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Year 4 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Glaucoma

A

a group of eye disease associated with acute or chronic damage to the optic nerve head with progressive loss of retinal ganglion feels & their axons leading to progressive visual field loss

one of the most common eye conditions

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2
Q

Types of glaucoma

A

open angle (90%)

angle-closure

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3
Q

Open angle glaucoma

A

generally bilateral progressive loss of optic nerve fibres with open chambre angles (ie the trabecular meshwork not obstructed) but obstructed & slowed drainage system outflow leads to ↑IOP (intraoccqular pressure)

most common form of glaucoma

prevalence ↑ with age

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4
Q

Risk factors for open angle glaucoma

A 
↑ age
Family history 
↑ IOP (ocular hypertension)
afro-carribbean race 
myopia (short-sightedness)
HTN
diabetes
corticosteroids
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5
Q

Presentation of open angle glaucoma

A

vast majority of pts are asymptomatic
very insidious onset
may be detected at routine optometry appointment

↓visual acuity
bilateral peripheral visual field loss (nasal scotoma progressing to tunnel vision)
mild headaches
impaired adaption to darkness

NB pts often only notice visual loss once severe & permanent damage has occurred

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6
Q

Investigating open angle glaucoma

A

ophthalmoscopy (↑ cup-to-disc ratio, >0.7, disc cupping optic disc pallor, bayoneting of vessels, cup notching, disc haemorrhages)

slit lamp (normal appearing anterior chamber angle)

tonometry (↑IOP)

nerve fibre layer analysis (loss/thinning of nerve fibre layer)

Optical coherence tomography (OCT) & automated perimetry

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7
Q

Management of open angle glaucoma

A

Eye drops/pharmacological:
1st line: prostaglandin analogues e.g. latanoprost
Beta blockers e.g. timolol
Sympathomimetics e.g. brimodine
carbonic anhydrase inhibitors e.g. donzolamide
meiotic e.g. pilocarpine

laser treatment/surgery (considered in refractory cases)

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8
Q

Driving with open angle glaucoma

A

the pt must inform the DVLA who will asses pt to see if they are fit to continue driving

if pt does not inform DVLA despite clear advice you can break confidentiality & inform the DVLA in public interest but you are advised to inform the pt of your intentions to do so

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9
Q

Angle-closure glaucoma

A

a group of disease where there is a reversible (appositional) or adhesion (synechial) closure of the anterior chamber angle resulting in ↑ IOP

more common in females

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10
Q

Types of angle-closure glaucoma

A

Acute: rapid rise in IOP due to relatively sudden blockage of the trabecular meshwork by the iris via the pupillary block mechanism

chronic: may develop after acute form where synechial closure of the angle persists for it may develop over time as angle closes from prolonged/repetitive contact between peripheral iris & the trabecular meshwork

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11
Q

Risk factors for angle-closure glaucoma

A 
female sex
hyperopia (far-sightedness)
southeast asian/inuit/asian heritage
↑ age
family history
mydriasis (e.g. drug induced via anticholinergics)
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12
Q

Presentation of angle closure glaucoma

A

chronic: similar to open-angle glaucoma

acute:
sudden onset unilateral reddened & severely painful eye
↓ visual acuity, blurred vision
coloured haloes around lights, symptoms worse in dark (due to mydriasis)
hard-red eye
corneal oedema (dull/hazy cornea)
non reactive mid dilated pupil

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13
Q

Investigating angle closure glaucoma

A

vision threatening emergency requiring emergency treatment as soon as clinically suspected

gonioscopy (trabecular meshwork not visible)
slit lamp (shallow anterior chamber, signs of glaucoma e.g. large cup, nerve fibre loss)
automatic static perimetry (visual field defect)
tonometry (↑IOP, typically >40mmHg)
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14
Q

Treatment of angle closure glaucoma

A

Pharmacological :
1st line: IV acetazolamide + supine position + topicals (e.g. beta blockers (timolol), steroids (prednisolone), pilocarpine, phenylephrine)

definitive management:
surgery/laser treatment e.g. laser peripheral iridotomy or surgical iridotomy

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15
Q

Cataracts

A

an opacification of the crystalline lens due to protein aggregation, leading cause of visual impairment & blindness world wide

very common (>50% aged >65)
more common in women
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16
Q

Aetiology of cataracts

A

congenital (<1%):
hereditary congenital cataracts associated with Trisomy 13/18/21, Marfan’s, Neurofibromatosis 2

acquired (>99%):
age related (>90%), Diabetes, glucocorticoid use, eye infections
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17
Q

Presentation of cataracts

A

depend on size & location of opacity
gradual painless visual loss (blurred, cloudy, dim vision)
glare (associated with halos around lights)
washed out colour vision
grey/yellow/brownish clouding visible in lens
↓ red reflex

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18
Q

Investigations for cataracts

A 
fundoscopy (normal fungus & optic nerve)
slit lamp (visible cataract)
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19
Q

Management of cataracts

A

Early stages: conservative (not frequently used)

Cataract surgery (lens removal & replacement, most pts >60y/o)

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20
Q

Retinal detachement

A

typically a progressive condition in which the neuroretina separates (detaches) from the retinal pigment epithelium (RPE)

most retinal detachments are preceded by posterior virtuous detachment causing traction on the retina

incidence ↑ with age, average age of presentation ~40yrs

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21
Q

Risk factors for retinal detachment

A

myopia (↑ risk of posterior virtuous detachment)
Family history of retinal break/detachment
personal history or retinal break

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22
Q

Classification of retinal detachment

A

Rhegmatogenous RD:
most common, due to retinal break e.g. posterior vitreous detachment allowing retinal fluid formed y vitreous degeneration to seep in between RPE & neuroretina

Non-rhegmatogenous RD:

exudative: sub retinal fluid accumulation without retinal tears
tractional: uncommon, fibres in vitreous contract pulling retina away

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23
Q

Presentation of retinal detachment

A

Posterior vitrous detachment (PVD) as prodrome: floaters, flashes of light in vision, blurred vision, cobwebs across vision, dark curtain descending down vision
Weiss ring on ophthalmology

floaters, flashes of light (photopsia), scotoma, veil/curtain over vision
sudden painless visual loss

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24
Q

Investigations of retinal detachment

A

visual acuity (↓)
slit lamp (shows retinal detachment/defect)
indirect opthalmoscopy
USS or OCT

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25
Q

Management of retinal detachment

A

cryotherapy/laser photocoagulation (permanent adhesion of RPE & retina)
vitrectomy (removes traction)
pneumatic retinopexy

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26
Q

Central retinal artery occlusion

A

an ophthalmic emergency characterised by occlusion of the retinal artery essentially an ischaemic stroke of the eye

one of the more common causes of severe visual impairment in elderly pts

pts usually >60y/o, more common in men

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27
Q

Aetiology of Central retinal artery occlusion

A

thrombotic emboli from carotid artery atherosclerosis = most common

embolism
thrombosis
vasculitis
arteritis

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28
Q

Presentation of central retinal artery occlusion

A

sudden unilateral painless visual loss (mostly reduced to finger counting, often described as ascending curtain)
+
relative afferent pupil defect

history of amaurosis fugax (transient loss of vision i.e. angina of the eye)

if branches affected = scoots

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29
Q

Investigations of central retinal artery occlusion

A

ophthalmoscopy (greyish white retinal discolouration - pale), cherry red spot on macula, retinal plaques/emboli, segmentation of blood column in arteries)

Bruits over carotids (on carotid doppler)

ESR/CRP (to rule out temporal arteritis)

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30
Q

Management of central retinal artery occlusion

A

ophthalmologic emergency, must reperfuse tissue asap

firm ocular massage
artery dilation (sublingual nitrites, carbon therapy)
hyperbaric oxygen

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31
Q

Central retinal vein occlusion

A

an interruption of the normal venous drainage from the retinal tissue affecting either the central retinal vein or its branches

one of the most common causes of painless unilateral vision loss

usually seen in pts >65 yrs

more common than central retinal artery occlusion

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32
Q

Risk factors for central retinal vein occlusion

A 
atherosclerosis
HTN
diabetes
smoking
cardiovascular disease
glaucoma
COCP use 
sickle cell disease
↑ age
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33
Q

presentation of central retinal vein occlusion

A

sudden reduction/loss of visual acuity (unilateral)
blurred vision
afferent pupillary defect

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34
Q

Investigations for central retinal vein occlusion

A

ophthalmoscopy (dot-and-blot and/or flame haemorrhages in all 4 quadrants, cotton wool spots, macular oedema, papilloedema, venous dilation & tortiosity)

fluorescin angiography (to differentiate ischaemic & non ischaemic)

OCT (macular oedema)

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35
Q

Management of central retinal vein occlusion

A

emergency opthalmic presentation

pan retinal photocoagulation (prevents neovascularisation) ± intravitreal anti-VEGF agents

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36
Q

Diabetic retinopathy

A

the retinal consequence of chronic progressive diabetic microvascular leakage & occlusion, a potentially sight threatening disease, almost all diabetic pts well develop some degree of retinopathy

most common cause of blindness in those aged 35-65

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37
Q

Presentation of diabetic retinopathy

A

generally asymptomatic until late stages

progressive blindness & visual impairment (gradual)

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38
Q

Ophthalmological finding for non proliferative diabetic retinopathy

A

most common form of diabetic retinopathy

intraretinal microvascular abnormalities, micro aneurysms, intraretinal haemorrhage, hard exudates, cotton wool spots, retinal oedema, dot-and-blot haemorrhages

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39
Q

Ophthalmological finding for proliferative diabetic retinopathy

A

pre retinal neovascularisation, vitreous haemorrhages, plus finding of non proliferative retinopathy

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40
Q

Ophthalmological finding for diabetic maculopathy

A

macula oedema, dot haemorrhages, macular ischaemia, hard exudates on macula

more common in T2DM

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41
Q

Investigating diabetic retinopathy

A

OCT (for macula oedema)

generally fundoscopy sufficient

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42
Q

Management of diabetic retinopathy

A

improved diabetic control
intravitreal anti-VEGF injections
pan retinal photocoagulation / focal photocoagulation

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43
Q

Vitreous haemorrhage

A

extravasation of blood in & around the vitreous body, one of the most common causes of painless visual loss

caused include proliferative diabetic retinopathy (accents for ~50% of cases), posterior vitreous detachment, ocular trauma, retinal vein occlusion

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44
Q

Risk factors for vitreous haemorrhage

A

neovascularisation
trauma
anticoagulants/antiplatelets
high myopia

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45
Q

Presentation of vitreous haemorrhage

A

sudden onset of unilateral painless visual loss
red-hue to vision (haze may turn green as Hb breaks down)
floaters & cobwebs
symptoms generally worse in mornings

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46
Q

Investigations of vitreous haemorrhage

A 
slit lamp (RBCs in anterior vitreous)
dilated fundoscopy (haemorrhage in vitreous cavity)

fluorescein angiography (to identify neovascularisation)

USS (to rule out retinal tear/detachement)
OCT

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47
Q

Management of vitreous haemorrhage

A

observation (haemorrhage may resolve spontaneous)
treat underlying cause
photocoagulation (for vitreous tears & neovascularisation)

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48
Q

Macular degeneration/age related macular degeneration

A

potentially progressive maculopathy i.e. progressive degenerative changes of the macula,

most common cause of blindness in the UK

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49
Q

Types of age related macular degeneration (AMD)

A

Dry AMD: (~90%)
also referred to as non-exudative
characterised by drusens (yellow round spots), on retinal pigment epithelium (RPE) + hyper/hypopigmentation of RPE
gradual progression of visual loss

Wet AMD (~10%)
also referred as exudative/neovascular
characterised by choroidal neovascularisation with leakage of serous fluid & blood between RPE & Bruch's membrane 
leads to sudden or rapid visual loss
worse prognosis
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50
Q

Risk factors of age related macular degeneration (AMD)

A 
↑ age 
smoking
family history of AMD
obesity
caucasian ethnicity
cardiovascular disease risk factors (HTN, Diabetes, dyslipidaemia)
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51
Q

Presentation of age related macular degeneration (AMD)

A

painless central/pericentral visual impairement (dry: usually over years/decades, wet: acute/weeks to months)
scotomas
loss/↓ contrast sensitivity
photopsia

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52
Q

Investigations/examinations age related macular degeneration (AMD)

A 
Ampler grid (focal area of distortion)
OCT (intra/subretinal fluid, RPE detachement/loss)
fluorescein angiography ( to identify neovascularisation)
fundoscopy (dry: drusens, RPE atrophy/hypertrophy) (wet: sub/intraretinal haemorrhage/exudate, scarring, retinal discolouration)
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53
Q

Management of dry age related macular degeneration (AMD)

A 
lifestyle modifications 
pt education & advice
dietary supplements
smoking cessation
must inform DVLA
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54
Q

Management of wet age related macular degeneration (AMD)

A

1st line: anti-VEGF injections e.g. ranibizumab

2nd line: laser photocoagulation

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55
Q

Giant cell arteritis

A

type of autoimmune vasculitis causing chronic inflammation of large & medium sized arteries particularly the carotids and its major branches (common carotid, ICA, ECA)

most common form of systemic vasculitis in adults

2-3x more common in females, usually aged >50 yrs

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56
Q

Presentation of giant cell arteritis

A 
recent onset temporal headaches, myalgia, malaise, fever
jaw claudication
scalp tenderness on palpation
double vision/blurred vision
visual loss (scotoma, amaurosis fungal)
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57
Q

Investigations for giant cell arteritis

A 
CRP/ESR (↑)
FBC (normochromic normocytic anaemia)
LFTs (mildly ↑ ALP & AST/ALT)
temporal artery biopsy (gold standard) 
temporal artery USS
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58
Q

Management of giant cell arteritis

A

high dose corticosteroids (can be given even if negative’ biopsy if high suspicion due to skip lesions)
low dose aspirin

NB visual loss often irreversible

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59
Q

Conjunctivitis (pink eye)

A

inflammation of the conjunctiva (the lining of the eyelids & eyeball) caused by bacteria/viruses/allergies/immunological reactions/mechanical irritation

if corneal involvement: keratoconjunctivitis

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60
Q

Presentation of conjunctivitis

A

conjunctival injections (conjunctival hyperaemia with blood vessel dilation = ocular hyperaemia & reddening)
discharge & crust formation
chemises (oedema of eyelids and/or conjunctiva)
photophobia
itching (mainly in allergic types)

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61
Q

Viral conjunctivitis

A

most common type of conjunctivitis usually caused by adenovirus

presents with unilateral symptoms but quickly spreads bilaterally
clear watery discharge, ↑ lacrimation
normal vision

often recent history of URTI

mangement:
supportive (cold compresses, lubricants) topical steroids if adenospots, topical antiviral e.g. ganciclovir if HSV

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62
Q

Bacterial conjunctivitis

A

most commonly due to staph aureus, usually unilateral

presents with thick purulent discharge (yellow/white/green), eyes feel stuck together in morning, reduced vision

management:
topical Abx e.g. chloramphenicol (give topical fusidic acid if pregnant)

63
Q

Neisseria gonorrhoea conjucnitivits

A

ocular emergency that can lead to keratitis, perforation & blindness without treatment

give IM/IV ceftriaxone + PO azithromycin

64
Q

Allergic conjunctivitis

A

inflammation of the ocular surface in response ti a transient allergen e.g. pollen, which may be seasonal in nature

presents with bilateral symptoms of conjunctivitis, excessive itching, ↑ lacrimation, sneezing

managed by avoiding irritants, topical or systemic antihistamines

65
Q

Episcleritis

A

inflammation of the episclera, lasting 7-10 days and then generally self resolved

characterised by vascular congestion of the episcleral surfaces

if there is a discrete elevated area of episclera = nodular episcleritis

usually idiopathic, but also associated with Rheumatoid arthritis

66
Q

Presentation of episcleritis

A

unilateral red eye
generally not painful (unlike scleritis which is painful)
vessels are mobile when gentle pressure applied
vision not affected
acute onset

67
Q

Investigations of episcleritis

A

use phenylephrine drops to differentiate from scleritis, normally blanches episcleral & conjunctival vessel but not scleral vessels

i.e. if there is improved redness post phenylephrine then episcelritis

68
Q

Management of episcleritis

A

lubricants
cold compresses
oral/topical NSAIDs

69
Q

Scleritis

A

transmural inflammation of the sclera, generally more severe than episcleritis & requiring systemic treatment

often associated with underlying systemic disorder, most commonly rheumatoid arthritis

70
Q

Presentation of scleritis

A

subacute/gradual onset

deep boring eye pain, exacerbated by movements
redness
watering
loss of vision
photophobia

up to 50% of cases are bilateral

71
Q

Investigating scleritis

A

test for underlying conditions e.g. RF, ANA, ANCA, HLA typing

USS to check for posterior scleritis

72
Q

Management of scleritis

A 
oral NSAIDs (1st line)
oral steroids (2nd line)
rheumatological inputs
73
Q

Keratitis

A

inflammation of the cornea, the transparent & clear covering of the iris & pupil, generally has an infective cause

commonly seen in contact lens wearers (especially if wearing for prolonged period)

74
Q

General features of keratitis

A 
painful red eye
↓ vision
photophobia
foreign body/gritty sensation 
discharge 
hypopyon (sediment of leukocytes at bottom of anterior chamber)
corneal ulcer
75
Q

Characteristic ulcer for herpes simplex keratitis

A

dendritic/geographical corneal ulcer

76
Q

Herpes simplex keratitis

A

most common viral keratitis

characterised by dendritic/geographical corneal ulcers

treated with ganciclovir

77
Q

Bacterial keratitis

A

most common keratitis, usually due to staph aureus or pseudomonas aeruginosa (if contact lens wearer)
↑ risk in contact lens wearers

frequently has hypopyon & purulent discharge
usually seen with round corneal ulcer

treatment with topical broad spectre Abx

78
Q

acanthamoebic keratitis

A

Primarily occurs in immunocompetent contact lens wearers

increased incidence if eye exposure to soil or contaminated water

Topical amoebicides are used in association with topical steroids

79
Q

Photokeratitis

A

welders arc eye

80
Q

Uveitis (anterior uveitis or iritis)

A

inflammation of the uvea (middle layer of eye consisting of iris, ciliary body & choroid)

anterior uveitis: affects iris & ciliary body (most common)
posterior uveitis: affects vitreous body, choirs, reitna

81
Q

Aetiology of uveitis

A

anterior uveitis is usually idiopathic but may be associated with HLA-B27 (ankylosing spondylitis) & IBD

82
Q

Rheumatological condition associated with anterior uveitis

A

HLA-B27 e.g. in ankylosing spondylitis

also IBD (e.g. Crohns)

83
Q

Presentation of uveitis

A 
dull progressive periocular pain
intense photophobia 
red eye (ocular hyperaemia)
blurry vision 
↓ vision acuity
↑ lacrimation
84
Q

Investigations for uveitis

A

slit lamp (leukocytes in anterior chambre vitreous haze, signs of inflammation of iris)

85
Q

Management of uveitis

A

topical steroids e.g. dexamethasone 0.1%
topical dilating drops e.g. cyclopentolate 1%

NB if posterior uveitis = intraocular steroid injections

86
Q

Endopthalmitis

A

inflammation of the vitreous humour usually due to infection (e.g. staph aureus & strep after ocular surgery)

rare sight threatening ophthalmic emergency

87
Q

Aetiology of endopthalmitis

A

most commonly post ocular surgery especially cataract surgery (most common cause of bacterial endopthalmitis)

causes usually staph aureus & strep

NB candida most common fungal cause

88
Q

Presentation of endopthalmitis

A 
severe deep seated ocular pain (usually dull & intense) 
acute loss/reduction of vision
photophobia 
redness
floated 
systemic features of infection
89
Q

Investigations for endopthalmitis

A

vitreous & aqueous samples for microbiology
USS (may confirm vitreous involvement)
slit lamp (conjunctival hyperaemia, chemises , hazy cornea, hypopyon)

90
Q

Management of endopthalmitis

A 
intravitreal Abx (for all cases)
± intravitreal antifungals (if fungal infection suspected e.g. candida)
91
Q

Peri-orbital cellulitis (pre-septal cellulitis)

A

infection/inflammation of the eyelid & periorbital soft tissue without involvement of the orbital contents/globe
i.e. it is anterior to orbital septum

usually seen in children (80% of pts <10y/o)

92
Q

Aetiology of peri-orbital cellulitis

A

usually due to spread of focal infection e.g. sinusitis (so ↑ incidence in winter), systemic infection or trauma

causative organisms include staph aureus, staph epidermis, strep

93
Q

presentation peri-orbital cellulitis

A

acute onset swelling/erythema/tenderness of eyelids
partial/complete ptosis
fever, malaise, irritability

NO orbital signs (e.g. pain on eye movements, proptosis or visual disturbance)

94
Q

Investigations peri-orbital cellulitis

A

generally clinical diagnosis

FBC (↑ WCC), CRP (↑)
CT orbit/sinuses (to differentiate pre & post septal)

95
Q

Management of peri-orbital cellulitis

A

close follow up (due to risk of progressing to orbital cellulitis)

oral Abx e.g. co-amoxiclav

children may need admission for observation (NB if discharging must safety net)

96
Q

Orbital cellulitis

A

infection/inflammation of the orbital soft tissue occurring posterior to the orbital septum, the globe is however not involved

most commonly due to spreading URTI e.g. bacterial rhino sinusitis

usually seen in children aged 7-12 yrs

97
Q

Causative organisms of orbital cellulitis

A

strep pneumonia
staph aureus
H. Influenzae (especially in unvaccinated children)

98
Q

Presentation of orbital cellulitis

A 
acute onset unilateral swelling of conjunctiva & eyelid
oedema/erythema/painful eyelids & chemosis 
ophthalmoplegia 
proptosis 
↓ visual acuity
blurred vision/diplopia
pain on eye movement
relative afferent pupillary defect

headache, fever, malaise

99
Q

Investigating orbital cellulitis

A

FBC (↑WCC), CRP (↑)
blood cultures/microbiological swab (to detect underlying organism)
CT orbit/sinuses + contrast (add contrast CT brain if abscess suspected)
LP (if cerebral or menial signs)

100
Q

Management of orbital cellulitis

A 
hospital admission (under ENT & opthal)
systemic Abx (IV/PO co-amoxiclav, if severe/intracranial give cefotaxime/ceftriaxone + metronidazole)
101
Q

neonatal conjunctivitis

A

conjunctivitis within 30 days of birth

causes include:
-chemical exposure e.g. silver nitrate, treat with saline washout

  • Neisseria gonorrhoea infection, treat with cefotaxime/ceftriaxone for mother & child
  • Chlamydial conjunctivitis, treat with erythromycin/azithromycin
  • viral conjuncitivits, treated with acyclovir
102
Q

Hypertensive retinopathy

A

arteriosclerotic & hypertensive related changes of the retinal vessels, which is generally asymptomatic till late in the disease when it presents with ↓ vision

103
Q

Fundoscopy for hypertensive retinopathy

A

cotton wool spots
retinal haemorrhages (i.e. flame shaped)
microaneurysms
macular star (due to exudation of macular)
arteriovenous nicking/nipping (tapering of retinal venue where it is crossed by arteriole)
marked swelling & prominence of optic disc (due to optic atrophy/papilloedema)

104
Q

Keith-Wagener scale

A

used for hypertensive retinopathy

I: arteriolar narrowing & tortuosity, silver wiring (↑ light reflex)

II: arteriovenous nipping (Gunn sign)

III: cotton wool exudates, flame & blot haemorrhages, macular star formation

IV: papilloedema, optic atrophy

105
Q

Blepharitis

A

inflammation of the eyelid margin, which can present as chronic and/or recurrent scaly inflammation of the eyelid margins

can be infectious (staph aureus), seborrheic

106
Q

Presentation of blepharitis

A

generally bilateral
chronic/recurrent swollen & erythematous eyelids margins
grittiness & discomfort around eyelid margins
dry eyes
itchiness
crusting of eyelids
lash loss (madarosis)

107
Q

Management of blepharitis

A

hot compresses
lid hygiene
lubricants/artificial tears

108
Q

Hordeolum (Stye)

A

common acute inflammation of the tear gland or eye lash follicles (meibomian glands) mainly caused by staph aureus

109
Q

Presentation of Hordeolum (Stye)

A

painful erythematous nodule (may be puss filled)
may perforate & discharge spontaneously
no eyelid/occular pain

110
Q

Management of Hordeolum (Stye)

A

generally self limiting, resolving in 1-2 weeks

hot compresses & eyelid hygiene

topical Abx if severe

111
Q

Chalazion

A

meibomian cyst, may be seen secondary to stye

presents as chronic slow growing firm rubbery nodule of eyelid & heavy feeling o the lid

generally self-resolves

112
Q

Thyroid eye disease

A

most common extra-thyroidal manifestation of graves disease (affects 25-50% of pts with graves)

due to an antibody mediated autoimmune reaction leading to retro-orbital inflammation which leads to collagen/glycosaminoglycan deposition in the msucles

113
Q

Presentation of thyroid eye disease

A 
exophthalmos (often asymmetric )
retropulsion
ocular motility problems (diplopia, poor convergence)
lid retraction
conjunctival inactions
sore dry eyes
ophthalmoplegia
114
Q

Investigations for thyroid eye disease

A

TFTs (↓ TSH, ↑T3/T4)
TSH receptor antibodies (+ve)
CT/MRI orbits

115
Q

Management of thyroid eye disease

A

topical lubricants
smoking cessation
controlling thyroid disease

116
Q

Strabismus (squint)

A

a misalignment of the visual axis of the eyes

117
Q

Types of Strabismus (squint)

A

concomitant:
common, due to imbalance in extraocular muscles

paralytic:
less common, due to paralysis of extra ocular muscles

118
Q

latent squint terminology

A

Heterophoria

119
Q

manifest squint terminology

A

tropia

120
Q

Squint in deviation terminology

A

esotropia

121
Q

Squint out deviation terminology

A

exo

122
Q

Squint up deviation terminology

A

hyper

123
Q

Squint down deviation terminology

A

hypo

124
Q

convergent squint terminology

A

esotropia

125
Q

divergent squint terminology

A

exotropia

126
Q

concomitant squint

A

usually congenital

children have full movement in both eyes if tested separately

no diplopia, pts may intermittently close one eye

127
Q

Paralytic squint

A

acquired due to damage to extra ocular muscles or nerves

diplopia common

128
Q

Investigating strabismus

A

cover test (cover/uncover test or alternate cover test)

Hirschberg test (to determine eye alignment)

129
Q

Management of strabismus

A

correction of refractory errors
strabismus surgery
occlusion therapy (eye patches, more effective if used early)

130
Q

Ambylopia (functional visual impairment)

A

↓ best corrected corrected visual acuity in one or both eyes that is not attributable to a structural abnormality of the eye/visual pathways

usually due to developmental vision disorder during early childhood e.g strabismus, congenital cataracts

treat early in childhood, correct refractive error, occlusion (patching) correct underlying cause e.g. strabismus

131
Q

Myopia (near sighted)

A

eyes have excessive optical power for the axial length of the eyeball and/or the eyeball is too long leading to focus pf the image in front of the retina

objects at distance are blurred

corrected by concave (minus) lens

132
Q

Hypermyetropia / Hyperopia (far sighted)

A

eyes have insufficient optical power for tis reactive length so the focus of the image is behind the retina or eyeball may be too short

objects up close are blurred

corrected with convex (plus) lens

133
Q

Astigmatism

A

normally light from a point in the visual field has to focus on a single point on the retina, in astigmatism the cornea & lens curvatures result in the light failing to focus on a single point

corrected with bifocal lens

134
Q

Presbyopia

A

↓ power of accommodation usually becoming significant at age of 40-50 when focusing on near objects e.g. reading becomes difficult

corrected using reading glasses

135
Q

Emmertropia

A

eye with no visual defects or refractive errors

i.e. light is perfectly focused on the retina

136
Q

Left eye anopsia

A

caused by optic nerve lesion e.g. optic neuritis or central retinal artery occlusion

137
Q

left nasal hemianopia

A

ipsilateral left temporal fibres of optic nerve damaged e.g. from ICA aneurysm expanding medially

138
Q

bitemporal hemianopia

A

optic chasm compression

if upper quadrants worse = inferior compression e.g. from pituitary adenoma

if lower quadrants worse = superior compression e.g. from craniopharyngioma

139
Q

Right homonymous hemianopia

A

damage to contralateral optic tract or lateral geniculate body e.g. from MCA infarction

140
Q

Right homonymous superior quadrantanopia

A

contralateral temporal radiation/meyers loop damage e.g. in MCA occlusions or temporal lobe tumour

141
Q

Left homonymous inferior quadrantanopia

A

contralateral parietal radiation/non-meters loop

142
Q

right homonymous hemianopia with macula sparing

A

contralateral damage to primary visual cortex e.g. from PCA occlusion

NB macular is spared due to contralateral blood supply

143
Q

nasolacrimal duct obstruction

A

nasolacrimal duct commonly canalises at ~8moths of fatal life but there is commonly a delay in this developmental process which can result in residual membrane tissue or stenosis at any level in the duct

most common cause of persistent watery eye in infants

investigated with fluroscein disappearance test

treated with massaging lacrimal ducts, 95% will resolve by age 1, if persistent >1y/o = surgery

144
Q

Retinopathy of prematurity

A

disease of the retina with abnormal vessel proliferation that affects preterm infants, due to ↑/fluctuating levels of PaO2 leading to extra retinal neovascularisation as it causes ↑ VEGGF

risk factors:
prematurity, ventialtion, O2 administration, birth weight <1500g

management:
laser photocoagulation (1st line)
anti-VEGF injections (2nd line)

145
Q

Screening for retinopathy of prematurity

A

screen all infants born <32 weeks or weighing <1501g
those born at 32-36 weeks with O2 administration

weekly/fortnightly screening

discontinued after completed retinal vascularisation

146
Q

Retinoblastoma

A

most common primary intraocular malignancy in children, usually diagnosed around age 18months

due to mutation of retinoblastoma gene (Rb)

if hereditary (autosomal dominant) = bilateral
sporadic = unilateral
147
Q

Presentation of retinoblastoma

A 
leukocoria (white pupillary reflex, i.e. absent red reflex)
strabismus
loss of vision
painful red eye
retinal detachment
148
Q

Investigations for retinoblastoma

A

fundoscopy (chalky white-grey retinal mass)
ocular USS
MRI head

149
Q

Management of retinoblastoma

A

localised:
eye conceiving therapy (photocoagulation, cryotherapy, radio & chemotherapy)

enucleation:
removal of eye & adult size implant to replace

150
Q

Holmes-Adie pupil

A

affects women in 3rd/4th decade of life
80% are bilateral

dilated pupil
once pupil is constricted it remains small for abnormally long period of time
slowly reactive to accommodation but very poor if any accommodation to light

151
Q

Argyll-Robertson pupil

A

highly specific for neurosyphilis

usually bilateral

tonically small pupil that treats poorly to light but briskly to accommodation (light-near dissociation)
difficult to pharmacological dilate pupil

152
Q

Marcus-Gunn pupil (relative afferent pupillary defect)

A

found on the swinging light test

the affected and normal eye appears to dilate when light is shone in the affected eye

caused by a lesion anterior to the optic chiasm e.g. optic neuritis or retinal detachment

153
Q

Retinitis pigmentosa

A

inherited condition (i.e. usually family history), primarily affects the peripheral retina resulting in tunnel vision, usually bilateral

Features
night blindness (initial sign)
tunnel vision due to loss of the peripheral retina

fundoscopy: arteriolar attenuation, black/bone–spicule peripheral retinal pigmentation and waxy optic disc pallor, mottling of the retinal pigment epithelium

Year 4 (12 decks)

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