General Flashcards
1
Q
what is blepharitis?
A
inflammation of the eyelids
2
Q
is blepharitis usually unilateral or bilateral ?
A
bilateral
if unilateral could be lid tumour
3
Q
what disease is associated w blepharitis?
A
rosacea
4
Q
name some lid hygiene techniques used to treat blepharitis?
A
warm compresses
lid massage
lid cleansing
5
Q
name 3 management points of blepharitis
A
lid hygiene
tear substitutes e.g. hypromellose
chloramphenicol ointment
6
Q
what is the episclera?
A
thin vascular tissue btw conjunctiva and sclera
7
Q
“your eye looks a bit red Gary” - others notice red eye - likey to be…
A
episcleritis
mild
8
Q
what is management of episcleritis
A
reassurance. better in 1-2wks. oral NSAIDs if pain.
9
Q
dark red eye in older person w PMH autoimmune. on ex its swollen and painful. thinking?
A
scleritis
10
Q
a pyogenic infection at the follice of eyelash. what’s this?
A
stye
11
Q
what is a stye?
A
pyogenic infection at follicle of eyelash
12
Q
what is most likely organism causing stye
A
s.aureus. more likely w blepharitis
13
Q
if a stye is recurrent, you might think of investigating for what?
A
diabetes
14
Q
name some ways to manage a stye
A
self limiting. burst in 4ds. hot compresses , avoid contact lens and eye make up. pull out eyelash may help drain.
15
Q
hordeolum aka
A
stye
16
Q
what is a chalazion?
A
blockage of meibomian gland –> oily cyst deeper in eyelid
17
Q
blockage of meibomian gland = what
A
chalazion
18
Q
what is a rare complication of chalazion
A
orbital cellulitis
19
Q
management of chalazion?
A
hot compress and massage cyst
if chronic excise and drain under local
20
Q
two other names for dry eyes
A
keratoconjunctivitis sicca
xeropthalmia (in vit A def)
21
Q
what do tears do?
A
complex solution of water protein salts lipids mucins
oxygenate and lubricate ocular surface
22
Q
which glands produce the different components of tears?
A
lacrimal glands - aqueous
meibomian - lipid
conjuncitval goblet - mucous
23
Q
which cells produce the mucuous layer of tears?
A
conjunctival goblet cells
24
Q
which glands produce the aqeous layer of tears?
A
lacrimal glands
25
which glands produce the lipid layer of tears?
meibomian
26
name some causes of dry eyes
Sjogrens syndrome
drugs (anticholinergics, antidepressants)
eye disease (conjunctivitis, blepharitis)
facial nerve palsy / parksinsons (blink on the blink)
contact lenses!
vit A def
27
vit A def cause of dry eyes true or false
true. xeropthalmia.
28
why does facial nerve palsy and parkinsons cause dry eyes
blink on the blink
29
important parts of history in someone w dry eyes
drug Hx!
| ask about contact lenses!
30
what is the treatment for dry eyes?
TEAR SUBSTITUTES E.G. HYPROMELLOSE DROPS
med rv, avoid contact lenses
31
name the two bits of conjunctiva
palpebral conjunctiva
| bulbar conjunctiva
32
commonest viral cause of conjunctivties
adenovirus
| plus systemic illness + sore throat
33
3 categories of conjunctivitis causes
viral
allergic
bacterial
34
commonest cause of bac conjunctivitis in adults
staph aureus
35
commonest cause of bac conjunctivitis in neonates
chlamydia/gonorrhoea
| opthalmia neonatorum = conjunctivitis in first 28ds of life
36
tell me about what you can learn from the discharge in conjunctivitis
```
serous = viral
mucus = allergic
purulent = bacterial
```
37
23yr old presents with red eye. discharging serous watery fluid. he has sore throat. most likely type of conjunctivits?
viral
38
27yr old presents with red eye. discharging mucus fluid and itchy.. likely type of conjunctivitis?
allergic
39
22yr old presents w red eye. discharging purulent fluid. most likely type of conjunctivitis?
bacterial
40
should the cornea look ok in conjunctivits?
yes
41
when do you refer to opthalm w conjunctivitis?
neonatal
severe purulent
non-response to treatment
42
mostly treatment of conjunctivits is just self-limiting and reassurance. if bac, you might add what? if allergic, you might add what?
bac - ?chloramphenicol
| allergic - ?topical antihistamines
43
is episcleritis usually painful?
no
44
epicleritis and conjunctivitis are two acute non-painful causes of red eye. give me 4 acute PAINFUL causes.
acute angle closure glaucoma
acute anterior uveitis
keratitis
scleritis
45
62 yr old presents w nausea and vomiting, headache and a painful red eye. she has an OVAL pupil, HAZY cornea, and eye feels HARD. She has blurred vision with a HALO around light sources. what do you do?
refer IMMEDIATELY
| acute angle closure glaucoma
46
OVAL HAZY HARD HALO what does this make you think of
acute angle closure glaucoma
47
inflammation of cornea = what?
keratitis
48
what is keratitis?
inflammation of cornea
49
name some signs of acute angle closure glaucoma
```
systemically unwell
hard eye
oval pupil
hazy cornea
halo around light sources
```
50
aqueous humour can't drain, so iris pushed up against cornea by fluid and increased pressure. what's this?
acute angle closure glaucoma
51
how soon do you refer acute angle closure glaucoma to opthalm
IMMEDIATEMENT
52
keratitis is infl of cornea. can be bac, fungal or viral. what sign might you see?
hypopyon
53
what is hypopyon?
pus in anterior chamber
54
uvea is made up of what?
iris
ciliary body
choroid
55
iris, ciliary body and choroid = what?
uvea
| vascular layer of eye
56
32 yr old with UC and ank spond presents w painful red eye, and pain on accomodating. she has an irregular pupil with keratitic precipitates. what do you do?
anterior uveitis
| refer within 24hrs
57
how soon do you refer anterior uveitis to opthalm
within 24hrs
58
how soon do you refer keratitis to opthalm
within 24hrs
59
inflammation of the whites of the eye (sclera) = what?
scleritis
60
70 yr old present w red eye and a severe borrring type pain, radiating to forehead. it is dark red. he has a diagnosis of Wegener's granulomatosis. what do you do?
scleritis
| refer within 24hrs
61
what is enopthalmitis?
infl of interior of eye
62
what is inflammation of the interior of the eye?
endopthalmitis
63
when can endopthalmitis happen?
after cataract surgery, in penetrating trauma, in imm comp
64
25 yr old stuck a fence in his eye and now has severe pain, redness, loss of vision and a hypopyon. what does he need?
immediate referral for Abx
| endopthalmitis
65
scratched your eye w contact lenses. what's this?
corneal abrasion
if contact lens might be infected w pseudomonas
66
bilateral red eye is usually less serious than unilateral, true or false?
true
pain and loss of vision and unilateral often mean cause is serious (i.e. not episcleritis, conjunctivits)
67
name 3 common causes of gradual loss of vision
cataracts
chronic open angle glaucoma
macular degeneration
68
which TORCH infection is most likely to cause congenital cataracts
rubella
69
name 3 risk factors for cataracts
ageing, corticiosteroid use, malnutrition
| indian
70
what is a cataract?
opacity in lens
clouding caused by protein aggregation
71
what might you see on examination of cataract
defect in red reflex
| looks white/brown when light shone on
72
nuclear sclerosis, cortical, posterior subscapular are all types of what
cataract
73
what is the surgery for cataracts?
lens extraction and replacement
74
what is the commonest type of gluacoma?
chronic open angle glaucoma
75
where does the aqueous humour leave the eye
through the trabecular meshwork
| this is the angle
76
what is the pathopysciolog of glaucome
dodgy optic nerve assoc w raised intracoular pressure
77
name some RFs for chronic open angle glaucooma
>65yrs, FHx, afro-caribbean
78
do you lose visual acuity or visual field in chronic open angle glaucoma?
visual FIELD
| painless progressive loss of visual field
79
tunnel vision but good visual acuity makes you think of
chronic open angle glaucoma
80
what might you see on fundoscopy in chronic open angle glaucoma
optic disc cupping
81
what test might you do to test intra ocular pressure in chronic open angle glaucoma
tonometry
82
visual field, once lost, is lost forever. in what disease?
chronic open angle glaucoma
83
describe the management of chronic open angle glaucoma
refer - drops (e.g. timolol) /laser therapy / surgery
84
what is the macula?
part of retina
where visual acuity is highest
contains fovea centralis
85
what is dry AMD?
atrophy of retina
86
what is wet amd?
new vessel growth in choroid
87
name a symptom of dry AMD?
central scotoma
88
name a symptom of wet AMD?
distortion
89
how do you check for distortion in wet AMD?
Amsler chart
90
drusen in retina are waste materials that collect in retinal epi. make you think of what?
AMD
91
68 yr old smoker presents with gradual painless loss of central vision but preseved peripheral vision. what do you do?
urgent referral <1wk
| AMD
92
why do you do urgent referral for AMD
because for wet AMD prompt treatment can preserve vision
93
name a risk factor for AMD
smoking
94
what is the treatment for wet AMD
intravitreal injections anti-VEGF
95
which form of AMD is more common?
dry AMD (90%)
96
name 4 causes of sudden loss of vision
vascular (retinal artery/vein occlusion/AION)
optic neuritis
retinal detachment
vitreous haemorrhage
97
name 3 VASCULAR causes of sudden visual loss
retinal artery occlusion
retinal vein occlusion
anterior ischaemic optic neuropathy
98
retinal artery occlusions are mainly central, while retinal vein occlusions mainly branch. true or false?
true
99
what causes retinal artery occlusion?
atherosclerosis/emboli from carotid or heart
100
name two signs of retinal artery occlusion
RAPD
| cherry spot on fovea
101
how does retinal artery occlusion?
sudden unilateral painless vision loss
102
can you get vision back from retinal artery occlusion?
:( vision once lost is lost forever
103
how would you manage retinal artery occlusion?
emergency referral
| secondary prevention of stroke/MI - carotid doppler, dual antiplts, carotid endarterectomy
104
amaurosis fugax and retinal artery occlusion are both sudden painless unliteral vision loss. what is the difference?
amaurosis fugax resolves completely, lasts ~30mins
'curtain coming down'
105
investigation after amaurosis fugax?
carotid doppler
dual antiplts
106
name three causes of transient obscurations.
- amaurosis fugax (TIA)
- GCA
- papilloedema
107
name two key difference between retinal artery and retinal vein occlusion?
retinal artery: always RAPD
retinal vein: sometimes
retinal artery: blackout
retinal vein: blurry
108
what might you see on fundoscopy with retinal vein occlusion?
flame haemorrhages and tortuosity
109
name 2 causes of anterior ischaemic optic neuropathy causing sudden painless unilateral vision loss
giant cell arteritis
| general CV rfs
110
what investigations would you do for suspected AION
ESR, temporal artery biopsy
111
what treatment do you give for AION caused by GCA?
high dose prednisolone
| + low dose aspirin
emergency referral
112
name 2 signs of AION
RAPD
| pale/oedematous optic disc
113
optic neuritis trio?
vision loss
colour loss
eye pain
114
is optic neuritis painful?
YES
115
apart from MS, name some secondary causes of anterior ischaemic optic neuropathy?
TB, syphilis, B12 def, lyme
116
name 3 signs on examination of optic neuropathy
RAPD
decreased visual acuity
decreased colour vision
117
investigations in optic neuritis?
MRI brain
LP
118
many patients w optic neuritis DONT go on to develop MS. true or false?
true
119
treatment for optic neuritis ?
oral methylprednisolone (speeds recovery but doesnt affect outcome)
120
in retinal detachment the retina gets detached from the layer below. this can be due to age or diabetic retinopathy. name three symptoms?
floaters
flashers
curtain / shadow - starts in peripheries
121
sudden onset painless loss of visual field, shadow starts in peripheries - makes you think of?
retinal detachement
emergency referral
122
blood leaks intro vitreous humour. what's this?
vitreous haemorrahge
123
what is the main cause of vitreous haemorrhage
DIABETIC RETINOPATHY
can also be precipitated by retinal detachment, posterior vitreous detachment or trauma
124
sudden painless unilateral vision loss w floaters in patient w diabetic retinopathy, could be what
vitreous detachment
| retinal haemorrhage
125
silver wiring makes you think of
hypertensive retinopathy
126
name some signs of diabetic retinopathy
hard exudates
cotton wool spots (ischaemia)
blot haemorrhages
new vessels
127
sudden painless unilateral vision loss w floaters in patient w diabetic retinopathy, could be what
vitreous detachment
| retinal haemorrhage
128
silver wiring makes you think of
hypertensive retinopathy
129
name some signs of diabetic retinopathy
hard exudates
cotton wool spots (ischaemia)
blot haemorrhages
new vessels
130
what can you use to dilate pupils in opthalmoscopy?
tropicamide drops
131
what four things do you look at on opthalmoscopy?
red reflex
optic disc
vessels
macula
132
name a condition in which u may not see red reflex
cataracts
133
what do you look for when youre looking at the optic disc
Colour
Contour
Cup
Circulation
134
sudden painless unilateral vision loss w floaters in patient w diabetic retinopathy, could be what
vitreous detachment
| retinal haemorrhage
135
silver wiring makes you think of
hypertensive retinopathy
136
name some signs of diabetic retinopathy
hard exudates
cotton wool spots (ischaemia)
blot haemorrhages
new vessels
137
what can you use to dilate pupils in opthalmoscopy?
tropicamide drops
138
where is the macula in relation to the optic disc
temporal
139
name a condition in which u may not see red reflex
cataracts
140
what do you look for when youre looking at the optic disc
Colour
Contour
Cup
Circulation
141
Colour
Contour
Cup
Circulation
is what you look for when?
when looking at optic disc in opthalmoscopy
142
there is cupping of the optic disc.
glaucoma
143
there is new vessels on the optic disc.
diabetic retinopathy
144
there is blurred margins on the optic disc.
papilloedema
145
the optic disc is pale.
optic atrophy
146
the optic disc is blue
normal in BAME pops
147
what is the dot in the middle of the macula
fovea
148
tip to find the macula on opthalmoscopy
ask them to look directly into the light
