Ophthal Flashcards
Leading cause of blindness in developing world + Rx:
TRACHOMA ~Chlamydia:
turned in eyelashes/lids (trichiasis) + chronic conjunctivitis
Rx: PO azithromycin
Posterior scleritis features and management
PAINFUL loss of vision + proptosis + swollen eye lid + swollen optic disc
Rx: PO NSAID +/- Prednisolone
OR subconjunctival steroid + Methotrexate
Infective keratitis features
PAINFUL blurred vision, photophobia, epiphora
Circumcorneal injection + conjunctivitis ~infection
AACG features and management
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
Acute anterior uveitis features and management
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)
Vitreous detachment features and management
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
CRVO features
Sudden painless loss of vision in those with CVS RFs
Fundoscopy: “stormy sunset” flame haemorrhages, optic disc oedema
CRAO features and Rx
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
Blue-tinged vision secondary to drug
Sildenfail/Viagra - often bought online
Dendritic ulcer cause and Rx:
HSV
Topical acyclovir
NO STEROIDS as can cause deep-seated infection and permanent vision loss
CMV retinitis features and Rx
White retinal deposits
Small haemorrhages
“pizza pie”
Often starts in one eye then progresses to other
Rx: antiviral
Newborn with white pupil + loss of red reflex. DX and RX?
Retinoblastoma
Rx: brachytherapy + chemotherapy (intraarterial)
Cryotherapy an option
Enucleation for large unilateral tumours
Newborn with cloudy pupil ?Dx
Congenital cataracts
Can be related to rubella
Rx: surgery (lens replacement)
Hutchinson’s sign
Vesicles on tip of nose ~specific sign for herpes zoster opthalmicus
Suggest nasociliary nerve involvement
Requires urgent antivirals + Ophthal referral
3rd nerve palsy signs
Down and out, ptosis, DILATED
Sebaceous cell carcinoma presentation
Often like a chalazion but persists
Associated loss of eyelashes
NB. 3rd most common eyelid malignancy following BCC and SCC
Pterygium presentation
Middle Easterns ~wind, dust, UV light
Triangular fibrovascular growth on conjunctiva that can irritate and affect vision
Dacrocystitis definition and presentation and management
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
Trichiasis definito and causes
Eyelashes growing toward eye (usually lower lid)
~irritation, redness, watery eyes
Causes:
- entropion
- Chlamydia
- burns
- pemphigoid
Genetic diseases associated with myopia
Marfans
Ehlers Danlos
Homocystinuria
Treat with concave (cave inward) lenses as light focussing in front of retina
Causes of choroiditis/chorioretinitis
Immunosuppressed individuals: CMV TB Toxo Sarcoid NOT Chlamydia
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
Cataracts
RFs: Smoking DM Steroids (prednisolone) Trauma Uveitis
Rapidly progressive proptosis in child, what to rule out?
Rhabdomyosarcoma:
Most common primary orbital malignancy in childhood
River blindness organism and treatment
Onchocera volvulus (microfilariae)
Rx: Ivermectin
Botulinum is injected into which muscle when treatingblepharospasm?
Orbicularis oculi
Fever and toothache -> swollen, warm red eyelid
Orbital cellulitis
Often starts from paranasal sinus infection, dental infection or external ocular infection
Needs urgent ENT/Ophtal/MaxFax review and ABX +/- surgery
Seasonal vs perennial allergic conjunctivitis
Seasonal: summer months (pollen)
Perennial: year round, often worse in winter (due to dust mites in blankets)
Keratoconjunctivtis sicca Px and Dx test
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
Cataracts:
causes
signs and symptoms
Rx
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
Holmes-Adie pupil features
Slowly reactive to accommodation Poorly reactive to light Dilated pupil 80% unilateral Benign
If associated with loss of reflexes = Holmes-Adie syndrome
Definitive treatment of AACG
Laser peripheral iridotomy;
creates new pathway for aqueous to drain from posterior to anterior chamber, in order to be drained into angle
Argyl Robertson Pupil features and causes
Accommodation Reflex Present, Pupillary Reflex Absent
Ax: DM, neurosyphilis
Presentation and causes of lens dislocation
Sudden loss of vision
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Associations:
- Marfans
- Ehlers-Danlos
- Homocystinuria
- Trauma
very similar associations for myopia
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scleritis vs episcleritis?
Scleritis much more painful
Eye manifestations of RA
Keratoconjunctivitis sicca (most common)
Keratitis
Episcleritis
Corneal ulcer
Opthalmia neonatorum organisms and presentation
Chlamydia: 2-3 weeks old
Gonorrhoea: 1-5 days, purulent +++
Toxoplasmosis retinitis
white focal retinitis + overlying vitreous inflammation
CVS RFs + pale, swollen optic disc
anterior ischaemic neuropathy
Post cataracts surgery, redevelop cloudy vision within a few months
Dx and Rx
Posterior capsule thickening
Rx: capsulotomy + laser surgery
(cataract recurrence would take longer)
Allergic conjunctivitis Rx
1st: Topical antihistamine eg. emadastine
Topical steroids if needed
Usual bacteria in bacterial keratitis
pseudomonas
