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Ophthalmology > Clinical features > Flashcards

Clinical features Flashcards

1
Q

Red Eye DDx

A

subconjunctival hge: posterior edge
retrobulbar hge: proptosis, restricted movement
episcleritis: mild pain, normal vision
scleritis: more painful
Phlyctenule: nodule
Conjunctivitis: sore, swelling, d/c
Keratitis: rapid LoV, ‘FB’, pain, circumcorneal, hypopyon, constriction
iridocyclitis: blurry, circumcorneal, cells/flare, constriction
PACG: sudden severe loss, pain, fixed dilated, hazy, circumcorneal
dendrictic ulcer
eye sepsis: contact lenses, circumcorneal, gritty pain

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2
Q

Gradual Loss of Vision DDx

A

cataracts: cloudy
glaucoma: cupping
corneal dystrophy/ectasia (thinning/keratoconus)
macula: AMD, dystrophy, CSMO
optic disc: compression, toxins
retinitis pigmentosa: spicules

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3
Q

Acute Painless Loss of Vision DDx

A

monocular:

  • corneal disease: painful, cloudy
  • anterior chamber (hyphaemia)
  • vitreous hge
  • AION: pale disc
  • retinal: a/v occlusion, detachment, macula hge

binocular

  • optic chiasm: pituitary
  • optic nerve: infiltration, papilloedema, neuritis
  • cortical: CVA, migraine
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4
Q

Diabetic Retinopathy

A

NPDR:

  • microaneurysms
  • exudates
  • hge/CWS
  • dilatation, beading, and IRMA

PDR:

  • NVD or NVE
  • tufts and ramifications
  • pre-retinal/vitreous hge; detachment (traction)

maculopathy:

  • focal: local thickening, ma/dilated, exudate
  • diffuse: diffuse oedema, no exudate
  • ischaemic: oedema, dark hge; angiography
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5
Q

Visual Field Defects

A

whole eye: neuritis/AION, glaucoma, optic atrophy, papilloedema, detachment, CRVO, hge
bitemp hemi: chiasm - aneurysm/tumour
homo hemi: strokes; optic tract/cortex
scotoma: glaucoma, AMD, neuritis, papilloedema, atrophy
peripheral: glaucoma, RP, hysteria
altitudinal: BRVO/BRAO, AION

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6
Q

Dilated Pupil

A

Holmes-Adie: reflexes; viral; vermiform; LND
CN III palsy: ptosis, ‘down and out’; med/surg
Drugs/poisons: atropine, CO, antifreeze, tropicomide
trauma

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7
Q

Constricted Pupil

A

Horner’s: SANS
Argyll Robertson: syphilis
Drugs/poisons: opiates, organophosphates, pilocarpine

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8
Q

CN Palsies

0 = full movement; 1 = 75% movement; 2 = 50%; 3 = 25%; 4 = no movement

A

III: down-and-out ptosis (hypoesotropia), near/reading worse; tumour, aneurysm, trauma, inflammation (BM/HTN)

IV: sits higher (hypertropia + excyclotorsion); head tilt/vertical diplopia, near worse; trauma, vascular (DM/HTN/CVA); congenital

VI: esotropia; distance worse; horizontal gaze defect/diplopia; tumour, ICP/IOP, MG/MS, vascular

VII: open eye, facial mm

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9
Q

Cataract Types

A

cortical: radial spokes; worse dark;
nuclear: central; yellow; myopia, distance worse
post. subcap: near worse reading/glare/central

age-related and congenital
DM: snowflake, osmotic hydration
Trauma: rosette
atopic dermatitis: stellate
other: infection, toxins, systemic disease
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10
Q

Glaucoma Types

A

POAG: cupping, atrophy, blurry’ VF (tunnel) aSx

PACG: pain, N&V, blurry vision; fixed mid-dilated pupil, cloudy, red eye; acute LoV, cupping, atrophy

Rubeotic: CRVO/DR; rare; neovasc

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11
Q

Trauma Types

A 
foreign body: photophobia, irritation
chemical: clouding
blunt: hyphaema, subconj hge, haematoma
blow-out fracture
penetrating
corneal laceration
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12
Q

Optic Disc Swelling DDx

A

papilloedema: bilateral, blurry, hge/exudate/cws
neuritis: blurry, normal colour, move pain, red desat, (R)APD; 45-80% MS
malignant HTN: silver wiring, nipping, hge, exudate
AAION: Sx, pale, blurred, n/large cup
NAION: hyperaemia, small cup
atrophy: pale, flat, sharp, loss of BV, RAPD
diabetic papillopathy: progressive VFD, colour vision, ?RAPD, uni or bilateral

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13
Q

Optic Disc Atrophy DDx

pale disc + APD + LOV

A

blood supply: ischaemia, AION

compression: tumours, glaucoma

neuritis

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14
Q

AMD

A

dry (atrophic)

  • atrophy: receptor death
  • drusen (Bruch’s membrane)

wet (neovascular):

  • fragile BV leak/scar
  • distortion (grid lines)
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15
Q

Correcting Refraction/Squint

A

hypermetropic (distance; short/weak): convergent (positive) lenses

myopic (near; long/strong): divergent (negative) lenses

squint:

  • glasses: refraction + align
  • cataract removal
  • occlusion: patch/atropine; 6h/d for 10/52
  • surgery: functional/cosmetic
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16
Q

Orbital Diseases

more detail needed on some

A

thyroid eye disease: Sx
orbital cellulitis: systemic
Idopathic orbital inflammatory disease (IOID): chemosis, plegia, pain
vascular: varicies, fistula; proptosis, bruit
capillary/cavernous haemangioma: cough/strain
lacrimal gland tumours: painless/slow vs. painful/fast
glioma: young girls, NF1, GLoV
meningioma: middle-age F, GLoV

17
Q

Thyroid Eye Disease

A 
eyelid lag/retraction, exposure keratopathy
periorbital oedema, exophthalmos
compressed optic nerve/neuropathy
restrictive myopathy and diplopia
Rx: radiation/drugs for thyroid
18
Q

Orbital Cellulitis

A

acute; sight and life-threat - abscess, meno, CS thrombosis
infection behind septum
malaise, fever, orbital signs (plegia, soft tissue, vision, pain, en/exophth)
Rx: Ax, ABx, ?surgery

19
Q

IOID

A

pseudotumour: non-neo, non-infectious; 20s-50s
Dx of exclusion
unilateral, proptosis, chemosis, oedema, plegia, acute, pain
Rx: anti-inflamm (NSAIDs, steroids, cytotoxic)

20
Q

Conjunctivitis

revise viral/bact/allergic

A

gritty pain: follicules (viral), papillae/cobbles (allergic)
watery/mucopus d/c, diffuse redness
Rx: lubrication, hygiene, cold compress, ?chloramphenicol

21
Q

Uveitis

A

achy, photophobia, diffuse and circumcorneal redness
mid-constricted (oval) pupil, posterior synichae
cells and flare (WCC)
inflammatory causes (IBD, sarcoid, Reiter’s, arthropathy)
Rx: eye casualty; dilate, steroids

22
Q

red eye - Haemorrhages

A

subconjunctival: aSx, sectoral, posterior margin
- BP spike, rubbing, post-op
- Rx: reassurance, ?#, ?BP

retrobulbar: homogenous red, no edge, plegia, IOP, proptosis
- iatrogenic, trauma
- Rx: referral (risk of nerve compression)

23
Q

Artery Occlusion

A

branch: sectoral/central; RAPD, bruit, VFD, emboli, nipping, flame hge
- BP, carotid doppler, blood, echo
- Rx: casualty referral

central: total light blindness, ‘shutter’; ADP/RAPD; oedema, cherry red spot, emboli, bruit
- temporary loss Hx, dopplers, BP, ESR, echo
- Rx: CO2, massage, acetazolamide + paracentesis, casualty ref

24
Q

Vein Occlusion

‘on waking’

A

branch: central blur, on waking; sectoral hge and CWS
- BP, ESR, FBC, BM
- Rx: collaterals = recovery

central: global defect on waking; may have RAPD; flame hge, CWS, oedema, disc swelling, neovasc
- BP, blood, IOP; 30% ischaemic - angiogram
- Rx: PRP (rubeosis risk)

25
Q

Retinal detachment

A

floaters, flashes, VF loss; ?RAPD, red reflex lost

tractional: PDR
Rhegmatous: tear
Exudative: uveitis, tumours

Rx: laser pexy, vitrectomy, gas tamponade

26
Q

anterior ischaemic optic neuropathy (AION)

A

arteritic: temporal aa; jaw claudication, scalp pain; atrophy, swelling

non-artertitic: atheroma/occlusion and ischaemia

27
Q

Vitreous Haemorrhage

A

PDR/neovasc common;
retinal tears
posterior vitreous detachment
trauma

cloudy fundoscopy, no red reflex, floaters
B Scan USS

Rx spontaneous resorption vs. removal

28
Q

optic neuritis

A

45-80% MS
60% normal disc, 25% papillitis, 18% blurred/pale disc

unilateral visual loss, pain on movement, red desaturation, (r)APD

29
Q

systemic diseases

A

vasculitis:
- SLE: conjunctivitis, episcleritis
- Reiters: conjunctivitis and/or uveitis
- PAN: episcleritis
- RhA: scleritis
- ankylosing spondylitis: uveitis

metabolic
granuloma
vascular retinopathy: HTN, emboli, haemorrhage

30
Q

visual impairment causes

Aids: magnifiers, binocular, strong glasses, talking devices

A

kids: 5% of LVA patients are

31
Q

amblyopia causes

Rx: correct refraction, occlusion, surgery

A

stimulus deprivation: cataracts, tumour, ptosis, cornea etc.
strabismus (squint)
anisometropic: >1D difference in refraction; higher error eye suppressed

32
Q

CN Palsy DDx

A

neurogenic: trauma, tumour, microvasc
- microvasc most common; pupil spared; DM/HTN
- inflammatory, infection, demyelination (neuritis; CN VI)

mechanical restriction:
blow out fracture (floor): elevation and depression
thyroid eye disease: elevation worst

myogenic:
MG: intermittent, fatigue, LPS worst
tumour/inflammation/mm disease

Ophthalmology (14 decks)

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