ophthal Flashcards
Acute painful red eye, fixed mid-dilated unreactive pupil, poor vision
Acute angle closure Glaucoma
Often starts in dark settings e.g. cinema, whilst eye is dilated.
Halos around eyes
Acute angle closure
What medication for acute angle glaucoma and why
CBT (traumatic)
Carbonic anhydrase inhibitor - Acetozolamide - reduces production of aq humour)
Brimonidine/Timolol - (reduces aq humour)
apraclonidine (if no MI).
Consider Pilocarpine - can paradoxically worsen pupil block
Iridotomy
Which presents with a dendritic ulcer?
How might it present
Herpes simplex keratitis.
This is a type of viral keratitis
Acuity may be decreased and it will be red and painful, maybe watery
Management= topical aciclovir
Infection that is common in contact lens wearers
Bacterial keratitis
Most common cause of viral conjunctivitis
Adenovirus
How to differentiate between scleritis and episcleritis
Pain.
Epi insn’t massively painful but scleritis is.
What is scleritis acssociated with
Autoimmune conditions.
How is scleritis treated
Steroid eye drops
How to differentiate between scleritis and episcleritis
Put phenylephrine drops in eye. If this causes vessels to disappear then its episcleritis.
Halos around vision differentials?
Acute angle closure
Cataracts
Which part of the vision is mainly affected in macular degeneration
Can’t see central portion (central scotoma)
What are Amslers grids used to help diagnose
Macular degeneration
How to treat macular degeneration
Dry - not much that can be done
Wet - anti VEGF
Which part of vision is affected in glaucoma
Peripheral so get tunnel vision
Is CRA occlusion painful or painless
What are the other features
Painless
RAPD
cherry red spot
Pale disc.
How to manage CRA occlusion
If due to GCA give steroids.
When might you get central scotoma
Optic neuritis
Macular degeneration
Triad for diagnosis of optic neuritis
visual loss, periocular pain, and dyschromatopsia (change in colour perception)
Also get RAPD
Optic neuritis management
High dose steroids
What is episcleritis associated with
RA
IBD
scleritis and episclerits management
Scleritis - NSAIDs or oral steroids if bad
episcleritis - conservative
Which conditions give you tunnel vision
Glaucoma
Retinitis pigmentosa
Retinitis pigmentosa fundoscopy
black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
What is anterior uveitis associated with
HLAb27
If you see a hypopion what might this be due to
Anterior uveitis
What is the uvea made up of
iris and ciliary body
Management of anterior uveitis
Alsocalled iritis.
urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
steroid eye drops
What is a Marcus gunn pupil?
what causes it?
When there’s a RAPD
Retinal detachment
Optic neuritis
What is Holmes Adie pupil?
Sluggish response to light with direct but constricts normally with accommodation
Argyll robertson pupil
A mnemonic used for the Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
Features
small, irregular pupils
no response to light but there is a response to accommodate
Causes
diabetes mellitus
syphilis
What is Mydriadis and what causes it?
Dilation
Anticholinergics. E.g. CAT
Cyclopentolate Atropine Tropicamide
Sympathomimetics e.g. adrenaline
What is Meiosis
What agents
Constriction
Pilocarpine
What is hypermetropia
Can’t see near
