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Year 2 - Nervous > Eye conditions > Flashcards

Eye conditions Flashcards

1
Q

What is an acute red eye (hint: what segment of eye does it affect)

A

Inflammation of structures in the anterior segment

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2
Q

Acute red eye differentials (7)

A 
Infective conjunctivitis
Allergic conjunctivitis
Corneal abrasion
Acute anterior uveitis
Scleritis
Acute angle closure glaucoma
Orbital cellulitis
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3
Q

Acute red eye general symptoms (5) /signs (2)

A 
Symptoms:
Eye redness
Eye pain
Eye discharge - purulent/mucoid/watery
Blurred vision

Signs:
Photophobia
Seeing flashing lights

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4
Q

Examination of red eye (4)

A

Test best corrected (i.e. with glasses) visual acuity with snellen chart

Fundal examination

  • ophthalmoscope OR
  • microscope + slit lamp (+volk lens)

Staining with fluoroscein + then viewing with micrscope + slit lamp with a COBALT BLUE light filter

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5
Q

What special lens is used in conjunction with a slit lamp to give good view of the posterior segment of the eye

A

Volk lens

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6
Q

What does staining with fluorescein allow you to see

A

Outlines epithelial defects

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7
Q

Symptoms (2) /signs (2) of infective conjunctivitis

A

Symptoms:
Gritty feeling in eye
Redness

Sign:
Purulent discharge
Eyelids stuck together in morning

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8
Q

Treatment of infective conjunctivitis (3)

  • if bacterial
  • if viral
A

Cleaning with water daily
Topical antibiotics - if bacterial
Topical antihistamines - if viral

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9
Q

Symptoms (3) /signs (3) of allergic conjunctivitis

A

Symptoms:
Itchy
Redness
Watering of eye

Signs:
Mucoid discharge
Eyelid swelling
Conjunctival swelling (chemosis - oedema of conjunctiva)

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10
Q

Treatment of allergic conjunctivitis (4)

A

Avoid allergen
Artificial tears
Topical antihistamine
Mast cell stabilisers - prophylactic (Treats future episodes, not current)

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11
Q

What is corneal abrasion + what causes it

A

Loss of an area of the corneal epithelium - corneal epithelial defect

Foreign body like fingernail or a twig

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12
Q

Symptoms (4) /signs (2) of corneal abrasion

A 
Symptoms:
Eye pain
Eye watering
Blurred vision
Feeling of a foreign body in eye

Signs:
Epithelial defect
Photophobia

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13
Q

Treatment of corneal abrasion (3)

A

Remove foreign body
Analgesia - NSAIDs
Topical antibiotics

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14
Q

What is acute anterior uveitis

A

Inflammation of anterior part of uvea = iris + ciliary body

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15
Q

Symptoms (3) /signs (6) of acute anterior uveitis

A

Symptoms:
Eye pain
Eye watering
Blurred vision

Signs:
Synechiae - iris adhering to cornea
Flare - inflammation and leukocytes floating in AC
Keratic precipitates - lymphocyte aggregates on the corneal endothelium
Photophobia
Redness
Small irregular pupil

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16
Q

Treatment of acute anterior uveitis (2)

A

Topical steroids

Dilating eye drops (e.g. cyclopentolate) - to break down adhesion and reduce pain

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17
Q

Symptoms (2)/ signs (2) of scleritis

A

Symptoms:
Eye pain
Eye redness

Signs:
Nodules on the sclera
Tender eyeball

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18
Q

Treatment of scleritis

A

Systemic steroids - high dose prednisolone IV or oral

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19
Q

Symptoms (5)/signs (4) of acute angle closure glaucoma

A 
Symptoms:
Eye pain
Redness
Blurry vision
Nausea/ vomiting
Headache
Signs:
Hazy cornea - corneal oedema
Fixed mid dilated pupil
Hard and tender eyeball
Increased IOP >40mmHg
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20
Q

Normal intra-ocular pressure range

A

10-21mmHg

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21
Q

Treatment of acute angle closure glaucoma (3)

A

1st line - Carbonic anhydrase inhibitors - e.g. acetazolamide

+/- Constrictor pupil eye drops

Laser peripheral iridotomy (when acute attack resolves)

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22
Q

Symptoms (4) /signs (4) of orbital cellulitis

A 
Symptoms:
Pain
Redness
Blurred vision
Malaise
Signs:
Diplopia
Pyrexia
Proptosis - protruding eye
Reduced eye movement
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23
Q

Orbital cellulitis vs peri-orbital cellulitis

A

Peri-orbital cellulitis is inflammation and infection of the superficial eyelid, usually from a superficial source, e.g. insect bite

Orbital cellulitis is an infection within the orbital soft tissues and is usually due to underlying bacterial sinusitis - far more serious than peri-orbital cellulitis

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24
Q

Investigations of orbital cellulitis

A

CT of sinuses

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25
Q

Treatment of orbital cellulitis (2)

A

URGENT TREATMENT

  • IV antibiotics
  • Drainage of pus if there’s abscess
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26
Q

What does adnexal refer to

A

Tissue around the eyeball = eyelids, extrinsic muscles, socket etc

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27
Q

Most common type of eyelid tumour + name another type of eyelid tumour

A

Basal cell carcinoma

squamous cell carcinoma

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28
Q

Name 2 major risk factors for basal cell carcinoma eyelid tumours

A

UV radiation

Frequent sun exposure

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29
Q

Possible treatment for basal cell carcinoma/squamous cell carcinoma eyelid tumours (3)

A

Surgical excision
Radiotherapy
Chemotherapy

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30
Q

Clinical features of basal cell carcinoma eyelid tumours (2)

A

Usually painless

Flat red mark

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31
Q

Symptoms/signs of lacrimal gland tumour (4)

A

Blurry vision
Double vision
Swelling of eyelid
Pain around the eye

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32
Q

Loss is vision is associated with damage of which segment of the eye

A

Posterior

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33
Q

Questions to ask someone presenting with loss of vision (just think socrates with these type of questions)

A

Is it unilateral/bilateral
Was it sudden or gradual onset
What type of loss - blurry/distorted/black
Any associated symptoms - pain/redness/discharge

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34
Q

Examination of someone with loss of vision (5)

A

Testing best corrected visual acuity with snellen chart

Testing pinhole visual acuity with snellen chart

Fundoscopy

Slit lamp

Ancillary tests (=other supportive tests; not compulsory)

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35
Q

2 ways of doing a fundal examination

A

Direct ophthalmoscope (fundoscope)

Slit lamp + volk lens

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36
Q

Name 5 ancillary (accessory) tests that can be done when examining loss of vision

A

Amsler chart - tests if central vision distorted

Colour vision test

Visual field test

Fluorescein angiography

Optical coherence tomography

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37
Q

Differentials of loss of vision (6)

A 
Central retinal artery occlusion
Anterior ischaemic optic neuropathy
Cataract
Glaucoma - primary open angle glaucoma, angle closure glaucoma
Age related macular degeneration 
Diabetic retinopathy
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38
Q

Name the 2 conditions causing sudden loss of vision

A

Central retinal artery occlusion

Anterior ischaemic optic neuropathy

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39
Q

Name the 6 conditions causing gradual loss of vision

A 
Cataract
Glaucoma
Primary open angle glaucoma (CHRONIC)
Angle closure glaucoma (ACUTE)
Age related macular degeneration 
Diabetic retinopathy
40
Q

2 causes of central retinal artery occlusion (–>SUDDEN loss of vision)

A

Embolus often from the carotids or the heart occludes the artery so no blood gets to retina –> retina becomes ischaemic so photoreceptors don’t work

Atherosclerosis of the central retinal artery

41
Q

Symptom/sign (2) of central retinal artery occlusion

A

Sudden PAINLESS vision loss

Afferent pupillary defect

42
Q

Treatment of central retinal artery occlusion (4)

A

Treat any risk factors:

  • BP control
  • Statins
  • Antiplatelets

Intravitreal anti Vegf

43
Q

4 Risk factors of central retinal artery occlusion

A

Atherosclerosis
Hypertension
Hypercholesterolaemia
Diabetes mellitus

44
Q

What does anti Vegf do

A

Blocks activity of vascular endothelial growth factor (VEGF)

VEGF increases permeability of capillaries in the eye (makes capillaries in eyes more leaky so anti Vegf can dry up the fluid in the retina and improve vision)

45
Q

Definition of anterior ischaemic optic neuropathy

A

Damage to anterior optic nerve due to ischaemia

Optic nerve supplied by short posterior ciliary arteries, if they’re occluded then optic nerve head infarcts and swells

46
Q

2 types of anterior ischaemic optic neuropathy

A

Arteritic (giant cell arteritis) and non-arteric type

47
Q

Pathophysiology of arteritic type anterior ischaemic optic neuropathy (2)

A

Giant cell arteritis (temporal arteritis):

Inflammation of blood vessels supplying blood to optic nerve –> thickens wall of artery and obstructs lumen

Inflammation of arteries of a certain calibre - usually MEDIUM/LARGE SIZED ARTERIES; branches of ECA

48
Q

Symptom (3) /signs (5) of arteritic type anterior ischaemic optic neuropathy

A

Symptoms:
Sudden painless loss of vision
Headache
Pain on chewing/facial pain

Signs:
Scalp tenderness/tenderness of superficial temporal arteries
Claudication of extremities
Loss of appetite 
Pale enlarged optic disc
Afferent pupillary defect
49
Q

Investigations of arteritic type anterior ischaemic optic neuropathy

A

Inflammatory markers:
ESR - raised
CRP - raised

Temporal artery biopsy

50
Q

Treatment of arteritic type anterior ischaemic optic neuropathy (i.e. treatment of giant cell arteritis)

A

High dose IV steroids - prednisolone

51
Q

What is non-arteritic type anterior ischaemic optic neuropathy

A

Non-inflammatory process of small blood vessels

52
Q

Causes of non-arteritic type anterior ischaemic optic neuropathy

A

Atheromatous narrowing of short posterior ciliary arteries

Drop in blood pressure to such a degree that blood supply to the optic nerve is decreased;

increased pressure inside the eyeball;

53
Q

Treatment of non-arteritic type anterior ischaemic optic neuropathy

A

Treat any underlying heart disease and other risk factors

54
Q

Risk factors of non-arteritic type anterior ischaemic optic neuropathy

A

Hypertension
Diabetes
Hypercholesterolaemia
Heart disease

55
Q

Investigations of of non-arteritic type anterior ischaemic optic neuropathy

A

Rule out arteritic type with:

  • ESR
  • CRP
56
Q

What is a cataract

A

Gradual opacification of the lens from normal ageing process, trauma, metabolic disorders (hereditary or acquired or congenital problems)

57
Q

Pathophysiology of age related cataracts (5)

A

Undergo a process called nuclear sclerosis – >nuclear cataract:

As we age, new collagen fibres form around the edges of the lens concentrically which pushes/compresses the older collagen fibres into the middle (into the nucleus of the lens)

This causes the nucleus of the lens to become cloudy, dense and yellow

As we age, the lens absorbs harmful UV rays to prevent these rays from damaging the retina but consequently, the lens gets damaged itself over time

Damaged lens fibres –> OPAQUE –> CATARACT

58
Q

Risk factors of cataract (4)

A

Smoking
UV rays
Age
Diabetes

59
Q

Symptoms (2) /signs (2) of cataract

A

Symptoms:
Gradual loss of vision
Blurry vision

Signs:
Glare (difficulty seeing when there’s bright lights)
Reduced visual acuity

60
Q

Main examination test of cataract

+ diagnostic criteria of cataract

A

Testing best corrected visual acuity with snellen chart

Diagnosis - detection of a decrease in visual acuity (can’t focus) that cannot be corrected by refractive correction

61
Q

Treatment of cataract

A

Surgery: phacoemulsification with intraocular lens implant

-surgical incision into the eye and removal of the opacified crystalline lens by breaking it up into small fragments then sucking it up and replacing with an artificial lens

62
Q

Commonest cause of vision loss + 2nd commonest

A

Cataract

Glaucoma

63
Q

What is glaucoma

A

Increased intra-ocular pressure above 23mmHg -due to improper drainage of AH -> increased pressure on optic nerve so damaging it –> VISUAL FIELD DEFECTS

64
Q

2 types of glaucoma

A

Primary open angle glaucoma - chronic

Angle closure glaucoma - can be acute or chronic

65
Q

Glaucoma - diagnostic triad of signs

A

1) Raised IOP
2) Visual field defects
3) Optic disc changes on ophthalmoscopy

66
Q

Symptoms/signs (4) of primary open angle glaucoma

A

Asymptomatic often

Signs:
Gradual peripheral field vision loss
Increased IOP
Notching of optic nerve cup
Loss of nerve fibre layer
67
Q

Examination (2)
Investigation (1)

of glaucoma

A

Fundoscopy
Microscope + slit lamp

Visual field test - manual or automated perimetry

68
Q

Pathophysiology of primary open angle glaucoma

A

Anatomically open angle of the AC but with an obstructed and slowed trabecular drainage system outflow –> gradual build up of IOP

69
Q

Treatment of primary open angle glaucoma

  • medical (3)
  • surgical (2)
A

Topical eye drops to decrease IOP by decreasing AH:

  • Prostaglandin analogues
  • Beta blockers
  • Carbonic anhydrase inhibitors

Laser trabeculoplasty - if eye drops fail
Trabeculotomy - creating new pathway for AH to drain

70
Q

2 causes of angle closure glaucoma

A

The iris may be pushed from behind against the trabecular meshwork - most commonly due to pupillary block (build up of AH in posterior chamber forces peripheral iris anteriorly which narrows/BLOCKS the angle of the AC)

The iris may be pulled up against the trabecular meshwork - e.g. contraction of inflamed membrane in uveitis

71
Q

Symptoms (5) /signs (5) of angle closure glaucoma

A 
Symptoms:
PAINFUL aching eye
Headache
Seeing halos around lights
Blurry vision
Nausea/vomiting
Signs:
Reduced visual acuity
Eye redness
Increased IOP
Fixed dilated pupil
Corneal oedema
72
Q

Examination (1)
Investigations (2)

of angle closure glaucoma

A

Microscope + slit lamp

Automated perimetry - tests visual field
Optical coherence tomography

73
Q

Treatment of acute angle closure glaucoma

  • medical (3)
  • surgical (1)
A

Decrease IOP with:

  • Topical or oral carbonic anhydrase inhibitors
  • AND/OR Topical beta blocker

+Analgesia

+ Laser peripheral iridotomy (after acute attack resolves)

74
Q

What is age related macular degeneration/ pathophysiology

A

Dystrophy/degeneration of PIGMENT EPITHELIAL LAYER OF THE RETINA which destructs rods and cones as DRUSEN develop between the pigment epithelial layer and the choroid
–> deprive the pigment epithelial layer and photoreceptors of oxygen and nutrients

75
Q

Signs of age related macular degeneration (4)

A

Gradual loss/DISTORTION of CENTRAL vision

Good peripheral vision

Drusen (fatty deposits) seen on fundal examination

Pigment epithelial changes (atrophy of pigment epithelial layer and subsequently the photoreceptors too )

76
Q

Name the 2 types of advanced ARMD

A

Dry (90%)

wet (neovascular) (10%)

77
Q

Pathophysiology of wet ARMD

A

New choroidal blood vessels develop from the choroid, grow up between individual pigment epithelial cells and sit between the pigment epithelial layer and the photoreceptor layer

These blood vessels can start bleeding between these 2 layers –> impairment of the retina –> GRADUAL VISION LOSS

78
Q

Major sign of dry ARMD

A

Drusen (fatty deposits) in the retina

79
Q

Examination (1)
Investigations (2)

of ARMD

A

Amsler grid - would show CENTRAL DISTORTION

Optical coherence tomography (OCT)
Fluorescein angiography - confirms wet ARMD

80
Q

Treatment of ARMD (not curative)

  • early stage (modify risk factors - 4)
  • dry ARMD (1)
  • wet ARMD (1)
A

Low vision aids - hand magnifier

Early stages: 
=Modify risk factors
-Stop smoking
-Lower cholesterol
-Lower glucose intake
-Control BP

Advanced dry ARMD:
-Observe and modify risk factors

Advanced wet ARMD:
-Intravitreal anti Vegf

81
Q

What is diabetic retinopathy/pathophysiology

A

Complication of chronic progressive diabetic microvascular leakage and occlusion of vessels in the retina

Microvascular damage leads to ISCHAEMIC RETINA which induces retina to produce VEGF –> stimulating growth of abnormal blood vessels (neovascularisation)

These new blood vessels can leak into VH and impair vision

82
Q

Signs of diabetic retinopathy (5)

A 
Gradual loss of vision
Microaneurysms
Retinal haemorrhages
Neovascularisation of the optic disc/retina
Macular oedema
83
Q

Examination (1)
Investigations (2)

of diabetic retinopathy

A

Fundus examination

Fluorescein angiography
OCT

84
Q

Treatment of diabetic retinopathy (for non-severe and severe)

  • if lots of macular oedema
  • if not much macular oedema
A

Intravitreal anti Vegf - if there’s lots of macular oedema
+/-Macular laser therapy

+/- pan-retinal photocoagulation - if not much macular oedema

85
Q

Why is the eye an immune privileged site

A

Because the avascularity of the cornea plays a good role in corneal transplant - less chance of foreign antigens from a corneal graft being recognised by the recipient so lesser chance of graft rejection

Therefore said to be immune privileged

86
Q

Causes of conjunctivitis (3)

A

Bacterial
Viral
Allergy

87
Q

What is a stye/hordeolum

A

Bacterial infection of an oil gland in the EYELID –> abscess formation in eyelid –> red tender bump (stye)

88
Q

2 types of stye + cause of each

A 
External stye (hordeolum externum)
-Blocked sebaceous glands of an eyelash
Internal style (hordeolum internum)
-blocked meibomian glands in tarsal plate
89
Q

Symptoms (2) /signs (2) of stye (hordeolum)

A

Pain/tenderness
Redness

Yellow pus at centre of bump
Swelling of eyelid

90
Q

Treatment of stye (3)

A 
Topical antibiotic eye ointment
Warm compress (placing hot water towel on eye 5 times a day)

Only need surgical incision + drainage if vision distorted or unresponsive to antibiotics

91
Q

Name an inflammatory and non-inflammatory corneal pathology/disease

A

Corneal ulcer - inflammatory

Corneal dystrophy - non-inflammatory

92
Q

Sign of corneal dystrophy/degeneration

A

Impaired vision

93
Q

How high can IOP increase to in acute angle closure glaucoma

A

70mmHg

94
Q

What part of the uvea is affected in intermediate uveitis

A

Posterior ciliary body

95
Q

What part of the uvea is affected in posterior uveitis + what other parts of the eye

A

Choroid
Retina
Optic nerve

96
Q

Pathophysiology of anterior uveitis

A

Inflamed iris leaks out plasma and WBCs into the AH –> hazy anterior chamber –> hazy vision

97
Q

Causes of uveitis (3)

A

Idiopathic,
Autoimmune - HLA-B27-related disease (UC)
Infection - viral, bacterial

Year 2 - Nervous (39 decks)

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