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YEAR 3 & 5 CORE CONDITIONS > Eye (ENT 3) > Flashcards

Eye (ENT 3) Flashcards

1
Q

What is the uvea?

A

Pigmented part of the eye:
Iris
Ciliary body
Choroid

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2
Q

What is the anterior and posterior uvea?

A

Iris and ciliary body = anterior uvea
- Inflammation is called anterior uveitis / iritis

Choroid = posterior uvea
- Inflammation is posterior uveitis / choroiditis

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3
Q

What is intermediate uveitis?

A

Affects vitreous = gel like substance that accounts for 80% of the volume of the eye

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4
Q

What are some associations of anterior uveitis?

A 
HLA B27 syndromes: 
Ankylosis spondylitis
Stills (JIA)
IBD
Psoriatic arthritis 
Reactive arthritis 
Behçets
Sarcoid
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5
Q

What is the most common cause of uveitis and most likely to present with a red eye?

A

Anterior uveitis

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6
Q

How does anterior uveitis present?

A

Red eye
Pain
Blurred vision
Photophobia

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7
Q

Describe how the red eye develops in anterior uveitis?

A

Starts with conjunctival infection around the junction of the cornea and slcera and increased lacrimation (but not sticky discharge, unlike conjunctivitis)

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8
Q

How is anterior uveitis diagnosed?

A

Slit lamp with dilated pupil - shows leucocytes in anterior chamber

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9
Q

What is the management of anterior uveitis?

A

Urgent eye clinic

Prednisolone 0.5-1% / 2hr - to reduce pain, redness and exudate

Cyclopentolate 1% / 8hr - to prevent adhesions between lens and iris (synechiae) and to relieve spasm of ciliary body

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10
Q

What can happen if there is prolonged inflammation of the eye following anterior uveitis?

A

Disrupts flow of aqueous leading to glaucoma

+/- adhesions between lens and iris

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11
Q

Why is posterior uveitis not painful (unlike anterior uveitis)?

A

Choroid is not innervated by sensory nerves

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12
Q

What is the conjunctiva?

A

Mucus membrane that lines the inside of the eyelids and the sclera

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13
Q

What are some causes of conjunctivitis?

A

Infective:
Bacterial
Viral

Non-infective:
Allergic

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14
Q

What is it called when there is inflammation of the conjunctiva and the cornea?

A

Keratoconjunctivis

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15
Q

How does conjunctivitis present?

A 
Red eye
Discharge
Burning
FB sensation
Photophobia
Itching
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16
Q

Compare bacterial vs viral conjunctivitis

A

Bacterial

  • Usually unilateral
  • Thick purulent discharge
  • Reduced vision and risk of vision loss

Viral

  • Bilateral (spreads from one to the other within a few days)
  • Clear watery discharge with mucoid component
  • Normal vision
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17
Q

What is the most common cause of viral conjunctivitis?

A

Adenoviruses

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18
Q

What is the management of viral conjunctivitis? Adenovirus vs HSV

A

Adenovirus - supportive eg application of cold moist compresses, artificial tears

Herpes simplex - topical antivirals eg ganciclovir

Topical abx is suspected overlying bacterial infection

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19
Q

Which bacterial conjunctivitis require systemic treatment?

A

Neisseria gonorrhoeae

Chlamydia

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20
Q

When are conjunctival scrapings and culture needed in conjunctivitis?

A

Persistent
Newborn conjunctivitis
Gonococcal / chlamydia suspected

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21
Q

How is conjunctivitis caused by neisseria gonorrhoea managed?

A

IV or IM ceftriaxone plus PO azithroymycin with saline irrigation

+/- topical abx

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22
Q

What is the management of bacterial conjunctivitis?

A

Self limiting in 60%
Should resolve in 1-2 weeks
Topical abx eg chloramphenicol 0.5% drops or 4/6hrs or fusidic acid can reduce duration of symptoms

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23
Q

What is the management of allergic conjunctivitis?

A

Antihistamine drops eg emedastine or olopatadine

Others eg cold compress, artificial tears

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24
Q

What can foreign bodies in the eye cause?

A 
Chemosis - swelling of conjunctivia
Subconjunctival bleeds
Irregular pupils
Iris prolapse
Hyphaemia - haemorrhage into anterior chamber of eye
Vitreous haemorrhage
Retinal tears
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25
Q

What should be done if a high velocity FB is suspected in the eye?

A

Orbital US

Pick up rate is 90% compared to 40% for x rays

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26
Q

What is a closed globe contusion?

A

Occurs in the absence of a full thickness ocular wall laceration

Eg blunt trauma

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27
Q

What is an open globe injury?

A

Full thickness perforation or laceration of the ocular globe

Eg sharp or high velocity blunt objects

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28
Q

What is endophthalmitis?

A

Inflammation of the tissues or fluid inside the eye

Esp occurs following retained intraocular FB

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29
Q

What is a a blowout fracture?

A

Orbital contents are typically forced through a fractured orbital floor

eg high velocity blunt trauma to the globe and upper eyelid from punch / tennis ball

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30
Q

How may an ocular chemical burn present?

A 
Intense pain
Visual impairment
Blepharospasm - involuntary eyelid closure
Erythematous conjunctiva 
Photophobia
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31
Q

What is the management of an ocular chemical burn?

A

Immediate and thorough irigation with copious sterile saline or cold tap water

Use plastic scleral lens (Morgan lens) until pH normalises for acidic agents or 2-3 hours for alkaline agents

Abx eye drops eg tetracycline

Topical steroids eg prednisolone acetate 1%

32
Q

What can cause sudden painless loss of vision?

A 
GCA
Optic neuritis
Central retinal vein occlusion
Central retinal artery occlusion
Vitreous haemorrhage
33
Q

How does GCA present?

A 
New onset headache
Malaise
Jaw claudication
Tender scalp and temporal arteries
Neck pain
Monocular vision loss
34
Q

What is GCA associated with?

A

Polymyalgia rheumatica

35
Q

What tests should be done for GCA?

A

ESR (>47)
CRP (>2.5)
- Preferably before steroids

Temporal artery biopsy within 1 week of starting prednisolone

36
Q

What is the management of GCA?

A

Prednisolone 60mg/24hr PO

Tailor off steroids as ESR and symptoms settle, may take :1yr

20% left with partial / complete visual loss

37
Q

How does optic neuritis present?

A

Unilateral loss of acuity over hrs-days
Colour vision affected - dyschromatopsia (red appears less red)
Eye movements hurt

38
Q

What is optic neuritis associated with?

A

MS

45-80% will develop in 15yrs

39
Q

What is the management of optic neuritis?

A

High dose methylprednisolone for 72hrs (1000mg/24hr IV)

then prednisolone 1mg/kg/d po for 11 days

40
Q

What is more common - retinal vein occlusion or retinal artery occlusion?

A

Retinal vein occlusion

41
Q

Structural changes in the eye occur with DM causing what two conditions?

A

Glaucoma

Cataracts

42
Q

How can DM cause glaucoma?

A

DM causes ocular ischaemia, which can cause new blood vessel forming on the iris (rubeosis), and if these block the drainage of aqueous fluid, glaucoma can occur

43
Q

What is the structural changes does DM cause in the eye?

A

Microvascular occlusion causes retinal ischaemia leading to arteriovenous shunts and neovascularisation

Leakage results in intraretinal haemorrhages and localised or diffuse oedema.

44
Q

What are the two types of diabetic retinopathy?

A

Non-proliferative retinopathy

Proliferative retinopathy

45
Q

How is non-proliferative diabetic retinopathy classified?

A

Mild
Moderate
Severe
= Depending on the degree of ischaemia

46
Q

What signs can be seen in non-proliferative diabetic retinopathy?

A 
Microaneurysms = dots
Haemorrhages = flames / blots
Hard exudates = yellow patches 
Engorged tortuous veins 
Ischaemic nerve fibres = cotton wool spots
Large blot haemorrhages
47
Q

What are signs of significant ischaemia in DR?

A

Engorged tortuous veins
Cotton wool spots
Large blot haemorrhages

48
Q

How does non-proliferative diabetic retinopathy progress to proliferative diabetic retinopathy?

A

Fine new vessels appear on the optic disc and retina

Can cause vitreous haemorrhage

49
Q

What is maculopathy?

A

Leakage from the vessels close to the macula cause oedema and can significantly threaten vision

50
Q

What is the macula?

A

Central area of the retina

51
Q

Who needs urgent referral in DR?

A

Severe NPDR
Proliferative retinopathy
Maculopathy

52
Q

How is DR screened?

A

DM type 1 and 2 should have their eyes screened at the time of diagnosis and annually thereafter

53
Q

What is the management of maculopathy and proliferative retinopathy?

A

Photocoagulation

54
Q

Other than photocoagulation, what can be used to treat macular oedema?

A

Intravitreal triamcinolone

Anti-VEGF drugs

55
Q

When is a haemorrhage a flame and when is it a blot?

A

Rupture of microaneurysms at the nerve fibre level = flame shaped haemorrhages

When deep in the retina = blot haemorrhages form

56
Q

What is hyperopia vs myopia?

A

Hyperopia (long sighted) = an image of a distant object becomes focused behind the retina, making objects up close appear out of focus

Myopia (short sighted) = an image of a distant object becomes focused in front of the retina, making distant objects appear out of focus

57
Q

In those with DR, what happens to their refractive index? What does this mean in terms of management?

A

At presentation - the lens may have a higher refractive index producing relative myopia

On treatment - the refractive index reduces and vision is more hyperopic

Do not correct refractive errors until diabetes is controlled

58
Q

What other nerves are affected in DR?

A

Typically III and IV

59
Q

Why may the pupil be spared in diabetic third nerve palsy?

A

Fibres to the pupil run peripherally in the nerve, receiving their blood supply from the pial vessels

60
Q

What are Argyll Robertson pupils?

A

Bilateral small pupils that reduce in size on a near object (accommodate) but do not constrict when exposed to bright light (unreactive)

‘Prostitues pupil’ - accommodates but does not react

Result of bilateral damage to the pretectal nuclei in the brainstem

61
Q

What causes Argyll Robertson pupils?

A

Non specific
Late stage syphilis
Diabetes

62
Q

What happens in arteriopathic retinopathy?

A

Arteriovenous nipping - arteries nip veins where they cross (they share the same connective tissue sheath)

63
Q

What happens in hypertensive retinopathy?

A

Damage from arterioslcerotic and HTN related processes

Arteriovenous nipping and arteriolar vasconstriction and leakage

64
Q

What are the stages of hypertensive retinopathy?

A

Grades I - IV

Keith-Wagener-Barker system

65
Q

What are grades I-IV of hypertensive retinopathy?

A

I - mild generalised retinal arteriolar narrowing or sclerosis

II - definite focal narrowing, AV nipping

III - cotton wool exudates, hard exudates, retinal haemorrhage, retinal oedema, macular star formation

IV - papilledema (optic disc swelling), optic atrophy

66
Q

When does hypertensive retinopathy usually become symptomatic?

A

III and IV

67
Q

Name two types of squint

A 
Convergent squint (esotropia)
Divergent squint (exotropia)
68
Q

Which type of squint is more common? What causes it?

A

Esotropia - either no cause or can be due to hypermetropia

69
Q

How are squints investigated?

A

Corneal reflection

Cover test

70
Q

Describe a corneal reflection test

A

Reflection from a bright light falls centrally and symmetrically if no squint

71
Q

Describe a cover test

A

Movement of the uncovered eye to take up fixation as the other eye is covered demonstrates a manifest squint

A latent squint is revealed by movement of the covered eye as the cover is removed

72
Q

What is a paralytic vs a non paralytic squint?

A

Paralytic (or concomitant) squint is when the squint occurs in all directions of gaze, double vision does not normally occur

Non-paralytic is not constant, occurs when child is tired

73
Q

Describe a 3rd nerve palsy

A

Down and out

Ptosis
Proptosis (decreased recti tone)
Fixed pupil dilatation

74
Q

Describe a 4th nerve palsy

A

Up and adducted eye

Diplopia
Head may hold head tilted
Cannot look down and in (superior oblique paralysed)

75
Q

Describe a 6th nerve palsy

A

Eye is medially deviated and cannot move laterally from midline - LR paralysed

Diplopia

76
Q

What is the management of a swuint?

A

Glasses for refractive errors
Eye patches
Operation eg resection and recession of rectus muscles to realign
Botulinum injections

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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