Conditions and assessment Flashcards
Vessels at back of the eye pale could suggest___
- central retinal artery occlusion
Vessels at back of eye red could suggest___
- central retinal vein occlusion
What should be used to assess epithelial loss?
- fluorescein drops
- cobalt blue light
Blow out fractures on CT will have what appearance?
- orbital contents leaked and visible on CT
What muscle is often trapped in a blow out fracture?
- inferior rectus
What assessment should be performed with a suspected globe rupture?
- USS or CT
Define hyphema?
- blood in the anterior chamber of the eye
Explain sympathetic ophthalmia?
- penetrating injury to one eye
- exposure of intra-ocular antigens
- immune reaction in both eyes
- inflammation in both eyes
- bilateral blindness
With intra-ocular foreign bodies what should be done?
- always x-ray
A __acid/alkali___ burn is rapid penetration?
- alkali burn is rapid penetration
___Acid/alkali___ burn causes coagulation of proteins?
- acid
What is the management of chemical burns to the eye?
- check toxbase
- check pH
- irrigate
- assess with slit lamp
On cover test what would esotropia appear like?
- inward movement - unchallanged
- cover test - outward
On cover test what would exotropia appear like?
- outward movement - unchallanged
- cover test - eye moves inwards
What is hypertropia
- visually one pupil is higher than the other
Define emmetropia?
- normal
- no refractive error
Define ametropia?
- refractive error present
- light focused in front or behind retina
Define anisometropia?
- significant difference between right and left ametropia
What is myopia?
- short sighted
What lens is used to correct myopia?
- diverging lens
- negative lens
A diverging lens may be used in what condition, and what is its affect on the size of the eye?
- myotopia
- eye may appear smaller
What risks are associated with myopia?
- open angle glucoma
- retinal detachment
What is hyperopia?
- long sighted
What lens may be used to correct hyperopia?
- converging lens
- positive lens
What may a converging lens be used in and what may it make the eyes appear like?
- used in hyperopia
- eyes bigger
What are risks associated with hyperopia?
- closed angle glaucoma
- childhood squints
Difficulty seeing near objects?
- long sighted
- hyperopia
Difficulty seeing far objects?
- short sighted
- myopia
Define astigmatism
- rugby shape lens
- unequal refractive powers at different meridia
What lens may be used to correct an astigmatism?
- cylindrical lens
Presbyopia?
- reduction in ability of the eye to accommodate for close work
- with age
- need for reading glasses
Where does the optic nerve synapse?
- synapses at the retina at the photoreceptors
The optic nerve is a __efferent/afferent___ nerve
- afferent
What are the 3C’s you use to describe an optic disk?
- Contour
- Colour
- Cup
What does it mean to describe the contour of an optic disk?
- can you draw a nice circle around the optic disk to separate from the retina
What colour is the optic disk normally?
- orange/pink
What is the cup diameter determined by?
- optic nerve diameter
- number of nerve fibres
What would glaucoma appear like on fundoscopy?
- loss of retinal ganglion fibres
- cupped nerve
What would a swollen nerve appear like on fundoscopy?
- loss of contour
- may have haemorrhages
- no cup visible
Disk drusen may appear as what on USG?
- B scan
- calcium deposits
What are some potential causes of a pale optic disk?
- loss of myelin
- infarction (arthritis)
- inflammation
- compression
- ethambutol
- vitamin B12 deficiency
What drug may cause a pale optic disk?
- ethambutol
When there is a possibility that a pale disk is related to giant cell artiritis what other questions should be asked?
- jaw pain
- scalp tenderness
- visible temporal arteries
- headaches
Myelinated nerves are____
- congential
- grey/white feathery edge of optic disk
What muscle does CN VI control?
- Lateral rectus
What is the clinical signs of a VI nerve palsy?
- Lateral rectus
- adduction of the eye (turned in)
What are some causes of VI nerve palsy?
- microvascular
- Raised ICP
Raised ICP is associated with what nerve palsy?
- CN VI
- Abducent
What muscle does CN IV supply?
- Superior oblique
What is the clinical signs of a CN IV nerve palsy?
- Unable to depress in adduction
- head tilt
What nerve palsy is associated with a head tilt?
- CN IV
- Loss of intorsion
What are causes of bilateral CN IV palsy?
- blunt trauma
What is the clinical signs of a CN III nerve palsy?
- down and out
What are the causes of a CN III nerve palsy?
- microvascular
- aneurysm (painful)
- MS
Define nystagmus?
- eye moves from side to side
What are causes of inter-nuclear ophthalmoplegia?
- MS
- Vascular
Defect on the medial longitudinal fasciculus pathway may cause?
- inter-nuclear ophthalmoplegia
Horizontal field defects are associated with a defect in the ___eye/brain___
- eye
Symptoms of optic neuritis?
- pain behind the eye especially on movement
- colour desaturation
Congruous vs incongruous?
- congruous defect is identical between the 2 eyes
- incongruous differs in appearance between the 2 eyes
Congruent lesions are characteristic of pathology ___near eye/near occipital lobe___
- near occipital lobe
How many layers make up the retina?
- 10 layers
What are the 3 subunits of diabetic retinopathy?
- non-proliferative
- proliferative
- macular oedema
What signs on fundoscopy can be seen in diabetic retinopathy?
- cotton wool spots
- aneurysms
- haemorrhages
- exudate
- new vessels
- loss of pericyctes
New vessel formation in diabetic retinopathy is associated with what signal?
- VEGF induced
Which diabetic retinopathy is associated with new vessel formation?
- proliferative
What treatment may be used in non-proliferative diabetic retinopathy?
- laser therapy
What treatment may be used in proliferative diabetic retinopathy
- anti VEGF
What is the criteria for pathologic myopia?
- axial length > 26mm
- prescription > -8
Posterior vitreous detachment may have what symptoms?
- floaters
- flashing lights
Central retinal artery occlusion complications?
- stroke
- MI
Central retinal vein occlusion the retina will appear like what?
- red
- hyperaemic?
What are some causes of sudden vision loss?
- vascular
- vitreous haemorrhage
- retinal detachment
- age related macular degeneration
- closed angle glaucoma
What type of glaucoma is associated with immediate/sudden vision loss?
- closed angle glaucoma
What are the symptoms of central retinal artery occlusion?
- sudden vision loss
- painless
What is the clinical signs of a central artery occlusion in the retina?
- RAPD
- Pale oedematous retina
What are potential causes of retinal central artery occlusion?
- carotid artery disease
- emboli from the heart
What type of retinal artery occlusion is transient?
- Amaurosis fugax
What are potential causes of retinal vein occlusion?
- endothelial injury
- abnormal blood flow
- hypercoagubility
What are the signs on fundoscopy for retinal vein occlusion
- retinal haemorrhages
- dilated tortuous veins
- disc swelling
Explain ischaemic optic neuropathy?
- posterior cilliary arteries become occluded
- infarction of the optic nerve head
What is the blood supply to the optic nerve head?
- posterior cilliary arteries
Loss of vision and floaters may be caused by what?
- vitreous haemorrhage
What type of age related macular degeneration is associated with sudden vision loss?
- wet
Explain wet age related macular degeneration?
- new blood vessels grow under retina
- leakage
- build up of pressure
- rapid central vision loss
What is the treatment of wet macular degeneration?
- anti-VEGF agents
Symptoms of closed angle glaucoma?
- sudden visual loss
- painful
- dilated pupil
What are some examples of gradual vision loss?
- cataracts
- open angle glaucoma
- dry age related macular degeneration
- refractive error
What causes cataracts?
- abnormal protein changes in lens
What are symptoms of cataracts?
- gradual vision loss
- glare when night driving
What may be seen on fundoscopy in dry age related macular degeneration?
- drusen
- atrophic patches
Signs on fundocsopy of open angle glaucoma?
- cupped disk
- visual field defect
- raised ICP
Bilateral optic disk swelling???
- papiloedema
- treat as a space occupying lesion until proven otherwise
What are the 3 components of intracranial pressure?
- brain
- blood
- CSF
Scleritis is associated with what conditions?
- autoimmune dysregulation
Symptoms of scleritis/
- pain on eye movement
- injected vessels
- photophobia
Treatment of scleritis?
- NSAIDs
Symptoms of episcleritis
- mild pain
- redness
Episcleritis is associated with what?
- idiopathic inflammation
Treatment of episcleritis?
- self-limiting
- +/- NSAIDs
What are the 3 types of diabetic retinopathy?
- proliferative
- non-proliferative
- macular oedema
Fundoscopy apperance of diabetic retinopathy?
- cotton wool spots
- aneurysms
- haemorrhages
- new vessels
Treatment of non-proliferative diabetic retinopathy?
- laser
What is subconjunctival haemorrhage?
- bleeding into the subconjunctival space
Recurrent subconjunctival haemorrhage what should be excluded?
- hypertension
- bleeding disorder
Symptoms of acute anterior uveitis?
- red and painful eye
- photophobia
- blurred vision
Treatment of acute anterior uveitis?
- topical steroids
- mydriatics
Blepharitis is what?
- inflamed eyelids
- burning and itching
- crusting
Treatment of blepharitis?
- 2-3months doxycycline
Stellate posterior cortical cataracts are associated with what condition?
- myotonic dystrophy
What is the optical involvement of neurofibromatosis?
- globe proptosis
- Lisch nodules (iris hamartomas)
What are Lisch nodules?
- iris hamatromas
- bilateral
- associated with neurofibromatosis
What is the ocular involvement of thyroid eye disease?
- peri-orbital swelling
- prominent eyes
- optic neuropathy
Heliotrope rash on eyelids may be?
- dermatomyositis
Long term steroid usage may cause?
- a rise in intra-ocular pressure
