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Finals Revision > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Blepharitis:

  • common associations?
  • features? (6)
  • management? (3)
A

Anterior: seborrhoeic dermatitis, rosacea, staph infection
Posterior: meibomian gland dysfunction

Usually unilateral
Grittiness and discomfort
Sticky eyes in morning
Eyelid may be red, usually swollen in staph infection
Styes and chalazions more common with blepharitis
Secondary conjunctivitis may occur

Rx:

  • Hot compress twice a day on lid margin
  • Remove debris with cotton wool dipped in cooled boiled water with baby shampoo OR flush eyes with cooled boiled water with sodium bicarb
  • Artificial tears for symptomatic dry eyes
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2
Q

Commonest cause of blindness in UK?
RF?
Types?

A

ARMD - degeneration of central photoreceptors with formation of drusen

  • Age
  • Smoking
  • FHx

Dry:
- Atrophic, drusen around Bruch’s membrane

Wet:

  • exudative
  • choroidal neovascularisation which can leak, worse prognosis
  • The new vessels are typically intra- or sub-retinal
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3
Q

Symptoms of ARMD?
Signs?
Ix?

A
  • reduced acuity for near objects
  • dark vision deterioration
  • vision may vary day to day
  • May see flashing lights and glare around objects

Signs:

  • Amsler test grid - distortion of lines
  • Macular drusen if dry, can fuse to form a macular scar in late disease
  • Demarcared red patches in wet

Ix:
1st line - slit lamp
2nd line - fluorescein angiography if wet suspected

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4
Q

Management of ARMD?

Monitoring?

A

Zinc and Vits A, C and E (anti-oxidants) - slow progression by 1/3

anti-VEFF if wet - 4 weekly injections

Laser photocoagulation can also be used for wet, but increased risk of acute visual loss

Monitoring:
Amsler grid to measure line distortion perception

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5
Q

Where does nasoplacrimal duct open into?
Muscles of the iris?
Cones and Rods?

A

Inferior meatus

Sphinctor pupillae (parasympathetic - constricts)
Dilator pupillae (sympathetic - dilates)

Cones - coloured vision (coloured)
Rods - dim vision, black & white (peripheral)

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6
Q

Extra-ocular muscles?

A

LR 6
SO 4
AO 3

IO pulls it up and in
SO pulls it down and in

(obliques move in adducted plane, rectus muscles move in abducted)

LPS 3 + sympathetic (mullers muscle)

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7
Q

Afferent and efferent limbs:

  • corneal reflex?
  • pupillary light reflex?
  • lacrimation?
  • accommodation?
A

Corneal:

  • afferent CNV1
  • efferent CNVII

Pupillary light:

  • afferent CN II
  • efferent CNIII

Lacrimation

  • afferent CNV1
  • efferent CNVII

Accommodation:

  • afferent CNII
  • efferent CNIII
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8
Q

Nerves containing:

  • preganglionic parasympathetic?
  • parasympathetic nucleus?
  • sympathetic?

Modalities of:

  • short ciliary nerve?
  • long ciliary nerve?
A
  • CNIII
  • Edinger Westphal nucleus in midbrain
  • Sympathetic chain

Short: sensory + sympathetic

Long: sympathetic, parasympathetic, sensory

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9
Q

Accommodation reflex what happens when looking close?
When looking far away?
3 things it tests?

A 
Afferent CNII
Efferent CNIII (para)

Focusing up close, makes lens round:

  • increased parasympathetic to ciliary body (long nerve)
  • contraction of ciliary body moves it closer to lens
  • Suspensory ligaments relax, allowing lens to become round

Focusing far away, makes lens flat:

  • Decreased parasympathetic output
  • Relaxation of ciliary body, moves it further away from lens
  • Suspensory ligaments tighten, making lens lens flat

Tests 3 things:

  • pupil constriction
  • lens accommodation
  • convergence
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10
Q

Most common cause of viral conjunctivitis?

What points towards viral?

A

Adenovirus

4 things:

  • bilateral from offset (instead of unilateral then bi)
  • watery discharge
  • Follicular inflammation (instead of papillary)
  • pre-auricular lymph nodes
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11
Q

Management of conjunctivitis?

A

Usually self resolves in 1-2 weeks, abx are quicker if bacterial

Chloramphenicol 1st line
Fusidic acid if pregnant/young

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12
Q

What points towards allergic conjunctivitis?

Management?

A

Seasonal
Itch
Swollen papillae w cobblestone appearance of conjunctivae (cheimosis)

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13
Q

What causes cotton wool spots?

A

Areas of infarction due to pre-capillary arteriolar occlusion

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14
Q

Causes of papilloedema?

A 
SOL - neoplastic/vascular
Malignant hypertension
Idiopathic intracranial hypertension
Hydrocephalus
Hypercapnia (induced hyperventilation a treatment for raised ICP)
low Ca
Hypoparathyroidism
VitA toxicity
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15
Q

Causes of vitreous haemorrhage?

Prognosis?

A

Diabetic/hypertensive retinopathy causing unstable vasculature
Anti-coagulant use
Trauma

Resolves with time

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16
Q

Treatment of herpes zoster ophthalmicus?

What eye complications can it have?

A

Aciclovir for 7-10 days ideally within 72 hours (IV if immunocompromised)

Topical steroids if any eye inflammation -> urgent ophthalmology review

Comps:

  • conjunctivitis, keratitis, episcleritis, anterior uveitis
  • post-herpetic neuralgia
17
Q

Ix orbital cellulitis?

Management?

A

CT contrast

Admit for IV abx

18
Q

4 grades of hypertensive retinopathy?

A

SAFE

  1. Silver wiring, tortuosity
    2, AV nipping
  2. Flame haemorrhages and cotton wool spots
  3. papilloEdema
19
Q

Argyll-Robertson pupil?

Causes?

A

Bilateral small pupils that constrict to accommodate but don’t react to bright light

Diabetes
Neurosyphilis

20
Q

Holmes-Adie pupil?

Causes?

A

Dilated pupil, usually unilateral
Once it constricts it stays small for a long time
Slowly constricts to accommodation but very poor/no reaction to light

Causes:

  • Can be idiopathic in females, assoc w missing knee and ankle reflexes
  • Can be caused by damaged parasympathetic innervation from viral/bacterial infection
21
Q

Marcus-Gunn pupil?

A

RAPD

Most commonly in optic neuritis or severe retinal disease

22
Q

Hutchison’s pupil?

Causes?

A

Unilateral dilated pupil unresponsive to light

Due to ipsilateral compression of CNIII by tumour/haematoma

23
Q

open angle glaucoma

A

1st line - Prostaglandin analogues +/- B blockers

2nd line - CAI, alpha agonists (sympathomimetics)

24
Q

Horner’s syndrome and ipsilateral facial pain?

A

Carotid artery dissection

25
Q

Horner’s syndrome and ipsilateral facial pain?

A

Carotid artery dissection

26
Q

Haloes are assoc w?

A

Cataracts

Acute angle closure glaucoma

27
Q

Management of amaurosis fugax?

A

Type of TIA so Rx the same

300mg Aspirin

28
Q

CRVO causes?

A

Incidence increases with age, more common than CRAO

glaucoma, polycythaemia, hypertension

Sudden painless loss of vision, haemorrhage on fundoscopy

29
Q

Causes of CRAO?

A

Arteritic - temporal arteritis

Thromboembolism (atherosclerosis)

RAPD, cherry red spot on pale retina

30
Q

Causes of vitreous haemorrhage?

A

Diabetes, bleeding disorders, anticoagulants

Sudden visual loss, dark spots. May have red hue as it gets bigger, and be worse on lying down

31
Q

How to differentiate vitreous detachment, vitreous haemorrhage and retinal detachment?

A

Vitreous detachment:

  • Flashes (photopsia) in peripheral visual field
  • Floaters on temporal side of vision

Vitreous haemorrhage:

  • Often precedes vitreous detachment
  • Large bleeds cause sudden visual loss, mild-mod may be several dark spots or floaters

Retinal detachment:

  • Dense shadow that starts peripherally and progresses to centre of vision
  • Straight lines appear curved
  • Central visual loss
32
Q

Hereditary progressive night blindness and tunnel vision,, blind by 50?

A

Retinitis pigmentosa

33
Q

Scleritis?

A
  • Painful eye movements
  • Dull, aching eye pain
  • Deep pink colour to eye
  • Visual acuity preserved until late

Assoc w RA

34
Q

Episcleritis?

A
  • Gritty eye sensation
  • Dilated, bright blood vessels
  • Hx of inflammatory conditions e.g. RA, ank spond
  • Classically not painful or only mildly painful
35
Q

Contact lens wearer with red, painful eye - what to do?

A

Same day assessment in ophthalmology to exclude microbial keratitis

Finals Revision (29 decks)

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