Day 3 Ophthalmology Flashcards
Which eye condition is common in diabetics, causing sudden loss of vision?
Vitreous haemorrhage
Nasolacrimal duct obstruction treatment
nasolacrimal duct massage
In which condition do you see central scotoma
optic neuritis
Which condition is associated with hypermetropia?
Which condition is associated with myopia?
Acute angle closure glaucoma is associated with hypermetropia,
Primary open-angle glaucoma is associated with myopia
A 49-year-old woman who is known to have multiple sclerosis presents to see her GP. Her partner has noticed a change in the appearance of her eyes over the past few weeks. On examination she has a ptosis on the left side associated with a small left pupil. Fundoscopy is nomal. What is the most likely diagnosis?
Horner’s
define Mydriasis
Anisocoria is unequal pupil size.
Commonly caused by third nerve palsy
A 65-year-old man with a history of primary open-angle glaucoma presents with sudden painless loss of vision in his right eye. On examination of the right eye the optic disc is swollen with multiple flame-shaped and blot haemorrhages. What is the most likely diagnosis?
Central retinal vein occlusion
Which infective organism causes acute penumonia most in COPD
Haemophilus influenzae
Define Heuristic
A technique, is any approach to problem solving or self-discovery that employs a practical method that is not guaranteed to be optimal
What are The Cardiff Acuity Test and LogMar charts?
alternative methods for testing visual acuity
A 79-year-old gentleman presents with a 3 months history of a red swollen left upper eyelid. He remembers initially developing a bump on the eyelid which was uncomfortable but then got bigger forming a hard lump. He reports no pain currently and has not noted any problems with his vision and the eye itself appears healthy.
A meibomian cyst presents as a firm painless lump in the eyelid
Which of the following is the strongest risk factor for subcapsular cataracts?
steroid use
A 6-year-old girl presents to your general practice surgery with her father.
He describes that for the past year, she develops intermittent flares of red, itchy eyelids.
This appears to bother her most in the mornings.
These episodes normally self-resolve with no intervention, but this flare has been particularly protracted - lasting over a month - and he would like some advice.
She has never experienced any visual changes.
Blepharitis - hot compresses to both eyes
Treatment of ARMD
- vascular endothelial growth factor (VEGF)
- laser photocoagulation
A 22-year-old woman presents with a red painful eye.
She describes the pain as tearing. When asked to scale the degree of pain, she gave a score of 7 out of 10.
She also reported that she uses contact lenses frequently.
microbial keratitis
Contact lens wearers who present with a red painful eye should be referred to eye casualty to exclude microbial keratitis
What is Argyll-Robertson syndrome?
Argyll-Robertson pupil is one of the classic pupillary syndromes.
It is sometimes seen in neurosyphilis.
Typically the pupil accommodates but doesn’t react.
A mnemonic used for the Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
Mechanism of action?
Notes?
Reduces aqueous production and increases outflow
Avoid if taking MAOI or tricyclic antidepressants
Adverse effects include hyperaemia
Which conditions can cause an RAPD?
(3)
Large retinal detachment
central retinal artery/vein occlusion
optic nerve ischaemia
A 50-year-old man presents with red-eye associated with slight watering and mild photophobia. He reports no pain or tenderness and vision is not affected
What is the most likely diagnosis?
Episcleritis
Patient has sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
retinal haemorrhages on fundoscopy, due to increased venous pressure following downstream occlusion.
most common cause of persistent watery eye in infants??
Nasolacrimal duct obstruction
A 67-year-old woman presents to an out-of-hours general practitioner with a painful, red left eye and nausea.
On examination, she has a left-sided, semi-dilated pupil that does not react to light with some surrounding conjunctival injection.
Acute closed-angle glaucoma presents with a fixed dilated pupil with conjunctival injection
A 25-year-old female patient presents to her GP due to a severe throbbing headache which is worst first thing in the morning. This has been happening for several weeks with no response to paracetamol. She has also been vomiting on most mornings and feels that her vision has been blurry.
Her pupils are equal and reactive and systemic examination is normal.
Which of the following would you expect to see on fundoscopy?
Increased intracranial pressure
Papilloedema is associated with blurring of optic disc margin on fundoscopy
How does primary open-angle glaucoma present/?
Primary open-angle glaucoma does not typically present acutely and has a more insidious onset.
Most cases are asymptomatic and if symptoms are noted, it will present as loss of peripheral vision. Pupillary changes are not seen in this case.
A 36-year-old female teacher presents to emergency eye casualty with unilateral right-sided red eye which is acutely painful. She complains of burning pain around the eye, photophobia and you note her eye is tearing excessively. Fluorescein staining shows a linear, branching epithelial defect. She is not a contact lens wearer and she has no past medical history of note.
Which option below is the most appropriate management?
Treatment for herpes simplex keratitis is topical aciclovir
Patient presents with eye pain, and often pain on eye movements.
Optic neuritis
A 75-year-old woman presents to surgery complaining of ‘blurry’ vision in her right eye for the past few months. She also notes that straight lines appear crooked or wavy. This only seem to affect the centre of her right visual field and no problems are noted with the left eye. She has never worn glasses or contact lens. On examination a central scotoma is noted in the right eye.
ARMD
What is Topical sodium cromoglicate used for?
Mast cell stabilizers in allergies
How does Horner’s syndrome present in eyes?
ptosis + constricted pupil = Horner’s
A 75-year-old lady, who has been a diabetic for over 25 years attend her regular follow-up sessions. During the consultation, the lady mentions to her GP that she has had difficulty with her vision over the past few months, especially in the left eye. She described it as a blurry vision and also reported seeing round figures around lights at night. The lady has never had problems with her vision in the past. She currently also takes medications to manage her blood pressure and cholesterol levels. Physical examination is otherwise unremarkable.
This patient has a classic presentation of cataract. The long history of diabetes mellitus in an elderly presentation along with unilateral blurry vision and halos surrounding light sources are strongly suggestive of a diagnosis of cataract.
Miotics (e.g. pilocarpine, a muscarinic receptor agonist)
Mechanism of action?
Notes?
Increases uveoscleral outflow
Adverse effects included a constricted pupil, headache and blurred vision
In ophthalmology, what is Aciclovir used to treat?
viral keratitis
What is “wet ARMD”?
- 10% of cases
- also know as exudative or neovascular macular degeneration
- characterised by choroidal neovascularisation
- leakage of serous fluid and blood can subsequently result in a rapid loss of vision
- carries worst prognosis
An 84-year-old man presents with loss of vision in his left eye since the morning.
He is otherwise asymptomatic and of note has had no associated eye pain or headaches.
His past medical history includes ischaemic heart disease but he is otherwise well.
On examination he has no vision in his left eye. The left pupil responds poorly to light but the consensual light reaction is normal. Fundoscopy reveals a red spot over a pale and opaque retina. What is the most likely diagnosis?
Central retinal artery occlusion
What is this?
A chalazion (Meibomian cyst) is a retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously but some require surgical drainage
Patient complains of “flashes and floaters” with no pain
Retinal detachment
A 73-year-old female presents to her GP with left shoulder and arm pain which came on quite suddenly a week ago and has been worsening. The pain is now unmanageable with regular co-codamol. The GP also notes that the patient’s left pupil is smaller than the other side and the eyelid is lagging slightly.
Pancost’s
characteristics of uveitis
(3)
small, fixed oval pupil, ciliary flush
investigation for cellulitis
Where orbital cellulitis is suspected, a contrast enhanced-CT scan of the orbits, sinuses and brain should be considered to support the diagnosis and to search for possible complications such as abscess which may require surgical drainage.*
A 42-year-old man is diagnosed with syphilis following months of ill health. On examination he is noted to have bilateral small pupils which accommodate but do not respond to light. What is the most likely diagnosis?
Argyll-Robertson pupil
Why might digoxin levels be higher than prescribed?
Digoxin is excreted by the kidneys, CKD patients will build up
Patient presents with a triad of a painful eye, vision loss and impaired colour vision.
optic neuritis
Which condition is associated with hypermetropia?
Which condition is associated with myopia?
Acute angle closure glaucoma is associated with hypermetropia
primary open-angle glaucoma is associated with myopia
On examination, the boy appears unsettled and is crying constantly.
His temperature is 38°C and other vital signs are normal.
On examination of the affected eye, the eyelid is erythematous and oedematous.
Proptosis of the left eye is noted and there seems to be limited ocular movement as well.
orbital cellulitis
A 30-year-old woman presents with a 2 day history of a painless red eye. She is otherwise well and has not noticed a decrease in her vision. The patient has no past medical history of note and is not on any long-term medications. On examination, her eyes are red and injected bilaterally. Upon applying light pressure on her eye with a cotton bud, you notice that the injected vessels seem to move.
Episcleritis
glaucoma characteristics
(3)
severe pain, haloes, ‘semi-dilated’ pupil
differences between orbital and periorbital cellulitis
Periorbital (preseptal):
Absence of painful movements, diplopia and visual impairment indicates the former
A 31-year-old man presents with a painful swelling of his right upper eyelid for the past 3 days. On lifting the eyelid a yellow head pointing at the lid margin can be seen.
Stye
