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Eye ENT Patho > Eye > Flashcards

Eye Flashcards

1
Q

Anterior segment components (5)

A

Cornea, conjunctiva, iris, ciliary body, crystalline lens

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2
Q

Posterior segment components (5)

A

Retina, choroid, sclera, vitreous humour, optic nerve

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3
Q

Corneal transplant now transplants the ___ layer of the cornea

A

endothelial layer (endothelial keratoplasty)

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4
Q

What forms the angle of the anterior chamber? What lies within the angle?

A

Corner between cornea, sclera, iris and ciliary body

Trabecular meshwork

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5
Q

Accommodation reflex of the lens

A

Far distance: ciliary muscles relax, suspensory ligaments become taut, lens become less convex

Near distance: ciliary muscles contract, suspensory ligaments become loose, lens become more convex

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6
Q

__ are for light vision, ___ for colour vision

A

rods
cones

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7
Q

Fovea
- highest density of __
- no ___

A

cones, rods

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8
Q

Optic disc is more __, macula is located __ to optic disc, in between ___ and ___

A

nasal
temporal

superior and inferior arcades

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9
Q

Fibres of optic radiation in the ___ lobe (aka ___ loop) represent the superior visual field. (pie in the sky)

A

temporal lobe
Meyer’s loop

contralateral superior homonymous quadrantanopia

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10
Q

Fibres of optic radiation in the ___ lobe (aka ___ loop) represents the inferior visual field. (pie on the floor)

A

parietal lobe
Baum’s loop

contralateral inferior homonymous quadrantanopia

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11
Q

Homonymous hemianopia is caused by ___ lesions. The ___ the lesion from the chiasm, the more ___ the hemianopia.

A

retrochiasmal lesions

further from chiasm, more congruent lesion (VF defect looks the same on both sides)

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12
Q

Name the parts of the visual pathway

A

Optic nerve -> optic chiasm -> optic tract -> lateral geniculate body -> optic radiation -> occipital lobe

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13
Q

What defect causes bitemporal hemianopia

A

Chiasmal lesions

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14
Q

What defect causes homonymous hemianopia with macular sparing?

A

Defect in the occipital lobe from PCA infarct with MCA intact

Tip of occipital lobe serves central visual field. Supplied by both MCA and PCA

Large occipital lobe damage can cause loss of macular sparing too

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15
Q

Patients with defect in superior visual field -> suspect ___ -> check for concomitant ___

A

pituitary adenoma
hyperprolactinemia (galactorrhea, gynaecomastia, amenorrhea)

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16
Q

Snellen chart 6/20 means?

A

At 6 metres, patient can see what a normal person can see at 20m

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17
Q

What is the pinhole effect?

A

focuses light by blocking peripheral light rays, corrects refractive errors up to -4D or +4D but cannot overcome organic/structural disease

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18
Q

Eyelid turn inwards: ___
eyelid turn outwards: ___

A

entropion
ectropion

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19
Q

Use ___ in ___ light to highlight corneal epithelial defects

A

Fluorescein strips in cobalt blue light

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20
Q

What is hyphema

A

Collection of blood in anterior portion of iris

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21
Q

what is hypopyon

A

Collection of leukocytic exudate in anterior portion of iris

seen in inflammatory conditions (eg uveitis) or infections (endopthalmitis)

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22
Q

What is the eclipse sign?

A

Shine light from temporal aspect of cornea towards nose to see width of shadow of iris in nasal area

Shadow broad = anterior chamber shallow = angle may be narrow = risk of angle closure glaucoma

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23
Q

What are the pupillary reflexes

A

Direct light reflex
Consensual
Relative afferent pupillary defect (RAPD)
Light near dissociation

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24
Q

Do the ___ to check for strabismus

A

Hirschberg corneal light reflex

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25
Q

What to look out for when checking optic disc

A

Colour: pink
Cup-disc ratio: normal = 0.3
Contour: edges
Margins: clear, blurred

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26
Q

Myopia = eyeball ___
hypermetropia = eyeball ___
astigmatism =
presbyopia =

A

myopia - eyeball long, light rays focused in front of retina

hypermetropia - eyeball short, light rays focus behind retina

astigmatism = inequality in refractive surface of the eye along 1 axis (rugby ball shape)

presbyopia = loss of lens elasticity and convexity due to aging, loss of accommodative ability

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27
Q

Prescription

Spherical = degree of ___
Cylinder = degree of ___
Axis =

A

myopia/hypermetropia
astigmatism
axis at which astigmatism power lies

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28
Q

Causes of acute visual loss (media opacity causes)

A

Media opacity
- painful, red: corneal ulcer, endopthalmitis, uveitis, acute angle-closure glaucoma

  • painless, not red: vitreous haemorrhage
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29
Q

Causes of acute visual loss (retinal disease)

A

retinal detachment

painless:
- retinal vein occlusion
- retinal artery occlusion

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30
Q

Causes of acute visual loss (optic nerve disorders)

A

inflammatory:
- pain with ocular movement: optic neuritis

ischemic:
- painless: ischemic optic neuropathy

compressive optic neuropathy

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31
Q

Causes of chronic visual loss

A

Glaucoma - peripheral vision loss

age related macular degeneration - central vision loss

cataracts - general blurring

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32
Q

10 differentials for red eye

A

1) Allergic conjunctivitis
2) Infection: blepharitis, cellulitis, conjunctivitis, keratitis, endopthalmitis
3) Inflammation: episcleritis, scleritis, uveitis
4) Trauma: FB, chemical injury
5) Glaucoma

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33
Q

papillae vs follicles

A

1) papillae
- fibrovascular mounds with central vascular tuft
- seen in allergic conjunctivitis

2) follicles
- small translucent, avascular mounds of plasma cells and lymphocytes
- seen in viral keratoconjunctivitis

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34
Q

Only ___ and ___ problems causes RAPD

A

retina
optic nerve

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35
Q

Methods to assess visual acuity in preverbal children

A
  • Observe fixation and following
  • Fixation preference: getting upset when good eye is occluded
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36
Q

__ cards to test forced preferential looking in children 6mo-2yo

A

Teller

Striped patterns on one side appeal more to child, child looks at stripe over plain

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37
Q

Snellen chart used in children more than __

A

4yo

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38
Q

Pathophysiology of amblyopia?

A

Abnormal visual stimulation during visual development -> disruption in development of lateral geniculate nucleus and primary visual cortex

Unilateral: difference in BCVA is 2 or more Snellen lines

Bilateral: BCVA of 6/12 or less

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39
Q

Causes of amblyopia

A

1) Strabismus
- child’s brain suppresses image from non-fixating eye to avoid diplopia
- cortical suppression of sensory input from eye

2) Stimulus deprivation
- occlusion of visual axis (eg. cataract, ptosis)

3) Refractive error
- anisometropia (difference in 2 eyes): hyperopia >1.5D, myopia > -3-4D, astig >1.5D
- ametropia (both eyes high deg): hyperopia >5D, myopia <-8D

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40
Q

Tx of amblyopia

A

1) Occlusion therapy
- Gold standard
- Cover good eye to force fixation by amblyopic eye

2) Provide clear retinal image
- identify and correct refractive error with spectacles
- remove obstacles in vision (eg. ptosis, cataracts)

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41
Q

Treatment of amblyopia is critical before __ years old

A

8 years old
Best to correct during infancy/childhood

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42
Q

Inward deviation of eye known as ___

Outward deviation known as ___

A

esotropia

exotropia

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43
Q

___ most common strabismus in children

A

Intermittent exotropia
- more apparent when child is tired/daydreaming

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44
Q

How to assess strabismus

A

1) Hirschberg corneal light reflex
- 1mm deviation = 7 degree squint

2) Cover-uncover

3) Alternate cover

4) Stereopsis - depth perception

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45
Q

Cx of strabismus

A

1) Amblyopia - deviated eye

2) Poor binocular vision - ability to appreciate depth or stereovision

3) Abnormal head posture

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46
Q

Comitant vs incomitant strabismus

A

Comitant
- non-paralytic
- congenital, accomodative, intermittent

Incomitant
- paralytic, eye movement limited from EOM paralysis

47
Q

What is leukocoria

A

White reflex - needs urgent referral

Absent red reflex also needs to be referred

48
Q

Causes of leukocoria

A

1) Retinoblastoma
2) Congenital cataracts
3) Retinopathy of prematurity

49
Q

Features of retinoblastoma

A
  • Presents ~18 months
  • RB1 gene on chr 13q14
  • Features: leukocoria, strabismus, reduced vision, change in eye appearance, eye pain
50
Q

Secondary cause of cataracts in children

A

TORCH infections
Trauma
Drug exposure
RB
Radiation

51
Q

What is retinopathy of prematurity? Risk factors

A

Abnormal vascularisation of retina in premature child

RF:
- early gestational age, low birth weight
- Supplemental O2
- Unstable clinical course post delivery

52
Q

Triad seen in congenital glaucoma

A

Blepharospasm - squeezing of eyes

Epiphora - tearing

Photophobia

53
Q

Causes of ophthalmia neonatorum

A

1) Neisseria gonorrhea (3-5 days after birth)
- can cause corneal perf

2) Chlamydia trachomatis (5-14 days after birth)

3) HSV (1-2 weeks)

54
Q

Trichiasis vs distichiasis

A

Trichiasis - normal eyelashes growing posteriorly towards eye

Distichiasis - eyelashes growing at abnormal positions

55
Q

The Valve of ___ fails to open in congenital nasolacrimal duct obstruction

A

Hasner - closed at birth and opens by 1st month of life

56
Q

Stye vs chalazion

A

Stye
- blocked oil gland on edge of eyelid
- staphylococcal abscess of lash follicles and associated glands

Chalazion
- infected meibomian gland
- nodule within tarsal plate

57
Q

Features of preseptal cellulitis

A
  • infection of subcutaneous tissue anterior to orbital septum
  • due to periorbital trauma or dermal infection
  • erythema, eyelid tenderness
  • usually NO systemic illness

tx: oral augmentin, warm compress, topical abx

58
Q

features of orbital cellulitis

A
  • SIGHT & LIFE THREATENING EMERGENCY
  • infection & inflammation within orbital cavity
  • usually spread from ethmoidal sinuses
  • pain, proptosis, chemosis, opthalmoplegia
  • decreased visual acuity, RAPD
  • FEVER/toxicity
  • requires admission and septic workup, CT orbits
  • IV abx, abscess drainage
59
Q

Conjunctivitis caused by ___ can lead to corneal perforation

A

neisseria gonorrheae

60
Q

What is endopthalmitis

A

Infection of vitreous and aqueous humour

  • secondary to trauma, ocular surgery, immunocompromised states
61
Q

Important to ___ when evaluating for foreign body

A

flip the eyelid

62
Q

In chemical injuries, ___ is more damaging to the eye than ___

A

alkali - saponification of fatty acids in tissue

acid - coagulates tissue proteins, layers of precipitated protein buffers and limits acid penetration through cornea

63
Q

What is enopthalmos

A

Eye sinking deeper into socket secondary to orbital floor fracture

64
Q

How does diabetes cause diabetic retinopathy

A

hyperperfusion -> increase in shear stress -> damage to pericytes -> capillary leakage -> exudation and oedema

advanced glycation end prodycts -> microvascular occlusions -> hypoxia -> ischemia

65
Q

Features of mild NPDR

A

microaneurysms due to weakened arterioles/capillaries

66
Q

Features of moderate NPDR

A

flame-shaped haemorrhages
dot-blot haemorrhages
hard exudates - leakage of proteins and lipids from microaneurysms
retinal oedema

67
Q

features of severe NPDR

A

4-2-1 rule (any of the following)

4 quadrants of dot blot haemorrhages
2 quadrants of venous beading, looping, segmentation
1 quadrant of intraretinal microvascular abnormalities (IRMA) - dilated vessels

cotton wool spots

68
Q

What are cotton wool spots and what do they indicate

A

Nerve fibre infarcts from local ischemia

indicates severe NPDR, hypertensive retinopathy

69
Q

ways diabetes can present in the eye

A
  • non-proliferative diabetic retinopathy
  • diabetic maculopathy (macular oedema)
  • proliferative diabetic retinopathy
70
Q

what is proliferative diabetic retinopathy

A

neovascularisation as a response to retinal ischemia

New vessels at disc (NVD)
New vessels elsewhere (NVE) - grows from arterial arcades

71
Q

Complications of proliferative DR

A
  • abnormal vessels break, causing vitreous haemorrhage (floaters, vision loss)
  • hard exudates cause tractional retinal detachment
71
Q

Management of diabetic retinopathy

A
  • optimise systemic risk factors
  • pan-retinal photocoagulation
  • macular laser
  • surgery: vitrectomy
72
Q

Principle of pan retinal photocoagulation

A

Kill peripheral tissue -> reduce blood demand in the peripheries of the retina -> ensure sufficient blood flow to central retina -> preserve central vision

73
Q

Features of hypertensive retinopathy

A

1) Arteriolar narrowing - AV nipping (constriction at junctions where arterioles and venules cross)

2) cotton wool spots

3) silver wiring - arterioles where central light reflex occupies entire width

4) optic disc oedema

74
Q

What is seen in retinal photograph of central retinal artery occlusion

A

Cherry red spot (blood supply to fovea is by separate artery)
Pale retina
attenuation of retinal arterioles

75
Q

What is seen in retinal photograph of central retinal vein occlusion

A

Blood and thunder appearance (flame and blot haemorrhages)
Cotton wool spots
Vascular tortuosity

76
Q

Investigations in thyroid eye disease

A

thyroid panel

CT orbit - fusiform enlargement of extraocular muscles that SPARES TENDON INSERTIONS

77
Q

In patients with MG, always do a ___ to look for ___

A

CT/MRI of anterior mediastinum
thymoma (15% have)

78
Q

Most common eye infection in AIDS patients

A

CMV retinitis

  • cheese and ketchup appearance (thick white infiltrate with retinal haemorrhage)
  • others: kaposi’s sarcoma, molluscum, herpes zoster, syphilis
79
Q

Keratoconjunctivitis sicca (aka ____) is seen in ___ and ___

A

dry eyes

rheumatoid arthritis
systemic lupus erythematosus

80
Q

Nerve impulses in the afferent pathway of the pupillary light reflex are consolidated at the ____ before being transmitted to the efferent pathway

A

Edinger-Westphal nucleus

81
Q

Ways to test visual field (clinical and objective)

A

Clinic
1) Amsler chart - central vision
2) Confrontation - finger counting, hand movement, light perception
3) Red targets - colour saturation less in visual defect

Objective
- humphrey perimeter (most sensitive, used nowadays)
- bjerumm screen
- goldmann perimeter

82
Q

Defects in parasympathetic efferent pathway causes anisocoria worse in ___ light, due to failure in ___

Defective side has pupil that is ___ than normal

A

bright

fail to constrict

larger

83
Q

Defects in sympathetic efferent pathway causes anisocoria worse in ___ light, due to failure in ___

Defective side will have pupil that is ___ than normal

A

low light
fail to dilate

smaller

84
Q

Causes of parasympathetic anisocoria

A

3rd nerve palsy
- dilated pupil + partial ptosis + affected eye rests at down and out position

Adie’s tonic pupil

Traumatic rupture of pupillary sphincter

85
Q

How to test for correction of parasympathetic anisocoria?

A

Administer pilocarpine eyedrops

  • 3rd nerve palsy: will constrict with 1% pilocarpine
  • Adie’s: will constrict with 0.1% pilocarpine
  • Traumatic: will not constrict
86
Q

Triad seen in Horner’s syndrome

A

Ptosis, miosis (constricted pupil), anhidrosis

Defect in sympathetic efferent pathway -> constricted pupil that fails to dilate in the dark

87
Q

What can cause diplopia (classify)

A

Extraocular muscle disease
- thyroid eye, myositis

NMJ disease
- MG

Oculomotor nerve disease
- CN 3, 4, 6 palsy

Brain disease
- progressive supranuclear palsy

88
Q

In suspected 3rd nerve palsy, always check for ___. Reason?

A

pupil involvement

Nerve fibers in CN3 supplying pupils are more peripheral

Compressive structures would compress these fibers first -> pupil involvement (dilation)

Ischemia would affect central CN3 fibers first -> no pupil involvement

89
Q

In CN 6 palsy, need to exclude ___, as this causes ____

A

raised ICP

CN6 to be stretched along sharp edge of petrous temporal bone

90
Q

What happens in acute angle closure glaucoma

A

Peripheral iris blocks outflow of aqueous humour from posterior to anterior chamber

due to shallow anterior chamber, thicker lens

RF
- female
- age >60 yrs
- hypermetropia (far-sightedness)
- racial group (eskimos > asians > caucasians)

91
Q

Signs of acute angle closure glaucoma

A

Circumciliary injection
Semi-dilated, non-reactive pupil
Raised IOP - eye feels hard
Corneal oedema - can cause acute vision loss

Gonioscopy shows narrow angles

92
Q

Types of retinal detachment

A

Rhegmatogenous
- retinal tear: tear in retina allows vitreous fluid to separate neurosensory retina from underlying retinal pigment epithelium

Non-rhegmatogenous
- exudative
- tractional

93
Q

Risk factors for rhegmatogenous retinal detachment

A
  • high myopia
  • acute posterior vitreous detachment
  • advanced age
  • trauma
  • retinal degeneration
94
Q

Sx of retinal detachment

A
  • flashes, floaters
  • partial visual field defect
  • +- RAPD
95
Q

How to treat retinal detachment

A

Relief traction - scleral buckle, vitrectomy

Seal breaks - photocoagulation, cryotherapy

96
Q

What causes cataracts

A

opacification of crystalline lens

97
Q

Steroid use is associated with ____ cataracts

A

Posterior subcapsular cataract

98
Q

Complications of cataracts

A
  • increased myopia
  • monocular diplopia

(leakage of lens proteins causes)
- lens induced glaucoma
- uveitis

99
Q

Types of cataract surgery

A

1) intra-capsular
- lens + capsule removed

2) extra-capsular
- capsule retained, allows IOL implantation
- large wound, prolonged recovery

3) phacoemulsification
- ultrasound to emulsify cataract
- irrigation + aspiration to remove residue
- small wound, no sutures, quicker recovery

100
Q

Types of intraocular lens

A

1) monofocal: vision at specified distance
2) multifocal: vision at various distances

+ toric: to reduce astigmatism

101
Q

Glaucoma causes ___, which can lead to ___ and ___

A

raised intraocular pressure

optic nerve damage and visual field loss

102
Q

What happens in primary open angle glaucoma

A

Cornea is not near iris, but aqueous humour not draining due to issues with trabecular meshwork

103
Q

Glaucoma presents with loss of ___ vision, becomes ____ when advanced

A

loss of peripheral vision

tunnel vision

104
Q

Triad in assessment of glaucoma

A

Increased optic disc cupping
- cup-disc ratio >0.3-0.4

Raised intraocular pressure
- measured with tonometer

Visual field defect
- Humphrey perimetry test

105
Q

Acute management of glaucoma

A

Topical eyedrops
- beta blockers (timolol) : reduce aqueous production

  • prostaglandin analogues (xalatan): increase uvoscleral outflow
  • miotics (pilocarpine): open trabecular meshwork
  • carbonic anhydrase inhibitor (dorzolamide)
106
Q

Definitive management of glaucoma

A

Peripheral laser iridotomy - closed angle

Trabeculoplasty - open angle

Trabeculectomy - creation of fistula between anterior chamber and sub-conjunctival space

107
Q

Normal structure of the retina

A

Choroid layer - provides blood supply

retinal pigment epithelium & Bruch’s membrane - separate choroidal layer from retinal neurons

Layer of retinal neurons

108
Q

What causes age-related macular degeneration

A
  • Progressive damage to RPE and Bruch’s membrane
  • formation of drusen (lipids and proteins) under the retina
  • choroidal neovascularisation causes bleeding and swelling in the macula
109
Q

Risk factors of AMD

A

smoking
age >60
female
HTN, HLD, obesity

110
Q

What defines wet AMD

A

presence of neovascularisation

111
Q

AMD causes ___ vision loss

A

central

mild distortion (wavy lines on Amsler chart) -> central blurring -> central scotoma

112
Q

Treatment for AMD

A

1) Anti-vascular endothelial growth factor injections
- blocks development of new vessels and leakage from abnormal vessels

2) Argon laser photocoagulation
- destroy neovessels away from fovea

3) Photodynamic therapy
- injection of light sensitive drug into bloodstream, absorbed by abnormal blood vessels
- laser light shone into eye, activates drug and damaged vessels

Eye ENT Patho (2 decks)

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