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OPTOM 450 > Anterior + uveitis (incl posterior uveitis) > Flashcards

Anterior + uveitis (incl posterior uveitis) Flashcards

1
Q

What are papillae

A

hyperplastic conjunctival epithelium

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2
Q

What two main features do papillae have

A

central vascular core

surrounding infiltrate of inflammatory cells

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3
Q

Papillae commonly occur in

A

allergic conditions
bacterial infections
CL wear

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4
Q

What are follicles

A

subepithelial hyperplastic lymphoid tissue

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5
Q

What two features do follicles have

A

central elevated pale lesion

surrounding vascularisation

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6
Q

Follices occur in

A

viral infections
chlamydial infections
hypersensitivity to topical medications

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7
Q

Mucoid/watery discharge is generally indicative of what

A

allergic reaction

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8
Q

mucopurulent discharge is generally indicative of what

A

chlamydial infection

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9
Q

purulent discharge is generally indicative of what

A

bacterial infection

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10
Q

What kind of reaction is an allergic seasonal/perennial conjunctivitis and what causes it?

A

hypersensitivity (type 1 IgE-histamine) reaction to airborne antigens

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11
Q

What are the symptoms of seasonal/perennial conjunctivitis (3)

A

pink eye
watering +/- mucous strands
itchiness

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12
Q

What are the signs of seasonal/perennial conjunctivitis (3)

A

lid oedema
conjunctival injection and oedema
small papillae

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13
Q

Management of perennial/seasonal conjunctivitis involves a stepwise approach. What are the first three Tx options before drug administration?

A

avoid allergen
lavage
cold compresses

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14
Q

Name topical antihistamine and dosage. This is used as Tx for what 2 conditions?

A

levocabastine (Livostin) bid to qid up to 2 months

allergic conjunctivitis and adenoviral conjunctivitis

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15
Q

Name topical mast cell stabiliser and dosage. This is used as Tx mainly for what condition?

A

lodoxamide (Lomide) qid
allergic conjunctivitis
nb longer lasting cf antihistamine, longer time to take effect, often used in combination with antihistamine and prophylactic use

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16
Q

Name the two combination topical antihistamine/mast cell stabiliser and dosage

A

olopatadine (Patanol) 1-2 drops bid

ketotifen (Zaditen) 1 drop bid

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17
Q

NSAIDs can be used as short term Tx of perennial conjunctivitis. Name one with dosage

A

ketorolac (Acular) 1 drop qid for 2-4 weeks

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18
Q

Non-penetrating topical corticosteroids can be used as short term Tx of perennial conjunctivitis. Name one and dosage

A

FML 0.1% (Flucon) 1-2 drops bid to qid

nb side effects increased IOP, increased risk SCC, HSK reactivation

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19
Q

CL-related giant papillary conjunctivitis is what sort of reaction

A

hypersensitivity reaction to protein build up

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20
Q

What is the typical presentation of someone with GPC

A

itching
mucous discharge
lens awareness
giant papillae on tarsal plate

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21
Q

What is the management of GPC

A

same as for moderate to severe allergic conjunctivitis

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22
Q

What organisms cause bacterial conjunctivitis (4)

A

staph aureus
staph epidermis
strep pneumoniae
haemophilus influenza

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23
Q

symptoms of bacterial conjunctivitis (3)

A

red, gritty eyes

sticky discharge, matting of lashes

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24
Q

Would you see follicles or papillae with bacterial conjunctivitis?

A

papillae

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25
Q

Management of bacterial conjunctivitis

A

usually self limiting 1-2 weeks

artificial tears/lubricants

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26
Q

In more serious cases of bacterial conjunctivitis, broad spectrum topical antibiotics can be used. Name 3

A

fusidic acid (Fucithalmic) bid
chloramphenicol (chlorofast and chlorsig) qid
ciprofloxacin (ciloxin) q2h-qid

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27
Q

Symptoms of adenoviral conjunctivitis

A

red, watery eyes
burning irritation
possible photophobia

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28
Q

signs of adenoviral conjunctivitis (5)

A 
watery discharge
follicles
purplish/pink conjunctival injection
preauricular adenopathy
possible scattered focal subepithelial opacities
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29
Q

Adenoviral conjunctivitis is usually self limiting. What supportive management options are there (2)

A

artificial tears/lubricants qid+

cool compresses qid+

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30
Q

what topical therapeutics are used to treat adenoviral conjunctivitis (3)

A

levocabastine (Livostin) qid for itch
FML 0.1% qid with long, slow taper for subepithelial infiltrates and decreased vision (refer severe cases with pseudomembranes)
Povidone (iodine) 0.8-2.0% in clinic Tx (Px must not have epithelial defect)

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31
Q

Chlamydial conjunctivitis symptoms (3)

A

acute or chronic slight red eye
irritation
mucopurulent discharge

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32
Q

signs of chlamydial conjunctivitis (3)

A

follicles (tarsal conj)
preauricular adenopathy
possible associated keratitis

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33
Q

Therapeutic Tx of chlamydial conjunctivitis (3)

A

azithromycin 1g po once weekly
doxycycline 100mg po bid 2-6 weeks
erythromycin 250mg po qid (children)

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34
Q

When is doxycycline contraindicated

A

Px on blood thinners
pregnancy
children - stains teeth and ceases bone growth

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35
Q

CL-related toxic/allergic keratoconjunctivitis presentation (3)

A

burning on insertion
injection
PEE

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36
Q

Management of CL-related toxic/allergic keratoconjunctivitis (4)

A

cease CL wear
remove source and lavage
lubricants
prophylactic Tx of chloramphenicol 0.5% qid

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37
Q

Management of punctate epithelial erosion/SPK

A

appropriate for etiology

often lubricants and ABs if more serious

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38
Q

Marginal keratitis is associated with what

A

blepharitis

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39
Q

Management of marginal keratitis

A

Treat bleph
-lid hygiene
-antibiotic ointment
Chloramphenicol 0.5% drops qid and ointment 1% nocte lid margin OR
Fucithalmic 1% drops/gel bid
Continue Tx for 48 hours after signs resolve

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40
Q

CL-related marginal keratitis presentation (3)

A

asymptomatic to acute red eye presentation
conj and limbal injection
single or multiple small (1mm) round greyish superficial peripheral corneal infiltrates

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41
Q

Management for mild CL-related marginal keratitis

A

tobramycin 0.3% (Tobrex) q1h initially (review next day)
treat min 1 week until epith healed (qid min.)
consider FML 0.1% qid to manage infiltrate once epith healed and clear signs of improvement

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42
Q

Management for more severe CL-related marginal keratitis

A

ciprofloxacin 0.3% (ciloxan) q15 then q1h, review next day, reduce dosage according to response (q1d), continue for min 1 week until epith healed.
Consider FML 0.1% qid to manage infiltrate once epith healed and clear signs of improvement

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43
Q

For CL-related marginal keratitis once the epithelium is healed and there are clear signs of improvement, what do you use to manage infiltrates

A

FML 0.1% qid

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44
Q

Symptoms of bacterial keratitis (5)

A 
FB sensation with increasing pain
injection
photophobia
blur
tearing/discharge
CL intolerance
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45
Q

A contact lens can mask symptoms by acting as a bandage lens. What does the Px feel

A

discomfort after taking lens out

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46
Q

Signs of bacterial keratitis (5)

A 
white stromal infiltrate
overlying epithelial defect
possible ulceration
stromal oedema
AC reaction
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47
Q

Suppurative infiltrate is characteristic of which two bacteria which cause keratitis?

A

pseudomonas

strep pneumoniae

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48
Q

well-defined white gray or creamy stromal infiltrate is characteristic of what sort of specific keratitis

A

staphylococcal keratitis

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49
Q

Treatment for large >2mm sight threatening lesions (bacterial keratitis)

A

duotherapy
cephalosporin (cefazolin) 5%
tobramycin 1.5%
loading dose q5min for 30 min, then q30 min for 24hr tapering to min qid

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50
Q

Management of smaller <1-2mm peripheral lesions in bacterial keratitis

A

monotherapy
ciprofloxacin (ciloxan) 0.3%
loading dose q5min for 15min, then q30min for 24hr

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51
Q

CL-related bacterial keratitis involves duotherapy, monotherapy and two other treatment options which are?

A

cyclopentolate 1% tid

FML 0.1% qid 1-2 weeks to treat infiltrates after cornea has healed

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52
Q

In viral keratitis, if infiltrates are affecting vision and not resolving what do you prescribe?

A

FML 0.1% qid

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53
Q

Symptoms of HSK

A

blurred vision
lacrimation
photophobia
discomfort

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54
Q

Signs of HSK

A 
dendritic ulcers
terminal end bulbs
reduced corneal sensation
AC reaction
increased IOP
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55
Q

DDx of HSK

A

acanthamoeba keratitis
healing epithelial abrasion (pseudodendrites)
HZO

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56
Q

Management of non-sight threatening dendritic ulcer (HSK)

A

topical acyclovir 3% ointment (Virupos) 10mm ribbon in fornix, 5 times a day for 10-14 days, continue for 3 days after resolution

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57
Q

Recurrent HSK Tx (esp with scarring) (2)

A

topical corticosteroids to control inflam after cornea healed
prophylactic oral acyclovir tabs 400mg bid

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58
Q

Signs/symptoms of fungal keratitis (6)

A 
slow onset
significant pain, photophobia, lacrimation
marked conj injection
dense corneal infiltration
corneal oedema
AC reaction - hypopyon
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59
Q

symptoms of acanthamoeba keratitis (6)

A 
severe pain - disproportionate
photophobia
injection
blurred vision
tearing
swollen lids
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60
Q

signs of acanthamoeba keratitis (9)

A 
epithelial or subepithelial infiltrates (snowstorm)
pseudodendrites
limbitis
perineural infiltrates
stromal ring infiltration (Wessely ring) with epith lesion
hypopyon
episcleritis
scleritis
corneal thinning
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61
Q

What investigations do ophthalmologists do for possible acanthamoeba keratitis (4)

A

corneal scrape
light microscopy with calcofluor white stain
culture on non-nutrient agar with E coli
in-vivo confocal microscopy

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62
Q

Tx of acanthamoeba keratitis (5)

A 
propamidine isethionate 1% q1h
PHMB 0.02% OR chlorhexadine 0.02%
cycloplegia
oral NSAIDs
penetrating keratoplasty
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63
Q

What pupil size would you expect to see with someone with anterior uveitis

A

miotic

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64
Q

Management of anterior uveitis

A

aggressive topical corticosteroid Tx e.g. prednisolone acetate

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65
Q

Management of episcleritis

A

supportive - advice and artificial tears for FB sensation

NSAIDs e.g. FML 0.1% 1 gtt qid 1 week and stop

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66
Q

Scleritis is associated with which other two conditions

A

HZO

RA

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67
Q

Subconjunctival haemorrhage is characterised by what

A

ecchymosis

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68
Q

What would you expect to see about the pupil in angle closure glaucoma

A

fixed and mid-dilated

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69
Q

Management of angle closure

A 
Topical
-pilocarpine (<45mmHg)
-beta-blocker e.g. timolol
-apraclonidine
-dorzolamide
Systemic
-azetazolamide (diamox) 500mg po 
-mannitol
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70
Q

Dermatochalasis is

A

age-related sagging or draping upper lid skin tissue due to loss of elastin

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71
Q

Blepharochalasis results from

A

repeated periorbital swelling and leads to eyelid tissue thinning and redundancy

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72
Q

Ptosis is

A

abnormally low position of upper lid margin relative to globe in primary gaze

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73
Q

Congential aetiologies of ptosis (3)

A

dystrophy of levator
mis-directed 3rd nerve
Marcus Gun jaw-winking syndome

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74
Q

aquired aetiologies of ptosis (4)

A

aponeurotic
mechanical e.g. trauma, tumour
myogenic e.g. MG
neurogenic e.g. Horner’s, III nerve palsy

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75
Q

ectropion

A

outward turning of lower lid away from globe

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76
Q

entropion is

A

inward turning of the lower lid

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77
Q

Entropion can result in

A

trichiasis, corneal/conj irritation and possible pannus

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78
Q

trichiasis is

A

posterior misdirection of the eyelashes

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79
Q

Floppy eyelid syndrome is

A

loose, rubbery eyelids with lax tarsi due to loss of elastin

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80
Q

floppy eyelid syndrome is commonly associated with

A

high BMI and sleep apnoea

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81
Q

lagophthalmos is

A

incomplete lid closure with normal blinking or eye closing resulting in exposure keratitis

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82
Q

A VII nerve palsy can cause what

A

ectropion

lagophthalmos

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83
Q

eyelid myokymia is

A

eyelid twitch due to activity of orbicularis oculi

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84
Q

blepharospasm is

A

bilateral, episodic spasm of orbicularis oculi leading to uncontrolled, exaggerated blinking

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85
Q

madarosis is

A

the loss of eyelashes (and is a sign of something else e.g. skin disease, infection)

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86
Q

distichiasis is

A

partial or complete second row of lashes growing posterior or out of meibomian gland orifices

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87
Q

epicanthus is

A

congenital, bilateral, inner canthal folds resulting in pseudo-strabismus (eso)

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88
Q

external hordeolum

A

acute infection of lash follicle, gland of zeis or moll

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89
Q

Tx of external hordeolum

A

hot compresses, lid hygiene and sometimes topical antibiotics

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90
Q

internal hordeolum

A

acute infection and/or inflammation of meibomian gland

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91
Q

chalazion

A

chronic, granulomatous, sterile inflammation of meibomian gland

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92
Q

Tx of chalazion if necessary

A

hot compresses followed by digital massage, may require intralesional injection of steroid or surgical excision

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93
Q

How do you get preseptal cellulitis

A

spread from sinusitis, lid infection, trauma

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94
Q

Treatment for preseptal cellulitis

A

oral antibiotics

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95
Q

How can you distinguish between orbital and preseptal cellulitis?

A 
With orbital cellulitis:
VA decreased 
pupils (RAPD)
Slit lamp - conj chemosis, proptosis
EOMs restricticted
IOP elevated
ophthalmoscopy ONH swelling
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96
Q

MGD stage 1 symptoms and corneal staining

A 
none 
none
(minimally altered expressibility and secretion quality)
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97
Q

MGD stage 2 symptoms and corneal staining

A

minimal to mild symptoms
none to limited corneal staining
(mildly altered expressibility and secretion quality)

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98
Q

MGD stage 3 symptoms and corneal staining

A

moderate symptoms
mild to moderate corneal staining (mainly peripheral)
(moderately altered expressibility and secretion quality)

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99
Q

MGD stage 4 symptoms and corneal staining

A

marked symptoms
marked staining (central in addition to peripheral)
severely altered expressibility and secretion quality)

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100
Q

What is the “plus” disease stage of MGD

A

co-existing or accompanying disorders of ocular surface and/or eyelids

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101
Q

Therapeutic intervention for MGD occurs at which stage? What drugs are used?

A

doxycycline 50mg nocte x 6 wks

azithromycin 500mg stat, then 250mg x 3 days

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102
Q

Which condition describes this: midline facial inflammatory disorder affecting adults showing signs/symptoms of:

  • erythema, pustules, papules, telangectasia of nose, forehead, cheeks
  • bulbous nose
  • bleph, chalazia, injection, KCS
A

rosacea

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103
Q

Treatment of rosacea? (3)

A

systemic ABs - doxycycline, azithromycin
lid hygiene, warm compresses
possible topical AB ointment

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104
Q

multiple vesicles or ulcerative cold sore lesions on or near lid margins is indicative of what

A

HSV infection

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105
Q

Tx of HSV infection affecting adnexa (3 Tx + management)

A

warm saline soaks
drying agents (calamine lotion)
sometimes acyclovir ointment
follow closely for corneal involvement

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106
Q

HZO is a viral infection of the ophthalmic division of which nerve?

A

trigeminal

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107
Q

Ocular involvement with HZO is common with infection of the

A

nasociliary branch

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108
Q

HZO Tx (3)

A

oral acyclovir
steroids if cornea involved
analgesics for pain

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109
Q

Is HZO an immediate referral?

A

yes

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110
Q

Pediculosis oculi is?

A

infestation of lid cilia with pubic lice (phthirus pubis)

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111
Q

petechial haemorrhages at the lash line may be indicative of what?

A

pediculosis oculi

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112
Q

Tx of pediculosis oculi (2)

A

any type of ointment applied thickly to lids qid for 10-14 days
pediculocidal agent on scalp, pubic region and body

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113
Q

pinpoint inflammatory lesion with surrounding lid oedema causing symptoms of itch, throbbing, stinging sensation characteristic of what?

A

insect bite/sting

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114
Q

signs of malignancy for lumps, bumps and pigment (4)

A

changing in size over time
changing in coloration
vascularisation
non-healing lesion

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115
Q

Which condition typically has raised pearly edges, depressed ulcerated center which is slow growing and non-resolving

A

BCC

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116
Q

Which condition looks like a hardened nodule or rough, scaly patch which develops ulcerations or erosions and metastasizes through the lymph system?

A

SCC

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117
Q

Which of these conditions require urgent referral, BCC or SCC?

A

SCC

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118
Q

Which condition tends to be flat and scaly, seen around the eye and face due to dysplasia of keratinocytes?

A

actinic (solar) keratosis

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119
Q

Which bump/lump can become SCC?

A

actinic (solar) keratosis

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120
Q

Name an extremely malignant neoplasm arising from Zeiss, Moll or meibomian glands which can mimic a chalazion or internal hordeolum?

A

sebaceous gland adeno-carcinoma

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121
Q

What characterises a malignant melanoma? (5)

A 
irregular borders
fast growing 
colour changes
vascularised
sudden onset
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122
Q

Which condition has pigmented, irregular shaped lesions which increase in size over several months and has a high association with immunocompromised patients?

A

kaposi’s sarcoma

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123
Q

Signs of non-malignancy (bumps, lumps, pigment)

A

stable or slow growing
little or no colour changes
regular borders
avascular

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124
Q

Which condition shows asymptomatic, bilateral, symmetrical depigmentation of skin and overlying hair (which requires no Tx)

A

vitiligo

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125
Q

which conditions shows whitening or loss of pigmentation of lashes or eyebrows which can be due to chronic staph infection, vitiligo or albinism

A

poliosis

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126
Q

congenital purplish hemangioma of skin from underlying telangectactic capillaries sometimes assoc with Sturge-Weber syndrome and a risk factor for glaucoma

A

naevus flammus (port wine stain)

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127
Q

which condition has aetiology of DNA poxvirus with small, single or multiple, round, waxy nodules with variable cheesy centre

A

molluscum contagiosum

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128
Q

Which condition can be infectious or UV related, variable in size and pigmentation characterised by hyperplastic squamous epithelium that can cause chronic conjunctivitis?

A

viral wart/squamous papilloma, verrucae

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129
Q

small, painless, round, translucent, fluid-filled vesicles?

A

cyst of moll (hydrocystoma)

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130
Q

DDx for naevi (1)

A

squamous papilloma

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131
Q

hyperkeratinised plaques, flat or slightly elevated, dry and scaly, usually light pigmentation, well-circumscribed, typically elderly

A

basal cell papilloma (seborrhoeic keratosis)

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132
Q

What condition involves benign, embryological tissue growth which contains multiple tissue types

A

dermoid cyst

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133
Q

DEWS II definition of dry eye

A

Multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play an etiological role

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134
Q

Dry eye risk factors

A 
older age
female
postmenopausal oestrogen therapy
omega 3 and 6 balance
antihistamines
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135
Q

Drug classes that cause dry eye

A

anti-histamines
anti-anxiety
roaccutane

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136
Q

Schirmer 1 test

  • done with or without anaesthesia?
  • does it measure basal or reflex tearing?
  • normal result is?
A

without
basal and reflex
>15mm wetting after 5 minutes

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137
Q

Schirmer 2 test

  • done with or without anaesthesia
  • does it measure basal or reflex tearing?
  • normal result is?
A

with
basal
10mm after 5 mins

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138
Q

What indicates tear deficiency in the phenol red thread test

A

less than 10mm in 15 secs

139
Q

Levels of what enzyme is elevated in dry eye

A

MMP-9

140
Q

DELPHI panel is used to grade what?

A

dry eye

141
Q

Contraindications of punctal plugs (6)

only effective for aqueous deficiency!

A 
infectious conjunctivitis and blepharitis
MGD
dacryocystitis
inflammation
epiphora
allergy to plug material
142
Q

epiphora treatment involves treating

A

underlying cause

143
Q

What test involves instillation of NaFl into BE and observing amount of NaFl reaching nasal passages

A

Jones no.1 test

144
Q

What test involves expressing saline through a syringe + canula to see if fluid is observed in the nasal passage

A

Jones no.2 test

145
Q

dacryocystorhinostomy (DCR) is a surgical intervention to treat what condition?

A

acquired epiphora

146
Q

what is inflammation of the main lacrimal gland called?

A

dacryoadenitis

147
Q

acute dacryoadenitis is usually caused by

A

infection

148
Q

chronic dacryoadenitis is usually

A

secondary to inflammatory disorders (sarcoidosis, graves, sjogrens)

149
Q

What is the characteristic anatomical sign of dacryoadenitis?

A

S curve of upper lid due to localised swelling and ptosis

150
Q

Actinomyces israelii is the most common cause of what condition in older patients?

A

canaliculitis

151
Q

Which condition most commonly causes canaliculitis in younger patients

A

HSV/HZO

152
Q

What is the condition involving infection/inflammation of the lacrimal sac

A

dacryocystitis

153
Q

What symptom would you expect to be different between chronic dacryoadenitis and chronic dacryocystitis?

A

no tenderness/pain with chronic dacryocystitis

154
Q

This condition occurs congenitally around the blood vessels that penetrate the sclera to anastamose with iridial circle and looks dark purplish/green

A

episcleral uveal pigmentation

155
Q

congenital, nerves that pass upwards through sclera then retrace their course back down. Name condition

A

recurrent loop of axenfeld

156
Q

congenital or acquired pigmentation of the conjunctiva is?

A

melanosis

157
Q

which type of melanosis can convert to malignancy

A

primary acquired melanosis

158
Q

areas of increased pigmentation often following distribution of V nerve

A

naevus of ota (oculodermal melanocytosis)

159
Q

naevus of ota has risk of becoming what two conditions

A

glaucoma

choroidal melanoma

160
Q

heterochromia, iris mammillations and fundus hyperpigmentation are signs of what condition?

A

naevus of ota

161
Q

acquired degeneration of conjunctiva due to exposure to environmental factors

A

pinguecula

162
Q

Redundant folds of conjunctival tissue assoc with aging, dry eye, CLs, thyroid disease

A

conjunctivochalasis

163
Q

what is often associated with valsalva maneuvers

A

subconjunctival haemorrhage

164
Q

pharyngoconjunctival fever is caused by which two types of adenovirus

A

3 and 7

165
Q

epidemic keratoconjunctivitis is caused by which two types of adenovirus

A

8 and 19

166
Q

caused by enterovirus 70 and looks like many flame haemorrhages in conj

A

acute haemorrhagic conjunctivitis

167
Q

Which type of conjunctivitis displays hyperacute onset with severe purulent discharge, papillae and chemosis

A

gonococcal conjunctivitis

168
Q

Conjunctivitis acquired within one month of birth due to usually Chlamydia or Neisseria gonorrhoeae is called

A

neonatal conjunctivitis

169
Q

What is the first step of action with toxic or chemical conjunctivitis

A

immediate copious irrigation with water/saline for at least 15 mins in case of acid or alkali

170
Q

Superior limbic keratoconjunctivitis is associated with what condition?

A

thyroid dysfunction

171
Q

What conjunctivitis is an allergic hypersensitivity response to some antigen and are characterised by small, localised, raised, pinkish-white nodular lesions with assoc sectoral injection

A

phlyctenular conjunctivitis

172
Q

the advancing line of pterygium is called what?

A

Stocker’s line

173
Q

Acne rosacea blepharoconjunctivitis is a problem of?

A

sebaceous glands involving primarily facial and meibomian glands

174
Q

Systemic treatment of rosacea blepharoconjunctivitis involves?

A

oral tetracyclines for long periods with taper as indicated

175
Q

Which mucous membrane disorder is an auto-immune condition which is progressive, causes chronic blistering of skin and mucous membranes?

A

cicatricial pemphigoid

176
Q

Which mucous membrane disorder is an immune-mediated condition with bullous reaction with painful erosions and pseudomembranes?

A

Stevens-Johnson syndrome

177
Q

Reiter’s syndrome is a disorder of what kind of tissue?

A

connective tissue

178
Q

Which syndrome is a triad of conjunctivitis with iritis, urethritis and arthritis?

A

Reiter’s syndrome

179
Q

Episcleritis is usually self-limiting and management often involves reassurance and ATs, but what topical drugs can be used?

A

NSAIDs - voltaren, acular

180
Q

What inflammatory condition is usually associated with underlying systemic condition such as RA, colalgen vascualr disease, metabolic disease, granulomatous disease, or infectious disease?

A

scleritis

181
Q

Necrotising anterior scleritis without inflammation is termed as?

A

scleromalacia perforans

182
Q

treatment of scleritis consists usually of?

A

topical and systemic anti-inflammatory agents or immunosuppressive agents

183
Q

Which conjunctival tumour is a carcinoma in situ and a precursor to SCC?

A

intraepithelial neoplasia

184
Q

What are the 5 topical anti-allergy agents?

A 
antihistamines with decongestants
antihistamines
mast cell stabilisers
steroids
cyclosporin
185
Q

Naphazoline 0.1% (Albalon), tetrahydrozoline 0.05% (Visine) and Xylometazoline 0.05% (otrivine-antistin) are examples of what class of drugs?

A

topical decongestant - a1 agonists

186
Q

Sodium cromoglycate 2% (opticrom) and lodoxaminde 0.1% (lomide) are examples of what class of drugs?

A

mast cell stabilisers

187
Q

Steroids mediate inflammation by inhibiting which enzyme?

A

phospholipase A2

188
Q

loratadine, cetirizine and fexofenadine are examples of what class of drugs?

A

ORAL anti-histamines

189
Q

What class of drugs should be prescribed with care with renal disease, pregnancy, lactation and children

A

oral anti-histamines

190
Q

Perennial conjunctivitis symptoms tend to be:
chronic?
acute?

A

chronic

191
Q

Which keratoconjunctivitis tends to be worse in spring, warm dry climates and can be assoc with asthma and eczema with symptoms of itching, injection, oedema, photophobia, FB sensation, lacrimation, stringy discharge, large papilae (typically upper lids) and exacerbated by exposure to wind, dust, heat, physical exertion?

A

vernal keratoconjunctivitis

192
Q

Horner-Trantas dots and Arlt’s line are associated with what condition?

A

vernal keratoconjunctivitis

193
Q

what condition is often assoc with atopic dermatitis and other allergic disease? Can also be assoc with keratoconus, cataract.

A

atopic keratoconjunctivitis

194
Q

itching on lens removal with discharge and CL intolerance may be indicative of what kind of conjunctivitis?

A

giant papillary conjunctivitis

195
Q

GPC Tx? (3)

A

remove cause
lubrication
mast cell stabilisers
(ie same as allergic conjunctivitis)

196
Q

Localised area of thinning at limbus is called?

A

dellen

197
Q

superficial vascularisation/scarring of the peripheral cornea due to inflammation or degeneration with superficial invasion from conjunctival vessel plexus is called?

A

pannus

198
Q

Hypoxia due to SCL overwear or tight fitting lenses can lead to which condition?

A

CL-related corneal neovascularisation

199
Q

what condition is characterised by a 0.5-1mm wide, greyish, white band in peripheral cornea with a limbal clear zone and sharp edge?

A

Arcus senilis

200
Q

Arcus senilis is usually associated with? (2)

A

normal aging change

faulty lipid metabolism

201
Q

what condition is characterised by subepithelial, white, needle-like opacities in the peripheral cornea?

A

limbal girdle of vogt

202
Q

what condition is characterised by hypertophied Schwalbe’s line with distinct white line paralleling limbus?

A

posterior embryotoxon

203
Q

What condition is also known as Hassall Henle warts and is characterised by collagen thickening of Descemet’s membrane?

A

endothelial guttata

204
Q

elevated, peripheral hyaline nodules (discrete, large greyish-white nodules in peripheral 1/3 of cornea) and of no consequence?

A

Salzmann’s nodular degeneration

205
Q

name condition which is non-inflammatory and causes peripheral thinning of stroma with pannus?

A

Terrien’s marginal degneration

206
Q

What condition has two types (benign and progressive) often painful with photophobia with greyish infiltration, stromal thinning, peripheral vascularisation and healing with opacification thought to be an autoimmune reaction?

A

Mooren’s ulcer

207
Q

reddish-brown iron deposits sub-epithelial in older individuals with no Tx necessary?

A

Hudson-Stahli line

208
Q

what condition is assoc with chronic iridocyclitis, phthisis bulbi, high blood levels of calcium or phosphorous presenting with calcium deposition at the level of Bowman’s layer?

A

band keratopathy

209
Q

What condition is characterised by lipid deposition in stroma due to chronic inflammation and vascularisation

A

lipid keratopathy

210
Q

Lines in descemet’s membrane are also called

A

endothelial striae

211
Q

What condition is characterised by surface drying due to atmospheric expsoure e.g. improper blink or incomplete closure at night?

A

exposure keratopathy

212
Q

What condition is characterised by anaesthesia/hypoesthesia of cornea due to loss of 5th nerve function which then causes exposure keratopathy. The most common cause of this condition is herpes infections.

A

neurotrophic keratopathy

213
Q

What condition would you expect to see in people with cystinosis, multiple myeloma, Waldenstrom’s macroglobulinemia, lymphoma, Fyder’s dystrophy?

A

crystalline keratopathy

214
Q

These medications can cause what condition?
(hydroxy)chloroquine - RA, lupus, collagen disease
phenothiazines (e.g. chlorpromazine) - psychiatric disorders
amiodarone - cardiac arrhythmias
tamoxifen

A

vortex keratopathy

215
Q

Recurrent corneal erosion syndrome occurs due to abnormal…?

A

basement membrane adherence of basal epithelial cells

216
Q

Recurrent corneal erosion syndrome has two phases which are?

A

acute and quiescent phase

217
Q

The acute phase of recurrent corneal erosion syndrome shows what?

A

corneal abrasion with FL staining and possibly secondary iritis

218
Q

the quiescent phase of recurrent corneal erosion syndrome shows what?

A

subepithelial microcysts and perhaps FL negative staining

219
Q

Tx of acute episodes of recurrent corneal erosion syndrome? (5)

A 
hyperosmotic ointments and drops
hair-dryer use
bandage CL
pressure patching with antibiotic ointment
cycloplegia for discomfort
220
Q

Prevantative therapy for recurrent corneal erosion syndrome (4)

A
  • hyperosmotic ointment atnight and drops during daytime
  • bandage CL
  • improvement of tear film e.g. PO doxycycline, azithromycin, dexamethazone ointment nocte/drops qid 2 weeks
  • more radical therapy - epithelial scraping, anterior st romal puncture, laser PTK
221
Q

What condition is characterised by “bread crumbs” on the cornea which is bilateral, recurrent and can look like subepithelial infiltrates from adenoviral keratitis.

A

Thygeson’s superficial punctate keratitis

222
Q

Thygeson’s superficial punctate keratitis management (4)

A

symptom relief

  • lubricants especially histamine
  • topical antibiotics if significant SPK
  • mild topic steroid during acute phase
  • bandage CL
223
Q

Corneal DYSTROPHIES tend to be _____ in location, tend to be ___lateral, and family history is ______

A

central
bilateral
common

224
Q

What is the most common anterior dystrophy?

A

epithelial basement membrane dystrophy

225
Q

EMBD is also known as? (2)

A

map-dot-fingerprint

Cogan’s microcystic dystrophy

226
Q

Which anterior dystrophy is characterised by bilateral, dot-like, cystic, linear or fingerprint like greyish sub- or intra-epithelial opacities

A

epithelial basement membrane dystrophy

227
Q

Which one condition has a high association with recurrent corneal erosions?

A

epithelial basement membrane dystrophy

228
Q

dot-like, cystic, fingerprint like greyish opacities in EBMD are best seen with which slit-lamp technique?

A

retroillumination

229
Q

In severe cases how is EMBD treated?

A

scraping

PTK

230
Q

Which anterior dystrophy is characterised by subepithelial opacification and changes in Bowman’s membrane forming a honey comb appearance?

A

Reis-Buckler’s dystrophy

231
Q

EBMD, Reis-Buckler’s dystrophy and lattice dystrophy are associated with what other condition?

A

recurrent corneal erosion syndrome

232
Q

There are 3 types of lattice dystrophy. Which type has an early presentation and is more symptomatic and more likely to require keratoplasty?

A

type 1

233
Q

Which type of lattice dystrophy has a later presentation and is less symptomatic and may have facial palsy

A

type 2

234
Q

type 3 lattice dystrophy is similar to what other type of lattice dystrophy but has more radial opacities and minimal haze?

A

type 2

235
Q

Granular dystophy is _____ corneal dystrophy and has what kind of appearance?

A

stromal

snowflake or breadcrumb

236
Q

Fuch’s endothelial dystrophy occurs spontaneously but occasionally hereditary through?

A

autosomal dominant transmission

237
Q

Fuch’s endothelial dystrophy is characterised by? (3 main points)

A

progressive increase in central corneal guttata with polymegathism and decreased endothelial cell count

238
Q

Guttata are best visualised with which techniques?

A

specular reflection

indirect retro-illumination

239
Q

Fuch’s endothelial dystrophy leads to endothelial ________ and leads to ______ _______

A

dysfunction

corneal oedema

240
Q

If oedema spreads to the epithelium in Fuch’s endothelial dystrophy it can lead to?

A

bullous keratopathy with painful erosions

241
Q

Tx of Fuch’s endothelial dystrophy? (3)

A

hyperosmotic agents
bandage CL
keratoplasty

242
Q

opacities in Descemet’s membrane (scalloped bands and geographic, gray hazy areas) are characteristic of which condition?

A

posterior polymorphous dystrophy

243
Q

Keratoconus is due to progressive thinning of which area of the cornea?

A

paracentral

244
Q

Central to inferior corneal protrusion is known as?

A

Munson’s sign

245
Q

In keratoconus what name is given to a basal layer of epithelium that demarcates the base of the cone with iron deposits?

A

Fleischer’s ring

246
Q

In keratoconus what name is given to stress lines in pre-Descemet’s membrane in a vertically oblique fashion?

A

Vogt’s striae

247
Q

Ruptures in descemet’s membrane is called

A

hydrops

248
Q

What are the different cone morphologies in progressing size?

A

nipple
oval
globus

249
Q

What condition is characterised by bilateral, painless, thinning of inferior peripheral cornea with ectasia?

A

pellucid marginal degeneration

250
Q

What condition is characterised by bilateral thinning with protrusion of the entire cornea?

A

keratoglobus

251
Q

Which four bacteria can penetrate intact epithelium?

A

Neisseria
corynebacterium
listeria
haemophilus

252
Q

What species of bacteria cause oval, 1-2mm, yellow white, dense, opaque opacities

A

staph and strep

253
Q

what species of bacteria cause irregular, thick, mucopurulent, necrosis, yellowish-green, large (3-5mm) deeply penetrating opacity?

A

pseudomonas

254
Q

what species of bacteria cause shallow, ulcerative, gray-white, irregular opacity with surrounding “ring” of infiltrates

A

enterobacteriae

255
Q

Which antibiotic do you not use to treat a gram negative caused bacterial keratitis?

A

Fucithalmic

256
Q

What are the stages of the life cycle of HSV

A

primary infection
latent stage
recurrent infection

257
Q

What should NEVER be used to treat active HSV keratitis?

A

steroids

258
Q

What are the three variants of HSK?

A

indolent or neurotrophic ulcer (metaherpetic)
necrotising interstitial keratitis
disciform keratitis

259
Q

how is indolent/neurotrophic ulcer (metaherpetic) HSK treated?

A

discontinuing antiviral meds and instituting prophylactic AB Tx, cycloplegics, lubricants and perhaps bandage CL

260
Q

Which division of which nerve is involved in reactivation of HSK and HSZ?

A

ophthalmic division (I) of Trigeminal nerve

261
Q

Ocular involvement is likely with HZO when which brance is is involved causing Hutchinson’s sign?

A

nasociliary branch

262
Q

Herpes Zoster can cause any _______ condition of the eye

A

inflammatory (ending in -itis)

263
Q

Treatment of acute phase of HZO?

A

oral acyclovir

264
Q

Treatment of fungal keratitis in hospital?

A 
anti-fungal topical agent (perhaps oral anti-fungal as well) e.g.
econazole
natamycin
amphotericin B
imidazole
265
Q

Which condition is treated with the following drugs:
Topical: propamidine, neomycin, polyhexamethylene biguanide
Systemic: ketocanazole and itraconazole

A

acanthamoeba keratitis

266
Q

Interstitial keratitis is associated with what systemic infections?

A

congenital syphillis
TB
Cogan’s syndrome

267
Q

Graft rejection lines by the endothelium is also konwn as?

A

Khodadoust line

268
Q

Gaft rejection management before immediate referal to ophthalmology?

A

intensive anti-inflammatories e.g. Pred Forte

269
Q

What condition is characterised by epicanthal folds, bilateral ptosis, short horizontal palpebral aperture, risk of ambly, lower eyelid ectropion with dominant family history

A

blepharophimosis

270
Q

Blepharophimosis is associated with what syndrome?

A

Fetal alcohol syndrome

271
Q

What is the most common eyelid tumour in infancy and seen in 25% of low birth weight babies

A

haemangiomas

272
Q

Which syndromes/conditions are related condition to congenital glaucoma? (2)

A

Sturge-Weber syndrome

neurofibromatosis (von Recklinhausen disease)

273
Q

What condition is characterised by iris strand attached to or near posterior embryotoxon and which can occasionally lead to glaucoma?

A

axenfeld’s anomaly

274
Q

Which condition is the same as axenfeld’s but more pronounced and attachments may be more anterior

A

Reiger’s anomaly

275
Q

DDx with Axenfled/Reiger

A

ICE syndrome

276
Q

ICE syndrome can lead to secondary what?

A

glaucoma

277
Q

What condition is characterised by iris or lens adhesions to the posterior corneal surface

A

Peter’s anomaly

278
Q

Congenital hereditiary endothelial dystrophy causes

A

bilateral clouding of cornea

279
Q

Maternal rubella, deafness, microcephaly, congenital heart defects are common causes for what condition?

A

congenital cataract

280
Q

What is tunica vasculosa lentis?

A

persistent pupillary membrane

281
Q

What is Mittendorf’s dot and where is it located

A

remnant of the hyaloid vessel on the posterior capsule

282
Q

What is displacement of the lens called?

A

ectopia lentis

283
Q

What conditions can cause ectopia lentis?

A

marfans syndrome
homocystinuria
trauma
tumours

284
Q

What is the order of cataract progressions?

A 
immature
mature
intumescent
hypermature
morgagnian
285
Q

Which condition can show these symptoms?

  • colored halos
  • monocular diplopia/polyopia
  • altered colored perception
  • behavioural changes in children
A

cataract

286
Q

Which type of cataract has early signs which include the formation of water vacuoles

A

cortical cataract

287
Q

Which type of cataract tends to progress the fastest?

A

posterior subcapsular

288
Q

Cataract risk factors (10)

A 
age
smoking
uveitis
RD
RP
any intraocular surgery
intraocular tumour
high myopia
trauma
acute glaucoma
289
Q

True diabetic cataract has what appearance?

A

snowflake

290
Q

Which cataract is due to deficiency in galactose pathway enzyme leading to osmotic imbalance?

A

galactosemia

291
Q

What cataract is characterised by small white dots that can aggregate into flakes?

A

hypoparathyroidism/hypocalcemia

292
Q

Sunfower cataract due to copper deposition is due to what disease?

A

Wilson’s disease

293
Q

Steroid induced cataract causes which type?

A

PSC

294
Q

miotic induced cataract causes which type?

A

ASC

295
Q

blunt trauma causes what type of cataract?

A

rosette or stellate

296
Q

What is the most common congenital cataract?

A

zonular/lamellar

297
Q

Which cataract is club shaped, located in the cortex and assoc with Down’s syndrome?

A

coronary

298
Q

What are the early most common post op complications of cataract surgery ?

A

iris prolapse
posterior capsule tear
corneal oedema
increased IOP

299
Q

What are the most common (late) post op complications of cataract surgery?

A

CMO
Post capsular opacity
AC cells and flare

300
Q

Endophthalmitis is intraocular inflammation excluding what structure?

A

sclera

301
Q

Granulomatous uveitis is?

a. chronic
b. acute

A

chronic

302
Q

non gratulomatous uveitis is?

a. chronic
b. acute

A

acute

303
Q

Active leakage shows the appearance of what in the anterior chamber?

A

cells

304
Q

Previous leakage in shows the appearance of what in the anterior chamber?

A

flare only

305
Q

Symptoms of acute uveitis?

A 
usually unilateral
red eye
photophobia
vision near normal
dull ache to deep boring pain
306
Q

Describe the usual pupil you would expect to see in acute uveitis

A

miotic pupil

307
Q

Grading of flare

A

1+ trace, barely detectable
2+ mild, iris details clear
3+ moderate, iris details hazy
4+ severe, exudate (hypopyon)

308
Q

Grading of cells in AC

A 
\+/-   <5 cells
1+   5-10 cells
2+   11-20
3+   21-50
4+   50+ cells
hypopyon
309
Q

Inflammatory cells adherent to corneal endothelium is seen in uveitis and are called

A

keratic precipitates

310
Q

Mutton Fat keratic precipitates are seen in?

A

granulomatous (chronic) uveitis

311
Q

Iris nodules are a feature of ?

A

granulomatous (chronic) uveitis

312
Q

Koeppe nodules are located at?

A

pupillary border

313
Q

Busacca nodules are located?

A

away from the pupil

314
Q

What usually happens to IOP in acute uveitis?

A

decreases

315
Q

IOP may be increased in uveitis. This is especially seen with what kind of uveitis?

A

herpetic uveitis

316
Q

Cells in the vitreous is only seen in what type of uveitis?

A

acute anterior uveitis

317
Q

DDx of acute anterior uveitis?

A

all other causes of red eye esp angle closure glaucoma
other uveitis’
RD

318
Q

HLA-B27+ is a _____ part of the ___ and associated with conditions such as ankylosing spondylitis, reiter’s syndrome, psoriatic arthritis, IBD

A

nucleated cell surface antigen

MHC

319
Q

Therapeutic Tx of acute anterior uveitis

A

-prednisolone acetate 1.0% (Prednisolone-AFT)
loading dose q5min - q1h for 1-2 days
mainteneance: q2h-qid until quiet
taper to qd for weeks to months

-cycloplegia
tid/qid and taper once AC quiet

320
Q

If uncomplicated, idiopathic, unilateral acute anterior uveitis is not responding to therapeutic treatment what condition should you suspect?

A

Fuchs heterochromatic iridocyclitis

321
Q

Complications of fuchs heterochromatic iridocyclitis?

A

iris heterochromia and atrophy
cataract and glaucoma
loss of vision

322
Q

How is Fuchs heterochromatic iridocyclitis usually treated?

A

topical anti glaucoma medication e.g. Timolol 0.25% bid

NOT LATANOPROST

323
Q

Chronic anterior uveitis patients show minimal redness and discomfort. What signs might you be able to see on a routine check up?

A

Mutton fat or pigmented KPs

iris nodules

324
Q

What are the “later” signs of chronic anterior uveitis? (6)

A 
iris atrophy
band keratopathy
secondary cataract
High or low IOP
CMO
Rubeosis
325
Q

What is management for chronic anterior uveitis?

A

possible co-management of acute phase (Tx as acute)

refer to GP or ophthal

326
Q

Intermediate uveitis can affect which three structures?

A

pars plana, peripheral retina, underlying choroid

327
Q

Intermediate uveitis is associated with what two conditions?

A 
Multiple sclerosis (10-15% develop)
genotype HLA-DR15
328
Q

What are symptoms of intermediate uveitis? (2)

A 
increasing floaters
decreased vision (CMO)
329
Q

What are four signs of intermediate uveitis?

A

vitritis
peripheral retinal periphlebitis
snowbanking (deposits at inf pars plana)
absence of focal lesions of fundus

330
Q

What are complications of intermediate uveitis?

A

CMO
cataract
tractional RD
cyclitic membrane formation

331
Q

Like posterior uveitis, intermediate uveitis management involves referral. However how is intermediate uveitis treated by ophthals?

A

sub-tenon steroid injections
systemic steroids
cryotherapy (vitreous base for NV)
pars plana vitrectomy (if haem, RD, opacification)

332
Q

choroiditis, vitritis, retinitis, vasculitis are all examples of what condition?

A

posterior uveitis

333
Q

What are the active and inactive signs of choroiditis

A

active: deep, yellow or greyish patches with fairly well demarcated borders
inactive: white defined atrophic lesions with pigment

334
Q

What is the sign of active retinitis?

A

white cloudy appearance obscuring retinal vessels

335
Q

What is the sign of vasculitis?

A

fluffy white haziness surrounding veins

336
Q

What are the complications of posterior uveitis? (4)

A

CMO
maculopathy
epiretinal membrane formation
RD

337
Q

Posterior uveitis is classified into three classes which are?

A

focal
multifocal
geographical

338
Q

Toxoplasmosis is the most common cause of posterior uveitis and is caused by the protozoan _______ which is found in the animal _____

A

toxoplasma gondii

cats

339
Q

Active lesions of toxoplasmosis are urgently referred where they are treated by? (2)

A 
systemic antibiotics (pyrimethamine, sulfadiazine, clindamycin)
systemic corticosteroids
340
Q

Histoplasmosis is a fungal infection caused by ____ and is asymptomatic unless the _____ is involved

A

histoplasma capsulatum

macula

341
Q

Histoplasmosis is characterised by asymptomatic lesions such as PPA, linear perpheral streaks and histo spots, the latter which has what appearance?

A

scattered small round yellow-white lesions

342
Q

When histoplasmosis affects vision it is because of ___ ____

A

exudative maculopathy

343
Q

The clinical features of a slowly progressive retinitis or fulminating retinitis with:
dense, white geographic retinal opacification
haemorhage
involvment of ONH
RD
loss of vision
are signs of what condition seen commonly in patients with AIDS?

A

CMV retinitis

OPTOM 450 (2 decks)

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