MRCP Opthalmology Flashcards
Earliest sign of diabetic retinopathy
microaneurysm
- in fundoscopy or fluorescein angiography
Uveitis
- bilateral
- blurring vision
- light sensitive
- painful
sarcoidosis
Mx:
topical steroid
mydriasis
conjunctivitis
- itchy and gritty
- watery discharge
- diffuse redness of eyes
- painless
no visual change
episcleritis
- bilateral
- inflamed eye
- minimal pain
- intact vision
scleritis
- bilateral
- PAINFUL
- photophobia
- tearing
- reduced visual acuity
Optic neuritis
reduced visual acuity
loss of colour vision
central scotoma
optic disc swelling
painful eye movement
central retinal artery occlusion
cherry red spot in macula
- sudden
- painless loss of vision
central retinal vein occlusion
diabetic, HTN, smoker
- sudden
- painless loss of vision
retinal detachment seen in…. needs surgical repair
EDS
CMV retinitis seen in…. and treatment is….
HIV
valganciclovir
GCA is associated with… which needs urgent…
arteritis ischaemic optic neuritis
corticosteroids
Eye features found in neurofibromatosis 1 is called…
lisch nodules
Treatment for acute anterior uveitis… and is associated with…
prednisolone drops
ulcerative colitis
Surgical 3rd nerve palsy present as…. and typically due to… which is at risk of…
- down and out, dilated pupil
- posterior communicating artery aneurysm
- SAH
Eye pathology associated with Marfan’s disease
lens dislocation
retinal detachment
Homocysturia vs marfan’s in lens dislocation
Homo - downward detachment
Marfan - upward detachment
Kayser fleischer rings
Wilson’s- copper
Corneal arcus
hyperlipidaemia
Anterior uveitis presents with
painful
red
photophobic eye
Hypopyon is… associated with…
collection of white blood cells in the front part of the eye
- anterior uveitis
Hyphema is…
a medical emergency
due to bleeding in front part of eye
secondary to trauma
Why are pupil dilatation avoided in hypema
prevent second bleed
Management of increases IOP due to hypema
IV carbonic anhydrase (azetazolamide)
increase drainage
Management for neuromyelitis optica
autoimmune spinal and eye inflammation
IV methylprednisolone 1g OD for 5-7 days
pseudoxanthoma elasticum is manifested by….. presenting with….
calcification of elastic fibres in the eye skin and heart.
loose skin folds and puckering = plucked chicken appearance
angioid streaks with bands radiating in spoke like.
Age related macular degeneration
bilateral change
risk factors:
- smoking
- age >75
- family history
Two types of macular degeneration are:
dry (90%)
- atrophic
- drunsen yellow spots in bruch’s membrane
wet (10%)
- exudate/neovascular
- choroidal neovascular
- leaking serous fluid –> visual loss
Mx: VEGF, photocoagulation
Anti-VEGF is effective in ….
WET age related macular degeneration
Painful reduced visual acuity with pale optic disc
optic neuritis- MS
Vestibulo ocular response is…. and seen in…
doll’s eye movement
supranuclear gaze palsy (PSP)
RAPD with unilateral painful visual loss
optic neuritis
Central retinal vein occlusion (CRVO)
unlilateral
sudden painless loss of acuity
stormy sunset haemorrhage
difference between CRAO and CRVO
artery- ischaemia, pale retina, cherry red spot NO haemorrhage
vein- stomry sunset haemorrhage
both- painless sudden loss of vision UNILATERAL
5 Glaucoma medications
prostaglanding analogue (lantanoprost)
- increase uveoscleral outlflow
beta blocker (timolol)
- reduce aqueous production
sympathomimetics (brimonidine)
- reduce production and increase outflow
carbonic anhydrase (dorzolamide)
- reduce production
miotics (polocarpine)
- increase uveoscleral outlflow
Sarcoidosis eye involvement
BILATERAL posterior uveitis
Temporal biopsy finding in GCA
giant cell infiltrate
Age adjusted ESR for GCA
female: age+10/2
male: age/2
Rods and cones
Cone (cone opsin)- light adaptation, central
Rod (Rhodopsin)-dark adaptation, peripheral
What is defective in inherited retinitis pigmentosa
rhodopsin
deteriorated night and peripheral vision
Altitude visual defect is…
loss of vision in upper and lower half of visual field
What is central scotoma
loss of central vision
CMV vasculitis fundoscopy appearance
vasculitis with haemorrgage
Acute angle glaucoma presents as…
painful eye
loss of visual acuity
pupillary dilatation
Investigation for acute angle glaucoma
tonometry- IOP
gonioscopy- slit lamp for angle
Medication that may trigger acute angle glaucoma
TCA
Antihistamine
Anti parkinsonain
Antipsychotic
Sulphonamide
Treatment for acute angle glaucoma
acetazolamide
beta blocker eye drop
pilocarpine
alpha adrenergic eye drop
Proliferative diabetic retinopathy
fragile new blood vessels into vitreous
prone to bleed causing vitreous haemorrhage
Vitreous haemorrhage
painless loss of vision
Marfans
autosomal dominant
fibrillin 1 gene
chromosome 15
extopia lentis means lens dislocation
Homocysturia vs marfans
both lens dislocation
homocysturia- learning disability
3rd nerve palsy
eye is deviated ‘down and out’
ptosis
pupil may be dilated (sometimes called a ‘surgical’ third nerve palsy)
medical 3rd nerve palsy- pupil sparing
Holmes adie pupil
enlarged pupil
poor reaction to light
sluggish accommodation
absent ankle jerk
Immune reconstitution uveitis
HIV recovery of CD4
causing reduced vision and discomfott in eye
Abnormal VEP
Optic neuritis
- delayed VEP due to prolonged velocity of action potentials
Band keratopathy is deposition of… in the…. as a result of…
calcium
bowman layer of cornea
hypercalcaemia (PTH to be checked)
6th nerve palsy
LR6
eye medially deviated
microvascular disease risk
resolve in 6-12 weeks
What diabetic retinopathy warrants urgent referral to opthalmologist
new vessel in disc
risk of vitreous haemorrhage and visual loss
surgical 3rd nerve palsy should raise suspicion of…
posterior communicating artery aneurysm
painful, 3rd nerve palsy, dilated pupils
Anterior ischaemic optic neuropathy fundoscopy
swollen optic disc with haemorrhages
flashing or floaters
retinal detachment
Ocular ischaemic syndrome (OIS)
gradual visual loss
amaurosis fugax (transient monocular blindness)
RAPD
neovascular iris
Diabetic retinopathy non proliferative
ABCDE A4 B2
aneurysm
beading
cotton wool
dot haemorrhage
exudate
anurysm in 4 quadrant
beading in 2 quadrant
Fundoscopy finding that puts risk of proliferative retinopathy
anurysm in 4 quadrant
beading in 2 quadrant
Mild non profilerature (background) diabetic retinopathy
1 microaneurysm
Moderate non profilerature (background) diabetic retinopathy
intra-retinal microaneurysm
Risk factors for CRVO
SLE
HTN
Branch retinal vein occlusion vs CRVO
branch- same signs as CRVO but not in all 4 quadrants of retina
Radiation optic neuropathy presents similar to…. and occur within…
optic neuritis but painless
1.5 years after radiation
gradual
Keratitis
inflamed cornea
- red eye
- painful
- photophobia
- gritty
Thyroid eye disease
proptosis
optic neuropathy- rare but need IV steroids!
Optic neuropathy presents with
loss of colour vision
reduced acuity
Keratitis due to…
infected contact lens
Wernicke’s encephalopathy eye sign
nystagmus
opthalmoplegia due to lateral rectus palsy
Why does pupil dilate
parasympathetic nerve damage
Paralysed upward gaze
PSP
4th nerve palsy
diplopia is torsional
- superior oblique depress eye and rotate inwards
- lesion in this nerve cause outward rotation of eye
Urgent neuroimaging for 3rd nerve palsy with…
pupil involvement
Features of neurofibromatosis
SODNO
Skeletal
Ocular
Dermatological
Neurological
Other
Lisch nodules (golden) in iris
NF-1
- lisch nodule
- axillary frexkles
- cafe au lait
Ash leaf spots
tuberous sclerosis
Ectopia lentis
dislocation of lens
Von hippel disease
H - Haemangiomas - cerebellar/retina/spinal cord
I - increased risk of clear cell renal cell cancer
P - pheochromocytoma
P - pancreatic cyst
E - Endolymphatic sac tumours
L - liver cyst, kidney cyst, epidydmal cyst
3 words in the syndrome - CHR 3
Medical cause of 3rd nerve palsy
diabetes
Subconjunctival haemorrhage (blood shot eye)
hypertension
resolves in 2 weeks
BP check
Trichiasis
inward direction of eyelash
Contact lens related ulcer
medical emergency!
Anterior uveitis
cells in anterior chamber (keratic precipitates, fibrin, syncechiae, hypopyon)
Horner’s syndrome
ptosis
miosis (fixed contricted)
anhidrosis (loss of sweat)
NO 3rd nerve palsy
