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Common diseases Flashcards

1
Q

List the aetiological causes of cataracts (7)

A 
Age related
Traumatic
Metabolic
Toxic
Secondary 
Maternal infection/drug ingestion
Hereditary
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2
Q

What are the 3 types of age-related cataracts?

What does each look like?

A

Subcapsular (ant/posterior*) → granular deposits
Nuclear sclerotic → opaque cloudiness
Cortical → radial spokes

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3
Q

What kinds of traumatic injuries can cause cataracts?

A 
Penetrating eye injury
Blunt injury
Glass blowers (infrared radiation)
Ionising radiation
Electric shock
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4
Q

What are the metabolic causes of cataracts (7)

A 
Diabetic (age related earlier + true diabetic (osmotic over hydration))
Galactosaemia
Mannodisosis
Hypocalcaemic syndromes
Fabry's
Wilson's
Lowe's
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5
Q

What are the toxic causes of cataracts? (3)

A

Corticosteroids
Chlorpromazine
Chemo

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6
Q

List some secondary causes of cataracts (4)

A

Anterior uveitis
Hereditary (retinitis pigmentosa, gyrate atrophy, stickler’s)
High myopia
Glaucomflecken

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7
Q

What maternal infections can cause neonatal cataracts?

A

Rubella (50%)
Toxoplasmosis
CMV

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8
Q

What maternal drug ingestion can cause neonatal cataracts? (2)

A

Corticosteroids

Thalidomide

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9
Q

What are some causes of presenile cataracts? (2) + 2 presentations/features of each

A

Myotonic dystrophy - cortical polyhchromatic, post subcapsular stellate
Atopic dermatitis - posterior stellate, dermatitis/no lashes

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10
Q

What are some syndromes associated with cataracts? (4)

A

Downs
Alports
Werner’s
Rothmund’s

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11
Q

What are the 3 classifications of cataracts?

A

Immature
Mature (lens totally opaque)
Hypermature (lens wrinkled)

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12
Q

What are the management options for cataracts? (2)

A 
Biometry
Surgical (phecoemulsification)
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13
Q

What other factors must be considered when deciding cataract management? (4)

What is NOT a contraindication for surgery
What is an indication/criteria for surgery

A

Effect on pt’s life (job, ADLs)
General health
Co-existing ocular pathology
Best visual acuity correction

Age not contraindication
Must be mature

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14
Q

What are some possible complications of cataract surgery? (4) + relative incidences

A 
Posterior capsule opacification (20%)
Vitreous loss (4%)
Retinal detachment (1%)
Endophthalmitis (0.1%)
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15
Q

What are the clinical features of acute bacterial endophthalmitis? (5)

What are the common pathogens

A 
Pain
Marked vision loss
Absent/poor red reflex
Corneal haze
Hypopyon/exudates

Staph epidermidis, s.Aureus, pseudomonas

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16
Q

What Ix can be done for cataracts? + why would Ix have to be done?

A

Ocular B scan (USS)

If suspect posterior pole pathology (but view obscured by dense cataract)

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17
Q

What happens in dry AMD? (physiology)

A 
Soft thickenings (Drusens) of Bruch's membrane
→ atrophy / death of photoreceptors (from RPE → inner choroid)
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18
Q

What happens in wet AMD

A 
Choroidal neovascularisation (inner choroid)
These vessels bleed/leak → scarring
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19
Q

What are some RFs for age-related macular degeneration? (5)

A 
Age
Smoking
CVD (hypertension/lipidaemia)
DM
Low anti-oxidants in blood
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20
Q

What age group does AMD affect?

How does it present?

A

> 50s

Blind spots in central vision + visual distortion

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21
Q

What are some of the social effects of AMD? (4)

A

High falls risk
Difficulty with ADLs
Distress/depression
High use of healthcare/community services

22
Q

How is AMD treated?

A 
No cure only low-vision aids
Wet AMD (CNV): 
Laser photocoag (not for foveal lesions) (prevent progression + leakage recurs in 50%)
Photodynamic therapy
Anti-VEGF
23
Q

Describe the basic pathophysiology behind diabetic retinopathy

And what happens specifically in proliferative?

A

Retinal vasculopathy of small vessels → leakage +/or closure and seqeulae (VEGF etc released)

Retinal ischaemia → new vessels on optic disc or retinal surface

24
Q

List the RFs for diabetic retinopathy (8)

A 
Duration of DM
Poor DM control
Age
Smoking
Hypertension
Hyperlipidaemia
Renal impairment
Pregnancy
25
What are the clinical manifestations of Non-Proliferative (Background retinopathy) (6)
``` Microaneurysms Retinal haemorrhages (dots/flames) Exudates Cotton wool spots Vascular dilations (beading) - severe Intra-retinal anastomoses - severe ```
26
What happens structurally regarding neovascularisation in PDR
Originate from veins Initially flat but raise into vitreous Fragile/bleed → Vitreous haemorrhage
27
What are some late changes of proliferative retinopathy? (3)
Retinal detachment / fibrosis Rubeosis iridis Neovascular glaucoma
28
What are the 3 subtypes of proliferative diabetic retinopathy? And what can be seen on fundoscopy in each?
Focal (retinal thickenings + exudates) Diffuse (oedema + haemorrhages but no exudates) Ischaemic (perifoveal capillary network closure → oedema + dark haemorrhages)
29
What can be used to Dx ischaemic retinopathy
Fluorescin angiography
30
What are some other effects of DM in the eye? (5)
``` Higher incidence of infections Delayed healing of infections + corneal abrasions/ulcers Higher incidence of cataracts More severe post-op ocular inflamm Cranial nerve palsies (3/4/6) ```
31
How is diabetic retinopathy managed?
Control diabetes + RFs PDR: laser photocoag (focals/ grid-diffuse / cannot use in ischaemic) Anti-VEGF
32
What are some of the modern treatments for age-related macular degeneration? (2) + what are their drawbacks
Anti-VEGF: neuroprotective + injections wear off 4-6wks + v expensive Long-acting steroids (triamcinolone): cause cataracts + raise IOP
33
What are the main factors affecting IOP ? Describe the pathology b/wn IOP and glaucoma
``` Aqeuous production (from ciliary body) Resistance of drainage (trab mesh) ``` Raised IOP ± vascular factors → optic disc cupping + death/atrophy of retinal nerve fibres
34
What are the 3 main symptoms of primary open angle glaucoma?
Usually asymp as chronic/slow-progressive Visual field defects Tunnel vision Blindness
35
What will be seen O/E in primary open angle glaucoma? (3) + what investigations can be done? (3)
IOP > 21 Optic disc atrophy (blurring of borders) Cup:disc ISNT thickness rule lost IOP (tonometer) Visual fields Fundoscopy
36
What are some RFs for Primary Open Angle Glaucoma (5)
``` Raised IOP FH** Black race Diabetes Myopia ```
37
Describe the pathophysiology behind primary angle closure glaucoma
Lens gradually grows with age → pushes iris closer to trabecular meshwork (+ cuts off at critical point)
38
What are some RFs for primary angle closure glaucoma?(3)
Narrow angle (smaller lens / shallow anterior chamber) i.e. smaller globes Hypermetropia (linked to above) FH
39
What are the symptoms / signs of acute angle closure glaucoma (6) In what time scale do symptoms present??
PAIN (eyes + headache) Blurred vision Red eye Vomiting (severe) Corneal oedema Fixed mid-dilated pupil Symps may be present for wks before attack (going to bed helps as pupil dilates + pulls away)
40
How is acute angle closure glaucoma managed? Urgent management (3) Long-term management
Urgent IV carbonic anhydrase inhibitor (acetazolamide) (Analgesia + anti-emetics) Wait 1hr Pilocarpine eye drops (every 5mins) Laser iridotomy Trabeculectomy
41
What are some secondary causes of glaucoma? (3) | III Advanced
Neovascular: central vv occlusion / DR (→ rubeosis iridis) Uveitic: inflamm/steroids Traumatic: blunt/penetrating Injury/Inflamm/Iatrogenic Advanced cataracts/diabetes
42
List the medical management options of glaucoma (mainly POAG) (5) How does each lower IOP
``` Prostaglandin analogues (latanaprost) Beta-blockers (timolol) Carbonic anhydrase inhibs (drops/p.o.) (dorzolamide) Alpha agonist (brimonidine) Cholinergic (pilocarpine) ```
43
List the SEs of each medical treatment of glaucoma (5)
Prostaglandins - thick lashes, pigmentation Beta - cardiac/resp effects Carbonic anhydrase inhibs - taste probs, acidosis Alpha - dizziness, syncope, allergy Cholinergic - eye ache + poorest compliance
44
What is done in a laser iridotomy (trabeculoplasty)? | Who is it done in?
Shots around trabecular meshwork | All age groups (primary treatment) + with open-angle
45
What is done in a trabeculectomy? | What are its main disadvantages? (2)
Creates controlled fistula where aqueous leaks out under conjunctiva ``` Open pathway for infection Treatment failure (when conjunctival tissue activates/scars) ```
46
What are the RFs for a trabeculectomy failing? (5) (PMH/DH)
``` Previous eye surgery Black race Diabetes (esp w. retinopathy) Long-term topical medications (e.g. pilocarpine) Coexisting/past uveitis ```
47
What are the obvious features of intraocular foreign body? + important things to check What Ix are done
Sudden onset irritation + photophobia (±vision loss) NB ask exact mechanism + check under eyelid X-Ray/CT
48
How is ocular chemical injury managed? (4)
Urgently irrigate w. saline (litres) Determine substance type Compare pH for both eyes (alkaline worse) Abx/VitC/Steroids/Mydriatics
49
List some complications of blunt ocular trauma? (8)
Peri-orbital haematoma Sub-conjunctival haemorrhage Hyphaema (+ acute glaucoma) ``` Traumatic cataracts Lens dislocation (zonule rupture) ``` Retinal tear/detachment Extensive retinal haemorrhage - v v severe Vitreous haemorrhage- v v severe
50
What is a blow out fracture + what features would present? (2) List a complications
Weak orbital floor fracture + eye thru floor into maxillary sinus Restriction of eye movements Periorbital swelling Inferior rectus can get trapped/ischaemic if not released
51
What investigations are done in a blow-out fracture (2)
X-Ray (checking opacification of sinus) (not Dx) | CT (for conclusive)

Opthalmology (6 decks)

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