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FCM > OPHTHALMOLOGY > Flashcards

OPHTHALMOLOGY Flashcards

1
Q

symptoms are usually bilateral
grittiness and discomfort, particularly around the eyelid margins
eyes may be sticky in the morning, may be swollen

can commonly also have chalazions and styes
secondary conjunctivitis also common

A

blepharitis

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2
Q

management of blepharitis

A

hot compress
lid hygiene
artificial tears

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3
Q

Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)
Itch is prominent
the eyelids may also be swollen
May be a history of atopy
May be seasonal (due to pollen) or perennial

A

allergic conjuctivitis

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4
Q

management for allergic conjunctivitis

A

first-line: topical or systemic antihistamines

second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

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5
Q

Purulent discharge in the eyes
Eyes may be ‘stuck together’ in the morning)
red bloodshot eyes
grittiness

A

bacterial conjunctivitis

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6
Q

Serous discharge from eyes
Recent URTI
Preauricular lymph nodes

A

viral conjucntivitis

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7
Q

management of conjunctivitis

A

usually self-limiting within a week or two

chloramphenicol can be offered in some severe cases. fusidic acid in pregnancy
0.5% drops, 1% ointments

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8
Q

red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen (milky white fluid in the iris)

A

keratitis

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9
Q

management for keratitis

A

stop wearing contact lenses
topical abx = quinolones - ciprofloxacin

cycloplegic for pain relief e.g. cyclopentolate

refer contact lens wearers to exclude microbial keratitis

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10
Q

a raised, triangular or wedge-shaped, benign growth of conjunctiva tissue.

can cause irritation, redness and tearing/watery eyes

A

pterygium

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11
Q

pterygium management

A

drops, ointments and topical steroids can be given to soothe the eye in minor irritation.

definitive treatment = surgery

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12
Q

firm painless lump in the eyelid

can be slightly erythematous but usually flesh coloured

A

chalazion

meibomian cyst

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13
Q

management of chalazion

A

conservative/self-resolving = hot compress advised

sometimes may require surgical drainage

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14
Q

infection of the glands of the eyelids

red swollen painful lump on the waterline/margin of the eyelid

A

stye/hordeolum

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15
Q

management of stye

A

hot compress and analgesia

chloramphenicol only given when there is associated conjunctivitis/severe or recurrent stye.

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16
Q 
Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis
A

orbital cellulitis

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17
Q

Ix of orbital cellulitis

A

bloods - increased WCC and CRP
CT contrast
Blood culture and swab - strep, staph aureus and Hib

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18
Q

management of orbital cellulitis

A

admission to hospital for IV antibiotics - co-amoxiclav

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19
Q

Excess tears (epiphora) - almost invariably.
Pain
Redness
Swelling on the inner corner of eye near nose

A

dacryoadenitis

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20
Q

management of dacryoadenitis

A

abx - co-amoxiclav
and analgesia

some may require incision and drainage

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21
Q

misalignment of the visual axes.

A

strabismus/squint

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22
Q

management for strabismus

A

referral to secondary care

eye patches may help prevent amblyopia

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23
Q 
gradual onset of...
reduced vision 
faded colour vision 
glare around lights 
halos around lights 
may have a opacity of the iris

defect in red-reflex
more common in women>men
usually 65yrs +

A

cataracts

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24
Q

management of cataracts

A

conservative contacts/glasses to improve vision

definitive = surgery

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25
Q

management of congenital cataracts

A

usually monitoring if not causing serious impairment to vision

cataract surgery - usually in the first 2/12 of life

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26
Q

reduced visual acuity
fluctuating visual disturbance
fundoscopy = drusen, yellow areas of pigment deposition in the macular area

older age, hx of smoking, family history

A

age related macular degeneration

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27
Q

Ix for macular degeneration

A

slit lamp microscopy - initial Ix of choice, used to assess for pigmentary, exudative or haemorrhagic changes

fluorescein angiography if neovascular MD suspected

ocular coherence tomography

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28
Q

management of macular degeneration

A

Vascular endothelial growth factor (VEGF) - ranibizumab, bevacizumab and pegaptanib - 4 weekly injection.
laser photocoagulation does slow progression of ARMD

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29
Q

Inner lining of the eyelid that droops forward may become dry and sore
eyelashes droop outwards

A

ectropion

30
Q

management of ectropion

A

surgery = tighten muscle around the eyes

31
Q

Irritation and pain on the front of the eye.
A watery eye.
If left untreated, the front of the eye (the cornea) may become damaged

A

entropion

32
Q

management of entropion

A

Taping the eyelid to the cheek; or
Injecting the muscles of the eyelid with botulinum toxin.
Lubricating eye ointment

definitive = surgery

33
Q 
eye pain or headache 
semi-dilating non-reacting pupils 
haloes around lights
decreased visual acuity 
red, hard eye
A

acute closure glaucoma

34
Q

insidious onset of peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping

usually symptomless for a long time typically present following an ocular pressure measurement during a routine examination by an optometrist

A

primary open angle glaucoma

35
Q

acute closure glaucoma management

A

prompt referral to ophthalmologist

eye drops = pilocarpine (parasympathomimetic), timolol (BB), apraclonidine (alpha-2 agonist)

IV acetazolamide

definitive management = laser peripheral iridotomy

36
Q

primary open-angle glaucoma management

A

first line: prostaglandin analogue (PGA) eyedrop - latanoprost (ending in -prost)

second line: beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eye drop

very advanced = surgery/laser may be considered

37
Q

microaneurysms
blot haemorrhages
hard exudates
cotton wool spots,

A

diabetic retinopathy

38
Q

Ix for diabetic retinopathy

A

gold standard for diagnosis is dilated retinal photography with accompanying ophthalmoscopy

39
Q

management for diabetic retinopathy

A

control of diabetes

40
Q

The sudden appearance of floaters (occasionally a ring of floaters temporal to central vision)
Flashes of light in vision
Blurred vision
Cobweb across vision
The appearance of a dark curtain descending down vision

A

retinal detachment

41
Q

what to do in suspected retinal detachment

A

ophthalmologist within 24 hours to rule out retinal tears or detachment.

42
Q

management of retinal detachment

A

surgical - vitrectomy or surgical buckling

43
Q

sudden visual loss

afferent pupillary defect, ‘cherry red’ spot on a pale retina

A

central retinal arterial occlusion

44
Q

sudden painless vision loss, usually unilateral

severe retinal haemorrhages are usually seen on fundoscopy

A

central retinal vein occlusion

45
Q

central retinal artery occlusion management

A

firm occular massage
Sublingual GTN
IV 500mg acetazolamide

46
Q

central retinal vein occlusion management

A

managed conservatively

refer to 24hr ophthalmologist if there is a treatable cause
and well as if there are signs for macular oedema/neovascularization

47
Q

absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems

average age of diagnosis is 18 months.

A

retinoblastoma

48
Q

management of retinoblastoma

A

surgery (including localised conservative surgical treatments), chemotherapy and radiation

49
Q

reduced vision

papilloedema

A

raised intracranial pressure

50
Q

management of raised intracranial pressure

A

head elevation to 30°
IV mannitol
control hyperventilation
removal of CSF

51
Q

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect)
central scotoma (blind spot)

A

optic neuritis

52
Q

common association with optic neuritis

A

multiple sclerosis

53
Q

management of optic neuritis

A

high dose steroids

should resolve in 4-6 weeks

54
Q

reduction in vision
loss of contrast or colour vision
pale optic disc

A

optic atrophy

55
Q

diagnosis of optic atrophy

A

fundoscopy

56
Q

management of optic atrophy

A

dependent on the underlying cause of the atrophy

57
Q 
exophthalmos
conjunctival oedema
optic disc swelling
ophthalmoplegia
inability to close the eyelids may lead to sore, dry eyes
A

thyroid eye disease

58
Q

management of thyroid eye disease

A

topical lubricants may be needed to help prevent corneal inflammation caused by exposure
steroids
radiotherapy
surgery

59
Q

restriction of extraocular movement, particularly upward gaze,
lid ecchymosis/bruising and oedema
enophthalmos (sunken eye) or exophthalmos (proptosis).
epistaxis

A

blow out fracture

60
Q

Ix for blow out fracture

A

Occipitomental (Waters) view plain X rays

CT Facial views

61
Q

management for blow out fracture

A 
ophthalm referral 
max-fax referral 
antibiotics 
nasal decongestants, ice packs 
don't blow nose
62
Q

Irritation, photophobia, and lacrimation occur

hx of trauma

A

corneal abrasion

63
Q

management of corneal abrasion

A

Prescribe regular antibiotic ointment (eg chloramphenicol) and oral analgesia.
eye patch
cyclopentolate or diclofenac eye drops

64
Q

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

A

horner’s syndrome

65
Q

management of horner’s

A

treat underlying cause

66
Q

unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation

absent ankle/knee reflexes

A

holme-adie

67
Q

management of holme-adie

A

Corrective spectacles may be prescribed; no other treatment is usually needed

68
Q

fixed dilated pupil which doesn’t accommodate
eye is deviated ‘down and out’
ptosis

A

third nerve palsy

69
Q

signs of intracranial pressure

blood in the anterior chamber of the eye

A

hyphema

70
Q

management of hyphema

A

in context of trauma = urgent referral to an ophthalmic specialist for assessment and management

strict bed rest + ophthalmic review

71
Q 
red eye
classically painful
mild pain/discomfort is present
watering and photophobia are common
gradual decrease in vision
A

sclecritis

FCM (16 decks)

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