Eye conditions Flashcards
roth spots (red dots in fundus)
infective endocarditis
brushfield spots (white spots in iris)
downs syndrome
previous eye trauma/surgery in one eye
bilateral granulomatous uveitis
floaters in eye
sympathetic ophthalmia
aetiology of monocular blindness (2)
optic neuritis (inflammation of optic nerve) tumours
something in optic canal
aetiology of bitemporal hemianopia (1)
pituitary tumour
something in optic chiasm
aetiology of missing vision on either left or right side (in both eyes) (3)
demyelination
tumour
vascular disease (stroke)
what is optic neuritis
inflammation of optic nerve
why is there pain on eye movement in optic neuritis
bc the optic nerve sheath is attached to the common tendinous ring for the rectus extraocular eye muscles
pain behind eye on movement
colour desaturation
unilateral vision loss over 24 hours
optic neuritis
emmetropia definition
no refractive error
ametropia definition
generic term for refractive error eg myopia, hypermetropia
whats another name for hypermetropia
long sightedness (can see things far away fine but not far away things)
which type of glasses are used for hypermetropia
convex
whats another name for myopia
short sightedness (can see things close by fine but not far away things)
which type of glasses are used for myopia
concave (bc CAVES are LONG and you want to fix their LONG sight so they can see in the CAVE)
astigmatism definition
rugby ball shaped cornea
astigmatism presentation
long and short sight is blurry (funny shaped cornea = distorted image passed on to retina)
presbyopia definition
who get it
loss of accommodation reflex
middle aged people (happens to most people)
treatment of presbyopia
reading glasses
amblyopia (cortical blindness) definition
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)
example of when amblyopia (cortical blindness) can occur
untreated wandering eye in kids
another name for a tropia
squint
if you cover a patients eye and the other moves outwards, what type of squint is it
esotropia (was previously in)
if you cover a patients eye and the other moves inwards, what type of squint is it
exotropia (was previously out)
if you cover a patients eye and the other moves upwards, what type of squint is it
hypotropia (was previously down)
if you cover a patients eye and the other moves downwards, what type of squint is it
hypertropia (was previously up)
diplopia treatment
prism glasses
aetiology of horizontal diplopia
CN VI palsy
which 5 extraocular muscles (and 1 intraocular) are affected in a CN III palsy
medial rectus superior rectus inferior rectus inferior oblique levator palpebrae superioris sphincter pupillae
how does a CN III palsy present
down out and dilated eye
bc the lateral rectus, superior oblique and sphincter pupillae (that causes constriction) all still work
is there a normal pupillary reflex in CN III palsy
no
bc of the down and out nature of the eye in CN III palsy, what may happen to the eyelid
dropping (ptosis)
if a CN III palsy (down out and dilated pupil) is PAINFUL what is the cause
treatment
aneurysm
treat fast!
general aetiology of CN palsies (4)
vascular disease (stroke)
tumours
demyelination
congenital
presentation of CN IV palsy (2)
tripping downstairs head tilt (to compensate)
trochlear nerve not working = superior oblique not working = cant look down
presentation of CN VI palsy (2)
permanent adduction (medial deviation) of affected eye diplopia (double vision)
general treatment of eye infection
chloramphenicol
general treatment of eye inflammation
steroids
treatment of eye swelling form allergy
anti histamines
general treatment of painful eye
topical NSAIDs
most common type of gradual vision loss
age related macular degeneration (ARMD) dry type
someone with eye pain and change of appearance of eyes AND weight loss
thyroid eye disease (hyperthyroidism)
aetiology of central retinal artery occlusion
emboli from carotid (or heart)
risk factors for central retinal artery occlusion (4)
hypertension, diabetes, high cholesterol, smoking
what is the vision loss like in central retinal artery occlusion (sudden/gradual? painful?)
think about it
painless and sudden
how bad is the vision loss in central retinal artery occlusion
what can they see
v bad
cant see Snellen chart, can count fingers
fundoscopy in central retinal artery occlusion
pale/oedematous retina
cherry red spot macula
thread like/non tortious veins
what investigations would you want to do after diagnosing a central retinal artery occlusion
why
carotid US
to find source of emboli
treatment of central retinal artery occlusion (2)
ocular massage (rub eye within 24 hours to try and dislodge it into one of the branches) surgery if ocular massage ineffective
if a central retinal artery occlusion isnt fixed within 70 mins what happens
vision prognosis
irreversible ischaemia
probs vision loss
another name for transient central retinal artery occlusion
amaurosis fugax
how long does transient central retinal artery occlusion last for
<5 mins
what is the vision loss like in transient central retinal artery occlusion (amaurosis fugax) (sudden/gradual? painful?)
think about it
sudden painless vision loss
how would a patient describe their vision in transient central retinal artery occlusion (amaurosis fugax)
‘like a curtain coming down’
treatment of transient central retinal artery occlusion (amaurosis fugax) (prophylaxis of full central retinal artery occlusion)
where do you refer them, why
aspirin
refer to stroke - at risk of having a stroke
‘like a curtain coming down’ <5mins
transient central retinal artery occlusion (amaurosis fugax)
‘like a curtain coming down’ >5mins
retinal detachment
cherry red spot on macula
pale fundus
non tortious veins
central retinal artery occlusion
dark tortious veins
blood and thunder fundus
retinal haemorrhages
new vessel formation
central retinal vein occlusion
sudden painless vision loss differentials in some with hypertension (2)
how do you differentiate between them
central retinal artery occlusion
central retinal vein occlusion
fundoscopy
how bad is the vision loss in central retinal vein occlusion
what can/cant they see
v bad
can see Snellen chart or counting fingers, can see some light
aetiology of central retinal vein occlusion
emboli
why is there haemorrhages etc in central retinal vein occlusion
bc its the veins the blood thats behind the blockage is in the eye (in central retinal artery occlusion is behind the eye)
treatment of central retinal vein occlusion
by what method
why
anti-VEGF (vascular endothelial growth factor)
intravitreal injection
stops new vessel growth
aetiology of posterior ciliary artery occlusion
giant cell arteritis
what does posterior ciliary artery occlusion do to the optic nerve
causes ischaemia
is posterior ciliary artery occlusion (associated with giant cell arteritis and optic nerve ischaemia) reversible
no
what happens to the vitreous gel in old people that makes them more susceptible to retinal detachment
it becomes more liquid = tugs on retina and pulls it in
what is the sensory retina detached form in retinal detachment
retinal pigment epithelium
is retinal detachment painful
no
what is the loss of vision like in retinal detachment
onset
‘curtains in field of vision’ >5mins
as well as painless vision loss, what else might someone with retinal detachment experience in their vision
sudden onset flashes and floaters
what do you see on fundoscopy of retinal detachment
line where retina has detached
treatment of retinal detachment
explanation (2 steps)
how fast
surgery
aspirate vitreous gel (it is the thing thats pulling on the retina)
reattach retina
urgent!
most common cause of blindness in UK
age related macular degeneration (ARMD)
what is the presentation of both wet and dry type age related macular degeneration
why
central vision ‘missing’
because the macula is degenerated (duh) = central vision affected
which type of ARMD (age related macular degeneration) is sudden
wet
as soon as the haemorrhage happens = vision affected (in the dry type theres no sudden pathological changes = no sudden vision loss)
which type of age related macular degeneration is gradual
dry
why is dry age related macular degeneration called the ‘dry type’
no leakage of blood vessels (haemorrhage)
treatment of wet age related macular degeneration
administration method
anti-VEGF
intra vitreal injection
what does anti-VEGF do
stops new vessel formation
why is wet age related macular degeneration called the ‘wet type’
haemorrhage (leakage of blood vessels)
is dry age related macular degeneration sudden or gradual vision loss
why
gradual
bc there is no haemorrhage (and it is the haemorrhage in wet type that makes the vision loss sudden)
fundoscopy in wet age related macular degeneration
haemorrhage
new vessel formation
atrophic retina near macula
fundoscopy in dry age related macular degeneration
drunsen (build up of waste products, white flecks)
atrophic retina near macula
treatment of dry age related macular degeneration
nothing - magnifying glasses, bright stickers etc
which angle is important in classifying glaucoma
iridocorneal angle (between iris and cornea)
generally speaking, what is glaucoma caused by
increased intraocular pressure
in glaucoma, increased intraocular pressure does what to the optic nerve head
atrophy
in closed angle glaucoma, increased pressure at … causes the trabecular meshwork to be blocked
iris/lens
what fluid cannot be drained in glaucoma
aqueous humour
iatrogenic cause of closed angle glaucoma (trabecular meshwork is block by something)
mydriatic eye drops - as they cause pupil dilation = pupil blocks angle
rare!!
what other common eye condition is associated with closed angle glaucoma
hypermetropia (long sighted)
presentation of someone with closed angle glaucoma (5)
pain?
onset
look of eye (2)
vomiting and nausea severe pain sudden onset red eye fixed pupil, mid dilated
initial treatment of closed angle glaucoma (to preserve vision)
example
mechanism
EMERGENCY
carbonic anhydrase inhibitor
acetazolamide PO, dorzolamide eye drops
decrease aqueous humour production = decrease intraocular pressure = prevent blindness
curative treatment of closed angle glaucoma
mechanism
potential complication (cosmetic)
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
alternative to acetazolamide for closed angle glaucoma (before surgery)
prostaglandin anaglogue (bimatoprost + nbenzalkonium to reduce bimatoprost conc)
which type of glaucoma (open or closed angle) has sudden visual loss and is a ophthalmic emergency
closed angle
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
something in the meshwork itself blocking it
is vision loss in open angle glaucoma; sudden or gradual painful? central or peripheral? red eye?
gradual
not painful (usually asymptomatic)
peripheral vision loss
no red eye (not an ophthalmic emergency unlike closed angle)
what is the positive finding on examination for open angle glaucoma
visual field defect - peripheral vision loss
treatment of open angle glaucoma
example (2)
mechanism
no cure, just want to preserve vision
carbonic anhydrase inhibitors
acetazolamide PO, dorzolamine eye drops
reduced aqueous humour production = reduced intraocular pressure = preserve vision
is vision loss in cataracts gradual or sudden
do glasses help (patient may have already tried this)
gradual
no
most common cause of cataracts
aging
how is a congenital cataract picked up
no red light reflex at birth
glare when driving at night
cataract
what is a cataract (generally)
clouding/opacification of lens from denaturation of proteins
treatment of cataract
lens replacement
what is hydrocephalus
associated eye condition
accumulation of CSF
papilloedema
what is papilloedema
optic disc swelling from increased intracranial pressure
most common cause of papilloedema
intracranial tumour
anatomically why does increased intracranial pressure cause the optic nerve to be compressed = optic disc swelling
optic nerve is surrounded by meninges = surrounded by CSF
what is the vision change like in papilloedema
v vague - can be anything!
blurring of vision
loss of vision
enlarged blind spot
what extraocular symptom is associated with papilloedema (think about the aetiology)
headaches for several months!
what does the cup look like on fundoscopy in papilloedema (2)
pale colour
blurry contour
investigations for papilloedema (3)
blood pressure (for hypertension as cause) head MRI lumbar puncture (to look at CSF pressure)
complication of untreated papilloedema
blindness
what is episcleritis
inflammation or the episclera (vascular layer above the sclera)
what does episcleritis look like
red sclera (bc vessels are on the surface)
is episcleritis common
is episcleritis serious
yes
no
what does scleritis look like
blue/purple sclera (bc vessels are deep)
is episcleritis or scleritis painful
how painful
scleritis (deeper)
v painful - wakes people from sleep
treatment of scleritis
PO NSAID
which one (episcleritis/scleritis) is serious
why
scleritis
deeper inflammation
what does anterior uveitis present similar to
conjunctivitis
is anterior uveitis inflammation or infection
inflammation
what is the pupil like in anterior uveitis
what is the name of the inflammatory exudate that causes this
small and irregular shaped
synechiae
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
collection of pus in anterior chamber
hypopyon
is there photophobia in anterior uveitis
yes
treatment of anterior uveitis
topical steroids for 4-8 weeks
what is bletharitis
inflammation of eyelids
where is anterior bletharitis
lashes
where is posterior bletharitis
behind the lashes (from meibomain gland) d
what is red in anterior bletharitis
lid margin (bit along the bottom)
what is red in posterior bletharitis
inside of eyelid
which type of bletharitis is the lashes involved in
anterior
which type of bletharitis may present like ‘a pea in eyelid’
posterior
what does bletharitis feel like
gritty eyes/foreign body sensation
treatment of bletharitis (2)
lid hygiene
PO doxycycline
what do you give to someone with a corneal graft to prevent rejection
steroids
what type of hypersensitivity reaction is corneal graft rejection
type IV (delayed)
what investigation do you want to do for eye infection
swabs for culture
what is the general treatment for eye infections
chloramphenicol ointment
alternative to chloramphenicol in extreme cases of eye infection
oxfloxacin
is conjunctivitis contagious
yes very
how does conjunctivitis present (2)
is vision affected
red eyes
discharge
no
if the discharge is watery in conjunctivitis what is the aetiology
viral
if the discharge is sticky (v nasty) in conjunctivitis what is the aetiology
bacterial
how does chlamydial (follicular) conjunctivitis present on the eyelids
‘rice grains’
‘raised cobblestoning of papillae’
oedematous conjunctiva is classic of which conjunctivitis
allergic conjunctivitis
investigations for conjunctivitis
swab for culture or viral PCR (depending on ?aetiology)
treatment of bacterial conjunctivitis
chloramphenicol ointment
NOT hospital admission (v contagious)
treatment of viral conjunctivitis (herpes zoster and chlamydial)
acyclovir if herpes zoster
oxytetracycline if chlamydial
complication of recurrent conjunctivitis with scar formation under eyelid
how does it present
trachoma
blindness
this is a big issue in developing countries that dont treat conjunctivitis
what is keratitis
infection of the cornea
infection with white blobs on cornea
bacterial keratitis
aetiology of keratitis (corneal infection) in someone with contact lenses
acanthemoeba fungi
aetiology of herpetic keratitis
herpes virus
aetiology of keratitis after a URTI
adenovirus
why is keratitis v sore
cornea has high sensory innervation
what does herpetic keratitis look like
dendritic corneal ulcer (looks like a white tree branch on cornea)
PMH of cold sores and has keratitis
herpetic keratitis
just like coldsores, what can make herpetic keratitis worse (2)
stress
fatigue
investigations for keratitis
swabs for culture
bacterial keratitis treatment
gentamicin and cefuroxime
herpetic keratitis treatment
acyclovir anti-viral
what happens if you give herpetic keratitis steroids
corneal melt/perforation
complication of keratitis
corneal ulcer
treatment of corneal ulcer
treat keratitis
what autoimmune condition can cause corneal ulcers
sjogrens (sicca symptoms)
what is endopthalmitis
infection of entire globe (infront and behind septum)
who gets endopthalmitis
post surgery
microbio of endopthalmitis (think of aetiology)
staph epidermidis (from skin)
presentation of endopthalmitis
v painful
v red
decreasing vision
treatment of endopthalmitis
intravitreal antibiotics asap
prognosis of endopthalmitis
poor - will probs loose eye
what is orbital cellulitis
infection of the orbit (behind the septum)
how do kids get orbital cellulitis
from paranasal sinusitis
does orbital cellulitis present in one or 2 eyes
1
what does orbital cellulitis look like
red and swollen skin around eye, confined to eye socket
systemic presentation of orbital cellulitis in kids (2)
think of aetiology
pyrexia (fever)
runny nose
aetiology is probs paranasal sinusitis
investigation for orbital cellulitis
what should you find
CT
paranasal sinus on affected side filled with fluid
treatment of orbital cellulitis
broad spectrum antibiotics (flucloxacillin, metronidazole, ceftriaxone IV)
what can happen to the cavernous sinus in orbital cellulitis
cavernous sinus thrombosis
prognosis of vision in orbital cellulitis
probs loose vision
what is chorioretinitis
infection of the choroid and retina
3 aetiology of chorioretinitis
CMV (cytomegalovirus) toxoplasma gondii (raw meat) toxocara canis (cats and dogs)
chorioretinitis aetiology
someone with AIDS/HIV
‘mozzarella pizza/pizza pie fundus’ (white ischaemia, red haemorrhages)
CMV (cytomegalovirus)
what is dacrocystitis
blockage of lacrimal canal = infection of lacrimal sac (stagnant tears)
how does dacrocystitis present (infection of lacrimal sac from blockage)
red and swollen medial to eye
ocular trauma
blow out fracture aetiology
squash ball
ocular trauma
which bones tend to fracture in blow out fractures
why
inferior and medial bony orbit walls
bc theyre thinner
ocular trauma
which nerve is most likely to be damaged in blow out fracture
why
infraorbital (CN V2)
bc it travels through the infraorbital canal and foramen (in the maxilla?)
ocular trauma
which muscle is most likely to be damaged in blow out fracture
how does this present
inferior oblique
pain on upgaze
ocular trauma
how does blow out fracture present on CT
‘tear drop sign’ (blood is in the paranasal sinus)
ocular trauma
treatment of orbital blow out fracture
probs nothing surgery if v bad
ocular trauma
which nerve may be damaged in zygomatic fracture
infraorbital (CN V2)
ocular trauma
zygomatic fracture causes … to fall which … the eyeball
suspensory ligament
drops
ocular trauma
why done kids’ eyes turn red when there are fractures in ocular trauma
bones are soft in kids
complication of penetrating trauma to eye
how does it present
sympathetic ophthalmia
bilateral inflammation even though trauma was in one eye
how does an acid burn look on the eye
v v red
how does an alkali burn look on the eye
‘china white appearance’ of sclera
are alkali or acid burns worse prognosis
alkali (even though they probs look better bc theyre white)
treatment of acid/alkali burn to eye
immediate irrigation, 2l saline
