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Ophthalmology Core Conditions > Core Conditions > Flashcards

Core Conditions Flashcards

1
Q

Which condition is being described:

‘A degenerative disorder of the macula affecting those over the age of 50’

A

Age-related Macular Degeneration

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2
Q

What are the two subtypes of age-related macular degeneration?

A

Wet and dry

Wet:

  • Accumulation of fluid secondary to neovascularisation from pigment epithelial disruption
  • See haemorrhages, scarring and swelling
  • Can develop quite dramatically. Needs treatment early.

Dry:

  • Accumulation of pigment epithelial waste products
  • Atrophy of the retinal pigment epithelium
  • Slow progression
  • Less dramatic symptoms
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3
Q

True or false: Macular degeneration will lead to loss of peripheral vision

A

False.

Macular pathologies lead to distortion and/or central scotoma

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4
Q

Which type of macular degeneration requires a more urgent referral?

A

Wet MD requires a specialist referral within 2 weeks as urgent treatment aimed at preventing angiogenesis (anti-VEGF) may prevent further damage, saving the patient’s sight.

Dry MD referrals are made under routine timeframes as there is no cure and the deterioration is much less dramatic.

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5
Q

How is dry macular degeneration treated?

A

There is no cure.

Lifestyle modifications may help slow progression of the disease.
- smoking cessation, minimal UV exposure, diet (greens, fresh fruit, oily fish).

Support vision: magnifiers, lighting modifications

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6
Q

How is wet macular degeneration treated?

A

Intravitreal injections of agents that reduce angiogenesis

Ranibizumab (Lucentis), an anti-VEGF agent.

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7
Q

What condition is characterised by an opacification of the lens of the eye?

A

Cataract

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8
Q

What signs and symptoms might be present when a patient has a cataract?

A
  • Blurred/hazy vision; loss of visual acuity
  • Glare
  • Monocular diplopia
  • Reduced red reflex
  • Poor view of the fundus
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9
Q

How are cataracts treated?

A

Surgery: Phacoemulsification and intraocular lens implantation

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10
Q

What is glaucoma?

A. Opacification of the lens
B. Chronic structural optic neuropathy
C. Raised intraocular pressure
D. Degenerative disease of the macula

A

B. Chronic structural optic neuropathy

Usually is linked to raised intraocular pressure, but that by itself is not glaucoma.

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11
Q

What is the commonest cause of blindness worldwide?

A

Cataracts

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12
Q

What is the second most common cause of blindness worldwide?

A

Glaucoma

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13
Q

What signs and symptoms might be present in a patient with glaucoma?

A

Usually few symptoms until end-stage

  • Bumping into things
  • Missing things in peripheral vision
  • Loss of acuity is very late stage
  • Optic disc: cupping, pallor and haemorrhages
  • Raised intraocular pressure
  • Reduced visual fields
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14
Q

How is glaucoma managed?

A

Medical
- topical ocular hypotensives

Surgical
- Glaucoma filtration

Counselling

  • Compliance
  • Driving/informing DVLA
  • International Glaucoma Association
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15
Q

When should a glaucoma referral be urgent?

A
  • When intraocular pressure is raised >30 mmHg
  • Acute angle closure glaucoma

Otherwise routine referral

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16
Q

What term describes an everted eyelid?

A

Ectropion

17
Q

What term describes an inverted eyelid?

A

Entropion

18
Q

What is being described:

Lump forming on the eyelid due to blockage of the meibomian gland.

A

Chalazion (meibomian cyst)

  • Blockage of meibomian gland within tarsal plate
  • Trapped sebaceous secretions
  • Chronic granulomatous inflammation
  • Generally not infected

Treatment:
• Many resolve spontaneously
• Hot compresses and massage
• Sometimes surgical drainage (incision & curettage)

19
Q

What is blepharitis?

A

Inflammation of the lid margins

Treatment:
• Hot compresses to help drain meibomian glands
• Lid hygiene e.g. cleaning with cotton bud dipped in dilute baby shampoo
• Oral tetracyclines in severe cases

20
Q

What is trichiasis?

A

Misdirected eyelashes leading to sensation of having a foreign body in the eye.

Cause:
• Often due to scarring of lid margin e.g. chronic blepharitis
• May result in corneal ulceration and scarring
• The eyelid itself is not malpositioned

Treatment:
• Simple epilation (but almost inevitably recur)
• Permanent lash removal e.g. electrolysis, cryotherapy, laser

21
Q

What are the key causes of ptosis?

A
  • Age-related degeneration of levator muscle aponeurosis
  • Mechanical (scar or mass)
  • Neurological (CN III palsy, Horner’s syndrome)
  • Myogenic (myasthenia gravis, myotonic dystrophy)
22
Q

Severely dry eyes can be a symptom of which syndrome?

A

Sjogren Syndrome

23
Q

How might you treat dry eyes?

A

Lubricating eye drops/ artificial tears

If severe, may warrant occlusion of the lacrimal puncta; either temporarily (plugs) of permanently (surgery) to retain tears for longer.

24
Q

True or false: Most cases of congenital nasolacrimal duct obstruction will require surgical probing.

A

False.

Most cases of congenital nasolacrimal obstruction will resolve spontaneously by the age of 1 year.

Some may require surgical probing under GA if they persist.

25
Q

True or false: A watery eye in a baby is not a concerning sign.

A

False.

Although rare, a watery eye in a baby can be sign of congenital glaucoma, a blinding condition.

26
Q

What is the pathophysiology of congenital nasolacrimal obstuction?

A

Delayed canalisation of the lower end of the nasolacrimal duct.

Usually resolves spontaneously by 1yo.

27
Q

What is acute dacryocystitis?

A

Infection of the lacrimal sac (usually staph/strep).

28
Q

What is the usual cause of dacryocystitis?

A

Usually due to nasolacrimal duct obstruction

29
Q

What is a common sequelae of acute dacryocystitis?

A

Preseptal cellulitis

30
Q

How would you treat acute dacryocystitis?

A

Oral antibiotics (e.g. flucloxacillin)

Warm compress to aid drainage

If required, surgical drainage

31
Q

How would you distinguish orbital cellulitis from preseptal cellulitis?

A

Restricted eye movements (patient reports diplopia), proptosis, loss of vision, very red/swollen conjunctiva

32
Q

How would you treat orbital cellulitis?

A

Urgent and aggressive treatment required to prevent loss of sight and/or fatal complications.

Admission for IV antibiotics

CT scan to check for orbital abscess or severe sinusitis that may need surgical drainage.

Ophthalmology Core Conditions (1 decks)

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