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Yr 5 - Ophthalmology > Corrections > Flashcards

Corrections Flashcards

1
Q

What can be given to help slow deterioration of vision loss in ARMD?

A

High dose of beta-carotene, vitamins C and E, and zinc

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2
Q

What 2 investigations should be performed in patients with AACG?

A

1) Tonometry (measures IOP)

2) Gonioscopy (measures angle of eye)

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3
Q

What is lupus retinopathy?

A

Typically features in chronically uncontrolled disease.

Can cause decreased visual acuity.

Fundoscopy:
- cotton wool spots
- microaneurysms
- hard exudates

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4
Q

Is peripheral iridotomy usually performed unilaterally or bilaterally in AACG?

A

Bilaterally due to the likelihood of occurence in the contralateral eye.

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5
Q

Is proliferative retinopathy more common in T1D or T2D?

A

T1D

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6
Q

Give 4 risk factors for scleritis

A

1) RA (most common)

2) SLE

3) sarcoidosis

4) granulomatosis with polyangiitis

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7
Q

Where are drusen located in ARMD?

A

Betwen Bruch’s membrane and the retinal pigment epithelium of the eye.

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8
Q

Are drusen seen in wet or dry ARMD?

A

Dry

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9
Q

Give 3 conditions associated with optic neuritis

A

1) MS
2) Diabetes
3) Syphilis

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10
Q

Give 3 factors that predispose to AACG

A

1) Hypermetropia (long-sightedness)

2) Pupillary dilatation

3) Lens growth associated with age

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11
Q

What is a vitreous haemorrhage?

A

Bleeding into the vitreous humour.

It is one of the most common causes of sudden PAINLESS loss of vision.

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12
Q

Is loss of vision in vitreous haemorrhage painful or painless?

A

Painless

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13
Q

Give 3 causes of vitreous haemorrhage?

A

1) proliferative diabetic retinopathy (over 50%)

2) posterior vitreous detachment

3) ocular trauma

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14
Q

What is the most common cause of vitreous haemorrhage in children & young adults?

A

Ocular trauma

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15
Q

Presentation of vitreous haemorrhage?

A

1) painless visual loss or haze (commonest)

2) red hue in the vision

3) floaters or shadows/dark spots in the vision

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16
Q

When should those with a +ve family history of glaucoma receive screening?

A

From 40 y/o

Annual screening

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17
Q

Define +ve FH in glaucoma

A

Have a first-degree relative (parent, sibling, or child) with open angle glaucoma

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18
Q

Purpose of Amsler grid test?

A

To check for distortion of line perception - may be useful in ARMD

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19
Q

Main action of latanoprost?

A

Increases uveoscleral outflow

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20
Q

Myopia vs hypermetropia in glaucoma?

A

Myopia –> higher risk of 1ary open angle glaucoma

Hypermetropia –> higher risk of AACG

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21
Q

Action of dorzolamide eye drops?

A

Carbonic anhydrase inhibitor

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22
Q

Mx of AACG?

A

1) Combination of eye drops
- pilocarpine (parasympathomimetic)
- timolol (beta blocker)
- apraclonidine (alpha-2 agonist)

2) IV acetazolamide

3) laser peripheral iridotomy

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23
Q

Can glaucoma occur in patients with normal IOP?

A

Yes

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24
Q

How can calcium affect the eyes?

A

Hypocalcaemia is a risk factor for cataracts

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25
Q

Key complication of cataract surgery?

A

Endophthalmitis –> intravitreal abx

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26
Q

Most common cause of CRAO?

A

Carotid artery atherosclerosis

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27
Q

Most common cause of CRAO in <40y/o?

A

Cardiac emboli

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28
Q

What is normally the cause of CRAO in older diabetic or hypertensive patients with a normal carotid doppler?

A

Small artery disease i.e. local atheroma within the central retinal artery itself

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29
Q

Is myopia or hypermetropia a risk factor for retinal detachment?

A

Myopia

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30
Q

What is seen on fundoscopy in CRVO?

A
  • widespread hyperaemia
  • severe retinal haemorrhages - ‘stormy sunset’
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31
Q

Who is CMV retinitis common in?

A

HIV patients with low CD4 count (<50)

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32
Q

How does CMV retinitis present?

A

Blurred vision

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33
Q

What does fundoscopy show in CMV retinitis?

A

retinal haemorrhages and necrosis, often called ‘pizza’ retina

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34
Q

Treatment of choice for CMV retinitis?

A

IV ganciclovir

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35
Q

Investigations in suspected microbial keratitis?

A

An accurate diagnosis can only usually be made with a slit-lamp, meaning SAME DAY referral to an eye specialist is usually required to rule out microbial keratitis

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36
Q

In what condition does fundoscopy reveal a ‘bull’s eye’ appearance?

A

Hydroxychloroquine retinopathy

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37
Q

What would a red, painful eye with loss of vision post cataract surgery indicate?

A

Endophthalmitis

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38
Q

1st line treatment for blepharitis?

A

Hot compresses

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39
Q

Flashes + floaters are most commonly caused by what?

A

Posterior vitreous detachment

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40
Q

What are the 2 mechanisms of sight loss in proliferative diabetic retinopathy?

A

1) retinal detachment
2) vitreous haemorrhage

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41
Q

Is vision loss in retinal detachment progressive or sudden?

A

Progressive

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42
Q

Mx of any patient who presents with new-onset flashes or floaters?

A

Urgent referral to ophthalmology (24h)

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43
Q

1st line treatment for a stye?

A

Regular warm steaming

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44
Q

What is the most common complication of thyroid eye disease?

A

Exposure keratopathy

This complication arises primarily due to the proptosis of the eyeballs and eyelid retraction associated with the condition, which can lead to difficulty in completely closing the eyes.

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45
Q

Pupil shape in anterior uveitis?

A

Oval

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46
Q

What is entropion?

A

Inward turning of eyelids

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47
Q

What is ectropion?

A

Outward turning of eyelids

48
Q

What is a potential complication of panretinal photocoagulation?

A

Decrease in night vision

49
Q

Role of pan-retinal laser photocoagulation in proliferative diabetic retinopathy?

A

Utilises a laser to create numerous micro-burns across the peripheral retina.

These burns serve to eradicate the newly formed blood vessels that arise due to neovascularisation.

50
Q

Mx of temporal arteritis with vision involvement?

A

IV methylprednisolone

51
Q

In diabetic retinopathy, what do cotton wool spots represent?

A

areas of retinal infarction

52
Q

What is acanthamoeba keratitis commonly associated with?

A

Contact lens use in bodies of water such as the sea or swimming pools.

Also soil & ponds.

53
Q

Pupil size in anterior uveitis?

A

Miosis (constricted pupil)

54
Q

What are posterior synachiae?

A

Adhesions between lens & iris

55
Q

What should immediately be done in babies with purulent eye discharge?

A

Take urgent swabs of the discharge for microbiological investigation, using methods that can detect chlamydia and gonococcus.

While the guidance is to start systemic antibiotic treatment for possible gonococcal infection while awaiting the swab microbiology results, swabs must be TAKEN FIRST.

56
Q

1st line abx therapy of bacterial conjunctivitis?

A

Chloramphenicol drops

57
Q

1st line abx therapy of bacterial conjunctivitis in pregnant women?

A

Topical fusidic acid

58
Q

Features of optic neuritis?

A
  • unilateral decrease in visual acuity over hours or days
  • poor discrimination of colours, ‘red desaturation’
  • pain worse on eye movement
  • RAPD
  • central scotoma
59
Q

What visual defect may be seen in optic neuritis?

A

RAPD

60
Q

What medication are a risk factor for a corneal ulcer?

A

Steroid eye drops - can lead to fungal infections (and then a corneal ulcer)

61
Q

CT head or IV abx first in suspected orbital cellulitis?

A

IV abx

62
Q

1st line investigation in suspected orbital cellulitis?

A

CT scan of orbits, sinuses & brain with contrast to assess the posterior spread of infection.

63
Q

What imaging is recommended in suspected optic neuritis?

A

MRI brain and orbits with gadolinium contrast

64
Q

1st line mx of allergic conjunctivitis?

A

Topical antihistamines

65
Q

What is Hutchinson’s sign? What does it indicate?

A

Vesicles extending to the tip of the nose.

This is strongly associated with ocular involvement in shingles –> urgent ophthalmological assessment

66
Q

What are risk factors for subcapsular cataracts?

A
  • steroids
  • hypermetropia
  • diabetes
67
Q

What is a corneal abrasion?

A

Refer to any defect of the corneal epithelium and most commonly come about from a recent history of local trauma (e.g. fingernails, branches).

68
Q

Features of a corneal abrasion?

A
  • eye pain
  • lacrimation
  • photophobia
  • foreign body sensation and conjunctival injection
  • decreased visual acuity in the affected eye
69
Q

1st line investigation in corneal abrasion?

A

fluorescein staining

70
Q

What will fluorescein staining typically show in a corneal abrasion?

A

Yellow-stained abrasion (representative of the de-epithelialised surface) which is usually visible to the naked eye

71
Q

1st line mx of a corneal abrasion?

A

Topic abx is recommended to prevent 2ary bacterial infection.

72
Q

What grade hypertensive retinopathy does papilloedema indicate?

A

IV

73
Q

Mx of acute optic neuritis?

A

High dose steroids

74
Q

Classic triad of symptoms of Horner’s?

A

1) miosis
2) ptosis
3) enophthalmos

+/- anhydrosis

75
Q

What is an Argyll-Robertson pupil?

A

Bilaterally small pupils that accommodate but don’t react to bright light.

76
Q

Give 2 causes of Argyll-Robertson pupil

A

1) neurosyphilis
2) diabetes

77
Q

What is Hutchinson’s pupil?

A

Unilaterally dilated pupil which is unresponsive to light

78
Q

Cause of Hutchinson’s pupil?

A

Compression of the occulomotor nerve of the SAME side by an intracranial mass e.g. tumour, haematoma

79
Q

what is a Marcus-Gunn pupil?

A

RAPD, seen during the swinging light examination of pupil response.

The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye.

80
Q

What is a common complication following panretinal laser photocoagulation?

A

Reduction in visual field

81
Q

Mx of a patient with an organic foreign body in their eye e.g. grass seed?

A

Immediate referral to ophthalmology for same-day assessment due to increased infection risk.

82
Q

1st line mx of orbital compartment syndrome?

A

Immediate canthotomy (decompression)

83
Q

1st line mx of Herpes zoster ophthalmicus requires?

A

1) urgent ophthalmological review

2) 7-10 days of oral antivirals e.g. famciclovir, aciclovir

84
Q

What is the best definitive treatment for proliferative retinopathy?

A

panretinal laser photocoagulation

85
Q

Risk factors for vitreous haemorrhage?

A
  • Diabetes
  • Trauma
  • Anticoagulants
  • Coagulation disorders
  • Severe short sightedness
86
Q

Mx of optic neuritis?

A

IM steroids

87
Q

Mx of contact lens wearers who present with a red painful eye?

A

referred urgently to eye casualty to exclude microbial keratitis

88
Q

What is most likely cause of contact lens associated keratitis?

A

Pseudomonas aeruginosa

89
Q

Mx of herpes zoster ophthalmicus?

A

Oral aciclovir

90
Q

What is the definitive treatment for wet ARMD?

A

Anti-VEGF e.g. bevacizumab

91
Q

What is involved in the mx of acute glaucoma?

A

1) reducing aqueous secretion

2) constricting the pupil (this helps to open up the drainage angle and promote outflow)

92
Q

Mx of contact lens wearers who present with a red painful eye?

A

Refer for same day ophthalmology assessment to exclude microbial keratitis

93
Q

What is the 1st line mx of 1ary open angle glaucoma if the IOP ≥24mmHg?

A

Laser trabeculoplasty –> targets trabecular meshwork and improves outflow.

94
Q

What are some potential complications of panretinal photocoagulation?

A

1) decrease in night vision

2) peripheral vision loss

3) increased sensitivity to light

95
Q

Mx of a stye (i.e. hordeolum externum)?

A

Analgesia & warm compress

96
Q

What organism typically causes a stye?

A

Staph. aureus

97
Q

Where can a pancoast tumour cause pain?

A

Shoulder & upper limb pain due to local extension of tumour

98
Q

Describe vision loss in retinal detachment

A

Dense shadow that starts peripherally and progresses towards the centrl vision

99
Q

Mx of anterior uveitis?

A

Topical steroid + cycloplegic/mydriatic drops e.g. atropine

100
Q

Role of beta blockers in 1ary open angle glaucoma e.g. timolol?

A

Reduce aqueous production –> reduce IOP

101
Q

What is Hutchinson’s sign?

A

A rash on tip of nose in herpes zoster –> strongly predictive for ocular involvement

102
Q

RAPD indicates a lesion where?

A

Optic nerve lesion or severe retinal disease

103
Q

In diabetic retinopathy, what do cotton wool spots represent?

A

Areas of retinal infartion

104
Q

How can a vitreous haemorrhage affect vision?

A
  • presents with dark spots obscuring vision/complete loss of vision if bleed is large enough
  • can cause a red hue
105
Q

Mx of a vitreous haemorrhage?

A

Will resolve with time

106
Q

Is metronidazole an enzyme inhibitor or inducer?

A

Inhibitor e.g. increases the anticoagulant effect of warfarin

107
Q

Typical presenting of an oculomotor nerve palsy?

A

‘Down and out’ eye with a fixed (non-reactive to light), dilated pupil.

Palsy of the oculomotor nerve will affect the ipsilateral eye, meaning that a R oculomotor nerve palsy will affect the R eye.

108
Q

What nerve is involved in a patient unable to abduct the left eye and worsening double vision when looking to the left?

A

CN VI palsy

109
Q

mx of acute angle closure glaucoma?

A

1) combination eye drops:
- pilocarpine
- beta blocker e.g. timolol
- alpha agonist e.g. apraclonidine

2) IV acetazolamide

110
Q

role of pilocarpine in AACG?

A

A direct parasympathomimetic

Causes contraction of ciliary muscle –> opens trabecular meshwork –> increases outflow of aqueous humour

111
Q

Role of beta blockers in AACg?

A

Decrease aqueous humour production

112
Q

Role of alpha agonists in AACG?

A

1) decreases aqueous humour production

2) increases uveoscleral outflow

113
Q

Role of IV acetazolamide in AACG?

A

Reduces aqueous secretions

114
Q

Definitive mx of AACG?

A

Laser peripheral iridotomy –> creates a tiny hole in the peripheral iris

115
Q

Topical ivermectin vs topical brimonidine in rosacea?

A

Topical ivermectin –> mild to moderate papules and/or pustules

Topical brimonidine –> predominant flushing but limited telangiectasia

116
Q

Myopia vs hypermetropia in AACG vs POAG?

A

AACG –> associated with hypermetropia

Primary open angle glaucoma –> associated with myopia

117
Q
A

Yr 5 - Ophthalmology (17 decks)

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