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ICSM Year 6 COPY Helen Lashwood > Medicine - Ophthalmology > Flashcards

Medicine - Ophthalmology Flashcards

1
Q

Recall the features of optic atrophy

A

Mnemonic: Optic Atrophy Can Reduce Sight
Optic disc pale
Acuity reduced
Colour vision reduced (especially red)
RAPD (relative afferent pupil defect)
Scomata centrally

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2
Q

What are the 2 most common causes of optic atrophy?

A

MS
Glaucoma

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3
Q

Recall 4 red flags when assessing red eyes

A

Photophobia
Poor vision
Fluorescein staining reveals foreign material
Abnormal pupil

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4
Q

Is photophobia more likely to be present in acute glaucoma or anterior uveitis?

A

Anterior uveitis

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5
Q

What are the typical signs and symptoms of acute closed angle glaucoma?

A

Reduced acuity
Nausea and Vomiting
Haloes around lights
Severe pain

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6
Q

What may be seen on examination in acute closed angle glaucoma?

A

Cloudy/red cornea
Fixed and dilated pupil

Photo source: https://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/acute-angle-closure.html

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7
Q

What are some risk factors for acute closed angle glaucoma?

A

Hypermetropia is the key one
Female
Family history
Old age

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8
Q

What sort of examination can examine fluid drainage from the eye?

A

Gonioscopy with slit lamp

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9
Q

What are the general principles of management of acute closed angle glaucoma?

A

Refer
Medicate
Laser peripheral iridiotomy
Lens extraction

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10
Q

What drugs can be used to treat acute closed angle glaucoma?

A

IV:
Carobonic anhydrase inhibitor (reduces aqueous formation)
Top:
Carobonic anhydrase inhibitor
Beta blocker (also reduces aqueous formation)
Alpha-2 agonist (miosis opens blockage)

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11
Q

How does anterior uveitis usually present?

A

Acute pain, photophobia, reduced acuity, hypopyon

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12
Q

How does the eye appear in anterior uveitis?

A

Irregular and small pupil, hypopyon

Photo source: https://www.researchgate.net/figure/Hypopyon-and-nasal-synechiae-in-the-left-eye-of-a-young-patient-suffering-from-acute_fig1_333459995

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13
Q

What is episcleritis?

A

Inflammation below the conjuctiva in the episcleral layer

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14
Q

How does episcleritis usually present?

A

Asymptomatic

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15
Q

What is scleritis and what conditions is it associated with?

A

Vasculitis of sclera:
Granulomatosis polyangiitis
Rheumatoid arthritis
Systemic Lupus Erythematous
Vasculitis

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16
Q

What is the main symptom of scleritis?

A

Severe pain worse on eye movement

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17
Q

What can be seen on examination in scleritis and how can it be differentiated from episcleritis?

A

Conjunctival oedema
Scleritis much more diffuse than episcleritis
If you add phenylephrine drops the sclera goes white in episcleritis but stays red in scleritis

photo source: https://www.msdmanuals.com/professional/eye-disorders/conjunctival-and-scleral-disorders/scleritis

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18
Q

How should you manage scleritis as a junior dr?

A 
Urgent referral (\<24 hours) 
Cortisosteroids/ immunosuppressants
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19
Q

How can viral vs bacterial vs allergic conjunctivitis be differentiated by appearance?

A

Viral: waterey and unilateral
Bacterial: sticky and unilateral
Allergic: pruritic, bilateral

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20
Q

Why do contact-lens wearers need urgent referral if they get conjunctivitis?

A

Difficult to distinguish between cojunctivitis and microbial keratitis which requires prompt treatment

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21
Q

How does the management of viral vs bacterial vs allergic conjunctivitis differ?

A

Viral: nil
Bacterial: chloramphenicol drops
Allergic: antihistamine drops

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22
Q

What classifies as a “corneal abrasion”?

A

Epithelial breech without keratitis

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23
Q

How can corneal abrasion be investigated?

A

Fluorescein stains the defect green

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24
Q

How can corneal abrasion be managed?

A

You just use antibiotic infection prophylaxis (chloramphenicol ointment)

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25
How does a corneal ulcer/keratitis appear?
visible defect and white corneal opacity Photo source: lhttps://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/
26
Why is corneal ulcer/keratitis an emergency?
It can cause scarring and vision loss
27
What is the cause of ophthalmic shingles?
CN VI reactivation of shingles
28
What is Huntchinson's sign?
Nose-tip zoster (nasocilliary branch) --\> ophthalmic involvement
29
How should ophthalmic shingles be managed?
Oral aciclovir +/- topical corticosteroids
30
Recall 2 possible complications of ophthalmic shingles?
Post-herpetic neuralgia Ptosis
31
Which artery is involved in anterior ischaemic optic neuropathy?
Posterior ciliary artery
32
What is the cause of arteritic anterior ischaemic optic neuropathy?
Giant cell arteritis
33
What are the 4 main symptoms of optic neuritis?
CRAP Central scomata RAPD Acuity loss Pain on movement
34
What is the most common cause of optic neuritis?
Multiple sclerosis
35
How should optic neuritis be managed (immediately and ongoing)?
72 hours IV methylprednisolone 11 days prednisolone PO
36
Recall the signs and symptoms of vitreous haemorrhage
Small bleeds --\> small black dots in vision and ring floaters Large bleeds --\> loss of red reflex, retina not visualised Fundal photo source: https://www.glycosmedia.com/education/diabetic-retinopathy/diabetic-retinopathy-features-of-diabetes-vitreous-haemorrhage/
37
What is the most common cause of vitreous haemorrhage?
Diabetes - causes angiogenesis
38
What is the best investigation for vitreous haemorrhage?
Brightness scan ultrasonography
39
How should small vitreous haemorrhages be managed?
They should resorb spontaneously
40
How should large vitreous haemorrhages be managed?
Vitrectomy
41
What is the aetiology of retinal detachment?
Holes in retina allow fluid to separate retina from the pigmented epithelium
42
What is the most common cause of retinal detachment?
Diabetes
43
Recall the 4 main signs and symptoms of retinal detachment
Floaters Flashes Field loss Fall in acuity
44
Describe the appearance of the retina in retinal detachment
Grey, opalescent retina, ballooining forwards Photo is of retinal detatchment secondary to horseshoe retinal tear - source: https://geekymedics.com/retinal-detachment/
45
On the other side of the card is a fundal photo of a central retinal vein occlusion for reference
Photo source: https://www.glycosmedia.com/education/diabetic-retinopathy/diabetic-retinopathy-features-of-diabetes-vitreous-haemorrhage/
46
On the other side of this card is a fundal photo of branch retinal vein occlusion for reference
Photo source: https://en.wikipedia.org/wiki/Branch\_retinal\_vein\_occlusion
47
How should retinal detachment be managed?
Urgent vitrectomy and gas tamponade with laser coagulation
48
Differentiate the symptoms of central retinal vs branch retinal vs cilioretinal artery occlusion
Central RAO: sudden painless total loss of vision + RAPD Branch RAO: sudden painless partial loss of vision with NO RAPD Ciliretinal AO: painless central vision loss
49
Recall 3 things that must be done to investigate possible retinal artery occlusion
1. CVS RF history 2. Temporal artery biopsy 3. ESR
50
Recall some ways of managing retinal artery occlusion
First thing to do is an eyeball massage (?!) Then options include: - Carbogen therapy (inhalation of 95% O2 and 5% CO2) - Haemodilution - Vasodilators - Measures to decrease IOP
51
Recall three possible causes of retinal vein occlusion
DM HTN Glaucoma
52
How does the nature of vision loss in retinal vein occlusion indicate whether it is ischaemic or non-ischaemic in nature?
If it is sudden total vision loss = ischaemic If it is subacute partial vision loss = non-ischaemic If RAPD = ischaemic
53
What is the best investigation for imaging retinal vein occlusion?
Fluorescin angiography
54
How can retinal vein occlusion be managed?
Can only be managed actively if ischaemic cause Mx = panretinal photocoagulation
55
What is the phrase 'cherry red macula' usually associated with?
Central retinal artery occlusion Photo source: https://en.wikipedia.org/wiki/Cherry-red\_spot
56
What is the most common cause of blindness in \>60yo?
Age-related macular degeneration ARMD
57
What are the 2 types of age-related macular degeneration?
Wet and dry Dry = geographic atrophy Wet = subretinal neovascularisation
58
What are drusen?
White fluffy spots around macula caused by fat deposits under retina Seen in dry ARMD Photo source: https://morancore.utah.edu/basic-ophthalmology-review/wet-versus-dry-macular-degenerative-changes/
59
What is the timeline of decline of vision in wet vs dry ARMD?
Dry: 1-2 years Wet: days to weeks
60
What is the relative prevalence of wet vs dry ARMD?
``` Wet = 10% of ARMD Dry = 90% of ARMD ```
61
What is the aetiology of wet ARMD?
Aberrant vascular growth into the retina from the choroid that leads to haemorrhage
62
What test is used during eye examiation to identify macular degeneration?
Amsler grid
63
How can wet ARMD be managed?
Photodynamic therapy VEGF inhibitors
64
How should ARMD be investigated?
Urgent referral to ophthalmology 1st = slit lamp microscopy to identify pigmentory, haemorrhage, exudative changes If wet ARMD --\> fluorescin angiography as this detects abnormal neovascularisation All pts should get a high-res image of retina = Optical Coherence Tomography
65
What lifestyle measure is most useful for slowing the progression of ARMD?
Smoking cessation
66
How can dry ARMD be managed?
Antioxidant vitamins (ACE) and zinc
67
What is tobacco-alcohol ambylopia?
Toxic effects of cyanide radicals combined with thiamine deficiency
68
Recall 3 signs and symptoms of tobacco-alcohol ambylopia
Optic atrophy Loss of red/green discrimination Scomata
69
Recall 5 drugs used to manage chronic glaucoma
Those that reduce aqueous production = ABC Alpha 2 antagonists Beta blockers Carbonic anhydrase inhibitors Those that Increase uveoscleral outflow: Prostaglandin analogues Pilocarpine (2nd line)
70
What IOP counts as 'increased'?
\>21mmHg
71
Describe 2 features of the optic disc in chronic OA glaucoma?
Atrophy Cupping Photo source: https://www.glaucomaassociates.com/glaucoma/what-is-glaucoma/
72
Recall 2 RFs for chronic open angle glaucoma
Myopia FHx
73
What is the main symptom of chronic open angle glaucoma?
Peripheral vision loss
74
When does glaucoma screening begin for people with a strong family history of glaucoma?
40 years old
75
What are the first and second line options for treating chronic open angle glaucoma?
First line: one, then the other, then both: - timolol/ betaxolol - Latanoprost Second line: - Brimonidine tartrate (alpha-2 antagonist) - acetazolamide (carbonic anhydrase inhibitor) - pilocarpine (topical miotic)
76
What is the surgical option for managing chronic open angle glaucoma?
Laser trabeculoplasty
77
What does annual eye screening involve for diabetic patients?
Fundus photography Fluorescin staining
78
Recall the stages of diabetic retinopathy and their features on fundoscopy
Background: hard Exudates, Microaneurysms and blot Haemorrhages (it's the lowkey one so it's MEH) Pre-proliferative: cotton wool spots and soft exudate Proliferative: angiogenesis Maculopathy: hard exudates near the macula Photo source: https://www.ophthalytics.com/our-technology/diabetic-retinopathy/
79
How should diabetic proliferative retinopathy be managed?
Pan-retinal photocoagulation
80
How should diabetic maculopathy be managed?
Focal retinal photocoagulation
81
Recall the types of hypertensive retinopathy and their features on fundoscopy
Grade 1: silver wiring and arteriole tortuosity Grade 2: AV-nipping Grade 3: flame haemorrhages and cotton wool exudates Grade 4: papilloedema Photo source: https://www.sciencedirect.com/science/article/pii/S093336571730427X
82
Describe the typical symptoms of cataracts
Dazzling bright lights, haloes, night vision loss
83
Recall some risk factors for cataracts
Age Steroids Diabetes Smoking Hypocalcaemia
84
How is the red reflex affected by cataracts?
It is darkened
85
How can cataracts be medically managed?
Mydriatic eye drops (tropicamide)
86
What is the most common complication of cataract surgery?
Posterior capsular opacification
87
What are the most common, best prognostic and worst prognostic inheritance pattern of retinitis pigmentosa (it has variable inheritance)?
Most common: AR Best prognosis: AD Worst prognosis: X-linked
88
What are the signs and symptoms of retinitis pigmentosa?
Night-blindness, tunnel-vision, blindness by mid-30s
89
Recall some fundoscopic findings in retinitis pigmentosa
Pale optic disc Macula-sparing peripheral retinal pigmentation Photo source: https://www.ncbi.nlm.nih.gov/books/NBK11553/figure/ch36clinicalerg.F12b/
90
What mutation is responsible for hereditary retinoblastoma?
RbP gene mutation (a TSG)
91
Recall 2 signs of retinoblastoma
Strabismus Leukocoria Photo source: https://www.aao.org/eye-health/diseases/what-is-retinoblastoma
92
Recall the 2 causes of inflammatory eyelid swelling
Stye (hordeolum externum/internum) Chalazion
93
What is a stye?
Abscess in lash follicle
94
What is a chalazion?
Abscess in Meibomian gland after a hordeolum internum Photo source: https://my.clevelandclinic.org/health/diseases/17657-chalazion
95
What is blepharitis?
Chronic eyelid inflammation
96
Recall 2 causes of blepharitis
Seborrhoeic dermatitis Staphylococcus
97
What are the signs and symptoms of blepharitis?
Red gritty/itchy eyes with scales on the lashes
98
How should blepharitis be managed?
Warm compresses, warm water cleanse BD and topical ABx (chloramphenicol)
99
What is lagophthalmos?
Difficulty closing the eyelid over the globe leading to exposure keratitis
100
Recall the signs and symptoms of orbital cellulitis
Inflammation of the orbit, lid swelling and pain on movement
101
How do the symptoms of periorbital cellulitis differ from orbital cellulitis?
Periorbital cellulitis does not have pain on eye movement or systemic symptoms or vision loss
102
How should you investigate suspected orbital cellulitis?
CT scan with contrast (orbits, sinuses and brain to assess for posterior spread
103
How should orbital cellulitis be managed?
IV cefuroxime, urgent ophthalmology referral
104
What would cause the following eye symptoms?: - engorgement of eye vessels - lid and conjunctival oedema - pulsatile exophthalmos - eye bruit
Carotid cavernous fistula
105
What is the layterm for strabismus?
Squint
106
What are the 2 forms of strabismus, and what is the difference between them?
Concomitant - imbalance of extraocular muscles Paralytic - paralysis of extraocular muscles
107
Describe the appearance of the eyes in CNIII vs IV vs VI palsy
CNIII: ptosis, fixed/dilated pupil, 'down and out' CNIV: diplopia going downwards CNVI: diplopia in horizontal plane
108
What are the 2 most common causes of CN III/IV/VI palsies?
DM Trauma
109
Recall 2 vascular causes of CNIII palsy
Cavernous sinus thrombosis PCA aneurysm
110
Recall 3 central causes of CNIV/VI palsy
MS SOL Vascular
111
What is the most common type of strabismus in children?
Esotropia (towards the nose)
112
Recall the '4 Os' of strabismus management
Ophthalmological review Optical (correct refractive errors) Orthoptic (eye patch to the GOOD eye to prevent ambylopia) Operations (rectus muscle resections)
113
What is the possible serious complication of intra-ocular haemorrhage?
Acute closed angle glaucoma | (Large blood volume may restrict outflow)
114
What is the aetiology of orbital blowout fracture?
Trauma --\> increase in IOP --\> orbital contents herniate into sinuses
115
Recall 5 causes of floaters
Retinal detachment (one of the 4 Fs) Vitrous haemorrhage Diabetes Old retinal branch occlusion Syneresis (degenerative opacities in vitreous)
116
Recall 3 causes of haloes in the vision
Cataracts Corneal oedema Acute glaucoma
117
Which pathology typically caues jaggered haloes in the vision?
Migraine
118
What pathology causes haloes with eye pain?
Acute glaucoma
119
What are the 1st and 2nd line options for managing seasonal allergic conjunctivitis
1st line: topical antihistamine 2nd line: mast cell stabiliser eg cromoglycate
120
What tropical eye diseases are spread by flies?
Trachoma (Chlamydia trachomitis) Onchocerciasis (onchocerca volvulus)
121
How is trachoma managed?
Tetracycyline
122
How is onchocerciasis managed?
Ivermectin
123
What is a sudden, painful loss of vision likely to be due to in a patient with a background of MS?
Optic neuritis - treat with methylprednisolone
124
How should acute closed angle glaucoma be treated initially?
Refer to ophthalmologist * Pilocarpine eye drops stat * Timolol topical * Acetazolamide 500mg **IV** stat * Analgseia and anti-emetics
125
What is the subsequent management of acute closed angle glaucoma once the immediate presentation has been managed?
Bilateral laser peripheral iridotomy once IOP has decreased
126
What is the uvea?
Pigmented part of the eye and includes iris, ciliary body and choroid Iris + ciliary body = anterior uvea
127
How should anterior uveitis be managed?
Prednisolone and cyclopentolate drops
128
How can episcleritis be managed?
Topical or systemic NSAIDs
129
What is the main complication of scleritis to be aware of?
Scleromalacia (scleral thinning) leading to **globe perforation**
130
What is the most likely viral cause of conjunctivitis?
Adenovirus
131
What anti-histamine drops can be used to treat allergic conunctivitis?
Emedastine
132
How should corneal abrasions be managed?
Give chloramphenicol ointment for infection prophylaxis
133
Recall some differentials for sudden vision loss and how to differentiate between them
HELLP: Headache-associated = GCA Eye movements are painful = optic neuritis Lights/ flashes prceding = detatched retina Like a curtain descending = TIA/GCA Poorly-controlled DM = vitreous bleed from new vessels
134
What is the cause of *non*-arteritis anterior ischaemic optic neuropathy?
HTN/ DM/ hyperlipidaemia/ smoking
135
In which field does vision loss begin in chronic open angle glacuoma?
Nasal superior
136
How should a stye be treated?
Topical fusidic acid
137
How should orbital cellulitis be managed?
IV cefuroxime
138
What is the most likely pathogen in contact-lens associated conjunctivitis?
Pseudomonas
139
Which type of glaucoma is associated with: a) hypermetropia? b) myopia?
Hypermetropia - risk factor for acute closed angle glaucoma Myopia - risk factor for primary open angle glaucoma
140
How is Herpes zoster ophthalmicus treated?
Urgent ophthalmological review and 7-10 days of **oral** antivirals IV aciclovir reserved for severe infection and immunocompromised
141
What are the 2 possible mechanisms of sight loss in proliferative diabetic retinopathy?
* Vitreous haemorrhage * Retinal detachment
142
What would be seen on fundoscopy on central retinal vein occlusion?
Severe retinal haemorrhages

ICSM Year 6 COPY Helen Lashwood (20 decks)

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