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ICSM Year 6 > 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

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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/

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59
Q

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

A

Dry: 1-2 years
Wet: days to weeks

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60
Q

What is the relative prevalence of wet vs dry ARMD?

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

What is the aetiology of wet ARMD?

A

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

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62
Q

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

A

Amsler grid

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63
Q

How can wet ARMD be managed?

A

Photodynamic therapy
VEGF inhibitors

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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

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65
Q

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

A

Smoking cessation

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66
Q

How can dry ARMD be managed?

A

Antioxidant vitamins (ACE) and zinc

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67
Q

What is tobacco-alcohol ambylopia?

A

Toxic effects of cyanide radicals combined with thiamine deficiency (seen in patients with alcohol dependence syndrome who also smoke)

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68
Q

Recall 3 signs and symptoms of tobacco-alcohol ambylopia

A

Optic atrophy
Loss of red/green discrimination
Scomata

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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)

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70
Q

What IOP counts as ‘increased’?

A

>21mmHg

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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/

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72
Q

Recall 2 RFs for chronic open angle glaucoma

A

Myopia
FHx

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73
Q

What is the main symptom of chronic open angle glaucoma?

A

Peripheral vision loss

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74
Q

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

A

40 years old

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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)
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76
Q

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

A

Laser trabeculoplasty

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77
Q

What does annual eye screening involve for diabetic patients?

A

Fundus photography
Fluorescin staining

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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/

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79
Q

How should diabetic proliferative retinopathy be managed?

A

Pan-retinal photocoagulation

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80
Q

How should diabetic maculopathy be managed?

A

Focal retinal photocoagulation

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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

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82
Q

Describe the typical symptoms of cataracts

A

Dazzling bright lights, haloes, night vision loss

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83
Q

Recall some risk factors for cataracts

A

Age
Steroids
Diabetes
Smoking
Hypocalcaemia

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84
Q

How is the red reflex affected by cataracts?

A

It is darkened

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85
Q

How can cataracts be medically managed?

A

Mydriatic eye drops (tropicamide)

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86
Q

What is the most common complication of cataract surgery?

A

Posterior capsular opacification

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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

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88
Q

What are the signs and symptoms of retinitis pigmentosa?

A

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

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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/

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90
Q

What mutation is responsible for hereditary retinoblastoma?

A

RbP gene mutation (a TSG)

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91
Q

Recall 2 signs of retinoblastoma

A

Strabismus
Leukocoria

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

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92
Q

Recall the 2 causes of inflammatory eyelid swelling

A

Stye (hordeolum externum/internum)
Chalazion

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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 (mydriatic/cycloplegic) 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

143
Q

What is keratoconus?

A

A condition where the cornea gradually becomes cone-shaped due to wearing away or thinning of the top layer, preventing light from focussing properly and affecting visual acuity.

144
Q

Who is keratoconus typically seen in?

A

Young patients

145
Q

What are the treatment options for keratoconus?

A
  • Collagen cross linking
  • Specially-made contact lenses
  • Regular eye drops and eye care (no rubbing or itching of the eyes)
146
Q

What type of contact lenses are recommended for keratoconus patients and how long do they typically last?

A

Rigid gas-permeable (RGP) lenses

Usually 1-2 years

147
Q

What is a rare but serious complication of cataract surgery?

A

Post-operative endophthalmitis - inflammation and infection of the aqueous and/or vitreous humour

148
Q

What are the symptoms of endophthalmitis?

A
  • Red eye
  • Pain
  • Ocular discharge - can progress to a hypophon
  • Worsening vision
149
Q

What is the management of endophthalmitis?

A

Intravitreal or IV Abx

150
Q

What should be used to treat conjunctivitis in pregnant women?

A

Topical fusidic acid

151
Q

How should contact lenses be managed in acute conjunctivitis?

A

Remove during an acute infection and use eye glasses in meantime

152
Q

What is the Mx of primary open angle glaucoma?

A

360 degrees selective laser trabeculoplasty (once IOP < 24mmHg)

153
Q

A ‘shadow appearing peripherally and progressing centrally’ is characteristic of what condition?

A

Retinal detachment

154
Q

What are the features of wet ARMD?

A
  • Decreasing vision
  • Metamorphopsia (“seeing straight lines as wavy”)
  • Central scotoma
  • Neurovascular changes under the retina and macula
155
Q

What feature differentiates wet ARMD from dry ARMD?

A

Neurovascular changes under retina and macula

156
Q

How can you differentiate a 3rd nerve palsy from Horner’s syndrome?

A

Horner’s syndrome - CONSTRICTED pupil (miosis) + ptosis

CNIII palsy - DILATED pupil + ptosis

157
Q

What is the management of an organic foreign body in the eye?

A

Same day ophthalmology assessment

158
Q

Give some examples of VEGF inhibitors for the eye

A
  • Avastin
  • Eylea
159
Q

Is there a limit to the number of IO VEGF injections someone can have?

A

No

160
Q

How does vitreous attachment relate to age?

A

It can occur as a natural ageing process and can cause temporal visual changes if there are tensile forces where it is attached to the retina

161
Q

What is a common complication of cataract surgery?

A

Posterior capsular opacification

162
Q

What is the Mx of posterior capsular opacification?

A

May be asymptomatic but if affecting vision can refer for YAG laser, often giving immediate relief of symptoms

163
Q

What is Ozurdex?

A

An intra-ocular steroid injection which can given longer-term benefits than VEGF injections

164
Q

What is the downside of intra-ocular steroid injections?

A

Need to be used with care as steroids can increase the IOP as well as accelerate cataract formation so should be avoided in individuals with glaucoma or pre-existing cataracts

165
Q

What is OCTA used for?

A

OCT-angiography - used to look at the blood flow through the eye

166
Q

What would ‘capillary drop out’ on fluorescein scanning indicate?

A

Areas of ischaemia

167
Q

How is distance vision determined if too poor for a Snellen chart?

A

Start by moving patient closer to the chart (at 3m and 1m - written as 3/60 or 1/60)

Then using fingers (counting fingers - CF)

Then use hand movements (HM)

Then use perception of light (PL)

Then if none of that can be seen, this is characterised as total blindness

168
Q

What approach should you take to describing a retina?

A
  • Start with basic details - patient, background, R or L eye
  • Describe most obvious abnormality
  • Describe the disc - colour, shape, margin, cup:disc ratio
  • Describe the macula and fovea
  • Describe the vessels (tortuosity, neovascularisation)
169
Q

What is seen in this photo?

A

Exudates

170
Q

What is seen in this photo?

A

Haemorrhages

171
Q

What is seen in this photo?

A

Cotton wool spots

172
Q

What is seen in this photo?

A

Laser scars

173
Q

What is the management of a sub-conjunctival haemorrhage?

A

Reassurance
Can contact GP for BP monitoring if suspicious/worried

174
Q

What duration should chloramphenicol eye drops be used for?

A

4x a day for 5 days

175
Q

What population of patients are corneal ulcers commonly seen in?

A

Contact lens users

176
Q

What are the SSx of a corneal ulcer?

A
  • Foreign body sensation
  • Sharp pain
  • White corneal infiltrate
177
Q

What is the Mx of a corneal ulcer?

A

Moxifloxacin eye drops

178
Q

What would be seen on examination of the eye in acute closed angle glaucoma?

A
  • Injection++
  • Rock hard eye
  • Very high IOP (can go up to 60-70mmHg, normal is 11-21mmHg)
  • Fixed mid-dilated pupil
179
Q

What is the MoA of latanoprost?

A

Prostaglandin analogue (increases outflow of fluid)

180
Q

When should someone be referred for high IOP?

A

If they have 3 or more consecutive measurements of IOP>24mmHg

181
Q

What is a cotton wool spot?

A

An ischaemic nerve fibre caused by occlusion of retinal pre-capillary arterioles supplying the nerve fibre layer, resulting in micro infarcts

182
Q

When are cotton wool spots clinically important?

A

When there are > 5

183
Q

What blood vessels does vitreous haemorrhage occur in?

A

New, abnormal proliferative vessels (as a result of diabetic retinopathy)

184
Q

What are risk factors for retinal detachment?

A
  • Trauma
  • Short-sightedness
185
Q

What is the Mx of retinal detachment?

A

Small: laser
Large: surgery

186
Q

What are some causes of optic atrophy?

A
  • Optic nerve compression - SOL, aneurysm
  • MS
  • Glaucoma
  • Metabolic/toxic - B12 deficiency, alcohol, DM
  • Ischaemia
  • Friedreich’s ataxia
  • Secondary to retinitis pigments
187
Q

What is meant by anisocoria?

A

Unequal pupil size

188
Q

What is the fovea?

A

Cone-rich area of the retina (with 6/6 vision)

189
Q

What is the macula?

A

Area of avascular rim around the fovea

190
Q

What is an ectropion and entropion?

A

Ectoprion - eyelids everted outwards
Entropion - eyelids inverted

191
Q

How can the location of a lesion causing a Horner’s syndrome be partially deduced?

A

Horner’s syndrome - anhydrosis determines site of lesion:
- Head, arm, trunk = central lesion: stroke, syringomyelia
- Just face = pre-ganglionic lesion: Pancoast’s, cervical rib
- Absent = post-ganglionic lesion: carotid artery dissection

192
Q

What is an ocular manifestation of syphilis infection (and describe it)?

A

Argyll-Robertson pupil - typically associated with neurosyphilis (tertiary form of syphilis). In this condition, the pupils are small and irregular in shape. They accommodate (constrict when focusing on near objects) but do not react to direct light, a phenomenon known as ‘light-near dissociation’. This occurs due to damage to the pretectal nuclei in the midbrain that control pupillary light reflex.

193
Q

What are some SSx of orbital compartment syndrome?

A
  • Blood in the anterior chamber
  • Proptosis
  • Stiff eyelid
  • Relative afferent pupillary defect (RAPD)
194
Q

What is the immediate Mx of orbital compartment syndrome?

A

Immediate canthotomy (decompression)

195
Q

What are the main side effects of prostaglandin analogues and their MoA?

A

Reduce IOP

SEs include:
* Increased lash length
* Iris pigmentation
* Periocular pigmentation
* Hyperaemia

196
Q

Where is the defect in a superior quadrantanopia?

A

Inferior fibres of the posterior visual pathway that pass to the temporal lobe

197
Q

Where is the defect in a inferior quadrantanopia?

A

Superior fibres of the posterior visual pathway that pass to the parietal lobe

198
Q

Nasal fibres of the optic tract correspond to what part of the visual field?

A

Temporal area (peripheral)

199
Q

What is the pathophysiology of Horner’s syndrome?

A

There is a problem with the sympathetic innervation of the iris which is usually involved in dilation. As a result, there is un- parasympathetic innervation, resulting in constriction (miosis).

200
Q

What is meant by a Holmes Adie pupil?

A
  • Unilateral –> bilateral pupil dilation (unilateral in 80% cases)
  • No response to light
  • Slow/sluggish response to accomodation (tonic pupil)
201
Q

What is a Holmes Adie pupil typically caused by?

A

Usually viral or post-ganglionic nerve damage

202
Q

What is Holmes Adie syndrome?

A
  • Tonic pupil (no light response + slow accomodation)
  • Absent knee and ankle reflexes
  • Low BP
203
Q

What is an Argyll-Robertson pupil?

A
  • No response to light
  • Normal response to accomodation
  • Small pupil
204
Q

What can cause an Argyll-Robertson pupil?

A
  • Neurosyphilis
  • Diabetes (nerve damage, less common)
205
Q

What are the features of a CNIV palsy?

A
  • Head tilt to the contralateral side
  • Slightly raised eye on one side (due to unopposed upward muscle action)
206
Q

What is the most common cause of CNIV palsy?

A

Trauma

207
Q

What is a neurosurgical emergency to be aware of that can cause a 3rd nerve palsy?

A

Aneurysm of the posterior communicating artery

208
Q

What nerve palsy would likely develop first as a result of raised ICP?

A

6th nerve palsy

209
Q

What is another antibody that can be checked in suspected myasthenia gravis if they are negative for anti-ACh receptor Abs?

A

Anti-muscle specific kinase antibodies (present in 40-60% anti-ACh R Ab patients)

210
Q

How should episcleritis be managed?

A

Lubricant eye drops (sometimes steroid eye drops may be needed)

211
Q

Where would lymphadenopathy typically develop in gonococcal or chlamydial conjunctivitis?

A

Pre-auricular (compared to usually submandibular or sublingual in viral/bacterial conjuctivitis)

212
Q

At what age does lacrimation begin?

A

2 weeks old

213
Q

What HLA allele is reactive arthritis associated with?

A

HLA-B27

214
Q

What is a hyphema?

A

A collection of blood within the anterior chamber of the eye

215
Q

What bacteria is usually implicated in bacterial keratitis associated with contact lense use?

A

Pseudomonas

216
Q

If a bacterial keratitis fails to improve with Abx, what is the likely causative organism?

A

Acanthamoeba

217
Q

What bacteria is usually implicated in bacterial keratitis NOT associated with contact lense use?

A

Staph aureus (very rare)

218
Q

How is HSV keratitis (dendritic ulcer) treated?

A

Acyclovir 800mg (5x day)

7 days - immunocompetent
10 days - immunocompromised

219
Q

What drug class is important to determine whether a patient is on before a cataract surgery and why?

A

Alpha blockers (e.g. tamsulosin) as can increase the risk of intra-operative floppy iris syndrome

220
Q

What is an ophthalmological complication of Marfan syndrome?

A

Dislocation of the lens

221
Q

What are some differentials for leucocoria?

A
  • Retinoblastoma
  • Congenital cataract
  • Persistent foetal vasculature (hyaloid artery that should have been obliterated during embryology)
  • Retinopathy of premature
  • Toxocara infection
222
Q

What are some causes of congenital cataracts?

A
  • Marfan syndrome
  • Congenital toxoplasmosis/rubella/syphilis
  • Myotonic dystrophy
  • Trisomy 13/18/21
223
Q

How should a central retinal artery occlusion be managed?

A

If within thrombolysis window = as a stroke (thrombolysis)
If not = as a TIA with referral and antihypertensive Mx

224
Q

What would CMV retinitis look like on fundoscopy?

A
  • Areas of white retina
  • Swollen disc
  • May look somewhat similar to BRVO
225
Q

What is a gene that is associated with primary open angle glaucoma?

A

GLCA1

226
Q

What type of vision loss is usually seen in primary open angle glaucoma?

A

Arcuate (superior) scotoma field loss

227
Q

What is the Mx of primary open angle glaucoma?

A

1st line - latanoprost (prostaglandin analogue)
2nd line - timolol (beta blocker)
3rd line - acetazolamide (carbonic anhydrase inhibitor)

228
Q

What is the typical demographic for idiopathic intracranial hypertension?

A

Young female, high BMI

229
Q

What are the symptoms of idiopathic intracranial hypertension?

A
  • Headache worse in mornings (due to raised ICP, worse on lying down)
  • +/- visual symptoms (swollen discs)
  • LP pressure > 25mmHg
230
Q

What is the most effective disease modifying treatment of IIH?

A

Weight loss (other migraine Mx only treats symptoms, doesn’t change anything intrinsically)

231
Q

What is the Mx of a retrobulbar haemorrhage?

A

Emergency canthotomy cantholysis

ICSM Year 6 (21 decks)

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