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Opthamology > eyes eyes eyes > Flashcards

eyes eyes eyes Flashcards

1
Q

What is glaucoma?

A

Where the intra occular pressure in the eye is raised due to the aqueous humour not being able to leave the eye

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2
Q

What is open angle vs closed angle glaucoma?

A

In acute angle-closure glaucoma: iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from draining –> Raised intraocular pressure –> oedema cornea –> blurred vision –> iris sphincter ischaemic so pupil is fixed and dilated

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3
Q

What are the RF for open angle glaucoma?

A

Afro carribean
near sighted (myopia)
fhx
age

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4
Q

What are the sx of open angle glaucoma?

A 
Reduction in peripheral visual fields - tunnel vision
Halos around light at night
Headache
fluctuating pain
blurred vision
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5
Q

How do you diagnose open angle glaucoma?

A

Measure the intra occular pressure via Goldmann applanation tonometry
Differentiate between open and closed using Gonioscopy to measure the iridocorneal angle.
Visual field testing
Fundoscopy to look at optic disc for cupping

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6
Q

What is the mx of open angle glaucoma?

A

In GP give pilocarpine (miotic) and acetazolamide (carbonic anyhydrase inhibitors)
FIRST LINE: Prostaglandins to increase aqueous humor leaving the eye - e.g. latanoprost
Topical beta blockers to decrease aqeous humour production e.g. timolol

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7
Q

What are the RF for closed angle glaucoma?

A 
Asian ethnicity
Female
Age
hypermetropia - long-sighted 
Drugs: anticholinergics, adrenergics
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8
Q

What is the presentation of closed angle glaucoma?

A 
Sx:
V PAINFUL RED EYE!!
Reduced acuity
Halos at night around lights
headache, N+V
Worse at night due to pupil dilating, but may resolve when sleep as that causes it to constrict 
O/E:
Red eye
Firm, hardened eye when palpate
Hazy cornea
fixed and dilated pupil
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9
Q

What is the mx of closed angle glaucoma?

A

Call 999
Get pt to lie back
Adminster pilocarpine and acetazolamide if have it
Opthamologists have more drugs and can do surgery to relieve the eye pressure - iridectomy

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10
Q

How does pilocarpine work?

A

Acts on andrenergic receptors and constricts the eye (miosis)

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11
Q

What is age related macular degeneration?

A

Degeneration of the macular portion of the eye which includes: the choriod (blood supply) and photoreceptors.
Most common cause of blindness in UK

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12
Q

What are the two different types of macular degeneration. Explain difference?

A

Dry (90%): macular degeration

Wet (10%): Dry + new vessels grow which leak blood + fluid. Worse prognosis. Presents more acutely.

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13
Q

What are the RF for AMD?

A

Age
Smoking
CVD
Fhx

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14
Q

What is the presentation of AMD?

A

Sx:
Reduced acuity from the CENTRE of vision
straight lines become wiggly

O/E:
Dresen (lipid deposits) on optic disc with fundoscopy
Scotoma (central visual field loss)
Amsler grid test to see distorted lines
Optical coherence tomography used by specialist

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15
Q

What is the mx of AMD?

A

Dry: Manage RF
Wet: Can get anti- VEGF injections into eye

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16
Q

What is diabetic retinopathy?

A

Diabetes causes damage to the walls of blood vessels —> the vessels then leak their contents (e.g. lipids forming hard exudates or haemorraging) or form microaneurysms (bulging)
Neoproliferation occurs as eye releases growth factors to deal with damage
Nerve damage causes cotton wool spots to form

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17
Q

What are the complications of diabetic retinopathy?

A

Retinal detachment
Cataracts
Vitreous haemorrhage

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18
Q

What is the mx of diabetic retinopathy?

A

Manage the DM!
Laser photocoagulation
Anti-VEGF injections
Surgery if v bad

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19
Q

Explain the pathophysiology of a cataract

A

The lens focuses light onto our retina. In a cataract is where the lens becomes cloudy.

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20
Q

What are the RF for a cataract?

A 
Congential (screened for in NIPE)
AGE!
Diabetes
Smoking
Steroids
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21
Q

How do cataracts present?

A 
A general decreased visual acuity 
Asymmetrical 
Starbursts form around lights at night
Colours become brown/ yellow
Loss of red reflex
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22
Q

What is the mx of cataracts?

A

If symptomatic then can operate - break down lens and replace with an artifical one

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23
Q

What is the pupil?

A

A hole in the iris

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24
Q

How does the pupil constrict vs dilate?

A

Constrict (miosis): Parasympathetic nerve fibres contstrict which travel along the occulomotor (3rd nerve)

Dilate (mydriosis): Sympathetic innervation

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25
Q

What are the causes of abnormal mydriasis?

A 
3rd nerve palsy
Raised ICP
Drugs e.g. cocaine
Trauma
Congenital
Anticholinergics
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26
Q

What are the causes of abnormal miosis?

A

Horner’s syndrome
Cluster headaches
Opioids

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27
Q

What is the pathophysiology of a third nerve palsy?

A

3rd Nerve supplies:
all eye muscles apart from superior oblique and abductor so is down and out
has parasympathetic nerve fibres so palsy results in mydriasis
supplies levator palpebrae superioris so without there is a ptosis

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28
Q

What is a possible cause of a 3rd nerve palsy?

A

3rd nerve travels through the carvenous sinus and along posterior communicating artery so an aneurysm/ thrombosis involving these

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29
Q

What is the pathophysiology of Horner’s syndrome?

A

Sympathetic nerve fibres arise from the spinal cord and travel alongside the carotid artery
Damage to them results in anhidrosis (no sweating), miosis and ptosis

30
Q

What is a test for Horner’s syndrome?

A

Cocaine eye drops not dilating pupil as noradrenalin is not being released so cocaine does not have usual effect

31
Q

What is blepharitis?

A

Eye lid inflammation

32
Q

How does blepharitis present?

A

Gritty, itchy, dry bilateral, red eyelid, may lead to style/ chelazia

33
Q

Mx of blepharitis?

A

Clean eyelid using baby shampoo. Can use lubricating eye drops

34
Q

What is a stye vs a chalazion?

A 
Stye = infection of glands in eye 
Chalazion = gland blocked so become a cyst
35
Q

How do styes vs chalazion present?

A 
Stye = Red, inflammed, painful, lump 
Chalazia = uncomfortable, red, nodule
36
Q

How are styes and chalazion mx?

A

Hot compress, analgesia, topical abx (only if obvious signs of infection like mucopurulent discharge and conjunctivitis)

37
Q

What is entropion vs ectropion?

A 
entropion = eyelid turns in
ectropion = eyelids turns outwards
38
Q

What is periorbital vs orbital cellulitis?

A

Periorbital = skin and eyelid infection in front of eye

Orbital = medical emergency as it is an infection around that involves tissues behind orbital septum - so will cause painful eye movement, visual changes, proptosis, abnormal pupil reactions etc.

39
Q

How does conjunctivitis present?

A 
Discharge
Red eye
bilateral
Itchy/ gritty feeling
Will effect inner and outer eyelid (so will see red when pull eyelid foward) - unlike blepharitis
40
Q

How do you differentiate between viral and bacterial and allergic conjunctivits?

A

Viral: clear discharge, systemic sx
Bacterial: purulent discharge
Allergic: itchy, mucus discharge, swelling

41
Q

What is the mx of conjunctivitis?

A

Clean eye and careful not to spread
If bacterial - fuscidic acid or chloramphenicol drops
If allergic - antihistamines

42
Q

What is the uvea?

A

Iris, ciliary body and choroid (layer between retina and sclera)

43
Q

What is anterior uveitis? What is the cause?

A

Inflammation and infiltration of immune cells in the uvea

Usually autoimmune

44
Q

Causes of acute and chronic uveitis?

A

Acute: HLA B27 conditions e.g. Ank Spond; IBD; reactive arthirits

Chronic: Sarcoidosis, syphilis, lymes, TB, HSV

45
Q

How does anterior uveitis present?

A 
Unilateral sx
Painful red eye
Ciliary flush (Ring of red spreading out from the cornea)
Reduced acuity
Floaters
Miosis
Photophobia
Lacrimation
Abnormally shapred pupil 
Hypopyon (Collection WBC in anterior chamber so can see yellow fluid in lower iris)
46
Q

Mx of anterior uveitis?

A

Steroids
atropine drops - antimuscarinic so will block action of iris sphincter muscles
Immunosuppressants

47
Q

Differentials for a red eye

A

Painless: conjunctivits, episcelritis, subconjunctival haemorrhage (conjunctiva vessel reuptures releasing bld after trauma/ strenuous activity)

Painful: 
glaucoma,
anterior uveitis,
corneal ulcer/ abrasion,
keratitis,
foreign body,
trauma
48
Q

What is episcleritis?

A

Inflammation of episclera (located between sclera and conjunctiva)

49
Q

How does episcleritis present?

A 
Young
Segmental (small patch redness)
Feels like foreign body but NO pain
watering but NO discharge 
dilated vessels
May have IBD/ RA
50
Q

How do you mx episcleritis?

A

Self-limiting

Safety net - if pain could be scleritis so then they need to go hospital

51
Q

What is scleritis?

A

Inflammation of the whole sclera - much more serious than episcleritis as can perforate

52
Q

What are some associated conditions with scleritis?

A 
IBD
RA
SLE
Sarcoidosis 
GPA - previously wegeners
53
Q

How does scleritis present?

A 
SEVERE pain
Photophobia
blue/ violet hue to sclera
Eye watering
Decresed acuity
abnormal pupil reaction to light
tender to palpation
54
Q

Mx of scleritis?

A

Any red eye that is potentially slight threatening needs same day opthamologist referral and assessment where they will use NSAIDs/ steroids. immunosuppression

55
Q

How do you diagnose a corneal abrasion?

A

Use fluorescein stain which will show ulcer/ abrasion in yellow-orange colour

56
Q

What is herpes keratits?

A

Corneal inflammation specifically caused by herpes but keratitis can be caused by any infection

57
Q

How does herpes keratitis present?

A 
Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced visual acuity
Dendritic ulcer seen on fluorescein staining
58
Q

What is the mx of herpes keratits?

A

Refer to opthamology who can give aciclovir and steroids

59
Q

What is retinal detachment?

A

Retina detaches from choriod - this is a sight threatening emergency as retina needs choriod for blood supply

60
Q

What are the RF for retinal detachement?

A 
Age
Fhx
Diabetic retinopathy
Posterior vitreous detachment (where the gel in the eye that pushes the retina up against the choriod becomes less firm with age)
Retinal malignancy
eye trauma
61
Q

How does retinal detachement present?

A

Sudden peripheral visual loss
Blurred vision
PAINLESS
floaters and flashes

62
Q

Mx of retinal detachement?

A

Immediately refer to opthamology who will try to reconnect retina and choriod with lazer/ cryotherapy or with surgery eg vitrectomy

63
Q

What is central retinal vein occlusion?

A

Clot in central retinal vein causing blood to pool in the retina –> macular oedema; haemorrhage and neovascularisation

Presents with sudden painless loss of vision and needs immediate opthamology assessment

64
Q

What is central retinal artery occlusion?

A

Occlusion of the artery via atherosclerosis/ GCA which presents with sudden painless loss of vision AND RAPD; fundoscopy shows pale retina and cherry red spot
Need immediate opthamology input

65
Q

What is a RAPD?

A

a relative afferent pupillary defect. This is where the pupil in the affected eye constricts more when light is shone in the other eye compared when it is shone in the affected eye. This occurs because the input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex.

66
Q

What is retinosa pigmentosa?

A

Congenital degenerations of rods and cones which presents with night blindness!

67
Q

What is vitreous haemorrhage?

A

Vitreous haemorrhage is bleeding into the vitreous humour. It is one of the most common causes of sudden painless loss of vision. BIG LINK WITH DM! Can’t see retina upon fundoscopy unlike retinal vein/ artery occlusion

68
Q

Findings on fundoscopy for diabetic retinopathy

A

Microaneurysms, flame-shaped haemorrhages, hard exudates, engorged tortuous veins.

69
Q

Findings on fundosocpy for hypertensive retinopathy

A

Arteriolar constriction (silver/copper wiring), arteries nipping veins where they cross (AV nipping), cotton wool spots or exudates, flame-shaped haemorrhages, papillloedema.

70
Q

What are you worried about with shingles and the eye?

A

Involvement of nasociliary branch –> Hutchinsons sign –> may involve cornea and lead to lack of corneal sensation i.e. when you touch it it doesnt blink –> risk of corneal ulcer

Opthamology (1 decks)

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