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4th Year Neuro > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Painful visual loss affecting the cornea

A

Keratitis

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2
Q

Painful visual loss affecting the iris

A

Anterior uveitis

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3
Q

Painful visual loss affecting the drainage angle

A

Acute angle-closure glaucoma

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4
Q

Painful visual loss affecting the optic nerve

A

Optic neuritis

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5
Q

Painful visual loss affecting the orbit

A
  • Orbital cellulitis
  • Endophthalmitis
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6
Q

Painless visual loss affecting the drainage angle

A

Primary open angle glaucoma

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7
Q

Painless visual loss affecting the lens

A

Cataract

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8
Q

Painless visual loss affecting the retina/macula

A
  • Retinal detachment
  • Central retinal vein occlusion
  • Central retinal artery occlusion
  • Macualar oedema
  • Wet age related macular degeneration
  • Vitreous haemorrhage
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9
Q

Definition of keratitis

A

Inflamation of the cornea

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10
Q

Microbial keratitis cause

A

Commonly infective

  • Bacterial: staphylococcus, pseudomonas
  • Viral: herpes
  • Fungal: candida
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11
Q

Risk factors for microbial keratitis

A
  • Contact lens
  • A breech in the corneal epithelium eg trauma
  • Dry eye
  • Prolonged use of steroid drops
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12
Q

Which bacteria is the most common culprit in microbial keratitis in a contact lens wearer?

A

Pseudomonas aeruginosa

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13
Q

Clinical features of microbial keratitis

A
  • Painful eye
  • Red eye
  • Purulent discharge
  • Blurred vision
  • Hypopyon (collection of WBCs)
  • White corneal opacity = corneal ulcer
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14
Q

Investigations in microbial keratitis

A
  • Stain with flourescein in to see epithelial defect
  • Corneal scrape: gram stain and culture
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15
Q

Management of microbial keratitis

A
  • Stop wearing contact lenses until healed
  • Topical antibiotic drops eg ciprofloxacin, ofloxacin
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16
Q

Which structures make up the uvea?

A

Iris, ciliary muscle and choroid

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17
Q

Definition of anterior uveitis

A

Inflammation of the iris

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18
Q

Risk factors for anterior uveitis

A
  • HLA-B27 allele
    • Ankylosing spondylitis
    • Psoriatic arthritis
    • Reiter’s syndrome
    • Inflammatory bowel disease
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19
Q

Clinical features of anterior uveitis

A

Symptoms

  • Photophobia
  • Red eye
  • Watering

Signs

  • Anterior chamber cells: WBCs floating in the anterior chamber
  • Hypopyon
  • Disorted pupil: due to posterior synechiae (adhesions from the iris to the lens)
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20
Q

Management of anterior uveitis

A
  • Topical steroids: dexamethasone 0.1%
  • If there is posterior synechiae: dilating drops (to try and break them)
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21
Q

Definition/pathophysiology of glaucoma

A
  • Optic nerve damage
  • With visual field defect
  • Related to raised IOP (intraocular pressure)
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22
Q

What are the two main types of glaucoma?

A
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23
Q

Describe the normal aqueous pathway within the eye

A
  • Aqueous humour is made by the ciliary body and secreted into the posterior chamber
  • Aqueous passes through the pupil into anterior chamber
  • Most of the aqueous leaves the eye via the trabecular meshwork → Schlemm’s canal → bloodstream
24
Q

Pathogenesis of acute angle closure glaucoma

A
  • Pupil dilation eg in dark conditions → peripheral iris “bunches up” → increased resistance to aqueous flow
  • Build up of aqueous in posterior chamber → bows iris forward → closes drainage angle
25
Q

Risk factors for acute angle glaucoma

A
  • Female
  • Small eyes
  • Asian ethnicity
  • Age
26
Q

Clinical features of acute angle closure glaucoma

A
  • IOP > 40mmHg
  • Red eye
  • Cloudy cornea
  • Fixed, oval, irregularly dilated pupil
  • Pain
  • Watering
  • Reduced vision
27
Q

Management of acute angle closure glaucoma

A
  • Immediate management: lower eye pressure
    • Topical drops
      • alpha 2 agonist
      • beta blockers
      • steroids
    • Systemic
      • Acetazolamide PO
  • Definitive treatment
    • Laser peripheral iridotomy (bilateral)
28
Q

Pathogenesis of primary open-angle glaucoma

A

Outflow of aqueous is impaired due to disruption of the trabecular mashwork channels eg extacellular material blocking RM spaces.

29
Q

Risk factors for chronic open-angle glaucoma

A
  • Age >60
  • African
  • Family history
  • Myopia
  • Diabetic
  • Long tern steroid drops
30
Q

Clinical features of primary open-angle glaucoma

A
  • Patient asymptomatic as the disease is slowly progressive
  • Raised IOP (>22mmHg)
  • Optic nerve cup:disc ratio >0.4
  • Loss of peripheral visual fields
31
Q

Treatment of primary open-angle glaucoma

A
  • Topical therapy
    • Prostaglandin analogues: lantanoprost
    • Beta-blockers: timolol
  • Laser
  • Surgery
    • Trabeculectomy
32
Q

Definition of retinal detachment

A

The potential space between the neuroretina and the retinal pigment epithelium (loosely attached in the eye) become separated.

33
Q

Risk factors for retinal detachment

A
  • Recent eye trauma
  • Retinal detachment in the other eye
  • High myope (large eye, so at risk of tears)
34
Q

Clinical features of retinal detachment

A
  • Flashing lights
  • > 100 new floaters
  • Shadow/curtain over vision
35
Q

Treatment for retinal detachment

A

Urgent referral to ophthalmology for surgery (pars plana vitrectomy)

36
Q

Pathophysiology of central retinal vein occlusion

A
  • Usually related to Virchow’s triad of thrombogenesis
    • Stasis
    • Vessel wall damage
    • Hypercoagulability
37
Q

Risk factors for central retinal vein occlusion

A
  • Age
  • Hypertension
  • Hyperlipidaemia
  • Diabetes mellitus
  • Smoker
38
Q

Clinical features of central retinal vein occlusion

A
  • Sudden, unilateral blurred vision
  • Fundus findings
    • Dilated tortuous veins
    • Haemorrhages in all 4 quadrants of the retina
    • Cotton wool spots
39
Q

Management of central retinal vein occlusion

A
  • No specific treatment for uncomplicated CRVO
    • Allow time to settle (should settle in 3 to 6 months)
    • Closely monitor
40
Q

Complications of central retinal vein occlusion and their management

A
  • Macular oedema
    • Cysts of fluid form at macula
    • Managment: intravitreal anti-VEGF injections
  • Retinal neovascularisation
    • New vessels in response to VEGF released from ischaemia retina
    • New vessels are fragile and can bleed
    • Managment: laser photocoagulation
41
Q

Clinical features of central retinal artery occlusion

A
42
Q

Managment of central retinal artery occlusion

A
  • Transfer to stroke unit
    • ​Carotid Doppler US
    • CT head angiogram
43
Q

Definition of cataract

A

Opacification of the intraocular lens

44
Q

Aetiology of cataract

A

Chemical and structural alteration of lens proteins (clear → opaque)

45
Q

Risk factors for cataracts

A
  • Old age
  • Diabetes
  • Steroid use (drops, PO)
  • UV light exposure
46
Q

Clinical features of cataracts

A
  • Gradual (over years - decades) progressive loss of vision
  • Glare at night
47
Q

Treatment of cataracts

A

Phacoemulsification

48
Q

Orbital cellulitis clinical features

A
  • Lid: induration, warm erythema, tenderness, unable to open eye
  • Fever
  • Proptosis
  • Chemosis
49
Q

Features of dry and wet age related macular degeneration

A
  • Drusen (yellow deposits of proteins and lipids)
  • Atrophy of the retinal pigment epithelium
  • Degeneration for eh photoreceptors
50
Q

Features unique to wet AMD

A

Development of new vessels growing from the choroid layer into the retina.

51
Q

Risk factors for age related macular degeneration

A
  • Age
  • Smoking
  • White or Chinese ethnic origin
  • Family history
  • Cardiovascular disease
52
Q

Presentation of AMD

A
  • Gradual worsening central visual field loss
  • Reduced visual acuity
  • Crooked or wavy appearance to straight lines
53
Q

Examination in AMD

A
  • Reduced acuity using a Snellen chart
  • Scotoma (a central patch of vision loss)
  • Amsler grid test can be used to assess the distortion of straight lines
  • Fundoscopy: drusen are the key finding
  • Slit lamp biomicroscopic fundus examination by a specialist can be used to diagnose AMD
  • Optical coherence tomography
  • Fluorescein angiography
54
Q

Management of dry age related macular degeneration

A
55
Q

Managment of wet age related macular degeneration

A

Anti-VEGF medications (ranibizumab) are injected directly into the vitreous chamber of the eye once a month.

4th Year Neuro (12 decks)

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