Medical Opthalmology Flashcards by Annie Caldwell

Risk factors for infective keratitis

Poor contact lens hygeine
Swimming / showering in lenses
Sleeping in lenses

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Does a corneal abrasion cause an infiltrate?

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What is keratitis

Inflammation of the cornea

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What is a hypopynon

Accumulation of white blood cells in the anterior chamber

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Most common causes of hypopynon

Infective keratitis
Uveitis

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Causes of keratitis

Trauma
Vitamin A deficieny
Chemical injury
Contact lenses
Infection
- bacterial
- fungal
- viral
- protozoal
Corenal dystrophy
Keratoconjunctivitis sicca (dry eye)

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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)

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A PAINFUL, acute unilateral third nerve palsy should raise the immediate suspicison of what

PCA aneurysm

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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)

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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

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What is red desaturation

When red looks more washed out to one eye than the other
Sensitive sign of optic nerve dysfunction

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What can an episode of optic or retrobulbular neuritis contribute to a diagnosis of

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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

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What is parinaud syndrome

Lesion in the dorsal midbrainn
Causes a variety of signs
Mid dilated pupils
Upper lid retraction
Paralysis of upward gaze

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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

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WHat is trichiasis

Eyelashes directed in towards the cornea

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Conditions assosiated with anterior uveritis

UC
AS

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HLA assosiation of anterior uveitis

HLA-B27

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Presentation of anterior uveitis

Red
Painful
conjunctival injection
cells and flare in anterior chamber
photophobia

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Ocular manifestations of marfans syndrome

Upward lens dislocation
Myopia
Keratoconus
Retinal detachment

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Signs of optic nerve dysfunction

Reduced visual acuity
Loss of colour vision
Central scotoma
Optic disc swelling

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Presentation of CRAO

Sudden, painless loss of vision

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What does the retina look like in CRAO

Pale
Cherry red spot in the macula

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Presentation of CRVO

Sudden, painless loss of vision

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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

1. Background 2. Pre prolliferative 3. Proliferative 4. 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