Ophthalmological Conditions Flashcards

1
Q

Acute chlamydial conjunctivitis (presentation, cause, diagnosis, treatment)

A

Presentation: Acute or subacute unilateral conjunctivitis with mucopurulent discharge or as a chronic conjunctivitis.
Cause: Exposure to STI (mother-to-child transmission, accidental transmission, or sexual abuse).
Diagnosis: Chlamydia PCR.
Treatment: Systemic treatment.
● > 1 month old - azithromycin 1 g (child 20 mg/kg) PO STAT
● Neonate - azithromycin 20 mg/kg PO for 3 days

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2
Q

Bacterial keratitis (symptoms, examination, management)

A

Epidemiology: 95% secondary to contact lens infection
Symptoms: Usually begin within 24 hours of infection.
● Red eye
● Reduced visual acuity
● Pain
● Eyelid swelling
● Photophobia
Examination: Corneal epithelial defect highlighted on fluorescein staining (common). Other - yellow or white stromal
infiltrates, corneal oedema.
Management:
● Immediate referral for corneal scraping and initiation of topical treatment is essential
● If referral is delayed or vision is threatened, start topical treatment ASAP.
○ Ciprofloxacin 0.3% eye drops 1-2 drops every 15 minutes for 6 hours, then hourly for 48 hours,
then every 4 hours until healed.

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3
Q

Cataracts (definition, terminology, RF, presentation, Ex, management)

A

Definition: Opacity of the lens that may cause blurred or distorted vision, glare problems or in advanced cases,
blindness.
Terminology:
● Immature cataract = view of the retina and transmission of red reflex still present.
● Mature cataract = red reflex is lost.
Risk factors: age, smoking, alcohol, sunlight, diabetes, systemic high-dose corticosteroids.
Presentation: problems with night driving, short-sighted.
Examination: Ensure eye is dilated for fundoscopy.
Cataract surgery: low-risk procedure. Indicated in interferes with ADLs.
● Optimise BP control
● Aspiring or anticoagulants can be continued for most patients
Complications: Risk for intraoperative floppy iris syndrome in patients on duodart or some antipsychotics (i.e. inform
surgeon).
Post-operative: Review by surgeon at 1 week and 1 month post-surgery. Minimal evidence for restriction of physical
activity.

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4
Q

71M, barber, presenting with difficulty driving at night because of the glare from street lights and oncoming headlights.
Associated with decline in vision. O/E: Bilateral visual loss especially distance vision, red reflexes diminished, view
limited on fundoscopy. What is the likely diagnosis?

A

Cataracts

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5
Q

Chalazion (cause, prognosis, presentation, examination, management)

A

Cause: Obstruction of Zeis or meibomian glands.
Prognosis: Small ones resolve without intervention over days or weeks.
Presentation: Plainless localised eyelid swelling.
Examination: Non-tender rubbery nodule of the inner eyelid.
Management:
● Warm compresses for 15 minutes about 4 times a day.
● Refer to an ophthalmologist if persistent.

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6
Q

Conjunctivitis (types)

A

Viral
- Red, irritated eyes with gritty sensation
- May have follicular appearance
- History of URTI, rapid progression over days, presence of mucopurulent discharge
Bacterial
- Redness and purulent discharge (follicle formation rare)
- Discharge appears at the lid margins and corners of eyes
- More often appears within minutes of wiping discharge
Allergic
- Red, irritated, itchy eyes
- Often have associated atopy, eczema, hay fever or asthma
Hypersensitivity
- Exposure to drugs, eye cosmetics, soaps or other chemicals

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7
Q

Allergic conjunctivitis (general advice, medication options)

A

General advice: Do not rub eyes, discontinue the use of contact lenses during symptomatic periods, apply cool
compresses, liberally use refrigerated artificial tears during the day, avoidance of allergens.
Medication options: antihistamine and mast cell stabilisers.
- Combination: Olopatadine (Patanol) 0.1% BD
- Antihistamine: Levocabastine 0.05% 2-4 times a day
- Mast cell stabilisers: Lodoxamide 0.1% QID
** Vasoconstrictor eye drops are not recommended because extended use can cause rebound ocular redness.

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8
Q

Episcleritis (key points, prognosis, presentation, management)

A

Key points
● Majority do not have an underlying infectious (rheumatic disease, herpes zoster) or systemic inflammatory
disease (rheumatoid arthritis, inflammatory bowel disease, vasculitis, systemic lupus erythematosus)

Prognosis: Good. Minimal discomfort, self-resolving after a few weeks.

Presentation: Aching or awareness (not usually pain).

Management: NSAIDs

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9
Q

Gonococcal conjunctivitis (presentation, diagnosis, complications, management)

A

Key point
● Requires advice from ophthalmologist urgently

Causative agent: Neisseria gonorrhoea

Presentation:
● Adult - Acute onset of copious, purulent discharge
● Neonate - As above ~ 2-5 days after birth

Diagnosis: Gonorrhoea PCR

Complications: Ulceration and perforation of the cornea

Management: Treat concurrently for Chlamydia
> 1 month = Ceftriaxone 1g (child 50 mg/kg) IM STAT
Plus Azithromycin 1 g (child 20 mg/kg) PO single dose
Neonates = Cefotaxime 100 mg/kg IM as a single dose
Plus Azithromycin 20 mg/kg PO for 3 days

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10
Q

Herpes simplex keratitis (key point, ocular manifestations, significance, examination, treatment)

A

Key point
● Prompt referral to ophthalmologist is recommended with suspected herpes simplex keratitis.

Ocular manifestations: blepharitis, conjunctivitis, keratitis, iritis and retinitis.

Significance: can result in corneal scarring and loss of vision.

Examination: Fluorescein staining. Can be confirmed on PCR.

Treatment:
● Aciclovir 3% eye ointment, 5 times a day, for 10-14 days OR
● Valaciclovir 500mg PO BD for 7-10 days (if ointment nor available)

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11
Q

Herpes zoster ophthalmicus (key points, treatment)

A

Key point
● Antiviral therapy aims to reduce pain.
● Can be started after 72 hours (ideally <72 hours) if there are active vesicles present or in
immunocompromised or elderly patients to reduce the risk of ocular complications.
● Concerning symptoms include red eye, visual loss and photophobia.

Treatment: Topical acyclovir has no role.
1. Valaciclovir 1g (child 20 mg/kg) PO, 8 hourly for 7 days

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12
Q

Hyphema - significance, management

A

Significance: Risk of secondary glaucoma.
● Ruptured vessels could fill the anterior chamber with blood, blocking the escape of aqueous humour and
causing a severe secondary glaucoma.

Management: Complete bed rest.
● Exclude penetrating eye injury
● Eye shield over affected eye
● Elevate patient’s head to 30 degrees and main patient at bed rest
● Dilate pupil
● Symptomatic management for nausea and topical pain control

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13
Q

Lens care and use

A

Length of lens use and wear
● Soft lenses allow only a limited time of safe and health usage
● Prescribed for use during waking hours only and not while sleeping
Monitor for: pain, redness, blurred vision, photophobia.
Complications:
● Increased risk of microbial keratitis with overnight use
● Corneal ulcers
● Corneal abrasions

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14
Q

Macular degeneration (presentation, fundocscopy)

A

Clinical presentation: Sudden fading of central vision. Others - distortion of vision, straight lines may seem wavy and
objects distorted, peripheral fields normal.
Fundoscopy: white exudates, haemorrhages in retina. Macula may look normal or raised.

** Refer to page 203 of GP Study Notes for picture

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15
Q

Marginal keratitis (cause, association, presentation, management)

A

Cause: Inflammation of the cornea.
Associated with: Blepharitis.
Presentation: Foreign body sensation or pain, epiphora, photophobia and occasionally reduced visual acuity.
Management: Warm compresses, lid massage, lid scrubs +/- antibiotic and steroid drops or ointments.

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16
Q

Optic neuritis (definition, significance, acute features)

A

Definition: Inflammatory, demyelinating condition that causes acute (usually monocular) visual loss.
Significance: Occurs in 50% of patients with multiple sclerosis at some point in time.
Acute features: Vision loss over a period of hours to days and eye pain (most common).
● Other - flickering or flashes of light, retrobulbar neuritis, loss of colour vision.

17
Q

31F, presenting with a sudden appearance of large black spots obstructing central vision of the left eye with some discomfort associated. Fundoscopy normal.

A

Optic neuritis

18
Q

Orbital cellulitis (RF, presentation)

A

Risk factor: Infection from paranasal sinuses. Children under 4 years.
Presentation: Reduced vision, limited or painful eye movements, diplopia, proptosis or chemosis (swelling of the eye
surface membranes because of fluid accumulation).

19
Q

Periorbital cellulitis (definition, presentation, complications, management)

A

Definition: Cellulitis involving the soft tissue of the eyelids.

Presentation: Vision and eye movements are normal and the patient is systemically well.

Complications: Children under 4 years are at a higher risk of orbital cellulitis due to incomplete orbital septum.

Management:
1. Investigate for orbital cellulitis if there are systemic symptoms
2. If mild - moderate: Treat with oral antibiotics and review in 48 hours to ensure improvement
● Flucloxacillin 500 mg (child 12.5 mg/kg) 6 hourly for 7 days
3. If severe: Treat with IV antibiotics

20
Q

Photokeratitis (definition, prognosis, presentation, examination, prevention, treatment)

A

Definition: Acute syndrome causing severe eye pain 6-12 hours after exposure to ultraviolet light

Prognosis: Resolution of symptoms in 24-72 hours.

Presentation: Foreign body sensation, eye injection and oedema, facial and lid erythema.

Examination: Fluorescein.

Prevention: Protective eyewear.

Treatment: Supportive.
● Antibiotic ointment - chlorsig
● Oral analgesia

** Topical anaesthetics should not be prescribed for ongoing management.

21
Q

Pinguecula (definition, epidemiology, prognosis, complication, treatment)

A

Definition: Yellowish elevated nodular growth on either side of the cornea.

Epidemiology: > 35 years.

Prognosis: Generally status and not requiring treatment.

Complication: Pingueculitis (inflammation of the growth).

Treatment:
● Excision is indicated if they are large and uncomfortable.
● If irritating, topical astringent drops such as naphazoline compound drops can give relief.

22
Q

Posterior vitreous detachment (epidemiology, timeframe, presentation, case)

A

Epidemiology: 50-75 years.
Timeframe: Usually over one week but can take up to 3 months to completely develop.
Presentation: New onset of cobweb-like floaters and/or increased floaters.
Case: 62F, Aboriginal with T2DM, seeing ants crawling on the toilet that aren’t there. Associated with flashing light in
the same eye. Symptoms worsening.

23
Q

Pterygium (definition, epidemiology, treatment)

A

Definition: Overgrowth of the conjunctiva onto the nasal side of the cornea.
Epidemiology: Adults living in dry, dusty, windy areas.
Treatment:
● Excision by specialist indicated if it is likely to interfere with vision or becomes red/uncomfortable/disfiguring.

24
Q

Red eye - differentials

A
Conjunctivitis (bacterial, viral, allergic, contact hypersensitivity)
Subconjunctival haemorrhage
Herpes simplex keratitis 
Corneal ulcer 
Scleritis/episcleritis 
Acute uveitis/iritis 
Acute glaucoma 

** Refer to page 251 of GP Study Notes

25
Q

Red eye and levels of care

A
GP management
- Stye
- Chalazion
- Blepharitis
- Subconjunctival haemorrhage
- Conjunctivitis (bacterial, viral, allergic)
- Corneal abrasion
● Urgent f/u if not better in
1-2 days
- Corneal foreign body
● Urgent f/u if not better in
1-2 days
- Contact lens overwear
● Urgent f/u if not better in
1-2 days
- Dry eye syndrome
- Episcleritis

ED management

  • Angle-closure glaucoma
  • Hyphema
  • Hypopyon (white cells in anterior chamber)
  • Bacterial infectious keratitis

Urgent referral

  • Iritis
  • Viral infectious keratitis
  • Scleritis
26
Q

Red eye - assessment questions

A
Visual acuity 
Foreign body sensation
Photophobia
Discharge 
Pain
27
Q

48M, carpenter, red right eye with discomfort and gritty sensation over the last 10 days. Trialled chlorsig with minimal effect. PHx of rosacea.

  1. What are the 3 most likely differential diagnoses for his red eye?
  2. On further assessment you also notice inflammation of his eyelids. What are your two non-pharmacological
    management options for his eyelid condition? (i.e. blepharitis)
A

What are the 3 most likely differential diagnoses for his red eye?
● Marginal keratitis
● Corneal ulcer/abrasion
● Corneal foreign body
● Herpes simplex keratitis
● Episcleritis
On further assessment you also notice inflammation of his eyelids. What are your two non-pharmacological
management options for his eyelid condition? (i.e. blepharitis)
● Eyelid hygiene with warm compress
● Eyelid firm massage
● Scrubbing the inside of the eyelid

28
Q

Retinal detachment (history, fundoscopy)

A
History:
● Painless loss of vision
● Flashes and floaters
● Curtain moving over the visual field
Fundoscopy: Detached retina appears corrugated and
partially opaque. Appears out of focus.
29
Q

Retinitis pigmentosa (process, typical features, examination)

A

Process: Degeneration of rods and cones associated with displacement of melanin-containing cells from the pigment
epithelium into the more superficial parts of the retina.
Typical features:
● Night blindness in childhood
● Concentrically narrowed visual fields
● Irreversible course
Examination: Irregular patches of dark pigment, especially at the periphery. Optic atrophy.

30
Q

Scleritis (key point, prognosis, presentation, history)

A

Key point
● Painful +++
● Usually associated with connective tissue disorder
Prognosis: Potentially blinding disorder that may involve the cornea, adjacent episclera, and underlying uveal tract.
Presentation: Highly symptomatic. Intense ocular pain, photophobia, and deep-red or purplish scleral hue.
History: Severe, constant pain. Worse at night or early in the morning hours.
● +/- headache, watering of the eyes, ocular redness, photophobia.

31
Q

Stye (definition, types, prognosis, complication, management)

A

AKA Hordeolum
Definition: Abscess of the eyelid that presents as a localised painful and erythematous swelling.
Types:
● Internal
○ Inflammation of the meibomian gland
● External
○ Arises from glands in the eyelash follicle or lid-margin
Prognosis: Generally resolves in 1 month.
Complication: Periorbital cellulitis.
Management: Warm compresses.

32
Q

Subconjunctival haemorrhage - potential causes

A

Potential causes:
● Blunt trauma (need to rule out potential globe rupture)
● Minor trauma or complications from contact lens use
● History of elevated venous pressure (Valsalva, coughing, vomiting)
● Hypertension
● Diabetes mellitus
● Coagulopathy

33
Q

Uveitis (key point, symptoms. associated conditions)

A

Key point
● Occurs in association with other systemic medical conditions (especially infections and inflammatory
diseases)
Symptoms
● Anterior uveitis: pain and redness
● Posterior or intermediate uveitis: painless, floaters and/or some degree of visual loss
Associated conditions: Spondyloarthritis, inflammatory bowel disease, sarcoidosis, juvenile idiopathic arthritis. Less
likely multiple sclerosis.

34
Q

44F, presenting with 2 days of photophobia in R) eye with pain. Visual acuity R) eye is 6/18.

What is the likely diagnosis?

A

R) eye uveitis