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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
Q

How does a corneal ulcer/keratitis appear?

A

visible defect and white corneal opacity

Photo source: lhttps://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/

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26
Q

Why is corneal ulcer/keratitis an emergency?

A

It can cause scarring and vision loss

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27
Q

What is the cause of ophthalmic shingles?

A

CN VI reactivation of shingles

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28
Q

What is Huntchinson’s sign?

A

Nose-tip zoster (nasocilliary branch) –> ophthalmic involvement

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29
Q

How should ophthalmic shingles be managed?

A

Oral aciclovir +/- topical corticosteroids

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30
Q

Recall 2 possible complications of ophthalmic shingles?

A

Post-herpetic neuralgia
Ptosis

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31
Q

Which artery is involved in anterior ischaemic optic neuropathy?

A

Posterior ciliary artery

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32
Q

What is the cause of arteritic anterior ischaemic optic neuropathy?

A

Giant cell arteritis

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33
Q

What are the 4 main symptoms of optic neuritis?

A

CRAP
Central scomata
RAPD
Acuity loss
Pain on movement

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34
Q

What is the most common cause of optic neuritis?

A

Multiple sclerosis

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35
Q

How should optic neuritis be managed (immediately and ongoing)?

A

72 hours IV methylprednisolone
11 days prednisolone PO

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36
Q

Recall the signs and symptoms of vitreous haemorrhage

A

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/

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37
Q

What is the most common cause of vitreous haemorrhage?

A

Diabetes - causes angiogenesis

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38
Q

What is the best investigation for vitreous haemorrhage?

A

Brightness scan ultrasonography

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39
Q

How should small vitreous haemorrhages be managed?

A

They should resorb spontaneously

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40
Q

How should large vitreous haemorrhages be managed?

A

Vitrectomy

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41
Q

What is the aetiology of retinal detachment?

A

Holes in retina allow fluid to separate retina from the pigmented epithelium

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42
Q

What is the most common cause of retinal detachment?

A

Diabetes

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43
Q

Recall the 4 main signs and symptoms of retinal detachment

A

Floaters
Flashes
Field loss
Fall in acuity

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44
Q

Describe the appearance of the retina in retinal detachment

A

Grey, opalescent retina, ballooining forwards

Photo is of retinal detatchment secondary to horseshoe retinal tear - source: https://geekymedics.com/retinal-detachment/

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45
Q

On the other side of the card is a fundal photo of a central retinal vein occlusion for reference

A

Photo source: https://www.glycosmedia.com/education/diabetic-retinopathy/diabetic-retinopathy-features-of-diabetes-vitreous-haemorrhage/

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46
Q

On the other side of this card is a fundal photo of branch retinal vein occlusion for reference

A

Photo source: https://en.wikipedia.org/wiki/Branch_retinal_vein_occlusion

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47
Q

How should retinal detachment be managed?

A

Urgent vitrectomy and gas tamponade with laser coagulation

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48
Q

Differentiate the symptoms of central retinal vs branch retinal vs cilioretinal artery occlusion

A

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

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49
Q

Recall 3 things that must be done to investigate possible retinal artery occlusion

A
  1. CVS RF history
  2. Temporal artery biopsy
  3. ESR
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50
Q

Recall some ways of managing retinal artery occlusion

A

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

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51
Q

Recall three possible causes of retinal vein occlusion

A

DM
HTN
Glaucoma

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52
Q

How does the nature of vision loss in retinal vein occlusion indicate whether it is ischaemic or non-ischaemic in nature?

A

If it is sudden total vision loss = ischaemic
If it is subacute partial vision loss = non-ischaemic
If RAPD = ischaemic

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53
Q

What is the best investigation for imaging retinal vein occlusion?

A

Fluorescin angiography

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54
Q

How can retinal vein occlusion be managed?

A

Can only be managed actively if ischaemic cause
Mx = panretinal photocoagulation

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55
Q

What is the phrase ‘cherry red macula’ usually associated with?

A

Central retinal artery occlusion

Photo source: https://en.wikipedia.org/wiki/Cherry-red_spot

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56
Q

What is the most common cause of blindness in >60yo?

A

Age-related macular degeneration ARMD

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57
Q

What are the 2 types of age-related macular degeneration?

A

Wet and dry
Dry = geographic atrophy
Wet = subretinal neovascularisation

58
Q

What are drusen?

A

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
Q

What is the timeline of decline of vision in wet vs dry ARMD?

A

Dry: 1-2 years
Wet: days to weeks

60
Q

What is the relative prevalence of wet vs dry ARMD?

A 
Wet = 10% of ARMD 
Dry = 90% of ARMD
61
Q

What is the aetiology of wet ARMD?

A

Aberrant vascular growth into the retina from the choroid that leads to haemorrhage

62
Q

What test is used during eye examiation to identify macular degeneration?

A

Amsler grid

63
Q

How can wet ARMD be managed?

A

Photodynamic therapy
VEGF inhibitors

64
Q

How should ARMD be investigated?

A

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
Q

What lifestyle measure is most useful for slowing the progression of ARMD?

A

Smoking cessation

66
Q

How can dry ARMD be managed?

A

Antioxidant vitamins (ACE) and zinc

67
Q

What is tobacco-alcohol ambylopia?

A

Toxic effects of cyanide radicals combined with thiamine deficiency

68
Q

Recall 3 signs and symptoms of tobacco-alcohol ambylopia

A

Optic atrophy
Loss of red/green discrimination
Scomata

69
Q

Recall 5 drugs used to manage chronic glaucoma

A

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
Q

What IOP counts as ‘increased’?

A

>21mmHg

71
Q

Describe 2 features of the optic disc in chronic OA glaucoma?

A

Atrophy
Cupping

Photo source: https://www.glaucomaassociates.com/glaucoma/what-is-glaucoma/

72
Q

Recall 2 RFs for chronic open angle glaucoma

A

Myopia
FHx

73
Q

What is the main symptom of chronic open angle glaucoma?

A

Peripheral vision loss

74
Q

When does glaucoma screening begin for people with a strong family history of glaucoma?

A

40 years old

75
Q

What are the first and second line options for treating chronic open angle glaucoma?

A

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
Q

What is the surgical option for managing chronic open angle glaucoma?

A

Laser trabeculoplasty

77
Q

What does annual eye screening involve for diabetic patients?

A

Fundus photography
Fluorescin staining

78
Q

Recall the stages of diabetic retinopathy and their features on fundoscopy

A

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
Q

How should diabetic proliferative retinopathy be managed?

A

Pan-retinal photocoagulation

80
Q

How should diabetic maculopathy be managed?

A

Focal retinal photocoagulation

81
Q

Recall the types of hypertensive retinopathy and their features on fundoscopy

A

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
Q

Describe the typical symptoms of cataracts

A

Dazzling bright lights, haloes, night vision loss

83
Q

Recall some risk factors for cataracts

A

Age
Steroids
Diabetes
Smoking
Hypocalcaemia

84
Q

How is the red reflex affected by cataracts?

A

It is darkened

85
Q

How can cataracts be medically managed?

A

Mydriatic eye drops (tropicamide)

86
Q

What is the most common complication of cataract surgery?

A

Posterior capsular opacification

87
Q

What are the most common, best prognostic and worst prognostic inheritance pattern of retinitis pigmentosa (it has variable inheritance)?

A

Most common: AR
Best prognosis: AD
Worst prognosis: X-linked

88
Q

What are the signs and symptoms of retinitis pigmentosa?

A

Night-blindness, tunnel-vision, blindness by mid-30s

89
Q

Recall some fundoscopic findings in retinitis pigmentosa

A

Pale optic disc
Macula-sparing peripheral retinal pigmentation

Photo source: https://www.ncbi.nlm.nih.gov/books/NBK11553/figure/ch36clinicalerg.F12b/

90
Q

What mutation is responsible for hereditary retinoblastoma?

A

RbP gene mutation (a TSG)

91
Q

Recall 2 signs of retinoblastoma

A

Strabismus
Leukocoria

Photo source: https://www.aao.org/eye-health/diseases/what-is-retinoblastoma

92
Q

Recall the 2 causes of inflammatory eyelid swelling

A

Stye (hordeolum externum/internum)
Chalazion

93
Q

What is a stye?

A

Abscess in lash follicle

94
Q

What is a chalazion?

A

Abscess in Meibomian gland after a hordeolum internum

Photo source: https://my.clevelandclinic.org/health/diseases/17657-chalazion

95
Q

What is blepharitis?

A

Chronic eyelid inflammation

96
Q

Recall 2 causes of blepharitis

A

Seborrhoeic dermatitis
Staphylococcus

97
Q

What are the signs and symptoms of blepharitis?

A

Red gritty/itchy eyes with scales on the lashes

98
Q

How should blepharitis be managed?

A

Warm compresses, warm water cleanse BD and topical ABx (chloramphenicol)

99
Q

What is lagophthalmos?

A

Difficulty closing the eyelid over the globe leading to exposure keratitis

100
Q

Recall the signs and symptoms of orbital cellulitis

A

Inflammation of the orbit, lid swelling and pain on movement

101
Q

How do the symptoms of periorbital cellulitis differ from orbital cellulitis?

A

Periorbital cellulitis does not have pain on eye movement or systemic symptoms or vision loss

102
Q

How should you investigate suspected orbital cellulitis?

A

CT scan with contrast (orbits, sinuses and brain to assess for posterior spread

103
Q

How should orbital cellulitis be managed?

A

IV cefuroxime, urgent ophthalmology referral

104
Q

What would cause the following eye symptoms?:

  • engorgement of eye vessels
  • lid and conjunctival oedema
  • pulsatile exophthalmos
  • eye bruit
A

Carotid cavernous fistula

105
Q

What is the layterm for strabismus?

A

Squint

106
Q

What are the 2 forms of strabismus, and what is the difference between them?

A

Concomitant - imbalance of extraocular muscles
Paralytic - paralysis of extraocular muscles

107
Q

Describe the appearance of the eyes in CNIII vs IV vs VI palsy

A

CNIII: ptosis, fixed/dilated pupil, ‘down and out’
CNIV: diplopia going downwards
CNVI: diplopia in horizontal plane

108
Q

What are the 2 most common causes of CN III/IV/VI palsies?

A

DM
Trauma

109
Q

Recall 2 vascular causes of CNIII palsy

A

Cavernous sinus thrombosis
PCA aneurysm

110
Q

Recall 3 central causes of CNIV/VI palsy

A

MS
SOL
Vascular

111
Q

What is the most common type of strabismus in children?

A

Esotropia (towards the nose)

112
Q

Recall the ‘4 Os’ of strabismus management

A

Ophthalmological review
Optical (correct refractive errors)
Orthoptic (eye patch to the GOOD eye to prevent ambylopia)
Operations (rectus muscle resections)

113
Q

What is the possible serious complication of intra-ocular haemorrhage?

A

Acute closed angle glaucoma

(Large blood volume may restrict outflow)

114
Q

What is the aetiology of orbital blowout fracture?

A

Trauma –> increase in IOP –> orbital contents herniate into sinuses

115
Q

Recall 5 causes of floaters

A

Retinal detachment (one of the 4 Fs)
Vitrous haemorrhage
Diabetes
Old retinal branch occlusion
Syneresis (degenerative opacities in vitreous)

116
Q

Recall 3 causes of haloes in the vision

A

Cataracts
Corneal oedema
Acute glaucoma

117
Q

Which pathology typically caues jaggered haloes in the vision?

A

Migraine

118
Q

What pathology causes haloes with eye pain?

A

Acute glaucoma

119
Q

What are the 1st and 2nd line options for managing seasonal allergic conjunctivitis

A

1st line: topical antihistamine
2nd line: mast cell stabiliser eg cromoglycate

120
Q

What tropical eye diseases are spread by flies?

A

Trachoma (Chlamydia trachomitis)
Onchocerciasis (onchocerca volvulus)

121
Q

How is trachoma managed?

A

Tetracycyline

122
Q

How is onchocerciasis managed?

A

Ivermectin

123
Q

What is a sudden, painful loss of vision likely to be due to in a patient with a background of MS?

A

Optic neuritis - treat with methylprednisolone

124
Q

How should acute closed angle glaucoma be treated initially?

A

Refer to ophthalmologist

  • Pilocarpine eye drops stat
  • Timolol topical
  • Acetazolamide 500mg IV stat
  • Analgseia and anti-emetics
125
Q

What is the subsequent management of acute closed angle glaucoma once the immediate presentation has been managed?

A

Bilateral laser peripheral iridotomy once IOP has decreased

126
Q

What is the uvea?

A

Pigmented part of the eye and includes iris, ciliary body and choroid

Iris + ciliary body = anterior uvea

127
Q

How should anterior uveitis be managed?

A

Prednisolone and cyclopentolate drops

128
Q

How can episcleritis be managed?

A

Topical or systemic NSAIDs

129
Q

What is the main complication of scleritis to be aware of?

A

Scleromalacia (scleral thinning) leading to globe perforation

130
Q

What is the most likely viral cause of conjunctivitis?

A

Adenovirus

131
Q

What anti-histamine drops can be used to treat allergic conunctivitis?

A

Emedastine

132
Q

How should corneal abrasions be managed?

A

Give chloramphenicol ointment for infection prophylaxis

133
Q

Recall some differentials for sudden vision loss and how to differentiate between them

A

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
Q

What is the cause of non-arteritis anterior ischaemic optic neuropathy?

A

HTN/ DM/ hyperlipidaemia/ smoking

135
Q

In which field does vision loss begin in chronic open angle glacuoma?

A

Nasal superior

136
Q

How should a stye be treated?

A

Topical fusidic acid

137
Q

How should orbital cellulitis be managed?

A

IV cefuroxime

138
Q

What is the most likely pathogen in contact-lens associated conjunctivitis?

A

Pseudomonas

139
Q

Which type of glaucoma is associated with:

a) hypermetropia?
b) myopia?

A

Hypermetropia - risk factor for acute closed angle glaucoma

Myopia - risk factor for primary open angle glaucoma

140
Q

How is Herpes zoster ophthalmicus treated?

A

Urgent ophthalmological review and 7-10 days of oral antivirals

IV aciclovir reserved for severe infection and immunocompromised

141
Q

What are the 2 possible mechanisms of sight loss in proliferative diabetic retinopathy?

A
  • Vitreous haemorrhage
  • Retinal detachment
142
Q

What would be seen on fundoscopy on central retinal vein occlusion?

A

Severe retinal haemorrhages

ICSM Year 6 COPY Helen Lashwood (20 decks)

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