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ΩΩ 4 Bateman - Specialities + Endo + GI + Liver > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is myopia?

A

Short sightedness

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2
Q

What is hyperopia?

A

Farsightedness

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3
Q

WHAT IS GLAUCOMA?

A

Raised intra-ocular pressure that compresses the optic nerve caused by inadequate drainage of aqueous humour.

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4
Q

What are the different types of glaucoma?

A

Open angle glaucoma

Acute angle-closure glaucoma

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5
Q

What is open angle glaucoma?

A

Gradual increases in resistance to the draining of aqueous humourthrough trabecular meshwork and canal of Schlemm.

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6
Q

What are the clinical features of open angle glaucoma?

A
  1. GRADUAL onset
  2. Loss of peripheral vision causing tunnel vision
  3. Fluctuating headaches
  4. Halos around bright lights
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7
Q

What are the investigations for open angle glaucoma?

A
  1. GOLD STANDARD - Goldmann applanation tonometer
    Requires topical anaesthesia and fluorescein but has a high level of accuracy. The force required to flatten a small area of cornea is measured by a prism fitted to a tonometer
  2. Fundoscopy/ophthalmoscopy
    Optic cup increases in size as nerve is pushes back though optic disc.
    If optic cup > half the size of optic disc = glaucoma
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8
Q

What is the management of open angle glaucoma?

A
  1. Prostaglandin eye drops to increase uveoscleral outflow eg. lantanoprost (SE eye discolouration)
  2. β-blocker timolol to reduce aqueous humour production.
    carbonic anhydrase inhibitor (darzolamide)
  3. Trabeculectomy operation creates new drainage hole from anterior chamber through sclera to conjunctiva.
  4. Annaul screening from age 40 if family history
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9
Q

WHAT IS ACUTE ANGLE-CLOSURE GLAUCOMA?

A

Medical emergency

Iris bulges forward and closes off and blocks outflow.

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10
Q

What are the risk factors for acute angle closure glaucoma?

A
  1. Hypermetropia (long-sightedness)
  2. Pupillary dilatation
  3. Lens growth associated with age
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11
Q

What is acute angle-closure glaucoma triggered by?

A
  1. Adrenaline
  2. Anticholinergics
  3. Amitriptyline
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12
Q

What are the clinical features of acute angle-closure glaucoma?

A
  1. Rapid onset
  2. Blurred vision
  3. Halos around lights
  4. Painful red eye
  5. N&V
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13
Q

What is the treatment for acute angle-closure glaucoma?

A
  1. Immediate admission
  2. Lie flat and supine
  3. Pilocaprine drops: 2% in blue eyes, 4% in brown eyes (miotic agent)
  4. Acetacolamide IV (carbonic anhydrase inhibitor so reduces aqueous humour production)
  5. Beta blocker timolol
  6. Analgesia and antiemetic
  7. Specialist definitive treatment is laser iridotomy creates hole in iris that allows drainage of aqueous humour
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14
Q

WHAT IS MACULAR DEGENERATION?

A

Degeneration of the central retina (macula) is the key feature with changes usually bilateral.

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15
Q

What are the two types of macular degeneration?

How common is each type?

What is each characterised by?

A

Dry

  1. 90% of cases
  2. Also known as atrophic
  3. Characterised by drusen - yellow round spots in Bruch’s membrane

Wet

  1. 10% of cases
  2. Also know as exudative or neovascular macular degeneration
  3. Characterised by choroidal neovascularisation
  4. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision
  5. Carries worst prognosis
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16
Q

What are the clinical features of macular degeneration?

A
  1. Gradual worsening central visual field loss
  2. Reduced visual acuity particularly in the dark
  3. Wavy appearance to straight line
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17
Q

What are the investigations for macular degreneration?

A
  1. Diagnosis - Slit lamp exam + optical coherence tomography (cross-sectional view of retina)
  2. Fundoscopy: drusen (yellow deposits of lipids and proteins)
  3. Fluorescein angiography if neovascular MD is suspected
  4. Scotoma
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18
Q

What is the treatment for macular degeneration?

A
  1. Anti-vascular endothelial growth factor
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19
Q

WHAT IS CATARACTS?

A

A cataract is a common eye condition where the lens of the eye gradually opacifies i.e. becomes cloudy.

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20
Q

What is the cause for cataracts?

A
  1. Response to normal aging - most common
  2. Smoking
  3. Alcohol
  4. Diabetes mellitus
  5. Hypocalcaemia
  6. Long-term steroids
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21
Q

What are the clinical features of cataracts?

A
  1. Reduced vision
  2. Faded colour vision: making it more difficult to distinguish different colour
  3. Glare: lights appear brighter than usual
  4. Halos around lights
  5. A Defect in the red reflex
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22
Q

What are the investigtations for cataracts?

A
  1. Ophthalmoscopy: done after pupil dilation. Findings: normal fundus and optic nerve
  2. Slit-lamp examination. Findings: visible cataract
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23
Q

What is the management for cataracts?

A
  1. Non-surgical management, stronger glasses, brighter lighting
  2. Surgical management - replacing the lens with an artifical one
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24
Q

WHAT ARE EXAMPLES OF PAINLESS RED EYES?

A
  1. Blepharitis
  2. Episcleritis
  3. Conjunctivitis
  4. Subconjunctival haemorrhage
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25
Q

WHAT ARE EXAMPLES OF PAINFUL RED EYES?

A
  1. Scleritis
  2. Anterior uveitis AKA iritis
  3. Corneal abrasion
  4. Herpes keratitis
  5. Acute angle-closure glaucoma
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26
Q

WHAT IS SCLERITIS?

A

Scleritis is an inflammatory condition in which the outer shell of the eye, the sclera, becomes oedematous and tender

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27
Q

What are some conditions associated with scleritis?

A
  1. RA
  2. SLE
  3. IBD
  4. Sarcoidosis
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28
Q

What are the clinical features of scleritis?

A
  1. Red eye
  2. Classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present
  3. Watering and photophobia are common
  4. Gradual decrease in vision
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29
Q

What is the treatment for scleritis?

A
  1. NSAIDs
    E.g. oxyphenobutazome and indomethacin
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30
Q

WHAT IS ANTERIOR UVEITIS/IRITIS?

A

Inflammation of the anterior portion of the uvea - iris and ciliary body

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31
Q

What conditions is anterior uveitis associated with?

A
  1. HLA B27
    Ankylosing spondylitis
  2. Reactive arthritis
  3. Sarcoidosis
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32
Q

What are the clinical features of anterior uveitis?

A
  1. Unilateral
  2. Acute onset
  3. Ocular discomfort & pain (may increase with use)
  4. Pupil may be small +/- irregular due to sphincter muscle contraction
  5. Ciliary flush
  6. Photophobia (often intense)
  7. Blurred vision
  8. Red eye
  9. Lacrimation
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33
Q

What is the management for anterior uveitis?

A
  1. Urgent review by ophthalmology
  2. Cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
  3. Steroid eye drops
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34
Q

WHAT IS CONJUNCTIVITIS?

A

Conjunctivitis is the most common eye problem presenting to primary care. It is characterised by sore, red eyes associated with a sticky discharge

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35
Q

What are the differences between bacterial and viral conjunctivitis?

A
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36
Q

What is the management of bacterial conjunctivitis?

A
  1. Normally a self-limiting condition that usually settles without treatment within 1-2 weeks
  2. Topical antibiotic therapy is commonly offered to patients, e.g. Chloramphenicol. Chloramphenicol drops are given 2-3 hourly initially where as chloramphenicol ointment is given qds initially
  3. Topical fusidic acid is an alternative and should be used for pregnant women. Treatment is twice daily
  4. Contact lens should not be worn during an episode of conjunctivitis
  5. Advice should be given not to share towels
  6. School exclusion is not necessary
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37
Q

WHAT ARE THE FEATURES OF ALLERGIC CONJUNCTIVITIS?

A
  1. Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)
  2. Itch is prominent
  3. the eyelids may also be swollen
  4. May be a history of atopy
  5. May be seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens)
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38
Q

What is the management of allergic conjunctivitis?

A
  1. first-line: topical or systemic antihistamines
  2. second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
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39
Q

WHAT IS A SUBCONJUNCTIVAL HAEMORRHAGE?

A

This presents as a bright red patch under the conjunctiva following rupture of a small conjunctival vessel

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40
Q

What is the cause of subconjunctival haemorrhage?

A
  1. Spontaneously
  2. Slight trauma
  3. Local congestion due to coughing or sneezing.
  4. In head injury, blood from a fracture at the base of the skull may travel through the floor of the orbit and into the subconjunctival space
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41
Q

What are the symptoms of subconjunctival haemorrhage?

A

There is no discharge. Usually, the condition is painless and does not usually impair vision.

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42
Q

WHAT IS EPISCLERITIS?

A

The episclera is the thin layer of vascular tissue overlying the sclera

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43
Q

What are the features of episcleritis?

A
  1. Red eye
  2. Classically not painful (in comparison to scleritis), but mild pain may be present
  3. Watering and mild photophobia may be present
  4. In episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera. In scleritis, vessels are deeper, hence do not move
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44
Q

How can you differentiate between episcleritis and scleritis?

A
  1. Phenylephrine drops
  2. Phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels.
  3. If the eye redness improves after phenylephrine a diagnosis of episcleritis can be made
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45
Q

What is the management of episcleritis?

A
  1. Conservative
  2. Artificial tears may sometimes be used
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46
Q

WHAT IS HERPES ZOSTER OPHTHALMICUS?

A

Herpes zoster ophthalmicus (HZO) describes the reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles.

47
Q

What are the features of herpes zoster ophthalmicus?

A
  1. Vesicular rash around the eye, which may or may not involve the actual eye itself
  2. Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
48
Q

What is the management of herpes zoster ophthalmicus?

A
  1. Oral antiviral treatment for 7-10 days
    • ideally started within 72 hours
    • intravenous antivirals may be given for very severe infection or if the patient is immunocompromised
    • topical antiviral treatment is not given in HZO
  2. Topical corticosteroids may be used to treat any secondary inflammation of the eye
  3. oOular involvement requires urgent ophthalmology review
49
Q

What are the complications of herpes zoster ophthalmicus?

A
  1. Ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
  2. Ptosis
  3. Post-herpetic neuralgia
50
Q

WHAT IS DIABETIC RETINOPATHY?

A

Diabetic retinopathy is the most common cause of blindness in adults aged 35-65 years-old.

51
Q

What does this picture show?

A

Lazer eye surgery

52
Q

What are the features of non-proliferative diabetic retinopathy?

A
  1. Microaneurysms
  2. Blot haemorrhages
  3. Hard exudates
  4. Cotton wool spots (‘soft exudates’ - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
53
Q

What are the features of proliferative diabetic retiniopathy?

A
  1. Retinal neovascularisation - may lead to vitrous haemorrhage
  2. Fibrous tissue forming anterior to retinal disc
  3. More common in Type I DM, 50% blind in 5 years
54
Q

What is the management of diabetic retiniopathy?

A
  1. All patients
    • optimise glycaemic control, blood pressure and hyperlipidemia
    • regular review by ophthalmology
  2. Maculopathy
    • if there is a change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors
  3. Non-proliferative retinopathy
    • regular observation
    • if severe/very severe consider panretinal laser photocoagulation
  4. Proliferative retinopathy
    • panretinal laser photocoagulation
    • intravitreal VEGF inhibitors
    • if severe or vitreous haemorrhage: vitreoretinal surgery
55
Q

What is the most common cause of visual loss in diabetic patients?

A

Vitreous haemorrhage

56
Q

WHAT IS THE CAUSE OF OPTIC NEURITIS?

A
  1. multiple sclerosis: the commonest associated disease
  2. diabetes
  3. syphilis
57
Q

What are the features of optic neuritis?

A
  1. unilateral decrease in visual acuity over hours or days
  2. poor discrimination of colours, ‘red desaturation’
  3. pain worse on eye movement
  4. relative afferent pupillary defect
  5. central scotoma
58
Q

What is the management of optic neuritis?

A
  1. high-dose steroids
  2. recovery usually takes 4-6 weeks
59
Q

WHAT IS KERATITIS?

A

Keratitis describes inflammation of the cornea. Microbial keratitis is not like conjunctivitis - it is potentially sight threatening and should therefore be urgently evaluated and treated.

60
Q

What are the causes of keratitis?

A
  1. Bacterial
    • typically Staphylococcus aureus
    • Pseudomonas aeruginosa is seen in contact lens wearers
  2. Fungal
  3. amoebic
    • acanthamoebic keratitis
    • accounts for around 5% of cases
    • increased incidence if eye exposure to soil or contaminated water
    • pain is classically out of proportion to the findings
  4. Parasitic: onchocercal keratitis (‘river blindness’)

Remember, other factors may causes keratitis:

  1. Viral: herpes simplex keratitis
    • Dendritic corneal ulcer
  2. Environmental
    • photokeratitis: e.g. welder’s arc eye
    • exposure keratitis
    • contact lens acute red eye (CLARE)
61
Q

What are the features of keratitis?

A
  1. Red eye: pain and erythema
  2. Photophobia
  3. Foreign body, gritty sensation
  4. Hypopyon may be seen
62
Q

What is done in evaluation of keratitis?

A
  1. Contact lens wearers
  2. Assessing contact lens wearers who present with a painful red eye is difficult
  3. An accurate diagnosis can only usually be made with a slit-lamp, meaning same-day referral to an eye specialist is usually required to rule out microbial keratitis
63
Q

What is the management of keratitis?

A
  1. Stop using contact lens until the symptoms have fully resolved
  2. Topical antibiotics
  3. Typically quinolones are used first-line
  4. Cycloplegic for pain relief
  5. e.g. cyclopentolate
64
Q

WHAT IS ORBITAL CELLULITIS?

A
  1. Orbital cellulitis is the result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe.
  2. It is usually caused by a spreading upper respiratory tract infection from the sinuses and carries a high mortality rate.
  3. Orbital cellulitis is a medical emergency requiring hospital admission and urgent senior review.
65
Q

What is periorbital cellulitis vs orbital cellulitis?

A
  1. Periorbital (preseptal) cellulitis is a less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury (chalazion, insect bite etc…).
  2. Periorbital cellulitis can progress to orbital cellulitis.
66
Q

What is the presentation of orbital cellulitis?

A
  1. Redness and swelling around the eye
  2. Severe ocular pain
  3. Visual disturbance
  4. Proptosis
  5. Ophthalmoplegia/pain with eye movements
  6. Eyelid oedema and ptosis
  7. Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)
67
Q

How do you differentiate orbital cellulitis from preseptal cellulitis?

A
  1. Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
68
Q

What are the investigations for orbital cellulitis?

A
  1. Full blood count – WBC elevated, raised inflammatory markers.
  2. Clinical examination involving complete ophthalmological assessment – Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema.
  3. CT with contrast – Inflammation of the orbital tissues deep to the septum, sinusitis.
  4. Blood culture and microbiological swab to determine the organism. Most common bacterial causes – Streptococcus, Staphylococcus aureus, Haemophilus influenzae B.
69
Q

What is the management for orbital cellulitis?

A
  1. Admission to hospital for IV antibiotics
    • Prevent the occurance of cavernous sinus thrombus
70
Q

WHAT IS CENTRAL RETINAL VEIN OCCLUSION?

A

Central retinal vein occlusion (CRVO) is a differential for sudden painless loss of vision.

71
Q

What are the risk factors for central retinal vein occlusion?

A
  1. increasing age
  2. hypertension
  3. cardiovascular disease
  4. glaucoma
  5. polycythaemia
72
Q

What are the features of retinal vein occulsion?

A
  1. sudden, painless reduction or loss of visual acuity, usually unilaterally
  2. fundoscopy
    • widespread hyperaemia
    • severe retinal haemorrhages - ‘stormy sunset’
73
Q

What are the investigations for retinak vein occlusion?

A
  1. Fundoscopy
    • Flame haemorrhages
    • Cotton woll spots
74
Q

What is the management of retinal vein occlusion?

A
  1. the majority of patients are managed conservatively
  2. indications for treatment in patients with CRVO include:
  3. macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents
  4. retinal neovascularization - laser photocoagulation
75
Q

WHAT IS RETINITIS PIGMENTOSA?

A

Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision

76
Q

What are the features of retinitis pigmentosa?

A
  1. night blindness is often the initial sign
  2. tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
  3. fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
77
Q

WHAT IS BLEPHARITIS?

A

Blepharitis is inflammation of the eyelid margins. It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis). Blepharitis is also more common in patients with rosacea

78
Q

What are hte feautres of blepharitis?

A
  1. symptoms are usually bilateral
  2. grittiness and discomfort, particularly around the eyelid margins
  3. eyes may be sticky in the morning
  4. eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis
  5. styes and chalazions are more common in patients with blepharitis
  6. secondary conjunctivitis may occur
79
Q

What is the management of blepharitis?

A
  1. softening of the lid margin using hot compresses twice a day
  2. ‘lid hygiene’ - mechanical removal of the debris from lid margins
    • cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used
    • an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled
  3. artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film
80
Q

WHAT IS A VITREOUS HAEMORRHAGE?

A

Vitreous haemorrhage is bleeding into the vitreous humour.

It is one of the most common causes of sudden painless loss of vision.

It causes disruption to vision to a variable degree, ranging from floaters to complete visual loss.

The source of bleeding can be from disruption of any vessel in the retina as well as the extension through the retina from other areas.

Once the bleeding stops, the blood is typically cleared from the retina at an approximate rate of 1% per day1.

81
Q

What are the risk factors for vitreous haemorrhage?

A
  1. Diabetes
  2. Trauma
  3. Anticoagulants
  4. Coagulation disorders
  5. Severe short sightedness
82
Q

What are the causes for vitreous haemorrhage?

A
  1. proliferative diabetic retinopathy (over 50%)
  2. posterior vitreous detachment
  3. ocular trauma: the most common cause in children and young adults
83
Q

What are the symptoms of vitreous haemorrhage?

A
  1. painless visual loss or haze (commonest)
  2. red hue in the vision
  3. floaters or shadows/dark spots in the vision
84
Q

What are the signs of vitreous haemorrhage?

A
  1. decreased visual acuity: variable depending on the location, size and degree of vitreous haemorrhage
  2. visual field defect if severe haemorrhage
85
Q

What are the investigations of vitreous haemorrhage?

A
  1. dilated fundoscopy: may show haemorrhage in the vitreous cavity
  2. slit-lamp examination: red blood cells in the anterior vitreous
  3. ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina
  4. fluorescein angiography: to identify neovascularization
  5. orbital CT: used if open globe injury
86
Q

WHAT IS HORNER’S SYNDROME?

A
  1. miosis (small pupil)
  2. ptosis
  3. enophthalmos* (sunken eye)
  4. anhidrosis (loss of sweating one side)
87
Q

How do you distinguish between different cuases of Horner’s syndrome?

A
  1. Heterochromia (difference in iris colour) is seen in congenital Horner’s
  2. Anhidrosis: see below
  3. Pharmacologic tests
    • can be useful to confirm the diagnosis of Horner syndrome and localise the lesion
    • apraclonidine drops (an alpha-adrenergic agonist) can be used: causes pupillary dilation in Horner’s syndrome due to denervation supersensitivity but produces mild pupillary constriction in the normal pupil by down-regulating the norepinephrine release at the synaptic cleft
88
Q

Where is the lesion for different Horner’s syndrome?

89
Q

WHAT IS RETINAL DETACHMENT?

A
  1. Retinal detachment occurs when the neurosensory tissue that lines the back of the eye comes away from its underlying pigment epithelium.
  2. It is a reversible cause of visual loss, provided it is recognised and treated before the macula is affected
90
Q

What are the risk factors for reitnal detachment?

A
  1. Age
  2. Previous surgery for cataracts (accelerates posterior vitreous detachment)
  3. Myopia
  4. Eye trauma (consider boxing)
  5. Family history
  6. Previous history of retinal break/detachment in either eye
91
Q

What are the symptoms of retinal detachment?

A
  1. Detachment should be suspected if patients complain of new onset floaters or flashes, as these indicate pigment cells entering the vitreous space or traction on the retina respectively.
  2. Sudden onset, painless and progressive visual field loss, described as a curtain or shadow progressing to the centre of the visual field from the periphery should also raise suspicion of detachment.
  3. If the macula is involved, central visual acuity and visual outcomes become much worse.
92
Q

What are the investigations for retinal detachment?

A
  1. On examination, peripheral visual fields may be reduced, and central acuity may be reduced to hand movements if the macula is detached.
  2. The swinging light test may highlight a relative afferent pupillary defect if the optic nerve is involved.
  3. On fundoscopy, the red reflex is lost and retinal folds may appear as pale, opaque or wrinkled forms. If the break is small, however, it may appear normal.
93
Q

What is the management for retinal detachment?

A
  1. Any patients with new onset flashes and floaters should be referred urgently (<24 hours) to an ophthalmologist for assessment with a slit lamp and indirect ophthalmoscopy for pigment cells and vitreous haemorrhage.
94
Q

WHAT ARE THE DIFFERENCES BETWEEN RETINAL VEIN AND RETINAL ARTERY OCCULSION?

A
  1. Central retinal vein occlusion
    • incidence increases with age, more common than arterial occlusion
    • causes: glaucoma, polycythaemia, hypertension
    • severe retinal haemorrhages are usually seen on fundoscopy
  2. Central retinal artery occlusion
    • due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
    • features include afferent pupillary defect, ‘cherry red’ spot on a pale retina
95
Q

WHAT ARE THE DIFFERENCE GRADES OF HYPERTENSIVE RETINOPATHY?

96
Q

What are some signs of hypertensive retinopathy?

A
  1. AV nipping
  2. Cotton wool spots
  3. Hard exudates
  4. Flame-shaped haemorrhages
  5. Papillioedema
97
Q

What are the stages of hypertensive retinopathy?

98
Q

WHAT IS PAPILLOEDMEMA?

A

Papilloedema describes optic disc swelling that is caused by increased intracranial pressure. It is almost always bilateral.

99
Q

What are the features seen on fundoscopy for papillodema?

A
  1. venous engorgement: usually the first sign
  2. loss of venous pulsation: although many normal patients do not have normal pulsation
  3. blurring of the optic disc margin
  4. elevation of optic disc
  5. loss of the optic cup
  6. Paton’s lines: concentric/radial retinal lines cascading from the optic disc
100
Q

What are the causes of papilloedema?

A
  1. space-occupying lesion: neoplastic, vascular
  2. malignant hypertension
  3. idiopathic intracranial hypertension
  4. hydrocephalus
  5. hypercapnia
101
Q

WHAT IS ENDOPHTHALMITIS?

A

Typically red eye, pain and visual loss following intraocular surgery

102
Q

WHAT IS ARGYLL-ROBERTSON PUPIL?

A

Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus

103
Q

WHAT ARE THE COMMON EYELID PROBLEMS?

A
  1. Blepharitis: inflammation of the eyelid margins typically leading to a red eye
  2. Stye: infection of the glands of the eyelids
  3. Chalazion (Meibomian cyst)
  4. Entropion: in-turning of the eyelids
  5. Ectropion: out-turning of the eyelids
104
Q

WHAT DOES THIS SHOW?

A

Age-related macular degeneration

105
Q

WHAT IS MARCUS-GUNN PUPIL?

A
  1. Marcus Gunn pupil (relative afferent pupillary defect) is diagnosed during the swinging light test. If there is damage to the afferent pathway (retina or optic nerve) of one eye, the pupil of that affected eye will abnormally dilate when a light is shone into it.
  2. This is because the consensual pupillary relaxation response from the healthy eye will dominate.
  3. Marcus Gunn pupil can be found in patients with multiple sclerosis.
  4. Therefore, given the history, this should be ruled out in this patient.
106
Q

WHAT ARE THE CAUSES OF TUNNEL VISION?

A
  1. papilloedema
  2. glaucoma
  3. retinitis pigmentosa
  4. choroidoretinitis
  5. optic atrophy secondary to tabes dorsalis
  6. hysteria
107
Q

WHAT CLASS OF MEDICATION CAUSES INCREASED EYELASH LENGTH, AND IRIS AND PERIOCULAR PIGMENTATION?

A

Prostaglandin analogues

108
Q

WHAT ARE THE FEATURES OF A CORNEAL FOREIGN BODY?

A
  1. eye pain
  2. foreign body sensation
  3. photophobia
  4. watering eye
  5. red eye
109
Q

What are the indications for referral to ophthalmology for a corneal foregin body?

A
  1. Suspected penetrating eye injury due to high-velocity injuries (e.g. drilling, lawn moving or hammering) or sharp objects (e.g. as glass, knives, pencils or thorns)
  2. Significant orbital or peri-ocular trauma has occurred.
  3. A chemical injury has occurred (irrigate for 20-30 mins before referring)
  4. Foreign bodies composed of organic material (such as seeds, soil) should be referred to ophthalmology as these are associated with a higher risk of infection and complications
  5. Foreign bodies in or near the centre of the cornea
  6. Any red flags e.g. severe pain; irregular, dilated or non-reactive pupils; significant reduction in visual acuity.
110
Q

WHAT ARE THE DIFFERENT TYPES OF CYST?

A
  1. external (hordeolum externum): infection (usually staphylococcal) of the glands of Zeis (sebum producing) or glands of Moll (sweat glands).
  2. internal (hordeolum internum): infection of the Meibomian glands. May leave a residual chalazion (Meibomian cyst)
111
Q

What is a chalazion?

A

A chalazion (Meibomian cyst) is a retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously but some require surgical drainage

112
Q

What is the management of a stye?

A

management includes hot compresses and analgesia. CKS only recommend topical antibiotics if there is an associated conjunctivitis

113
Q

WHAT IS A AQUINT (STRABISMUS)?

A

Squint (strabismus) is characterised by misalignment of the visual axes. Squints may be divided into concomitant (common) and paralytic (rare). It is important to detect as uncorrected may lead to amblyopia (the brain fails to fully process inputs from one eye and over time favours the other eye).

114
Q

What is the management of a squint?

A
  1. referral to secondary care
  2. eye patches may help prevent amblyopia

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