Atropine can cause redness and warmness of the face
- Whitening of eyelids due to vasoconstriction
Think about side effects of anticholinergics e.g dry mouth
How do you apply mydriatic/cycloplegic drops?
What are fluorescein drops used for and whay are the contraindications of these?
Uses:
- Detect defects in the corneal epithelium
- Assess tear drainage in children with congenital nasolacrimal duct obstruction
- Helps in tonometry to measure intraocular pressure
- Can be administered in a solution with local anaesthetic
What are the side effects of fluoroscein drops?
- Staining of skin or clothes. Lasts for 6-12 hours
- Can discolour contacts so take them out and don’t put them in for another hour after the stain
How do you apply fluorescein drops?
What are miotic eye drops?
They cause pupil constriction, used in the treatment of acute angle closure glaucoma as they increase aqueous drainage
What are steroid and NSAID eye drops used for and why do they need to be used with caution?
Used for the treatment of allergy, episcleritis, scleritis, or iritis
They can increase the IOP so can precipitate glaucoma and can cause progression of dendritic ulcers.
Must look in slit lamp before application as can miss ulcers on opthalmoscopy
What are some topical antibiotics used for the eye?
- Fusidic acid
- Chloramphenicol
- Neomycin
Some systemic drugs can cause opthalmological side effects. What drugs cause the following opthalmological side effects:
- Dry eyes
- Corneal deposits
- Lens Opacities
- Glaucoma
- Papilloedema
- Retinopathy
Dry eyes: B-blockers, anticholinergics
Corneal Deposits: amiodarone, chloroquine, chlorpromazine
Glauvoma
How do you take an opthalmological history?
(important card)
PC (see further cards): onset and duration, has it happened before, discomfort?, visual loss?, double vision?, colour changes?, any trauma?
PMHx: any inflammatory conditions (AS,RA), previous eye surgery/injections, contact lenses, smoker, thyroid issues, hypertension
DHx: any toxic drugs
FHx: of eye disease
ICE
What are some symptoms of eye discomfort and examples of differentials associated with this?
Foreign Body Sensation: foreign body, conjunctivitis, blepharitis, eyelid cysts
Photophobia: Anterior uveitis, Corneal ulcer, Corneal abrasion
Eye pain: Scleritis, Acute angle closure glaucoma
Headache: GCA, Migraine, Meningitis, Raised ICP, cluster headache
Lid irritation: Blepharitis, Stye, Chalazion, Eczema
If a patient presents with visual disturbance, what questions do you need to ask in the history and what differentials could each symptom be?
(Important card)
•Generalized blurring? Refractive error, cataracts, steroids
•Central blurring? Macula or Optic disc pathology e.g AMD, Diabetic maculopathy, optic disc swelling
•Black spots, blob or curtain? Amaurosis Fugax, Retinal detachment, Vitreous detachment
•Photopsia? Migraine, Retinal detachment
•Double vision- monocular or binocular? vertical or horizontal?
•Colour changes? Cataracts, Optic nerve pathology
What is the difference between monocular and binocular double vision?
Binocular double vision only occurs if both eyes are open, can correct by closing one eye
Monocular double vision is due to pathology of the affected eye e.g cataracts, cornea abrasion. Binocular is due to pathology of nerves, neuromuscular junction or muscles
What are some important co-morbidities to acquire about in opthalmological histories?
- Any vascular risk factors
What tests can you do to test visual function?
(IMPORTANT CARD)
- Visual acuity with Pinhole test added on (Snellen Chart)
- Near visual acuity
- Visual Fields: Confrontation test, Perimetery
- Colour Vision: Ishari chart
- Macula: Amsler Grid
How do you perform an OSCE eye examination?
https://geekymedics.com/wp-content/uploads/2021/04/OSCE-Checklist-Eye-Examination.pdf (watch video, important card)
1. Intro and Consent
2. Visual Acuity, Colour Vision, Visual fields
3. Inspect eye (make sure to flip eyelids)
4. Eye movements
5. Cover test
6. Pupil reflexes (direct, consensual, accomodation, swinging light test for RAPD)
7. Anterior segment of eye: cornea reflexes, corneal opacities, hypopyon (pus), hyphema (blood)
8. Dilate the pupil: mydriatics, turn lights down
9. Direct Opthalmoscopy: red reflex, optic disc, retina, macula
10. Thank patient and further tests: Slit lamp, Tonometry, Ishari, Amsler