Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Opthalmology > clinical > Flashcards

clinical Flashcards

1
Q

what is conjunctivitis?

A

Condition where the conjunctiva is inflamed with infection of the superficial vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the causes of conjunctivitis?

A

Infectious causes:

1.Viral is main cause: Adenovirus

other viral causes: Herpes simplex, Varicella zoster

  1. bacteria not as big of a cause: Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae

other causes: chlamydia

  1. Chlamydia can also cause Ophthalmia neonatorum (conjunctivitis of new born)

Non infectious causes:

  1. Allergic conjunctivitis
  2. Drugs
  3. autoimmune
  4. skin disease - eczema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs and symptoms of conjunctivitis?

A

symptoms

foreign body sensation

discharge - sticky eye

itch = allergy

Signs:

Red eye - not the pattern of redness

discharge - serous or mucopurulent

Papillae or follicles

sub conjunctivitis haemorrhage

Chemosis

pre-auricular glands swelling - if viral

VISION IS UNAFFECTED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how do you diagnose conjunctivitis?

A

mainly on signs and symptoms

examine eye

can do conjunctival cultures - really only needed for gonococcal/chlamydial infection

Viral PCR and bacterial swabs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the distinct features of viral conjunctivitis?

A

follicular inflammation

subconjunctival haemorrhages.

Epidemic keratoconjunctivitis (due to adenovirus)

Less discharge (usually watery) than bacterial conjunctivitis.

Upper respiratory tract infection and pre-auricular lymphadenopathy.

itchy

  1. Herpes simplex typically presents as unilateral red eye with vesicular lesions visible
  2. Herpes zoster infection should be assumed if lesions are present at the tip of the nose (Hutchinson’s sign).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the main causes of follicular conjunctivitis?

ii. what is follicular conjunctivitis secondary to?

A

Viral (adeno, HS and HZ)

chlamydial

drugs e.g. propine, trusopt

ii. Molluscum contagiosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the main distinct features of bacterial conjunctivitis?

A

Purulent or mucopurulent discharge with crusting (gritty) of the lids which may be stuck together on waking.

mild or no pruritus

papillae inflammation

self limiting - will clear after 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the clinical presentation of chronic conjunctivitis?

A

Blepharitis - inflammation of the eyelids

chlamydial infection

keratoconjunctivitis sicca

lacrimal disease

sensitive to topical glaucoma medication

sub-tarsal foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you manage conjunctivitis?

A
  1. Most cases are viral and only need symptomatic relief with artificial tears and cold compress ]
  2. bacterial and viral (non-herpetic) are usually self- limiting (2 weeks)
  3. Bacterial conjunctivitis can use antibiotics to decrease duration of symptoms:

1st line: bathe/clean eyelids regularly to remove crusting

2nd line: Chloramphenicol 0.5% eyedrops applied four times daily for less severe infections

Continue for 48 hours after
resolution.

3rd line: Send swab prior to treatment. Fusidic acid 1% eye drops applied bd (Note: no gram negative activity). Continue

  1. Seek specialist advice if very severe, vision affected or infection persists for >10-14 days after treatment initiated.

Consider Chlamydia trachomatis or gonococcal infection if sexually active

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is subconjunctival haemorrhage?

A

bleeding into the subconjunctival space.

may occur spontaneously or as a result of trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the clinical presentation of subconjunctival haemorrhage?

A

bright red blood overlying the sclera

well defined borders - masks the overlying conjunctival markings

painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations would you need to do for subconjunctival haemorrhage?

A

if the patient has a history of trauma ensure there is no globe rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how do you manage subconjunctival haemorrhage?

A

no management is required as the haemorrhage will reabsorb over 10 to 14 days

lubricants are helpful to prevent conjunctival desiccation and ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is blepharitis?

A

inflammation of the eye lids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the two types of blepharitis?

A

Anterior- seborrheic scales form on the lashes. Lid margin redder than deeper part of lid

posterior- Meibomian gland dysfunction. redness is in deeper part of lid. Lid margin often quite normal looking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the causes of blepharitis?

A

Staph aureus

seborrheic dermatitis

acne rosacea

dry eyes- from contact lens

demodex infestatin - mites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the signs and symptoms of Blepharitis?

A

Gritty eye lids

Redness/irritation of the lid and eye

+/- marginal keratitis (sterile inflammation of the cornea).

mild discharge

foreign body sensation

  1. Anterior signs:

A. seborrhoeic:

eye lid is margin red

Scales

dandruff

no ulcerations and unaffected lashes

B. Staphylococcal

eye lid is margin red

lashes distorted, loss of lashes or trichiasis

ulcers of lid margin

corneal staining, marginal ulcers due to exotoxin

  1. Posterior blepharitis signs:

“Meibomian gland disease”

Lid margin skin and lashes unaffected

Meibomian gland openings and swollen

inspissated secretion at gland openings

Meibomian cysts (chalazia)

associated with ance rosacea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how do you manage blepharitis?

A

Lid hygiene - daily bathing/ warm compresses

supplementary tear drops

oral doxycycline for 2-3 months

difficult to remove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is keratitis? (corneal disease)

A

inflammation of the cornea - identified by a white area on the cornea indicating a collection of white cells in corneal tissue

it is an umbrella term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is corneal ulcer?

A

an open sore of the cornea it is a specific type of keratitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the causes of corneal ulcers?

A

1.Central causes:

viral e.g. Herpes simplex virus Type 1.

fungal - candida, aspergillus

bacterial - pseudomonas

acanthamoeba

  1. Peripheral causes (autoimmune):

Rheumatoid arthritis

hypersensitivity e.g. marginal ulcers

N.B Herpes simplex causes dendritic corneal ulcers - epithelial keratitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are the signs and symptoms of corneal ulcers?

A

symptoms:

Pain - feels needle like .

photophobia

profuse lacrimation

reduced vision (maybe)

red eye

Signs:

Redness- circumcorneal

corneal reflex is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what special types of corneal ulcers are there?

A
  1. Exposure keratitis
  2. keratoconjunctivitis sicca
  3. neurotrophic keratitis
  4. vitamin A deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do you diagnose corneal ulcers?

A

Examine eye - fluorescein stain

Corneal scrape for gram stain and culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do you manage corneal ulcers?

A

Bacterial - topical fluoroquinolone e.g. ofloxacin or Gentamicin + cefuroxime

Herpes simplex - ganciclovir (Acyclovir was discontinued according NHS Tayside formulary)

Fungal - Amphotericin

Acanthamoeba - Propamidine 0.1% + Chlorhexidine 0.02%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is anterior uveitis?

A

inflammation of the middle layer of the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the causes of anterior uveitis?

A
  1. Ankylosing spondylitis
  2. IBD
  3. reactive arthritis
  4. sarcoidosis
  5. TB
  6. syphilis
  7. Herpes simplex
  8. Herpes zoster
  9. Leukaemia
  10. idiopathic
  11. trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the signs and symptoms of anterior uveitis?

A

Symptoms

  1. Pain - referred pain too
  2. vision may be reduced
  3. photophobia
  4. Red eye (circumcorneal)

Signs

  1. Ciliary injection
  2. Cells & flare in anterior chamber
  3. Keratic precipitates
  4. Hypopyon
  5. Synechiae - small or irregular pupil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how do you diagnose anterior uveitis?

A

slit lamp with a dilated pupil - you see leucocytes in the anterior chamber

intraocular pressure can be reduced in effected eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do you manage anterior uveitis?

A

Topical steroids e.g. prednisolone - reduces inflammation and prevent complication such as glaucoma and adhesions

Mydriatic drops e.g. cyclopentolate - dilates pupil which reduces pressure and pain in the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is episcleritis?

A

relatively common, benign, self limiting condition where the episclera becomes inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are the signs and symptoms of episcleritis?

A

diffuse scleral redness with:

mild discomfort

no changes in vision or other ocular symptoms

mainly found in women and normally unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how do you manage episcleritis?

A

Self limiting

topical NSAIDS

artificial tears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is scleritis?

A

Generalised inflammation of the sclera itself with oedema of the conjunctiva, scleral thinning and vasculitis changes.

A serious disease and much more rarer disease than episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are diseases is scleritis associated with?

A

rheumatoid arthritis

granulomatosis with polyangiitis (Wegener’s granulomatosis)

uveitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the signs and symptoms of scleritis

A

deep severe pain of the globe : necrotising scleritis can also cause globe perforation

severe dull ache

violaceous hue

reduced vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

how do you diagnose scerlitis?

A

When differentiating episcleritis from scleritis, clinicians often use the phenylephrine blanching technique:

episcleritis vessels will blanch

scleritis vessels wont blanch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do you manage scerlitis?

A

Oral NSAIDs

Oral steroids

steroid sparing agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is acute closed angle glaucoma?

A

Acute angle-closure glaucoma (AACG) is an acute rise in intraocular pressure associated with narrowing of the anterior chamber angle of the eye (the angle between the iris and cornea) causing optic nerve damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what are the signs and symptoms of an acute closed angle glaucoma

A

painful red eye

Fixed mid-dilated pupil

increased IOP makes eye feel hard

cornea is cloudy - oedematous

headache

nausea

vomiting

Visual changes such as blurred vision and halos around lights at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

how do you diagnose acute closed angle glaucoma?

A

Gonioscopy is the gold standard investigation for assessing the angle between the iris and cornea

Tonometry is used to measure intraocular pressure. In AACG, intraocular pressure is typically >30mmHg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how do you manage acute closed angle glaucoma?

A

Pharmacological to lower IOP:

Topical timolol: a beta-blocker to decrease aqueous humour production

Topical pilocarpine: a miotic that constricts the pupil and increases aqueous humour outflow

Oral or intravenous acetazolamide: a carbonic anhydrase inhibitor to decrease aqueous humour production

can also use analgesia and antiemetics

surgery:

peripheral iridotomy (laser and surgery) - done in both eyes once IOP is controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

when should you urgently refer somebody if they have red eye?

A

when the red eye is:

  1. affecting their vision
    or
  2. causing marked photophobia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the pathophysiology of closed- angle type glaucoma?

A

In AACG, there is reduced drainage of aqueous humour due to anterior chamber angle narrowing.

This causes a rapid rise in intraocular pressure and subsequent optic nerve damage.

A common cause of anterior chamber angle closure is pupillary block, which occurs when aqueous humour outflow is obstructed due to contact between the iris and lens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what is endophthalmitis?

A

inflammation of the internal eye, often secondary to infection following surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is a glaucoma?

A

A progressive optic neuropathy with characteristic changes in the optic nerve head and corresponding loss of visual field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is an open angle glaucoma?

A

The drainage angle formed by the cornea and iris remains open, but the trabecular meshwork is partially blocked. This causes pressure in the eye to gradually increase. This pressure damages the optic nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are the signs and symptoms of an open angle glaucoma?

A

Usually asymptomatic - picked up by optician . can have loss of peripheral vision

signs:

Cupped disc ( loss of retinal ganglion cells)

Visual field defect

may/May not have have high IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

how do you diagnose open angle glaucoma?

A

IOP measurement - tonometry

central corneal thickness measurement

Peripheral anterior chamber configuration and depth assessments - gonioscope

visual field measurement

optic nerve assessment with slit lamp

NHS free eye test for patients >40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

how do you manage open angle glaucoma?

A

Pharmacological

1st line: Topical prostaglandin analogues such as latanoprost, tafluprost, travoprost, or bimatoprost . increases uveoscleral outflow

  1. Beta blockers e.g. Timolol or betaxolol. decreases production of aqueous
  2. alpha adrenergic agonist e.g. Brimonidine, apraclonidine. decreases production of aqueous
  3. carbonic anhydrase inhibitors e.g. dorzolamide, brinzolamide and acetazolamide. Decrease production of aqueous
  4. Milotic’s
  5. combination drops (fixed - dose)
    surgery: used if drugs fail

Trabeculectomy

trabeculoplasty (laser)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is a cataract?

A

a cloudiness of the lens

abnormal changes in les proteins (crystallins) result in their chemical and structural alteration, leading to loss of transparency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what are the risk factors of the cataract?

A

age related

systemic disease ( diabetes)

ocular disease (uveitis)

smoking

alcohol excess

UV light

trauma

radiotherapy

congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what types of cataracts are there?

A

Nuclear cataracts: they change the lens refractive index

cortical cataracts : spoke-like wedge-shaped opacities which have milder effects on vision

posterior sub capsular cataracts: typically progress faster and cause the classic glare from sunlight

congenital cataracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the signs and symptoms of cataracs?

A

clouded/blurred vision

unilateral cataracts are unnoticed

loss of stereopsis - affects judgement distance

dazzling in bright light

monocular diplopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

how do you manage cataracts?

A

if patient is symptomatic than offer surgery:

phacoemulsification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is orbital cellulitis?

A

Severe sight and life-threatening emergency

infection of soft tissues posterior to the orbital septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the causes of orbital cellulitis?

A

Strep Pneumoniae

Staph aureus

Strep pyogenes

Haemophilius Influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what are the sign and symptoms of orbital cellulitis?

A

inflammation in the orbit

fever

lid swelling

decrease in eye mobility

diplopia

painful eye movements

conjunctival swelling

proptosis

59
Q

How do you diagnose orbital cellulitis?

A

CT sinus and orbit

60
Q

how do you manage orbital cellulitis?

A

Medical Emergency: Transfer to hospital immediately and refer to ENT and/or Ophthalmology.
Ceftriaxone IV 2g bd + Flucloxacillin IV 2g qds + Metronidazole IV 500mg tds
(Penicillin allergy: seek advice)
Step down to Co-amoxiclav PO 625mg tds (10-14 days total)

61
Q

What is Periorbital/ pre septal orbital cellulitis?

A

infection effects the anterior of the eye orbital

62
Q

what is Periorbital/ pre septal orbital cellulitis caused by?

A

caused by infection to adjacent structures

dacryocystitis

insect bite

hordeolum

trauma

63
Q

What are the signs and symptoms of Periorbital/ pre septal orbital cellulitis?

A

inflamed eye-lids

white eyes are normal

no proptosis

no reduction in vision

no pain or limitation of eye movement

64
Q

How do you diagnose Periorbital/ pre septal orbital cellulitis?

A

same as orbital cellulitis

65
Q

How do you manage Periorbital/ pre septal orbital cellulitis?

A

Co-amoxiclav PO 625mg tds or IV 1.2g tds
(Pencillin allergy: PO Clindamycin <50kg 300mg tds 50-90kg 450mg tds
>90kg or very severe illness 600mg tds or 450mg qds)
Duration: 7-10 days If any concerns seek specialist opinion from Ophthalmology

66
Q

Give examples of conditions which cause sudden vision loss?

A
  1. Acute glaucoma
  2. central retinal artery occlusion
  3. Vitreous haemorrhage
  4. Branch retinal artery occlusion
  5. Central retinal vein occlusion
  6. branch retinal vein occlusion
  7. macular degeneration (wet)
67
Q

Give examples of conditions which cause gradual vision loss?

A
  1. Cataract
  2. Glaucoma (open angle)
  3. Macular degeneration (dry)
  4. Diabetic retinopathy
  5. optic atrophy
  6. Retinal dystrophies
68
Q

What is central retinal artery occlusion?

A

disease of the eye where the flow of blood through the central retinal artery is blocked (occluded)

this is an emergency as there is a dramatic loss in vision within seconds of occlusion

69
Q

what are the causes of central retinal artery occlusion?

A

thromboembolic- carotid artery disease

atherosclerosis

Giant cell arteritis (GCA)

70
Q

what are the signs and symptoms of central retinal artery occlusion?

A

Symptoms:

Sudden visual loss (painless)

Signs:

RAPD (relative afferent pupil defect)

Pale oedematous retina

retina appears white with a cherry red spot at the macula

signs of atherosclerosis (bruits and hypertension)

94% of cases, vision is usually reduced to counting fingers (worse suggests that the ophthalmic artery may also be affected).

71
Q

How do you diagnose central retinal artery occlusion?

A

rule out is giant cell arteritis: fluorescein angiography and optical coherence tomography

Urgent ESR and CRP are measured in patients over 60 years of age, when a diagnosis of giant cell arteritis cannot be exclude

FBCs to check for vasculitis

HbA1c and lipid profile: to assess for underlying cardiovascular risk factors

ECG: to look for atrial fibrillation

72
Q

How do you manage central retinal artery occlusion?

A

Immediate management:

Ocular massage: repeatedly massaging the globe over the closed lid for ten seconds with five-second interludes may occasionally dislodge the obstructing thrombus.

Increase blood oxygen content and dilate retinal arteries: administration of sublingual isosorbide dinitrate or oral pentoxifylline. Inhalation of a carbogen or hyperbaric oxygen.

Reduce intraocular pressure: to increase retinal artery perfusion pressure with intravenous acetazolamide and mannitol, plus anterior chamber paracentesis.

If the patient presents within 24 hours, intra-arterial fibrinolysis through local injection of urokinase into the proximal part of the ophthalmic artery,

Long term management:

Diet and lifestyle management

73
Q

what are the two further variants of retinal arterial occlusion?

A

Brach retinal artery occlusion

Amaurosis fugax

74
Q

what is branch retinal artery occlusion

A

occlusion of branch retinal arteries

not as bad as its central counterpart

doesnt have any cherry red spots and has less profound vision loss

oh yeah its occlusion is in the BRANCH arteries and not the CENTRAL arteries

75
Q

What is amaurosis fugax (transient central retinal arterial occlusion)?

A

painless temporary loss of vision in one or both eyes

its when a TIA effects the eye

its due to transient blockage of the central retinal artery

76
Q

what are the signs and symptoms of amaurosis fugax?

A

symptoms:

transient painless visual loss -“like a curtain coming down”

lasts 5 mins then has full recovery

no abnormal signs

77
Q

How do you manage amaurosis fugax?

A

same as TIA;

lipid modification drugs

anti coagulants

Anti-hypertensive drugs

Antiplatelet therapy

B vitamins or folate; vitamins A, C, or E; selenium; and calcium

78
Q

what is retinal vein occlusion?

A

2nd most common retinal vascular disease after diabetic retinopathy

occlusion of retinal veins lead to sudden visual loss

79
Q

what types of retinal vein occlusion are there?

A

Central - occurs at level of the optic nerve

Branch - occurs at arteriovenous crossing and may be asymptomatic if the macula is not affected

80
Q

What are the signs and symptoms of central retinal vein occlusion?

A

sudden, painless unilateral visual loss - more gradual than CRAO

Relative afferent pupillary defect (RAPD): suggestive of ischaemia (?)

Visual field defect

signs:

Retinal haemorrhages

dilated tortuous veins

disc swelling and macular swelling

81
Q

What are the risk factors of central retinal vein occlusion?

A

Age

Atherosclerosis: hyperlipidaemia, hypertension and diabetes

Open-angle glaucoma

Inflammatory causes: sarcoidosis, Lyme disease

Hypercoagulable states: smoking, oral contraceptive pill, pregnancy, malignancy, sickle cell disease

Myeloproliferative disorders

Systemic vasculitis: Behcet’s disease, polyarteritis nodosa

82
Q

how do you diagnose CRVO?

A

General:

FBC

glucose

BP

ESR

Imaging:

Fundus fluorescein angiography for retinal ischaemia

Fundal photography: typically wide-field views

Optical coherence tomography: for assessment of macula oedema

83
Q

How do you manage CRVO?

A
  1. Treatment for macular oedema:

anti VEGF agents (ranibizumab, aflibercept or bevacizumab)

Intravitreal steroid implant (dexamethasone)

Macular laser therapy: less common

  1. photocoagulation for neovascular complications caused by retinal ischaemia
84
Q

compare colour of artery to vein retinal occlusion

A

Arterial retinal occlusion is pale

vein retinal occlusion is dark

85
Q

what two types of Ischaemic optic neuropathy are there?

A

Arteritic (temporal arteritis)

Non arteritic

86
Q

what is ischaemic optic neuropathy?

A

is the loss of structure and function of a portion of the optic nerve due to obstruction of blood flow to the nerve

87
Q

What are the causes of arteritic ischaemic optic neuropathy?

A

Giant cell arteritis

88
Q

what are the signs and symptoms of arteritic ischaemic optic neuropathy?

A

New onset headache

scalp tenderness

temporal arteries - arteries are thickened and absent pulse

malaise

jaw/tongue claudication

visual loss is typically monocular

associated with polymyalgia rheumatica

89
Q

How do you diagnose Arteritic ischaemic optic neuropathy?

A

Raised ESR and CRP

FBC: raise in platelets

temporal artery biopsy

90
Q

How do you manage Arteritic ischaemic optic neuropathy?

A

Other eye is at risk so give high dose of oral steroids e.g. prednisolone

also give PPI with low dose aspirin

91
Q

what is the cause of Non arteritic ischaemic optic neuropathy?

A

Associations

Hypertension

hyperlipidaemia

smoking

DM

92
Q

What are the signs and symptoms of NAION?

A

same as GCA temporal arteritis

93
Q

How do you manage NAION?

A

Management of CVS risk factors

94
Q

What is a vitreous haemorrhage?

A

Vitreous haemorrhage is the extravasation, or leakage, of blood into the areas in and around the vitreous cavity

95
Q

what are the causes of vitreous haemorrhage?

A

Bleeding from abnormal vessels: diabetic retinopathy, RVO (neovascularisation - weak vessels which grow in response to ischaemia)

Bleeding from normal retinal vessels: bridging a retinal tear

retinal detachment

trauma

96
Q

What are the signs and symptoms of vitreous haemorrhage?

A

Symptoms:

sudden loss of vision - if really big

floaters (patient describe dark dots)

signs:

loss of red reflex - if really big

97
Q

How do you diagnose vitreous haemorrhage?

A

test Visual acuity

test pupil reactions

fundoscopy helps see haemorrhage

ophthalmoscope to test for red reflex

98
Q

How do you manage vitreous haemorrhage?

A

1.urgent vitrectomy
Remove vitreous haemorrhage, if the haemorrhage prevents visualisation of the retina

2.Intravitreal anti-VEGF agents
These agents (eg, bevacizumab) are used to cause regression of neovascularisation in proliferative retinopathies
99
Q

what is retinal detachment ?

A

the separation of sensory retina from retinal pigment epithelium by subretinal fluid (SRF)

100
Q

what two types of retinal detachment are there?

A

Rhegmatogenous - caused by a retinal break

Non rhegmatogenous- no retinal tear. caused by:

traction : Vitreous membranes pull on the retina which separates it from the epithelial layer beneath. There are no tears or holes formed. This is more common in patients with diabetic retinopathy.

or

exudate: an underlying retinal disease leads to the build-up of exudative fluid underneath the retina (e.g. exudative tumours, inflammation and posterior scleritis).

101
Q

what is the pathogenesis of rhegmatogenous RD?

A

Two components required for retinal break formation:

  1. Acute Posterior vitreous detachment
  2. predisposing peripheral retinal degeneration
102
Q

what is the pathogenesis for exudative RD?

A
  1. damage to RPE by subretinal disease

2. Passage of fluid derived from choroid into subretinal space

103
Q

What are the causes of Exudative RD?

A
  1. choroidal tumours
  2. Intraocular inflammation
  3. systemic
  4. Iatrogenic
  5. Miscellaneous
104
Q

what are the signs and symptoms of retinal displacement?

A

symptoms:

painless loss of vision

sudden onset of flashes/floaters

signs:

may have RAPD

may have detached grey wrinkled retina

may have visible tear

signs of exudative RD:

convex smooth elevation

may be very mobile and deep with shifting fluid

subretinal pigment after flattening

105
Q

how do you manage retinal displacement?

A

Preventative management

laser photocoagulation

Surgical management

Vitrectomy

most common treatment of RD. The vitreous and the subretinal fluid are drained, which allows the retina to lie flat against the underlying epithelium.

Pneumatic retinopexy:

An expansile gas is injected into the vitreous which flattens and pushes the retina back onto the underlying epithelium.

Scleral buckle - less common

Cryotherapy or laser photocoagulation is used to create a scar around the retinal break.

106
Q

What is optic neuritis?

A

inflammation of the optic disc

107
Q

what are the signs and symptoms of optic neuritis?

A

unilateral loss of vision occurs over hours or days with pain which is typically worse on eye movement

Reduced colour vision - especially red desaturation

RAPD

108
Q

what are the causes of optic neuritis?

A

MS (Main)- 30% of patients with MS have neuritis as there initial presentation

infection (e.g. a tooth abscess in the upper jaw, syphilis, Lyme disease, herpes zoster)

methanol poisoning, Vitamin B12 deficiency, beriberi, dysautonomia

109
Q

how do you diagnose optic neuritis?

A

Fundoscopy is often normal but the disc may appear pale or swollen.

110
Q

how do you manage Optic neuritis?

A

investigate for MS

vision usually resolves itself but rarely complete

high does of oral steroids may hasten recovery e.g. methylprednisolone then prednisolone

111
Q

what is age related macular degeneration (AMD)?

A

the commonest cause of blindness in the UK

degeneration of the macular - pretty fucking simple

112
Q

what are the risk factors for AMD?

A

Age

family history
smoking

hypertension

raise in BMI

diet low in omega 3 & 6

113
Q

what are the two main types of AMD?

A

Wet - sudden visual loss

Dry - gradual visual loss

114
Q

what is dry AMD?

A

gradual deterioration in central vision, usually over decades

it causes 90% of the cases for AMD

115
Q

what is the clinical presentation of Dry AMD?

A

symptoms:

gradual decline in vision

central vision loss

signs:

Drusen - build up of waste products below RPE

Atrophic patches of retina

116
Q

how do you diagnose dry AMD?

A

usually through clinical diagnosis

and

Ocular coherence tomography

“ask do window and door frames look straight?” - if distorted then refer

117
Q

How do you manage dry AMD?

A

No cure

supportive management:

magnifiers

social support (e.g. guide dogs)

118
Q

What is wet AMD?

A

new blood vessels grow under retina (neovascularisation) - leakage causes build up of fluid/blood and eventually scarring

119
Q

what are the signs and symptoms of wet AMD?

A

symptoms:

sudden loss of central vision

distortion (metamorphopsia)

signs:

haemorrhage/exudate

120
Q

how do you diagnose Wet AMD?

A

normally through clinical diagnosis

ophthalmoscopy shows fluid exudation localised detachment of the pigment and sometimes haemorrhage

121
Q

how do you manage Wet AMD?

A

urgent fluorescein angiogram is performed to determine the type of new vessels alongside OCT which examines extent of intraretinal and subretinal fluid

anti VEGF therapy - decreases formation of new blood vessels and vascular leaks. this increases visual acuity

122
Q

what are the five main ocular motility defects?

A

IIIrd nerve palsy

IVth nerve palsy

VIth nerve palsy

Inter-nuclear ophthalmoplegia

Supra-nuclear ophthalmoplegia

123
Q

what are the causes of VIth nerve palsy?

A

Raised Intracranial pressure

microvascular

tumour

congenital

124
Q

What is the clinical presentation of VIth nerve palsy?

A

medial deviation of eye with:

Failure in abduction of the eye - palsy effects lateral rectus muscle

horizontal double vision

125
Q

what are the causes of IVth nerve palsy?

A

congenital decompensated

microvascular

tumour

bilateral IVth nerve palsy due to closed head trauma

126
Q

what are the clinical presentations of IVth nerve palsy?

A
  1. Eyes look up and in
  2. superior oblique muscle is effected leads to:

intorsion

depression in adduction

abduction is also weak

head tilt in left IVth nerve palsy - incyclo torsion weak

  1. bilateral IVth palsy

torsion

chin depressed

127
Q

what are the causes of third nerve palsy?

A

Microvascular

tumour

aneurysm - causes really painful third nerve palsy

MS

congenital

128
Q

What is the clinical presentation of third nerve palsy?

A
  1. ocular position is down and out with:

ptosis

may have blown pupil

2.the following muscles are affected:

Medial rectus muscle

inferior rectus

superior rectus

inferior oblique

sphincter pupillae

Levator palpebrae superioris

129
Q

what is inter-nuclear ophthalmoplegia?

A

where the eyes fail to move together due to failure of the medial longitudinal fasiculus

130
Q

what are the causes of inter-nuclear ophthalomoplegia?

A

MS (main cause)

vascular

131
Q

what is the clinical presentation of inter-nuclear ophthalmoplegia?

A

when looking towards the unaffected side:

the affected eye fails to adduct

unaffected eye abducts but with nystagmus

132
Q

what can effect the optic nerve?

ii. what defect does this cause?

A

optic neuritis

ii. loss of whole visual fields

133
Q

what can effect the optic chiasm?

ii. what defect does this cause?

A
  1. craniopharyngioma
    pituitary tumours
    meningioma

ii. Bitemporal hemianopia - vertically abiding, bilateral loss of peripheral field without macular sparing

134
Q

what can effect the optic radiation?

ii. what defect does this cause?

A
  1. Stroke
    Demyelination
    Tumours

ii. Incongruent quadrangular hemianopia without macular sparing

the same as for the optic tracts but just one quarter involved

135
Q

what can effect the optic tract?

ii. what defect does this cause?

A

Stroke
demyelination
tumours

ii. incongruent homonymous hemianopia without macular sparing. vertically abiding - nasal field defect

136
Q

what can effect the occipital lobe?

ii. what defect does this cause?

A

stroke
demyelination

ii. congruent homonymous hemianopia with macular sparing

vertically abiding. same side of visual fields affected in both eyes

137
Q

what is papilloedema?

A

bilateral optic disc swelling secondary to raised intracranial pressure (ICP)

138
Q

what are the causes of papillooedema?

A

nausea/vomiting - related to rise in ICP

double vision to CN VI palsy

headaches worse in the morning and centred in the frontal region - aggravated by bending down or coughing

139
Q

how do you diagnose papilloedema?

A

1.imaging:

MRI is gold standard - CT is quicker though

  1. measure BP for hypertension
  2. Ophthalmoscopy - examination of optic discs;

part of the cranial nerve II examination which also examines:

  1. visual acuity
  2. pupil exam
  3. visual field assessment
  4. colour vision
140
Q

give examples of refractive error conditions?

A
  1. myopia - short sighted
  2. hypermetropia - long sighted
  3. astigmatism - irregular corneal curvature
  4. presbyopia - loss of accommodation with ageing
141
Q

what does metamorphopsia indicate?

A

macular disease

142
Q

what is holmes-adie pupil?

A

unilateral and then bilateral dilated pupil w/:

Slow and incomplete response to light.

Normal response to accommodation.

Positive pilocarpine test.

143
Q

give examples of drugs which dilute the eye.

A

Block parasympathetic: Cyclopentolate (long acting), Tropicamide (short acting), atropine.

Stimulate sympathetic: phenylephrine.

144
Q

give examples of drugs which constrict the eye.

A

Stimulate parasympathetic: Pilocarpine.

Block sympathetic: Timolol, brominidine

Opthalmology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions