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
What is Horner's syndrome?
Miosis (small pupil) Ptosis Enopthalmos (sunken eye) Anhidrosis (loss of sweating one side)
26
What is seen in congenital Horner's syndrome?
Heterochromia (difference in iris colour)
27
When Horner's syndrome is caused by central lesions, what form of anhidrosis is seen?
Anhidrosis of the face, arm and trunk
28
When Horner's syndrome is caused by pre-ganglionic lesions, what form of anhidrosis is seen?
Anhidrosis of the face
29
When Horner's syndrome is caused by post-ganglionic lesions, what form of anhidrosis is seen?
No anhidrosis
30
What are the central lesion causes of Horner's syndrome?
S ``` Stroke Syringomyelia Multiple Sclerosis Tumour Encephalitis ```
31
What are the pre-ganglionic lesion causes of Horner's syndrome?
T Pancoast's Tumour Thyroidectomy Trauma Cervical rib
32
What are the post-ganglionic lesion causes of Horner's syndrome?
C Carotid artery dissection Carotid aneurysm Cavernous sinus thrombosis Cluster headache
33
What classification is used in Hyperetensive Retinopathy?
Keith-Wagener classfication
34
What is stage I of the Keith-Wagener classification of hypertensive retinopathy?
Arteriolar narrowing and tortuosity | Increased life reflex - silver wiring
35
What is stage II of the Keith-Wagener classification of hypertensive retinopathy?
Arteriovenous nipping
36
What is stage III of the Keith-Wagener classification of hypertensive retinopathy?
Cotton-wool exudates | Flame and blot haemorrhages
37
What is stage IV of the Keith-Wagener classification of hypertensive retinopathy?
Papilloedema
38
What is mydriasis?
Dilated pupil
39
What are the physiological causes of mydriasis?
``` Third nerve palsy Holmes-Adie pupil Traumatic iridoplegia Phaeochromocytoma Congenital ```
40
What are the drug causes of mydriasis?
Topical mydriatics: tropicamide, atropine Sympathomimetic drugs: amphetamines, cocaine Anticholinergic drugs: tricyclic antidepressants
41
What is aniscoria?
Difference in sizes of pupils
42
What is nasolacrimal duct obstruction?
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
What is the management of nasolacrimal duct obstruction?
Teach parents to massage lacrimal duct | 95% will resolve by 1 y/o
44
What is hyphema?
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
What is the main risk to sight in hyphema?
Raised ICP due to blockage of the angle and trabecular meshwork with erythrocytes
46
What is the treatment of hyphema?
Strict bed rest to prevent redistribution of settled blood | High risk cases may be admited
47
What is optic neuritis?
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
What are the causes of optic neuritis?
Multiple sclerosis Diabetes Syphilis
49
What is the management of optic neuritis?
High-dose steroids | Recovery usually takes 4-6 weeks
50
What is the prognosis of optic neuritis?
> 3 white-matter lesions, 5-year risk of developing multiple sclerosis is 50%
51
What is papilloedema?
Optic disc swelling that is caused by increased intracranial pressure. Almost always bilateral.
52
What is seen on fundoscopy in papilloedema?
``` 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
What are the causes of papilloedema?
``` Space-occupying lesion: neoplastic, vascular Malignant hypertension Idiopathic intracranial hypertension Hydrocephalus Hypercapnia ``` Rare: Hypoparathyroidism Hypocalcaemia Vitamin A toxicity
54
What is Endopthalmitis?
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
What is Relative afferent pupillary defect?
Also known as the Marcus-Gunn pupil, found by the swinging light test.
56
What is the cause of a Relative afferent pupillary defect?
A lesion anterior to the optic chiasm i.e. optic nerve or retina. Causes: Retina: Detachment Optic nerve: Optic neuritis
57
What is seen on a swinging light test in a Relative afferent pupillary defect?
The affected and normal eye appears to dilate when light is shone on the affected eye.
58
What is the pathway of the afferent pupillary light reflex?
Afferent: retina → optic nerve → lateral geniculate body → midbrain
59
What is the pathway of the efferent pupillary light reflex?
Efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve
60
What are the most common causes of sudden painless loss of vision?
Ischaemic/vascular (thrombosis, embolic, temporal arteritis), occlusion of central retinal vein and artery. Vitreous haemorrhage Retinal detachment Retinal migraine
61
What are the ischamic/vascular causes of sudden visual loss?
Wide differential Atherothrombosis, embolus, dissection, anterior ischamic optic neuropathy, vasculitis, temporal arteritis, venous disease, hypoperfusion, TIA Curtain coming down TIA - aspirin 300mg
62
What are the causes of tunnel vision?
``` Papilloedema Glaucoma Retinitis pigmentosa Choroidoretinitis Optic atrophy secondary to tabes dorsalis Hysteria ```