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General practice > ophthal II > Flashcards

ophthal II Flashcards

1
Q

What is a key finding associated with macular degeneration in fundoscopy

A

Drusen (larger and in greater numbers indicate macular degeneration)

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2
Q

Types of age related macular degeneration

A

Wet and dry (wet carries worse prognosis)

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3
Q

What are drusen

A

Yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane

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4
Q

Features of wet and dry AMD

A

Drusen
Atrophy of the retinal pigment epithelium
Degeneration of the photoreceptors

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5
Q

Feature specific to wet AMD

A

Development of new vessels growing from the choroid layer into the retina due to VEGF

These vessels can leak fluid or blood and cause oedema and more rapid loss of vision

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6
Q

Risk factors for AMD

A 
Age
Smoking
White or Chinese ethnic origin
Family history
Cardiovascular disease
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7
Q

Key visual changes in AMD

A

Gradual worsening central visual field loss
Reduced visual acuity
Crooked or wavy appearance to straight lines

(Wet presents more acutely)

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8
Q

Examination findings in AMD

A

Reduced acuity using a Snellen chart
Scotoma (a central patch of vision loss)
Fundoscopy. Drusen are the key finding.

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9
Q

Which test can assess for distortion of straight lines in AMD

A

Amsler grid test

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10
Q

Diagnosis of AMD

A

Slit-lamp biomicroscopic fundus exam

Optical coherence tomography

Fluorescein angiography

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11
Q

Mx of dry AMD

A

Ophthal referral

Avoid smoking
Control BP
Vitamin supplementation

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12
Q

Mx of wet AMD

A

Urgent referral

Anti-VEGF meds(bevacizumab)

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13
Q

Signs of hypertensive retinopathy on fundoscopy

A 
Silver/copper wiring 
Arteriovenous nipping 
Cotton wool spots 
Hard exudates 
Retinal haemorrhages 
Papilloedema
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14
Q

What does silver/copper wiring refer to in fudoscopy

A

the walls of the arterioles become thickened and sclerosed causing increased reflection of the light.

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15
Q

What is arteriovenous nipping

A

Arterioles cause compression of the veins where they cross. This is again due to sclerosis and hardening of the arterioles.

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16
Q

Classification used for hypertensive retinopathy

A

Keith-Wagener Classification

Stage 1 - mild narrowing of arterioles

Stage 4 - papillodema

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17
Q

Risk factors for cataracts

A 
Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia
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18
Q

Presentation of cataracts

A

Very slow reduction in vision

Progressive blurring of vision

Change of colour of vision with colours becoming more brown or yellow

“Starbursts” can appear around lights, particularly at night time

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19
Q

Mx of cataracts

A

Surgery

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20
Q

Potential serious complication of cataracts

A

Endophthalmitis

It is inflammation of the inner contents of the eye, usually caused by infection

Can lead to vision loss and loss of eye itself

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21
Q

What can cause the pupil to appear as a vertical oval shape

A

Acute angle closure glaucoma can cause ischaemic damage to the muscles of the iris causing an abnormal pupil shape, usually a vertical oval.

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22
Q

What is rubeosis iridis

A

(neovascularisation in the iris) can distort the shape of the iris and pupil

This is usually associated with poorly controlled diabetes and diabetic retinopathy.

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23
Q

What is a tadpole pupil and what is associated with

A

There is spasm in a segment of the iris causing a misshapen pupil. This is usually temporary and associated with migraines.

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24
Q

Causes of mydriasis

A 
Third nerve palsy
Holmes-Adie syndrome
Raised ICP 
Congenital
Trauma
Stimulants
Anticholinergics
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25
Q

Causes of miosis

A 
Horners syndrome
Cluster headaches
Argyll-Robertson pupil (in neurosyphilis)
Opiates
Nicotine
Pilocarpine
26
Q

What can cause compression of oculomotor nerve

A

Cavernous sinus thrombosis and a posterior communicating artery aneurysm

27
Q

What does a third nerve palsy with sparing of the pupil indicate

A

microvascular cause as the parasympathetic fibres are spared

28
Q

Causes of CN III palsy with pupil sparing

A

Diabetes
Hypertension
Ischaemia

29
Q

Causes of CN III palsy without pupil sparing

A 
Idiopathic
Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised intracranial pressure

(Called a surgical third)

30
Q

Causes of horner’s syndrome

A 
Stroke 
MS
Pancoast's
Trauma 
Carotid aneurysm
31
Q

What is congenital horner syndrome associated with

A

Heterochromia

32
Q

What can be used to test for horner syndrome

A

Cocaine eye drops (no pupil reaction on administration)

33
Q

What is a Holmes Adie pupil

A

unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction

caused by damage to the post-ganglionic parasympathetic fibres

34
Q

What is argyll-robertson pupil

A

Specific finding in neurosyphilis. It is a constricted pupil that accommodates when focusing on a near object but does not react to light

35
Q

What is blepharitis

A

gritty, itchy, dry sensation in the eyes. It can be associated with dysfunction of the Meibomian glands

36
Q

Mx of blepharitis

A

hot compresses and gentle cleaning of the eyelid margins(sterilised water and baby shampoo)

Lubricating eye drops

37
Q

Types of stye

A

Hordeolum external - sweat glands at base of eyelashes tender red lump along eyelid

Hordeolum internum - meibomian glands - deeper infection

38
Q

Mx of stye

A

hot compresses and analgesia

Topical antibiotics(chloramphenicol) if conjunctivitis present

39
Q

What is a chalazion

A

Meibomian gland becomes blocked and swells up

40
Q

Mx of chalazion

A

Treatment is with hot compress and analgesia. Consider topic antibiotics (i.e. chloramphenicol) if acutely inflamed.

41
Q

What is an entropion

A

eyelid turns inwards with the lashes against the eyeball

Results in corneal damage and ulceration

42
Q

Mx of entropion

A

taping the eyelid down to prevent it turning inwards

Definitive mx is surgical intervention (same day referral required if risk to sight)

43
Q

What is an ectropion

A

Ectropion is where the eyelid turns outwards with the inner aspect of the eyelid exposed. It usually affects the bottom lid.

44
Q

What can ectropion result in

A

exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected

45
Q

Mx of ectropion

A

Mild cases may not require treatment. Regular lubricating eye drops are used to protect the surface of the eye. More significant cases may require surgery to correct the defect.

Same day referral if risk to sight

46
Q

What is trichiasis

A

inward growth of the eyelashes

can result in corneal damage and ulceration

47
Q

Mx of trichiasis

A

Management by a specialist is to remove the eyelash (epilation).

Recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent the lash regrowing.

Same day referral may be required if risk to sight

48
Q

What is periorbital cellulitis

A

eyelid and skin infection in front of the orbital septum (in front of the eye). It presents with swelling, redness and hot skin around the eyelids and eye.

49
Q

How can periorbital cellulitis be differentiated from orbital cellulitis

A

CT scan

50
Q

Treatment of periorbital cellulitis

A

Systemic antibiotics(oral or IV)

51
Q

What is orbital cellulitis

A

Orbital cellulitis is an infection around the eyeball that involves tissues behind the orbital septum.

52
Q

Orbital vs periorbital cellulitis

A

Key features that differentiate this from periorbital celluitis is pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball (proptosis).

53
Q

Mx of orbital cellulitis

A

medical emergency that requires admission and IV antibiotics. They may require surgical drainage if an abscess forms.

54
Q

Presentation of retinal vein occlusion

A

Sudden painless loss of vision

Macula oedema

Retinal haemorrhages

Neuovascularisaiton

55
Q

Risk factors for retinal vein occlusion

A 
Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
SLE
56
Q

Mx of retinal vein occlusion

A

Immediate referral
Laser photocoagulation
Intravitreal steroids(dexamethasone)
Anti-VEGF therapies

57
Q

Causes of central retinal artery occlusion

A

Atherosclerosis

Giant cell arteritis

58
Q

Risk factors for retinal artery occlusion

A 
Older age 
FHx 
Smoking 
Alcohol 
HTN 
Diabetes
59
Q

Presentation of central retinal artery occlusion

A

Sudden painless loss of vision

RAPD

60
Q

what might fundoscopy show in CRAO

A

Pale retina with cherry red spot(pale due to lack of perfusion and cherry-red spot is macula)

61
Q

General mx of CRAO

A

Immediate referral

IX for GCA

62
Q

Acute mx of CRAO

A

Ocular massage
Removal of fluid from anterior chamber
Carbogen
Sublingual isosorbide dinitrate

General practice (26 decks)

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