Neuro & Opthal - Ophthalmology Flashcards
Role of blinking
Spreads a thick film of tears across the eyes and replenishes moisture
Disorders of tear film
Low quantity of tears
Poor quality tears
Disturbance of blink reflex
Increased evaporation through exposure
Causes of low quantity of tears
Age
Eye surgery
Damage to tear gland
Cause of poor quality tears
Blepharitis
When might you see disturbance of blink reflex
After surgery
Causes of increased tear evaporation through exposure
Post-surgery
VII palsy
Thyroid eye disease
Poor obicularis tone (ageing/ VII palsy)
What does exposure in the eye cause
Drying of ocular surface
Sx of exposure
Irritation
Stinging
Burning
Red, sticky eye in morning
Complications of exposure
Microbial keratitis
Loss of vision
Lagophtalmos
Incomplete eye lid closure
What is chalaza often associated w/
Blepharitis
How may chalzion px initially
Diffuse, swelling ‘stye’
Mx of chalazioon
Often resolves spontaneously
Hot lid massage and incision & curettage
Lid hygiene for underying blepharitis
Main cause of lid malposition
Lid laxity/ ageing
Other causes incl congenital, spastic, cicatricial
Entropion
Eyelid rolls inward
Sx of eyelid malposition - entropion
Irritation
Watering
Grittiness
Stickiness
Recurrent infections
Entropion mx
Usually conservative
Lubricants
Taping lower eyelid
Botox
Surgery - definitive
Why would botox be given as mx of entropion
Combat blepharism - lasts 3/12
Possible surgery for entropion
Everting sutures
Lid tightening
Ectropion
Eyelid rolls outwards from ocular surface
Causes of ectropion
Lid laxity/ ageing
Paralytic - VII nerve palsy
Cicatricial
Sx of ectropion
Watering
Red appearance to eyes
Discharge
Blurred vision
If exposure - stinging and pain
Tx of ectropion
Lubrication
Surgery
What is ptosis
Malposition of upper eyelid
Sign and NOT a dx
Hx for ptosis
Recent or gradual onset (sudden onset requires referral)
Associated sx - diplopia, variability (day to day), visual loss
Eye hx
Fhx
Systemic disease - neurology, myasthenia
Examination and ix for ptosis
Lid heights and variability
Lid movements
Ocular surface dryness
Obicularis tone and function
Risk of exposure?
Extraocular motility
Pupil reactions
VA
Why is VA important to test for in children w/ ptosis
Amblyopia is a risk
Congenital causes of ptosis
Dystrophic muscle
Acquired causes of ptosis
Aponeurotic/ senile
Traumatic
Neurogenic
Myogenic
Mechanical
Treating aponeurotic ptosis
Levator advancement
Dermatochalasis
Excess skin in upper eyelid, causing eyelid to be pushed down
Features of malignant lid lesions
Recent onset
Rapid growth
Bleeding
Pigmented
Examination findings of malignant lid lesions
Ill-defined borders
Loss of lashes
Destruction of lid architecture
Bleeding
Ulceration
Diplopia
Examples of benign lid lesions
Chalazion
Cyst of Moll
Cyst of Zeiss
Papilloma
Xanthelasma
Examples of pre-malignant lid lesions
Keratoacanthoma
Solar keratosis
Lentigo maligna
Examples of malignant lid lesions
BCC- nodular, infiltrative
SCC
Merkel cell Ca
Risk factors for orbital extension from neglected BCC
Previous RT
Previous surgery for BCC
Elderly
Mental health problem e.g. dementia
Disorders of lacrimal system
Dacrocystitis
Dacryoadenitis
Nasolacrimal duct obstruction
Dacryoadenitis
Infl of lacrimal gland
Settles on conservative mx w/ anti-infl
Sx of lacrimal gland swelling
Dry eyes
Reduced vision
Swollen upper lids
S shaped deformity in upper lid
Mx of lacrimal gland swelling
Conservative mx
If not, lacrimal gland debulking
Dacrocystitis
Abscess in lacrimal sac
Hx of dacrocystitis
Watery eye
Recent onset
Painful swelling in medial canthal area
Ddx of dacryocystitis
Lacrimal sac mass/ tumour - will have blood-stained tears
Mx of dacryocystitis
Oral abx
Drain
DCR surgery
Bypass nasolacrimal duct obstruction
Sx of orbital disease
Diplopia
Swelling around the eye
Bulging, prominent eye
Ache behind the eye
Pain on eye movements
Awareness of a ‘lump’
Signs of orbital disease
Restricted eye movement
Swelling around the eye
Proptosis
Lid retraction
Reduced vision
Reduced colour vision
Pupil abnormalities
What is proptosis
Eye swelling within orbit
Bulging eyes, pushed forward
May be bilateral
Causes of proptosis
Usually, thyroid eye disease
Primary orbital tumour - lymphoma, glioma
Metastasis - breast, prostate
Sx of proptosis
Double vision
Reduced vision if compressing optic nerve
Exposure can result if eye cannot close
Swelling of which muscles can lead to esotropia
Medial & inferior rectus
Signs requiring urgent opthal referral
Exposure of the eye - refer urgently
Double vision and ptosis
Reduced vision
Rapidly suspicious eye lid lesion
Proptosis
Swelling in lacrimal gland or sac area
Entropion
What does the orbit contain
Eyeball and associated structures
Extrinsic and intrinsic muscles of the eye
Fat and periorbital fascia
Which CNs pass through or supply structures in the orbit
II, III, IV, V and VI
Is the optic nerve found anteriorly or posteriorly
Posteriorly
How many layers in the eye surrounded by
3 concentric layers
Compartments of the eye
Anterior
Posterior
Features of anterior compartment of eye
Transparent
~1/6th of eyeball
Anterior and posterior chamber
Makes aq humour
Features of posterior compartment
Opaque
~5/6th of eyeball
Makes vitreous humour
Which layers of the eye make up its structure
Fibrous outer layer
Vascular middle layer
Neural inner layer
Fibrous outer layer of eye
Anterior cornea - transparent
Posterior sclera - opaque
What does the vascular middle layer of the eye consist of
Choroid
Ciliary body and iris
What is the neural layer pf the eye
Retina - optic and non-visual parts
What is the cornea
Transparent, anterior continuation of sclera
Since the cornea is avascular, how does it receive nourishment?
Peripheral capillary beds
Lacrimal gland
Aq humour
What is the sclera
‘White of the eye’
Tough, opaque fibrous membrane, relatively avascular
Visible anteriorly through the transparent bulbar conjunctiva
Function of sclera
Maintenance of the eyeball shape
Attachment for extrinsic muscles
Anatomical relationship between sclera and optic nerve
Optic nerve pierces sclera anteriorly - continuous w/ Dural sheath
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