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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
Q

Cause of CRAO?

A

Thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)

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26
Q

Features of CRAO?

A

1) RAPD

2) ‘Cherry red’ spot on a pale retina

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27
Q

Causes of a vitreous haemorrhage?

A

1) diabetes
2) bleeding disorders
3) anticoagulants

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28
Q

What may precede retinal detachment?

A

Vitreous detachment

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29
Q

Features of a posterior vitreous detachment?

A

1) Flashes (peripheral vision)

2) Floaters (central vision)

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30
Q

Features of retinal detachment?

A

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

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31
Q

Features of vitreous haemorrhage?

A
  • Large bleeds cause sudden visual loss
  • Moderate bleeds may be described as numerous dark spots
  • Small bleeds may cause floaters
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32
Q

Features of mild non-proliferative diabetic retinopathy (NPDR)?

A

1 or more microaneurysm

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33
Q

Features of moderate NPDR

A

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

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34
Q

What do cotton cool spots represent?

A

Areas of retinal infarction

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35
Q

Features of severe NPDR?

A

1) blot haemorrhages and microaneurysms in 4 quadrants

2) venous beading in at least 2 quadrants

3) IRMA in at least 1 quadrant

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36
Q

What are the key features of proliferative diabetic retinopathy?

A

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

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37
Q

Is proliferative diabetic retinopathy more common in type I or II DM?

A

Type I DM

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38
Q

Prognosis of proliferative diabetic retinopathy?

A

50% blind in 5 years

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39
Q

2 key mx options in proliferative retinopathy?

A

1) panretinal laser photocoagulation

2) intravitreal VEGF inhibitors

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40
Q

Mx of non-proliferative retinopathy?

A

Mainly regular observation

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41
Q

What is the definitive mx for wet ARMD?

A

Anti-VEGF

42
Q

Features of wet ARMD?

A

Reduction in visual acuity, particularly for near field objects, worse at night

43
Q

Fundoscopy features in wet ARMD?

A

Red patches representing intra-retinal or sub-retinal fluid leakage or haemorrhage visible on fundoscopy

44
Q

What classification is used in the diagnosis of hypertensive retinopathy?

A

Keith-Wagener classification

45
Q

Features of stage I - IV of the Keith-Wagener classification for hypertensive retinopathy?

A

I:
- Arteriolar narrowing and tortuosity
- Increased light reflex - silver wiring

II:
- AV nipping

III:
- Cotton-wool exudates
- Flame & blot haemorrhages

IV:
- Papilloedema

46
Q

What is a common cause of sudden visual loss in diabetics?

A

Vitreous haemorrhage

47
Q

Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of what?

A

acanthamoebic keratitis

48
Q

What is a Holmes-Adie pupil?

A

A benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.

49
Q

Features of a Holmes-Adie pupil?

A
  • 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
Q

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

A

Nasolacrimal duct obstruction

Symptoms often resolve by 1 year of age

51
Q

Define a hyphema

A

blood in the anterior chamber of the eye

52
Q

Mx of a hyphema?

A

warrants urgent referral to an ophthalmic specialist for assessment (especially in the context of trauma)

53
Q

What is the main risk in a hyphema?

A

Raised IOP

54
Q

Assessment for what should be made for in ocular trauma?

A

orbital compartment syndrome

55
Q

features of orbital compartment syndrome?

A
  • eye pain/swelling
  • proptosis
  • ‘rock hard’ eyelids
  • RAPD
56
Q

Mx of orbital compartment syndrome?

A

urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit

57
Q

Speed of vision loss in wet vs dry ARMD?

A

Dry: over many years

Wet: over weeks/months

58
Q

Is hypermetropia or myopia a risk factor for AACG?

A

Hypermetropia

59
Q

Mx of AACG?

A

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
Q

Definitive mx of AACG?

A

Laser peripheral iriodtomy

61
Q

When should 360° selective laser trabeculoplasty (SLT) be offered in primary open angle glaucoma?

A

IOP ≥24mmHg

62
Q

Mx of primary open-angle glaucoma?

A

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
Q

What can be considered in refractory cases of open angle glaucoma?

A

trabeculectomy (surgery)

64
Q

When should those with a positive family history of glaucoma be screened annually?

A

Annually from 40 y/o

65
Q

Most common cause of keratitis in contact lens wearers vs non-contact lens wearers?

A

Contact lens wearers –> Pseudomonas aeruginosa

Non-contact lens wearers –> Staph. aureus

66
Q

Can glaucoma occur in patients with a normal IOP?

A

Yes

67
Q

What are some causes of mydriasis (large pupil)?

A

1) third nerve palsy
2) Holmes-Adie pupil
3) traumatic iridoplegia
4) phaeochromocytoma
5) congenital
6) drugs e.g. atropine

68
Q

Define anisocoria

A

Unequal pupil sizes

69
Q

what does anisocoria that is worse in the light suggest?

A

Inability of the eye to constrict in response to light

70
Q

What is the parasympathetic ganglion of the eye?

A

The ciliary ganglion

71
Q

Result of damage to the right ciliary ganglion?

A

a mydriatic right eye.

72
Q

What is an Argyll-Robertson pupil?

A

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

73
Q

2 causes of an Argyll-Robertson pupil?

A

1) neurosyphilis
2) diabetes mellitus

74
Q

What is an adie pupil?

A

Tonically dilated pupil, slowly reactive to light with more definite accommodation response.

Commonly seen in females, accompanied by absent knee or ankle jerks.

75
Q

Mx of infective conjunctivitis?

A

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
Q

Alternative to chlormaphenicol in pregnancy?

A

Topical fusidic acid

77
Q

Mx of infective conjunctivitis in contact lens wearers?

A

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
Q

What doe viral conjunctivitis typically follow?

A

URTI

79
Q

Key features of retinitis pigmentosa?

A

1) primarily affects the peripheral retina resulting in tunnel vision

2) night blindness is often the initial sign

80
Q

Fundoscopy features of retinitis pigmentosa?

A

black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

81
Q

Cause of cotton wools spots?

A

pre-capillary arteriolar occlusion, leading to retinal infarction.

82
Q

What is the leading cause of curable blindness worldwide?

A

Cataracts

83
Q

What metabolic disorder can cause cataracts?

A

Hypocalcaemia

84
Q

Features of cataracts?

A

1) Reduced vision

2) Faded colour vision

3) Glare: lights appear brighter than usual

4) Halos around lights

85
Q

Use of what medication is a risk factor for cataracts?

A

Steroids

86
Q

Risk factors for cataracts?

A
  • age
  • smoking
  • alcohol
  • trauma
  • diabetes
  • steroids
  • radiation exposure
  • myotonic dystrophy
  • hypocalcaemia
87
Q

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?

A

Problem with parasympathetic innervation (pupil is unable to constrict properly).

88
Q

Cause of Adie’s tonic pupil?

A

ciliary ganglion dysfunction –> impaired pupil constriction

89
Q

What condition is most commonly associated with scleritis?

A

RA

90
Q

Fundoscopy findings after pan-retinal photocoagulation?

A

dark circular scars at the periphery

91
Q

Pupils in Argyll Robertson pupils vs Holmes Adie syndrome?

A

Argyll Robertson: small and often irregular

Holmes Adie: dilated pupils

92
Q

Aiming for pupillary dilation or constriction in AACG?

A

Constriction.

93
Q

What can be given to slow deterioration of visual loss in dry AMD?

A

High dose beta-carotene and vitamins C & E

94
Q

Why are prostaglandin analogue eyedrops (including latanoprost) not used in AACG?

A

Can take up to 8-12 hours to become effective (instead used in primary open-angle glaucoma)

95
Q

Tortuosity and silver wiring are features of what grade hypertensive retinopathy?

A

Grade 1

96
Q

risk factors for vitreous haemorrhage?

A

1) Diabetes
2) Trauma
3) Anticoagulants
4) Coagulation disorders
5) Severe short sightedness

97
Q

Mx of herpes zoster ophthalmicus?

A

1) urgent ophthalmological review
2) 7-10 days of oral antivirals

98
Q

Mechansim of latanoprost?

A

Increases uveoscleral outflow

99
Q

What is Hutchinson’s sign?

A

Vesicles extending to the tip of the nose –> this is strongly associated with ocular involvement in shingles

At risk of anterior uveitis

100
Q
A

Yr 5 - Ophthalmology (17 decks)

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