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The One Deck To Rule Them All > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Relative afferent pupillary defect
Central scotoma
Red-desaturation (red-green colour vision)

A

Optic neuritis

  • seen in MS
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2
Q

Normal intraocular pressure

A

10-21mmHg

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3
Q

Macular oedema is seen in

A

Diabetes

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4
Q

Maculopathy is seen in
(causes areas of vision to be blurred)

  • hard exudates”
A

Diabetes

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5
Q

Normal disc to cup ratio

A

0.2 (20%)

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6
Q

Moderate disc to cup ratio

A

0.5 (50%)

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7
Q

Severe disc to cup ratio

A

0.8 (80%)

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8
Q

Site of anaesthesia for eye

A

Subtenon space

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9
Q

Papilloedema =

A

Increased ICP

  • LP is contraindicated
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10
Q

A test used to test the presence of assess aqueous humor leakage from anterior chamber of the eye from a corneal injury

  • used fluorescein
A

Seidel’s test

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11
Q

Tropicamide

A

Dilates pupil
Short acting anti-muscarinic
Paralyses sphincter papillae
works for 4 hours

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12
Q

Cyclopentolate

A

Dilates pupil
Long acting anti-muscarinic
Paralyses sphincter papillae + ciliary muscle

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13
Q

Atropine

A

Dilates pupil
Ani-muscarininc
Paralyses sphincter papillae + ciliary muscle

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14
Q

mydriasis (mydriatic drugs)

A

dilation of the pupil

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15
Q

miosis (mitotic drugs)

A

constriction of the pupil

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16
Q

Night blindness
Peripheral vision loss “tunnel vision”
Fundoscopy: Bone-spicule shaped pigmentation
Dark retina mottling

A

Retinitis Pigmentosa

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17
Q

Retinitis Pigmentosa + hearing loss

A

Usher’s syndrome

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18
Q

Retinitis Pigmentosa + abnormal fat metabolism

A

Bassen-Kornzweig syndrome

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19
Q

Retinitis Pigmentosa + peripheral neuropathy

A

Refsum’s disease

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20
Q 
Gradual onset
Decreased visual acuity 
Blurred vision
Faded colour vision (dull)
Light appears brighter
Halos around lights "starbursts"
Absent red reflex
Cloudy lens
A

Cataracts

Lens of eye becomes cloudy

  • F>M
    > 65 years
  • associated with diabetes
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21
Q

Risk factors of cataracts

A 
Age
Smoking
Alcohol
Trauma
Hypocalcaemia
Steroids 
Radiation
Myotonic dystrophy
DM
Uveitis
Down's syndrome
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22
Q

Management of Cataracts

A

Decrease bright lights
Glasses
Surgical replacement with artificial lens
- risk of endophthalmitis

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23
Q

Shingles + vesicles on tip of nose (Hutchinson’s sign)

A

Herpes zoster opthalmicus

  • 10 % of shingles
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24
Q

Management of Herpes zoster opthalmicus

A

Refer

Oral antiviral 7-10days

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25
Fundoscopy: - Bilateral - Venous engorgement - Blurring of optic disc margin - Paton's lines outwards from retinal disc Headache Lower limb weakness Upgoing plantar reflexes
Papilloedema optic disc swelling due to increased ICP
26
Causes of papilloedema
``` SOL HTN IC HTN Hydrocephalus Hypercapnia Hypoparathyroidism Hypocalcaemia Vit A toxicity ```
27
Persistent watery eye in infant
Nasolacrimal duct obstruction | - caused by imperforate membrane
28
Management of Nasolacrimal duct obstruction
Massage lacrimal duct | self resolves by 1 year
29
Sub-acute visual loss Difficulty seeing in dark Photopsia (flashing lights) Near field objects difficult to see
Age related macular degeneration (ARMD) - most common cause of blindness in UK - degeneration of retinal photoreceptors
30
Risk factors for ARMD
``` 2M:1F > 75 years = ( x 3 risk) Smoking FHx ( 4 x risk) Arthropathies ```
31
Investigations for ARMD
Fundoscopy Ampler grid testing: distortion of line (metamorphopsia) Optical coherence tomography: diagnostic Fluorescein angiography: to identify wet ARMD
32
Types of ARMD
Dry ARMD: 90% (geographic atrophy) | Wet ARMD: 10% (exudative, neovascular)
33
New vessel formation (neovascularisation) Oedema Central vision affected first (progressive) Haemorrhages on fundoscopy
Wet ARMD
34
Drusen (yellow fatty lipid deposits in Broch's membrane) | Alternations to retinal pigment epithelium
Dry ARMD
35
Management for Wet ARMD
Intravitreal Anti-VEGF (monthly) = stops neovascularisation - Ranibizumab - Bevacizumab - Pegaptanib
36
Management for Dry ARMD
Anti oxidants + vitamin supplements | Not much else can be done
37
Types of retinopathy
Hypertensive | Diabetic
38
``` Cotton wool spots (areas of retinal infarction) Haemorrhages Papilloedema AV nicking Silver wiring Hard exudates ```
Hypertensive Retinopathy
39
Classification system for Hypertensive retinopathy
Keith-Wagener staging system 1. Increased light reflex (silver wiring) Mild arteriole narrowing (tortuosity) 2. Focal blood vessel construction AV nipping 3. Cotton wool spots Exudates Flame + blot haemorrhages 4. Papilloedema
40
``` Cotton wool spots Neovascularisation Microaneurysms Blot Haemorrhages Hard exudates ```
Diabetic retinopathy - most common cause of blindness 35-65 years
41
Diabetic retinopathy + micro-aneurysms + haemorrhages + cotton wool spots
Non-proliferative disease
42
Diabetic retinopathy | + neovascularisation
Proliferative disease
43
Complication of neovascularisation
Vitreous haemorrhage
44
Management of Diabetic retinopathy
Laser photocoagulation Intravitreal Anti-VEGF Severe: Vitreoretinal surgery
45
Pin-hold occludes are used
to check if blurred vision is due to a refractive error
46
Types of styes infections of the glands of the eyelids
External: Hordeolum externum - infection of zeis (sebum) or moll (sweat) glands by staphy bacteria Internal: Hordeolum internum - infection of meibomian glands - can lead to chalazion
47
Management of styes
Hot compress Analgesia Abx if ?conjunctivitis
48
Firm painless lump in eyelid
Chalazion (meibomian cyst) - following an internal stye Tx: Self resolves Abx if severe
49
Out-turning of the eyelid Dropping eyelid Watery + sore eye
Ectropium - risk of keratopathy
50
In-turning of the eyelid
Entropium - risk of corneal damage + ulceration Tx: Eye lubricants Tape eyelid Surgery
51
Involuntary twitching or contraction of eyelid
Blepharospasm | - focal dystonia due to stress/fatigue
52
Bilateral grittiness feeling in eyes Eyes sticky in the morning Red eyelid margins
Blepharitis - inflammation of the eyelid margins - associated with seborrheic dermatitis + rosacea
53
Types of blepharitis
Anterior: - Seborrheic dermatitis - Staph aureus infection Posterior: - Most common - Meibomian gland dysfunction
54
Management of blepharitis
Hot compression (twice daily) Lid hygiene Artificial tears
55
Lesion of the optic chasm causes a
Bitemporal hemianopia
56
Bitemporal hemianopia | Upper > lower quadrant defect
Pituitary adenoma - inferior chiasmal compression
57
Bitemporal hemianopia | Lowe > upper quadrant defect
Craniopharyngioma - superior chasmal compression
58
Lesion of optic radiations
Homonymous quadrantanopias PITS= Parietal inferior, temporal superior
59
Homonymous quadrantanopia | Contralateral superior
Temporal lobe (Meyer's loop) - inferior optic radiation lesion
60
Homonymous quadrantanopia | Contralateral inferior
Parietal lobe - superior optic radiation
61
Lesions of the optic tract
Homonymous hemianopia - contralateral Left Homonymous hemianopia= Lesion of the right optic tract
62
Homonymous hemianopia + incongruous defects
Optic tract lesion
63
Homonymous hemianopia + congruous defects
Optic radiation lesion | Occipital cortex lesion
64
Homonymous hemianopia + macular sparing
Occipital cortex lesion
65
Causes of painful sudden loss of vision
Retinal tear | Retinal necrosis
66
Curtain/ shadow coming across peripheral vision | Painful
Retinal tear
67
Management of retinal tear
Laster therapy | Cryotherapy
68
Acute unilateral loss in vision | Painful
Retinal necrosis Slit lamp: - multiple focuses of retinal whitening + opacification - scalloped edges that become confluent
69
Transient los of vision < 24hrs
Transient monocular visual loss (TMVL)
70
Causes of painless loss of vision
``` Vitreous haemorrhage Amaurosis fugax Cataracts Retinal Detachment Central retinal vein occlusion (CRVO) Central Refinery artery occlusion (CRAO) ```
71
Unilateral loss of vision "curtain coming down" Painless
Amaurosis fugax - similar to TIA - arteriopaths are at increased risk
72
Management of Amaurosis fugax
Aspirin 300mg
73
``` Floaters + flashes of light Dark spots in vision Acute onset Decreased visual acuity Reddish "hue" to vision ```
Vitreous haemorrhage Self resolves (1% per day)
74
Investigations for vitreous haemorrhage
Fundoscopy: haemorrhage Slit lamp: RBC in anterior chamber US if retina is obscured Fluorescein to identify neovascularisation
75
Causes of vitreous haemorrhage
Diabetic retinopathy (50%) Posterior vitreous detatchment Trauma Blood thinning agents increase risk
76
Curtain/shadow coming across peripheral vision first then moving centrally Flashing lights Spindly shapes Spider-web floaters
Retinal detachment
77
Management of retinal detachment
Virectomy + replacement Scleral buckling Pneumatic retinopexy
78
Painless flashes + floaters No LOV VA normal
Posterior vitreous detachment (PVD) - 75% of those > 65 years - myopic (short sighted) patients at increased risk - can lead to retinal detachment
79
Sudden painless LOV Fundoscopy: Dark retina Retinal flame haemorrhages
Central Retinal vein occlusion (CRVO)
80
Investigations for CRVO
FBC: Anaemia ESR: Myeloma, inflammatory conditions BP: HTN Glucose: Diabetes
81
Risk factors for CRVO
Increased age Glaucoma Polycythaemia
82
Complications of CRVO
Macular oedema Neovascularisation Glaucoma
83
Sudden painless LOV Fundoscopy: Pale retina Cherry red spot Relative afferent pupillary defect
Central retinal artery occlusion (CRAO) - caused by thromboembolism giant cell arteritis (ESR, Temporal AB)
84
Diplopia Impairment of adduction of ipsilateral eye Contralateral eye abducts with nystagmus
Internuclear ophthalmoplegia - Seen in MS
85
Constant (manifest) squint | Diplopia
Tropia
86
Latent squint Normal with both eyes open When one eye covered = abnormal
Phoria
87
Misalignment of the eyes
Stabismus (squint)
88
Convergent strabismus (nasal)
Esotropia
89
Divergent strabismus (temporal)
Exotropia
90
Upward strabismus
Hypertropia
91
Downward strabismus
Hypotropia
92
Most common type of strabismus
Concominant (Convergent- Esotropia) due to imbalance in extraoccular muscles
93
Rare type of strabismus
Paralytic due to paralysis of extra ocular muscles
94
Brain fails to process inputs form one eye, and over time favours the other eye causing blindness in said eye
Amblyopia "Lazy eye"
95
Preventative measures against Amblyopia "Lazy eye"
Eye-patch on good eye
96
Investigations for strabismus
Corneal light reflection test: does light reflect symmetrically on both pupils Cover test: cover one eye, observe movement of uncovered eye
97
Dilated pupil | Sluggish reactions
Holmes-adie pupil - caused by post-ganglionic parasympathetic fibre damage
98
Bilateral dilated pupils | Fixed/sluggish response
Poor CNS perfusion
99
Dilated pupil Ptosis Down + out
Third nerve palsy
100
Relative afferent pupillary affect | Dilated pupils
Marcus Gunn pupil
101
Test for relative afferent pupillary defect - damage to afferent pathway of one eye then the pupil of the affected eye will abnormally dilate when light is shone into it
Swinging light test
102
Constricted pupil | Accommodates but does not react
Argyll-Robertson Pupil "Prostitutes pupil" - associated with neurosyphilis
103
Ptosis Miosis Anhidrosis Enophthalmos (sunken eye)
Horner's Syndrome - caused by sympathetic nerve supply damage
104
Investigation for horner's syndrome
Cocaine eye drop test no change = damage dilate = normal
105
Horner's syndrome + heterochromia
Congenital Horner's syndrome
106
Inflammation of cornea | Hx of construction work
Welder's Arc Eye - from UV radiation from the arc of welding metal
107
Milky white fluid in anterior chamber of eye
Hypopyon
108
Causes of painless red eye
Infective conjunctivitis Episcleritis Subconjunctival haemorrhage Primary Open Angle Glaucoma
109
Painless red eye | Hx of heavy coughing/lifting
Subconjunctival haemorrhage space between sclera + conjunctiva is affected - check BP
110
Painless red eye Watery Photophobia Bilateral (50%)
Episcleritis - Associated with RA - Injected vessels are mobile when gentle pressure applied to sclera - phenylephrine will blance vessels
111
Management for episcleritis
Lubricating eye drops
112
Painful red eye Purulent discharge Eyes stuck together in morning
Bacterial infective conjunctivitis - Strep pneumoniae - Staph aureus - Haemophilus influenzae In newborn < 1year: Gonococcal / Chlamydia - school exclusion not necessary
113
Painful red eye Serous discharge Recent URTI Preauricular lymph nodes
Viral infective conjunctivitis
114
Management of infective conjunctivitis
Self limiting (2 weeks) Avoid sharing towels, don't wear eye contacts Chloramphenicol drops 2-3 hours Pregnant: Fuscidic acid (BD)
115
Increased resistance to aqueous humour outflow in the trabecular meshwork due to increased intra ocular pressure
Primary open angle glaucoma
116
``` Insidious onset Peripheral vision affected first Decreased visual acuity Optic disc cupping (>0.7) Increased IOP Pale optic disc Bayonetting of vessels ```
Primary open angle glaucoma
117
Risk factors for Primary open angle glaucoma
``` 0.5% > 40 years Increasing age 1 degree relatives have 16% risk (screen from 40years) Myopia (short sight) HTN Diabetes Steroids Head trauma ```
118
Gold standard investigation for Primary open angle glaucoma
Goldmann applanation tonometry to assess IOP
119
1st line management for Primary open angle glaucoma
Prostaglandin analogue drops (latanoprost) Increases outflow Side effects: - eyelash growth - eyelid pigmentation
120
2nd line management for Primary open angle glaucoma
1. Beta-blockers (Timolol): decreases secretions 2. Carbonic anhydrase inhibitor (Dorzolamide): decreases secretions 3. Sympanomimetic drops: mixed action 4. Alpha-2-agonist (apraclonidine): mixed action 5. Pilocarbine: increases outflow Severe: Trabeculectomy
121
Causes of painful red eye
``` Scleritis Anterior uveitis Corneal abrasion Endophthalmitis Keratitis (corneal ulcer) Acute angle closure glaucoma Orbital cellulitis ```
122
``` Seeing halos around lights Painful red eye Fixed + dilated pupil (non-reactive) Hazy + dull cornea Worse with dilated pupil (in dark room) Decreased visual acuity Headache ```
Acute angle close glaucoma Iris pressed forwards by blocking outflow in posterior chamber of the eye, causing increased IOP behind iris can be caused by drugs: - adrenergic - anticholinergic - tri-cyclic antidepressants
123
Acute angle glaucoma is associated with
Hypermetropia (long-sightedness)
124
Management of Acute angle glaucoma
Phone 999 Place in supine position (without pillow) 1. Pilocarbine eye drops (constrict pupi, increases outflow) + Acetazolamide: decreases secretions + Latanoprost (prostaglandin): increases outflow 2. Timolol: decreases outflow 3. Alpha-2-agonist (apraclonidine): mixed Definitive: Laser iridotomy (creates hole in iris allowing outflow)
125
``` Dull eye pain Headaches LOV Watery eye Worse on movement ```
Scleritis Scleritis is sore - Associated with RA - deep vessels, do not move when applied pressure - phenylephrine does not blanche
126
``` Acute onset Blurred vision Photophobia Small, fixed + oval pupil (adhesions) Ciliary flush Hypopyon (white spot in anterior chamber) ```
Anterior uveitis - Inflammation of anterior portion of uvea
127
Anterior uveitis is associated with
HLA B27 - Ank Spond - Reactive arthritis - Ulcerative colitis - Crohn's - Behcet's disease - Sarcoidosis (bilateral)
128
Bilateral anterior uveitis
Sarcoidosis
129
Management of Anterior uveitis
Cycloplegics: - atropine - cyclopentolate - steroids
130
Visual loss following surgery | Painful red eye
Endophthalmitis
131
``` Photophobia Epiphora (excessive watering of eye) Decreased VA Painful red eye Gritty feeling ```
Keratitis (corneal ulcer) - contact lenses are a risk factor - steroids can make infection worse
132
Investigations for keratitis
Fluorescein stain: linear branching corneal ulcer = dendritic Slit lamp
133
Types of keratitis (corneal ulcers)
Viral: Dendritic (Herpes) Bacterial: Staph Aureus, Psudomonas A (contact lenses) Fungal: from steroid use Aoembic: Acanthamoebic keratitis Parasitic: Onchocercal keratitis "River blindness"
134
Management of Keratitis (corneal ulcers)
Viral: Topical aciclovir Bacterial: Quionolones (ciprofloxacin) Analgesia: cyclopentolate
135
Horner's syndrome + no anhidrosis
Carotid artery dissection
136
Horner's syndrome + anhidrosis of head, arm, trunk
stroke | syringomyelia
137
Horner's syndrome + anhidrosis of face
Pancoast's tumour | Cervical rib

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