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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
Q

Fundoscopy:

  • Bilateral
  • Venous engorgement
  • Blurring of optic disc margin
  • Paton’s lines outwards from retinal disc

Headache
Lower limb weakness
Upgoing plantar reflexes

A

Papilloedema

optic disc swelling due to increased ICP

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26
Q

Causes of papilloedema

A 
SOL
HTN
IC HTN
Hydrocephalus
Hypercapnia
Hypoparathyroidism
Hypocalcaemia
Vit A toxicity
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27
Q

Persistent watery eye in infant

A

Nasolacrimal duct obstruction

- caused by imperforate membrane

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28
Q

Management of Nasolacrimal duct obstruction

A

Massage lacrimal duct

self resolves by 1 year

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29
Q

Sub-acute visual loss
Difficulty seeing in dark
Photopsia (flashing lights)
Near field objects difficult to see

A

Age related macular degeneration (ARMD)

  • most common cause of blindness in UK
  • degeneration of retinal photoreceptors
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30
Q

Risk factors for ARMD

A 
2M:1F
> 75 years = ( x 3 risk)
Smoking
FHx ( 4 x risk)
Arthropathies
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31
Q

Investigations for ARMD

A

Fundoscopy
Ampler grid testing: distortion of line (metamorphopsia)
Optical coherence tomography: diagnostic
Fluorescein angiography: to identify wet ARMD

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32
Q

Types of ARMD

A

Dry ARMD: 90% (geographic atrophy)

Wet ARMD: 10% (exudative, neovascular)

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33
Q

New vessel formation (neovascularisation)
Oedema
Central vision affected first (progressive)
Haemorrhages on fundoscopy

A

Wet ARMD

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34
Q

Drusen (yellow fatty lipid deposits in Broch’s membrane)

Alternations to retinal pigment epithelium

A

Dry ARMD

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35
Q

Management for Wet ARMD

A

Intravitreal Anti-VEGF (monthly) = stops neovascularisation

  • Ranibizumab
  • Bevacizumab
  • Pegaptanib
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36
Q

Management for Dry ARMD

A

Anti oxidants + vitamin supplements

Not much else can be done

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37
Q

Types of retinopathy

A

Hypertensive

Diabetic

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38
Q 
Cotton wool spots (areas of retinal infarction)
Haemorrhages
Papilloedema
AV nicking 
Silver wiring 
Hard exudates
A

Hypertensive Retinopathy

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39
Q

Classification system for Hypertensive retinopathy

A

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
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40
Q 
Cotton wool spots
Neovascularisation
Microaneurysms
Blot Haemorrhages
Hard exudates
A

Diabetic retinopathy

  • most common cause of blindness 35-65 years
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41
Q

Diabetic retinopathy
+ micro-aneurysms
+ haemorrhages
+ cotton wool spots

A

Non-proliferative disease

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42
Q

Diabetic retinopathy

+ neovascularisation

A

Proliferative disease

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43
Q

Complication of neovascularisation

A

Vitreous haemorrhage

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44
Q

Management of Diabetic retinopathy

A

Laser photocoagulation
Intravitreal Anti-VEGF
Severe: Vitreoretinal surgery

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45
Q

Pin-hold occludes are used

A

to check if blurred vision is due to a refractive error

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46
Q

Types of styes

infections of the glands of the eyelids

A

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
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47
Q

Management of styes

A

Hot compress
Analgesia
Abx if ?conjunctivitis

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48
Q

Firm painless lump in eyelid

A

Chalazion (meibomian cyst)
- following an internal stye

Tx: Self resolves
Abx if severe

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49
Q

Out-turning of the eyelid
Dropping eyelid
Watery + sore eye

A

Ectropium

  • risk of keratopathy
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50
Q

In-turning of the eyelid

A

Entropium

  • risk of corneal damage + ulceration

Tx: Eye lubricants
Tape eyelid
Surgery

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51
Q

Involuntary twitching or contraction of eyelid

A

Blepharospasm

- focal dystonia due to stress/fatigue

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52
Q

Bilateral grittiness feeling in eyes
Eyes sticky in the morning
Red eyelid margins

A

Blepharitis

  • inflammation of the eyelid margins
  • associated with seborrheic dermatitis + rosacea
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53
Q

Types of blepharitis

A

Anterior:

  • Seborrheic dermatitis
  • Staph aureus infection

Posterior:

  • Most common
  • Meibomian gland dysfunction
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54
Q

Management of blepharitis

A

Hot compression (twice daily)
Lid hygiene
Artificial tears

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55
Q

Lesion of the optic chasm causes a

A

Bitemporal hemianopia

56
Q

Bitemporal hemianopia

Upper > lower quadrant defect

A

Pituitary adenoma

  • inferior chiasmal compression
57
Q

Bitemporal hemianopia

Lowe > upper quadrant defect

A

Craniopharyngioma

  • superior chasmal compression
58
Q

Lesion of optic radiations

A

Homonymous quadrantanopias

PITS= Parietal inferior, temporal superior

59
Q

Homonymous quadrantanopia

Contralateral superior

A

Temporal lobe (Meyer’s loop)

  • inferior optic radiation lesion
60
Q

Homonymous quadrantanopia

Contralateral inferior

A

Parietal lobe

  • superior optic radiation
61
Q

Lesions of the optic tract

A

Homonymous hemianopia

  • contralateral

Left Homonymous hemianopia= Lesion of the right optic tract

62
Q

Homonymous hemianopia + incongruous defects

A

Optic tract lesion

63
Q

Homonymous hemianopia + congruous defects

A

Optic radiation lesion

Occipital cortex lesion

64
Q

Homonymous hemianopia + macular sparing

A

Occipital cortex lesion

65
Q

Causes of painful sudden loss of vision

A

Retinal tear

Retinal necrosis

66
Q

Curtain/ shadow coming across peripheral vision

Painful

A

Retinal tear

67
Q

Management of retinal tear

A

Laster therapy

Cryotherapy

68
Q

Acute unilateral loss in vision

Painful

A

Retinal necrosis

Slit lamp:

  • multiple focuses of retinal whitening + opacification
  • scalloped edges that become confluent
69
Q

Transient los of vision < 24hrs

A

Transient monocular visual loss (TMVL)

70
Q

Causes of painless loss of vision

A 
Vitreous haemorrhage 
Amaurosis fugax
Cataracts
Retinal Detachment
Central retinal vein occlusion (CRVO)
Central Refinery artery occlusion (CRAO)
71
Q

Unilateral loss of vision
“curtain coming down”
Painless

A

Amaurosis fugax

  • similar to TIA
  • arteriopaths are at increased risk
72
Q

Management of Amaurosis fugax

A

Aspirin 300mg

73
Q 
Floaters + flashes of light
Dark spots in vision
Acute onset
Decreased visual acuity 
Reddish "hue" to vision
A

Vitreous haemorrhage

Self resolves (1% per day)

74
Q

Investigations for vitreous haemorrhage

A

Fundoscopy: haemorrhage
Slit lamp: RBC in anterior chamber
US if retina is obscured
Fluorescein to identify neovascularisation

75
Q

Causes of vitreous haemorrhage

A

Diabetic retinopathy (50%)
Posterior vitreous detatchment
Trauma
Blood thinning agents increase risk

76
Q

Curtain/shadow coming across peripheral vision first then moving centrally
Flashing lights
Spindly shapes
Spider-web floaters

A

Retinal detachment

77
Q

Management of retinal detachment

A

Virectomy + replacement
Scleral buckling
Pneumatic retinopexy

78
Q

Painless flashes + floaters
No LOV
VA normal

A

Posterior vitreous detachment (PVD)

  • 75% of those > 65 years
  • myopic (short sighted) patients at increased risk
  • can lead to retinal detachment
79
Q

Sudden painless LOV
Fundoscopy: Dark retina
Retinal flame haemorrhages

A

Central Retinal vein occlusion (CRVO)

80
Q

Investigations for CRVO

A

FBC: Anaemia
ESR: Myeloma, inflammatory conditions
BP: HTN
Glucose: Diabetes

81
Q

Risk factors for CRVO

A

Increased age
Glaucoma
Polycythaemia

82
Q

Complications of CRVO

A

Macular oedema
Neovascularisation
Glaucoma

83
Q

Sudden painless LOV
Fundoscopy: Pale retina
Cherry red spot
Relative afferent pupillary defect

A

Central retinal artery occlusion (CRAO)

  • caused by thromboembolism
    giant cell arteritis (ESR, Temporal AB)
84
Q

Diplopia
Impairment of adduction of ipsilateral eye
Contralateral eye abducts with nystagmus

A

Internuclear ophthalmoplegia

  • Seen in MS
85
Q

Constant (manifest) squint

Diplopia

A

Tropia

86
Q

Latent squint
Normal with both eyes open
When one eye covered = abnormal

A

Phoria

87
Q

Misalignment of the eyes

A

Stabismus (squint)

88
Q

Convergent strabismus (nasal)

A

Esotropia

89
Q

Divergent strabismus (temporal)

A

Exotropia

90
Q

Upward strabismus

A

Hypertropia

91
Q

Downward strabismus

A

Hypotropia

92
Q

Most common type of strabismus

A

Concominant (Convergent- Esotropia)

due to imbalance in extraoccular muscles

93
Q

Rare type of strabismus

A

Paralytic

due to paralysis of extra ocular muscles

94
Q

Brain fails to process inputs form one eye, and over time favours the other eye causing blindness in said eye

A

Amblyopia “Lazy eye”

95
Q

Preventative measures against Amblyopia “Lazy eye”

A

Eye-patch on good eye

96
Q

Investigations for strabismus

A

Corneal light reflection test: does light reflect symmetrically on both pupils

Cover test: cover one eye, observe movement of uncovered eye

97
Q

Dilated pupil

Sluggish reactions

A

Holmes-adie pupil

  • caused by post-ganglionic parasympathetic fibre damage
98
Q

Bilateral dilated pupils

Fixed/sluggish response

A

Poor CNS perfusion

99
Q

Dilated pupil
Ptosis
Down + out

A

Third nerve palsy

100
Q

Relative afferent pupillary affect

Dilated pupils

A

Marcus Gunn pupil

101
Q

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
A

Swinging light test

102
Q

Constricted pupil

Accommodates but does not react

A

Argyll-Robertson Pupil

“Prostitutes pupil”
- associated with neurosyphilis

103
Q

Ptosis
Miosis
Anhidrosis
Enophthalmos (sunken eye)

A

Horner’s Syndrome

  • caused by sympathetic nerve supply damage
104
Q

Investigation for horner’s syndrome

A

Cocaine eye drop test

no change = damage
dilate = normal

105
Q

Horner’s syndrome + heterochromia

A

Congenital Horner’s syndrome

106
Q

Inflammation of cornea

Hx of construction work

A

Welder’s Arc Eye

  • from UV radiation from the arc of welding metal
107
Q

Milky white fluid in anterior chamber of eye

A

Hypopyon

108
Q

Causes of painless red eye

A

Infective conjunctivitis
Episcleritis
Subconjunctival haemorrhage
Primary Open Angle Glaucoma

109
Q

Painless red eye

Hx of heavy coughing/lifting

A

Subconjunctival haemorrhage

space between sclera + conjunctiva is affected
- check BP

110
Q

Painless red eye
Watery
Photophobia
Bilateral (50%)

A

Episcleritis

  • Associated with RA
  • Injected vessels are mobile when gentle pressure applied to sclera
  • phenylephrine will blance vessels
111
Q

Management for episcleritis

A

Lubricating eye drops

112
Q

Painful red eye
Purulent discharge
Eyes stuck together in morning

A

Bacterial infective conjunctivitis

  • Strep pneumoniae
  • Staph aureus
  • Haemophilus influenzae

In newborn < 1year: Gonococcal / Chlamydia
- school exclusion not necessary

113
Q

Painful red eye
Serous discharge
Recent URTI
Preauricular lymph nodes

A

Viral infective conjunctivitis

114
Q

Management of infective conjunctivitis

A

Self limiting (2 weeks)
Avoid sharing towels, don’t wear eye contacts
Chloramphenicol drops 2-3 hours
Pregnant: Fuscidic acid (BD)

115
Q

Increased resistance to aqueous humour outflow in the trabecular meshwork due to increased intra ocular pressure

A

Primary open angle glaucoma

116
Q 
Insidious onset
Peripheral vision affected first
Decreased visual acuity 
Optic disc cupping (>0.7)
Increased IOP
Pale optic disc
Bayonetting of vessels
A

Primary open angle glaucoma

117
Q

Risk factors for Primary open angle glaucoma

A 
0.5% > 40 years 
Increasing age
1 degree relatives have 16% risk (screen from 40years)
Myopia (short sight)
HTN
Diabetes
Steroids
Head trauma
118
Q

Gold standard investigation for Primary open angle glaucoma

A

Goldmann applanation tonometry to assess IOP

119
Q

1st line management for Primary open angle glaucoma

A

Prostaglandin analogue drops (latanoprost)

Increases outflow

Side effects:

  • eyelash growth
  • eyelid pigmentation
120
Q

2nd line management for Primary open angle glaucoma

A
  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
Q

Causes of painful red eye

A 
Scleritis
Anterior uveitis 
Corneal abrasion 
Endophthalmitis
Keratitis (corneal ulcer) 
Acute angle closure glaucoma
Orbital cellulitis
122
Q 
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
A

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
Q

Acute angle glaucoma is associated with

A

Hypermetropia (long-sightedness)

124
Q

Management of Acute angle glaucoma

A

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
Q 
Dull eye pain
Headaches
LOV
Watery eye
Worse on movement
A

Scleritis

Scleritis is sore

  • Associated with RA
  • deep vessels, do not move when applied pressure
  • phenylephrine does not blanche
126
Q 
Acute onset
Blurred vision 
Photophobia
Small, fixed + oval pupil (adhesions)
Ciliary flush
Hypopyon (white spot in anterior chamber)
A

Anterior uveitis

  • Inflammation of anterior portion of uvea
127
Q

Anterior uveitis is associated with

A

HLA B27

  • Ank Spond
  • Reactive arthritis
  • Ulcerative colitis
  • Crohn’s
  • Behcet’s disease
  • Sarcoidosis (bilateral)
128
Q

Bilateral anterior uveitis

A

Sarcoidosis

129
Q

Management of Anterior uveitis

A

Cycloplegics:

  • atropine
  • cyclopentolate
  • steroids
130
Q

Visual loss following surgery

Painful red eye

A

Endophthalmitis

131
Q 
Photophobia
Epiphora (excessive watering of eye)
Decreased VA
Painful red eye
Gritty feeling
A

Keratitis (corneal ulcer)

  • contact lenses are a risk factor
  • steroids can make infection worse
132
Q

Investigations for keratitis

A

Fluorescein stain: linear branching corneal ulcer = dendritic
Slit lamp

133
Q

Types of keratitis (corneal ulcers)

A

Viral: Dendritic (Herpes)
Bacterial: Staph Aureus, Psudomonas A (contact lenses)
Fungal: from steroid use
Aoembic: Acanthamoebic keratitis
Parasitic: Onchocercal keratitis “River blindness”

134
Q

Management of Keratitis (corneal ulcers)

A

Viral: Topical aciclovir
Bacterial: Quionolones (ciprofloxacin)

Analgesia: cyclopentolate

135
Q

Horner’s syndrome + no anhidrosis

A

Carotid artery dissection

136
Q

Horner’s syndrome + anhidrosis of head, arm, trunk

A

stroke

syringomyelia

137
Q

Horner’s syndrome + anhidrosis of face

A

Pancoast’s tumour

Cervical rib

The One Deck To Rule Them All (50 decks)

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