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Ophthalmology > Ophtalmology General > Flashcards

Ophtalmology General Flashcards

Ophthalmology for the Undergraduate Medical Student in South Africa (Bachelors of Medicine and Bachelors of Surgery).

1
Q

Causes of Exposure Keratopathy

A 
Anaesthesia
Unconsciousness
Exophthalmos
Bell's Palsy with lagophthalmos
Severe ectropion
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2
Q

Parts of the Lens

A

Capsule
Cortex
Nucleus

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3
Q

Causes of Cataracts

A 
Age
Metabolic disease (especially DM)
Drugs (especially steroids)
Trauma
Uveitis
Infections of the Foetus (CMV, Rubella, Toxoplasmosis)
Smoking
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4
Q

Symptoms: Cataracts

A

Gradual painless LOV
Monocular diplopia
Vision varies with illumination
New myopia

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5
Q

Complications of Cataracts

A

Phagolytic Glaucoma

Phagoanaphylactic Uveitis

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6
Q

Indications for Cataract Surgery

A

Functional impairment
Need to see fundus
Complications

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7
Q

Contraindications to Cataract Surgery

A

Patient refusal
Supportive management is adequate
Surgery will not improve the vision

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8
Q

Causes of Ectopia Lentis

A

Trauma

Collagen disease e.g. Marfan’s Disease

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9
Q

Complications of Ectopia Lentis

A

Pupil Block

Acute Angle Closure Glaucoma

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10
Q

Functions of Aqueous Humour

A

Nutrition of surrounding structures
Transport of waste from surrounding structures
Thermoregulation of surrounding structures
Optical medium for light conduction
Maintenance of IOP

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11
Q

Symptoms: Acute Angle Closure Glaucoma

A 
Acute deep-seated unilateral ocular pain radiating to hemicranium
Nausea & vomiting
Red eye
Dramatic reduction in VA
Coloured halos around lights
Reflex tearing
Photophobia
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12
Q

Signs: Acute Angle Closure Glaucoma

A 
Reduced VA
Fixed middilated pupil
Ciliary injection
Corneal haze
Positive eclipse test
Fundus not seen
Raised IOP, hard on palpation
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13
Q

Emergency Treatment: Acute Angle Closure Glaucoma

A 
Carbonic Anhydrase Inhibitor (Acetazolamide)
Glycerol
Topical Beta-Blocker
Pilocarpine
Systemic analgesia
Anti-emetics
Urgent ophthalmological referral
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14
Q

Causes: Secondary Acute Angle Closure Glaucoma

A

Posterior Synechiae in anterior uveitis
Lens swelling in advanced cataracts
Lens displacement
Drugs: miotics and mydriatics

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15
Q

Signs: Primary Open Angle Glaucoma

A 
Visual acuity normal until terminal
Loss of visual fields
Neuroretinal rim pallor
Increased cup/disk ratio
Nasal displacement of vessels
Nerve fibre layer haemorrhage
Increased IOP
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16
Q

Medical Treatment: Primary Open Angle Glaucoma

A

Topical Beta-blockers
Topical Prostaglandin Analogues
Topical Adrenaline preparations
Topical Pilocarpine

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17
Q

Causes: Secondary Open Angle Glaucoma

A

Clogging of trabeculum
Trabeculitis
Trabecular scarring
Drugs: steroids

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18
Q

Symptoms: Congenital Glaucoma

A

Tearing
Photophobia
Blepharospasm

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19
Q

Signs: Congenital Glaucoma

A

Megalocornea/Enlarged Globe
Corneal haze
Enlarged optic cup
Small/moderate IOP

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20
Q

Non-Infective Causes of Uveitis

A 
Trauma
Sarcoidosis
Ankylosing Spondylitis
Juvenile Chronic Arthritis
Reiter's Syndrome
Behcet's Syndrome
Sympathetic Ophthalmia
Infection elsewhere
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21
Q

Infective Causes of Uveitis

A 
Toxoplasma
Tuberculosis
Syphilis
HSV
HZV
CMV
Meningococcus
Candida
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22
Q

Symptoms: Anterior Uveitis

A 
Dull vision
Redness
Tearing
Deep seated eye pain
Photophobia
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23
Q

Signs: Anterior Uveitis

A 
Decreased VA
Cilliary injection
Anterior chamber flare
Keratic precipitates
Hypopion
Miosis
Positive iritis test
Discomfort not relieved by local anaesthetic
Dull view of fundus
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24
Q

Symptoms: Posterior Uveitis

A

LOV

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25
Q

Signs: Posterior Uveitis

A

Vitreous haze: flare and cells

Inflammatory foci: cotton wool appearance, retinal vasculitis

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26
Q

Complications: Anterior Uveitis

A 
Posterior Synechiae
Irregular fixed pupil
Secondary acute angle closure
Blockage of trabeculum by cells/debris
Trabeculitis --> Trabecualr sclerosis
Cataract
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27
Q

Complications: Posterior Uveitis

A 
Choroidoretinal scar formation
Permanent loss of visual acuity
Exudative retinal detachment
Rhegmatogenous retinal detachment
Papillitis
Optic atrophy
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28
Q

Characteristics of Uveal Naevus

A 
Small size (<3 disk diameters)
Does not grow after puberty
Does not distort surrounding structures
Flat
Asymptomatic
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29
Q

Characteristics of Uveal Melanoma

A 
Large
Expands
Elevated
Distorts surrounding structures
Cause loss of vision
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30
Q

Difference between superficial and deep retinal haemorrhage

A

SUPERFICIAL: tracks along fibres of nerve fibre layer, therefore flame-shaped or striated appearance.
DEEP: tracks along deeper fibres, therefore a dot&blot appearance.

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31
Q

Define: Retinal Microaneurysms

A

small, perfectly round, red spots on retina with diameter smaller than that of the large vein at the disk margin

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32
Q

Difference: Hard Exudates vs Cotton Wool Spots

A

HARD EXUDATES:

  1. Yellowish-white spots with well-circumscribed margins
  2. Represent intraretinal lipid deposition

COTTON WOOL SPOTS

  1. White spots, poorly circumscribed, striated/fluffy margins
  2. Represent severe nerve fibre layer ischaemia or infarction
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33
Q

Hypertensive Retinal Changes

A
  1. Diffuse narrowing in visible arteriolar blood columns (generalised vasoconstriction)
  2. Areas of focal narrowing (indicates diastolic >110mmHg)
  3. Arteriolar obstruction + vessel wall necrosis = nerve fibre layer haemorrhages, hard exudates, cotton wool spots
  4. Optic disk swelling (indicates diastolic 130-140mmHg)
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34
Q

Arteriosclerotic Retinal Changes

A
  1. Diffuse narrowing of arteriolar blood columns (hypertrophy and fibrosis)
  2. Copper wiring/Silver wiring
  3. AV nipping (venule tapers to disappear behind arteriole)
  4. Venule direction change at crossing
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35
Q

Pathology of Diabetic Retinopathy

A
  1. Capillary outpouching = microenurysms

2. Capillary occlusion = leakage, haemorrhage, ischaemia

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36
Q

Complications of Neovascularisation

A
  1. Neovascular glaucoma
  2. Massive intraretinal exudation
  3. Vitreous heamorrhage
  4. Tractional retinal detachment
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37
Q

Classify Extramacular Retinopathy

A

A: BACKGROUND
Microaneurysms
Hard exudates
Haemorrhages (mainly deep)

B: PRE-PROLIFERATIVE
Venous kinking/beading/looping
Cotton wool spots
Extensive deep haemorrhages
Vascular occlusions

C. PROLIFERATIVE
Neovascularisation

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38
Q

Classify Maculopathy

A

A. BACKGROUND
Microaneurysms
Haemorrhages (mainly deep)

B. EXUDATIVE
Oedema
Hard exudates

C. ISCHAEMIC
Angiographic

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39
Q

Treatment: Diabetic Retinopathy

A
  1. Glucose control
  2. Early ophthalmology referral
  3. Argon laser photocoagulation
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40
Q

Signs: Central Retinal Arterial Occlusion

A 
Reduced VA (to hand movements or no PL)
Visual field loss
RAPD
Mild optic disk swelling
Milky white retina
Cherry red spot (of macula)
Narrowed arterioles and venules
Embolism may be visible in artery
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41
Q

Management of Central Retinal Arterial Occlusion

A
  1. Digital globe massage
  2. Inhalation of 95% Oxygen + 5% CO2
  3. Systemic vasodilators (isosorbide dinitrite)
  4. Acetazolamide
  5. Ophthalmology referral
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42
Q

Ophthalmological interventions in central retinal arterial occlusion

A

Retrobulbar vasodilator injection

Paracentesis to remove aqueous humour

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43
Q

Treatable causes of central retinal arterial occlusion

A

carotid arteriosclerosis
polycythaemia
systemic hypertension
diabetes mellitus

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44
Q

Associations of central retinal venous occlusion

A

Hypertension
Arteriosclerosis
Diabetes Mellitus
Glaucoma

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45
Q

Signs: Central Retinal Venous Occlusion

A
  1. LOV variable
  2. Afferent pupil defect
  3. Dilated/tortuous venules
  4. Optic disk swelling
  5. Nerve fibre layer retinal haemorrhages
  6. Cotton wool spots
  7. Hard exudates
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46
Q

Which form of retinal occlusion has neovascularisation as complication?

A

Central Retinal Vein Occlusion

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47
Q

Risk Factors: Retinopathy of Prematurity

A
  1. Birth weight <30 weeks

4. High saturation oxygen therapy

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48
Q

Classification: Age-Related Macular Degeneration

A

A. Atrophic type / dry / avascular degeneration

B. Exudative type / wet / subretinal neovascularisation

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49
Q

Symptoms: ARMD

A
  1. Painless LOV
  2. Metamorphosia
  3. Central/Paracentral scotoma
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50
Q

Specific Therapies: Wet Type ARMD

A

Laser photocoagulation
Photodynamic therapy
Intravitreal injection of anti-VEGF agents

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51
Q

Initial Presentation of Retinoblastoma

A
  1. Leukocoria (67%)
  2. Strabismus (20%)
  3. Proptosis
  4. Uveitis
  5. Hyphema
  6. Glaucoma
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52
Q

Treatment of Retinoblastoma

A 
Enucleation
Radiotherapy
Photocoagulation
Cryotherapy
Chemotherapy
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53
Q

Classify: Retinal Detachment

A

Serous/Exudative
Traction
Rhegmatogenous

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54
Q

Principles of Retinal Detachment Surgery

A

Reapply edges of the break to the RPE
Relieve vitreous traction
Drain subretinal fluid

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55
Q

Causes: Optic Disk Swelling

A
  1. Congenital anomalies e.g. Hamartoma
  2. Passive swelling e.g. raised ICP, optic nerve compression, systemic hypertension
  3. Inflammatory e.g. papillitis
  4. Vascular e.g. AION, CRVO)
  5. Infiltration e.g. neoplasia
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56
Q

Causes: Optic Neuritis

A

Autoimmune e.g. demyelinating disease
Systemic infections e.g. EBV, CMV, measles, syphilis, TB
Idiopathic systemic inflammations e.g. sarcoidosis
Adjacent inflammation e.g. choroidoretinitis, orbital cellulitis

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57
Q

Signs: Optic Neuritis

A
  1. Reduced VA
  2. Central scotoma
  3. Sluggish pupillary reaction to light
  4. RAPD
  5. Disc swelling
    6.
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58
Q

Complications: Optic Neuritis

A

Secondary optic atrophy

Permanent LOV

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59
Q

Causes: Optic Neuritis with Normal VA

A

Idiopathic
Congenital abnormalities
Increased ICP
Systemic hypertension

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60
Q

Causes: Optic Neuritis with Reduced VA

A

Vascular events
Inflammation
Infiltration
Compression

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61
Q

Commonest causes of optic neuritis in adults and children

A

ADULTS: Multiple Sclerosis
CHILDREN: Viral

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62
Q

Define Anterior Ischaemic Optic Neurophathy (AION)

A

Partial or complete infarction of the optic disk due to posterior ciliary arterial occlusion

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63
Q

Signs: AION

A 
Severe LOV
Reduced VF
Sluggish pupillary reaction to light
RAPD
Pale swollen disk
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64
Q

Causes: AION

A

Giant cell arteritis

Artesclerosis

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65
Q

Causes: Optic Atrophy

A 
Congenital
Traumatic
Inflammatory
Compression
Vascular
Metabolic
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66
Q

Inflammatory causes of optic atrophy

A

Optic neuritis

Widespread retinitis

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67
Q

Compression causes of optic atrophy

A

Tumours
Aneurysm
Chronic disc swelling

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68
Q

Vascular causes of optic atrophy

A 
CRAO
AION
Glaucoma
Diabetes Mellitus
Arteriosclerosis
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69
Q

Metabolic causes of optic atrophy

A

Methanol poisoning

Nutritional amblyopia

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70
Q

DDX: Rapid painful onset of proptosis in child

A

orbital cellulitis

rhabdomyosarcoma

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71
Q

DDX: Rapid painful onset of proptosis in adult

A

orbital cellulities

pseudotumour

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72
Q

Important history in new onset proptosis

A

Malignancies
Thyroid dysfunction
Orbital trauma
Sinusitis

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73
Q

Causes: Pseudoproptosis

A

Eye enlargement (buphthalmos)
Contralateral enophthalmos
Eyelid retraction
Shallow orbit

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74
Q

DDX: Proptosis + Increased resistance to ocular retropropulsion

A

Solid tumour

Thyroid eye disease

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75
Q

DDX: Restricted Eye Movements

A

Restrictive myopathy e.g. ocular ophthalmopathy
Splinting of optic nerve e.g. meningioma
Neurological lesion
Blow out fracture with muscle entrapment

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76
Q

DDX: Proptosis worsened by vascular engorgement

A
  1. Orbital varices

2. Capillary haemangioma

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77
Q

Characteristics: Preseptal Cellulitis

A 
Secondary to trauma/local skin infection
Periorbital swelling and tenderness
Infection does not penetrate orbital septum
No proptosis
No impairment of eye movement
Tx: Oral antibiotics
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78
Q

Characteristics: Orbital Cellulitis

A 
Dangerous: arises in paranasal sinuses
Orbital pain
Diplopia
Eyelid oedema
Generalised redness of eye
Conjunctival chemosis
Proptosis
Limited eye movements
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79
Q

Complications: Orbital Cellulitis

A

Blindness
Meningitis
Brain Abscess
Cavernous Sinus Thrombosis

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80
Q

Define orbital varices

A

Vascular hamartoma consisting of plexus of thin walled veins with connections to normal orbital circulation

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81
Q

Characteristics: Orbital varices

A 
Intermittent non-pulsatile proptosis
Pain
Orbital haemorrhage
No bruit
Precipitated by vascular engorgement
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82
Q

Characteristics: Caroticocavernous Fistula

A 
Reduced VA
Generalised redness (severe)
Conjunctival chemosis
Pulsatile proptosis
Audible bruit
Ophthalmoplegia
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83
Q

Vascular Tumours of the Orbit

A

Capillary Haemangioma
Cavernous Haemangioma
Lymphangioma

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84
Q

Orbital Tumour Classification

A
  1. Lymphoproliferative tumours (e.g. Inflammatory Pseudotumour)
  2. Vascular tumours
  3. Lacrimal gland tumours
  4. Rhabdomyosarcoma
  5. Cystic tumours
  6. Neural tumours
  7. Metastatic tumours
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85
Q

Lacrimal Tumours

A

Pleomorphic Adenoma

Adenocarcinoma

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86
Q

Cystic Tumours of the Orbit

A

Dermoid cyst
Mucocele
Hydatid cyst

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87
Q

Neural Tumours of the Orbit

A

Optic Nerve Glioma

Optic Nerve Sheath Meningioma

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88
Q

Decisions in suspected strabismus

A
  1. Is strabismus present?
  2. Is strabismus concommitant or incomitant?
  3. Is there a danger of amblyopia?
  4. What should be done?
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89
Q

Definition: Strabismus

A

Misalignment of visual axes

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90
Q 
Define:
Esotropia
Exotropia
Hypertropia
Hypotropia
A
  1. Deviant eye inwards
  2. Deviant eye outwards
  3. Deviant eye upwards
  4. Deviant eye downwards
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91
Q

Consequences: Strabismus

A

Amplyopia
Suppression
Diplopia

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92
Q

Define Amblyopia

A

Subnormal vision due to abnormal visual experience;

sensory adaptation mechanism to prevent diplopia

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93
Q

Types of Amblyopia

A
  1. Strabismic Amblyopia
  2. Deprivation Amblyopia
  3. Refractive Amblyopia
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94
Q

Concomitant vs Incomitant Strabismus

A

Concomitant strabismus has no impairment of eye movement;

Angle of deviation is the same in all test positions.

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95
Q

Causes: Incomitant Strabismus

A
  1. Neurological - CN III, IV, VI
  2. Myoneural junction - MG
  3. Muscular - thyroid
  4. Mechanical - blow-out, orbital mass
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96
Q

Characteristics: Incomitant Strabismus

A

Angle of deviation varies with direction of gaze
Angle of deviation maximal in test position of affected muscle
Strabismus not present in all gaze directions
Ocular torticollis

97
Q

Muscles innervated by CNIII/Oculomotor Nerve

A 
Medial Rectus
Inferior Rectus
Superior rectus
Inferior Oblique
Levator Palpebrae Superioris
Sphincter Pupillae
Cilliary muscle
98
Q

Tests for Strabismus

A

Corneal light reflex

Cover test

99
Q

Neurons of Light Reflex Pathway

A
  1. Afferent neurons from retinal ganglion cells
  2. Intercalated neurons from pretectal nucleus synapse
  3. Edinger-Westphal parasympathetic outflow in CNIII
  4. Cilliary ganglion efferent fibres to iris/cilliary muscles
100
Q

Triad of the Near Reflex

A
  1. Accommodation
  2. Convergence
  3. Miosis
101
Q

Causes: Light-Near Dissociation

A

Prechiasmal visual pathway lesion (RAPD, Marcus Gunn Pupil)
Dorsal midbrain syndrome (region of pretectal nucleus)
Adie’s pupil (lesion of cilliary ganglion)
Argyl-Robertson pupil (bilateral small pupils, NB in neurosyphilis)

102
Q

Characteristics: Horner’s Syndrome

A
  1. Partial ptosis of upper lid
  2. Miosis
  3. Anhydrosis
  4. Anisochromia
    All on one side of the face
103
Q

Occulomotor Nerve (CNIII) supplies…

A 
Medial Rectus
Superior Rectus
Inferior Rectus
Inferior Oblique
Parasympathetic fibres to intraocular muscles
104
Q

CNIII paralysis causes:

A
  1. Horizontal and vertical diplopia
  2. Inability to elevate, depress and adduct
  3. Ptosis
  4. Dilate, non-reactive pupil
105
Q

Lesions causing CNIII paralysis

A

Intracranial aneurysms
Head injuries
Brain tumours

106
Q

Characteristics: CNIV (Trochlear Nerve) paralysis

A

Vertical and/or oblique diplopia
Diplopia worse on adduction
Head tilted to opposite shoulder

107
Q

Causes: CNIV Paralysis

A
  1. Congenital
  2. Closed head injury
  3. Vascular disease
  4. Space occupying lesion
  5. Aneurysm
108
Q

CNVI (Abducens Nerve) Palsy Characteristics

A

Horizontal diplopia

Diplopia worse on looking in affected eye’s direction

109
Q

Causes: CNVI Palsy

A 
Intracranial tumours
Head injuries
Vascular disease
Raised ICP
Aneurysm
110
Q

Myasthenia Gravis test:

A

Edrophonium Chloride (Tensilon) test

111
Q

Define Nystagmus

A

Rhythmic involuntary to and fro movements of eyes

112
Q

Nystagmus Classifications

A
  1. Type
  2. Speed
  3. Direction
113
Q

Nystagmus Types

A

A. Jerk Nystagmus

B. Pendular Nystagmus

114
Q

Nystagmus Directions

A

Horizontal
Vertical
Rotary

115
Q

Phsyiological Nystagmus Types

A

Endpoint

Caloric

116
Q

Visual System Manifestation of Grave’s Disease

A
  1. Eyelid swelling
  2. Eyelid retraction
  3. Lid lag
  4. Conjunctival chemosis/erythema
  5. Proptosis = Exophthalmos
  6. Limited eye movements (may cause diplopia)
  7. Exposure keratopathy
  8. Optic neuropathy
117
Q

Ocular Manifestations of Diabetes Mellitus

A
  1. Increased ocular infections
  2. Sudden refractive changes
  3. Cataracts
  4. Increased incidence of anterior uveitis
  5. Diabetic Retinopathy
  6. Neovascular glaucoma
  7. Extraocular muscle paralysis
118
Q

Define Amaurosis Fugax

A

sudden LOV in one eye which recovers spontaneously within a few minutes

119
Q

Ocular Manifestations of Rheumatoid Arthritis

A
  1. Keratoconjunctivitis Sicca
  2. Increased incidence of corneal infections
  3. Peripheral corneal thinning
  4. Scleritis
120
Q

Ocular Manifestations of Juvenile Chronic Arthritis

A
  1. Chronic Anterior Uveitis
  2. Posterior Synechiae
  3. Dense cataracts
  4. Glaucoma
121
Q

Visual Manifestations of SLE

A 
OCULAR
Dry eyes
Peripheral corneal thinning
Anterior uveitis
Retinopathy

CNS
Homonymous hemianopia
Optic atrophy
CN III and VI paresis

122
Q

Reiter’s Syndrome Triad

A
  1. Conjunctivitis
  2. Urethritis
  3. Arthritis
    +/- Uveitis, Keratitis
123
Q

Behcet’s Syndrome Triad

A
  1. Oral/Genital ulcers
  2. Arthritis
  3. Anterior uveitis
124
Q

AIDS retinal vascular involvement

A

Cotton wool spots
Microaneurysms
Retinal haemorrhages

125
Q

AIDS opportunistic infections in the eye

A

HZV Ophthalmicus
CMV
Toxoplasma retinochoroiditis
Cryptococcus Neoformans retinochoroiditis

126
Q

AIDS tumours in the eye

A

Kaposi’s Sarcoma
SCC of the eyelids
Burkitt’s lymphoma of the orbit

127
Q

Define: Phacomatoses

A

Disease in which neurological abnormalities are associated with congenital defects of the skin, eyes, etc.

128
Q

Sturge Weber Syndrome: Optical and Other Manifestations

A

OPTICAL
Conjunctival haemangioma
Choroidal haemangioma
Open angle glaucoma

OTHER
Facial haemangioma (port wine stain)
Meningeal haemangioma

129
Q

Neurofibrimatosis: Optical and Other Manifestations

A 
OPTICAL:
Eyelid neuroma
Iris nodules (Lisch nodules)
Open Angle Glaucoma
Choroidal naevus
Optic nerve glioma

OTHER:
Skin neurofibromas
CNS tumours
Endocrine tumours

130
Q

Appearance of Blunt Lid Trauma

A

Abrasions

Periorbital Haematoma

131
Q

Treatment of Blunt Lid Trauma

A

Clean abrasions
Remove foreign bodies
Topical broad spectrum antiseptic - do not get in eye!
Systemic analgesics/anti-inflammatories

132
Q

Different Classes of Lid Lacerations

A

A. not involving eyelid margin
B. involving lacrimal canaliculi and medial canthal ligament
C. involving eyelid margin

133
Q

Treatment: Ocular Foreign Body

A
  1. Local anaesthetic drops
  2. Remove with wet cotton bud or blunt metal spatula
  3. Remove rust ring with corneal millar if present
  4. Prophylactic topical antibiotic drops
  5. Eye covered
  6. Examine wound/abrasion daily until disappearance
  7. Do not give local anaesthetic TTO
  8. Systemic analgesics
134
Q

Management: Penetrating Eye Injury

A
  1. X-rays or CT of orbit and sinuses
  2. Refer to ophthalmological unit
  3. Protect eye with rigid eye shield during transfer
  4. Avoid ointments
  5. Antibiotic drops
  6. Remove iron/copper containing intraocular foreign bodies ASAP
  7. Remove blinded eye within 14 days to prevent sympathetic ophthalmia
135
Q

Complications of Blunt Eye Trauma

A

Subconjunctival haemorrhage

Corneal oedema

136
Q

Classify: Ocular Burns

A
  1. Chemical: Acid
  2. Chemical: Alkali
  3. Thermal
  4. Ultraviolet
137
Q

Management: Chemical Ocular Burns

A
  1. Immediate irrigation, sterile n. saline if possible, start at scene of accident!
  2. Do not neutralise acid with weak alkali or vice versa
  3. Eyelid speculum and topical anaesthetic to stop blepharospasm
  4. Wipe foreign material from eye/fornices
  5. Test pH periodically (aim for 7)
  6. Systemic analgesics
  7. Topical cycloplegics
  8. Refer to ophthalmologist
138
Q

Complications: Chemical Ocular Burns

A 
Glaucoma
Corneal Scarring
Symblepharon
Entropion
Dry eyes
139
Q

Management: Thermal Ocular Burns

A
  1. Do not irrigate!
  2. Topical antibiotics
  3. Cycloplegic drops
  4. Systemic analgesics
  5. Ophthalmology referral
140
Q

Management: UV Ocular Burns

A
  1. Pad eye
  2. Topical cycloplegics
  3. Prophylactic antibiotics
  4. Systemic analgesics
141
Q

Early Complications: Hyphaema

A

Raised IOP
Haematocornia
Secondary haemorrhage

142
Q

Treatment: Hyphaema

A
  1. If >5%, admit to hospital for 5 days bed rest
  2. Measure IOP, size of hyphaema and corneal condition daily
  3. 1% Atropine
  4. Topical steroids
  5. Oral Cyclokapron
  6. Treat raised IOP if presents
  7. Assess anterior chamber angle and retina once stable
  8. Patient education
143
Q

Intraocular Complications: Blunt Trauma

A 
Hyphaema
Motility abnormalities
Traumatic uveitis
Traumatic glaucoma
Traumatic mydriasis
Lens dislocation/subluxation
Cataract formation
Vitreous haemorrhage
Intraretinal/subretinal haemorrhage
Retinal oedema
Retinal holes
Retinal detachment
Choroidal rupture
Contustion of optic nerve
144
Q

Signs: Orbital Fracture

A 
Diplopia
Limited eye movement
Proptosis/enophthalmos
Periorbital crepitus
Decreased sensation in cheek and tip of nose
145
Q

Clinical presentation: Caroticocavernous fistula

A 
Loud bruit in head
Visible pulsating exophthalmos
Conjunctival vessels congested
Conjunctiva chemotic/haemorrhagic
Changes in ocular motility
146
Q

Categories of eye-related complaints

A
  1. Visual disturbance
  2. Ocular or peri-ocular discomfort
  3. Discharge
  4. Abnormal appearance
147
Q

Questions to ask every eye-patient

A
  1. Is there any visual disturbance
  2. Is there any ocular or peri-ocular discomfort
  3. Is there any photophobia
  4. Is there any discharge from the eye
  5. Do the eyelids stick together when waking up in the mornings
148
Q

DDX: Painful Red Eye

A
  1. Conjunctivitis
  2. Keratitis
  3. Anterior Uveitis
  4. Acute Angle Closure Glaucoma
149
Q

Three NB Questions in a Painful Red Eye

A
  1. Is there visual loss?
  2. What is the pattern of redness?
  3. Could it be acute angle closure glaucoma?
150
Q

DDX: Visual Loss in a Comfortable White Eye

A 
MEDIA:
Contact lens loss
Lens dislocation
Lens swelling
Vitreous heamorrhage
RETINA/CHOROID:
Retinal detachment
Wet ARMD
Acute choroidoretinitis
Retinal vascular occlusion
VISUAL PATHWAYS:
AION
Acute optic neuritis
TIA/RIND/CVA
151
Q

DDX: Gradual Visual Loss

A 
MEDIA:
Change in refractory error
Presbyopia
Cataract
Chronic Choroidoretinitis
RETINA/CHOROID:
Dry ARMD
RP
Choroidal melanoma
VISUAL PATHWAYS:
Space occupying lesion
152
Q

Ocular Emergencies: Painful red eyes

A

Acute angle closure glaucoma
Open eye injuries
Chemical burns
Corneal abscess

153
Q

Ocular Emergencies: Comfortable White Eyes

A

CRAO
AION
Acute retinal tear with vitreous haemorrhage
Retinal detachment which threatens to involve the macula

154
Q

In order to produce a clear image the eye must have…

A
  1. Constant dimensions
  2. Clear optical pathway
  3. Ability to focus light on the retina
155
Q

3 Layers of the Eye

A
  1. Outer fibrous layer (sclera, cornea)
  2. Middle vasculo-muscular layer (uveal tract)
  3. Inner neural layer (retina)
156
Q

3 Internal Zones of the Eye

A
  1. Aqueous
  2. Lens
  3. Vitreous
157
Q

Six structures of the visual system

A
  1. Eye
  2. Ocular adnexa
  3. Orbit
  4. Visual pathways
  5. Cranial nerves
  6. Sympathetic and parasympathetic supply
158
Q

7 Features of the Visual System

A
  1. High resolution (photoreceptor density, macula)
  2. Wide field (binocularity)
  3. Ocular movement (binocular single vision)
  4. Stereopsis (depth perception from binocular single vision and higher centres)
  5. Colour representations
  6. Integration
  7. Interpretation
159
Q

Components: Anterior Segment

A 
Cornea
Anterior chamber
Posterior chamber
Iris
Ciliary body
Lens 
Zonules
160
Q

Components: Posterior segment

A 
Sclera
Choroid
Retina
Optic disk
Vitreous humour
161
Q

Layers of the Cornea

A
  1. Epithelium
  2. Bowman’s Membrane
  3. Stroma
  4. Descemet’s Membrane
  5. Endothelium
    * note: new research indicates Dua’s Layer between 3&4
162
Q

Nerve supply to the cornea

A

Ophthalmic division of the Trigeminal Nerve (CN V)

163
Q

Function of Cornea

A
  1. Transparency for vision

2. Optical refraction

164
Q

Two refractive components of the eye

A

Cornea

Lense

165
Q

Refractive power of cornea

A

45 dioptres

166
Q

Factors causing corneal transparency

A
  1. Avascularity
  2. Relative acellularity and uniform structure
  3. Relative dehydration
167
Q

Conjunctiva is continuous with:

A

Skin at lid margin

Corneal epithelium at the limbus

168
Q

Sclera is continuous with:

A

Cornea at the limbus anteriorly

Dural sheath of optic nerve posteriorly

169
Q

Intra-ocular pressure is maintained at steady level through which mechanisms?

A

A. Constant secretion of aqueous humour into posterior chamber by ciliary body
B. Constant drainage of aqueous humour by trabecular meshwork in anterior chamber angle

170
Q

Accommodation is mediated by which pathway?

A

Parasympathetic

171
Q

Parts of the Ciliary Body

A
  1. Pars Plicata - secretes aqueous, anterior part)
  2. Pars Plana - posterior part, provides safe access to interior of eye
  3. Ora Serrata - juntion between retina and ciliary body)
172
Q

Retinal Structures visible with direct ophthalmoscope

A

Optic nerve head and cup
Central retinal artery and nasal/temporal branches
Central retinal vein and nasal/temporal branches
Neural retina
Macula lutea with foveolar light reflex

173
Q

Explain: Arterial Supply to the Eye

A

A. Ophthalmic artery is the first branch of the intracranial portion of the internal carotid artery
B. Opthalmic artery branches into the central retinal artery, long posterior ciliary artery and short posterior ciliary artery

174
Q

Explain: Venous Drainage of the Eye

A

A. Vortex veins, anterior ciliary veins and central retinal vein
B. Drain into superior and inferior ophthalmic veins
C. Communicate with cavernous sinus

175
Q

Differentiate External Hordeolum, Internal Hordeolum, Chalazion

A

External: staph abscess of eyelash follicle
Internal: staph abscess of meibomian gland
Chalazion: obstruction of meibomian gland duct

176
Q

Treatment: Internal Hordeolum

A
  1. remove affected eyelash
  2. local antibiotic cream
  3. warm compress
177
Q

Treatment: External Hordeolum

A
  1. local antibiotic cream
  2. systemic antibiotic if cellulitis severe
  3. drainage when head forms
178
Q

Treatment: Chalazion in absence of spontaneous resolution

A
  1. incision and curettage
  2. antibiotic cream
  3. cover eye for day
  4. systemic pain relief
179
Q

Aetiology: Chronic Blepharitis

A
  1. staph infection of eyelid follicles

2. abnormal secretions of eyelashes/meibomian glands

180
Q

Associations: Chronic blepharitis

A

seborrhoeic dermatitis
acne rosacea
atopic eczema
dry eyes

181
Q

Complications: Chronic Blepharitis

A

recurrent conjunctivitis
internal hordeolum
external hordeolum
chalazion

182
Q

Treatment: Chronic Blepharitis

A
  1. eyelid hygiene
  2. antibiotics
  3. warm compresses
  4. manual expression of thickened secretions
  5. treat seborrhoeic dermatitis of scalp
183
Q

Medication options in chronic blepharitis

A
  1. fucidic acid cream
  2. antibiotic ointments
  3. steroid drops
  4. tetracyclines
184
Q

Reasons to treat molluscum contagiosum

A
  1. speedy recovery
  2. reduce transmission
  3. prevent corneal complications
185
Q

Complication of molluscum contagiosum

A

toxic secondary keratoconjunctivitis

186
Q

causes of entropion/ectropion

A
  1. involutional changes of ageing

2. scarring

187
Q

treatment of entropion/ectropion

188
Q

Causes: Ptosis

A
  1. NEUROGENIC
    - CNIII paralysis
    - Horner’s
  2. INVOLUTIONAL
  3. MECHANICAL
    - oedema
    - tumours
  4. MYOGENIC
    - congenital dystrophy
    - myasthenia gravis
189
Q

Malignancies of eyelids in order of incidence

A
  1. Basal cell carcinoma
  2. Squamous cell carcinoma
  3. Tarsal gland carcinoma
  4. Kaposi’s sarcoma
190
Q

Name the layers of tear film and what secretes them

A

OUTER LIPID LAYER - tarsal/meibomian glands
MIDDLE AQUEOUS LAYER - lacrimal gland
INNER MUCIN LAYER - goblet cells of conjunctiva

191
Q

REQUIREMENTS FOR STABLE TEAR FILM

A
  1. constant renewal/blinking
  2. intact separate layers
  3. smooth surface
  4. good eyelid apposition
192
Q

CAUSES: KERATOCONJUNCTIVITIS SICCA (a.k.a. aqueous layer deficiency)

A
  1. IDIOPATHIC - e.g. postmenopausal women
  2. INJURIES TO LACRIMAL GLAND
    - infection
    - surgery
    - autoimmune
  3. OCCLUSION OF GLAND DUCT BY SCARRING
    - chemical burns
    - trachoma
    - Stevens-Johnson Syndrome
193
Q

CAUSES: LIPID/MUCIN LAYER DEFICIENCIES

A
  1. Blepharitis (lipids)
  2. Cicatrial conjunctival disease
    - chemical burns
    - trachoma
    - SJS
  3. Xerophthalmia
194
Q

SIGNS SEEN ONLY IN LATE STAGES OF TEAR ABNORMALITIES:

A
  1. corneal vascularisation
  2. corneal opacification
  3. corneal keratinisation
195
Q

EYELID ABNORMALITIES CAUSING EXPOSURE KERATITIS

A
  1. Abnormal eyelid contour
    - trauma
    - tumour
    - trachoma
  2. Abnormal eyelid movement
    - lagophthalmos
    - symblepharon
196
Q

DEFINE SYMBLEPHARON

A

adhesion of palpebral and bulbar conjuntiva caused by trachoma, chemical burns or SJS.

197
Q

TREATMENT: TEAR ABNORMALITIES

A
  1. avoid triggers
  2. artificial tears
  3. gels
  4. ointments
198
Q

Treatment: Acute Dacryocystitis

A
  1. local + systemic antibiotics
  2. drainage if abscess points
  3. dacryocystorhinostomy after resolution
199
Q

QUESTIONS TO ASK IN CONJUNCTIVITIS

A
  1. type of discharge
  2. appearance of conjunctiva
  3. lymphadenopathy
200
Q

TYPES OF DISCHARGE AND WHAT CONJUNCTIVITES CAUSE THEM

A 
WATERY
- viral
- allergic
MUCOID
- vernal
- keratoconjuncitivitis sicca
PURULENT
-bacterial
201
Q

CAUSES: FOLLICULAR CONJUNCTIVITIS

A
  1. viral

2. chlamydia

202
Q

CAUSES: SUBCONJUNCTIVAL HAEMORRHAGE

A 
spontaneous
valsalva
trauma
conjunctivitis
systemic vasculitis
coaggulation defects
203
Q

TYPES OF BACTERIAL CONJUNCTIVITIS

A

acute bacterial conjunctivitis
gonococcal conjunctivitis
chlamydial conjunctivitis
secondary blepharoconjuncitivitis

204
Q

ORGANISMS: ACUTE BACTERIAL CONJUNCITIVITIS

A

staph aureus
staph epidermidis
haemophilus
streptococcus

205
Q

SYMPTOMS: ACUTE BACTERIAL CONJUNCTIVITIS

A

redness
scratching
purulent discharge
eyelids stick together in the mornings

206
Q

SIGNS: ACUTE BACTERIAL CONJUNCTIVITIS

A

generalised conjunctival injection

purulent discharge

207
Q

SIGNS: GONOCOCCAL CONJUNTIVITIS

A 
conjunctival hyperaemia + chemosis
eyelid oedema
copious purulent discharge
membranes/pseudomembranes
preauricular lymphadenopathy
corneal ulceration/perforation
208
Q

TREATMENT: GONOCOCCAL CONJUNCTIVITIS

A

3rd gen cephalosporin e.g. ceftriaxone

local and systemic

209
Q

CHLAMYDIAL CONJUNCTIVITIS TYPES

A

A. inclusion conjuntivitis (venereal)

B. trachoma (poor hygiene)

210
Q

TREATMENT: CHLAMYDIAL CONJUNCTIVITIS

A 
A. TOPICAL
- tetracycline
- erythromycin
B. SYSTEMIC
- tetracycline
- erythromycin
- doxycycline
- azithromycin (stat dose, preferred by many)
211
Q

FEATURES OF TRACHOMA

A 
ACUTE
- folicular conjunctivitis
- keratitis on superior cornea
CHRONIC
- white lines on palpebral conjunctiva
- pannus on superior cornea
LONG TERM
- conjuntival scarring
- entropion
- trichiasis
212
Q

VIRAL CONJUNCTIVITIS TYPES

A
  1. Adenoviral
  2. Acute haemorrhagic
  3. Herpes simplex keratoconjunctivitis
  4. Molluscum contagiosum keratoconjunctivitis
213
Q

CLINICAL FEATURES: ADENOVIRAL CONJUNCTIVITIS

A 
redness
tearing
scratching
follicles
preauricular lymphadenopathy
photophobia
chemosis
subconjuntival haemorrhage
pseudomembranes
punctate superficial corneal stromal infiltrates
214
Q

TREATMENT: ADENOVIRAL CONJUNCTIVITIS

A

NON-SPECIFIC

  1. prophylactic antibiotic drops
  2. vasoconstrictor drops
  3. steroid drops if infiltrates
215
Q

CLINICAL FEATURES: HAEMORRHAGIC CONJUNCTIVITIS

A

as with acute viral (scratching, tearing, etc)
bilateral
severe redness, severe subconj haemorrhages
marked tearing
eyelid oedema
palpebral follicles

216
Q

ALLERGIC CONJUNCTIVITIS CLASSIFICATION

A
  1. hayfever conjunctivitis
  2. acute allergic blepharoconjuntivitis
  3. vernal conjunctivitis
  4. GPC
  5. SJS
217
Q

TYPES OF VERNAL CONJUNCTIVITIS

A

a. palpebral

b. limbal

218
Q

TREATMENT: VERNAL CONJUNCTIVITIS

A
  1. antihistamine drop with vasoconstrictor
  2. sodium chromoglycate
  3. avoid steroids despite efficacy!
219
Q

TREATMENT: GIANT PAPILLARY CONJUNCTIVITIS

A
  1. no contact lens wear for 3/12
  2. topical mast cell stabilisers
  3. topical steroids
  4. discard solution with preservatives
220
Q

OCULAR COMPLICATIONS: STEVENS-JOHNSON SYNDROME

A
  1. conjunctival destruction with symblepharon formation
  2. destruction of goblet cells
  3. destruction of duct of lacrimal gland
  4. conjunctival scarring
  5. entropion
  6. trichiasis
  7. corneal ulceration/vascularisation/perforation
221
Q

TREATMENT: OCULAR SJS

A

topical steroids
cyclosporin
ophthalmology referral

222
Q

NEONATAL PROPHYLACTIC OCULAR AGENTS

A
  1. silver nitrate (for gonococcus, not for chlamydia)
  2. povidone iodine
  3. antibiotic drops
223
Q

TREATMENT: NEONATAL GONOCOCCAL CONJUNCTIVITIS

A

a. topical penicillin G with irrigation for 5 days

b. systemic benzylpenicillin or cefotaxime

224
Q

TREATMENT: NEONATAL CHLAMYDIAL CONJUNCTIVITIS

A

oral erythromycin syrup

225
Q

TREATMENT: PTERYGIUM

A
  1. artificial tears
  2. antihistamine drops
  3. vasoconstrictor drops
  4. antibiotic drops (secondary infection)
  5. steroid drops (noninfective inflammation)
  6. surgical excision
226
Q

INDICATIONS FOR PTERYGIUM SURGERY

A
  1. discomfort not relieved by medical treatment
  2. increasing astigmatism
  3. growth over visual axis
  4. enabling contact lens wear
  5. cosmesis
  6. suspect malignancy
227
Q

CONJUNCTIVAL TUMOURS

A
  1. naevi
  2. melanoma
  3. squamous cell carcinoma
  4. kaposi’s sarcoma
228
Q

CLINICAL FEATURES: CORNEAL INFILTRATION/ULCERATION

A 
redness
pain
photophobia
blepharospasm
tearing
reduced vision
halos around lights
229
Q

CORNEAL LESIONS THAT SHOULD BE REFERRED

A
  1. reducing visual acuity
  2. staining with fluorescein, except peripheral HSV
  3. any hypopion
230
Q

ORGANISMS THAT INVADE CORNEA WITHOUT NEEDING AN ENTRY PORTAL

A
  1. N. Gonorrhoea
  2. N. Meningitides
  3. Corynebacterium Diphtheria
231
Q

MOST COMMON ORGANISMS CAUSING CORNEAL ULCERATION

A
  1. Pneumococcus
  2. Pseudomonas
  3. Staph aureus/epidermidis
232
Q

MANAGEMENT: CORNEAL ULCERATION

A
  1. irrigate eye with normal saline
  2. cycloplegic drops
  3. antibiotic drops (gatifloxacin, moxifloxacin, ciprofloxacin, ofloxacin)
  4. ophthalmology consultation/referral
233
Q

COMPLICATIONS: CORNEAL ULCERATION

A
  1. permanent corneal thinning
  2. permanent corneal opacification
  3. corneal perforation
  4. anterior uveitis with hypopion
  5. endophthalmitis
  6. permanent LOV
234
Q

CLINICAL FEATURES: FUNGAL CORNEAL ULCERATION

A
  1. red inflamed eye
  2. satellite lesions
  3. hypopion with fungus
  4. slowly enlarging ulcer
235
Q

TREATMENT OF FUNGAL CORNEAL ULCERATION

A

A. Topical Natamycin/Amphotheracin B

B. Systemic Fluconazole

236
Q

TREATMENT: HSV CORNEAL ULCERATION

A

A. Topical acyclovir

B. Cycloplegia

237
Q

COMPLICATIONS: HSV CORNEAL ULCERATION

A 
Disciform keratitis
Stromal keratitis (when erronously treated with steroids)
238
Q

MANAGEMENT: HZV OPHTHALMICA

A
  1. early referral
  2. systemic acyclovir
  3. topical acyclovir with fluorescein
  4. careful use of steroids
  5. systemic analgesia

Ophthalmology (2 decks)

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