Ophthal Flashcards
Q: What is glaucoma?
A: Glaucoma is a group of disorders characterized by optic neuropathy, primarily due to raised intraocular pressure (IOP). However, a minority of patients with raised IOP do not have glaucoma, and vice versa.
Q: What is acute angle-closure glaucoma (AACG)?
A: AACG is a condition where there is a rise in IOP secondary to impairment of aqueous outflow.
Q: What are the factors predisposing to acute angle-closure glaucoma (AACG)?
A: Factors include hypermetropia (long-sightedness), pupillary dilatation, and lens growth associated with age.
Q: What are the common features of acute angle-closure glaucoma (AACG)?
A: Features include severe ocular pain or headache, decreased visual acuity, symptoms worsened by mydriasis (e.g. watching TV in a dark room), hard, red eye, haloes around lights, semi-dilated non-reacting pupil, corneal oedema resulting in a dull or hazy cornea, and systemic upset such as nausea, vomiting, and abdominal pain.
Q: What investigations are used for acute angle-closure glaucoma (AACG)?
A: Tonometry to assess elevated IOP and gonioscopy to visualize the angle using a special slit lamp lens.
Q: What is the management for acute angle-closure glaucoma (AACG)?
A: AACG is an emergency requiring urgent referral to an ophthalmologist, with medical treatment to lower IOP followed by definitive surgical treatment once the acute attack settles.
Q: What is the definitive management for acute angle-closure glaucoma (AACG)?
A: The definitive treatment is laser peripheral iridotomy, which creates a tiny hole in the peripheral iris to allow aqueous humour to flow to the angle.
Q: What is age-related macular degeneration (ARMD)?
A: ARMD is the most common cause of blindness in the UK, characterized by degeneration of the central retina (macula), often bilateral. It involves degeneration of retinal photoreceptors and the formation of drusen visible on fundoscopy and retinal photography.
Q: What are the risk factors for age-related macular degeneration (ARMD)?
A: Risk factors include advancing age, smoking, family history (especially first-degree relatives), hypertension, dyslipidaemia, and diabetes mellitus.
Q: What is the greatest risk factor for developing ARMD?
A: Advancing age is the greatest risk factor, with the risk increasing threefold in patients over 75 years compared to those aged 65-74.
Q: What are the two traditional classifications of macular degeneration?
A: The two traditional forms are dry macular degeneration (90% of cases) and wet macular degeneration (10% of cases). Dry ARMD is characterized by drusen, while wet ARMD involves choroidal neovascularization and fluid leakage.
Q: What are the clinical features of age-related macular degeneration (ARMD)?
A: Clinical features include subacute onset of visual loss (gradual in dry ARMD and subacute in wet ARMD), difficulties with dark adaptation, fluctuating visual disturbances, photopsia (flickering or flashing lights), glare around objects, and visual hallucinations (Charles-Bonnet syndrome).
Q: How is ARMD detected on fundoscopy?
A: On fundoscopy, drusen (yellow areas of pigment deposition) may be seen in the macular area, which may coalesce to form a macular scar in late-stage disease. In wet ARMD, red patches indicating fluid leakage or hemorrhage may be visible.
Q: What investigations are used to diagnose ARMD?
A: Investigations include slit-lamp microscopy, color fundus photography, fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) for detailed 3D visualization of the retina.
Q: What are the treatment options for dry ARMD?
A: The AREDS trial showed that a combination of zinc and antioxidants (vitamins A, C, and E) reduces disease progression by around one-third in dry ARMD, especially in patients with more extensive drusen.
Q: What is the treatment for wet ARMD?
A: Anti-vascular endothelial growth factor (VEGF) agents like ranibizumab, bevacizumab, and pegaptanib are used to limit progression, stabilize, or reverse visual loss. These agents are typically administered via injection every four weeks.
Q: What role does laser photocoagulation play in ARMD treatment?
A: Laser photocoagulation can slow the progression of wet ARMD where new vessel formation is present but carries a risk of acute visual loss, particularly in sub-foveal ARMD, so anti-VEGF therapies are preferred.
Q: What is allergic conjunctivitis?
A: Allergic conjunctivitis is an eye condition often associated with hay fever, characterized by conjunctival erythema, conjunctival swelling (chemosis), and itchiness.
Q: What are the common features of allergic conjunctivitis?
A: Features include bilateral conjunctival erythema, conjunctival swelling, prominent itching, swollen eyelids, and a possible history of atopy. It may be seasonal (due to pollen) or perennial (due to dust mites, washing powder, or other allergens).
Q: What are the possible causes of seasonal and perennial allergic conjunctivitis?
A: Seasonal allergic conjunctivitis is typically triggered by pollen, while perennial allergic conjunctivitis can be caused by dust mites, washing powder, or other allergens.
Q: What is the first-line treatment for allergic conjunctivitis?
A: The first-line treatment for allergic conjunctivitis is topical or systemic antihistamines.
Q: What is the second-line treatment for allergic conjunctivitis?
A: Second-line treatment includes topical mast-cell stabilizers like Sodium cromoglicate and nedocromil.
Q: What is anterior uveitis (iritis)?
A: Anterior uveitis is inflammation of the anterior portion of the uvea (iris and ciliary body), often referred to as iritis. It is an important differential diagnosis for a red eye and is associated with HLA-B27.
Q: What are the common features of anterior uveitis?
A: Features include acute onset, ocular discomfort and pain (which may increase with use), small and possibly irregular pupil, photophobia (often intense), blurred vision, red eye, lacrimation, ciliary flush (a ring of red spreading outwards), hypopyon (pus and inflammatory cells in the anterior chamber), and initially normal visual acuity that may become impaired.