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Neurology and Special Senses > Ophthalm Presentations > Flashcards

Ophthalm Presentations Flashcards

1
Q

What could cause a red eye? What are the key buzzwords for each

A

Conjunctivitis - Dicharge can be purulent or serous
Blepharitis - Crusts
Subconjunctival haemorrhage
Uveitis - small fixed oval pupil, perilibical injection
Epicleritis - blanch with phenylephrine
Scleritis
Corneal abrasion - visible with fluoroscein
Corneal ulcer (infectious keratitis) - ulcer (dendritic = herpes)
Acute closed angle glaucoma - semi dilated pupil, hazy cornea
Entropion - visible lash involvement

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2
Q

What can cause gradual vision loss?

A 
Macular Degeneration
Diabetic retinopathy
Open angle glaucoma
Cataract
Refractive error
Optic nerve pathology
Drugs
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3
Q

What can cause sudden vision loss?

A 
Retinal vessel occlusion
Closed angle glaucoma
Retinal detachment
Vitreous haemorrhage
Ischaemia
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4
Q

What does painful loss of vision indicate?

A

Serious pathology - malignancy or inflammatory process

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5
Q

What does loss of red reflex mean?

A

Problem with cornea, lens or vitreous

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6
Q

Where is the lesion likely to be if a patient has monocular blindness?

A

Ipsilateral optic nerve

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7
Q

Where is the lesion likely to be if a patient has a homonymous hemianopia?

A

Contralateral optic tract

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8
Q

Where is the lesion likely to be if a patient has a bitemporal hemianopia?

A

Optic chiasm

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9
Q

Where is the lesion likely to be if a patient has a superior quadrantanopia?

A

Contralateral temporal lobe or inferior optic radiation

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10
Q

Where is the lesion likely to be if a patient has a inferior quadrantanopia?

A

Contralateral parietal lobe or superior optic radiation

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11
Q

What does a homonymous hemianopia with macula sparing suggest?

A

Occipital love damage due to posterior cerebral artery infarct

Occipital pole supplied by middle cerebral artery

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12
Q

What can cause double vision?

A 
Microvascular problems
Squint
Trauma
Myasthenia gravis
Thyroid eye disease
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13
Q

What is the difference between monocular and binocular diplopia?

A

Monocular - double vision remain on occlusion of uninvolved eye

Binocular - double vision corrected when either eye is occluded

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14
Q

What causes monocular diplopia?

A

Refractive error
Cataracts
Dislocated lens
Retinal detachment

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15
Q

What causes binocular diplopia?

A

Intermittent - myasthenia gravis

Constant - CN palsy, orbital disease (thyroid), post surgery or trauma

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16
Q

What does a unilateral large pupil indicate?

A

Pupil is poorly constricted in well lit room

Trauma
3rd nerve palsy
Rubeosis Iridis
Holmes-adie
Pharmacological dilation
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17
Q

What causes a unilateral small pupil?

A

Poorly dilated in low lit room

Uveitis
Horner’s
Argyll Robertson
Pharmacological constriction

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18
Q

What is a Holmes Adie pupil?

A

Benign condition due to damage to ciliary ganglion or post ganglionic parasympathetics

Once pupil constricted, remain for long time
Pupil accommodate but slow to react to light

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19
Q

What is an Argyll Robertson pupil?

A

Bilateral sign of neurosyphilis
Damage to midbrain nuclei
Accommodate but slow to react to light

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20
Q

What can cause a relative afferent pupillary defect?

A

Defect in pupillary response - issue with optic nerve/retina

Optic neuritis
Giant cell arteritis
Retinal detachment
Unilateral glaucoma
Retinal artery disease
Optic nerve tumour/infections
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21
Q

What can a fixed dilated pupil be indicative of?

A 
Post traumatic iridocyclitis
Intracranial pathology
CNIII injury
Brainstem injury
Post. communicating artery aneurysm
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22
Q

What drugs cause dilation of a pupil?

A

Topical -
Sympathomimetics (adrenaline)
Antimuscarinics

Systemic - 
Adrenaline
Atropine
TCA's
Amphetamines and ecstasy
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23
Q

What drugs cause pupillary constriction?

A 
Muscarinic agonists (pilocarpine)
Opiates
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24
Q

What can cause ptosis?

A 
CN3 palsy
Bells palsy
Horners syndrome
Myasthenia gravis
Thyroid eye disease
MS
Trauma, infection or lesion
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25
Q

What is optic atrophy?

A

Loss of some or all of the nerve fibres within the optic nerve

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26
Q

How does optic atrophy present?

A

Loss of vision - type depend on cause

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27
Q

How does optic atrophy appear on Fundoscopy?

A

Pale retina
Well demarcated disc
Fewer small vessels crossing surface

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28
Q

What is the aim of management of optic atrophy?

A

Stop progression - optic nerve can’t regenerate

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29
Q

What can bilateral optic atrophy commonly be caused by?

A

Intracranial neoplasm

> 40 - vascular

30
Q

What are the causes for optic atrophy?

A

Primary - MS, Raised IOP, Trauma

Secondary - papilloedema, giant cell arteritis, non arteritis ischaemia

Retinal - artery occlusion

Toxins - quinine, methanol, arsenic

Vitamin B1,2,6,12 deficiency

31
Q

What is myopia/hypermetropia?

A

Myopia = short sightedness

Hypermetropia = long sightedness

32
Q

What are the risks of myopia?

A

Retinal detachment

Macular degeneration

33
Q

What are the risks of hypermetropia?

A

Acute closed angle glaucoma

Convergent squint

34
Q

Why may hypermetropia be picked up late?

A

Accommodation can compensate

Can lead to headaches

35
Q

What is presbyopia?

A

Reduction in accommodative ability with age

Lens and capsule less elastic - less able to accommodate

36
Q

How is presbyopia corrected?

A

Give convex lens

Bifocals if pre-existing refractive error

37
Q

What is astigmatism?

A

Abnormal curvature of the eye - rugby ball

Can cause blurred vision and headaches

38
Q

What is amblyopia?

A

Eye functioning normally but dysfunction processing of visual information

39
Q

How is amblyopia treated?

A

Correct any causative issues
Patch over good eye
Atropine drops in good eye

Aim to blur good eye so the bad eye has to work

40
Q

How is amblyopia diagnosed?

A

Unilateral decrease in visual acuity >2 lines on snellen chart

41
Q

What are the ocular manifestations of diabetes?

A

Retinopathy
Rubeosis iridis
Ocular nerve palsies
Maculopathy - complication of retinopathy

42
Q

How does diabetic retinopathy appear on Fundoscopy?

A

Mild non proliferative - microaneurysms

Moderate non proliferative - microaneurysms, cotton wool spots, flame haemorrhages, hard exudates, venous beading

Severe non proliferative - as above in more quadrants of eye

Severe proliferative - + neovascularisation and vitreous haemorrhage

43
Q

What are flame haemorrhages?

A

Haemorrhages due to weak vessels that track along nerve fibre bundles

44
Q

What are cotton wool spots?

A

Build up of axonal debris - poor axonal metabolism in infarcted areas

45
Q

How is diabetic retinopathy diagnosed?

A

Dilated retinal photography and ophthalmoscopy

46
Q

How often are diabetic patients screened for retinopathy?

A

At diagnosis and annually for patients >12yo

47
Q

How does diabetic retinopathy present?

A

Painless reduction in central vision

Dark painless floaters

48
Q

How is diabetic retinopathy managed?

A

Prevent
Laser treatment of new vessels
Intravitreal steroids
Vitrectomy

49
Q

What is diabetic maculopathy?

A

Macula oedema occurring with retinopathy

Breakdown of blood retinal barrier allow fluid to accumulate

Reduction in central vision

Treat with anti VEGF injections

50
Q

What are the ocular manifestations of neurofibromatosis?

A

Lisch nodules

51
Q

What are the ocular manifestations of shaken baby syndrome?

A

Intra retinal haemorrhages

52
Q

What are the ocular manifestations of TIA?

A

Amaurosis Fugax

53
Q

What are the ocular manifestations of hyper viscosity syndromes?

A

Amaurosis fugax, visual loss, retinal vein dilation, haemorrhage, disc oedema

54
Q

What are the ocular manifestations of sickle cell?

A

Retinal artery occlusion - peripheral neovascularisation and haemorrhage

55
Q

What cancers metastasise to the eye and how do they manifest?

A

Breast and Lung

Creamy white lesion in choroid
Irregular pupil shape
Hyphema

56
Q

How does papilloedema look on Fundoscopy?

A

Cupping of optic disc
Blurring of optic disc margin
Venous engorgement
Loss of venous pulsation

57
Q

What are the types of uveitis?

A

Granulomatous - blurred vision, mild pain, watering, sarcoid, TB

Non granulomatous - acute pain and photophobia - herpes, ank spond, IBD

58
Q

What causes retinal vasculitis?

A 
Behcet
Sarcoid
MS
RA
SLE
Temporal arteritis
59
Q

How does retinal vasculitis present?

A

Painless loss of vision - esp. colours
Floaters
Scotomas

60
Q

How does optic neuritis present?

A

Reduced vision - exaggerated by heat
Pain on eye movement
Impaired colour vision

Can have socotoma, photopsia, RAPD

61
Q

How is optic neuritis managed?

A

V high dose steroids

62
Q

How does amaurosis fugax present?

A

Curtain drawing from above

Temporary loss of vision - between seconds to hours

63
Q

What causes amaurosis fugax?

A

Emboli or atherosclerosis
Temporary vasospasm
Giant cell arteritis

64
Q

What can cause hornets syndrome?

A

Pancoast tumour
Thyroid tumour
Carotid dissection
Cavernous sinus thrombosis

65
Q

What are the phases of thyroid eye disease?

A

Active inflammatory - expansion of extra ocular muscles and orbital fat

Inactive fibrotic - lead to sight loss if active phase not treated

66
Q

How does thyroid eye disease present?

A 
Proptosis
Lid retraction
Orbital fat prolapse
Diplopia
Optic neuropathy
Exposure keratopathy
Decreased ocular mobility
67
Q

How would you investigate thyroid eye disease?

A

TSH, free t4, thyroid autoantibodies

MRI

68
Q

How is thyroid eye disease managed?

A

Achieve euthyroid state
Smoking cessation
Lubricants, steroids, prisms and surgery can be done/used

69
Q

What is herpes zoster opthalmicus?

A

Reactivation of varicella zoster in area supplied by ophthalmic division of trigeminal nerve

70
Q

How does herpes zoster ophthalmicus present?

A

Vesicular rash around eye

Hutchinson’s sign - rash on tip or side of nose

71
Q

How is herpes zoster ophthalmicus managed?

A

Urgent ophthalmology review
Oral antiviral treatment for 7-10 days (systemic)
Topical corticosteroids can be used

72
Q

What are the complications associated with herpes zoster ophthalmicus?

A 
Conjunctivitis
Keratitis
Episcleritis
Anterior uveitis 
Ptosis
Post herpetic neuralgia

Neurology and Special Senses (28 decks)

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