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Finals - Opthalmology and ENT > General: Opthalmology > Flashcards

General: Opthalmology Flashcards

1
Q

What conditions should you be able to diagnose and treat?

A

Common causes of a red eye

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2
Q

What conditions should you be able to recognise and refer on?

A

Painful, red eye
Loss of vision
Double vision
Eyelid problems

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3
Q

What are some causes of lid lump?

A 
Stye
Chalazion
Basal cell carcinoma (rodent ulcer)
Molluscum contagiosum (umbilicated lesions)
Papilloma
Squamous cell carcinoma
Keratoaanthoma
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4
Q

What are some causes of red eye?

A 
Benign:
Conjunctivitis
Blepharitis
Dry Eye
Episcleritis
Dangerous:
Acute angle glaucoma
Iritis
Disthyroid eye disease
Corneal ulcer
AML (acute leukemic retinopathy)
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5
Q

Do you need to manage loss of vision?

A

No, just refer

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6
Q

What is gradual loss of vision?

A

Days, weeks, months

Degenerative, neuropathic, vasculopathy

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7
Q

What is sudden vision loss?

A

Seconds, minutes, hours
Inflammatory, vascular occlusion, haemorrhage
(can be just noticed visual loss - happen to shut good eye)

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8
Q

What do you need to do for visual loss examination? (5)

A
  1. History: onset, distortion, PMH, pain
  2. Assess vision: mild, moderate or proound loss.
  3. Test pupil for relative afferent pupil defect
  4. Test field for central scotoma or hemianopia
  5. Ask about colour vision (optic neuritis)
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9
Q

What are causes of distorted vision?

A

Retinal detachment
Macular degeneration
Diabetic retinopahty

Get advice quickly

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10
Q

What causes of the gradual onset visual loss are there? (5)

A

Gradual onset

  1. Cataract
  2. Chronic glaucoma
  3. Macular degeneration
  4. Optic nerve compression: RAPD
  5. Glasses requirement
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11
Q

What are some of the sudden causes of visual loss? (5)

A
  1. Ischaemic optic neuropathy (PMR/GCA)
  2. Retinal detachment (flashes, floaters, field loss)
  3. Vitreous haemorrhage
  4. Vascular occlusion (artery and vein, branch and central, abrupt and variable)
  5. Acute glaucoma
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12
Q

Other causes of visual loss? (2)

A
  1. Optic/retrobulbar neuritis

2. Diabetic retinopathy (screened for)

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13
Q

What visual defects should you know about?

A

Homonymous hemianopia (vascular or tumor)
Bitemporal hemianopia (usually tumour)
Central scotoma
Transient visual loss (papilloedema, GCA, TIA)

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14
Q

What is Argyll-Robertson pupil?

A

Classic pupillary syndrome

Prostitutes Pupil -
Accomodation reflex present but pupillary reflex absent

Small irregular pupils, no response to light but a response to accomodation

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15
Q

What conditions is Argyll-Robertson pupil seen in?

A

Diabetes mellitus

Neurosyphilis

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16
Q

What is an entropion?

A

In-turning of the eyelids

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17
Q

What is an ectropion?

A

Out-turning o the eyelids.

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18
Q

What is Herpes Zoster Ophthalmicus (HZO)?

A

Describes the reactivation of the varicella-zoster virus (shingles) in the area supplied by the opthalmic devision of the trigeminal nerve. (10% cases)

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19
Q

What are the features of Herpes Zoster Ophthalmicus (HZO)?

A

Vesicular rash around the eye, which may or may not involve the actual eye itself

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20
Q

What is Hutchinson’s sign in Herpes Zoster Ophthalmicus (HZO)?

A

A rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement.

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21
Q

What is the management of Herpes Zoster Ophthalmicus (HZO)?

A

Oral antiviral treatment for 7-10 days (IV if immunocompromised)
Topical corticosteroids for eye inflammation
Ocular involvement requires urgent opthalmology review

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22
Q

What are the complications of Herpes Zoster Ophthalmicus (HZO)?

A

Ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
Ptosis
Post-herpetic neuralgia

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23
Q

What is Holmes-Adie pupil?

A

A benign condition most commonly seen in women.
Differential of a dilated pupil

Unilateral in 80% of cases
Dilated pupil
Once the pupil has constricted it remains small for an abnormally long time
Slowly reactive to accommodation but very poorly (if at all) to light

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24
Q

What is Holmes-Adie syndrome

A

Association of Holmes-Adie pupil with absent ankle/knee reflexes

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25
Q

What is Horner’s syndrome?

A

Miosis (small pupil)
Ptosis
Enopthalmos (sunken eye)
Anhidrosis (loss of sweating one side)

26
Q

What is seen in congenital Horner’s syndrome?

A

Heterochromia (difference in iris colour)

27
Q

When Horner’s syndrome is caused by central lesions, what form of anhidrosis is seen?

A

Anhidrosis of the face, arm and trunk

28
Q

When Horner’s syndrome is caused by pre-ganglionic lesions, what form of anhidrosis is seen?

A

Anhidrosis of the face

29
Q

When Horner’s syndrome is caused by post-ganglionic lesions, what form of anhidrosis is seen?

A

No anhidrosis

30
Q

What are the central lesion causes of Horner’s syndrome?

A

S

Stroke
Syringomyelia
Multiple Sclerosis
Tumour
Encephalitis
31
Q

What are the pre-ganglionic lesion causes of Horner’s syndrome?

A

T

Pancoast’s Tumour
Thyroidectomy
Trauma
Cervical rib

32
Q

What are the post-ganglionic lesion causes of Horner’s syndrome?

A

C

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

33
Q

What classification is used in Hyperetensive Retinopathy?

A

Keith-Wagener classfication

34
Q

What is stage I of the Keith-Wagener classification of hypertensive retinopathy?

A

Arteriolar narrowing and tortuosity

Increased life reflex - silver wiring

35
Q

What is stage II of the Keith-Wagener classification of hypertensive retinopathy?

A

Arteriovenous nipping

36
Q

What is stage III of the Keith-Wagener classification of hypertensive retinopathy?

A

Cotton-wool exudates

Flame and blot haemorrhages

37
Q

What is stage IV of the Keith-Wagener classification of hypertensive retinopathy?

A

Papilloedema

38
Q

What is mydriasis?

A

Dilated pupil

39
Q

What are the physiological causes of mydriasis?

A 
Third nerve palsy
Holmes-Adie pupil
Traumatic iridoplegia
Phaeochromocytoma
Congenital
40
Q

What are the drug causes of mydriasis?

A

Topical mydriatics: tropicamide, atropine
Sympathomimetic drugs: amphetamines, cocaine
Anticholinergic drugs: tricyclic antidepressants

41
Q

What is aniscoria?

A

Difference in sizes of pupils

42
Q

What is nasolacrimal duct obstruction?

A

Most common cause of a persistent watery eye in an infant.
Caused by an imperforate membrane, usually at the lower end of the lacrimal duct.
1/10 infants

43
Q

What is the management of nasolacrimal duct obstruction?

A

Teach parents to massage lacrimal duct

95% will resolve by 1 y/o

44
Q

What is hyphema?

A

Blood in the anterior chamber (water-line iris appearance)

In the context of trauma warrants urgent referral to an ophthalmic specialist for assessment and management.

45
Q

What is the main risk to sight in hyphema?

A

Raised ICP due to blockage of the angle and trabecular meshwork with erythrocytes

46
Q

What is the treatment of hyphema?

A

Strict bed rest to prevent redistribution of settled blood

High risk cases may be admited

47
Q

What is optic neuritis?

A

Occurs when swelling damages the optic nerve
Presents as pain with eye movement
Sudden temporary unilateral decrease in visual acuity (visual loss) over hours or days

Poor discrimination of colours - red desaturation
Relative afferent pupillary defect
Central scotoma

48
Q

What are the causes of optic neuritis?

A

Multiple sclerosis
Diabetes
Syphilis

49
Q

What is the management of optic neuritis?

A

High-dose steroids

Recovery usually takes 4-6 weeks

50
Q

What is the prognosis of optic neuritis?

A

> 3 white-matter lesions, 5-year risk of developing multiple sclerosis is 50%

51
Q

What is papilloedema?

A

Optic disc swelling that is caused by increased intracranial pressure.
Almost always bilateral.

52
Q

What is seen on fundoscopy in papilloedema?

A 
Venous engorgement: first sign
Loss of venous pulsation
Blurring of the optic disc margin
Elevation of optic disc
Loss of optic cup
Paton's lines: concentric/radial retinal lines cascading from the optic disc
53
Q

What are the causes of papilloedema?

A 
Space-occupying lesion: neoplastic, vascular
Malignant hypertension
Idiopathic intracranial hypertension
Hydrocephalus
Hypercapnia

Rare:
Hypoparathyroidism
Hypocalcaemia
Vitamin A toxicity

54
Q

What is Endopthalmitis?

A

Endophthalmitis is a purulent inflammation of the intraocular fluids (vitreous and aqueous) usually due to infection.
Red-eye, pain and visual loss typically following intraocular surgery.

55
Q

What is Relative afferent pupillary defect?

A

Also known as the Marcus-Gunn pupil, found by the swinging light test.

56
Q

What is the cause of a Relative afferent pupillary defect?

A

A lesion anterior to the optic chiasm i.e. optic nerve or retina.

Causes:
Retina: Detachment
Optic nerve: Optic neuritis

57
Q

What is seen on a swinging light test in a Relative afferent pupillary defect?

A

The affected and normal eye appears to dilate when light is shone on the affected eye.

58
Q

What is the pathway of the afferent pupillary light reflex?

A

Afferent: retina → optic nerve → lateral geniculate body → midbrain

59
Q

What is the pathway of the efferent pupillary light reflex?

A

Efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

60
Q

What are the most common causes of sudden painless loss of vision?

A

Ischaemic/vascular (thrombosis, embolic, temporal arteritis), occlusion of central retinal vein and artery.

Vitreous haemorrhage

Retinal detachment

Retinal migraine

61
Q

What are the ischamic/vascular causes of sudden visual loss?

A

Wide differential
Atherothrombosis, embolus, dissection, anterior ischamic optic neuropathy, vasculitis, temporal arteritis, venous disease, hypoperfusion, TIA
Curtain coming down

TIA - aspirin 300mg

62
Q

What are the causes of tunnel vision?

A 
Papilloedema
Glaucoma
Retinitis pigmentosa
Choroidoretinitis
Optic atrophy secondary to tabes dorsalis
Hysteria

Finals - Opthalmology and ENT (44 decks)

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