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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
management of congenital cataracts
usually monitoring if not causing serious impairment to vision cataract surgery - usually in the first 2/12 of life
26
reduced visual acuity fluctuating visual disturbance fundoscopy = drusen, yellow areas of pigment deposition in the macular area older age, hx of smoking, family history
age related macular degeneration
27
Ix for macular degeneration
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
28
management of macular degeneration
Vascular endothelial growth factor (VEGF) - ranibizumab, bevacizumab and pegaptanib - 4 weekly injection. laser photocoagulation does slow progression of ARMD
29
Inner lining of the eyelid that droops forward may become dry and sore eyelashes droop outwards
ectropion
30
management of ectropion
surgery = tighten muscle around the eyes
31
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
entropion
32
management of entropion
Taping the eyelid to the cheek; or Injecting the muscles of the eyelid with botulinum toxin. Lubricating eye ointment definitive = surgery
33
``` eye pain or headache semi-dilating non-reacting pupils haloes around lights decreased visual acuity red, hard eye ```
acute closure glaucoma
34
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
primary open angle glaucoma
35
acute closure glaucoma management
prompt referral to ophthalmologist eye drops = pilocarpine (parasympathomimetic), timolol (BB), apraclonidine (alpha-2 agonist) IV acetazolamide definitive management = laser peripheral iridotomy
36
primary open-angle glaucoma management
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
microaneurysms blot haemorrhages hard exudates cotton wool spots,
diabetic retinopathy
38
Ix for diabetic retinopathy
gold standard for diagnosis is dilated retinal photography with accompanying ophthalmoscopy
39
management for diabetic retinopathy
control of diabetes
40
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
retinal detachment
41
what to do in suspected retinal detachment
ophthalmologist within 24 hours to rule out retinal tears or detachment.
42
management of retinal detachment
surgical - vitrectomy or surgical buckling
43
sudden visual loss | afferent pupillary defect, 'cherry red' spot on a pale retina
central retinal arterial occlusion
44
sudden painless vision loss, usually unilateral | severe retinal haemorrhages are usually seen on fundoscopy
central retinal vein occlusion
45
central retinal artery occlusion management
firm occular massage Sublingual GTN IV 500mg acetazolamide
46
central retinal vein occlusion management
managed conservatively refer to 24hr ophthalmologist if there is a treatable cause and well as if there are signs for macular oedema/neovascularization
47
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.
retinoblastoma
48
management of retinoblastoma
surgery (including localised conservative surgical treatments), chemotherapy and radiation
49
reduced vision | papilloedema
raised intracranial pressure
50
management of raised intracranial pressure
head elevation to 30° IV mannitol control hyperventilation removal of CSF
51
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)
optic neuritis
52
common association with optic neuritis
multiple sclerosis
53
management of optic neuritis
high dose steroids | should resolve in 4-6 weeks
54
reduction in vision loss of contrast or colour vision pale optic disc
optic atrophy
55
diagnosis of optic atrophy
fundoscopy
56
management of optic atrophy
dependent on the underlying cause of the atrophy
57
``` exophthalmos conjunctival oedema optic disc swelling ophthalmoplegia inability to close the eyelids may lead to sore, dry eyes ```
thyroid eye disease
58
management of thyroid eye disease
topical lubricants may be needed to help prevent corneal inflammation caused by exposure steroids radiotherapy surgery
59
restriction of extraocular movement, particularly upward gaze, lid ecchymosis/bruising and oedema enophthalmos (sunken eye) or exophthalmos (proptosis). epistaxis
blow out fracture
60
Ix for blow out fracture
Occipitomental (Waters) view plain X rays | CT Facial views
61
management for blow out fracture
``` ophthalm referral max-fax referral antibiotics nasal decongestants, ice packs don't blow nose ```
62
Irritation, photophobia, and lacrimation occur | hx of trauma
corneal abrasion
63
management of corneal abrasion
Prescribe regular antibiotic ointment (eg chloramphenicol) and oral analgesia. eye patch cyclopentolate or diclofenac eye drops
64
miosis (small pupil) ptosis enophthalmos* (sunken eye) anhidrosis (loss of sweating one side)
horner's syndrome
65
management of horner's
treat underlying cause
66
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
holme-adie
67
management of holme-adie
Corrective spectacles may be prescribed; no other treatment is usually needed
68
fixed dilated pupil which doesn't accommodate eye is deviated 'down and out' ptosis
third nerve palsy
69
signs of intracranial pressure | blood in the anterior chamber of the eye
hyphema
70
management of hyphema
in context of trauma = urgent referral to an ophthalmic specialist for assessment and management strict bed rest + ophthalmic review
71
``` red eye classically painful mild pain/discomfort is present watering and photophobia are common gradual decrease in vision ```
sclecritis

FCM (16 decks)

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