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Opthalmology > Conditions > Flashcards

Conditions Flashcards

1
Q

What is acute angle closure glaucoma

A

when your iris and cornea move closer together, increasing the intraocular pressure because there is no way to drain the fluid

this causes damage to the optic nerve (glaucoma)

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2
Q

What causes acute angle closure glaucoma

A

when the gap between your iris and your cornea closes because e.g.

you:

  • go into a dark room
  • get dilating eye drops
  • are excited or stressed
  • take drugs e.g. antidepressants
  • have cataracts, diabetic retinopathy or tumours
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3
Q

What health conditions are risk factors for acute angle closure glaucoma

A

cataracts

ectopis lens (lens moves from where it should be)

diabetic retinopathy

ocular ischaemia

Uveitis

Tumour

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4
Q

what is the epidemiology of acute angle closure glaucoma

A
  • Women
  • SE Asian
  • Farsighted
  • 55-65
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5
Q

what are the symptoms of acute angle closure glaucoma

A
  • eye pain
  • severe headache
  • nausea/ vomiting
  • blurry vision
  • redness in eye
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6
Q

What tests do you do to diagnose acute angle closure glaucoma

A

Gonioscopy (microscope with slit lamp- checks angle between iris and cornea and sees how well fluid drains)

Tonometry (measures intraocular pressure)

Opthalmoscopy (for damage to optic nerve)

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7
Q

How do you treat acute angle closure glaucoma

A

Initially:

  • eye drops containing beta-blockers to reduce fluid production e.g. Timolol
  • IV acetazolamide (to reduce IOP)

Then Bilateral peripheral iridotomy

Pilocarpine eye drops which constrict pupil (aren’t used much anymore)

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8
Q

What is Orbital Cellulitis

A

infection of soft tissues of the eye socket posterior or deep to the orbital septum (divides eye lid from eye socket

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9
Q

What is the difference between orbital and peri-orbital cellulitis and which one is more severe

A

Orbital is inflammation of the soft tissue posterior/ deep to the orbital septum

Peri-orbital is anterior to the septum (superficial upper eyelid)

orbital is more severe because it actually affects stuff in the orbital cavity

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10
Q

What is the cause of orbital cellulitis

A

when an exisitng infection spreads from its origin

most commonly when a bacterial infection spreads from the paranasal sinuses e.g. ethmoid

or eyelid skin infection spreads

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11
Q

Which bacteria most commonly cause orbital cellulitis

A

Staph. aureus

Streptococci e.g. group A B haemoltyic, pneumoniae,

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12
Q

How do you investigate someone with orbital cellulitis

A

CT scan

Full blood count (leukocytosis (high))

blood culture prior to administration of antibiotics

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13
Q

how does orbital cellulitis present (history and examination)

A

History:
fever, malaise, recent sinusitis/ URT infection

often recent facial trauma/ surgery/ dental work

  • decreased vision
  • eye pain
  • swelling
  • erythema
  • edema of eyelids
  • proptosis (bulging)

OE:

  • elevated IOP
  • RAPD
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14
Q

How do you treat orbital cellulitis

A

prompt hospitalisation

broad spectrum IV antibiotics for 1-2 weeks e.g. Ceftriaxone, ampicillin-sulbactam, moxifloxacin

surgery:

  • canthotomy and cantholysis (incision into canthi) if orbital compartment syndrome is diagnosed (very high IOP)
  • drain if abcess

ENT consultation if recent sinusitis

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15
Q

give 3 examples of antibiotics for orbital cellulitis

A

Ceftriaxone, ampicillin-sulbactam, moxifloxacin

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16
Q

what is the difference between penetrating and perforating eye injuries

A

penetrating= penetrated into eye but no exit wound

perforating= entrance and exit wound

both aka open globe injury

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17
Q

what are the risk factors for a penetrating/ perforating eye injury

A

male gender

occupation

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18
Q

how does a penetrating/ perforating eye injury present

A
  • pain
  • double vision
  • foreign body sensation
  • blurred vision
  • redness
  • light sensitivity
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19
Q

how do you investigate an open globe injury

A

aka penetrating/ perforating eye injury

visual acuity and pupillary exam important

gentle ultrasound and computed tomography

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20
Q

how do you manage a penetrating/ perforating eye injury

A

prophylactic antibiotics e.g. vancomycin, cephalosporin

surgery to close the open globe

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21
Q

what are the two types of chemical injury to the eye and which is worse

A

acid or alkali

alkali is much worse because the acids denature and cant pass the phospholipid bilayer where as alkali burrows down

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22
Q

what are the common causes of chemical eye injuries

A

acid:

  • HCL (cleans swim pools)
  • Sulphuric acid (car batteries)

Alkali:

  • sodium hydroxide (drain cleaner)
  • ammonia (bleach)
  • calcium hydroxide
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23
Q

how do you treat a chemical eye injury

A

irrigation with any noncaustic fluid available until pH of ocular surface is between 7 and 7.2

depending on severity treat with antibiotics, control inflammation, debridement

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24
Q

what are the common causes of conjunctivitis

A

Viral:

  • HSV
  • VZV

Bacterial:

  • Staph. aureus
  • haemophilus influenzae
  • strep. pneumoniae
  • pseudomonas

Allergens:

  • pollen
  • moulds

Think STIs

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25
Q

How does conjunctivitis present

A
  • red sclera
  • increased tearing
  • thick yellow discharge that crusts over the eyelashes (bacterial)
  • itchy eyes (allergic)
  • blurred vision
  • photosensitive
  • swollen eyelids
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26
Q

how do you investigate conjunctivitis

A

slit lamp
visual acuity tests
eye culture if stays for 2-3 weeks

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27
Q

how do you treat conjunctivitis

A

bacterial= antibiotics e.g. levofloxacin

viral= let it run its course- help with cold compress

allergic= antihistamines (drops)

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28
Q

what are the typical causes of corneal ulcers

A

Bacterial=

  • stap. aureus
  • strep. pnuemoniae
  • pseudomonas

Viral=

  • HSV
  • VZV
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29
Q

what are the risk factors for corneal ulcers

A

contact lenses (especially overnight ones)

steroid eye drops

existing eye conditions e.g. blepharitis, dry eyes

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30
Q

how do corneal ulcers present

A
  • pain
  • redness
  • foreign object sensation
  • tearing
  • photophobia
  • decreased vision
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31
Q

how do you investigate corneal ulcers

A

slit lamp with fluorescein stain to diagnose

cornea culture to rule out infectious cause

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32
Q

how do you treat corneal ulcers

A
  • artificial tears
  • systemic immunosuppressive therapy (methylprednisolone)
  • corneal transplant if severe
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33
Q

What causes giant cell arteritis

A

actual cause is uncertain

associated with autoimmune disease

it is an autoimmune disorder

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34
Q

how does giant cell arteritis present

A

bilateral temple pain and scalp tenderness

jaw pain

vision loss/ diplopia

fever

fatigue

weight loss

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35
Q

how do you investigate giant cell arteritis

A

increased ESR, CRP, thrombocytosis

temporal artery biopsy to diagnose

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36
Q

how do you treat giant cell arteritis

A

immediate high dose corticosteroid (e.g. prednisone)

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37
Q

what are the 3 causes of retinal detachment

A

Rhegmatogenous (most common):

  • hole/ tear in the retina so fluid can pass under it pulling it away from underlying tissue
  • most commonly caused by ageing which causes posterior vitreous detachment

Tractional:

  • scar tissue on surface
  • in poorly controlled diabetes

Exudative:

  • fluid accumulation under the retina
  • caused by age-related macular degeneration, tumour
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38
Q

what are the risk factors for retinal detachment

A

age (posterior vitreous detachment)

Previous retinal detachment

family history

extreme myopia

Poorly controlled diabetes (tractional)

age-related macular degeneration (exudative)

eye injury (exudative)

inflammatory disorders (exudative)

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39
Q

Symptoms of retinal detachment

A

painles

sudden appearance of floaters

flashes of light

blurred vision

gradually reduced peripheral vision

curtain going down/ up

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40
Q

investigations of retinal detachment

A

to diagnose:
Visual acuity testing

slit-lamp examination,

opthalmology

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41
Q

treatment of retinal detachment

A

surgery to repair detachment

photocoagulation (welding) or cryopexy (freezing) to weld the retina to the eye wall if tear hasnt progressed to detachment

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42
Q

what is amaurosis fugax

A

transient loss of vision in one or both of the eyes

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43
Q

cause of amaurosis fugax

A

plaque/ blood clot in the carotid artery (at the side of the lesion)

44
Q

what are the risk factors for amaurosis fugax

A

heart disease

hypertension

high cholesterol

smoking

alcohol

cocaine

MS

optic neuritis

45
Q

how does amaurosis fugax present

A

vision loss in one or both eyes

grey curtain that progresses from the periphery towards the centre

no pain, lasts 2-30 mins

46
Q

how do you investigate amaurosis fugax

A

blood pressure (hypotension could be cause)

FBC for anaemia

ESR and CRP for elderly patients to rule out GCA

Imaging of carotid arteries to find blockage

47
Q

how do you treat amaurosis fugax

A

treat underlying condition

e.g. anticoagulant, hypotensives

lifestyle changes e.g. stop smoking

48
Q

What is a meibomian cyst

A

aka chalazion

sterile, inflammatory granuloma caused by obstruction of a sebaceous gland

these run along the eyelid margin and produce secretion which provides lipid layer of tear film

49
Q

cause of meibomian cyst

A

obstruction of a sebaceous gland

these produce a lipid secretion which makes the lipid layer of tear film

50
Q

what are the risk factors for a meibomian cyst

A

Chronic blepharitis

Rosacea (red face)

51
Q

how does a meibomian cyst present

A

painless bump in eyelid (usually upper)

mild irritation causing watery eyes

blurred vision if it is large and pushes on the eyeball

52
Q

how do you treat a meibomian cyst

A

application of warm compress for 10-15 mins

gentle massage 5 times a day

53
Q

what are the common causative organisms of blepharitis

A

low grade infections

staph. epidermidis
staph. aureus

54
Q

what causes blepharitis

A

unclear

can spread from person to person

can be associated with other conditions e.g. seborrheic dermatitis, infection, rosacea

55
Q

what are risk factors for blepharitis

A

seborrheic dermatitis

rosacea

diabetes

allergies

56
Q

symptoms of blepharitis

A

watery eyes

red eyes

stinging eyes

greasy eyelides

red eyelids

swollen eyelids

flaky skin

photosensitive

blurred vision- improves with blinking

57
Q

how do you investigate blepharitis

A

if severe:

lid biopsy

lid margin culture

but usually none

58
Q

how do you manage blepharitis

A

self-care e.g. washing, warm compreßes

if doesnt work then antibiotics/ steroid drops

59
Q

what causes corneal abrasions

A

when your cornea gets scratched by contact with dust, dirt, sand, wood shavings etc

60
Q

how does corneal abrasion present

A

eye pain
tearing
photosensitivity

foreign body sensation
blurry vision
blepharospasm

61
Q

how do you treat a corneal abrasion

A

flush with clean water/ saline

lubricating eye drops to keep moist

antibiotics if severe

62
Q

how does a corneal foreign body present

A

eye pain

foreign body sensation

photophobia

tearing

red eye

decreased visual acuity (blurred vision)

63
Q

how do you treat a corneal foreign body

A

antibiotic drops prophylactically e.g. Polytrim

remove foreign body under topical anaesthetia

perhaps topical NSAID for analgesia and anti-inflammatory

64
Q

what causes uveitis

A

often unknown cause

associated with auto-immune diseases e.g. UC, sarcoid, idiopathic juvenile arthritis

can be infective e.g. Herpes, syphillis

65
Q

how does uveitis present

A

acutely with red eye

pain

blurred vision

photosensitivity

floaters

chronically with floaters and blurred vision

66
Q

how is uveitis treated

A

if infective antimicrobial

if auto-immune with steroid eye drops

67
Q

cause of episcleritis and scleritis

A

often no apparent cause

often underlying stystemic inflammatory condition e.g. rheumatoid arthirtis, lupus, crohn’s

68
Q

how does episcleritis present vs scleritis

A

both have:
- red eye

Episcleritis:

  • acute onset
  • mild pain

Scleritis:

  • subacute onset
  • severe pain
  • pain on movement
  • photophobia
69
Q

how do you treat episcleritis vs scleritis

A

episcleritis:

  • usually clears without treatment
  • often cool compress/ iced arificial tears

scleritis:

  • opthalmology consult
  • systemic steroids/ NSAIDS
70
Q

causes of vitreous haemorrhage

A

conditions which cause the formation of new, abnormal blood vessels:

diabetic eye disease

macular degenration

retinal vein occlusion

retinal tear causing posterior vitreous detachment

71
Q

how does vitreous haemorrhage present

A

visual haze

painless vision loss

floaters

cloudy vision

photophobia

72
Q

how do you treat a vitreous haemorrhage

A

laser photocoagulation to stop abnormal vessels from bleeding

other treatments e.g. cryotherapy can be used

treat underlying condition e.g. diabetes

73
Q

what causes dry eyes

A
  • dysfunction in any of the three tear layers (fatty, mucus, water)
    reasons e.g. hormone changes, autoimmune disease, inflamed eyelid glands
  • decreased tear production (keratoconjunctivitis sicca) due to aging, Sjogren’s syndrome, RA, meds (e.g. antihistamines, antidepressants), corneal nerve desensitivity through contact lens use
  • increased tear evaporation due to posterior blepharitis, allergies
74
Q

what are the risk factors for dry eyes

A

age (over 50)
women (oestrogen/ pill)
Vit A deficiency
Contact lenses

75
Q

how are dry eyes treated

A

education/ modify environment (e.g. humidifier)

topical ocular lubricants (artifical tear drops)

topical anti-inflammatory eye drops

76
Q

how do dry eyes present

A

stinging, burning, itchy

stringy mucus in/ around eyes

photophobia

eye redness

foreign body sensation

77
Q

what causes a blocked naso-lacrimal duct

A

congenital

age- related (puncta get narrower)

infection/ inflammation e.g. sinusitis

tumour

chronic eyedrop use

78
Q

what are the risk factors for a blocked naso-lacrimal duct

A

age

chronic eye inflammation

previous surgery

glaucoma (higher pressure)

previous cancer/ treatment

79
Q

how does a blocked naso-lacrimal duct present

A

excessive tearing

scleritis/ conjunctivitis

painful swelling near puncta

crusting of the eyelids

blurred vision

80
Q

how do you treat a blocked naso-lacrimal duct

A

depends on cause

if infective cause treat infection

e.g. congenital often gets better by itself

dilation with stent/ balloon

81
Q

what causes cataracts

A

clouding of the lense caused by proteins and fibres in the lenses breaking down and clumping together

usually caused by age/ injury

82
Q

what are risk factors for catraracts forming

A

age

diabetes

excessive sunlight exposure

smoking

obesity

hypertension

83
Q

how do cataracts present

A

clouded, blurred vision

photophobia

halos around lights

diplopia in one eye

84
Q

how do you treat cataracts

A

surgery to remove lens and replace with a new one

85
Q

what causes of open angle glaucoma

A

blockage of the trabecular meshwork

86
Q

what are the risk factors for open angle glaucoma

A
  • high IOP
  • age
  • black, asian, hispanic
  • family history of glaucoma
87
Q

how does an open angle glaucoma

A

insidious- asymptomatic in the early stages

patchy blind spots in peripheral/ central vision frequently (bilateral)

often will be found after visual acuity test

88
Q

how do you investigate open angle glaucoma

A

tonometry
slit lamp- mycrocystic oedema
gonioscopy through slit lamp to check angle

89
Q

how do you treat an open angle glaucoma

A

eye drops to lower IOP:

  • latanoprost, bimatoprost to improve drainage
  • timolol, dorzolamide to reduce eye fluid formation

trabeculectomy to create a channel in the iris for flow of aqueous humour

laser treatment targeting trabecular meshwork

90
Q

what are the causes of macular degeneration

A

unknown cause

macular tissue thins and loses cells

91
Q

what are the risk factors for macular degeneration

A 
age!!!!
family history 
race (caucasian)
smoking
obesity
CV disease
92
Q

how does macular degeneration present

A

visual distortion e.g. straight lines seeming bent

reduced central vision (mono or bilateral)

difficulty in low light levels

93
Q

how do you investigate macular degeneration

A

Amsler grid

tomography

angiography to determine if blood vessels are getting adequate blood flow and to investigate the extent of degeneration

94
Q

how do you treat macular degeneration

A

Dry- no treatment but vision aids can help symptoms

Wet:

  • Bevacizumab, ranibizumab to stop new blood vessel growth (injections)
  • photodynamic therapy if abnormal blood vessels at fovea (light activates verteporfin injected in arm vein)
  • photocoagulation to seal abnormal blood vessels (can cause blind spot)
95
Q

what is a 3rd nerve palsy

A

damage to oculomotor nerve/ branch thereof

affects 4/6 extrocular muscles (lateral rectus and superior oblique spared)

96
Q

what is the cause of 3rd nerve palsy

A

either congenital or acquired

acquired can be microvascular, trauma, compression from neoplasm or post-neurosurgery

97
Q

how does 3rd nerve palsy present

A
  • complete ptosis (closed eyelid)
  • deviation of the eye out and down
  • enlarged pupil and doesnt react to light
98
Q

what is the most life-threatening type of nerve palsy

A

third nerve palsy

because a subset of them are caused by life-threatening aneurysms

99
Q

how do you treat third nerve palsy

A

surgery if tumour or aneurysm

vision therapy
eye patch patching

usually recovers in 3 months

100
Q

what causes 4th nerve palsy

A

congenital

trauma

microvascular disease

101
Q

how does 4th nerve palsy present

A

diplopia
hypertropia (one eye deviates up)
further elevation as it moves medially

102
Q

is 4th nerve palsy dangerous

A

could be a symptom of a stroke

6 months for spontaenous resolution

eye muscle surgery recommended which speeds it up

103
Q

what causes 6th nerve palsy

A

stroke

brain aneurysm

diabetic neuropathy

trauma

infection

104
Q

how does 6th nerve palsy present

A

dipolpia

strabismus (eye might be slightly adducted cos no lateral rectus function)

105
Q

how do you treat 6th nerve palsy

A

will sometimes disappear without treatment

steroids if inlfammation suspected

eye patch

Opthalmology (2 decks)

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