Ophthal Flashcards
Sudden painless vision loss, unilateral
Central Retinal Artery Occlusion
-Cherry red spot over a pale retina
-Relative afferent pupillary defect
Typically caused by an embolus leading to ischaemia of retina
What is a Marcus Gunn pupil?
Whats is indicate of?
Also known as a RAPD
Either optic neuritis or retinal detachment or ischaemia
What are the symptoms of AACG
-Severe pain
-Decreased visual acuity
-Haloes of light
-Vomiting and headache
-Semi dilated, non reactive pupil
-corneal oedema
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How do you manage AACG?
A combination of;
-Pilocarpine
-beta blocker
-alpha 2 agonist (apraclonidine)
can also use
-IV acetazolamide
Definitive management is
-laser peripheral iridotomy
Most common cause of blindness in the UK?
Age related macular degeneration
What are the two types of ARMD?
-Dry (90% of cases); typically see drusen which is yellow spots on brusch’s membrane
-Wet (10% of cases), also known as exudative or neovascular
Symptoms of ARMD?
A reduction in visual acuity, especially for near objects
-Gradual in dry
-Subacute in wet
-Difficulties in dark adapatation
-Suffer from photopsia- flickering lights and a glare around objects
-visual hallucinations can occure- charles bonnet syndrome
Signs of ARMD?
-Distorition of lines on amsler grids
-fundoscopy reveals the presence of drusen, can form a macular start
-in wet ARMD, well demarcated red patches can be seen which is intra-retinal or sub-retinal fluid leakage
Treatment of ARMD
-For dry use a combination of zinc with antioxidant vitamins A, C and E
-For wet, use anti-vegf injections such as ranabizumab, bevacizumab and pegaptanib
Treatment of anterior uveitis?
urgent ophtal review
cycloplegics eg atropine
What are the features of an argyll robertson pupil?
ARP PRA- accomodation relfex present but pupillary reflex absent
eg no response to light but response to accomodation
Causes of argyll robertson pupil?
Syphilis
Diabetes mellitus
Sudden unilateral vision loss
Central retinal vein occlusion
-Fundoscopy shows widespread hyperaemia and severe retinal haemorrages (stormy sunset)
Treatment is usually conservative, can use veg-f or photocoagulation
What is this and what are the risk factors?
Corneal ulcer/keratitis
-contact lenses
-vitamin A deficiency
What are the three types of diabetic eye disease?
-non proliferative diabetic retinopathy
-proliferative diabetic retinopathy
-maculopathy
Features of NPDR?
-Microaneurysms
-blot haemorrages
-hard exudates
-cotton wool spots (areas of retinal infarction)
Severe when blot haemorrages and microaneurysms in 4 quadrants/venous bleeding in 2 quadrants/IRMA in 1 quadrant
Feature of proliferative diabetic retinopathy
tx?
Retinal neovascularisation- may lead to vitreous haemorrage
Fibrous tissue forming anterior to reitnal disc
More common in T1DM
Tx with photocoagulation and veg-f
What is maculopathy?
tx?
Hard exudates and other ‘background’ changes on macula, more common in T2DM
Treated with intravitreal anti veg-f
Episcleritis vs scleritis differences
What can you use to help differentiate them?
Episcleritis is not painful
In episcleritis the injected vessels are mobile
Can use phenylephrine drops, if the eye redness improves then suggestive of episcleritis
Difference between a chalazion and a stye?
Stye (hordeolum externum), usually a staph infection
Chalazion (meibomian cyst) presents a firm painless lump in the eyelid
Features of holmes aide pupil?
More common in women
Dilated pupil
Slowly reactive to accomodate but very poorly reactive to light
Can also get absent ankle and knee reflexes
What are the features of horner’s syndrome?
-miosis (constricted pupil)
-ptosis
-enophthalmos
-anhidrosis
What is used to classify hypertensive retinopathy?
Keith- Wagener classification
What are the stages of hypertensive retinopathy?
1- arteriolar narrowing and increased light reflex
2-AV nipping
3-Cotton wool exudates, flame and blot haemorrages, can lead to macula star
4- papilloedema
