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Year 5 Core Conditions > Eye > Flashcards

Eye Flashcards

1
Q

What are the causes of conjunctivitis?

A
  1. Viral (most cases e.g. adenovirus, herpes simplex)
  2. Bacterial (e.g. Staphylococcus, streptococcus), chlamydia (in young sexually active patients)
  3. Allergic - commonly seasonal
  4. Toxins - chemical splash, chlorine
  5. Radiation - direct irritation of conjunctival tissue
  6. Trauma - blinking of very dry eyes
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2
Q

What are the symptoms associated with conjunctivitis?

A
  1. Uncomfortable eye (not typically painful)
  2. Vision typically normal
  3. Redness
  4. Swollen eyelids
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3
Q

What are the signs associated with conjunctivitis?

A
  1. Redness
  2. Sticky discharge
  3. Swollen eyelids (follicles - typically in infection, papillae - typically in allergy)
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4
Q

What investigations if any are needed for conjunctivitis?

A

It is usually self-limiting, however if persistent or very severe, then conjunctival swabs and viral cultures

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5
Q

What treatment is there for conjunctivitis? (2)

A
  1. Often ocular lubricants (artificial tears) alone are adequate and provide symptomatic relief
  2. Chloramphenicol gives broad spectrum, bacteriostatic cover.
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6
Q

What can cause a corneal ulcer? (4)

A
  1. Infections - viral (herpes simplex ‘dendritic’ ulcer), bacterial (staphylococcus, streptococcus), rarely fungal
  2. Cold sores (HSV)
  3. Contact lens wear
  4. Lid margin disease (blepharitis)
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7
Q

What are the symptoms of a corneal ulcer? (4)

A
  1. Pain
  2. Photophobia
  3. Blurred vision
  4. Sensation of foreign body
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8
Q

What are the signs of a corneal ulcer? (4)

A
  1. Red eye
  2. Corneal opacity
  3. Corneal stain with fluorescein
  4. Hypopyon (sediment of white cells in the anterior chamber)
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9
Q

What investigations are carried out for a suspected corneal ulcer?

A

If the ulcer is severe or persistent then scrape samples are taken from the cornea for microscopy, culture and sensitivities (MC&S) analysis

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10
Q

What is the treatment for corneal ulcer?

A
  1. Herpes simplex infection - aciclovir ointment
  2. Bacterial keratitis - topical antibiotics
  3. Topical steroids added only when microbiology is known or there is clinical improvement
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11
Q

What is iritis?

A

Inflammation of the iris - a common ophthalmic presentation

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12
Q

What is the cause of iritis?

A

> 95% idiopathic
Remainder are associated with systemic conditions: HLA-B27, ankylosing spondylitis, sarcoid, TB, etc. or an intrinsic eye problem e.g. corneal ulcer, retinal detachment

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13
Q

How does iritis present? (3)

A
  1. Pain
  2. Photophobia
  3. Blurred vision
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14
Q

What are the signs of iritis?

A
  1. Redness often around the cornea
  2. Cells in the anterior chamber
  3. Pupil stuck to lens in parts
  4. Clumps of cells stuck to inner surface of cornea
  5. Increased or decreased intra-ocular pressure
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15
Q

What are the investigations for iritis?

A

Screening tests for systemic conditions if iritis is recurrent, severe or bilateral

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16
Q

What is the treatment for iritis? (2)

A
  1. Topical steroid

2. Cycloplegic/mydriatic (dilating) drops (e.g. cyclopentolate, atropine)

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17
Q

What are the symptoms of acute angle-closure glaucoma? (6)

A
  1. Intermittent eye pain
  2. Headache
  3. Haloes (corneal oedema)
  4. Blurred vision
  5. Severe pain
  6. Nausea and vomiting (during acute angle-closure)
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18
Q

How are some people predisposed to acute angle glaucoma?

A

They have an anatomical predisposition - shallow anterior chamber

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19
Q

What are the signs of acute angle glaucoma? (6)

A
  1. Raised intraocular pressure
  2. Red eye
  3. Mild-dilated oval pupil
  4. Shallow anterior chamber
  5. Corneal oedema
  6. Other eye also has shallow anterior chamber
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20
Q

What investigation can be done for someone with suspected acute angle glaucoma?

A

Gonioscopy (special lens examination) shows an occluded iridocorneal angle in the affected eye and an at-risk configuration in the other eye’s angle

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21
Q

What is the treatment for acute angle glaucoma? (2)

A
  1. Medical; aimed at lower intraocular pressure with systemic and topical antiglaucoma drugs e.g. mannitol, pilocarpine
  2. Surgical; peripheral laser iridotomy done to prevent further attack of angle-closure
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22
Q

What is age-related macular degeneration?

A

A common cause of central visual loss in older (50+ years) patients. The central retina (or macula) undergoes degenerative change.

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23
Q

What is the dry form of macular degeneration?

A

Deposition of particulate debris (drusen) and pigmentary disturbance in the macula

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24
Q

What is the wet form of macular degeneration?

A

Abnormal, leaky new vessels grow in degenerative macula

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25
Q

What are the symptoms of macular degeneration?

A

Blurring of central vision or a distortion of straight-edges occurs when abnormal new vessels grow at the macula

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26
Q

What are the signs of macular degeneration? (3)

A
  1. Haemorrhage
  2. Lipid exudation
  3. Thickened tissue at the macula
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27
Q

What investigations can be carried out for macular degeneration? (2)

A
  1. Fundus angiography

2. Optical coherence tomography to delineate the neovascular complex

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28
Q

What is the treatment for age related macular degeneration?

A

Injection of growth-inhibitor drugs into the eye (intravitreal therapy) which suppress the neovascular process

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29
Q

Why does diabetic retinopathy occur?

A

It tends to occur in long-standing diabetes related to poor gylcaemic control. The basic problem is damage to the blood-retina barrier. This damage causes occlusion or leakage in the retinal circulation.

30
Q

In terms of classification of diabetic retinopathy, what are the 4 stages that the disease progression can be at?

A
  1. Background retinopathy
  2. Pre-proliferative retinopathy
  3. Proliferative retinopathy
  4. Advanced retinopathy
31
Q

What are the features of background retinopathy? (the mnemonic used is HOME)

A

H- haemorrhage (leakage or blood into the retina, dot, blot, flame-shaped haemorrhages)
O- oedema (leakage of fluid - transudate, diabetic macular oedema can occur even in background disease)
M- microaneurysms - outpouchings of venous end of capillaries, earliest sign of retinopathy, found in the central macula
E- exudates - leakage of lipid, yellowish deposits, usually in the macula

32
Q

What are the features of pre-proliferative diabetic retinopathy? (2)

A
  1. Cotton wool spot - with blockage of fine retinal capillaries (axoplasmic) flow is slowed, producing a feathery whitish area called a ‘cotton wool spot’ - this represents a focal infarct
  2. Vein abnormalities - characterise an ischaemic retina, venous looping, beading and engorgement can be seen
33
Q

What are the features of proliferative retinopathy? (3)

A
  1. New vessel growth from the retina
  2. New vessel growth from the optic disc
  3. New vessel growth from the iris (rubeosis)
34
Q

What are the features of advanced retinopathy? (4)

A
  1. Scar tissue is laid down inside the eye
  2. Tractional retinal detachment (scar tissue associated with neovascular processes pulls on the retina)
  3. Retinal gliosis (scarring)
  4. Vitreous haemorrhage
35
Q

What are the treatments for diabetic retinopathy? (2)

A
  1. Medical; optimise glycaemic control

2. Surgical; laser photocoagulation - can prevent progression from proliferative retinopathy

36
Q

What are the presenting features of acute closed angle glaucoma? (6)

A
  1. Seeing haloes
  2. Acute onset severe pain
  3. Cloudy cornea
  4. Circumcorneal injection
  5. Mid-dilated fixed pupil
  6. Tonometry >40mmHg
37
Q

What are the risk factors for acute angle closure glaucoma? (6)

A
  1. Hypermetropic eyes
  2. Female
  3. Age increasing
  4. Family history
  5. Drug history including anticholinergics, TCA’s, antihistamines
  6. Pupil dilatation at night
38
Q

What is the short-term management of acute angle closure glaucoma? (3)

A
  1. Pilocarpine - mitosis eases blocked angle
  2. Topical beta blocker - timolol
  3. Acetazolamide - decreased aqueous formation
39
Q

What is the long-term management for acute angle closure glaucoma? (1)

A

Iridotomy (laser to stop pressure building up) - procedure to both eyes as prophylaxis
(Aim is to decrease pressure as quickly as possible and then prevent recurrence)

40
Q

Are subconjunctival haemorrhages worrying?

A

Generally no, unless they indicate a trauma that could have occurred to their head etc.

41
Q

What are the risk factors for a subconjunctival haemorrhage? (3)

A
  1. Trauma
  2. Valsalva or increased intra-thoracic/abdominal pressure - e.g. coughing, vomiting
  3. Anti-coagulants
42
Q

What are the features of a subconjunctival haemorrhage? (4)

A
  1. Diffuse or localised blood
  2. Not within the capillary system
  3. Usually painless
  4. Can look very alarming
43
Q

What is the management for a subconjunctival haemorrhage? (2)

A
  1. Nothing unless traumatic event lead to it - if traumatic check for signs of orbital fractures/battle sign
  2. If causes irritation then trial lubricating drops
44
Q

What are the types of conjunctivitis?

A
  1. Bacterial
  2. Viral
  3. Allergic/irritant
45
Q

What are the features of bacterial conjunctivitis and what is the cause and management? (4)

A
  1. Purulent discharge
  2. Sticky eyes, difficulty opening in the morning
  3. Commonly staph. and strep. but other causes include chlamydia and gonorrhoea
  4. Treatment is chloramphenicol
46
Q

What are the features, causes and management for viral conjunctivitis? (4)

A
  1. Watery, gritty eye
  2. Usually bilateral - starts on one side and spreads to the other
  3. Most commonly adenovirus
  4. Conservative management - hot compress, avoid sharing towels
47
Q

What are the features, causes and management for irritant/allergic conjunctivitis? (4)

A
  1. Watery, itchy red eye
  2. Might see papillae on eyelid eversion
  3. Give antihistamine topical or oral
  4. Avoidance of irritant
48
Q

What are the risk factors for anterior uveitis? (5)

A
  1. Reiters (can’t see, can’t pee, can’t climb a tree)
  2. IBD
  3. HLA-B27
  4. NH-lymphoma
  5. Seronegative arthropathies
49
Q

What are the features of anterior uveitis? (5)

A
  1. Photophobia
  2. Irregular pupil
  3. Painful eye including painful convergence
  4. Circumcorneal injection
  5. Hypopeon
50
Q

What is the management for anterior uveitis? (2)

A
  1. Topical steroids

2. Atropine - helps to prevent synechiae

51
Q

What are the risk factors for scleritis?

A
  1. Wegners, RA, ank spond, SLE

2. Other forms of vasculitis

52
Q

What are the clinical features of scleritis? (5)

A
  1. Boreing eye pain
  2. Wakes at night due to pain
  3. Lacrimation
  4. Photophobia
  5. Does not blanch with phenylephrine
53
Q

What is the management for scleritis? (2)

A
  1. Corticosteroids or immunosuppression

2. Specialist management is needed

54
Q

What are the risk factors for episcleritis? (2)

A
  1. Usually idiopathic

2. Possibly RA or SLE

55
Q

What are the clinical features of episcleritis? (3)

A
  1. Segmental injection below the conjunctival
  2. Can be moved over the sclera
  3. Blanches with phenylephrine
56
Q

What is the management for episcleritis? (1)

A

NSAIDs

57
Q

What are the risk factors for a foreign body in the eye? (2)

A
  1. Trauma

2. Work involving metal grinding etc.

58
Q

How can a foreign body in the eye present? (4)

A
  1. Red irritated eye
  2. May have difficulty opening eye
  3. FB may still be present (remember to evert eyelid)
  4. Corneal abrasions (stain with fluorescein)
59
Q

What is the management for a FB in the eye? (6)

A
  1. Tetracaine if unable to open eye
  2. Full visual acuity check
  3. X-ray orbit if metallic FB is suspected
  4. Analgesia
  5. Chloramphenicol drops to prevent infection
  6. Tetanus check
60
Q

What are the differences between abrasions and ulcers of the eye?

A

Abrasions are generally caused by trauma and there is material ‘sloughed off’, whereas ulcers are clouding looking and usually of infective causes - from contact lens or viral/bacterial (keratitis)

61
Q

In hypertensive retinopathy, what is the pathophysiology? (7)

A
  1. Blood pressure is high
  2. Vessels vasoconstrict
  3. Increased pressure damages blood vessels
  4. Damaged vessels leak leading to mural thickening
  5. Leads to ischaemia in the retina
  6. Abnormal vessels bleed
  7. Combination of ischaemia and haemorrhage leads to optic disc swelling
62
Q

What is the pathophysiology behind diabetic retinopathy? (7)

A
  1. Blood sugars are high
  2. Damages blood vessels
  3. Blood vessels bleed
  4. Retinal ischaemia leads to VEGF release
  5. New blood vessels form (neovascularisation)
  6. New blood vessels bleed more easily
  7. Perpetuates cycle
63
Q

What is stage 1 of hypertensive retinopathy?

A

Tortuosity and silver/copper wiring

64
Q

What is stage 2 of hypertensive retinopathy?

A

AV nipping

65
Q

What is stage 3 of hypertensive retinopathy? (3 things)

A
  1. Flame haemorrhages
  2. Hard exudate
  3. Cotton wool spots
66
Q

What is stage 4 of hypertensive retinopathy?

A

Papilloedema

67
Q

What are the stages of diabetic retinopathy called? (4)

A
  1. Non-proliferative
  2. Pre-proliferative
  3. Proliferative
  4. Maculopathy
68
Q

What occurs in non-proliferative diabetic retinopathy stage? (2)

A
  1. Dot and blot haemorrhages

2. Hard exudate

69
Q

What occurs in the pre-proliferative diabetic retinopathy stage? (3)

A
  1. Cotton wool spots
  2. Haemorrhages
  3. Microvascular problems ?
70
Q

What occurs in the proliferative diabetic retinopathy stage? (3)

A
  1. New vessels - neovascularisation
  2. Haemorrhages
  3. Retinal detachment
71
Q

What occurs in the maculopathy stage of diabetic retinopathy? (2)

A
  1. Hard exudate in macula

2. Decreased acuity

Year 5 Core Conditions (25 decks)

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