Eye quick Flashcards
What is seen in a Fundoscopy in Age-Related Macular Degeneration?
- Dry: drusen (yellow deposits)
2.Wet: neovascularisation, subretinal fluid
=multiple fatty deposits across the retina
Distortion of central vision
Age-Related Macular Degeneration clue
- Elderly patient with central vision loss
(eg, trouble reading faces) - Straight lines look wavy (metamorphopsia)
- Dry AMD (90%): gradual, bilateral - Visual fluctuation. Difficulty reading stuff
- Wet AMD: sudden, more severe, unilateral. Subconjunctival haemorrhage. choroidal neovascularisation. New blood vessels
= wet AMD progresses more rapidly than dry AMD
Management of dry and wet AMD
Dry: no cure = Zinc and antioxidant vitamin supplementation. STOP SMOKING
Wet: anti-VEGF injections
= ranibizumab
Investigations of Age-Related Macular Degeneration
- Amsler grid (lines distorted)
- OCT (optical coherence tomography)
To confirm WET - Fluorescein angiography
What is Central Retinal Artery Occlusion
- Sudden painless vision loss
- Usually complete in one eye
- History of AF or carotid disease.
Fundoscopy:
4. Pale retina with a cherry-red spot at the macula - small red opacification
Management:
5. Emergency! refer urgently
6. Ocular massage
7. lower intraocular pressure = acetazolamide
What is Central Retinal Vein Occlusion?
- Sudden painless vision loss, but not total
- Often hypertensive or diabetic.
Fundoscopy:
3. “Blood and thunder” appearance – diffuse retinal haemorrhages, dilated tortuous veins
= ‘stormy sunset’
Management:
4. Refer to ophthalmology
5. Treat risk factors = (A) Hypertension (B) diabetes
6. Anti-VEGF may help in macular oedema
What is Retinal Detachment?
- Flashes, floaters, “curtain” coming over vision (painless)
Fundoscopy
2, May show detached retina (greyish folds)
Management
3. Urgent referral for surgical repair
What are the 3 types of diabetic retinopathy?
- Non-proliferative
- Proliferative
- Maculopathy
What is Non-proliferative diabetic retinopathy?
microaneurysms, haemorrhages, hard exudates
= ‘dots’, large ‘blots’
What is Proliferative diabetic retinopathy?
new vessels
What is maculopathy?
central vision affected
Management for diabetic retinopathy
- Control blood sugar, BP, lipids
- Laser photocoagulation (proliferative)
- Anti-VEGF for macular oedema
What is the grading system for hypertensive retinopathy, and what are the characteristics of each grade?
(1) Grade I: Vascular attenuation =narrowing of retinal arteries
= Increased light reflex - silver wiring
(2) Grade II: Vascular attenuation + AV nipping
(3) Grade III: Vascular attenuation + AV nipping + retinal haemorrhages, hard exudates, and cotton wool spots + flame
(4) Grade IV: Everything + pa lipoedema
What is hypertensive retinopathy?
- History of hypertension
- vision may be unaffected
Signs:
3. Arteriolar narrowing
4. AV nicking
5. Flame haemorrhages
6. Cotton wool spots
7. Papilloedema (if severe)
- Graded I–IV
What is Anterior Uveitis (Iritis)?
- Painful red eye
- Photophobia
- Blurred vision
- Small, irregular pupil
Slit lamp
5. Cells and flare
Associations
6. HLA-B27 (e.g. ankylosing spondylitis, IBD)
Management:
7. Urgent ophthalmology
8. Topical steroids + cycloplegics
= Cyclopentolate
What is Herpes Zoster Ophthalmicus?
- Elderly with painful vesicular rash in V1 dermatome on forehead + tip of nose
- = Hutchinson’s sign
- Red eye, vision issues
Complication
4. Can cause keratitis or uveitis
Management:
5. Oral aciclovir 7–10 days (start within 72 hrs) + urgent eye review if vision is involved
What is Optic Neuritis?
- Young woman
- Painful eye movements
- Central scotoma
= blind spot or area of reduced vision in the centre of the visual field - RAPD (Marcus Gunn pupil)
Association
5. Multiple sclerosis
Investigation
6. MRI brain + orbits
Management:
7. Neurology referral
8. IV methylprednisolone
What is Cataracts?
- Gradual, painless blurring of vision, glare in lights, older person
Signs:
2. Reduced red reflex
3. Cloudy lens
Management
4. Elective phacoemulsification surgery
What is Viral Conjunctivitis?
- Watery discharge
- red eye
- recent URTI
- both eyes
Management:
5. Self-limiting, hygiene advice
- Adenovirus
- Illnesss
- Palpable pre-auricular lymph nodes
What is Bacterial Conjunctivitis?
- Purulent discharge
- Sticky eyes
Management:
3. Topical antibiotics (e.g. chloramphenicol)
What is Allergic Conjunctivitis?
- Bilateral itchy eyes
- Watery discharge
- Allergic hx
Management:
4. Antihistamines or mast cell stabilisers
- sodium cromoglycate and antazoline drops
Painless vision loss + Optic disc swelling suggest what?
Ischaemic optic neuropathy
jaw claudication is associated with Arteritic Ischemic Optic Neuropathy
Cherry red spot at the macula with retinal whitening
Retinal Artery Occlusion
Drusen in the macula with gradual central vision loss
Macular Degeneration
Crusting of eyelashes with inflammation of the eyelid margins
Blepharitis
Cloudy vision with halos around lights, especially at night
Cataracts
Misalignment of the eyes, leading to double vision
Strabismus
Increased intraocular pressure (IOP) with cupping of the optic disc
Glaucoma
Bilateral optic disc swelling due to raised intracranial pressure
Papilloedema
“On examination, her peripheral nervous system is unremarkable. Upon shining a light into her left eye, both pupils appear to constrict. When the light is immediately moved to her right eye, both appear to dilate”
Why is the answer right-sided optic neuritis and not left-sided optic neuritis?
The answer is right-sided optic neuritis because the pupils dilate when light moves to the right eye. This indicates an afferent pupillary defect in the right optic nerve, as it fails to properly sense light, causing abnormal dilation of both pupils instead of constriction
- Blurred or wavy central vision
- Colours may look faded or washed out
- Dark or empty spot in the centre of vision (in severe cases)
If these symptoms come up, what does this mean + management
Macular oedema
= Anti-VEGF injections (e.g. ranibizumab, aflibercept)
A 67-year-old woman with a history of type 2 diabetes presents with sudden visual loss preceded by a red hue to their vision to the emergency department. She is on multiple medications for her diabetes. Bloods done one week ago at her GP revealed an HbA1c of 87 mmol/mol.
What is the most likely diagnosis?
Vitreous haemorrhage
= most common causes of sudden painless loss of vision in diabetics
Describe Retinal detachment
- Dark floaters are common.
- Flashes of light and a shadow or curtain effect over vision.
- Red hue may also occur if there’s blood in the vitreous, but typically more associated with a detached retina.
Describe Vitreous haemorrhage
- Dark floaters.
- Red or black hue in vision due to blood in the vitreous body.
- Vision loss can be gradual, but there’s often no curtain effect
