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J Ophthalmology > Eye conditions > Flashcards

Eye conditions Flashcards

1
Q

roth spots (red dots in fundus)

A

infective endocarditis

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2
Q

brushfield spots (white spots in iris)

A

downs syndrome

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3
Q

previous eye trauma/surgery in one eye
bilateral granulomatous uveitis
floaters in eye

A

sympathetic ophthalmia

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4
Q

aetiology of monocular blindness (2)

A 
optic neuritis (inflammation of optic nerve) 
tumours

something in optic canal

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5
Q

aetiology of bitemporal hemianopia (1)

A

pituitary tumour

something in optic chiasm

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6
Q

aetiology of missing vision on either left or right side (in both eyes) (3)

A

demyelination
tumour
vascular disease (stroke)

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7
Q

what is optic neuritis

A

inflammation of optic nerve

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8
Q

why is there pain on eye movement in optic neuritis

A

bc the optic nerve sheath is attached to the common tendinous ring for the rectus extraocular eye muscles

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9
Q

pain behind eye on movement
colour desaturation
unilateral vision loss over 24 hours

A

optic neuritis

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10
Q

emmetropia definition

A

no refractive error

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11
Q

ametropia definition

A

generic term for refractive error eg myopia, hypermetropia

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12
Q

whats another name for hypermetropia

A

long sightedness (can see things far away fine but not far away things)

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13
Q

which type of glasses are used for hypermetropia

A

convex

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14
Q

whats another name for myopia

A

short sightedness (can see things close by fine but not far away things)

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15
Q

which type of glasses are used for myopia

A

concave (bc CAVES are LONG and you want to fix their LONG sight so they can see in the CAVE)

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16
Q

astigmatism definition

A

rugby ball shaped cornea

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17
Q

astigmatism presentation

A

long and short sight is blurry (funny shaped cornea = distorted image passed on to retina)

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18
Q

presbyopia definition

who get it

A

loss of accommodation reflex

middle aged people (happens to most people)

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19
Q

treatment of presbyopia

A

reading glasses

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20
Q

amblyopia (cortical blindness) definition

A

no pathological problem but one eye can see better than the other (one has gained more cortical territory and the other has lost its function as a result)

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21
Q

example of when amblyopia (cortical blindness) can occur

A

untreated wandering eye in kids

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22
Q

another name for a tropia

A

squint

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23
Q

if you cover a patients eye and the other moves outwards, what type of squint is it

A

esotropia (was previously in)

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24
Q

if you cover a patients eye and the other moves inwards, what type of squint is it

A

exotropia (was previously out)

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25
Q

if you cover a patients eye and the other moves upwards, what type of squint is it

A

hypotropia (was previously down)

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26
Q

if you cover a patients eye and the other moves downwards, what type of squint is it

A

hypertropia (was previously up)

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27
Q

diplopia treatment

A

prism glasses

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28
Q

aetiology of horizontal diplopia

A

CN VI palsy

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29
Q

which 5 extraocular muscles (and 1 intraocular) are affected in a CN III palsy

A 
medial rectus 
superior rectus
inferior rectus 
inferior oblique 
levator palpebrae superioris 
sphincter pupillae
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30
Q

how does a CN III palsy present

A

down out and dilated eye

bc the lateral rectus, superior oblique and sphincter pupillae (that causes constriction) all still work

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31
Q

is there a normal pupillary reflex in CN III palsy

A

no

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32
Q

bc of the down and out nature of the eye in CN III palsy, what may happen to the eyelid

A

dropping (ptosis)

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33
Q

if a CN III palsy (down out and dilated pupil) is PAINFUL what is the cause

treatment

A

aneurysm

treat fast!

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34
Q

general aetiology of CN palsies (4)

A

vascular disease (stroke)
tumours
demyelination
congenital

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35
Q

presentation of CN IV palsy (2)

A 
tripping downstairs 
head tilt  (to compensate)

trochlear nerve not working = superior oblique not working = cant look down

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36
Q

presentation of CN VI palsy (2)

A 
permanent adduction (medial deviation) of affected eye 
diplopia (double vision)
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37
Q

general treatment of eye infection

A

chloramphenicol

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38
Q

general treatment of eye inflammation

A

steroids

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39
Q

treatment of eye swelling form allergy

A

anti histamines

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40
Q

general treatment of painful eye

A

topical NSAIDs

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41
Q

most common type of gradual vision loss

A

age related macular degeneration (ARMD) dry type

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42
Q

someone with eye pain and change of appearance of eyes AND weight loss

A

thyroid eye disease (hyperthyroidism)

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43
Q

aetiology of central retinal artery occlusion

A

emboli from carotid (or heart)

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44
Q

risk factors for central retinal artery occlusion (4)

A

hypertension, diabetes, high cholesterol, smoking

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45
Q

what is the vision loss like in central retinal artery occlusion (sudden/gradual? painful?)

think about it

A

painless and sudden

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46
Q

how bad is the vision loss in central retinal artery occlusion

what can they see

A

v bad

cant see Snellen chart, can count fingers

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47
Q

fundoscopy in central retinal artery occlusion

A

pale/oedematous retina
cherry red spot macula
thread like/non tortious veins

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48
Q

what investigations would you want to do after diagnosing a central retinal artery occlusion

why

A

carotid US

to find source of emboli

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49
Q

treatment of central retinal artery occlusion (2)

A 
ocular massage (rub eye within 24 hours to try and dislodge it into one of the branches) 
surgery if ocular massage ineffective
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50
Q

if a central retinal artery occlusion isnt fixed within 70 mins what happens

vision prognosis

A

irreversible ischaemia

probs vision loss

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51
Q

another name for transient central retinal artery occlusion

A

amaurosis fugax

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52
Q

how long does transient central retinal artery occlusion last for

A

<5 mins

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53
Q

what is the vision loss like in transient central retinal artery occlusion (amaurosis fugax) (sudden/gradual? painful?)

think about it

A

sudden painless vision loss

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54
Q

how would a patient describe their vision in transient central retinal artery occlusion (amaurosis fugax)

A

‘like a curtain coming down’

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55
Q

treatment of transient central retinal artery occlusion (amaurosis fugax) (prophylaxis of full central retinal artery occlusion)

where do you refer them, why

A

aspirin

refer to stroke - at risk of having a stroke

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56
Q

‘like a curtain coming down’ <5mins

A

transient central retinal artery occlusion (amaurosis fugax)

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57
Q

‘like a curtain coming down’ >5mins

A

retinal detachment

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58
Q

cherry red spot on macula
pale fundus
non tortious veins

A

central retinal artery occlusion

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59
Q

dark tortious veins
blood and thunder fundus
retinal haemorrhages
new vessel formation

A

central retinal vein occlusion

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60
Q

sudden painless vision loss differentials in some with hypertension (2)

how do you differentiate between them

A

central retinal artery occlusion
central retinal vein occlusion

fundoscopy

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61
Q

how bad is the vision loss in central retinal vein occlusion

what can/cant they see

A

v bad

can see Snellen chart or counting fingers, can see some light

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62
Q

aetiology of central retinal vein occlusion

A

emboli

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63
Q

why is there haemorrhages etc in central retinal vein occlusion

A

bc its the veins the blood thats behind the blockage is in the eye (in central retinal artery occlusion is behind the eye)

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64
Q

treatment of central retinal vein occlusion

by what method

why

A

anti-VEGF (vascular endothelial growth factor)

intravitreal injection

stops new vessel growth

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65
Q

aetiology of posterior ciliary artery occlusion

A

giant cell arteritis

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66
Q

what does posterior ciliary artery occlusion do to the optic nerve

A

causes ischaemia

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67
Q

is posterior ciliary artery occlusion (associated with giant cell arteritis and optic nerve ischaemia) reversible

A

no

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68
Q

what happens to the vitreous gel in old people that makes them more susceptible to retinal detachment

A

it becomes more liquid = tugs on retina and pulls it in

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69
Q

what is the sensory retina detached form in retinal detachment

A

retinal pigment epithelium

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70
Q

is retinal detachment painful

A

no

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71
Q

what is the loss of vision like in retinal detachment

onset

A

‘curtains in field of vision’ >5mins

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72
Q

as well as painless vision loss, what else might someone with retinal detachment experience in their vision

A

sudden onset flashes and floaters

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73
Q

what do you see on fundoscopy of retinal detachment

A

line where retina has detached

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74
Q

treatment of retinal detachment

explanation (2 steps)

how fast

A

surgery

aspirate vitreous gel (it is the thing thats pulling on the retina)
reattach retina

urgent!

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75
Q

most common cause of blindness in UK

A

age related macular degeneration (ARMD)

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76
Q

what is the presentation of both wet and dry type age related macular degeneration

why

A

central vision ‘missing’

because the macula is degenerated (duh) = central vision affected

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77
Q

which type of ARMD (age related macular degeneration) is sudden

A

wet

as soon as the haemorrhage happens = vision affected (in the dry type theres no sudden pathological changes = no sudden vision loss)

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78
Q

which type of age related macular degeneration is gradual

A

dry

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79
Q

why is dry age related macular degeneration called the ‘dry type’

A

no leakage of blood vessels (haemorrhage)

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80
Q

treatment of wet age related macular degeneration

administration method

A

anti-VEGF

intra vitreal injection

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81
Q

what does anti-VEGF do

A

stops new vessel formation

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82
Q

why is wet age related macular degeneration called the ‘wet type’

A

haemorrhage (leakage of blood vessels)

83
Q

is dry age related macular degeneration sudden or gradual vision loss

why

A

gradual

bc there is no haemorrhage (and it is the haemorrhage in wet type that makes the vision loss sudden)

84
Q

fundoscopy in wet age related macular degeneration

A

haemorrhage
new vessel formation
atrophic retina near macula

85
Q

fundoscopy in dry age related macular degeneration

A

drunsen (build up of waste products, white flecks)

atrophic retina near macula

86
Q

treatment of dry age related macular degeneration

A

nothing - magnifying glasses, bright stickers etc

87
Q

which angle is important in classifying glaucoma

A

iridocorneal angle (between iris and cornea)

88
Q

generally speaking, what is glaucoma caused by

A

increased intraocular pressure

89
Q

in glaucoma, increased intraocular pressure does what to the optic nerve head

A

atrophy

90
Q

in closed angle glaucoma, increased pressure at … causes the trabecular meshwork to be blocked

A

iris/lens

91
Q

what fluid cannot be drained in glaucoma

A

aqueous humour

92
Q

iatrogenic cause of closed angle glaucoma (trabecular meshwork is block by something)

A

mydriatic eye drops - as they cause pupil dilation = pupil blocks angle

rare!!

93
Q

what other common eye condition is associated with closed angle glaucoma

A

hypermetropia (long sighted)

94
Q

presentation of someone with closed angle glaucoma (5)

pain?
onset
look of eye (2)

A 
vomiting and nausea 
severe pain 
sudden onset
red eye
fixed pupil, mid dilated
95
Q

initial treatment of closed angle glaucoma (to preserve vision)

example

mechanism

A

EMERGENCY
carbonic anhydrase inhibitor

acetazolamide PO, dorzolamide eye drops

decrease aqueous humour production = decrease intraocular pressure = prevent blindness

96
Q

curative treatment of closed angle glaucoma

mechanism

potential complication (cosmetic)

A

surgery (laser iridotomy)

make hole in iris (at the top) to relieve pressure

sclera contents may spill over onto iris = white dip at top of iris

97
Q

alternative to acetazolamide for closed angle glaucoma (before surgery)

A

prostaglandin anaglogue (bimatoprost + nbenzalkonium to reduce bimatoprost conc)

98
Q

which type of glaucoma (open or closed angle) has sudden visual loss and is a ophthalmic emergency

A

closed angle

99
Q

in open angle glaucoma, if the iridocorneal angle is open (no pressure from iris/lens) then what is it that causes the increased intraocular fluid

A

something in the meshwork itself blocking it

100
Q 
is vision loss in open angle glaucoma;
sudden or gradual
painful?
central or peripheral?
red eye?
A

gradual
not painful (usually asymptomatic)
peripheral vision loss
no red eye (not an ophthalmic emergency unlike closed angle)

101
Q

what is the positive finding on examination for open angle glaucoma

A

visual field defect - peripheral vision loss

102
Q

treatment of open angle glaucoma

example (2)

mechanism

A

no cure, just want to preserve vision

carbonic anhydrase inhibitors

acetazolamide PO, dorzolamine eye drops

reduced aqueous humour production = reduced intraocular pressure = preserve vision

103
Q

is vision loss in cataracts gradual or sudden

do glasses help (patient may have already tried this)

A

gradual

no

104
Q

most common cause of cataracts

A

aging

105
Q

how is a congenital cataract picked up

A

no red light reflex at birth

106
Q

glare when driving at night

A

cataract

107
Q

what is a cataract (generally)

A

clouding/opacification of lens from denaturation of proteins

108
Q

treatment of cataract

A

lens replacement

109
Q

what is hydrocephalus

associated eye condition

A

accumulation of CSF

papilloedema

110
Q

what is papilloedema

A

optic disc swelling from increased intracranial pressure

111
Q

most common cause of papilloedema

A

intracranial tumour

112
Q

anatomically why does increased intracranial pressure cause the optic nerve to be compressed = optic disc swelling

A

optic nerve is surrounded by meninges = surrounded by CSF

113
Q

what is the vision change like in papilloedema

A

v vague - can be anything!

blurring of vision
loss of vision
enlarged blind spot

114
Q

what extraocular symptom is associated with papilloedema (think about the aetiology)

A

headaches for several months!

115
Q

what does the cup look like on fundoscopy in papilloedema (2)

A

pale colour

blurry contour

116
Q

investigations for papilloedema (3)

A 
blood pressure (for hypertension as cause) 
head MRI 
lumbar puncture (to look at CSF pressure)
117
Q

complication of untreated papilloedema

A

blindness

118
Q

what is episcleritis

A

inflammation or the episclera (vascular layer above the sclera)

119
Q

what does episcleritis look like

A

red sclera (bc vessels are on the surface)

120
Q

is episcleritis common

is episcleritis serious

A

yes

no

121
Q

what does scleritis look like

A

blue/purple sclera (bc vessels are deep)

122
Q

is episcleritis or scleritis painful

how painful

A

scleritis (deeper)

v painful - wakes people from sleep

123
Q

treatment of scleritis

A

PO NSAID

124
Q

which one (episcleritis/scleritis) is serious

why

A

scleritis

deeper inflammation

125
Q

what does anterior uveitis present similar to

A

conjunctivitis

126
Q

is anterior uveitis inflammation or infection

A

inflammation

127
Q

what is the pupil like in anterior uveitis

what is the name of the inflammatory exudate that causes this

A

small and irregular shaped

synechiae

128
Q

white line (filled in from the bottom to the line) along bottom part of iris in anterior uveitis, what is going on

what is the name of this

A

collection of pus in anterior chamber

hypopyon

129
Q

is there photophobia in anterior uveitis

A

yes

130
Q

treatment of anterior uveitis

A

topical steroids for 4-8 weeks

131
Q

what is bletharitis

A

inflammation of eyelids

132
Q

where is anterior bletharitis

A

lashes

133
Q

where is posterior bletharitis

A

behind the lashes (from meibomain gland) d

134
Q

what is red in anterior bletharitis

A

lid margin (bit along the bottom)

135
Q

what is red in posterior bletharitis

A

inside of eyelid

136
Q

which type of bletharitis is the lashes involved in

A

anterior

137
Q

which type of bletharitis may present like ‘a pea in eyelid’

A

posterior

138
Q

what does bletharitis feel like

A

gritty eyes/foreign body sensation

139
Q

treatment of bletharitis (2)

A

lid hygiene

PO doxycycline

140
Q

what do you give to someone with a corneal graft to prevent rejection

A

steroids

141
Q

what type of hypersensitivity reaction is corneal graft rejection

A

type IV (delayed)

142
Q

what investigation do you want to do for eye infection

A

swabs for culture

143
Q

what is the general treatment for eye infections

A

chloramphenicol ointment

144
Q

alternative to chloramphenicol in extreme cases of eye infection

A

oxfloxacin

145
Q

is conjunctivitis contagious

A

yes very

146
Q

how does conjunctivitis present (2)

is vision affected

A

red eyes
discharge

no

147
Q

if the discharge is watery in conjunctivitis what is the aetiology

A

viral

148
Q

if the discharge is sticky (v nasty) in conjunctivitis what is the aetiology

A

bacterial

149
Q

how does chlamydial (follicular) conjunctivitis present on the eyelids

A

‘rice grains’

‘raised cobblestoning of papillae’

150
Q

oedematous conjunctiva is classic of which conjunctivitis

A

allergic conjunctivitis

151
Q

investigations for conjunctivitis

A

swab for culture or viral PCR (depending on ?aetiology)

152
Q

treatment of bacterial conjunctivitis

A

chloramphenicol ointment

NOT hospital admission (v contagious)

153
Q

treatment of viral conjunctivitis (herpes zoster and chlamydial)

A

acyclovir if herpes zoster

oxytetracycline if chlamydial

154
Q

complication of recurrent conjunctivitis with scar formation under eyelid

how does it present

A

trachoma

blindness

this is a big issue in developing countries that dont treat conjunctivitis

155
Q

what is keratitis

A

infection of the cornea

156
Q

infection with white blobs on cornea

A

bacterial keratitis

157
Q

aetiology of keratitis (corneal infection) in someone with contact lenses

A

acanthemoeba fungi

158
Q

aetiology of herpetic keratitis

A

herpes virus

159
Q

aetiology of keratitis after a URTI

A

adenovirus

160
Q

why is keratitis v sore

A

cornea has high sensory innervation

161
Q

what does herpetic keratitis look like

A

dendritic corneal ulcer (looks like a white tree branch on cornea)

162
Q

PMH of cold sores and has keratitis

A

herpetic keratitis

163
Q

just like coldsores, what can make herpetic keratitis worse (2)

A

stress

fatigue

164
Q

investigations for keratitis

A

swabs for culture

165
Q

bacterial keratitis treatment

A

gentamicin and cefuroxime

166
Q

herpetic keratitis treatment

A

acyclovir anti-viral

167
Q

what happens if you give herpetic keratitis steroids

A

corneal melt/perforation

168
Q

complication of keratitis

A

corneal ulcer

169
Q

treatment of corneal ulcer

A

treat keratitis

170
Q

what autoimmune condition can cause corneal ulcers

A

sjogrens (sicca symptoms)

171
Q

what is endopthalmitis

A

infection of entire globe (infront and behind septum)

172
Q

who gets endopthalmitis

A

post surgery

173
Q

microbio of endopthalmitis (think of aetiology)

A

staph epidermidis (from skin)

174
Q

presentation of endopthalmitis

A

v painful
v red
decreasing vision

175
Q

treatment of endopthalmitis

A

intravitreal antibiotics asap

176
Q

prognosis of endopthalmitis

A

poor - will probs loose eye

177
Q

what is orbital cellulitis

A

infection of the orbit (behind the septum)

178
Q

how do kids get orbital cellulitis

A

from paranasal sinusitis

179
Q

does orbital cellulitis present in one or 2 eyes

A

1

180
Q

what does orbital cellulitis look like

A

red and swollen skin around eye, confined to eye socket

181
Q

systemic presentation of orbital cellulitis in kids (2)

think of aetiology

A

pyrexia (fever)
runny nose

aetiology is probs paranasal sinusitis

182
Q

investigation for orbital cellulitis

what should you find

A

CT

paranasal sinus on affected side filled with fluid

183
Q

treatment of orbital cellulitis

A

broad spectrum antibiotics (flucloxacillin, metronidazole, ceftriaxone IV)

184
Q

what can happen to the cavernous sinus in orbital cellulitis

A

cavernous sinus thrombosis

185
Q

prognosis of vision in orbital cellulitis

A

probs loose vision

186
Q

what is chorioretinitis

A

infection of the choroid and retina

187
Q

3 aetiology of chorioretinitis

A 
CMV (cytomegalovirus) 
toxoplasma gondii (raw meat)
toxocara canis (cats and dogs)
188
Q

chorioretinitis aetiology

someone with AIDS/HIV
‘mozzarella pizza/pizza pie fundus’ (white ischaemia, red haemorrhages)

A

CMV (cytomegalovirus)

189
Q

what is dacrocystitis

A

blockage of lacrimal canal = infection of lacrimal sac (stagnant tears)

190
Q

how does dacrocystitis present (infection of lacrimal sac from blockage)

A

red and swollen medial to eye

191
Q

ocular trauma

blow out fracture aetiology

A

squash ball

192
Q

ocular trauma

which bones tend to fracture in blow out fractures

why

A

inferior and medial bony orbit walls

bc theyre thinner

193
Q

ocular trauma

which nerve is most likely to be damaged in blow out fracture

why

A

infraorbital (CN V2)

bc it travels through the infraorbital canal and foramen (in the maxilla?)

194
Q

ocular trauma

which muscle is most likely to be damaged in blow out fracture

how does this present

A

inferior oblique

pain on upgaze

195
Q

ocular trauma

how does blow out fracture present on CT

A

‘tear drop sign’ (blood is in the paranasal sinus)

196
Q

ocular trauma

treatment of orbital blow out fracture

A

probs nothing surgery if v bad

197
Q

ocular trauma

which nerve may be damaged in zygomatic fracture

A

infraorbital (CN V2)

198
Q

ocular trauma

zygomatic fracture causes … to fall which … the eyeball

A

suspensory ligament

drops

199
Q

ocular trauma

why done kids’ eyes turn red when there are fractures in ocular trauma

A

bones are soft in kids

200
Q

complication of penetrating trauma to eye

how does it present

A

sympathetic ophthalmia

bilateral inflammation even though trauma was in one eye

201
Q

how does an acid burn look on the eye

A

v v red

202
Q

how does an alkali burn look on the eye

A

‘china white appearance’ of sclera

203
Q

are alkali or acid burns worse prognosis

A

alkali (even though they probs look better bc theyre white)

204
Q

treatment of acid/alkali burn to eye

A

immediate irrigation, 2l saline

J Ophthalmology (6 decks)

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