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Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Open Angle Glaucoma

what is a glaucoma

A

refers to the optic nerve damage that is caused by a significant rise in intraocular pressure

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2
Q

Open Angle Glaucoma

what is the raised intraocular pressure caused by in glaucomas

A

blockage in aqueous humour trying to escape the eye

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3
Q

Open Angle Glaucoma

the vitreous chamber of the eye is filled with ___

A

vitreous humour

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4
Q

where is the anterior chamber

A

between the cornea and the iris

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5
Q

where is the posterior chamber

A

between the lens and iris

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6
Q

the anterior and posterior chamber is filled with ___

A

aqueous humour which supplies nutrients to the cornea

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7
Q

what produces the aqueous humour

A

the ciliary body

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8
Q

describe the flow of aqueous humour

A

from the ciliary body

around the lens and under the iris

through the anterior chamber

through the trabecular meshwork

and into the canal of Schlemm

eventually entering the general circulation

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9
Q

what is the normal intraocular pressure

A

10-21 mmHg

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10
Q

how is intraocular pressure created

A

by the resistance to flow through the trabecular meshwork into the canal of Schlemm

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11
Q

Open Angle Glaucoma

pathophysiology

A

gradual increase in resistance through the trabecular meshwork

more difficult for aqueous humour to flow through the meshwork and exit the eye

pressure slowly builds within the eye and this gives a slow and chronic onset of glaucoma

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12
Q

Acute Angle-Closure Glaucoma

pathophysiology

A

the iris bulges forward and seals off the trabecular meshwork from the anterior chamber

preventing aqueous humour from being able to drain away

leading to a continual build-up of pressure

ophthalmology emergency

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13
Q

what causes cupping of the optic disc

A

increased pressure in the eye

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14
Q

what is in the centre of a normal optic disc

A

the optic cup, a small indent in the optic disc less than half the size of the optic disc

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15
Q

what is cupping

A

when there is raised intraocular pressure, the optic cup becomes larger as the pressure in the eye puts pressure on that indent making it wider and deeper

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16
Q

what is an abnormal optic cup size

A

greater than 0.5 the size of the optic disc

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17
Q

Open Angle Glaucoma

RFs (4)

A
  • increasing age
  • FH
  • black ethnic origin
  • myopia (short sighted)
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18
Q

Open Angle Glaucoma

presentation

A
  • asymptomatic for a long period of time
  • affects peripheral vision first
  • gradually peripheral vision closes until they experience tunnel vision
  • gradual onset of fluctuating pain
  • headaches
  • blurred vision
  • halos appearing around lights esp at night
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19
Q

Open Angle Glaucoma

dx

A

routine screening when attending optometry for eye check

Non-contact tonometry

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20
Q

Open Angle Glaucoma

what is non-contact tonometry

A

the commonly used machine for estimating intraocular pressure by opticians

shoots a puff of air at the cornea and measures the corneal response to that air

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21
Q

Open Angle Glaucoma

what is Goldmann applanation tonometry

A

the gold standard way to measure introcular pressure

special device mounted on slit lamp that makes contact with the cornea and applies different pressures to the front of the cornea to get an accurate measurement of what the intraocular pressure is

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22
Q

Open Angle Glaucoma

dx and inx

A

Goldmann applanation tonometry: intraocular pressure

Fundoscopy: optic disc cupping and optic nerve health

Visual field assessment: peripheral vision loss

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23
Q

Open Angle Glaucoma

aim of mnx

A

reduce intraocular pressure

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24
Q

Open Angle Glaucoma

when is treatment started

A

when intraocular pressure is 24 mmHg or above

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25
Q

Open Angle Glaucoma

first line mnx

A

Prostaglandin analogue eye drops eg. latanoprost

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26
Q

Open Angle Glaucoma

how does latanoprost work

A

prostaglandin analogue eye drops increase uveoscleral outflow

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27
Q

Open Angle Glaucoma

prostaglandin analogue eye drop SEs eg. latanoprost

A
  • eyelash growth
  • eyelid pigmentation
  • iris pigmentation (browning)
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28
Q

Open Angle Glaucoma

other mnx options apart from latanoprost

A
  • BB e.g. timolol
  • carbonic anhydrase inhibitors e.g. dorzolamide
  • sympathomimetics e.g. brimonidine

Trabeculectomy

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29
Q

Open Angle Glaucoma

how do BB work

A

reduce the production of aqueous humour

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30
Q

Open Angle Glaucoma

how do carbonic anhydrase inhibitors work

A

reduce the production of aqueous humour

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31
Q

Open Angle Glaucoma

how do sympathomimetics work

A

reduce the production of aqueous fluid and increase uveoscleral outflow

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32
Q

Open Angle Glaucoma

when is a trabeculectomy indicated

A

where eye drops are ineffective

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33
Q

Open Angle Glaucoma

what is involved in a trabeculectomy

A

creating a new channel from the anterior chamber, through the sclera to a location under the conjunctiva

it causes a ‘bleb’ under the conjunctiva where the aqueous humour drains

it is then reabsorbed from this bleb into the general circulation

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34
Q

Acute Angle Close Glaucoma

cause

A

when the iris bulges forward and seals off the trabecular meshwork from the anterior chamber, preventing aqueous humour from being able to drain away

continual build up of pressure in the eye, esp in the posterior chamber which causes pressure behind the iris and worsens the closure of the angle

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35
Q

Acute Angle Close Glaucoma

RFs (5)

A
  • increasing age
  • 4F:1M
  • FH
  • Chinese + East Asian ethnic origin
  • shallow anterior chamber
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36
Q

Acute Angle Close Glaucoma

what medications can precipitate acute angle-closure glaucoma

A
  • Adrenergics: noradrenalin
  • Anticholinergics: oxybutynin + solifenacin
  • TCA: amitriptyline, which have anticholinergic effects
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37
Q

Acute Angle Close Glaucoma

presentation

A
  • generally unwell in themselves
  • severely painful red eye
  • blurred vision
  • halos around lights
  • headache, N+V
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38
Q

Acute Angle Close Glaucoma

examination findings (7)

A
  • red eye
  • teary
  • hazy cornea
  • decreased visual acuity
  • dilatation of the affected pupil
  • fixed pupil size
  • firm eyeball on palpation
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39
Q

Acute Angle Close Glaucoma

initial mnx

A

same day assessment by opthalmologist

while waiting for an ambulance:

  • lie pt on their back without a pillow
  • pilocarpine eye drops
  • PO acetazolamide 500mg
  • analgesia + antiemetic PRN
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40
Q

Acute Angle Close Glaucoma

initial mnx: if blue eyes what % pilocarpine do you give

A

2%

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41
Q

Acute Angle Close Glaucoma

initial mnx: if brown eyes what % pilocarpine do you give

A

4%

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42
Q

Acute Angle Close Glaucoma

how does pilocarpine act?

A

Miotic agent: acts on the muscarinic receptors in the sphincter muscles in the iris and causes constriction of the pupil

also causes ciliary muscle contraction

these 2 effects cause the pathway for the flow of aq humour from the ciliary body, around the iris and into the trabecular meshwork to open up

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43
Q

Acute Angle Close Glaucoma

how does Acetazolamide work

A

carbonic anhydrase inhibitor.

This reduces the production of aq humour

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44
Q

Acute Angle Close Glaucoma

secondary care mnx to reduce the pressure

A
  • Pilocarpine
  • Acetazolamide (oral or IV)
  • Hyperosmotic agents: glycerol, mannitol
  • Timolol
  • Dorzolamide
  • Brimonidine
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45
Q

Acute Angle Close Glaucoma

how do hyperosmotic agents like glycerol or mannitol work

A

they increase the osmotic gR between the blood and fluid in the eye

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46
Q

Acute Angle Close Glaucoma

how does Timolol work

A

BB: reduces production of the aq humour

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47
Q

Acute Angle Close Glaucoma

how does Dorzolamide work

A

carbonic anhydrase inhibitor: reduces the production of aq humour

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48
Q

Acute Angle Close Glaucoma

how does Brimonidine work

A

sympathomimetic: reduces the production of aq fluid and increases uveoscleral outflow

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49
Q

Acute Angle Close Glaucoma

definitive trx

A

laser iridotomy

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50
Q

Acute Angle Close Glaucoma

what does laser iridotomy involve

A

using a laser to make a hole in the iris to allow the aq humour to flow from the posterior chamber into the anterior chamber

this relieves pressure that was pushing the iris against the cornea and allow the humour to drain

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51
Q

Age Related Macular Degeneration

what is it

A

a condition where there is degeneration in the macula that cause a progressive deterioration in vision

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52
Q

in the UK, what is the most common cause of blindness

A

Age Related Macular Degeneration

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53
Q

Age Related Macular Degeneration

key finding

A

drusen seen during fundoscopy

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54
Q

Age Related Macular Degeneration

what are the 2 types

A

wet (10%) - worse prognosis

and dry

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55
Q

Age Related Macular Degeneration

what are the 4 key layers of the macula

A

bottom: choroid layer

Bruch’s membrane

Retinal pigment epithelium

Top: photoreceptors

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56
Q

Age Related Macular Degeneration

what does the choroid layer of the macular contain

A

blood vessels that provide blood supply to the macula

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57
Q

Age Related Macular Degeneration

what are drunsen

A

yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane

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58
Q

Larger and greater numbers of drusen can be an early sign of ____

A

macular degeneration

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59
Q

Age Related Macular Degeneration

common features of both wet and dry AMD (2)

A
  • atrophy of the retinal pigment epithelium

- degeneration of the photoreceptors

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60
Q

Age Related Macular Degeneration

pathophysiology of wet AMD

A

development of new vessels growing from the choroid layer into the retina

These vessels can leak fluid or blood and cause oedema and more rapid loss of vision

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61
Q

Age Related Macular Degeneration

name a key chemical that stimulates the development of new vessels

A

vascular endothelial growth factor (VEGF)

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62
Q

Age Related Macular Degeneration

RFs (5)

A
  • age
  • smoking
  • white or chinese ethnicity
  • FH
  • CVS disease
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63
Q

Age Related Macular Degeneration

presentation (3)

A
  • gradual worsening central visual field loss
  • reduced visual acuity
  • crooked or waxy appearance to straight lines
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64
Q

Age Related Macular Degeneration

difference in presentation of wet and dry AMD

A

wet is more acute

loss of vision over days and progress to full loss of vision over 2-3 years.

often progresses to bilateral disease.

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65
Q

Age Related Macular Degeneration

examination + inx findings

A
  • Snellen chart: reduced acuity
  • Scotoma: central patch of vision loss
  • Amsler grid test: distortion of straight lines
  • Fundoscopy: drusen
  • Slit-lamp biomicroscopic fundus examination
  • Optical coherence tomography
  • Fluorescein angiography
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66
Q

Age Related Macular Degeneration

dx with what

A

Slit-lamp biomicroscopic fundus examination by a specialist

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67
Q

Age Related Macular Degeneration

what is Optical coherence tomography

A

a technique used to gain a cross-sectional view of the layers of the retina.

can be used to diagnose wet AMD.

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68
Q

Age Related Macular Degeneration

what is Fluorescein angiography

A

involves giving a fluorescein contrast and photographing the retina to look in detail at the blood supply to the retina

useful to show up any oedema and neovascularisation

used 2nd line to diagnose wet AMD

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69
Q

Age Related Macular Degeneration

mnx of dry AMD

A

refer to ophthalmologist

  • Avoid smoking
  • Control blood pressure
  • Vitamin supplementation
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70
Q

Age Related Macular Degeneration

mnx of wet AMD

A

Anti-VEGF medications:

ranibizumab, bevacizumab and pegaptanib block VEGF and slow the development of new vessels

need to be started within 3m to be beneficial

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71
Q

Age Related Macular Degeneration

how often are Anti-VEGF medication injected

A

once a month injected directly into the vitreous chamber

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72
Q

Diabetic Retinopathy

what is it

A

condition where the blood vessels in the retina are damaged by prolonged exposure to high blood sugar levels

causing a progressive deterioration in the health of the retina

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73
Q

Diabetic Retinopathy

pathophysiology : hyperglycaemia leads to…

A

hyperglycaemia –> damage to retinal small vessels + endothelial cells

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74
Q

Diabetic Retinopathy

pathophysiology: increased vascular permeability leads to ….

A

leakage from blood vessels, blot haemorrhages and the formation of hard exudates (yellow/white deposits of lipids in the retina)

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75
Q

Diabetic Retinopathy

pathophysiology: damage to blood vessel walls lead to

A

microaneurysms: weakness in the wall causes small bulges

and venous beading: walls of the veins are no longer straight and parallel and look more like a string of beads or sausages

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76
Q

Diabetic Retinopathy

pathophysiology: damage to nerve fibres in the retina causes..

A

cotton wool spots: fluffy white patches formed on the retina

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77
Q

Diabetic Retinopathy

pathophysiology: what is intraretinal microvascular abnormalities (IMRA)

A

where there are dilated and tortuous capillaries in the retina

these can act as a shunt between the arterial and venous vessels in the retina

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78
Q

Diabetic Retinopathy

pathophysiology: what is neovascularisation

A

when growth factors are released in the retina causing the development of new blood vessels

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79
Q

Diabetic Retinopathy

how can diabetic retinopathy be split into

A
  • non-proliferative
  • proliferative
  • diabetic maculopathy

depending on whether new blood vessels have developed

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80
Q

Diabetic Retinopathy

mild non-proliferative diabetic retinopathy

A

microaneurysms

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81
Q

Diabetic Retinopathy

moderate non-proliferative diabetic retinopathy

A
  • microaneurysms
  • blot haemorrhages
  • hard exudates
  • cotton wool spots
  • venous beading
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82
Q

Diabetic Retinopathy

severe non-proliferative diabetic retinopathy

A
  • blot haemorrhages + microaneurysms in 4 quadrants
  • venous beading in 2 quadrants
  • intraretinal microvascular abnormality (IMRA) in any quadrant
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83
Q

Diabetic Retinopathy

proliferative diabetic retinopathy (2)

A
  • neovascularisation

- vitreous haemorrhage

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84
Q

Diabetic Retinopathy

diabetic maculopathy (2)

A
  • macular oedema

- ischaemic maculopathy

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85
Q

Diabetic Retinopathy

complications (5)

A
  • retinal detachment
  • vitreous haemorrhage
  • Rebeosis iridis
  • Optic neuropathy
  • Cataracts
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86
Q

Diabetic Retinopathy

complications: what are vitreous heamorrhages

A

bleeding into the vitreous humour

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87
Q

Diabetic Retinopathy

complications: what is Rebeosis iridis

A

new blood vessel formation in the iris

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88
Q

Diabetic Retinopathy

mnx

A
  • laser photocoagulation
  • anti-VEGF meds: ranibizumab, bevacizumab
  • vitreoretinal surgery: keyhole surgery on the eye may be required in severe disease
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89
Q

Cataracts

what is it

A

where the lens becomes cloudy and opaque

this reduces visual acuity by reducing the light that enters the eye

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90
Q

Cataracts

what is the lens’ function

A

to focus light coming into the eye onto the retina at the back of they eye

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91
Q

Cataracts

what is the lens held in place by

A

suspensory ligaments attached to the ciliary body

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92
Q

Cataracts

how does the lens thicken

A

when the ciliary body contracts it releases tension on the suspensory ligaments and the lens thicken

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93
Q

Cataracts

how does the lens narrow

A

when the ciliary body relaxes it increases the tension in the suspensory ligaments and the lens narrows

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94
Q

Cataracts

how is the lens nourished

A

by the surrounding fluid, it doesn’t have a blood supply

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95
Q

Cataracts

how is congenital cataracts screened for

A

using the red reflex during the neonatal examination

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96
Q

Cataracts

RFs (6)

A
  • increasing age
  • smoking
  • alcohol
  • diabetes
  • steroids
  • hypocalcaemia
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97
Q

Cataracts

presentation

A
  • usually asymmetrical
  • very slow reduction in vision
  • progressive blurring of vision
  • change in colour of vision: colours more brown or yellow
  • ‘starbursts’ can appear around lights esp at night
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98
Q

Cataracts

key sign

A

loss of the red reflex

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99
Q

Cataracts

mnx if symptoms are manageable

A

no intervention

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100
Q

Cataracts

mnx

A

cataract surgery

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101
Q

Cataracts

what does cataract surgery involve

A

drilling and breaking the lens into pieces, removing the pieces

then implanting an artificial lens into the eye

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102
Q

Cataracts

why might the pt still have poor visual acuity after cataract surgery

A

other pathology may be detected after surgery as cataracts can prevent the detection beforehand

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103
Q

Cataracts

what is a rare but serious complication of cataract surgery

A

Endophthalmitis

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104
Q

Cataracts

what is endophthalmitis

A

rare but serious complication of cataract surgery

inflammation of the inner contents of the eye, usually caused by infection

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105
Q

Cataracts

how can endophthalmitis be treated

A

with intravitreal antibiotics injected into the eye

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106
Q

Conjunctivitis

what is the conjunctiva

A

a thin layer of tissues that covers the inside of eyelids and the sclera of the eye

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107
Q

Conjunctivitis

what are the 3 types

A
  • bacterial
  • viral
  • allergic
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108
Q

Conjunctivitis

presentation

A
  • unilateral or bilateral
  • red eyes
  • bloodshot
  • itchy or gritty sensation
  • discharge from the eye
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109
Q

Conjunctivitis

does it cause pain, photophobia or reduced visual acuity?

A

NO

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110
Q

Conjunctivitis

how does bacterial conjunctivits present

A

purulent discharge

inflamed conjunctiva

worse in morning when eyes may be stuck together

starts in 1 eye and spread to other

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111
Q

Conjunctivitis

how does viral conjunctivitis present

A

clear discharge

other sx of a viral infection

tender preauricular lymph nodes

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112
Q

Ddx for painless red eye

A
  • conjunctivitis
  • episcleritis
  • subconjunctival haemorrhage
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113
Q

Ddx for painful red eye

A
  • glaucoma
  • anterior uveitis
  • scleritis
  • corneal abrasions or ulceration
  • keratitis
  • foreign body
  • traumatic or chemical injury
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114
Q

Conjunctivitis

mnx

A

usually resolves within 1-2w

good hygiene: avoid sharing towels, wash hands, avoid contacts, clean eyes with hot water

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115
Q

Conjunctivitis

when can antibiotic eye drops be considered

A

in bacterial conjunctivitis: chloramphenicol and fuscidic acid

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116
Q

Conjunctivitis

why do pts <1y need urgent ophthalmology review

A

neonatal conjunctivits can be associated with gonococcal infection

and can cause loss of sight and more severe complications such as pnuemonia

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117
Q

Conjunctivitis

what is allergic conjunctivitis caused by

A

contact with allergens

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118
Q

Conjunctivitis

what does allergic conjunctivitis present as

A
  • swelling of conjunctival sac and eye lid

- significant watery discharge and itch

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119
Q

Conjunctivitis

trx for allergic conjunctivitis

A

oral or topical antihistamines

topical mast-cell stabiliser if chronic seasonal sx

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120
Q

Conjunctivitis

how do mast-cell stabiliser work

A

preventing mast cells releasing histamine

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121
Q

Anterior Uveitis

what is it

A

inflammation in the anterior part of the uvea

aka iritis

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122
Q

Anterior Uveitis

what does the uvea involve

A
  • iris
  • ciliary body
  • choroid
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123
Q

Anterior Uveitis

what is the choroid

A

the layer between the retina and sclera all the way around the eye

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124
Q

Anterior Uveitis

pathophysiology

A
  • inflammation and immune cells in the anterior chamber of the eye
  • the anterior chamber of the eye becomes infiltrated by neutrophils, lymphocytes and macrophages
  • usually caused by an autoimmune process but can be due to infection, trauma, ischaemia or malignancy
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125
Q

Anterior Uveitis

what causes floaters in the pt’s vision

A

inflammatory cells in the anterior chamber

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126
Q

Anterior Uveitis

what types are there

A

acute or chronic

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127
Q

Anterior Uveitis

difference between acute and chronic

A

chronic: more granulomatous (has more macrophages) and has a less severe and longer duration of symptoms, lasting >3m

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128
Q

Anterior Uveitis

what is acute anterior uveitis associated with

A

HLA B27 conditions:

  • ankylosing spondylitis
  • IBD
  • Reactive arthritis
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129
Q

Anterior Uveitis

what is chronic anterior uveitis associated with

A
  • sarcoidosis
  • syphilis
  • lyme disease
  • TB
  • herpes virus
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130
Q

Anterior Uveitis

presentation

A
  • unilateral
  • may occur with a flare of reactive arthritis
  • dull, aching, painful red eye
  • ciliary flush
  • miosis
  • photophobia
  • pain on movement
  • lacrimation
  • abnormally shaped pupil
  • hypopyon
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131
Q

Anterior Uveitis

what is ciliary flush

A

a ring of red spreading from the cornea outwards

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132
Q

Anterior Uveitis

what causes miosis

A

sphincter muscle contraction

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133
Q

Anterior Uveitis

what causes photophobia

A

ciliary muscle spasm

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134
Q

Anterior Uveitis

what causes an abnormal shaped pupil

A

posterior synechiae (adhesions) pulling the iris into abnormal shapes

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135
Q

Anterior Uveitis

what is hypopyon

A

a collection of WBCs in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris with a fluid level

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136
Q

Anterior Uveitis

NICE guidelines on pts with potentially sight threatening causes of red eye

A

refer for same day assessmentt by ophthalmologist

full slit lamp assessment and intraocular pressures

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137
Q

Anterior Uveitis

trx choices

A
  • steroids (PO, top, IV)
  • cycloplegic-mydriatic meds: cyclopentolate or atropine eye drops
  • immunosuppresants: DMARDS and TNF inhibitors
  • laser therapy, cryotherapy, vitrectomy for severe cases
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138
Q

Anterior Uveitis

what does cycloplegic mean

A

paralysing the ciliary muscles

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139
Q

Anterior Uveitis

what does mydriatic mean

A

dilating the pupils

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140
Q

Anterior Uveitis

how do cyclopentolate and atropine work

A

antimuscarinics that block the action of iris sphincter muscles and ciliary body

these dilate the pupil and reduce pain associated with ciliary spasm by stopping the action of the ciliary body

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141
Q

Retinal Detachment

what is it

A

where the retina separates from the choroid underneath

usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and choroid

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142
Q

Retinal Detachment

what makes it a sight-threatening emergency

A

the outer retina relies on the blood vessels of the choroid for its blood supply

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143
Q

Retinal Detachment

RFs(6)

A
  • posterior vitreous detachment
  • diabetic retinopathy
  • trauma to the eye
  • retinal malignancy
  • older age
  • FH
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144
Q

Retinal Detachment

presentation (3)

A
  • peripheral vision loss. Often sudden and like a shadow coming across the vision
  • blurred or distorted vision
  • flashes and floaters
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145
Q

Retinal Detachment

presents with painless flashes and floaters. Mnx?

A

detailed assessment of retina to detect retinal tears or detachment

immediately refer to ophthalmology

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146
Q

Retinal Detachment

mnx of retinal tears

A

aim to create adhesions between the retina and choroid to prevent detachment

  • laser therapy
  • cryotherapy
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147
Q

Retinal Detachment

mnx options for reattaching the retina

A
  • vitrectomy
  • scleral buckling
  • pneumatic retinopexy
148
Q

Retinal Detachment

what does vitrectomy involve

A

removing the relevant parts of the vitreous body and replacing it with oil or gas

149
Q

Retinal Detachment

what does scleral buckling involve

A

using a silicon ‘buckle’ to put pressure on the outside of the eye (the sclera) so that the outer indents bring the choroid inwards and into contact with the detached retina

150
Q

Retinal Detachment

what does pneumatic retinopexy involve

A

injecting a gas bubble into the vitreous body and positioning the patient so the gas bubble creates pressure that flattens the retina against the choroid and close the detachment.

151
Q

Blepharitis

what is it

A

inflammation of the eyelid margins

152
Q

Blepharitis

presentation

A

gritty, itchy, dry sensation in the eyes

153
Q

Blepharitis

what can it be associated with

A

dysfunction of the Meibomian glands, which are responsible for secreting oil onto the surface of the eye

can lead to styes and chalazions

154
Q

Blepharitis

mnx

A
  • hot compresses
  • gentle cleaning of the eyelid margins to remove debris using cotton wool dipped in sterilised water + baby shampoo
  • lubricating eye drops to relieve symptoms
155
Q

Blepharitis

what lubricating eye drop is usually started with

A

Polyvinyl alcohol

the middle viscous choice

156
Q

Blepharitis

which lubricating eye drop is the least viscous and how long does it last for

A

Hypromellose

least viscous lasting around 10 min

157
Q

Blepharitis

which lubricating eye drop is the most viscous and how long does it last for

A

Carbomer

most viscous and lasts 30-60min

158
Q

Stye

what is Hordeolum externum

A

an infection of the glands of Zeis or glands of Moll

159
Q

Stye

what are the glands of Zeis

A

sebaceous glands at the base of the eyelashes

160
Q

Stye

what are the glands of Moll

A

sweat glands at the base of the eyelashes

161
Q

Stye

presentation

A

tender red lump along the eyelid that may contain pus

162
Q

Stye

what is Hordeolum internum

A

infection of the Meibomian glands

deeper, more painful

may point inwards towards the eyeball underneath the eyelid

163
Q

Stye

trx

A

hot compresses and analgesia

consider topical abx (i.e. chloramphenicol) if assc w/ conjunctivitis or persistent

164
Q

Chalazion

when does it occur

A

when a Meibomian gland becomes blocked and swells up

165
Q

Chalazion

aka?

A

Meibomian cyst

166
Q

Chalazion

presentation

A

swelling in the eyelid

typically not tender

but can be tender and red

167
Q

Chalazion

trx

A

hot compress and analgesia

consider topical abx (i.e. chloramphenicol) if acutely inflamed

surgical drainage may be required

168
Q

Entropion

what is it

A

where the eyelid turns inwards with the lashes against the eyeball

169
Q

Entropion

what does it result in

A

pain and corneal damage and ulceration

170
Q

Entropion

initial mnx

A

tape eyelid down to prevent it turning inwards

+ regular lubricating eye drops to prevent eye drying out

171
Q

Entropion

definitive mnx

A

surgical intervention

172
Q

Entropion

when to refer to ophthalmology same day

A

if there is a risk to sight

173
Q

Ectropion

what is it

A

where the eyelid turns outwards with the inner aspect of the eyelid exposed

usually affects the bottom lid

174
Q

Ectropion

what can it lead to and why

A

exposure keratopathy as the eyeball is exposed and not adequately lubricated and protected

175
Q

Ectropion

trx

A

mild: none

regular lubricating eye drops

severe: surgery

176
Q

Trichiasis

what is it

A

inward growth of the eyelashes

results in pain, corneal damage and ulceration

177
Q

Trichiasis

mnx

A

epilation (remove eyelash)

178
Q

Trichiasis

recurrent cases mnx

A

electrolysis, cryotherapy or laser trx to prevent the lash regrowing

179
Q

Periorbital Cellulitis

what is it

A

eyelid and skin infection in the front of the orbital septum (in front of the eye)

180
Q

Periorbital Cellulitis

presentation

A

swelling, redness and hot skin around the eyelids and eye

181
Q

Periorbital Cellulitis

Ddx

A

orbital cellulitis ! a sight and life threatening emergency

182
Q

Periorbital Cellulitis

how to distinguish between periorbital and orbital cellulitis

A

CT scan

183
Q

Periorbital Cellulitis

trx

A

systemic abx (PO or IV)

vulnerable pts or sever may require admission as can develop into orbital cellulitis

184
Q

Orbital Cellulitis

what is it

A

infection around the eyeball that involves tissues behind the orbital septum.

185
Q

Orbital Cellulitis

key features that differentiate this from periorbital cellulitis

A
  • pain on eye movement
  • reduced eye movements
  • changes in vision
  • abnormal pupil reactions
  • proptosis (forward movement of the eyeball)
186
Q

Orbital Cellulitis

mnx

A

medical emergency that requires admission and IV antibiotics

may require surgical drainage if an abscess forms.

187
Q

Subconjunctival Haemorrhage

what is it

A

one of the small blood vessels within the conjunctiva ruptures and release blood into the space between the sclera and the conjunctiva

188
Q

Subconjunctival Haemorrhage

what activities may it occur after

A

episodes of strenuous activity such as heavy coughing, weigh lifting or straining when constipated

or trauma to the eye

189
Q

Subconjunctival Haemorrhage

what conditions may have contributed to it

A
  • HTN
  • bleeding disorders (e.g. thrombocytopenia)
  • whooping cough
  • medications (warfarin, NOACs, antiplatelets)
  • non-accidental injury
190
Q

Subconjunctival Haemorrhage

presentation

A
  • patch of bright red blood underneath the conjunctiva and in front of the sclera covering the white of the eye
  • painless, doesn’t affect vision
191
Q

Subconjunctival Haemorrhage

dx

A

hx and examination

192
Q

Subconjunctival Haemorrhage

mnx

A

2w to resolve spontaneously

possible causes: HTN, bleeding disorders may need further inx

193
Q

Subconjunctival Haemorrhage

if there is a foreign body sensation, what can help

A

lubricating eye drops

194
Q

Retinal Vein Occlusion

where does the central retinal vein run through

A

the optic nerve

195
Q

Retinal Vein Occlusion

what is the central retinal vein responsible for

A

draining blood from the retina

196
Q

Retinal Vein Occlusion

what is central retinal vein occlusion

A

thrombus forms in the retinal veins and blocks the drainage of blood from the retina

197
Q

Retinal Vein Occlusion

how many branched veins come together to form the central retinal vein

A

4

198
Q

Retinal Vein Occlusion

what does blockage of one of the branched vein cause

A

problems in the area drained by that branch

199
Q

Retinal Vein Occlusion

what does blockage in the central vein cause

A

problems with the whole retina

200
Q

Retinal Vein Occlusion

symptom

A

sudden painless loss of vision

201
Q

Retinal Vein Occlusion

what inx is diagnostic

A

fundoscopy

202
Q

Retinal Vein Occlusion

what does fundoscopy show

A
  • flame and blot haemorrhages
  • optic disc oedema
  • macula oedema
203
Q

Retinal Vein Occlusion

why is there macula oedema and retinal haemorrhages

A

blockage of retinal vein causes pooling of blood in the retina

this results in leakage of fluid and blood

204
Q

Retinal Vein Occlusion

what do macula oedema and retinal haemorrhages lead to

A

damage to the tissue in the retina and loss of vision

also leads to the release of VEGF which stimulates the development of new blood vessels (neovascularisation)

205
Q

Retinal Vein Occlusion

RFs (6)

A
  • HTN
  • high cholesterol
  • diabetes
  • smoking
  • glaucoma
  • SLE
206
Q

Retinal Vein Occlusion

inx to check for possible associated conditions

A
  • full medical hx
  • FBC: leukaemia
  • ESR: inflammatory disorders
  • BP
  • serum glucose
207
Q

Retinal Vein Occlusion

should you refer

A

yes if suspected, refer immediately to ophthalmologist

208
Q

Retinal Vein Occlusion

mnx

A
  • laser photocoagulation
  • intravitreal steroids (dexamethasone intravitreal implant)
  • anti-VEGF therapies (ranibizumab, aflibercept or bevacizumab)
209
Q

Retinal Vein Occlusion

what is the aim of mnx

A

to treat macular oedema and prevent complications such as neovascularisation of the retina and iris and glaucoma

210
Q

Central Retinal Artery Occlusion

what supplies the blood to the retina

A

the central retinal artery

211
Q

Central Retinal Artery Occlusion

what is the central retinal artery a branch of

A

the ophthalmic artery, which is a branch of the internal carotid artery

212
Q

Central Retinal Artery Occlusion

most common cause

A

atherosclerosis

can also be caused by GCA

213
Q

Central Retinal Artery Occlusion

how does giant cell arteritis cause it

A

vasculitis affecting the ophthalmic or central retinal artery causes reduced blood flow

214
Q

Central Retinal Artery Occlusion

RFs

A

the same for CVD:

  • older age
  • FH
  • Smoking
  • alcohol
  • hypertension
  • diabetes
  • poor diet
  • inactivity
  • obesity
215
Q

Central Retinal Artery Occlusion

main presentation

A

sudden painless loss of vision

216
Q

Central Retinal Artery Occlusion

what is relative afferent pupillary defect

A

the pupil in the affected eye constricts more when light is shone in the other eye compared when it is shone in the affected eye

217
Q

Central Retinal Artery Occlusion

why does relative afferent pupillary defect occur

A

because the input is not being sensed by the ischaemic retina when testing the direct light reflex

but is being sensed by the normal retina during the consensual light reflex

218
Q

Central Retinal Artery Occlusion

what will fundoscopy show

A

a pale retina

with a cherry-red spot

219
Q

Central Retinal Artery Occlusion

why is the retina pale

A

due to a lack of perfusion with blood

220
Q

Central Retinal Artery Occlusion

what is the cherry-red spot on fundoscopy

A

the macula, which has a thinner surface that shows the red coloured choroid below and contrasts with the pale retina

221
Q

Central Retinal Artery Occlusion

mnx

A

refer immediately

if suspecting GCA: ESR, temporal artery biopsy , high dose steroids

222
Q

Central Retinal Artery Occlusion

immediate mnx

A
  • ocular massage
  • remove fluid from anterior chamber to reduce intraocular pressure
  • inhale carbogen (5% CO2 + 95% O2) to dilate artery
  • sublingual isosorbide dinitrate to dilate the artery
223
Q

Central Retinal Artery Occlusion

long term mnx

A

treat reversible RFs and secondary prevention of CVD

224
Q

Posterior Vitreous Detachment

what is the vitreous body

A

the gel inside the eye that maintains the structure of the eyeball and keeps the retina pressed on the choroid

225
Q

Posterior Vitreous Detachment

what is the vitreous body made of

A

collagen and water

226
Q

Posterior Vitreous Detachment

what is it

A

the vitreous gel comes away from the retina

very common, esp in older pts

227
Q

Posterior Vitreous Detachment

presentation

A
  • painless
  • spots of vision loss
  • floaters
  • flashing lights

presents similarly to retinal tear/detachment

228
Q

Posterior Vitreous Detachment

mnx

A

none, over time the sx will improve as the brain adjusts

229
Q

Posterior Vitreous Detachment

what are pts predisposed to

A

retinal tears and retinal detachment

230
Q

Herpes Keratitis

what is keratitis

A

inflammation of the cornea

231
Q

causes of keratitis

A
  • viral: herpes simplex
  • bacterial: pseudomonas or staph
  • fungal: candida or aspergillus
  • contact lens acute red eye
  • exposure karatitis
232
Q

what is the most common cause of keratitis

A

herpes simplex keratitis

233
Q

Herpes Keratitis

what layer does herpes keratitis usually only affect

A

the epithelial layer of the cornea

234
Q

Herpes Keratitis

what is stromal keratitis

A

if there is inflammation of the stroma (the layer between the epithelium and endothelium)

235
Q

Herpes Keratitis

what is stromal keratitis associated with

A

complications such as stromal necrosis, vascularisation and scarring and can lead to corneal blindness

236
Q

Herpes Keratitis

presentation

A
  • painful red eye
  • photophobia
  • vesicles around the eye
  • foreign body sensation
  • watering eye
  • reduced visual acuity
237
Q

Herpes Keratitis

what will staining with fluorescein show

A

dendritic corneal ulcer

238
Q

Herpes Keratitis

what is required to find and diagnose keratitis

A

slit lamp

Corneal swabs or scrapings can be used to isolate the virus using a viral culture or PCR.

239
Q

Herpes Keratitis

mnx

A
  • Aciclovir (topical or oral)
  • Ganciclovir eye gel
  • Topical steroids may be used alongside antivirals to treat stromal keratitis
240
Q

Herpes Keratitis

trx for corneal scarring caused by stromal keratitis

A

a corneal transplant may be required

241
Q

Scleritis

what is the most severe type

A

necrotising scleritis: visual impairment but may not have pain

242
Q

Scleritis

what is the most significant complication

A

perforation of the sclera

243
Q

Scleritis

what are some associated systemic conditions

A
  • RA
  • SLE
  • IBD
  • Sarcoidosis
  • Granulomatosis w/ polyangiitis
244
Q

Scleritis

presentation

A
  • acute severe pain
  • pain w/ eye movement
  • photophobia
  • eye watering
  • reduced visual acuity
  • abnormal pupil reaction to light
  • tenderness to palpation of the eye
245
Q

Scleritis

mnx

A
  • NSAIDs
  • Steroids
  • Immunosuppression for underlying systemic condition
246
Q

Episcleritis

what is it

A

benign and self-limiting inflammation of the episclera, the outermost layer of the sclera.

247
Q

Episcleritis

whom is it common in

A

young and middle-aged adults

248
Q

Episcleritis

which inflammatory disorders is it associated with

A

RA and IBD

249
Q

Episcleritis

presentation

A
  • acute + unilateral
  • no pain
  • segmental redness
  • foreign body sensation
  • dilated episcleral vessels
  • watering of eye
  • no discharge
250
Q

Episcleritis

mnx

A
  • recovers in 1-4w
  • analgesia
  • cold compresses
  • lubricating eye drops
251
Q

Pupil Disorders

what causes pupil constriction

A

parasympathetic nervous system using ACh contracts circular muscles in the iris which cause pupil constriction

travels along CN III (oculomotor)

252
Q

Pupil Disorders

what causes pupil dilation

A

dilator muscles stimulated by the sympathetic NS using adrenalin as a neurotransmitter

253
Q

Pupil Disorders

what can cause trauma to the sphincter muscles in the iris

A

cataract surgery and other eye operations causing an irregular pupil

254
Q

Pupil Disorders

how can anterior uveitis cause misshapen pupils

A

can cause adhesions in the iris

255
Q

Pupil Disorders

what can cause a vertical oval pupil

A

Acute angle closure glaucoma can cause ischaemic damage to the muscles of the iris

256
Q

Pupil Disorders

what is Rubeosis iridis

A

neovascularisation in the iris can distort the shape of the iris and pupil.

usually associated with poorly controlled diabetes and diabetic retinopathy.

257
Q

Pupil Disorders

what is Coloboma

A

congenital malformation in the eye.

This can cause a hole in the iris causing an irregular pupil shape.

258
Q

Pupil Disorders

what is tadpole pupil

A

spasm in a segment of the iris causing a misshapen pupil.

usually temporary and associated with migraines.

259
Q

Pupil Disorders

causes of mydriasis (dilated pupil)

A
  • 3rd nerve palsy
  • Holmes-Adie syndrome
  • raised ICP
  • congenital
  • trauma
  • stimulants: cocaine
  • anticholinergics
260
Q

Pupil Disorders

causes of miosis (constricted pupil)

A
  • Horner’s syndrome
  • cluster headaches
  • Argyll-Robertson pupil (in neurosyphilis)
  • opiates
  • nicotine
  • pilocarpine
261
Q

Pupil Disorders

3 signs in 3rd nerve palsy

A
  • divergent strabismis: down + out
  • ptosis
  • dilated non-reactive pupil
262
Q

Pupil Disorders

what does the 3rd nerve (oculomotor) supply

A

all of the extraocular muscles except the lateral rectus and superior oblique: down + out

levator palpebrae superioris: ptosis

sphincter muscle of the iris: dilated fixed pupil

263
Q

Pupil Disorders

how can a cavernous sinus thrombosis and posterior communicating artery aneurysm cause compression of the 3rd nerve, causing palsy

A

the oculomotor nerve travels from the brainstem through the cavernous sinus and close to the posterior communicating artery

264
Q

Pupil Disorders

what does a 3rd nerve palsy with sparing of the pupil suggest

A

a microvascular cause as the parasympathetic fibres are spared. May be due to:

  • DM
  • HTN
  • ischaemia
265
Q

Pupil Disorders

what is a full 3rd nerve palsy (surgical 3rd) cause

A

compression of the 3rd nerve inc the parasympathetic fibres

266
Q

Pupil Disorders

what is a full 3rd nerve palsy due to

A
  • Idiopathic-
  • Tumour
  • Trauma
  • Cavernous sinus thrombosis
  • Posterior communicating artery aneurysm
  • Raised ICP
267
Q

Pupil Disorders

Horner syndrome triad

A
  • ptosis
  • miosis
  • anhidrosis (loss of sweating)
268
Q

Pupil Disorders

Horner syndrome cause

A

damage to the sympathetic nervous system supplying the face.

269
Q

Pupil Disorders

Horner syndrome: journey of the sympathetic nerves

A
  • spinal cord in chest (pre-ganglionic nerves)
  • enter into the sympathetic ganglion at the base of the neck
  • exit as post-ganglionic nerves
  • then travel to the head, running alongside the internal carotid artery.
270
Q

Pupil Disorders

location of Horner’s syndrome if there is anhidrosis of the arm, trunk and face

A

central lesions (4 Ss):

  • Stroke
  • MS
  • Swelling (tumour)
  • Syringomyelia (cyst in the spinal cord)
271
Q

Pupil Disorders

location of Horner’s syndrome if there is anhidrosis in the face only

A

Pre-ganglionic lesions (4 Ts):

  • Pancoast’s tumour
  • Trauma
  • Thyroidectomy
  • Top rib: a cervical rib growing above the first rib above the clavicle
272
Q

Pupil Disorders

location of Horner’s syndrome if no anhidrosis

A

Post-ganglionic lesions (4 Cs)

  • Carotid aneurysm
  • Carotid artery dissection
  • Cavernous sinus thrombosis
  • Cluster headache
273
Q

Pupil Disorders

what is Congenital Horner syndrome associated with

A

heterochromia: difference in the colour of the iris on the affected side.

274
Q

Pupil Disorders

what test can be used for Horner Syndrome

A

Cocaine eye drops/Apraclonidine
or
adrenalin eye drop (0.1%)

275
Q

Pupil Disorders

how does cocaine eye drops test for Horner’s syndrome

A

Cocaine acts on the eye to stop noradrenalin re-uptake at the neuromuscular junction

normal eye dilates because there is more noradrenalin stimulating the dilator muscles of the iris

Horner: the nerves are not releasing noradrenalin to start with so blocking re-uptake does not make a difference and there is no reaction of the pupil

276
Q

Pupil Disorders

results of adrenalin eye drop (0.1%) test for Horner’s syndrome

A

normal: won’t dilate
horner: dilates

277
Q

Pupil Disorders

what is Holmes Adie Pupil

A

unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction

Over time the pupil will get smaller

278
Q

Pupil Disorders

what is Holmes Adie pupil caused by

A

damage to the post-ganglionic parasympathetic fibres. The exact cause is unknown but may be viral.

279
Q

Pupil Disorders

what is Holmes Adie Syndrome

A

Holmes Adie pupil with absent ankle and knee reflexes.

280
Q

Pupil Disorders

what is Argyll-Robertson Pupil

A

specific finding in neurosyphilis

constricted pupil that accommodates when focusing on a near object but does not react to light. They are often irregularly shaped

281
Q

Pupil Disorders

what is Argyll-Robertson Pupil often called and why

A

“prostitutes pupil” due to the relation to neurosyphilis and because “it accommodates but does not react“.

282
Q

Retinitis Pigmentosa

what is it

A

congenital inherited condition

degeneration of the rods and cones in the retina

283
Q

Retinitis Pigmentosa

when do most cases start

A

in childhood

284
Q

Retinitis Pigmentosa

presentation

A

1st symptom: night blindness

peripheral vision is lost before central vision

285
Q

Retinitis Pigmentosa

why is night blindness the first symptom

A

the rods degenerate more than cones

286
Q

Retinitis Pigmentosa

what will fundoscopy show

A

“bone-spicule” pigmentation

287
Q

Retinitis Pigmentosa

what does “bone-spicule” pigmentation mean

A

spicule: sharp, pointed

Bone-spicule is used to refer to the similarity to the networking appearance of bone matrix.

288
Q

Retinitis Pigmentosa

associated systemic diseases

A
  • Usher’s Syndrome: hearing loss + retinitis pigmentosa
  • Bassen-Kornzweig Syndrome: disorder of fat absorption + metabolism causing progressive neuro sxs and retinitis pigmentosa
  • Refsum’s Disease: metabolic disorder of phytanic acid causing neuro, hearing and skin sxs and retinitis pigmentosa
289
Q

Retinitis Pigmentosa

general mnx

A
  • refer to ophthalmologist
  • genetic counselling
  • vision aids
  • sunglasses
  • inform DVLA
  • follow up regularly
290
Q

Retinitis Pigmentosa

medical mnx which may be considered

A
  • Vitamin and antioxidant supplements
  • PO acetazolamide
  • Topical dorzolamide
  • Steroid injections
  • Anti-VEGF injections
291
Q

Corneal Abrasions

common causes

A
  • contact lenses
  • foreign bodies
  • finger nails
  • eyelashes
  • entropion (inward turning eyelid)
292
Q

Corneal Abrasions

what organism is associated with use of contact lenses

A

pseudomonas

293
Q

Corneal Abrasions

important differential

A

herpes keratitis: needs antiviral eye drops

294
Q

Corneal Abrasions

presentation

A
  • History of contact lenses or foreign body
  • Painful red eye
  • Foreign body sensation
  • Watering eye
  • Blurring vision
  • Photophobia
295
Q

Corneal Abrasions

dx

A

fluorescein stain highlights abrasions or ulcers

slit lamp for more significant abrasions

296
Q

Corneal Abrasions

mnx

A
  • refer immediately if sight threatening cause of red eye
  • Simple analgesia (e.g. paracetamol)
  • Lubricating eye drops can improve symptoms
  • Antibiotic eye drops (i.e. chloramphenicol)
  • review in 1w to check it has healed
  • Cyclopentolate eye drops dilate the pupil and improve significant symptoms, particularly photophobia.
  • Uncomplicated corneal abrasions usually heal over 2-3 days.
297
Q

Hypertensive Retinopathy

what is it

A

damage to the small blood vessels in the retina relating to systemic hypertension

298
Q

Hypertensive Retinopathy

cause

A
  • years of chronic hypertension

- or it can develop quickly in response to malignant hypertension

299
Q

Hypertensive Retinopathy

signs in the eye

A
  • silver/copper wiring
  • arteriovenous nipping
  • cotton wool spots
  • hard exudates
  • retinal haemorrhages
  • papilloedema
300
Q

Hypertensive Retinopathy

signs: what is silver or copper wiring

A

the walls of the arterioles become thickened and sclerosed causing increased reflection of the light

301
Q

Hypertensive Retinopathy

signs: what is arteriovenous nipping

A

sclerosis and hardening of the arterioles cause compression of the veins where they cross.

302
Q

Hypertensive Retinopathy

signs: what causes cotton wool spots

A

ischaemia and infarction in the retina causing damage to nerve fibres

303
Q

Hypertensive Retinopathy

signs: what are hard exudates caused by

A

damaged vessels leaking lipids into the retina

304
Q

Hypertensive Retinopathy

signs: what are retinal haemorrhages caused by

A

damaged vessels rupturing and releasing blood into the retina

305
Q

Hypertensive Retinopathy

signs: what is papilledema caused by

A

ischaemia to the optic nerve resulting in optic nerve swelling (oedema) and blurring of the disc margins

306
Q

Hypertensive Retinopathy

Stage 1 Keith-Wagener Classification

A

Mild narrowing of the arterioles

307
Q

Hypertensive Retinopathy

Stage 2 Keith-Wagener Classification

A

Focal constriction of blood vessels and AV nicking

308
Q

Hypertensive Retinopathy

Stage 3 Keith-Wagener Classification

A

Cotton-wool patches, exudates and haemorrhages

309
Q

Hypertensive Retinopathy

Stage 4 Keith-Wagener Classification

A

Papilloedema

310
Q

Hypertensive Retinopathy

mnx

A
  • control BP

- control RFs: smoking, blood lipid levels

311
Q

what is trachoma

A

a bacterial keratoconjunctivitis caused by Chlamydia trachomatis

312
Q

who is trachoma common in

A

children and adults with poor hygiene e.g, in resource poor areas of the world.

313
Q

presentation of trachoma

A
  • conjunctival scarring and corneal abrasion
314
Q

trx of trachoma

A

typically Azithromycin as a one-off dose

315
Q

what is a common finding in acute ischaemic optic neuropathy

A

swollen optic disc

316
Q

what is ophthalmia neonatorum

A

aka neonatal conjunctivitis

an infection of the conjunctiva contracted by neonates within the first 28 days following birth

317
Q

sx of ophthalmia neonatorum

A

hyperaemia, swollen eyelids, conjunctival discharge and chemosis

318
Q

what is chemosis

A

oedema of the conjunctiva

319
Q

what are the 2 most common causes of ophthalmia neonatorum

A

chlamydia and gonorrhoea

320
Q

difference between chlamydia and gonorrhoea conjunctivitis

A

Gonococcal:

  • commonly presents from 0-3d following birth
  • purulent discharge

Chlamydial:

  • commonly presents from 5d onwards following birth
  • mucopurulent discharge
321
Q

‘A single, well demarcated white ulcer’

what is it

A

bacterial keratitis

322
Q

‘Vertical linear defects in the corneal epithelium’

what is it

A

corneal abrasion

represents the damage caused every time the patient blinks due to a foreign object

323
Q

what is the Ishihara plate score

A

test for determining colour vision deficiency

324
Q

how would acute optic neuropathy present as (4)

A
  1. central scotoma
  2. Reduced colour vision
  3. Relative afferent pupillary defect
  4. Acutely: optic disc swelling;
    chronically, with death of optic nerve fibres: atrophy (seen as a pale disc)
325
Q

Ddx of optic neuropathy (5)

A
  1. Demyelinating (MS associated) optic neuritis -
  2. Ischaemic optic neuropathy (eg GCA)
  3. Compression (eg optic nerve glioma, metastatic tumour)
  4. Nutrition: B12/folate deficiency, alcohol excess - usually bilateral, symmetrical (thus no RAPD)
  5. Raised ICP, malignant hypertension, sarcoid, ethambutol
326
Q

trx of gonococcal conjunctivitis

A
  • IV Ceftriaxone
  • bacitracin ointment
  • hourly saline lavage
327
Q

what is ciliary injection

A

involves branches of the anterior ciliary arteries and indicates inflammation of the cornea, iris, or ciliary body.

328
Q

6-hour history of dull pain in his right eye.

O/E: eye appears red, cornea is cloudy and there is evidence of ciliary injection

what is it

A

acute angle closure glaucoma.

329
Q

what is the definitive test for diagnosing acute angle closure glaucoma

A

Gonioscopy: using goniolens + slit lamp in to gain a view of the angle between the eye’s cornea and iris

330
Q

what is a strong indicator of ocular involvement in Herpes Zoster Ophthalmicus

A

Hutchinson’s sign: A skin lesion on the tip or side of the nose

331
Q

Small penetrating objects can often leave a sealed wound and may not be visible clinically. what imaging is required?

A

urgent CT scan

332
Q

mnx if a foreign body is found on CT scan

A

urgent surgery to close the wound and remove the foreign body

333
Q

what medication may raise IOP

A

Topical steroids, steroid eye drops, and systemic steroids

334
Q

causes of Horner’s syndrome

A

Pancoast tumour (affecting sympathetic nerve supply)
Stroke
Carotid artery dissection (Red flag: neck pain)

335
Q

describe a keratocanthoma

A

A rapidly growing, well differentiated lesion that is “dome shaped” in appearance

central depression and debris within

painless

can be on eyelid

336
Q

what is a retinoblastoma

A

a malignant tumour of the retina, and the most common intraocular tumour of childhood

337
Q

presentation of retinoblastoma

A
  • leukocoria (white pupil)
  • deteriorating vision
  • strabismus
  • failure to thrive
338
Q

fundoscopy shows a stormy sunset. What is it

A

Central retinal vein occlusion

339
Q

difference on examination with Argyll-Robertson pupil or Holmes-Adie tonic pupil

A

Holmes-Adie: after the patient is asked to accommodate, the dilated pupil tones up, so much so that it becomes smaller compared to the other pupil (ie the anisocoria is reversed)

Argyll-Robertson: some constriction will be seen, but the pathological pupil will remain bigger compared to the other

340
Q

mnx of Holmes-Adie

A

reassure

341
Q

is long sightedness a RF for acute angle glaucoma

A

yes

342
Q

mnx for idiopathic intracranial hypertension

A

Acetazolamide

mannitol would cause a fluid shift too rapidly

343
Q

when is contrast used in CT

A
  1. to see if normal blood vessels have become blocked (PE or ischaemic stroke)
  2. to see if abnormal structures have developed new blood supplies (ie neovascularisation surrounding a malignancy)
344
Q 
punched in eye
proptosis 
severe pain
restricted eye movement
rapid deterioration in vision

what is it

A

retrobulbar haemorrhage, leading to orbital compartment syndrome

345
Q

mnx of orbital compartment syndrome

A

urgent decompression by lateral canthotomy

346
Q

when would you give anti-VEGF vs photocoagulation in diabetes

A

anti-VEGF: clinically significant diabetic macular oedema

photocoagulation: proliferative diabetic retinopathy

347
Q

most common cause of surgical 3rd nerve palsy

A

posterior communicating artery aneurysm.

Other causes: cavernous sinus lesions (infection, thrombosis, tumour infiltration).

348
Q

which therapy is contraindicated in thyroid eye disease

A

Radioactive iodine ablation therapy

349
Q

is plasma copper high or low in wilson’s disease

A

low

because it quickly accumulates in the liver and the CNS

350
Q

A patient with signs of an oculomotor nerve palsy (cranial nerve 3) with pupillary signs (mydriasis) should be assumed to have?

A

an aneurysm of their ipsilateral posterior communicating artery until proven otherwise

351
Q

what inx for a retinal tear if cannot view retina because of a vitreous haemorrhage

A

A B-scan ultrasound will help determine if the retina has detached as it is not possible to view this patient’s retina.

352
Q

eye cannot look out away from the nose. What palsy is it

A

6th nerve palsy

353
Q

eye is upwards and inwards and the patient may present with a tilted head. What palsy is it

A

4th nerve palsy

354
Q

painful red nodule on her left lower eyelid.

lesion has a pearly margin with an ulcerated centre. What is the most likely diagnosis?

A

Basal cell carcinoma

355
Q

12m old baby has large cream coloured mass in the fundus of both eyes.

The red reflex is absent. What is it

A

Hereditary retinoblastoma

356
Q

Fundoscopy reveals a large yellow lesion at the back of the eye. 40 pack smoker

what is it

A

Ocular metastases

357
Q

6-month-old child with a 5-month history of a rapidly growing bright red lesion on his right upper eyelid.

the right upper eyelid bisects the pupil and the lesion blanches on pressure

what is it

A

large haemangioma

358
Q

trx of a large haemangioma obstructing vision

A

PO propranolol

359
Q

difference between surgical and medical 3rd nerve palsy

A

surgical: pupil is dilated

360
Q

double vision that is worse particularly when looking down and gets better when tilting his head to the right side. He particularly struggles to walk down stairs. what is it

A

Left fourth-nerve palsy

361
Q

where is the likely source of infection if she has orbital cellulitis involving the ocular muscles and causing compression of the optic nerve

A

the ethmoid sinus

sits medially to the orbit

362
Q

pain started last night when he accidentally scratched his eye while taking his contact lens out. On examination, you note hyperaemia and a white deposit on the cornea. what is it

A

Bacterial keratitis

363
Q

which common conditions lead to Charles Bonnet syndrome

A

age related macular degeneration, followed by glaucoma and cataract.

364
Q

sx of Charles Bonnet syndrome

A

well formed, vivid, elaborate, and often stereotyped visual hallucinations in a partially sighted person who has insight into the unreality of what he or she is seeing.

365
Q

A 6m child with 5m history of a rapidly growing bright red lesion on his right upper eyelid.

right upper eyelid bisects the pupil and the lesion blanches on pressure

mnx?

A

large haemangioma that is obstructing vision

so BB first line

366
Q

which medication can raise IOP

A

topical steroids, steroid eye drops, and systemic steroids

Finals (47 decks)

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