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ENT & Opthalmology > Eye > Flashcards

Eye Flashcards

1
Q

What is the pathology of diabetic retinopathy?

A

thickening basement membrane and increased permeability of retinal arteries - leads to ischaemia, nerve fibre damage, vascular leakage

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2
Q

What are some things you would see in the eye of someone with diabetic retinopathy?

A

cotton wool spot - ischaemic nerve fibres
small vessels around optic disc
yellow patches = hard exudate
Flame haemorrhages

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3
Q

What are the stages of diabetic retinopathy?

A

Non-proliferative
- mild, moderate, severe
- background retinopathy, pre-proliferative retinopathy
Proliferative: fine new vessels in optic disc/retina
Maculopathy: oedema due to leakage

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4
Q

What do you urgently refer a patient with suspected diabetic retinopathy?

A

From severe non-proliferative onwards

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5
Q

How do you treat diabetic retinopathy?

A

good glycaemic control

pranretinal photocoagulation causes regression of new blood vessels

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6
Q

What would be seen on the retina in severe HTN retinopathy?

A 
arteriolar constriction 
arteries nipping veins when they cross
cotton wool spots 
exudates 
papilloedema
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7
Q

How would you treat HTN retinopathy?

A

good BP control

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8
Q

What are the grades of HTN retinopathy?

A

I - thickening of arterioles
II - focal arteriolar spasms, vein constriction
III - haemorrhages, dot-blot, cotton wool, hard exudates
IV - papilloedema

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9
Q

What is malignant retinopathy?

A

very high BP, accelerated vascular damage with necrosis of small arteries (papilloedema), end stage organ damage

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10
Q

What are some causes of HTN retinopathy?

A

uncontrolled BP -phaeochromocytoma = adrenaline

neuroendocrine tumour of medulla of adrenal glands = catecholamines

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11
Q

What are some risk factors for cataracts?

A

steroids, DM, age, smoking, eye trauma, uveitis, congenital, congenital infection

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12
Q

What are some things you would see on examination of someone with cataracts?

A

clouding of the lens, absent light reflex, increasing myopia

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13
Q

What tests would you do if you suspect cataracts?

A

blood glucose
serum calcium
liver biochemistry

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14
Q

How would you treat cataracts?

A

phacoemulsification

- breaks the lens US guided, aspiratte, replace lens

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15
Q

Which type of glaucoma is primary degenerative condition? What is it?

A

open angle glaucoma

Drainage of fluid is blocked (due to iris pushed up by trabecular meshwork)

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16
Q

What are some symptoms of glucoma?

A

heading, nausea and vomiting, blurred vision, decreased visual acuity, pain, unilateral, red eye, dilated pupil, halo around lights, raised ICP

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17
Q

What are some treatments of glucoma?

A

constrict pupil and decrease aqueous fluid

  • acetazolamide (reduces secretion)
  • timolol (suppresses aqueous humour secretion)
  • pilocarpine (pupil constriction)
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18
Q

What is normal eye pressure?

A

11-21 mmHg

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19
Q

What is the most common cause of visual loss in elderly?

A

age related macular degeneration

- 30% of adults >75

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20
Q

What are some symptoms of ARMD?

A

blurring lines, central vision loss, painless, confabulatory hallucinations (Charles Bonnet)

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21
Q

How would you test for ARMD?

A

amsler chart, tomography

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22
Q

What are the two types of ARMD and how do you treat them?

A

Wet - exudate, neovascular
- anti-VEGF, laser photocoagulation, intravitreal steroids
Dry - not treatable, vitamins only
smoking cessation, inform DVLA

23
Q

What is ARMD pathology?

A

deteriorating central vision secondary to pathological neovascularisation under retina
- leak fluid and blood and form a scar

24
Q

What are some causes of red eye?

A

conjunctivitis, glaucoma, iritis, dry eyes, local trauma, lid disorders

25
Q

What are some conditions that cause visual disturbance?

A

cataract, glaucoma, vascular changes, diabetic retinopathy, optic neuritis, macular degeneration, retinal detachment, hysterical visual loss, squint, amblyopia, cranial nerve palsies, optic tract disorders, papilloedema

26
Q

What is blephritis?

A

Inflammation, usually margins of eyelids. Very common, gritty burning and irritable eyes

27
Q

What are the signs of blephritis?

A

red eyelides, loss of eyelashes, growing in eyelashes, recurrent lid lumps

28
Q

How do you treat blephritis?

A

not curable
Lid hygiene, chloramphenicol ointment at base of eyelashes, warm massage of lids, tear substitutes, treat underlying skin disorders

29
Q

What are some red flags of conjunctivitis?

A

one eye, recurrent, neonate

30
Q

What are the types of conjunctivitis and treatment?

A

Viral: reassurance
Allergic: topical medication
Bacterial:
Rule out STD

31
Q

What is the most common viral cause of conjunctivitis?

A

adenovirus

32
Q

What is the fancy name for dry eye?

A

Keratoconjunctivitis sicca

33
Q

What is the investigation/treatment of dry eye?

A

drug history, contact lens break, explain it, topical lubricants, blinking more, eye protection
investigate autoimmune or mechanical problems

34
Q

What is episcleritis?

A

inflammation of the episclera
- usually one eye, no pain, redness
Treat is reassurance

35
Q

What is scleritis?

A

Very serious, sclera is tough outer layer of globe, autoimmune
PAIN, unilateral, darker red than episcleritis

36
Q

What are the 2 common lid lumps?

What is the difference?

A

styes - infection at base of eyelash

chalazion - inflammation of meibomian gland deeper in eye

37
Q

How would you treat styes?

A 
self limiting
heat to lid 
possible topical antibiotic 
remove lash 
puncture and drain
38
Q

How would you treat chalazion?

A

heat
lid massage
referral if chronic

39
Q

What are some rarer lid lumps?

A

basal cell carcinoma, herpes, molluscum contagiosum, papilloma, squamous cell carcinoma, keratoaanthoma

40
Q

What are some symptoms of age-related macular degeneration?

A

acute visual disturbances, straight lines look wiggly, central vision loss, painless, confabulatory hallucinations

41
Q

What are the 2 types of age-related macular degeneration?

A

Wet - rapid deterioration, treatable

Dry - slow but untreatable

42
Q

What is the syndrome that can develop with vision loss?

A

Charles Bonnet - confabulating to replace gaps in vision

43
Q

How would you treat ARMD?

A

Wet - anti-VEGF, laser photocoagulation, intravitreal steroids
Dry - vitamins (zinc, B-carotene, Vit C and E)

44
Q

What are symptoms of optic nerve compression?

How would you treat it?

A

Gradual vision loss
Dark, dimmed or blurred vision
Problems with sharpness and colour perception
TREAT - surgery

45
Q

What are the symptoms of retinal detachment?

A

flashes, floaters, field loss

URGENT REFERRAL

46
Q

What are the symptoms of vitreous haemorrhage?

A

sudden, painless, visual loss
(from haziness, floaters to complete)
Red hue to eye
URGENT REFERRAL

47
Q

What is the difference in appearance between retinal vein occlusion and retinal artery occlusion?

A

RVO: dilated veins, retinal haemorrhage, cotton wool spots, abnormal fluid leak so retinal oedema
RAO: infarction, retinal becomes opaque and oedematous, cherry red spot

48
Q

How could you treat retinal artery occlusion?

A

ocular massage
acetazolamide to reduce ocular pressure
breath into paper bag to build up CO2 and act as vasodilation and dislodge emboli

49
Q

What is the classic symptom of anterior uvetitis?

A

redness, pain, photophobia

50
Q

How would you treat anterior uveitis?

A

topical steroids

51
Q

How is ischaemic optic neuropathy different to optic neuropathy?

A

ischaemic - abrupt and profound

Normally the blurring of vision develops over hours to days

52
Q

What is optic neuritis?

A

inflammation of optic nerve, most commonly through demyelination
Disc swelling is accompanied by dull ocular pain with severe and early visual loss

53
Q

How does retrobulbar neuritis present?

A

inflammatory process is within optic nerve but behind bulb

  • no abnormality seen at disc
  • visual impairment

ENT & Opthalmology (5 decks)

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