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YR6 Rotations > Medicine - Ophthalmology > Flashcards

Medicine - Ophthalmology Flashcards

1
Q

Esotropia

A

Form of strabismus
1 eye deviates towards the nose

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2
Q

Strabismus

A

eye misalignment caused by imbalance in muscles holding the eye

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3
Q

Myopia

A

Near-sightedness
Light focuses in front of retina
Eye too long

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4
Q

Hyperopia/ Hypermetropia

A

Far-sightedness
Light focuses (theoretically) beyond retina
Eye too short

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5
Q

Presybopia

A

Age related loss of reading vision
Diminishing flexibility of lens

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6
Q

Emmetropia

A

No refractive error or visual defects

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7
Q

Amblyopia

A

“Lazy eye”
vision development disorder in which an eye fails to achieve normal visual acuity, even with prescription glasses or contact lenses

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8
Q

Metamorphopsia

A

Straight lines appear wavy

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9
Q

Astigmatism

A

Cornea or crystalline lens of the eye (or both) are not the ideal spherical ‘football’ shape, but more like the pointed end of a rugby ball.
Eye focuses light at 2 separate points on the retina, which blurs + distorts vision.

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10
Q

Where is the macula? What is it responsible for?

A

Central part of retina
Sharp, detailed vision
Depression/ pit = Fovea: greatest VA

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11
Q

Give differentials for sudden painless visual loss

A

Vitreous haemorrhage
Retinal detachment
Retinal migraine
Central retinal vein occlusion
Central retinal artery occlusion
Non-arteritic ischaemic optic neuropathy

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12
Q

Give differentials for painful visual loss

A
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13
Q

How can you tell which eye is being examined on fundoscopy pictures?

A

Optic disc usually on nasal side of patient

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14
Q

Give the 4 features of Horner’s syndrome

A

Miosis (constricted)
Ptosis
Enopthalmos (sunken eye/ narrow palpebral aperture)
Anhidrosis (loss of sweating 1 side)

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15
Q

What feature distinguishes congenital Horner’s syndrome from other causes?

A

Heterochromia: difference in iris colour

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16
Q

Which causes of Horner’s syndrome cause anhidrosis of the face, arm and trunk?

A

Central lesions
Stroke
Syringomyelia
MS
Tumour
Encephalitis

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17
Q

Which causes of Horner’s syndrome cause anhidrosis of the face?

A

Pre-ganglionic lesions
Pancoast’s Tumour
Thyroidectomy
Trauma
Cervical rib

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18
Q

Which causes of Horner’s syndrome DONT cause anhidrosis?

A

Post-ganglionic lesions
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

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19
Q

Give signs and symptoms caused by Pancoast tumours

A

Ipsilateral invasion of sympathetic cervical plexus causes:
Horner’s syndrome
Shoulder + arm pain (brachial plexus invasion)
Hoarseness (pressing on recurrent laryngeal nerve)

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20
Q

3 features of an Adie pupil

A

Tonically dilated pupil
Slowly reactive to light with more definite accommodation response

Commonly seen in females accompanied by absent knee/ ankle jerks

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21
Q

What causes an Adie pupil?

A

Damage to parasympathetic innervation of eye due to viral/ bacterial infection

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22
Q

What is characteristic of a Marcus-Gunn pupil?

A

RAPD seen in swinging light test
Pupils constrict less + therefore appear to dilate when light is swung from unaffected to affected side

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23
Q

What are the most common causes of a Marcus-Gunn pupil?

A

Damage to optic nerve
Severe retinal disease

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24
Q

What is Hutchinson’s pupil?

A

Unilaterally dilated pupil, unresponsive to light

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25
Q

What does Hutchinson’s pupil result from?

A

Compression of occulomotor nerve of same side by intracranial mass e.g. tumour, haematoma

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26
Q

What are Argyll-Robertson pupils?

A

Bilaterally small irregular pupils that accommodate but don’t react to bright light

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27
Q

Give 2 causes of Argyll-Robertson pupils

A

Neurosyphilis
Diabetes mellitus

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28
Q

What mneumonic can be used to remember the features of Argyll-Robertson pupils?

A

Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

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29
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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30
Q

What are the 2 most common causes of optic atrophy?

A

MS
Glaucoma

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31
Q

Recall 4 red flags when assessing red eyes

A

Photophobia
Poor vision
Fluorescein staining reveals foreign material
Abnormal pupil

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32
Q

Give 5 signs/ symptoms of corneal foreign body

A

Eye pain
FB sensation
Photophobia
Watering eye
Red eye

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33
Q

Give 6 indications for referral to ophthalmology with corneal FB

A

Penetrating eye injury due to high velocity/ sharp objects

Significant orbital/ peri-ocular trauma

Chemical injury (irrigate for 20-30 mins before referring)

FB composed of organic material e.g. soil, seeds (higher infection risk)

FB in or near centre of cornea

Any red flags e.g. severe pain, irregular, dilated or non reactive pupils, significant reduction in visual acuity

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34
Q

List 7 causes of blurred vision

A

Refractive error: most common
Cataracts
Retinal detachment
ARMD
AACG
Optic neuritis
Amaurosis fugax

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35
Q

What can be used to determine whether blurred vision is due to refractive error?

A

Pinhole occluder
If blurring improves with pinhole occluder then likely cause is a refractive error
Refer to optician

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36
Q

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

A

Anterior uveitis

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37
Q

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

A

Reduced acuity
N+V
Haloes around lights
Severe pain

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38
Q

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

A

Cloudy/ red cornea
Fixed + mid-dilated pupil

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39
Q

What are some risk factors for acute closed angle glaucoma?

A

Hypermetropia (key one)
Female
FH
Old age

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40
Q

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

A

Gonioscopy with slit lamp

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41
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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42
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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43
Q

How does anterior uveitis usually present?

A

Acute pain
Photophobia
Reduced acuity
Hypopyon

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44
Q

How does the eye appear in anterior uveitis?

A

Irregular, small pupil
Hypopyon

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45
Q

What is episcleritis?

A

Inflammation below the conjuctiva in the episcleral layer

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46
Q

How does episcleritis usually present?

A

Asymptomatic

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47
Q

What is scleritis?

A

Full-thickness inflammation of sclera
usually non-infective cause

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48
Q

What conditions is scleritis associated with?

A

Rheumatoid arthritis (most commonly)
Systemic Lupus Erythematous
Granulomatosis polyangiitis
Sarcoidosis

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49
Q

Give 5 signs and symptoms of scleritis

A

Red eye
Painful + worse on eye movement
Watering
Photophobia
Gradual decrease in vision

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50
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

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51
Q

Describe management of scleritis

A 
Urgent referral + assessment by opthalmologist(\<24 h) 
NSAIDs PO
Cortisosteroids PO for severe presentations
Immunosuppressants for resistant cases
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52
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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53
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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54
Q

Which cause of keratitis is associated with contact lens use in the sea/ swimming pools?

A

Acathamoeba keratitis

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55
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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56
Q

What classifies as a “corneal abrasion”?

A

Epithelial breech without keratitis

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57
Q

How can corneal abrasion be investigated?

A

Fluorescein stains the defect green

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58
Q

How can corneal abrasion be managed?

A

You just use antibiotic infection prophylaxis (chloramphenicol ointment)

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59
Q

How does a corneal ulcer/keratitis appear?

A

visible defect + white corneal opacity

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60
Q

Why is corneal ulcer/keratitis an emergency?

A

It can cause scarring and vision loss

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61
Q

What is the cause of ophthalmic shingles?

A

CN VI reactivation of shingles

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62
Q

What is Huntchinson’s sign?

A

Herpes zoster opthalmicus vesicles extending to tip of nose
Indicates nasociliary involvement
Strongly a/w ocular involvement in shingles (anterior uveitis)

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63
Q

How should ophthalmic shingles be managed?

A

Aciclovir/ Famciclovir PO 7-10d
+/- topical corticosteroids for inflammation
Urgent opthalmology review if ocular involvement

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64
Q

Recall 2 possible complications of ophthalmic shingles?

A

Post-herpetic neuralgia
Ptosis
Ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis

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65
Q

Which artery is involved in anterior ischaemic optic neuropathy?

A

Posterior ciliary artery

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66
Q

What is the cause of arteritic anterior ischaemic optic neuropathy?

A

Giant cell arteritis

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67
Q

What are the 4 main symptoms of optic neuritis?

A

CRAP DR
Central scomata
RAPD
Acuity loss (unilateral over hours-days)
Pain worse on movement

DR (RD: red desaturation- poor discrimination of colours)

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68
Q

List 3 causes of optic neuritis

A

Multiple sclerosis (most common)
Diabetes
Syphilis

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69
Q

What investigation should be performed for suspected optic neuritis?

A

MRI brain + orbits with gadolinium contrast

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70
Q

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

A

72h Methylprednisolone IV
11d Prednisolone PO
Recovery 4-6w

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71
Q

What is the prognosis for optic neuritis?

A

MRI: if > 3 white-matter lesions, 5y risk of developing MS is ~50%

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72
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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73
Q

What are 5 risk factors for vitreous haemorrhage?

A

Diabetes - causes angiogenesis (most common)
Trauma
Anticoagulants e.g. Warfarin
Coagulation disorders
Severe short sightedness

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74
Q

What is the best investigation for vitreous haemorrhage?

A

Brightness scan ultrasonography

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75
Q

How should small vitreous haemorrhages be managed?

A

They should resorb spontaneously

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76
Q

How should large vitreous haemorrhages be managed?

A

Vitrectomy

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77
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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78
Q

What is the most common cause of retinal detachment?

A

Diabetes
due to breaks in the retina due to traction by the vitreous humour
tears may proceed to detachment if left untreated

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79
Q

List 5 RFs for retinal detachment

A

DM
Myopia
Age
Previous surgery for cataracts (accelerates posterior vitreous detachment)
Eye trauma e.g. boxing

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80
Q

Recall 5 signs and symptoms of retinal detachment

A

FLOATERS: pigment cells entering vitreous space

FLASHES: traction on retina

FIELD LOSS: curtain/ shadow progressing to centre from periphery

FALL in ACUITY: if macula involved

RAPD: if optic nerve involved

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81
Q

Describe the appearance of the retina on fundoscopy in retinal detachment

A

Loss of red reflex
Retinal folds: pale, opaque, wrinkled
May appear normal if break is small

Photo: retinal detatchment secondary to horseshoe retinal tear

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82
Q

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

A
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83
Q

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

A
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84
Q

How should retinal detachment be managed?

A

Uregent referal to opthalmologist assessment with slit lamp + indirect opthalmoscopy for pigment cells + vitreous haemorrhage

Urgent vitrectomy + gas tamponade with laser coagulation

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85
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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86
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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87
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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88
Q

Recall 5 RFs for central retinal vein occlusion

A

Age
HTN
Cardiovascular disease
Glaucoma
Polycythaemia

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89
Q

What happens in central retinal vein occlusion?

A

As vein becomes blocked excess fluid + blood leak into retina + appear as severe haemorrhages (“cheese + tomato pizza appearance”)

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90
Q

What is the main feature of central retinal vein occlusion? Give 2 signs seen on fundoscopy

A

Sudden, painless reduction/ loss of visual acuity, usually unilaterally

Fundoscopy:
Widespread hyperaemia
Severe retinal haemorrhages- ‘stormy sunset’

91
Q

Name a differential to central retinal vein occlusion

A

Branch retinal vein occlusion (BRVO)
Occurs when a vein in distal retinal venous system is occluded + is thought to occur due to blockage of retinal veins at arteriovenous crossings.
Results in a more limited area of fundus being affected.

92
Q

Describe management of central retinal vein occlusion

A

Majority managed conservatively

93
Q

Give 2 indications for treatment in central retinal vein occlusion. What treatment is used?

A

Macula oedema: intravitreal anti-VEGF agents

Retinal neovascularisation: Laser photocoagulation

94
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

95
Q

What is the best investigation for imaging retinal vein occlusion?

A

Fluorescin angiography

96
Q

How can retinal vein occlusion be managed?

A

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

97
Q

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

A

Central retinal artery occlusion

98
Q

What causes Central retinal artery occlusion?

A

Thromboembolism (from atherosclerosis)
Arteritis (GCA)

99
Q

Give 2 S/S Central retinal artery occlusion

A

Sudden painless unilateral visual loss
RAPD

100
Q

What is the management for Central retinal artery occlusion?

A

Mx difficult + prognosis poor

Identify + treat underlying conditions e.g. IV steroids for GCA

If patient presents acutely intraarterial thrombolysis may be attempted (mixed evidence)

101
Q

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

A

Age-related macular degeneration (ARMD)

102
Q

What is age related macula degeneration characterised by?

A

Degeneration of retinal photoreceptors that results in formation of Drusen

103
Q

Give 3 key risk factors for age related macular degeneration

A

Age (greatest RF)
Smoking
FH

104
Q

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

A

Wet and dry
Dry = geographic atrophy
Wet = subretinal neovascularisation

105
Q

What characterises dry macular degeneration?

A

DRUSEN
Yellow round spots in Bruch’s membrane

106
Q

What are drusen?

A

White fluffy spots around macula caused by fat deposits under retina
Seen in dry ARMD

107
Q

What characterises wet macular degeneration?

A

Choroidal neovascularisation
Leakage of serous fluid + blood can subsequently result in rapid loss of vision
Carries worst prognosis

108
Q

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

A

Dry: 1-2y
Wet: days to weeks

109
Q

What is the relative prevalence of wet vs dry ARMD?

A 
Wet = 10% of ARMD 
Dry = 90% of ARMD
110
Q

What is each form of macular degeneration also known as?

A

Dry: Atrophic
Wet: Exudative/ neovascular

111
Q

What is the aetiology of wet ARMD?

A

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

112
Q

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

A

Amsler grid

113
Q

How can wet ARMD be managed?

A

Photodynamic therapy
VEGF inhibitors

114
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

115
Q

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

A

Smoking cessation

116
Q

How can dry ARMD be managed?

A

Antioxidant vitamins (ACE) and zinc

117
Q

What is tobacco-alcohol ambylopia?

A

Toxic effects of cyanide radicals combined with thiamine deficiency

118
Q

Recall 3 signs and symptoms of tobacco-alcohol ambylopia

A

Optic atrophy
Loss of red/green discrimination
Scomata

119
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)

120
Q

What IOP counts as ‘increased’?

121
Q

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

A

Atrophy
Cupping

122
Q

Recall 7 RFs for primary open angle glaucoma

A

Myopia
FH
Age
Afro-Carribean
HTN
DM
Steroids

123
Q

What is the main symptom of chronic open angle glaucoma? Give 2 other features

A

Peripheral visual field loss: nasal scotomas progressing to ‘tunnel vision’

Decreased visual acuity
Optic disc cupping

124
Q

Does IOP need to be raised to diagnose glaucoma?

A

No
Can have normal tension glaucoma

125
Q

List 4 signs on fundoscopy in primary open angle glaucoma

A

Optic disc CUPPING: cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen + deepen

Optic disc PALLOR: indicating optic atrophy

BAYONETTING of vessels: vessels have breaks as they disappear into the deep cup + re-appear at the base

Additional features: Cup notching (usually inferior where vessels enter disc), Disc haemorrhages

126
Q

How is primary open angle glaucoma diagnosed?

A

Case finding + provisional dx done by an optometrist
Referral to ophthalmologist via GP
Final dx confirmed with Ix

127
Q

What investigations are performed for primary open angle glaucoma?

A

Automated perimetry to assess visual field

Slit lamp exam with pupil dilatation: assess optic nerve + fundus for baseline

Applanation tonometry to measure IOP

Central corneal thickness measurement

Gonioscopy: assess peripheral anterior chamber configuration + depth

Assess risk of future visual impairment, using RFs such as IOP, central corneal thickness (CCT), FH, life expectancy

128
Q

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

A

40y
Annual screening
Early stages asymptomatic

129
Q

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

A

1st line: one, then the other, then both:
- Prostaglandin analogue: Latanoprost
- B-blockers: Timolol/ Betaxolol

2nd line:
- Sympathomimetic: Brimonidine tartrate (alpha-2 antagonist)
- Carbonic anhydrase inhibitor: Acetazolamide, Dorzolamide
- Miotic: Pilocarpine (TOP)

130
Q

What is the MOA of Latanoprost in POAG? How is it prescribed? Name 2 side effects

A

Prostaglandin analogue
Increases outflow of aqueous humour
OD
SE: Brown pigmentation of iris + increased eyelash length

131
Q

What is the MOA of B-blockers in POAG? In which patients should these be avoided?

A

Reduces aqueous humour production
Avoid in asthmatics + heart block

132
Q

What is the MOA of sympathomimetics in POAG? In which patients should these be avoided? Name 1 adverse effect

A

Reduces aqueous production + increases outflow
Avoid if taking MAOI or TCAs
SE: hyperaemia

133
Q

What is the MOA of carbonic anhydrase inhibitors in POAG? In which patients should these be avoided?

A

Reduces aqueous production
Systemic absorption causes sulphonamide-like reactions

134
Q

What is the MOA of miotics in POAG? Name 3 side effects?

A

Increase uveoscleral outflow
SE: constricted pupil, headache + blurred vision

135
Q

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

A

Laser trabeculoplasty

136
Q

What does annual eye screening involve for diabetic patients?

A

Fundus photography
Fluorescin staining

137
Q

Recall the stages of diabetic retinopathy and their features on fundoscopy

A

Background: hard Exudates, Microaneurysms + blot Haemorrhages (it’s the lowkey one so it’s MEH)

Pre-proliferative: cotton wool spots + soft exudate

Proliferative: angiogenesis

Diabetic maculopathy: hard changes + background changes on macula

138
Q

What do cotton wool spots in diabetic retinopathy represent?

A

areas of retinal infarction

139
Q

How should diabetic proliferative retinopathy be managed?

A

Pan-retinal photocoagulation

140
Q

What is diabetic maculopathy?

A

Progressive vision loss (most common cause of vision loss in diabetics)
Any structural abnormality due to diabetes affecting macula
Often preceded by diabetic retinopathy

141
Q

How should diabetic maculopathy be managed?

A

Focal retinal photocoagulation

142
Q

Recall the types of hypertensive retinopathy and their features on fundoscopy

A

Grade 1: silver wiring + arteriole tortuosity
Grade 2: AV-nipping
Grade 3: flame haemorrhages + cotton wool exudates
Grade 4: papilloedema

143
Q

Describe the features of hypertensive retinopathy seen here

A

Cotton-wool spots (widespread white-ish areas resulting from ischaemia)

Retinal haemorrhages (red blotches around the centre of image)

A ‘macular star’ composed of intraretinal lipid exudates (the radial, sunburst pattern of white streaks around the macular)

Optic nerve head is swollen, which is the feature that separates grade 3 + grade 4 hypertensive retinopathy

144
Q

List 6 features of papilloedema on fundoscopy

A

Venous engorgement (usually 1st sign)
Loss of/ abnormal venous pulsation
Blurring of optic disc margin
Elevation of optic disc
Loss of optic cup
Paton’s lines: concentric/ radial lines cascading from optic disc

145
Q

List 5 causes of papilloedema

A

Space occupying lesion: neoplastic, vascular
Malignant HTN
Idiopathic intracranial hypertension
Hydrocephalus
Hypercapnia

146
Q

Describe the classification of cataracts

A

Nuclear
Cortical
Subcapsular
Dot opacities

147
Q

Describe Nuclear cataracts

A

Primarily involves nucleus of lens
Central opacification + discolouration interferes with visual function
Common in old age

148
Q

Describe cortical cataracts

A

primarily opacification of cortex of lens.
Can be central or peripheral, + spoke-like or nummular in appearance.

149
Q

Describe sub-capsular cataracts

A

develops in subcapsular cortex.
Anterior or posterior.

150
Q

What are posterior sub-capsular cataracts associated with?

A

Drug related e.g. topical corticosteroids
Metabolic cataracts

151
Q

What are anterior sub-capsular cataracts associated with?

A

Blunt trauma injuries

152
Q

Describe the typical symptoms of cataracts

A

Glare + sensitivity to light
Haloes
Reduced acuity
Faded colour vision esp. blue
Night vision loss

153
Q

Recall some risk factors for cataracts

A

Age
Steroids
Diabetes
Smoking
Hypocalcaemia

154
Q

How is the red reflex affected by cataracts?

A

It is darkened

155
Q

How can cataracts be medically managed?

A

Mydriatic eye drops (tropicamide)

156
Q

What is the most common complication of cataract surgery?

A

Posterior capsular opacification

157
Q

Name a serious but rare complication of cataract surgery. What is it caused by? List 5 S/S

A

Endopthalmitis
Inflammation of aqueous +/ or vitreous humour

Caused by peri-operative introduciton of organisms

S/S: Retinal periphlebitis, pain, red eye, discharge + worsening vision

158
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

159
Q

What are the signs and symptoms of retinitis pigmentosa?

A

Night-blindness
Tunnel-vision
Blindness by mid-30s

160
Q

Recall some fundoscopic findings in retinitis pigmentosa

A

Pale optic disc
Macula-sparing peripheral retinal pigmentation

161
Q

What mutation is responsible for hereditary retinoblastoma?

A

RbP gene mutation (a TSG)

162
Q

Recall 2 signs of retinoblastoma

A

Strabismus
Leukocoria

163
Q

Recall the 2 causes of inflammatory eyelid swelling

A

Stye (hordeolum externum/internum)
Chalazion

164
Q

What is a stye?

A

Abscess in lash follicle

165
Q

What is a chalazion?

A

Abscess in Meibomian gland after a hordeolum internum

166
Q

What is blepharitis?

A

Chronic eyelid inflammation

167
Q

Recall 2 causes of blepharitis

A

Seborrhoeic dermatitis
Staphylococcus

168
Q

What are the signs and symptoms of blepharitis?

A

Red gritty/ itchy eyes with scales on the lashes
Eyes sticky in morning
Usually bilateral

169
Q

How should blepharitis be managed?

A

Hot compresses BD
“Lid hygiene”: mechanical removal of debris from lid margins with cotton bud diffed in cooled boiled water + baby shampoo
Artificial tears for Sx relief if dry eyes

170
Q

What is lagophthalmos?

A

Difficulty closing the eyelid over the globe leading to exposure keratitis

171
Q

Recall 7 signs and symptoms of orbital cellulitis

A

Redness + swelling around eye
Severe ocular pain
Visual disturbance
Proptosis
Opthalmoplegia or pain on movement
Eyelid oedema + ptosis
Drowsiness, N+V if meningeal involvement (rare)

172
Q

What is preseptal cellulitis aka?

A

Periorbital cellulitis

173
Q

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

A

Periorbital cellulitis does NOT have:
Reduced visual acuity
Proptosis
Opthalmoplegia or pain on eye movement Systemic Sx

174
Q

How should you investigate suspected orbital cellulitis?

A

CT w/ contrast: orbits, sinuses + brain to assess for posterior spread
FBC: raised WCC + inflammatory markers
Blood culture + swab to determine organism

175
Q

How should orbital cellulitis be managed?

A

IV cefuroxime
Urgent ophthalmology referral

176
Q

What would cause the following eye symptoms?:

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

Carotid cavernous fistula

177
Q

What is the layterm for strabismus? What is this?

A

Squint
misalignment of the visual axes

178
Q

How can squint be classified?

A

to nose: esotropia
temporally: exotropia
superiorly: hypertropia
inferiorly: hypotropia

179
Q

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

A

Concomitant: imbalance of extraocular muscles (common)
Paralytic: paralysis of extraocular muscles (rare)

180
Q

What tests can be used to detect strabismus?

A

Corneal light reflection test: hold light 30cm from child’s face to see if light reflects symmetrically on the pupils

Cover test: cover 1 eye, observe movement of uncovered eye. Repeat with other eye.

181
Q

How is strabismus managed? What does uncorrected strabismus lead to?

A

Refer to secondary care: Eye patches
Amblyopia

182
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

183
Q

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

184
Q

Recall 2 vascular causes of CNIII palsy

A

Cavernous sinus thrombosis
PCA aneurysm

185
Q

Recall 3 central causes of CNIV/VI palsy

A

MS
SOL
Vascular

186
Q

What is the most common type of strabismus in children?

A

Esotropia (towards the nose)

187
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)

188
Q

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

A

Acute closed angle glaucoma

(Large blood volume may restrict outflow)

189
Q

What is the aetiology of orbital blowout fracture?

A

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

190
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)

191
Q

Recall 3 causes of haloes in the vision

A

Cataracts
Corneal oedema
Acute glaucoma

192
Q

Which pathology typically caues jaggered haloes in the vision?

193
Q

What pathology causes haloes with eye pain?

A

Acute glaucoma

194
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

195
Q

What tropical eye diseases are spread by flies?

A

Trachoma (Chlamydia trachomitis)
Onchocerciasis (onchocerca volvulus)

196
Q

How is trachoma managed?

A

Tetracycyline

197
Q

How is onchocerciasis managed?

A

Ivermectin

198
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

199
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
200
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

201
Q

What is the uvea?

A

Pigmented part of the eye
inc. iris, ciliary body + choroid

Iris + ciliary body = anterior uvea

202
Q

How should anterior uveitis be managed?

A

Prednisolone and cyclopentolate drops

203
Q

How can episcleritis be managed?

A

Topical or systemic NSAIDs

204
Q

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

A

Scleromalacia (scleral thinning) leading to globe perforation

205
Q

List 6 complications of scleritis

A

Perforation of the globe
Glaucoma
Cataracts
Raised IOP
Retinal detachment
Uveitis

206
Q

What is the most likely viral cause of conjunctivitis?

A

Adenovirus

207
Q

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

A

Emedastine

208
Q

How should corneal abrasions be managed?

A

Chloramphenicol ointment for infection prophylaxis

209
Q

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

A

HELLP:

Headache-associated = GCA

Eye movements painful = optic neuritis

Lights/ flashes prceding = detatched retina

Like a curtain descending = TIA/GCA

Poorly-controlled DM = vitreous bleed from new vessels

210
Q

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

A

HTN
DM
Hyperlipidaemia
Smoking

211
Q

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

A

Nasal superior

212
Q

How should a stye be treated?

A

Topical fusidic acid

213
Q

How should orbital cellulitis be managed?

A

IV cefuroxime

214
Q

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

A

Pseudomonas

215
Q

Which type of glaucoma is associated with:

a) hypermetropia?
b) myopia?

A

Hypermetropia - acute closed angle glaucoma

Myopia - primary open angle glaucoma

216
Q

How is Herpes zoster ophthalmicus treated?

A

Urgent ophthalmological review

7-10 days of oral antivirals

IV aciclovir reserved for severe infection and immunocompromised

217
Q

How does herpes simplex keratitis most commonly present?

A

Dendritic corneal ulcer

218
Q

Give 5 signs/ symptoms of herpes simplex keratitis

A

Red painful eye
Photophobia
Epiphora
Decreased visual acuity
Fluorescein staining shows epithelial ulcer

219
Q

Describe management of herpes simplex keratitis

A

Urgent referral to opthalmologist
Aciclovir TOP

220
Q

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

A
  • Vitreous haemorrhage
  • Retinal detachment
221
Q

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

A

Severe retinal haemorrhages

222
Q

What is the most common cause of abnormal tearing in infants and children?

A

Nasolacrimal duct obstruction
Causes intermittent tearing, occasional redness of conjunctiva

223
Q

Give 2 characteristics of posterior vitreous detachment

A

Flashes of light (photopsia) in peripheral field of vision

Floaters often on temporal side of central vision

YR6 Rotations (22 decks)

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