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Yr 5 - Ophthalmology > Corrections 2 > Flashcards

Corrections 2 Flashcards

1
Q

What is the most common underlying cause of a vitreous haemorrhage?

A

Proliferative diabetic retinopathy

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2
Q

Mx of proliferative diabetic retinopathy? (2)

A

1) intravitreal VEGF inhibitors

2) panretinal laser photocoagulation

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3
Q

Mx of a corneal abrasion?

A

topical abx to prevent 2ary bacterial infection

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4
Q

What 2 investigations are required to confirm the diagnosis of AACG?

A

1) tonometry (measures IOP)
2) gonioscopy (measures angle)

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5
Q

In what condition are severe retinal haemorrhages seen on fundoscopy?

A

Central retinal vein occlusion –> ‘stormy sunset’

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6
Q

What is a key difference for central retinal vein occlusion (CRVO)?

A

Branch retinal vein occlusion (BRVO)

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7
Q

What happens in BRVO?

A

This occurs when a vein in the distal retinal venous system is occluded and is thought to occur due to blockage of retinal veins at AV crossings.

It results in a more limited area of the fundus being affected.

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8
Q

How to differentiate CRVO from BRVO on fundoscopy?

A

BRVO –> more limited area of fundus is affected

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9
Q

1st line mx of primary open angle glaucoma?

A

360° selective laser trabeculoplasty (SLT) if the IOP is ≥24 mmHg

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10
Q

2nd line mx of 1ary open angle glaucoma?

A

Prostaglandin analogues e.g. latanoprost

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11
Q

Mechanism of action of latanoprost?

A

Increases uveoscleral outflow

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12
Q

Adverse effects of latanoprost (prostaglandin analgoue)?

A

1) brown pigmentation of the iris

2) increased eyelash length

3) periocular pigmentation

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13
Q

Complications of ocular involvement in herpes zoster ophthalmicus?

A
  • anterior uveitis
  • keratitis
  • conjunctivitis
  • episcleritis
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14
Q

Role of cycloplegic eyedrops (e.g. atropine)?

A

Paralysis of ciliary muscle –> dilatation of pupil & paralysis of accomodation.

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15
Q

Mx of anterior uveitis?

A

steroid drops + cycloplegic (mydiatric) drops

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16
Q

Effect of cycloplegic drops on pupil size?

A

Pupil dilation

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17
Q

What is the most common cause of a persistent watery eye in an infant?

A

Nasolacrimal duct obstruction

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18
Q

What ethnicity is a risk factor for 1ary open angle glaucoma?

A

Afro-Caribbean

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19
Q

What are the most common causes of a sudden painless loss of vision?

A

1) Ischaemic/vascular (‘amaurosis fugax’) e.g. thrombosis, embolism, temporal arteritis

2) Central retinal vein occlusion

3) Central retinal artery occlusion

4) Vitreous haemorrhage

5) Retinal detachment

6) Retinal migraine

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20
Q

Causes of amaurosis fugax?

A

1) large artery disease (atherothrombosis, embolus, dissection)

2) small artery occlusive disease (anterior ischemic optic neuropathy, vasculitis e.g. temporal arteritis),

3) venous disease

4) hypoperfusion

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21
Q

Mx of amaurosis fugax?

A

300mg aspirin (may represent a form of TIA)

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22
Q

Typical description of loss of vision in amaurosis fugax?

A

‘Curtain coming down’

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23
Q

Is central retinal artery or vein occlusion more common?

A

Central retinal vein occlusion

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24
Q

Causes of CRVO?

A
  • glaucoma
  • polycythaemia
  • HTN
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25
Cause of CRAO?
Thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
26
Features of CRAO?
1) RAPD 2) 'Cherry red' spot on a pale retina
27
Causes of a vitreous haemorrhage?
1) diabetes 2) bleeding disorders 3) anticoagulants
28
What may precede retinal detachment?
Vitreous detachment
29
Features of a posterior vitreous detachment?
1) Flashes (peripheral vision) 2) Floaters (central vision)
30
Features of retinal detachment?
1) Dense shadow that starts peripherally progresses towards the central vision 2) Straight lines appear curved 3) Central visual loss 4) A veil or curtain over the field of vision
31
Features of vitreous haemorrhage?
- Large bleeds cause sudden visual loss - Moderate bleeds may be described as numerous dark spots - Small bleeds may cause floaters
32
Features of mild non-proliferative diabetic retinopathy (NPDR)?
1 or more microaneurysm
33
Features of moderate NPDR
1) microaneurysms 2) blot haemorrhages 3) hard exudates 4) cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
34
What do cotton cool spots represent?
Areas of retinal infarction
35
Features of severe NPDR?
1) blot haemorrhages and microaneurysms in 4 quadrants 2) venous beading in at least 2 quadrants 3) IRMA in at least 1 quadrant
36
What are the key features of proliferative diabetic retinopathy?
1) retinal neovascularisation - may lead to vitrous haemorrhage 2) fibrous tissue forming anterior to retinal disc 3) more common in Type I DM, 50% blind in 5 years
37
Is proliferative diabetic retinopathy more common in type I or II DM?
Type I DM
38
Prognosis of proliferative diabetic retinopathy?
50% blind in 5 years
39
2 key mx options in proliferative retinopathy?
1) panretinal laser photocoagulation 2) intravitreal VEGF inhibitors
40
Mx of non-proliferative retinopathy?
Mainly regular observation
41
What is the definitive mx for wet ARMD?
Anti-VEGF
42
Features of wet ARMD?
Reduction in visual acuity, particularly for near field objects, worse at night
43
Fundoscopy features in wet ARMD?
Red patches representing intra-retinal or sub-retinal fluid leakage or haemorrhage visible on fundoscopy
44
What classification is used in the diagnosis of hypertensive retinopathy?
Keith-Wagener classification
45
Features of stage I - IV of the Keith-Wagener classification for hypertensive retinopathy?
I: - Arteriolar narrowing and tortuosity - Increased light reflex - silver wiring II: - AV nipping III: - Cotton-wool exudates - Flame & blot haemorrhages IV: - Papilloedema
46
What is a common cause of sudden visual loss in diabetics?
Vitreous haemorrhage
47
Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of what?
acanthamoebic keratitis
48
What is a Holmes-Adie pupil?
A benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.
49
Features of a Holmes-Adie pupil?
- unilateral in 80% of cases - dilated pupil - once the pupil has constricted it remains small for an abnormally long time - slowly reactive to accommodation but very poorly (if at all) to light - association with absent ankle/knee reflexes
50
What is the most common cause of a persistent watery eye in an infant?
Nasolacrimal duct obstruction Symptoms often resolve by 1 year of age
51
Define a hyphema
blood in the anterior chamber of the eye
52
Mx of a hyphema?
warrants urgent referral to an ophthalmic specialist for assessment (especially in the context of trauma)
53
What is the main risk in a hyphema?
Raised IOP
54
Assessment for what should be made for in ocular trauma?
orbital compartment syndrome
55
features of orbital compartment syndrome?
- eye pain/swelling - proptosis - 'rock hard' eyelids - RAPD
56
Mx of orbital compartment syndrome?
urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit
57
Speed of vision loss in wet vs dry ARMD?
Dry: over many years Wet: over weeks/months
58
Is hypermetropia or myopia a risk factor for AACG?
Hypermetropia
59
Mx of AACG?
1) combination of eye drops: - a direct parasympathomimetic (e.g. pilocarpine) - beta blockers e.g. timolol - an alpha-2 agonist (e.g. apraclonidine) 2) IV acetazolamide
60
Definitive mx of AACG?
Laser peripheral iriodtomy
61
When should 360° selective laser trabeculoplasty (SLT) be offered in primary open angle glaucoma?
IOP ≥24mmHg
62
Mx of primary open-angle glaucoma?
1st line --> 360° selective laser trabeculoplasty if IOP ≥24mmHg 2nd line --> prostaglandin eye drops (e.g. latanoprost) 3rd line: - beta blocker eye drops - carbonic anhydrase inhibitor eye drops - sympathomimetic eye drops e.g. brimonidine
63
What can be considered in refractory cases of open angle glaucoma?
trabeculectomy (surgery)
64
When should those with a positive family history of glaucoma be screened annually?
Annually from 40 y/o
65
Most common cause of keratitis in contact lens wearers vs non-contact lens wearers?
Contact lens wearers --> Pseudomonas aeruginosa Non-contact lens wearers --> Staph. aureus
66
Can glaucoma occur in patients with a normal IOP?
Yes
67
What are some causes of mydriasis (large pupil)?
1) third nerve palsy 2) Holmes-Adie pupil 3) traumatic iridoplegia 4) phaeochromocytoma 5) congenital 6) drugs e.g. atropine
68
Define anisocoria
Unequal pupil sizes
69
what does anisocoria that is worse in the light suggest?
Inability of the eye to constrict in response to light
70
What is the parasympathetic ganglion of the eye?
The ciliary ganglion
71
Result of damage to the right ciliary ganglion?
a mydriatic right eye.
72
What is an Argyll-Robertson pupil?
Bilaterally small pupils that accommodate but don't react to bright light.
73
2 causes of an Argyll-Robertson pupil?
1) neurosyphilis 2) diabetes mellitus
74
What is an adie pupil?
Tonically dilated pupil, slowly reactive to light with more definite accommodation response. Commonly seen in females, accompanied by absent knee or ankle jerks.
75
Mx of infective conjunctivitis?
1) normally a self-limiting condition that usually settles without treatment within 1-2 weeks 2) topical antibiotic therapy is commonly offered to patients, e.g. Chloramphenicol. Chloramphenicol drops are given 2-3 hourly initially
76
Alternative to chlormaphenicol in pregnancy?
Topical fusidic acid
77
Mx of infective conjunctivitis in contact lens wearers?
1) topical fluoresceins should be used to identify any corneal staining 2) treatment as above 3) contact lens should not be worn during an episode of conjunctivitis
78
What doe viral conjunctivitis typically follow?
URTI
79
Key features of retinitis pigmentosa?
1) primarily affects the peripheral retina resulting in tunnel vision 2) night blindness is often the initial sign
80
Fundoscopy features of retinitis pigmentosa?
black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
81
Cause of cotton wools spots?
pre-capillary arteriolar occlusion, leading to retinal infarction.
82
What is the leading cause of curable blindness worldwide?
Cataracts
83
What metabolic disorder can cause cataracts?
Hypocalcaemia
84
Features of cataracts?
1) Reduced vision 2) Faded colour vision 3) Glare: lights appear brighter than usual 4) Halos around lights
85
Use of what medication is a risk factor for cataracts?
Steroids
86
Risk factors for cataracts?
- age - smoking - alcohol - trauma - diabetes - steroids - radiation exposure - myotonic dystrophy - hypocalcaemia
87
In anisocoria, it is essential to determine whether this is a result of a problem with dilation (sympathetic) or constriction (parasympathetic). What does anisocoria that is worse in bright light indicate?
Problem with parasympathetic innervation (pupil is unable to constrict properly).
88
Cause of Adie's tonic pupil?
ciliary ganglion dysfunction --> impaired pupil constriction
89
What condition is most commonly associated with scleritis?
RA
90
Fundoscopy findings after pan-retinal photocoagulation?
dark circular scars at the periphery
91
Pupils in Argyll Robertson pupils vs Holmes Adie syndrome?
Argyll Robertson: small and often irregular Holmes Adie: dilated pupils
92
Aiming for pupillary dilation or constriction in AACG?
Constriction.
93
What can be given to slow deterioration of visual loss in dry AMD?
High dose beta-carotene and vitamins C & E
94
Why are prostaglandin analogue eyedrops (including latanoprost) not used in AACG?
Can take up to 8-12 hours to become effective (instead used in primary open-angle glaucoma)
95
Tortuosity and silver wiring are features of what grade hypertensive retinopathy?
Grade 1
96
risk factors for vitreous haemorrhage?
1) Diabetes 2) Trauma 3) Anticoagulants 4) Coagulation disorders 5) Severe short sightedness
97
Mx of herpes zoster ophthalmicus?
1) urgent ophthalmological review 2) 7-10 days of oral antivirals
98
Mechansim of latanoprost?
Increases uveoscleral outflow
99
What is Hutchinson's sign?
Vesicles extending to the tip of the nose --> this is strongly associated with ocular involvement in shingles At risk of anterior uveitis
100

Yr 5 - Ophthalmology (17 decks)

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