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Ophthalmology for Finals > Disorders of vision > Flashcards

Disorders of vision Flashcards

1
Q

What are the risk factors for cataracts?

A
  • diabetes
  • age
  • smoking
  • steroid use
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2
Q

What happens to the eye in cataracts?

A

there is protein aggregation leads to lens opacification. This means that light is scattered as it enters

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3
Q

What are the signs and symptoms of cataracts?

A
  • gradual painless vision loss
  • glare (lights appear brighter)
  • haloes
  • myopic shift (increased short sightedness)
  • loss of red reflex
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4
Q

When and how is cataracts managed?

A

No set point so when the patient feels it is interfering with their life
- Phacoemulsification (anterior capsule, nucleus and cortex removed and a prosthetic one inserted that is supported by posterior capsule)

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5
Q

What are the complications of cataract surgery?

A
  • posterior capsule opacification

- posterior capsule rupture leading to vitreous prolapse and retinal detachment

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6
Q

Compare the pathophysiology of open and closed angle glaucoma

A

open: open irido-corneal angle but a blockage in the trabecular meshwork leading to reduced flow
closed: blocked irido-corneal angle with the lens pushed against the iris

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7
Q

What are the risk factors for open angle glaucoma

A
  • Afro Caribbean
  • family history
  • myopes
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8
Q

What is the symptom of open angle glaucoma?

A

gradual, painless, peripheral vision loss

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9
Q

How would you investigate open angle glaucoma and what are the results?

A
  • Raised IOP
  • visual field defect
  • optic disc cupping, pallor and bayoneting of vessels
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10
Q

Aside from primary idiopathic open angle glaucoma, what else can cause it?

A
  • steroids
  • neovascularisation in the drainage angle
  • pigment deposits
  • pseudoproliferative deposits (dandruff like material)
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11
Q

What are the risk factors/ causes of closed angle gluacoma?

A
  • age (lens grows so pushes the iris forward and narrows the angle)
  • hypermetropes (naturally narrow angle)
  • asian
  • pupil dilation (iris pushed forward)
  • alpha agonists, antimuscarinics, TCAs
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12
Q

What are the symptoms or closed angle glaucoma and what does the eye look like?

A

Acutely painful eye with blurring and loss of vision
+/- coloured haloes around lights
+/- nausea and vomiting

Eye: fixed oval mid-dilated pupil, red, hazy cornea

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13
Q

What is the definitive management of closed angle glaucoma and how is it managed in the mean time?

A

Laser iridotomy

Pilocarpine topical drops
Acetazolamide
Analgesia and antiemetics

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14
Q

What topical drops are used in the management of open angle glaucoma? How do they work?

A
  1. Latanoprost: prostaglandin analogue that increases uveoscleral flow
  2. Timolol: b-blocker that reduced aqueous production by the ciliary body
  3. Pilocarpine: miotic that contracts the ciliary muscle and opens the trabecular meshwork
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15
Q

What are some general side effects of topical drops used in glaucoma?

A
  • red eye
  • dry eye
  • irritation
  • can get systemic absorption (timolol is CI in asthma, latanoprost in CI in pregnancy)
  • allergic reaction to preservative used
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16
Q

What are the risk factors for ARMD?

A

CVS risk factors: smoking, diabetes, obesity

17
Q

What are the signs and symptoms of ARMD? What are some specific ones to dry and wet?

A
  • Painless central vision loss
  • difficulty adapting from light to dark
  • inability to discern colour shades

Dry: vision loss is especially to small print
Wet: sudden onset, straight lines appear curvy

18
Q

How does dry ARMD appear on fundoscopy?

A

Drusen (yellow deposits)
Macula scar (thick yellow patch)
Hypo/ hyperpigmentation of the peripheral retina

19
Q

How does wet ARMD appear on fundoscopy?

A

Neovascularisation with haemorrhages

20
Q

What is the management of wet ARMD?

A

Anti-VEGF

21
Q

What is the inheritance pattern of retinitis pigmentosa?

A

x- linked recessive

22
Q

What are the symptoms of retinitis pigmentosa?

A

Peripheral vision loss - tunnel vision

Night blindness

23
Q

What is seen on fundoscopy of retinitis pigmentosa?

A

Black spicules on the peripheral retina and a waxy looking disc

24
Q

What is a retinoblastoma and what are the examination findings?

A

Cancer originating from the retinal cells seen in children typically about 18 months

  • Leukocoria (whitening of the eye) leading to loss of red reflex
  • Strabismus
  • Eye watering
25
Q

What is retinal detachment and what are the various pathophysiology’s leading to it?

A

NEURO RETINA DETACHED FROM PIGMENTED

Age related vitreous shrinkage = posterior vitreous detachment = retinal tear = fluid seeps under leading to detachment

Scarring and fibrosis seen in diabetics and can pull the retina away

Fluid accumulating beneath the retina but with no tear - seen in ARMD and tumours

26
Q

What are the symptoms of retinal detachment? What may this be preceded by?

A

Painless peripheral progressing to central vision loss occurring over hours

Can can flashes and floaters leading up to this episode indicating posterior vitreous detachment

27
Q

How is retinal detachment diagnosed?

A

OTC

28
Q

How is a retinal tear managed? How is retinal detachment managed?

A

Retinal tear: laser therapy to make adhesions between the neural and pigmented layers

Retinal detachment: inject air or oil in to the vitreous to push the retina back

29
Q

What are the complications of retinal detachment?

A
  • posterior vitreous haemorrhage
  • permanent vision loss
  • scar tissue from surgery leading to a secondary detachment
  • macula oedema
30
Q

What are the causes/ risk factors for vitreous haemorrhage?

A
  • retinal detachment
  • diabetic retinopathy
  • anticoagulants
31
Q

What are the symptoms of vitreous haemorrhage?

A

painless red tinged vision and dark spots

32
Q

What are the risk factors/ causes of retinal artery occlusion?

A
  • atherothrombus
  • embolism from internal carotids
  • giant cell arteritis
  • cocaine
  • thrombophilia’s
33
Q

What is the symptom of retinal artery occlusion? What may this be preceded by?

A

Painless sudden loss of vision on a background of amaurosis fugax

34
Q

What is seen on fundoscopy in retinal artery occlusion?

A

Pale retina with cherry red spot

35
Q

How can retinal artery occlusion be managed?

A
  • ocular massage
  • inhale high CO2 (paper bag breathing)
  • topical drops
36
Q

What are the risk factors for retinal vein occlusion?

A
  • hyperlipidaemia
  • diabetes
  • inflammatory diseases
  • hyper viscosity eg myeloma, PV
37
Q

What are the symptoms of retinal vein occlusion?

A

Painless vision loss often starting on waking up

38
Q

What is seen on fundoscopy in retinal vein occlusion?

A
  • dilated, tortuous vessels
  • flame haemorrhages
  • cotton wool spots
39
Q

What are the complications of retinal vein occlusion?

A

macula oedema and retinal neovascularisation due to hypoxia

Ophthalmology for Finals (8 decks)

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