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Tomakesense 2 > Ophthal > Flashcards

Ophthal Flashcards

1
Q

Leading cause of blindness in developing world + Rx:

A

TRACHOMA ~Chlamydia:
turned in eyelashes/lids (trichiasis) + chronic conjunctivitis

Rx: PO azithromycin

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2
Q

Posterior scleritis features and management

A

PAINFUL loss of vision + proptosis + swollen eye lid + swollen optic disc

Rx: PO NSAID +/- Prednisolone
OR subconjunctival steroid + Methotrexate

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3
Q

Infective keratitis features

A

PAINFUL blurred vision, photophobia, epiphora

Circumcorneal injection + conjunctivitis ~infection

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4
Q

AACG features and management

A

PAINFUL loss of vision + systemic symptoms + minimally reactive to light + haloes
Semi dilated pupil

(loss of vision tends to be peripheral)

Rx:
Initial:
- miotics eg. pilocarpine (to allow drainage)
- acetazolamide (reduce aqueous production)

Definitive: Laser/surgical iridcectomy once IOP down

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5
Q

Acute anterior uveitis features and management

A

Often seen in those with AI Disease
HLAB27 - Ank Spond
HLAB5 - Behcet’s

Features:
acutely painful and red eye, photophobia, reduced visual acuity
Slitlamp: inflammatory cells/hypopyon in anterior chamber
Small pupil
Positive Talbot’s sign: worse pain on convergence and accommodation

Complication: Posterior synechiae (irregular pupil stuck to lens ie. dilates poorly)

Rx: steroid eye drops + anticholinergics eg. cyclopentolate/atropine (relaxes ciliary body to mrdriate and discourage adhesions between iris and lens)

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6
Q

Vitreous detachment features and management

A

Caused by bleeding of new vessels

Small haemorrhage: floaters/spots, no loss of acuity

Large haemorrhage: dark streaks, shadow/haze, reduced acuity, absent red reflex, may be unable to see retina

Resolve spontaneously

Rx: Laser photoagulation

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7
Q

CRVO features

A

Sudden painless loss of vision in those with CVS RFs

Fundoscopy: “stormy sunset” flame haemorrhages, optic disc oedema

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8
Q

CRAO features and Rx

A

Sudden painless loss of vision
Fundoscopy: pale retina, cherry red spot, RAPD
Responds poorly to light but consensual reflex present

Rx: RF control

Permanent visual loss within 1 hour

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9
Q

Blue-tinged vision secondary to drug

A

Sildenfail/Viagra - often bought online

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10
Q

Dendritic ulcer cause and Rx:

A

HSV

Topical acyclovir
NO STEROIDS as can cause deep-seated infection and permanent vision loss

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11
Q

CMV retinitis features and Rx

A

White retinal deposits
Small haemorrhages
“pizza pie”
Often starts in one eye then progresses to other

Rx: antiviral

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12
Q

Newborn with white pupil + loss of red reflex. DX and RX?

A

Retinoblastoma

Rx: brachytherapy + chemotherapy (intraarterial)
Cryotherapy an option
Enucleation for large unilateral tumours

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13
Q

Newborn with cloudy pupil ?Dx

A

Congenital cataracts
Can be related to rubella

Rx: surgery (lens replacement)

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14
Q

Hutchinson’s sign

A

Vesicles on tip of nose ~specific sign for herpes zoster opthalmicus

Suggest nasociliary nerve involvement

Requires urgent antivirals + Ophthal referral

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15
Q

3rd nerve palsy signs

A

Down and out, ptosis, DILATED

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16
Q

Sebaceous cell carcinoma presentation

A

Often like a chalazion but persists
Associated loss of eyelashes

NB. 3rd most common eyelid malignancy following BCC and SCC

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17
Q

Pterygium presentation

A

Middle Easterns ~wind, dust, UV light

Triangular fibrovascular growth on conjunctiva that can irritate and affect vision

18
Q

Dacrocystitis definition and presentation and management

A

Inflammation of lacrimal sac, often recurrent

Pain, swelling, epiphora of medial eyelids, purulent d/c on palpation

Rx: systemic ABx and Opthal referral ?I+D

NB. Distinct to dacroadentis which is inflammatory of gland and is more lateral

19
Q

Trichiasis definito and causes

A

Eyelashes growing toward eye (usually lower lid)
~irritation, redness, watery eyes

Causes:

  • entropion
  • Chlamydia
  • burns
  • pemphigoid
20
Q

Genetic diseases associated with myopia

A

Marfans
Ehlers Danlos
Homocystinuria

Treat with concave (cave inward) lenses as light focussing in front of retina

21
Q

Causes of choroiditis/chorioretinitis

A 
Immunosuppressed individuals:
CMV
TB
Toxo
Sarcoid
NOT Chlamydia
22
Q 
Gradual visual deterioration with frequent glasses changes
Difficulty driving at night
Haloes and glare
Difficulty reading
BILATERAL symptoms
NO PAIN
Loss/defect of red reflex

Dx and RFs

A

Cataracts

RFs:
Smoking
DM
Steroids (prednisolone)
Trauma
Uveitis
23
Q

Rapidly progressive proptosis in child, what to rule out?

A

Rhabdomyosarcoma:

Most common primary orbital malignancy in childhood

24
Q

River blindness organism and treatment

A

Onchocera volvulus (microfilariae)

Rx: Ivermectin

25
Q

Botulinum is injected into which muscle when treatingblepharospasm?

A

Orbicularis oculi

26
Q

Fever and toothache -> swollen, warm red eyelid

A

Orbital cellulitis
Often starts from paranasal sinus infection, dental infection or external ocular infection

Needs urgent ENT/Ophtal/MaxFax review and ABX +/- surgery

27
Q

Seasonal vs perennial allergic conjunctivitis

A

Seasonal: summer months (pollen)
Perennial: year round, often worse in winter (due to dust mites in blankets)

28
Q

Keratoconjunctivtis sicca Px and Dx test

A

Unable to cry
Manifestation of rheum disease eg. Sarcoid, Sjogrens, RA, amyloid, haemochromatosis

Dx: Schirmer’s test: place strip of filter paper on lower eyelid

29
Q

Cataracts:

causes
signs and symptoms
Rx

A 
o	Causes:
	Normal ageing
	Smoking
	Alcohol
	Trauma
	Hypocalcaemia
	Myotonic dystrophy
	DM
	Long term steroids
o	Sx:
	Gradual onset reduced vision, glare, haloes, faded colour
o	Fundoscopy: defect in red reflex
o	Slit lamp: visible cataract
o	Rx:
	Conservative: glasses/lenses
	Surgical
30
Q

Holmes-Adie pupil features

A 
Slowly reactive to accommodation
Poorly reactive to light
Dilated pupil
80% unilateral
Benign

If associated with loss of reflexes = Holmes-Adie syndrome

31
Q

Definitive treatment of AACG

A

Laser peripheral iridotomy;

creates new pathway for aqueous to drain from posterior to anterior chamber, in order to be drained into angle

32
Q

Argyl Robertson Pupil features and causes

A

Accommodation Reflex Present, Pupillary Reflex Absent

Ax: DM, neurosyphilis

33
Q

Presentation and causes of lens dislocation

A

Sudden loss of vision

```
Associations:
- Marfans
- Ehlers-Danlos
- Homocystinuria
- Trauma
very similar associations for myopia
~~~

34
Q

scleritis vs episcleritis?

A

Scleritis much more painful

35
Q

Eye manifestations of RA

A

Keratoconjunctivitis sicca (most common)
Keratitis
Episcleritis
Corneal ulcer

36
Q

Opthalmia neonatorum organisms and presentation

A

Chlamydia: 2-3 weeks old

Gonorrhoea: 1-5 days, purulent +++

37
Q

Toxoplasmosis retinitis

A

white focal retinitis + overlying vitreous inflammation

38
Q

CVS RFs + pale, swollen optic disc

A

anterior ischaemic neuropathy

39
Q

Post cataracts surgery, redevelop cloudy vision within a few months

Dx and Rx

A

Posterior capsule thickening

Rx: capsulotomy + laser surgery

(cataract recurrence would take longer)

40
Q

Allergic conjunctivitis Rx

A

1st: Topical antihistamine eg. emadastine

Topical steroids if needed

41
Q

Usual bacteria in bacterial keratitis

A

pseudomonas

Tomakesense 2 (18 decks)

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