Clinical Flashcards
1
Q
what investigation must always be carried out if there is a suspected intra-ocular foreign body?
A
X ray
2
Q
which is better for the eye- acid or alkali burn? (and explain)
A
acid burn because it coagulates causing little penetration
whereas alkali penetrates the intra-ocular structures
3
Q
what is the management of chemical injury?
A
immediate irrigate with minimum 2l of saline or until the pH is normal
4
Q
what are the 3 Cs of describing the optic disc?
A
Contour
Colour
Cup
5
Q
What is the colour of a healthy optic disc?
A
pinky orange with white centre
6
Q
where is the optic disc thickest?
A
Inferior then Superior then Nasal then Temporal (ISN'T rule)
7
Q
what happens to the cup when you have a swollen optic nerve?
A
the cup gets smaller
8
Q
what is optic disc drusen?
A
bits of calcium stuck to the nerve
9
Q
what can be seen when looking through an ophthalmoscope of a patient with optic disc drusen?
A
contour of optic disc is poorly defined
disc looks lumpy
10
Q
what may happen to the blind spot of a patient with optic disc drusen?
A
enlarged blind spot
11
Q
What tests allow you to examine the function of the optic nerve?
A
visual field test
tvisual acuity test
colour vision test
pupillary reflex
12
Q
which retina is responsible for the nasal field?
A
temporal retina
13
Q
which retina is responsible for the temporal field?
A
nasal retina
14
Q
where is the lesion causing a uniocular defect?
A
before the optic chiasm
15
Q
where is the lesion causing a homonomous hemianopia
A
after the optic chiasm
16
Q
where is the lesion causing a bitemporal hemianopia?
A
the optic chiasm
17
Q
what is quadrantanopia?
A
when a specific quadrant of the visual field of an eye is not seen
18
Q
compare homonomous hemianopia to bitemporal hemianopia?
A
in both half the visual field is lost
homonomous: the lost side is on the same side of both eyes
bitemporal: the lost side is on the temporal side of both eyes (opposite sides)
19
Q
what kind of molecular weight drugs are able to penetrate the cornea?
A
low molecular weight drugs
20
Q
compare the stroma and epithelium in terms of what drugs (lipid vs water soluble) can readily penetrate it?
A
lipid soluble drugs penetrate epithelium
water soluble drugs penetrate stroma
21
Q
what can ocular inflammation do to the hydrophobic nature of the endothelium?
A
makes it more hydrophilic
22
Q
compare prednisolone acetate and prednisolone phosphate in terms of penetration of uninflamed cornea?
A
prednisolone acetate has a much better penetration of the cornea
23
Q
when is prednisolone acetate generally used?
A
post operatively
24
Q
when is prednisolone phosphate generally used?
A
cornea disease
when low dose steroids are required
25
why is benzalkonium added to some topical drugs?
as a preservative, also aids penetration by disrupting lipid layer of tear film
26
what antibiotic is mainly used for the treatment of infections within the eye?
chloramphenicol
27
what are topical steroids used in?
post op cataracts
uveitis
to prevent corneal graft injection
28
what is anterior uveitis?
inflammation of the iris
29
why might uveitis cause a pain when the eye is hit by light?
the muscles of the iris are inflamed so constricting is painful
30
what type of steroid is uveitis treated with?
prednisolone acetate
31
what are the 3 main local side effects of topical steroids?
- can induce cataracts
- glaucoma
- exacerbation of viral infection
32
what is glaucoma?
a group of diseases characterised by a progressive optic neuropathy resulting in characteristic field defects
33
with glaucoma, what part of the visual field is always preserved?
central part
34
what is the main treatment of glaucoma?
lantanoprost drops
35
how are antibiotics delivered in endophthalmitis?
intravitreal injections
36
what is anti-VEGF for?
anti- vascular endothelial growth factor
| prevents the growing of new blood vessels
37
how is anti-VEGF administed?
intravitreal injection
38
how are intra-ocular injections administered?
intravitreal injection
39
what are the 4 main uses for local anaesthetic drops?
foreign body removal
tonometry
corneal scraping
comfort
40
what is tonometry?
intra-ocular pressure measurement
41
what are the 4 main functions of fluorescein?
- shows corneal abrasion
- tonometry
- diagnostic nasolacrimal duct obstruction
- angiography
42
what is a rare but serious side effect of mydriatics?
acute angle closure glaucoma
43
how will you detect if someone has AACG after a mydriatic drop?
they will have a bad headache after
44
how do mydriatics work?
blocks parasympathetic supply to iris and causes pupil dilation
45
how do sympathomimetics work?
act on sympathetic system to cause pupil dilation
46
why do mydriatics cause visual blurring but sympathomimetics dont?
mydriatics affect the ciliary muscle
47
what epilepsy medication can constrict visual fields?
vigabatrin
48
what TB medication can cause optic neuropathy?
Ethambutol
49
what rheumatology drug can cause maculopathy in the long term?
hydroxychloroquine
50
what drug causes corneal verticillata?
amiodarone
51
what are the 3 key features of neuro-ophthalmic disease?
double vision
loss of visual acuity
visual field loss
52
what is the main cause of neuro-ophthalmic disease?
vascular disease
53
what happens in CN VI nerve palsy?
loss of abduction
54
what are the 3 main causes of CN VI nerve palsy?
microvascular event
raised intracranial pressure
tumour
55
why can raised intracranial pressure cause CN VI palsy?
squashes CN VI against the petrous part of the temporal bone
56
the majority of IV nerve palsy is caused by what?
congenital causes
57
what are the 3 main causes of unilateral CN IV palsy?
congenital
microvascular events
tumour
58
what is the main cause of bilateral CN IV palsy?
blunt head trauma
59
what is the ocular position in a CN III nerve palsy?
down and out
60
what are the 3 signs within the eye which show CN III nerve palsy?
down and out position
ptosis
dilated pupil
61
what are the 3 main causes of CN III nerve palsy?
microvascular
tumour
aneurysm
62
how do you differentiate between CN III palsy caused by microvascular event and a CN III palsy caused by aneurysm?
aneurysm is sore and causes dilated pupil
microvascular event, not painful, normal pupil
63
why does a microvascular event cause CN III nerve palsy without a dilated pupil?
parasympathetics are superficial in the nerve and aren't involved in a microvascular event
64
what is inter-nuclear ophthalmoplegia?
disorder of conjugate lateral gaze causing diplopia
65
what is the most common cause of inter-nuclear ophthalmoplegia?
MS
66
what cranial nerves are involved in inter-nuclear ophthalmoplegia?
CN III and CN VI
67
a problem in what area of the brain causes inter-nuclear ophthalmoplegia?
medial longitudinal fasciculus
68
how does MS cause inter-nuclear ophthalmoplegia or a visual field defect?
through demyelination
69
explain progression of optic neuritis?
J shaped curve
| gets worse then gradually gets better
70
what are the 5 key features of optic neuritis?
```
unilateral
progressive vision loss
pain behind eye (esp on movement)
colour desaturation
central scotoma
```
71
what is a scotoma?
gap in visual field
72
what are the main pathologies of the optic tracts and radiaitons?
tumours
demyelination
vascular anomalies
73
is the macula spared in pathologies of the optic tracts and radiations?
no
74
what does it mean to be 'cortically blind'?
eyes and nerves are normal but you still have areas of visual field loss due to pathology in occipital cortex
75
is the macula spared in pathologies of the occipital cortex?
yes
76
what neuro-ophthalmological pathology should you suspect in a young child with a head tilt and double vision?
congenital 4th nerve palsy
77
which artery supplies the inner 2/3 of the retina? (including ganglion cells)
central retinal artery of the ophthalmic artery
78
which artery supplies the outer 1/3 of the retina? (including photo receptive layer)
posterior ciliary artery of the ophthalmic artery
79
which artery supplies the head of the optic nerve?
posterior ciliary artery of the ophthalmic artery
80
is central retinal artery occlusion sudden or gradual vision loss?
sudden
81
is the vision loss with central retinal artery occlusion painful?
no
82
is the vision loss with central retinal artery occlusion profound or mild?
profound
83
why on fundoscopy might you see a small island of normal retina in central retinal artery occlusion?
small area supplied by a different artery
84
describe the optic disc of a patient with central retinal artery occlusion?
pale
| oedematous
85
what are the 2 possible causes of central retinal artery occlusion?
carotid artery disease
| embolism from heart
86
what is the management of central retinal artery occlusion if presented within 24 hours? and why?
ocular massage
| to try convert central retinal artery occlusion to branch artery occlusion
87
what is the name of a transient central retinal artery occlusion?
amaurosis fugax
88
what type of transient visual loss is usually followed by a headache?
migraine
89
how long does amaurosis fugax last?
5-10 minutes
90
what is an ocular cause of central retinal vein occlusion? (ie a cause out with CVD)
raised intraocular pressure causing venous stasis
91
does central retinal vein occlusion cause sudden or gradual vision loss?
sudden
92
does central retinal vein occlusion cause mild or profound vision loss?
moderate to severe
93
what are the 4 main signs of central retinal vein occlusion on fundoscopy?
retinal haemorrhages
dilated tortuous veins
optic disc swelling
macular swelling
94
apart from treating underlying cause of central retinal venous occlusion, what other treatment can be given?
anti VGEF intravitreal injections
95
what is the other name for occlusion of optic nerve head circulation?
ischaemic optic neuropathy
96
which arteries are occluded in ischaemic optic neuropathy?
posterior ciliary arteries
97
in ischaemic optic neuropathy why might the patient have profound visual loss yet will not go completely blind?
posterior ciliary arteries are not end arteries so there is still some other supply
98
what are the 2 types of ischaemic optic neuropathy?
arteriric
| non-arteritic
99
what causes arteritic ischaemic optic neuropathy?
temporal arteritis
100
what causes non-arteritis ischaemic optic neuropathy?
atherosclerosis
101
what does the disc look like in ischaemic optic neuropathy?
pale and swollen
102
does ischaemic optic neuropathy cause sudden or gradual visual loss?
sudden
103
what is bleeding from abnormal retinal vessels associated with?
retinal ischaemia and subsequent new vessel formation
104
what is bleeding from normal retinal vessels associated with
retinal tear
105
what are the 2 key features of viteous haemorrhage?
sudden loss of vision
| floaters
106
what are the main signs of viterous haemorrhage on fundoscopy?
loss of red reflex
| floaters
107
what is the management of viterous haemorrhage?
should resolve itself
| vitrectomy for non-resolving cases
108
what are the 3 signs of central retinal artery occlusion?
relative afferent pupil defect
pale, oedematous retina
thread like retinal vessels
109
what are the 3 main symptoms of retinal detachment?
sudden loss of vision
painless
sudden onset of flashes/floaters
110
what are the 2 signs of retinal detachment?
may have relative afferent pupil defect
| may see tear on ophthalomoscopy
111
what is the management of retinal detachment?
surgical
112
what are the black specks seen in retinal detachment?
floating bits of retina
113
what causes flashes in retinal detachment?
the vitreous fluid pulling on the retina causes flashes
114
what are the 2 types of age related macular degeneration?
dry
| wet
115
compare dry and wet ARMD in terms of time period of loss of vision?
dry: gradual
wet: sudden
116
what causes the visual loss in wet ARMD?
new abnormal blood vessels growing under the retina leak fluid and blood which eventually causes scarring
117
what are the 3 main symptoms of wet ARMD?
rapid visual loss
central visual loss
metamorphopsia
118
what are the signs of wet ARMD on fundoscopy?
haemorrhage/exudate
119
what is the treatment of wet ARMD?
anti VEGF intravitreal injections
120
what are the causes of gradual visual loss?
```
Catartact
ARMD (dry)
Refractive error
Diabetic retinopathy
Inherited disease
Glaucoma
```
121
why must you check red reflex in neonates?
to check for congenital cataracts
122
what is the management of symptomatic cataracts?
surgical removal with intraocular lens implant
123
what are the 2 signs of dry ARMD on fundoscopy?
drusen
| atrophic patches of retina
124
what causes the central vision loss in dry ARMD?
the drusen builds up and causes retina to become atrophic and therefore doesn't function properly
125
what causes closed-angle glaucoma?
when aqueous humour builds behind the iris and pushes it forwards causing the angle between the iris and the cornea to close
126
compare presentation of closed and open angle glaucoma?
closed: often acute presentation with painful, red eye with vision loss and associated symptoms
open: often no symptoms
127
what is a laser iridotomy?
a procedure done to lower the introcular pressure by allowing fluid to pass through a hole in the iris preventing the angle from closing
128
until proven otherwise, all patients with bilateral optic disc swelling should be suspected of having what?
raised ICP due to a space occupying lesion
129
why is raised ICP a medical emergency?
with raised ICP the brain is squeezed through the foramen magnum, this compresses the brainstem causing the patient to stop breathing and die
130
why must you always check BP of a patient with bilateral optic disc swelling?
to rule out malignant hypertension
131
what 2 mechanisms can cause idiopathic intracranial hypertension?
obstructed CSF circulation
| impaired CSF absorption
132
what are the 9 main causes of an acute red eye?
```
conjunctivitis
blepharitis
anterior uveitis
scleritits
episcleritis
keratitis
acute angle closure glaucoma
subconjunctival haemorrhage
orbital disease (cellulitis)
```
133
how do subconjunctival haemorrhages usually present?
very red eye
| no pain
134
what are the 2 types of eye pain felt?
foreign body sensation
| aching pain
135
compare the indications of foreign body sensation to aching pain?
ache: intraocular infection
| foreign body sensation: ocular surface is irriated
136
what does an itchy eye suggest?
allergic reaction
137
compare mucopurulent,stringy mucoid and watery discharge in terms of cause?
mucopurulent: bacterial infection
stringy mucoid: allergic
watery: viral infection
138
what keratitis causing parasite are contact lens wheres more likely to get?
acantomoeba
139
in what ocular infection/inflammation is there likely to be redness maximal in the limbus?
```
intraocular inflammation (eg anterior uveitis)
keratitis
```
140
in what ocular infection/inflammation is there likely to be redness maximal in the fornices?
conjunctivitis
141
when palpating an eye with glaucoma, what is the clinical sign?
stony hard on palpation
142
compare anterior and posterior blepharitis in terms of what anatomy is affected?
anterior blepharitis- eye lashes affected
| posterior blepharitis- meibomian glands affected
143
what are the 2 types of anterior blephartiis?
seborrhoeic (squamous)
| staphylococcal
144
what is seborrhoeic (squamous) anterior blepharitis?
scales on the lashes
145
what is staphylococcal anterior blepharitis?
infection involving the lash follicle
146
what is posteiror blepharitis?
meibomian gland dysfunction
147
compare the location of redness in anterior and posterior blepharitis?
anterior: lid margin redder than deeper part of lid
posterior? deeper part of lid redder than margin (often looks quite normal)
148
what is a stye?
acute purulent infection of eyelash follicle (anterior blepharitis)
149
what is a tee pee sign and where is it seen?
lashes stuck together due to oil and sebaceous matter
| seen in seborrheic anterior blepharitis
150
what is the function of the fluid meibomian glands produce?
float on tear film preventing evaporation
151
what happens when the meibomian glands get blocked?
they become meibomian cysts
152
what is 50% of posteiror blepharitis associated with?
acne rosacea
153
what are the 3 infective causes of conjunctivitis?
bacterial
viral
chlamydial
154
what are the 3 non-infective causes of conjunctivitis?
allergic
chemical/drugs
skin diseased eg eczema
155
compare papillae and follicles of conjunctivitis?
bacterial cause: papillae- smaller bumps with a central red dot (blood vessel)
viral/chlamydial: follicle- bigger bump with red around the periphary
156
what type of conjunctivitis is itchy?
allergic conjunctivitis
157
in viral conjunctivitis, which lymph nodes become palpable?
pre-auricular
158
what are the most common causative bacterial organisms of conjunctivitis?
staph aureus
strep pneumoniae
haemophilus influenzae
159
what are the most common causative viral organisms of conjunctivitis?
adenovirus
HSV
herpes zoster
160
what is chemosis?
conjunctival oedema (like a blister)
161
how long must conjunctivitis last to be called chronic?
4 weeks
162
what are the layers of the cornea?
epithelium
stroma
endothelium
163
compare infective and autoimmune corneal ulcers in terms of location of ulver?
infective: central corneal ulcers
autoimmune: peripheral corneal ulcers (towards limbus)
164
what type of patients tend to get corneal ulcers caused by acanthamoeba?
young, contact lens wearers
165
what are the 4 main symptoms of a corneal ulcer?
pain
photophobia
profuse lacrimation
sometimes reduced vision
166
what are the 5 main signs of corneal ulcer?
```
red eye
abnormal corneal reflex
corneal opacity
staining with fluorescein
hypopyon
```
167
why can a corneal ulcer lead to permanent vision loss?
healing occurs by collagen laying down in a haphazard fashion
168
what are the 4 groups of patients at risk of corneal ulcers?
exposure keratitis
keratoconjunctivitis sicca
neutrophic keratitis
vit A deficiency
169
how do you acquire a sample of a corneal ulcer for gram stain and culture?
corneal scraping
170
what is the treatment of a herpetic corneal ulcer?
aciclovir ointment 5x per day
171
what is the treatment of an autoimmune corneal ulcer
oral/topical steroids
172
what are the 4 most common autoimmune causes of anterior uveitis?
reiters syndrome
ulcerative colitis
ankylosing spondylitis
sarcoidosis
173
what malignancy is known to cause anterior uveitis?
leukemia
174
what is a synechiae?
small or irregular pupil
175
what are the 3 main symptoms of anterior uveitis?
pain (could also be referred)
photophobia
sometimes reduced vision
176
where is the redness in anterior uveitis?
circumcorneal
| ie around the limbus
177
what are the 5 signs of anterior uveitis?
```
ciliary injection
cells and flare in anterior chamber
keratic precipitates
hypopyon
synechiae
```
178
what is the treatment of anterior uveitis?
topical steroids
| mydriatics
179
what is the purpose of mydriatics within the treatment of anterior uveitis?
dilate pupil to stop iris getting stuck down
180
in cases of recurrent or chronic anterior uveitis what should you do?
investigate for systemic associations
| eg reiters, ank spond, sarcoidosis, UC
181
what condition is associated with episcleritis?
gout
182
what is the treatment of episcleritis?
self limiting
| may need lubricants and topical nsaids/mild steroids
183
how can you tell between episcleritis and scleritis?
scleritis is very painful
use vasoconstrictor drops
if blood vessels blanche: episcleritis
if blood vessels don't blanche: scleritis
184
inflammation of what part of the eye is associated with serious systemic vaculitides? (eg RA, wegners)
scleritis
185
what is the treatment of scleritis?
oral NSAIDS
oral steroids
if long term- steroid sparing agents
186
does myopia or hypermetropia predispose to acute closed angle glaucoma?
hypermetropia
187
does myopia or hypermetropia predispose to retinal dettachment?
myopia
188
where are the injected blood vessels seenin acute closed angle glaucoma?
circumcorneal
| round limbus
189
what happens to the cornea in acute closed angle glaucoma?
becomes cloudy due to oedema
190
what happens to the pupil in acute closed angle glaucoma?
mid dilated
191
laser therapy causes the retina to turn what colour?
white
192
what is rubeosis iridis?
blood vessel growth on iris
193
what is rubeosis iridis a sign of?
severe ischaemia
194
how will papilloedema affect vision?
enlarged blind spot but wont reduce visual acuity
195
why is a cherry red spot seen in central artery occlusion?
retinal nerve fibre layer becomes swollen everywhere except fovea (stays red)
196
what is symblepharon?
palpebral conjunctiva gets stuck to bublar conjunctiva, causing turning in of eyelid
197
what type of conjunctivitis commonly causes symblpharon?
chlamydial conjunctivitis
198
in a red eye, if the pupil is larger in that eye what should you suspect?
glaucoma
199
in a red eye, if there is photophobia, what should you suspect?
iritis
200
in a red eye, if the cornea stains with fluorescein, what should you suspect?
keratitis
201
what does trichiasis mean?
lashes touch eyeball
202
if the red eye is bilateral what are the 2 main causes?
conjunctivitis
| dry eyes
