JB-Opthalmology Flashcards
What is glaucoma
Damage to the optic nerve normally by a significant rise in intraocular pressure
Definition of open angle glaucoma
Gradual rise in resistance through trabecular meshwork -> increased pressure
Key change on fundoscopy in glaucoma
Cupping of optic disc (greater than 0.5) abnormal
4 risk factors for open angle glaucoma
Age, FH, black, myopia (nearsightedness)
What is myopia
Nearsighted/ short sighted
Cannot see things far away clearly
[shorter word than hypermetropia]
Two ways to measure intraocular pressure
Non-contact (puff of air)
Goldmann applanation (gold standard but need slip light)
Visual loss in glaucoma
Peripheral -> tunnel vision
Open angle glaucoma first line treatment
Prostaglandin analogue eyedrops (lantoprost)
Increase uveoscleral outflow
Eyelash growth, eyelid pigmentation, iris browning
Open angle glaucoma management
1:Prostaglandin analogue eyedrops (lantoprost) - increase outflow
2:BB (timolol) - decrease production
3: carbonic anhydrase inhibitor (dorzolamide) - decrease production
4: sympathomimetics (brimonidine) - decrease production
Trabeculectomy
Screening in open angle glaucoma
Annual from 40 if 1st line relative
Pathophysiology of closed angle glaucoma
Iris bulges forward and seals off trabecular meshwork from anterior chamber -> fluid cannot drain away -> increased pressure
Medications which can precipitate acute angle closure glaucoma
Adrenergic (adrenaline), anticholinergic (oxybutynin) and TCAs
4 symptoms of AACG
Painful red eye
Blurred vision
Halos around lights
Headaches (nausea and vommiting)
Signs in AACG
Red, teary, hazy cornea, fixed and dilated pupil, firm on palpation
3 key management steps in AACG
Pilocarpine (mitotic agent to increase room around iris)
Acetazolamide (carbonic anhydrase inhibitor - reduce production)
Lie on back without a pillow
Definitive treatment of AACG
Laser iridotomy
Most common cause of blindness in UK
Age related macular degeneration
Key finding on fundoscopy in macular degeneration
Druseen
2 key symptoms in macular degeneration
Worsening central visual loss
Wavy appearance to straight lines
Piece of equipment to test for macular degeneration
Amsler grid test (distorted straight lines)
Snellen chart
Optical coherence tomography - wet AMD
How is wet AMD diagnosed
Optical coherence tomography
Treatment for dry AMD
Stop smoking, control BP
Vitamins (A,C,E and zinc)
Treatment for wet AMD
Anti-VEGF medications
Need to be started within 3 months to be beneficial
Fundoscopy changes in diabetic retinopathy
Blot haemorrhages
Hard exudates
Microaneurysms
Cotton wall spots
3 management options for diabetic retinopathy
Laser photocoagulation
Anti-VGEF medications
Vitreoretinal surgery
2 fundoscopy signs in hypertensive retinopathy that are unlikely in diabetic
Copper wiring
AV nipping
Classification of hypertensive retinopathy
Keith-Wagener (1-4)
RF for cataracts
Age, smoking, alcohol, diabetes, steroids, hypocalcaemia
In ophthalmology what causes
Central visual loss?
Peripheral visual loss?
Generalised visual loss?
Central = AMD
Peripheral = glaucoma
Generalised = cataracts
Key complication of cataracts surgery
Endophthalmitis
Inflammation of inner eye
Treated with intravitreal antibiotics
Commonly used eye drops for allergic rhinitis
Anatazoline (antihistamine)
Sodium cromoglicate (mast cell stabiliser)
topical mydriatics
Tropicamide (used to examine as short half life)
Atropine
Cocaine and TCAs
Drug used to examine for corneal defects
Fluroescein
Central retinal vein occlusion presenting complaint
Sudden painless vision loss
Central retinal vein occlusion fundoscopy changes
Retinal haemorrhages +++ (sunset appearance)
Widespread hyperaemia (red eye)
Central retinal artery occlusion presenting complaint
sudden, painless unilateral visual loss
Central retinal artery occlusion fundoscopy findings
‘cherry red’ spot on a ++ pale retina
RAPD also present
Retinitis pigmentosa presenting complaint (2)
Tunnel vision and night blindness
Retinitis pogmentosa fundoscopy changes
Black spicule-shaped pigmentation in the peripheral retina (looks like mottling)
Treatment for herpes zoster opthamos
Oral aciclovir treatment for 7-10 days
Should start within 72 hrs
Cornea changes in Acute angle closure glaucoma
Hazy
“Cilliary flush” -> dx
Anterior uveitis
Blurred vision and photophobia
small, fixed oval pupil, ciliary flush
Treatment of anterior uveitis
steroid + cycloplegic (mydriatic) drops
“irregular pupil” -> dx
anterior uveitis
Are high or low levels of ca a cause of cataracts
Hypocalcaemia causes cataracts
(I have no cataracts)
