Eye Flashcards
What is the pathology of diabetic retinopathy?
thickening basement membrane and increased permeability of retinal arteries - leads to ischaemia, nerve fibre damage, vascular leakage
What are some things you would see in the eye of someone with diabetic retinopathy?
cotton wool spot - ischaemic nerve fibres
small vessels around optic disc
yellow patches = hard exudate
Flame haemorrhages
What are the stages of diabetic retinopathy?
Non-proliferative
- mild, moderate, severe
- background retinopathy, pre-proliferative retinopathy
Proliferative: fine new vessels in optic disc/retina
Maculopathy: oedema due to leakage
What do you urgently refer a patient with suspected diabetic retinopathy?
From severe non-proliferative onwards
How do you treat diabetic retinopathy?
good glycaemic control
pranretinal photocoagulation causes regression of new blood vessels
What would be seen on the retina in severe HTN retinopathy?
arteriolar constriction arteries nipping veins when they cross cotton wool spots exudates papilloedema
How would you treat HTN retinopathy?
good BP control
What are the grades of HTN retinopathy?
I - thickening of arterioles
II - focal arteriolar spasms, vein constriction
III - haemorrhages, dot-blot, cotton wool, hard exudates
IV - papilloedema
What is malignant retinopathy?
very high BP, accelerated vascular damage with necrosis of small arteries (papilloedema), end stage organ damage
What are some causes of HTN retinopathy?
uncontrolled BP -phaeochromocytoma = adrenaline
neuroendocrine tumour of medulla of adrenal glands = catecholamines
What are some risk factors for cataracts?
steroids, DM, age, smoking, eye trauma, uveitis, congenital, congenital infection
What are some things you would see on examination of someone with cataracts?
clouding of the lens, absent light reflex, increasing myopia
What tests would you do if you suspect cataracts?
blood glucose
serum calcium
liver biochemistry
How would you treat cataracts?
phacoemulsification
- breaks the lens US guided, aspiratte, replace lens
Which type of glaucoma is primary degenerative condition? What is it?
open angle glaucoma
Drainage of fluid is blocked (due to iris pushed up by trabecular meshwork)
What are some symptoms of glucoma?
heading, nausea and vomiting, blurred vision, decreased visual acuity, pain, unilateral, red eye, dilated pupil, halo around lights, raised ICP
What are some treatments of glucoma?
constrict pupil and decrease aqueous fluid
- acetazolamide (reduces secretion)
- timolol (suppresses aqueous humour secretion)
- pilocarpine (pupil constriction)
What is normal eye pressure?
11-21 mmHg
What is the most common cause of visual loss in elderly?
age related macular degeneration
- 30% of adults >75
What are some symptoms of ARMD?
blurring lines, central vision loss, painless, confabulatory hallucinations (Charles Bonnet)
How would you test for ARMD?
amsler chart, tomography
What are the two types of ARMD and how do you treat them?
Wet - exudate, neovascular
- anti-VEGF, laser photocoagulation, intravitreal steroids
Dry - not treatable, vitamins only
smoking cessation, inform DVLA
What is ARMD pathology?
deteriorating central vision secondary to pathological neovascularisation under retina
- leak fluid and blood and form a scar
What are some causes of red eye?
conjunctivitis, glaucoma, iritis, dry eyes, local trauma, lid disorders
What are some conditions that cause visual disturbance?
cataract, glaucoma, vascular changes, diabetic retinopathy, optic neuritis, macular degeneration, retinal detachment, hysterical visual loss, squint, amblyopia, cranial nerve palsies, optic tract disorders, papilloedema
What is blephritis?
Inflammation, usually margins of eyelids. Very common, gritty burning and irritable eyes
What are the signs of blephritis?
red eyelides, loss of eyelashes, growing in eyelashes, recurrent lid lumps
How do you treat blephritis?
not curable
Lid hygiene, chloramphenicol ointment at base of eyelashes, warm massage of lids, tear substitutes, treat underlying skin disorders
What are some red flags of conjunctivitis?
one eye, recurrent, neonate
What are the types of conjunctivitis and treatment?
Viral: reassurance
Allergic: topical medication
Bacterial:
Rule out STD
What is the most common viral cause of conjunctivitis?
adenovirus
What is the fancy name for dry eye?
Keratoconjunctivitis sicca
What is the investigation/treatment of dry eye?
drug history, contact lens break, explain it, topical lubricants, blinking more, eye protection
investigate autoimmune or mechanical problems
What is episcleritis?
inflammation of the episclera
- usually one eye, no pain, redness
Treat is reassurance
What is scleritis?
Very serious, sclera is tough outer layer of globe, autoimmune
PAIN, unilateral, darker red than episcleritis
What are the 2 common lid lumps?
What is the difference?
styes - infection at base of eyelash
chalazion - inflammation of meibomian gland deeper in eye
How would you treat styes?
self limiting heat to lid possible topical antibiotic remove lash puncture and drain
How would you treat chalazion?
heat
lid massage
referral if chronic
What are some rarer lid lumps?
basal cell carcinoma, herpes, molluscum contagiosum, papilloma, squamous cell carcinoma, keratoaanthoma
What are some symptoms of age-related macular degeneration?
acute visual disturbances, straight lines look wiggly, central vision loss, painless, confabulatory hallucinations
What are the 2 types of age-related macular degeneration?
Wet - rapid deterioration, treatable
Dry - slow but untreatable
What is the syndrome that can develop with vision loss?
Charles Bonnet - confabulating to replace gaps in vision
How would you treat ARMD?
Wet - anti-VEGF, laser photocoagulation, intravitreal steroids
Dry - vitamins (zinc, B-carotene, Vit C and E)
What are symptoms of optic nerve compression?
How would you treat it?
Gradual vision loss
Dark, dimmed or blurred vision
Problems with sharpness and colour perception
TREAT - surgery
What are the symptoms of retinal detachment?
flashes, floaters, field loss
URGENT REFERRAL
What are the symptoms of vitreous haemorrhage?
sudden, painless, visual loss
(from haziness, floaters to complete)
Red hue to eye
URGENT REFERRAL
What is the difference in appearance between retinal vein occlusion and retinal artery occlusion?
RVO: dilated veins, retinal haemorrhage, cotton wool spots, abnormal fluid leak so retinal oedema
RAO: infarction, retinal becomes opaque and oedematous, cherry red spot
How could you treat retinal artery occlusion?
ocular massage
acetazolamide to reduce ocular pressure
breath into paper bag to build up CO2 and act as vasodilation and dislodge emboli
What is the classic symptom of anterior uvetitis?
redness, pain, photophobia
How would you treat anterior uveitis?
topical steroids
How is ischaemic optic neuropathy different to optic neuropathy?
ischaemic - abrupt and profound
Normally the blurring of vision develops over hours to days
What is optic neuritis?
inflammation of optic nerve, most commonly through demyelination
Disc swelling is accompanied by dull ocular pain with severe and early visual loss
How does retrobulbar neuritis present?
inflammatory process is within optic nerve but behind bulb
- no abnormality seen at disc
- visual impairment
