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Opthalmology > Eye disorders - the rest > Flashcards

Eye disorders - the rest Flashcards

1
Q

define ptergium

A
  • Raised, yellowish wedge shaped growth of conjunctiva that extends onto cornea.
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2
Q

RF for ptergium

A
  • Exposure to wind, dryness, dust ad sunshine (solar radiation).
  • Hot climates
  • Common In those that spend a lot of time outdoors - aka surfers eye or farmers eye
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3
Q

presentation of pterygium

A
  • Painless – can cause dryness and irritation.
  • Obstructs vision.
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4
Q

Diagnosis of ptergium

A

slit lamp exam

clinical

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5
Q

Mx of ptergium

A
  • Corticosteroid drops and artificial tears
  • Surgery – if vision impaired or for cosmetic reasons.
  • Often comes back – prevented w/ sunglasses and artificial tear drops.
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6
Q

Define stabismus

A

aka squint

  • Both eyes do not line up in same direction (misaligned).
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7
Q

Causes of squint

A
  • Disorder of ext ocular muscles
  • Abn in neuromuscular control of eye movement.
  • Congenital (before 6 months) or acquired.
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8
Q

RF in developing squint

A
  • Idiopathic
  • Cerebral palsy, downs syn, hydrocephalus, space occupying lesion.
  • Stroke – common cause in adults.
  • Graves disease.
  • Trauma – damage to oculomotor cortex or direct damage to eye muscles.
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9
Q

presentation of squint

A

diplopia in adults and amblyopia (dim/ blurry eyesight) in children.

  • Paralytic squint = paralysis in one or more extra ocular muscles.
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10
Q

What are esotropia, exotropia, hypertropia and hypotropia?

A
  • ESO = inwards
  • EXO = outwards
  • HYPO = downwards
  • HYPER = upwards
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11
Q

Diagnosis of squint

A
  • Fundoscopy (or red reflex) to rule out retinoblastoma, cataracts and other retinal pathology.
  • Hirschberg’s test.
    o

cover test

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12
Q

What is Hirschberg’s test for squint?

A

Observe where reflection of pen torch lies on cornea.
o Normal – reflection central bilaterally.
o Exotropia – reflection lies at inner margin of pupil.
o Esotropia – reflection lies on outer margin.

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13
Q

What is cover test for squint?

A

cover one eye and ask ptx to focus on object, this eye is observed for movement.
o This eye is then covered and other eye in uncovered and observed for movement.
o Esotropia – eyes move outwards (i.e the eye was turned inwards initially when covered). Opp for exotropia.

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14
Q

Mx of squint.

A

neonate - refer

  • < 8 yrs w/ amblyopia and strabismus - eye patching (of good eye) ± cycloplegic drops, e.g atropine
  • Glasses.
  • Surgical alignment.
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15
Q

Define cataract

A
  • Lens in eye becomes cloudy and opaque – reduces light entering eye – reduces visual acuity.
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16
Q

RF for cataract

A
  • Increasing age – esp > 65yrs
  • Smoking
  • Alcohol
  • Diabetes
  • UV exposure
  • Trauma
  • Previous eye surgery
  • Steroids
  • hypoCa
  • congenital cataract – are screened for using red reflex.
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17
Q

presentation of cataract

A
  • painless
  • difficulty reading/ watching TV/ recognising faces
  • slow reduction in vision
  • progressive blurring of vision
  • color of vision changes – becomes more brown/ yellow
  • starburst appear around light – esp at night.
  • Paediatric cataract can present w/ squint
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18
Q

Dx of cataract

A
  • loss of red reflex.
  • lens appear grey/ white on slit lamp, also appears on flash photography.
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19
Q

Mx of cataract

A

surgery - pseudophakia

if symp are manageable - no Tx

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20
Q

Complications of cataract

A

hide pathologies, e.g macular degeneration , diabetic retinopathy

Endophthalmitis

  • Posterior lens capsule opacification
  • glaucoma

corneal and macular oedema.

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21
Q

Define age related macular degenration

A
  • Degeneration of macula – causes progressive vision loss (most common cause of blindness).
  • 2 types – wet and dry (wet has worse prognosis).
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22
Q

RF for age related macular degeneration.

A
  • Aging
  • Smoking
  • White or Chinese
  • FHx
  • Male
  • CVD + CVD risk factors
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23
Q

Presentation of age related macular degneration.

A
  • Drusen
  • Atrophy of retinal pigment ep.
  • In wet AMD – release of VEGF stimulates production of new blood vessels – rapid vision loss (loss of vision over days and blindness over 2-3 yrs).
    o Wet AMD usually bilateral.
  • Gradual worsening central visual field loss.
  • Reduced visual acuity- worse on near vision. Poor vision at night.
  • Photopsia
  • Straight lines appear crooked or wavy.
  • subretinal or intraretinal haemorrhages in wet ARMD.
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24
Q

Diagnosis of age related macular degeneration.

A

fundoscopy - drusen and scotoma.

snellen chart - reduced visual acuity

optial CT - gold tsnadard to Dx wet AMD

fluorescein angio - Dx of AMD

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25
Q

Mx of AMD

A

refer

dry - lifestyle changes to reduce progression

wet - anti-VEGF via injection to virteous chamber, x1/ month

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26
Q

Define retinal detachment

A
  • Retina separated from choroid.
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27
Q

Pathophysiology of retinal detachment.

A

retinal tear - allows vitreous fluid to leak under retina and fill space between retina and choroid.

no blood supply to retina - ischaemia

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28
Q

RF for retinal detachment

A
  • Diabetic retinopathy
  • Eye trauma (rhegmatogenous retinal detachment)
  • Old age
  • Retinal malignancy
  • FHx
  • posterior vitreous detachment – vitreous comes away from retina at back of eye – happens w/ age.
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29
Q

presentation of retinal detachment

A
  • painless
  • peripheral vision loss – sudden.
    o Shadow coming across vision.
  • Blurred/ distorted vision.
  • Flashes and floater.
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30
Q

Dx of retinal detachment

A

painless flashers and floaters – assessment to detect retinal tears or detachment.

31
Q

Mx of retinal detachment

A

refer

laser/ cryotherapy - prevent detachment

reattach - Vitrectomy, scleral bulking, Pneumatic retinopexy

32
Q

complications of retinal detachment

A

if progresses to macula - blind

33
Q

Define CRAO

A

RETINAL ARTERY OCCLUSION

  • Blockage in central retinal A.
34
Q

Causes and RF for CRAO

A

atherosclerosis - CVD RF

Giant cell arteritis - >50yrs, F, PMR

35
Q

Presentation of CRAO

A
  • sudden painless loss of vision
    • Relative afferent pupillary defect
36
Q

Dx of CRAO

A
  • Fundoscopy – pale retina and cherry red spot.

check for carotid bruits, HTN, DM, AF

37
Q

Mx of CRAO

A

Refer

test older people of giant cell arteritis - steroids

attempt to dislodge thrombus (only if present quickly after symp) - via massage, remove fluid from ant chamber, sublingual nitrates

longterm - conservative and 2* CVD prevention

38
Q

Define CRVO

A
  • Thrombus in retinal veins – blocking drainage of blood from retina.
39
Q

Pathophysiology of CRVO

A
  • blocked vein - retinal haemorrhage and macular oedema.
  • VEGF - neovascularisation
40
Q

Pathophysiology of CRVO

A
  • blocked vein - retinal haemorrhage and macular oedema.
  • VEGF - neovascularisation
41
Q

Presentation of CRVO

A

Sudden painless loss of vision

42
Q

Diff between CRVO and CRAO presentation

A

both sudden loss of vision, and painless.

renal A occlusion causes quicker vision loss

43
Q

RF for CRVO

A

CVD risk factors

glaucoma

systemic inflammatory diseases

44
Q

Dx of CRVO

A

fundoscopy - flame, blot hamorrhage, optic disc and macula oedma

check for leukaemia, inflammation, HTN, DM

45
Q

Mx of CRVO

A

Refer

o Laser photocoagulation
o Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
o Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab)

46
Q

define optic atrophy

A

aka optic neuropathy

  • Death of retinal ganglion cells (nerve fibres) that make up optic nerve.
47
Q

RF for optic atrophy

A
  • Increase ocular pressure (glaucoma).
  • Ischaemia
  • Compression (tumour).
  • Inflammation – optic neuritis, giant cell arteritis in older people.
  • Infection – in children presents as flu like history or post vaccinal optic neuritis, syphilis.
  • Drugs that are toxic to optic N = ethambutol, amiodarone, alcohol, methotrexate and ciclosporin.
  • Diabetes
48
Q

presentation of optic atrophy

A

rapid vision loss (if gradual = hereditary).

symp vary according to optic N damage - from impaired colour vision to loss of vision

disc damage - painful

49
Q

How is presentation of optic atrophy diff in elderly and young people?

A
  • Young – history of eye pain, paraesthesia, ataxia or weakness – suggests demyelination.
  • Older – transient vision loss, diplopia, temporal pain, fatigue, weight loss and myalgia – suggests ischemic optic neuritis due to giant cell arteritis.
50
Q

Dx of optic atrophy

A

fundoscopy - pale, disc cupping if glaucoma

  • visual function tests - red colour desaturation is early sign

neuoimaging - compression, demyelination

if unexplained - full workup - bruits,genetic abn, DM, MRI brain

51
Q

Mx of optic atophy

A

remove cause, e.g pit tumour

Tx cause

lifestyle and drug modifications - reduce progression

52
Q

define diabetic retinopathy

A
  • Blood vessels supplying retina damaged by prolonged exposure to high sugar – causes progressive deterioration of retina.
53
Q

Pathophysiology of diabetic neuropathy.

A

hyperglycaemia -> blot haemorrhages and hard exudates

microaneurysm and venous beading

cotton wool spots

growth factors - neovascularisation

54
Q

what are the 2 types of diabetic retinopathy? and how do they present?

A

non proliferative (NDPR) and proliferative (PDR).

NDPR:
- Mild – microaneurysm
- Moderate: microaneurysms, blot haemorrhages, hard exudates, cotton wool spots and venous beading
- Severe: blot haemorrhages plus microaneurysms in 4 quadrants, venous beading in 2 quadrates, intraretinal microvascular abnormality (IMRA) in any quadrant

PDR
* Neovascularisation in retina or optic disc.
* Vitreous haemorrhage (blood in vitreous cavity).

55
Q

Dx of diabetic retinopathy

A

fundoscopy

o Mild disease – microaneurysms, hard exudates, blot haemorrhages.

o Severe disease and signif ischemia - tortuous veins, cotton wool spots, large blot haemorrhages

56
Q

Mx of diabetic neuropathy.

A
  • Laser photocoagulation
  • anti-VEGF meds
  • Vitreoretinal surgery of severe
57
Q

urgent 2 wk wait in opthal

A

PDR, macular involvement, retinal detachment, virtuous haemorrhage, CRAO, CRVO

58
Q

pathophysiology of hypertensive retinopathy.

A

silver/ copper wiring - increase reflection of light

arteriovenous nipping

cotton wool spots

hard exudates

retinal haemorrhage

papilloedema

59
Q

Dx of HTN retinopathy

A

fundoscopy

classification:
o Stage 1: Mild narrowing of the arterioles
o Stage 2: Focal constriction of blood vessels and AV nicking
o Stage 3: Cotton-wool patches, exudates and haemorrhages
o Stage 4: Papilloedema

60
Q

Mx of HTN retinopathy

A

risk factors

HTN meds

61
Q

Define glaucoma.

A

optic nerve damage due to rise in intraocular pressure

62
Q

define open angle glaucoma and RF?

A

increase in resistance through trabecular meshwork – therefore aq humour cannot flow through meshwork and exit eye – so pressure increases slowly.
o SLOW, CHRONIC ONSET.

RF:
- Raised IOP
- HTN
- DM
- Corticosteroids
- Myopia (near-sightedness).
- Afro-Caribbean
- Genetics

63
Q

define ACUTE angle glaucoma and RF?

A

iris bulges forward – seals off trabecular meshwork – prevents aq humour from draining – cont build-up of pressure.

RF:
- Female
- Chines and East Asia (rare in black).
- Shallow ant chamber
- Adrenergic meds – NA
- Anticholinergic meds – oxybutynin, solifenacin
- Tricyclid anti-dep – amitriptyline.
- Long sighted

64
Q

Diff in presentation of open and acute angle glaucoma?

A

open angle:
- Rise in IOP asymp for long period.
- Diagnosed by routine screening.
- Gradual onset of fluctuating pain.
- Central scotoma in advanced disease.

acute angle:
- Severely painful red eye.
- N+/- V
- Hazy cornea
- Fixed, dilated affected pupil.
- Reduced visual acuity.
- Firm eyeball on palpation.

65
Q

Diff in Dx of open and acute angle glaucoma?

A

open:
- Goldmann applanation tonometry
- fundoscopy - disc cupping, bonneting, pale optic disc
- visual field tests

acute angle:
- slit lamp
- gonioscope

66
Q

Diff in Mx of open and acute angle glaucoma?

A

open:
- Tx if IOP ≥24 mmHg and risk of vision disturbance
- 1st line = trabeculoplasty
- 2nd = meds (1st latanoprost, 2. timolol, 3rd carbonic anhydrase inhibitor).

acute:
- admit and until then pilocarpine every 15 mins, o Acetazolamide 500mg oral, Analgesia and anti-emetic

definitive Mx - laser iridotomy

67
Q

Pathophysiology of retinoblastoma.

A

inherited.

Rb1 on ch. 13 (recessive)

68
Q

how does retinoblastoma present?

A

onset 3rd motnh preg to 5 yrs

leukocoria

strabismus

pain, buphthalmos

  • Metastases to CNS, bones, bone marrow and liver.
69
Q

Mx of retinoblastoma

A

– urgent referral.

radiotherpay/ chemo

70
Q

DEARISM Arc (welders) eye

A

aka SNOWBLINDESS/ PHOTOKERATITIS

DEFINITION
- Sunburn of cornea and conjunctiva by ultraviolet (UV) light – causing sup keratitis.

RISK FACTORS
- climbers/skiers, welders, and sunbed users who have not used protective goggles
PRESENTATION
- After a delay of 6 to 12 hours following exposure to arc welding, sun lamps or other sources of UV light, the eyes become red, painful, watery and unduly sensitive to light.
- Blepharospasm

DIAGNOSIS/Ix
- fluorescein staining which may reveal multiple punctate corneal lesions.

MANAGEMENT
- Resolves in 24 hrs.
- Discharge with an eye pad, oral analgesia, and advice not to drive until recovered.

71
Q

curtain coming down?

A

AMAUROSIS FUGAX

complete recovery after sec-mins

cause - embolis in retinal, ophthalmic, or ciliary artery orginate from carotid plaque

urgent referal

72
Q

presentation of thyroid eye disease

A

aka graves

lid retraction
exopthalamos
lid lag
diplopia

73
Q

What condition cause following:
a) starbusts around lights
b) halos around eye
c) crooked/ wavy appearance of straight lines

A

a) catarct
b) glaucoma
c) AMD

74
Q

presentation and Tx of temporal giant cell arteritis

A
  • Rapid and profound visual loss may be preceded by headaches, jaw claudication, general malaise, and muscular pains.

temporal A tender to palpate

pale papillodema, pale disc , high ESR

Tx - hydrocortisone

Opthalmology (6 decks)

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