Medical Opthalmology Flashcards
Risk factors for infective keratitis
Poor contact lens hygeine
Swimming / showering in lenses
Sleeping in lenses
Does a corneal abrasion cause an infiltrate?
No
What is keratitis
Inflammation of the cornea
What is a hypopynon
Accumulation of white blood cells in the anterior chamber
Most common causes of hypopynon
Infective keratitis
Uveitis
Causes of keratitis
Trauma
Vitamin A deficieny
Chemical injury
Contact lenses
Infection
- bacterial
- fungal
- viral
- protozoal
Corenal dystrophy
Keratoconjunctivitis sicca (dry eye)
Presentation of corneal ulcer / keratitis
Severe eye pain
Epiphoria (watery eye)
Visual loss (more common in corneal abrasions)
Red eye
Foreign body sensation
Photophobia
Corneal oedema
+/- signs of anterior uveitis
- miosis
- aqueous flare (protein)
A PAINFUL, acute unilateral third nerve palsy should raise the immediate suspicison of what
PCA aneurysm
What is the saying for retrobulbar neuritis
The patient sees nothing and the doctor sees nothing
(the inflammation is behind the optic nerve head (i.e. retrobulbar) as opposed to optic neuritis, and therefore the optic nerve head or the optic disc appears normal)
Presentation of retrobulbar neuritis
Visual acuity reduced to a very variable degree
Relative afferent pupillary defect will be apparent during the “swinging flashlight test”
Colour vision reduced to a greater extent than might be predicted from visual acuity
Red desaturation
Visual field defects (typically a central scotoma) but defect can vary
What is red desaturation
When red looks more washed out to one eye than the other
Sensitive sign of optic nerve dysfunction
What can an episode of optic or retrobulbular neuritis contribute to a diagnosis of
MS
What is Holmes Adie pupil
Idopathic condition
Typically affects young women
Presents with an enlarged pupil that is poorly reactice to light and only sluggishly accomodates
Absent ankle jerks frequently assosiated
Consensual pupil reflex typically unaffected
What is parinaud syndrome
Lesion in the dorsal midbrainn
Causes a variety of signs
Mid dilated pupils
Upper lid retraction
Paralysis of upward gaze
Sight threatning causes of red eye
Acute glaucoma
Corneal laceration
Contact lens related ulcer
Corneal ulcer
Endopthalmitis (inflammation of vitroeus and aqueous fluids)
Intraocular foreign body
Trauma
Chemical injury
WHat is trichiasis
Eyelashes directed in towards the cornea
Conditions assosiated with anterior uveritis
UC
AS
HLA assosiation of anterior uveitis
HLA-B27
Presentation of anterior uveitis
Red
Painful
conjunctival injection
cells and flare in anterior chamber
photophobia
Ocular manifestations of marfans syndrome
Upward lens dislocation
Myopia
Keratoconus
Retinal detachment
Signs of optic nerve dysfunction
Reduced visual acuity
Loss of colour vision
Central scotoma
Optic disc swelling
Presentation of CRAO
Sudden, painless loss of vision
What does the retina look like in CRAO
Pale
Cherry red spot in the macula
Presentation of CRVO
Sudden, painless loss of vision
What does examination look like in CRVO
Swollen optic disc
Flame shaped haemorrhages
Dilated veins
Tortuoisty
Cotton wool spots
Fundoscopy of HTN retinopathy
Arteriolar narrowing
AV crossing
Nipping
Retinal flame haemorrhages and exudates
How does sight loss occur in diabetic retinopathy
Neovascularisation
- leading to tractional retinal detachment or glaucoma
Macular disease
Features of background retinopathy
Haemorrhages
Hard exudates
Microaneruysms
Features of pre proliferative DR
Cotton wool spots
Venous changes
IRMAs
Features of proliferative DR
Retinal neovascularisation either at the disc or elsewhere
Treatment for macular oedema
Focal laser therapy
Vascular endothelial growth factor (VEGF) via intravitreal injection
Treatment of proliferative DR
Pan retinal photocoagulation
Progression of DR
- Background
- Pre prolliferative
- Proliferative
- Maculopathy
Criteria for mild non proliferative (background) DR
at least one micro aneurysm
Screening criteria also includes exudates
Criteria for moderate non proliferative DR
Intra retinal haemorrhages
Micro aneurysms
Severe non proliferative retinopathy consists of
Intra retinal haemorrhages or microaneurysms in all 4 quadrants
Venous beading in 2 quadrants or more
IRMA in one quadrant
What way does the eye point in a 3rd nerve palsy
Down and out position
What does a ptosis and constricted pupil indicate
Horners syndrome
Diagnosis of holmes aiede pupil
Dilute pilocarpine eye drop test
Most modified risk factor for ARMD
Smoking
Treatment for exudative (wet) ARMD
Anti-VGEF
Treatment for non exudative (dry) ARMD
None
Changes in macular region seen on examination in MD
Drusen
RPE abnormalities (hyper/hpo pigementation)
Geographic atrophy
Neovascular exudate
Symptoms of macular degeneration
Visual distorsions
Painless loss of central vision
Central scotoma
Difficulty reading or seeing fine detail
Photopsia (flashes of light or floaters)
difficulty adjusting to dim light
visual hallucinations
Occular manifestations of sarcoidosis
posterior uveitis
optic nerve involvement
cataracts
glaucoma
venous occlusion
Treatment of anterior uveitis
Intensive prednisolone eye drop therapy
Occular manifestations of wilsons disease
Kayser fishcers rings
What causes a failure of eye abduction
Lateral rectus palsy / 6th CN palsy
What should asymmetric diabetic retinopathy raise a suspicion of
Ocular ischaemic syndrome (OIS) on the side affected worse
Investigation of OIS
Fluorescin angiography and carrotid doppler ultrasound
Method of action of dorzolamide drops (for glaucoma)
Carbonic anhydrase inhibitor
Drugs that cause acute closed angle glaucoma
TC antidepressants e.g. amitriptyline
Antihistamines
Anti PD agents
Antipsychotics
Sulphonamides
WHat does a IV CN palsy cause
Superior oblique muscle
- outward rotation and tosional element to diplpoia
Which is move severe, episcleritis or scleritis
Scleritis
What is retinitis pigmentosa and what causes it
Deteriorating night vision (hereditary)
Defects in rhodopsin
What does CMV retinitis look like
Vasculitis with haemorrhages
Brush fire appearance
Treatment of CMV retinitis
Oral valganciclovir
Eye conditioon assosiated with wernickes
Nystagmus
Opthalmoplegia (usually lateral rectus muscle)
How does vitreous haemorrhage commonly occur in diabetic patients
Bleeidng of fragile new vessels of the retina
Consistent with neovascularisation in proliferative diabetic retinopathy
Eye manifestation NF1
Lisch nodules
What are patients with ehler danlos syndrome more at risk of
Retinal detachment
Features on slit lamp examination of scleritis
Prominant vessels throughout sclera
Clear views of the retina
Features of retinis pigmentosa
Progressive loss of night vision
Followed by loss of acuity which begins peripherally
Complete loss of vision is uncommon
Inheritance of retinis pigmentosa
30-40% AD
50-60% AR
5-15% X linked
Fundoscopy changes of retinis pigmentosa
Dispersion and aggrevation of retinal pigment bilateralyl, which has the appearance of bony spicules
Presentation of orbital apex syndrome
optic neuropathy
proptosis
chemosis
horners syndrome
opthalmoplegia
involvement of the first branch of the trigeminal nerve
