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Ophthal Flashcards

1
Q

What is the difference between anterior and posterior uveitis?

A

Anterior - inflammation of the iris

Posterior - inflammation of the choroid

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2
Q

What are the risk factors for uveitis?

A

Autoimmune disease
HLA-B27
Intra-ocular lymphoma
Idiopathic

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3
Q

What are the symptoms of anterior uveitis?

A

Pain
Redness
Photophobia
Diplopia

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4
Q

What are the symptoms of posterior uveitis?

A

Gradual visual loss
Blurred vision
Absence of anterior symptoms

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5
Q

What is seen on fundoscopy in anterior uveitis?

A

Diffuse conjunctival injection
Hazy aqueous
Anterior synechiae
Keratitic precipitates on cornea

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6
Q

What is seen on fundoscopy in posterior uveitis?

A

Inflammatory cells in the vitreous

Oedeomatous optic nerve and disc

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7
Q

What is the treatment of uveitis?

A

Topical/PO steroids

Cyclopentolate (cycloplegic-mydriatic drug) to paralyse ciliary body, relieve pain and prevent adhesions

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8
Q

What are the features of episcleritis?

A

Mild pain/discomfort
Grittiness
Watering

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9
Q

What is the most common type of scleritis?

A

Anterior

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10
Q

What are the risk factors for scleritis?

A

RA and GPA
CTDs
Sarcoid
UC

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11
Q

What are the features of scleritis?

A

Severe boring pain radiating to forehead/jaw
Localised or diffuse red eye
Gradual decrease in vision

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12
Q

What are the signs of scleritis?

A

Reduced visual acuity
Bluish tinge to sclera
Sectoral or diffuse redness
Tender globe

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13
Q

What percentage of scleritis patients have a systemic vasculitis?

A

15%

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14
Q

How is scleritis diagnosed?

A

B-scan USS of globe

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15
Q

What is the treatment of scleritis?

A

PO NSAIDs –> PO pred –> MTX/AZA

If necrotising, skip furst step

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16
Q

What are the 3 types of blepharitis?

A

Staphylococcal
Seborrhoeic
Meibomian

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17
Q

What are the complications of scleritis?

A

Scleral thinning
Raised IOP
Retinal detachment
Phthisis (globe atrophy)

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18
Q

What is chalazion?

A

Meibomian cyst

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19
Q

What is madarosis?

A

Loss of eyelash

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20
Q

How can you differentitate keratitis from uveitis?

A

Normal pupillary reaction in keratitis

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21
Q

How is herpes simplex keratitis diagnosed?

A

Dendritic corneal ulcer - fluoroscein stainin

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22
Q

What is orbital cellulitis?

A

Infection of the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe

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23
Q

What is periorbital cellulitis?

A

Infection anterior to the orbital septum

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24
Q

What is the clinical difference between orbital and periorbital cellulitis?

A

In periorbital - no visual changes, proptosis, ophthalmoplegia, or pain with eye movements

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25
How is orbital cellulitis diagnosed?
CT with contrast Swab Blood cultures
26
What is seen on examination in orbital cellulitis?
Reduced visual acuity Afferent pupillary defect Proptosis Oedema and erythema
27
Where do the changes of macular degeneration occur?
Central area of retina - macula
28
What are the characteristics of dry AMD?
``` Soft drusen (Yellow round spots in Bruch's membrane) Atrophy and changes to pigment of the retinal pigment epithelium (RPE) ```
29
What are the characteristics of wet AMD?
New blood vessels grow in from the choriocapillaris under the retina They spread around the RPE, are fragile and leak easily Cause disciform scarring
30
Name 5 risk factors for AMD?
``` Smoking Age Family history Obesity AMD in one eye ```
31
How does AMD present?
Scotoma Reduced visual acuity particularly for near vision Decreased contrast, colour, dark adaptation Photopsia and light glare Wet - diplopia and distortion
32
How is dry AMD diagnosed?
Distortion of Amsler grid lines Fundoscopy - drusen, yellow macular scar, hypo/hyperpigmentation of RPE
33
How is wet AMD diagnosed?
Well demarcated red patches - retinal/sub RPE haemorrhages Fluorescein angiography
34
What does colour fundus photography do?
Records the appearance of the retina
35
What is the treatment of dry AMD?
Stop smoking | Zinc with vit A, C, E reduce progression in 1/3
36
For which patients is zinc and anti-oxidants contraindicated?
Smokers - beta-carotene increases risk of lung cancer
37
What is the treatment of wet AMD?
Intra-vitreal anti-VEGF e.g. ranibizumab Laser photocoagulation
38
What is VEGF?
Pro-angiogenic growth factor which stimulates vascular permeability
39
What is damaged in glaucoma?
Optic nerve head | Loss of retinal ganglion cells and axons
40
What is raised intra-ocular pressure?
>21mmHg
41
What are the causes of secondary glaucoma?
``` Inflammatory e.g. with uveitis Phacogenic (caused by capsular rupture of the lens) Intra-ocular haemorrhage Steroid induced Traumatic ```
42
What are the characteristics of absolute glaucoma?
NO vision Pupillary reflex lost Stony eye Painful +++
43
What part of the eye produces aqueous humour?
Ciliary body
44
What is the anterior chamber angle?
Junction of the iris and cornea at the periphery of the anterior chamber Aqueous humour drains through the trabecular meshwork here
45
What part of the visual field is affected in glaucoma?
Peripheral --> central
46
What is the cause of primary open angle glaucoma?
Chronic degenerative obstruction of trabecular meshwork | Painless
47
What is the cause of closed angle glaucoma?
Iris displaced against cornea which closes iridocorneal angle - aqueous humour cannot flow from posterior to anterior chamber
48
What are the risk factors for glaucoma?
``` Raised IOP Myopia Diabetes Positive FH Women - shallow anterior chambers Steroids ```
49
Which drugs precipitate acute glaucoma?
Anti-cholinergics | TCAs
50
How does closed angle glaucoma present?
Redness Ocular pain Blurred vision
51
How does acute closed angle glaucoma present?
Severe pain Coloured halos around lights Very high IOP N+V
52
What is a direct marker of disease progression in glaucoma?
Diameter of optic disc
53
How is IOP measured?
Tonometry
54
What is seen on examination in CAG?
``` Hazy cornea, redness Non-mid reactive mid-dilated pupil Shallow anterior chambers Closed iridocorneal angles Corneal epithelial oedema ```
55
What is the mechanism of topical timolol in glaucoma?
Reduce aqueous secretion by inhibiting beta-adrenoreceptors on the ciliary body
56
What is the mechanism of topical prostaglandin analogue in glaucoma?
Increase aqueous outflow via the uveoscleral route
57
What are the side effects and contraindications of topical travaprost?
SE: change in eye colour, thickening/lengthening of eyelashes CI: severe asthma, aphakia
58
What is the mechanism of action of topical pilocarpine?
Causes contraction of the ciliary muscle, opens the trabecular meshwork, causes increased outflow of the aqueous humour
59
What is surgical management of glaucoma?
Laser peripheral iridotomy | Trabeculectomy
60
What is the condition where there is reactivation of VZV in the area supplied by the ophthalmic division of the trigeminal nerve?
Herpes Zoster ophthalmicus
61
What is Hutchinson's sign in herpes zoster ophthalmicus?
Rash on tip or side of nose Indicates nasociliary involvement Strong risk factor for ocular involvement
62
What are 3 causes of optic neuritis?
MS Diabetes Syphilis
63
What are the stages of non-proliferative diabetic retinopathy?
1. Background - microaneurysms 2. Mod - microaneurysms, intraretinal haemorrhages, cotton wool spots, venous beading 3. Severe - the above in all quadrants
64
What is the treatment of proliferative diabetic retinopathy?
Panretinal photocoagulation
65
How is diabetic retinopathy diagnosed?
Dilated retinal photography
66
What is the treatment of diabetic maculopathy?
Focal laser photocoagulation
67
What are the types of diabetic maculopathy?
Focal/diffuse macular oedema Ischaemic maculopathy Clinically significant macular oedema
68
What is the Keith-Wagener classification of hypertensive retinopathy?
1. silver wiring 2. AV nipping 3. Cotton wool exudates, flame and blot haemorrhages 4. Papilloedema
69
What is seen on fundoscopy in central retinal artery occlusion?
Cherry red spot
70
How is central retinal vein occlusion differentiated from central retinal artery occlusion?
Vein - severe retinal haemorrhages, disc oedema | Artery - cherry red spot, RAPD
71
What is the treatment of central retinal vein thrombosis?
Panretinal laser photocoagulation if macular oedema/neovascularisation
72
What is the treatment of central retinal artery thrombosis?
Ocular massage Anterior chamber paracentesis/lower IOP Artery dilatation
73
What is retinal detachment?
The neurosensory layer of the retina separates from the underlying retinal pigment epithelium
74
What are 8 risk factors for retinal detachment
``` Age Jewish Marfans Myopia FH Prev cataract surgery Wet AMD Lattice degeneration ```
75
Why is myopia a risk factor for retinal detachment?
Eyeball is longer | Peripheral retina is thinner and more likely to tear
76
What is the visual loss in retinal detachment?
Peripheral --> central | Flashes and floaters
77
What are the symptoms of vitreous haemorrhage?
Floaters, but no flashes
78
What are the symptoms of vitreous detachment?
Floaters and flashes
79
What are the signs of retinal detachment?
Gross visual defects Cells in the anterior chamber Tobacco dust RAPD
80
What is a risk factor for vitreous haemorrhage?
Diabetes
81
What is the pathway of the pupillary light reflex?
Afferent: retina --> optic nerve --> lateral geniculate body --> midbrain Efferent: Edinger-Westphal nucleus in midbrain --> oculomotor nerve
82
What is the cause of Marcus-Gunn pupil?
RAPD Lesion anterior to optic chiasm: optic nerve lesions or severe retinal defect Retinal detachment Optic neuritis
83
What is the swinging light test in RAPD?
Light shone to unaffected eye - both pupils constrict Light shone to affected eye - less light detected so both pupils dilate
84
Interruption of the sympathetic nerve supply to the eye is known as?
Horner's syndrome
85
What are the symptoms of Horner's syndrome?
Miosis (constricted pupil) Ptosis Enophthalmos (sunken eye) Anhidrosis (loss of sweating to one side)
86
In what condition is heterochromia seen?
Congenital horner's
87
How can the cause of Horner's syndrome be differentiated?
Anhidrosis Face, trunk, arms -> central Face--> pre-ganglionic None --> post ganglionic
88
What are 5 central causes of Horner's syndrome?
``` Stroke Syringomyelia MS Tumour Encephalitis ```
89
What are 4 pre-ganglionic causes of Horner's syndrome?
Pancoast's tumour Thyroidectomy Trauma Cervical rib
90
What are 3 post-ganglionic causes of Horner's syndrome?
Carotid artery dissection/aneurysm Cavernous sinus thrombosis Cluster headache
91
How is Horner's syndrome diagnosed?
Apraclonidine eye drops - causes dilation | Hydroxyamphetamine
92
Which genetic condition causes night blindness and tunnel vision?
Retinitis pigmentosa
93
What is seen on fundoscopy in retinitis pigmentosa?
Black bone spicule shaped pigmentation in the peripheral retina, mottling of RPE
94
What is retinis pigmentosa associated with?
``` Refsum disease Usher syndrome Abetalipoproteinaemia Lawrence-Moon-Biedl syndrmoe Kearns-Sayer syndrome Alport syndrome ```
95
What is the pathophysiology of pseudoxanthoma elasticum?
Calcium accumulates in abnormal elastic fibres
96
What are the features of pseudoxanthoma?
``` Yellow lax wrinkled skin Claudication, angina, MV prolapse Cardiomyopathy Angioid streaks and retinal haemorrhages Increased risk of miscarriage ```
97
What are 6 differentials for painless loss of vision?
``` Cataracts PVD or RD Retinal artery/vein occlusion Amaurosis fugax POAG Hydroxychloroquine/isoretinoin ```
98
What is seen on fundoscopy in papilloedema?
``` Venous engorgement Loss of venous pulsation Elevation of optic disc Loss of optic cup Blurring of disc margin Paton's lines ```
99
Name 5 causes of papilloedema.
``` Space occupying lesions Malignant hypertension Vitamin A toxicity Hypercapnia IIH ```
100
What are the congenital causes of optic atrophy?
Friedreich's ataxia Leber's optic atrophy DIDMOAD
101
What are the acquired causes of optic atrophy?
MS Raised IOP Ischaemia Vit B1, B2, B6, B12 deficiency
102
What are the characteristics of Holmes-Adie pupil?
Dilated pupil Once constricted, remains small for an abnormally long time Slowly reactive to accommodation but very poorly to light
103
What is Holmes-Adie syndrome associated with?
Absent knee and ankle reflexes
104
What are 4 causes of mydriasis?
3rd nerve palsy Holmes Adie pupil Traumatic iridoplegia Phaeochromocytoma
105
What drugs cause mydriasis?
Atropine, tropicamide Cocaine TCAs
106
What is the cause of thyroid eye disease?
Cross-reactivity against shared antigens in thyroid and orbital tissue Stimulates orbital fibroblasts to produce glycosaminoglycans which causes increased T lymphocytes
107
What is a risk factor for thyroid eye disease?
Smoking
108
What is a complication of thyroid eye disease?
Dysthyroid optic neuropathy - loss of colour vision and reduced acuity

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