Common Conditions of the Eye Flashcards
In which conditions can there be hypertrophy of orbital fat?
Thyroid diseases
Autoimmune diseases
What happens when the orbital fat hypertrophies?
Pushes eyeball out and gives a staring appearance
Proptosis?
Eyeball is protruding out of orbit more than normal
When you ask a patient to look up and out, which muscle is this testing?
Superior rectus
->these questions can help in OSCE stations
When you ask a patient to look outwards, which muscle is this testing?
Lateral rectus
When you ask a patient to look down and out, which muscle is this testing?
Inferior rectus
When you ask a patient to look down and in, which muscle is this testing?
Inferior oblique
When you ask a patient to look medially, which muscle is this testing?
Medial rectus
When you ask a patient to look up and in, which muscle is this testing?
Inferior oblique
You check the eye movements of a patient and soon see that their right eye does not move over the midline and only works medially.
Which muscle is likely affected and why?
Lateral rectus, sixth nerve palsy
If the LPS muscle is affected, it can cause dropping of the eyelid. Which type of nerve palsy would this be?
3rd nerve palsy
Which nerve do the efferent fibre of the pupillary reflex travel with?
Third nerve
Which long-term condition can increase risks of a third nerve palsy?
Diabetes
Which muscle is affected in a fourth nerve palsy?
Superior oblique
What are some common causes of absent pupillary reflexes?
Diseases of retina
Diseases of optic nerve
Disease of CN III
RECAP- which muscle of facial expression helps to close the eyes and what innervates it?
Orbicularis oculi
Innervated by CN VII (facial nerve).
Which nerve may be affected if there is ptosis (drooping of eyelid)?
Third nerve
Which nerve may be affected if a patient cannot properly close their eye?
CN VII
If you are unable to close your eye, it can cause drying of the cornea leading to what?
Exposure keratopathy
What is a collection of pus on or in the eyelid called?
Stye
->can be either external or internal
What is the treatment for an external/internal stye?
Warm compress, eyelid hygiene
What is the treatment for styes if they don’t resolve after warm compresses and eyelid hygeine?
Surgical incision and curettage
Which glands are blocked in someone with an external stye?
Sebaceous glands
Why would an external stye occur?
Due to infection of the hair follicle of the eyelash and sebaceous glands.
Why would an internal stye occur?
Due to blockage and infection of Meibomian glands
What is conjunctivitis?
Self limiting infection of conjunctiva.
What type of infection can cause conjunctivitis?
Usually bacterial or viral
What are the symptoms of conjunctivitis?
Red, watery eyes, discharge
When would there be loss of vision in a patient with conjunctivitis?
If infection spread to cornea
What is the treatment for conjunctivitis?
Antibiotic eyedrops if likely to be bacterial
Give an example of a virus which can cause conjunctivitis.
Adenovirus
What is the treatment for opacification of the cornea?
Corneal transplant- keratoplasty
What may cause corneal ulcers?
Viral/bacterial/fungal infection
Why do corneal ulcers need aggressive management?
To prevent spreading and scarring.
Also aggressive as avascular
What are some non-infectious causes of corneal ulcers?
Trauma
Corneal degenerations or dystrophy
Why do cateracts develop?
Damaged lens fibres become opaque and cause cataract
Why does a cataract form in the middle of the eye?
Old fibres get pushed into centre as newer fibres grow inwards
How does UV rays affect the lens?
sacrifice
Absorbs harmful rays to prevent them damaging retina but damages itself in the process
Do cataracts usually affect sight when the pupil is dilated or constrcited?
Dilated as prevents light getting into retina- often complaints of driving in dim light
Cataracts can develop as a complication from use of which drugs?
Steroid eye drops
What is the name of the condition in which only the nucleus of the cataract become opaque?
Nuclear sclerosis
Why may cataracts develop in childhood?
Periods of malnutrition in utero.
What is the treatment of cataracts?
Surgery
->eye drops do not treat cataracts!!!
Describe a cataract operation.
Day case- small incision made and the lens capsule opened.
Lens affected by cataracts removed by emulsification and replaced by a capsular bag
Checking you were reading- which process removes the cataracts lens?
Emulsification (phacoemulsification).
Which type of lens is implanted in cataract surgery?
Posterior Chamber Intra Ocular Lens
PCIOL
RECAP- where is aqueous humor produced?
Ciliary body
What is one of the most common causes of raised intra-ocular pressure?
Glaucoma
What is the most commonly seen form of primary glaucoma?
Primary Open Angle Glaucoma
(POAG)
Is glaucoma usually unilateral or bilateral?
Usually bilateral
What can raised intraocular pressure cause?
Pressure on nerve fibres on the surface of retina meaning they die out and cause visual field defects.
List the triad of signs for the diagnosis of glaucoma.
- Raised intra ocular pressure
- Visual filed defects
- Optic disc changes on ophthalmoscopy
What is the management for primary open angular glaucoma?
Eye drops to decrease IOP
Laser trabeculoplasty
Trabeculctomy surgery
Which types of drugs may be used in the form of eye drops to reduce IOP in those with POAG?
Prostaglandin analogues
Neta-blockers
Carbonic anhydrase inhibitors
Which part of the eye is not functioning in POAC?
Trabecular meshwork
Why does angle closure glaucoma occur?
Aqueous humor cannot reach trabecular meshwork as angle of the anterior chamber is blocked
What are some symptoms of angle closure glaucoma?
Sudden onset, painful, vision lost/blurred, headaches
->this can often be confused with migraines
What are the signs of angle closure glaucoma?
Red eye
Cornea often opaque
Why is the cornea often opaque in those with closed angle glaucoma?
Increased IOP which drives fluid into the cornea
How do you treat closed angle glaucoma?
Decrease IOP- primary treatment
Iridotomy (laser) to both eyes to bypass blockage- secondary treatment
List some ways to decrease IOP in those with closed angle glaucoma.
IV infusion +/- oral therapy
Analgesics, antimetrics
Constrictor eye drops
Beta-blocker drops
Steroid eye drops e.g. dexamethasone
TEST TIME!!!
Which is painful-
Primary Open Angle Glaucoma
Closed Angle Glaucoma
?
Closed Angle Glaucoma
TEST TIME!!!
Which condition is there an increased in IOP?
Primary Open Angle Glaucoma
Closed Angle Glaucoma
?
Both:)
What is the other name for the vascular coat of the eye?
Uvea
RECAP- what makes up the uvea of the eye?
Ciliary body, choroid, iris
Uveitis?
Inflammation of uvea
Which part of the uvea is inflamed in anterior uveitis?
Iris +/- ciliary body
Which part of the uvea is inflamed in intermediate uveitis?
Ciliary body
Which part of the uvea is inflamed in posterior uveitis?
Choroid
Give a non-infectious cause of uveitis.
Autoimmune causes e.g. presence of HLA-B27
Which type of uveitis does presence of HLA-B27 lead to?
Anterior uveitis
Give an example of an infectious cause of uveitis.
Chronic diseases like TB
Give an example of a systemic disease which is associated with uveitis.
Ankylosing spondylosis
