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Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the causes of blepharitis

A

staph infection, meibomian gland dysfunction, seborrheic dermatitis

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2
Q

draw the visual defect diagram

A

(check online)

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3
Q

what is homonymous hemianopia

A

when the visual field defect is on the same side on each eye eg the left

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4
Q

what is heteronymous hemianopia

A

bitemporal/binasal- half a visual field is lost

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5
Q

what is the outer layer of the eye called

A

sclera

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6
Q

what structures influence the length of the lens

A

ciliary bodies, suspensory ligaments

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7
Q

what is the jelly like fluid infront of the pupil covered with?

A

cornea

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8
Q

what is the layer under the sclera

A

choroid

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9
Q

what is the innermost layer of the eye called

A

retina

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10
Q

what is the spot at the back of the eye called that is specialised for visual acuity

A

fovea

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11
Q

what photo receptor cells does the fovea contain? what are their function?

A

cones, colour vision

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12
Q

function and location of meibomian glands

A

oil production which prevents eyes from drying out– line the margin of the eye lids (where eyelashes are)

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13
Q

sx of blepharitis

A 
gritty eyes
burning sensation
conjunctival redness
****loss of eyelashes
recurrent lid lumps (chalazion, styes)
*****worse in the morning
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14
Q

what other conditon may blepharitis be associated with? tx?

A

may be assoc with Rosacea (Skin condition with redness/flushing/telangiestasia/pustules on the face)- tx with metronidazole

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15
Q

Blepharitis Management

A

hygiene
1. warm massage of the eyelids
***tear substitutes
chloramphenicol ointment 1%

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16
Q

What is a chalazion

A

Meibomian Cyst, due to gland blockage

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17
Q

sx of chalazion

A

swelling on eyelid
PAINLESS
may start as a stye (painful)
often not quite on lashline and on upper eyelid

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18
Q

tx of chalazion

A

hot compress
gentle massage of the gland
safety net periorbital cellulitis- change in vision, very painful/uncomfortable, fever
if not resolved within 4w- refer

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19
Q

what is UL blepharitis a red flag for

A

tumour

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20
Q

sx of a stye

A

small lump on the lash line

angry, tender, red lump, uncomfortable

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21
Q

what is a stye

A

infection of a lash follicle- usually staph

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22
Q

What are the most common causative organsisms of Periorbital cellulitis

A

Staph aureus, H.influenzae type B- often follows URTI

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23
Q

sx of periorbital cellulitis

A

systemically unwell
often a child
fever
erythema, tenderness around the eyeball

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24
Q

tx periorbital cellulitis

A

5-7 day course of abx

adults- co-amox 500/125mg TDS for 1 week/clarithro 500mg BD for 1 week with metronidazole

children- fluclox 125mg QDS for 1 week/coamox

incision an ddrainage

referral to paeds, ENT, MDT

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25
Q

Complications of Periorbital cellulitis/red flags

A 
ocular proptosis
limited ocular movement
decreased visual acuity
loss of red/green colour vision- optic nerve is comprimised
visual loss
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26
Q

what is conjunctivitis

A

inflammation of the conjuncitva- white part of the eye, covering the sclera), and inner layer of the eye

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27
Q

causes of conjuncitvitis

A

Viral- adeno (lymphadenopathy)
Allergy
Bacterial- Staph
Chemical

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28
Q

Sx of conjuncitvitis

A 
generally BL
red eye
discharge- clear=viral, mucous=allergy, purulent- bacterial
blurry vision due to discharge
lids sticking together
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29
Q

Management of conjunctivitis

A

Viral- pt reassurance
Allergic- antihistammine eye drops/PO
Bacterial- Abx if severe />7days– Fusidic Acid 1% eye drops, Chloramphenicol 1% ointment
Bathing/cealning eyelids with cotton wool soaked in sterile salt water (boiled)

COOL compress
artificial tears

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30
Q

What is the difference between scleritis and episceritis

A

Scleritis

  • inflammation of the full thickness of the sclera
  • serious but rare
  • commonly seen with other AI conditions

Episcleritis:
- inflammation of the thin vasular tissue later between conjunctiva and sclera- inflamamtory, AI

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31
Q

sx and tx of scleritis

A
  • severe eye pain worse on eye movs
  • red, blood shot eye in sclera
  • **- photophobia
  • eye watering
  • polymyalgia rhuematica, RA, SLE, spndyloarthropathies, Granulomatosis, GCA

tx- refer urgently, NSAIDs, immunosupression

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32
Q

sx and tx of episcleritis

A

UL, no pain, may be a bit uncomfortable
Acute onset
localised redness eg half of the eye

tx

  • very common
  • reassure
  • lubricating eyedrops
  • if severe- topical corticosteroids/oral NSAIDs

if it’s very red and painful- redflag for scleritis

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33
Q

Anterior Uveitis- what is it

A

inflammation of the uvea- which concludes the iris anteriorly and the ciliary bodies, and choroid posteriolrly

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34
Q

Causes of anterior uveitis

A

seronegative arthritis eg ank spond, JIA; sarcoidosis

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35
Q

sx and signs on examination of anterior uveitis

A 
UL
acute onset
intensely painful red eye
reduced visual acuity
photophobia
***irregular or small fixed pupil(s)
with or without back pain (ank spond)

ciliary flush
may have pus in anterior chamber

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36
Q

what would you see on slit lamp in someone with anterior uveitis, what other things would you check?

A

fibrin clot in anterior chamber of cornea
kerratic precipitates
irregular pupils

check visual acuity and red reflex

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37
Q

management of stye

A

self-limiting NO NEED FOR ABX
WARM compress
if recurrent- punture and drain

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38
Q

ix and management of anterior uveitis?

A 
fundoscopy
slit lamp
ocular pressure
find the cause:
bloods- autoantibodies- RF, anti-CCP, CRP, ESR, HLA-B27
- CXR (sarcoidosis)
  • treat with eye dilation (cyclopentolate)
  • prednisone drops
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39
Q

what is optic neuritis

A

inflammaiton of the optic nerve

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40
Q

causes of optic neuritis

A 
demyelination- MS
idiopathic
hereditary- Leber's
infectious- viral, toxoplasmosis, TB, Lyme, AIDS
autoimmune- sarcoidosis, SLE
tertiary syphillis
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41
Q

sx of optic neuritis

A 
UL loss of vision over hours-days
- ***central scotoma!!!!!
- diplopia
- pain (on moving eyes)
- loss of/change in colour vision/haziness of vision
photophobia sometimes
- ***RAPD/marcus gunn- light in affected pupil only causes pupils to react mildly, and light to unaffected eye will cause normal constiction in both pupils
- papilloedema

check for MS sx- twitching, uncoordinated eye movements, slurred speech, Uhtoff’s phenomenon

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42
Q

Management of optic neuritis

A

do MRI- may resolve spontaneously in MS
abx if infectious
high dose corticosteroids over 4-6 weeks

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43
Q

presentation of herpectic keratitis

A 
Eye pain, redness.
**Grittiness
Watery discharge.
Blurred vision.
**Sensitivity to light.
lid oedema

^^ these are sx of any microbial keratitis / corneal ulcer !

  • **oral lesions- ASK ABOUT THESE
  • Contact lenses- likely to be pseudomonas aeruginosa, Acanthamoeba castellanii ( also causes photophobia)
  • herpetic keratitis- dendritic ulcer
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44
Q

what ix do you do and what do you see for ?herpectic keratitis

A

fluorescein staining drops- you will see dendritic corneal ulcers

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45
Q

management of herpectic keratitis

A

acyclovir eye ointment

NO STEROIDS- thats for SHINGLES

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46
Q

what is ophthalmic shingles

A

Varicella zoster virus lies dormant in the sensory ganglion of the V nerve- reactivated and travels down the 1st branch )ophthalmic N)

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47
Q

What is Hutchinson’s sign of ophthalmic shingles and why does it occur

A

due to Herpes zoster ophthalmicus- reactivation of HERPES zoster over ophthalmic division of CN V
If the shingles involves the nasociliary branch of the Ophthalmic nerve.– vesicles on the tip of the nose

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48
Q

Management of Ophthalmic shingles

A

Admit

oral acyclovir within 72 hours of rash onset

if significant eye involvement- steroid eye drops

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49
Q

ophthalmic shingles sx

A

vesicular rash and prodromal pain over area of ophthalmic branch of V

unexplained redness of the eye, changes in vision

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50
Q

What is Ramsay Hunt Syndrome

A

VARICELLA Zoster virus involving the VII nerve

sx- UL painful vesciular rash around 1 ear
UL facial pain/weakness
hearing loss, vertigo
Dry eyes, difficulty closing the eye

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51
Q

sx of retinal artery occlusion

A

sudden loss of vision (total if central artery occlusion, superior/inferior loss if branch artery occlusion)

Relative afferent pupillary defect (affected eye responds different to light stimuli when compared to the other)

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52
Q

ix for person with sudden loss of vision, with PMHx of hTN, DMT2, smoker. What ix would you do? What would you see if your main differential is correct

A

?retinal artery occlusion

  • fundosocopy - cherry red spot on a pale retina
  • could do a carotid doppler if ?cause
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53
Q

Management of retinal artery occlusion

A

vision cannot be saved once ischaemia has occurred

prevention of further events:

  • aspirin
  • Bp meds
  • statins
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54
Q

sx and signs of retinal vein occlusion

A

blurring of vision, visual field defect
Central vein: sudden UL visual loss, cheesy pizza on fundoscopy

painless
may have afferent pupillary defect

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55
Q

what would you see on fundoscopy and testing in someone with retinal vein occlusion

A
  • ***optic disc swelling
  • **RAPD
  • severe flame haemorrhages (arery occlusion would be cherry red spots)
  • cotton wool spots
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56
Q

what other ix would you need other than fundoscopy for ?retinal vein occlusion

A

fundus fluorescein angiogram

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57
Q

tx retinal vein occlusion

A

pan-retinal photocoagulation

dexamethasone and anti-vEGF implants if neovascularisation occurs (risk of vitreous haemorrhage)– ((((Anti–vascular endothelial growth factor therapy,)))

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58
Q

what is your main differential in someone with floaters/dark spots, a red hue, followed by obscured/loss of vision

A

vitreous haemorrhage– secondary to retinal vein occlusion, leading to neovascularisaiton, retinal detachment/tears

Vitreous haemorrhage sx

  • sudden appearance of spots, floaters, shadows
  • sudden blurring of vision, red tint
  • sudden blindness
  • eyesight worse in morning (blood pooling)
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59
Q

Management of vitreous haemorrhage

A
  • generally get better on their own

- virectomy

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60
Q

A man with COPD and HTN comes to your GP practice with a sudden onset, UL, painless bright red area on his eye- main differential and management

A

Subconjunctival haemorrhage

  • check for other injuries if due to trauma
  • check for coagulopathies if spontaneous
  • avoid aspirin/nsaids

resolves on it’s own

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61
Q

Mechanism of diabetic retinopathy

A

microangiopathy in capillaries- occlusion and ischaemia

new blood vessel formation on the iris

bleeding of the new blood vessels- increased risk of reintal detachments

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62
Q

Pattern of blindness in diabetic retinopathy

A

cotton woll spots, all visual fields

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63
Q

what do you see on fundoscopy in diabetic retinopathy

A
  • haemorrhages
  • microaneurysms
  • cotton wool patches (retinal infarction due to capillary occlusion)
  • oedema
64
Q

Management of diabetic retinopathy

A

ctonrol BP, glucose

laser photocoagulation and anti-vEGF

65
Q

what is the macula

A

part of the retina, found lateral to optic disc, site of highest visual acuity. At the centre of the macula you have the fovea

66
Q

Different types of macular degeneration

A

dry- retina atrophy

wet- new vessel growth under the retina

67
Q

presentation of macular degen

A

dry- Macular-Middle!

  • CENTRAL SCOTOMA (blind spot/vision loss) with ok peripheral vision
  • loss of colour differentiation
  • may be worse at night and fluctuate daily

wet-

  • more rapid changes in vision, (MONTHS) , with a sudden deterioration recently.
  • central scotoma
  • flashing, glares off lights at night
  • floaters
  • Objects become smaller
  • lines not appearing as straight
  • can still have central scotoma
68
Q

ix of ?macular degen

A

slit lamps
colour fundus photography
ocular coherence tomography

69
Q

management of macular degen

A

dry- vit A, C, E, zinc, stop smoking

wet- photocoagulation, anti-VEGF (eg ranibizumab), Intravitreal injections of anti-TNF beta

70
Q

where is the aq humour made and drained

A

made- ciliary bodies
travels through pupil into the anterior chamber

drains- through trabecular meshwork, flows into the canal of Schelmn (angle)

71
Q

what is glaucoma and why does it happen

A

build up of fluid and increase in intra-ocular pressure

open angle:
- Aq outflow is reduced despite ant chamber angle being open
- More common in older patients obstruction of the angle
eye is producing too much fluid

closed angle
- ant chamber drainage (angle) is closed

72
Q

what is intraocular pressure in glaucoma

A

> 21mmHg

73
Q

sx and signs of chronic open angle glaucoma

A

often asymptomatic
optic nerve compression- loss of sight /visual field defects
TUNELLING of vision as PERIPHERAL vision is lost

NB: no haloing around lights (this is acute close angle glaucoma)

optic disc cupping on fundoscopy

74
Q

What type of glaucoma is often asymptomatic

A

chronic open-angle glaucoma- picked up on screening

75
Q

management of chronic open angle glaucoma

A
  1. prostaglandin analogue- latanoprost - improve flow
  2. BB timolol- reduce Aq prod.
    - mitotic agent (parasymp)- pilocarpine - flow
    - topical sympathomimetic alpha 2 agonist eg brimonidine- prod
    - carbonic anhydrase inhibitor (acetazolaMIDE) - prod

definitive: laser therapy
surgery

76
Q

presentation of acute angle closure glaucoma

A 
UL eye pain
headache
nausea, vomiting
poor vision, halos around lights 
signs:
- mild dilated pupil
- eye looks 'hazy' (corneal oedema)
- reduced vision

complication- permanent loss of vision

77
Q

tx of acute angle closure glaucoma

A

AIM: decrease Aq production, constrict the pupil.

  • Lie pt flat
  • IV acetazolamide (diamox)- carbonic anhydrase inhib, reduce aq humour prod

Combination eye drops:

  • BB- timolol drops (reduce Aq humour production)
  • pilocarpine- (ciliary contrraction, opens trabecular meshwork) /
  • alpha 2 agonist eg brimonidine , apraclonidine (reduce a sectretion)
  • (latanoprost)

definitive- surgery (iridotomy)

78
Q

signs of cataracts

A

white pupil
loss of red reflex
can see grey not red through slit lamp
halos around lights

79
Q

RFs for retinal detachment

A 
diabetic retinopathy 
retinal tear
vitreous haemorrhage/retinal vein occlusion
eye surgery
high myopia (short sightedness)
80
Q

presentation of retinal detachment

A

3 Fs
Floaters
Flashes
Field defects- sudden, painless. often like a dark curtain/shadow. if you get superior detachment, visual field defect will be inferior

NB: dark spots +- floaters, red hue is vitreous haemorrhage
NB2: floaters/flashes without visual defect may be vitreous detachment

81
Q

management of retinal detachment

A

seal retina with lasers

82
Q

what is myopia, management

A

short sightedness- eye is too long

management- concave glasses

83
Q

what is hypermetropia

A

long sightedness , eyeball is too short

too much ciliary contraction

84
Q

what are you at increased risk of with myopia

A

(Near sightedness)

  • retinal and vitreous detachment
  • cataracts
  • open angle glaucome
85
Q

what is astigmatism

A

irregular lens/corneal surface so it is not perecftly curved. Light rays do not meet perfectly as a common foucs so images are perceived in a distorted fashion

86
Q

What is your main differential with someone with night blindness followed by tunnel vision and poor visual acuity

what would you see on examination

tx

A

Xerophthalmia- decreased tear production, causing dry eyes. Due to Vit. A deficiency

See Bilots spots (foamy plaques) on conjunctiva

tx with vit A supplements

87
Q

A 23 year old male presents with a boggy, tender, swollen inner canthus (skin mdeial to eye). It sometimes expresses pus when massaged. PMHx- recurrent conjunctivitis. what is your main differential

A

Nasolacrimal duct obstruction- dacryostenosis/dacryocystitis

88
Q

management of dacryostenosis/dacryocystitis

A

blocked tear flow from lacrimal gland (above eyelide) or from nasolacrimal duct (below medial eye edge)

warm compress
nasolacrmial duct massage
abx if needed (pus)
surgery to restore flow of tears into nose from the lacrimal sac

89
Q

What is strabismus

A

misalignment of the visual axes of the two eyes- they point in different directions

90
Q

What is a manifest strabismus?

A

– present at rest

91
Q

What is a latent strabismus

A
  • a squint controlled by subconsious effort and so is not always apparent. In certain conditions eg fatigue, tetsing, the squint will manifest.
92
Q

what are the different types of latent strabismus

A

Esophoria – looks inwards
Exophoria – looks outwards
Hyperphoria – looks upwards
Hypophoria – looks downwards

93
Q

What are the different types of manifest strabismus

A

Esotropia- looks inwards
Exotropia- looks outwards

Hypertropia- looks upwards
Hypotropia- looks downwards

94
Q

what is a pseudo squint

A

large epicanthic folds give the appearance of a squint

95
Q

Causes of strabismus

A

hereditary
*refractive error- needs glasses, hypermetropia, anisometropia (eyes have varying refractive powers)
idiopathic
secondary visual loss
*neuro defects eg cerebral palsy
*neuro aetiology- raised ICP, CN palsy (III, IV, VI)
*febrile illness

96
Q

what is amblyopia

A

lazy eye

97
Q

ix for strabismus

A

corneal reflections
cover test- manifest or latent , direction of strabismus
visual acuity
ocular movements- exludes paralytic strabismus

98
Q

what is the cover test

A

cover one eye and see if the other moves to focus on the target
uncover the eye and see that eye moves back

the pt will use the eye with the better visual acuity preferentially and allow these worse eye to point in the direction of the strabismus

99
Q

what would you find on the cover test if someone has exotropia

A

(Manifest strabismus) when the aligned eye is covered, the misaligned eye will then focus on the point of focus. When the good eye is uncovered, the eye will then move out again to the position of strabismus. When the bad eye is covered, the good eye doesnt move

100
Q

what would you find on the cover test if someone has exophoria

A

(latent strabismus) when an eye is covered, the eye will move out underneath the cover. When you remove the cover, you will see that eye moving back into alignment

101
Q

management of strabismus

A

Conservative

  • glassess/contacts
  • convex for hypermetropia
  • concave for myopia
  • prisms
  • orthoptic exercises

botulinum toxin to extraocular muscles- does wear off after few months

Surgical
- esotropia- medial recession resection (weakening)/UL medial rectus recession and lateral rectus resection

  • exotropia- lateral rectus recession/UL lateral rectus recession and medial recust resection
102
Q

A child comes into your clinic with sudden onset strabismus- what do you do

A

usually not sudden onset- urgently refer

check for other neuro signs

103
Q

What CNs serve the eye and how?

A

CN II (optic)- sees
CNIII Occulomotor- all other extraocular muscles
CN IV Trochlear- Superior oblique
CN V Trigem- sensation (ophthalmic branch)
CN VI Abducens- lateral rectus
CN VII Facial– closes the eye (orbicularis oculi)

104
Q

What are you likely to see on fundoscopy for dry macular degen

A

Drusen- white accumulations of extracellular matter

105
Q

What are the differences in onset of the different types of macula degeneration?

A

Wet- subacute (weeks/days/months)

Dry- chronic (year)

106
Q

In a pt with optic neuritis, what is likely to be present in their csf

A

MS- oligoclonal bands IgG

107
Q

Differentials of a red eye

A
  • bacterial/microbial keratitis
  • Trauma
  • **- Acute angle-closure glaucoma
  • **- Uveitis
  • Scleritis
  • Herpes simplex keratitis
  • subconjunctival haemorrhage
  • Episcleritis
  • conjuncitvitis
  • blepharitis
    • behcet’s- eye sx (red, pain, blurring), swollen/painful/stiff joints, painful genital/mouth ulcers
108
Q

How would your hx and examination narrow down cause of red eye

A
  • *- bacterial/microbial keratitis (contact lens wearer)
  • *- Hx of trauma
  • Acute angle-closure glaucoma- hypermetropia (long sighted), asian, N+V, headache, blurred vision with **haloes, hazy cornea, mid dilated pupil
  • Uveitis- photophobia, small irregular pupil, hx of joint/back pain?
  • Scleritis- **autoimmune diseases, severe eye pain, photophobia, eye watering
  • Herpes simples keraitis- pain, photophobia, ***profuse watery discharge, dendritic ulcer
  • Subconjunctival haemorrhage-bright red, no pain
  • Episcleritis- uncomfortable, not very painful
  • Conjunctivitis- discharge
109
Q

Examination findings of hypertensive retinopathy

A

Bilateral:

1) Arteriolar constriction, tortuous vessels
2) Arteriolar nipping- due to atherosclerosis
3) microaneurysms, cotton wool spots, flame-haemorrhages
4) Papilloedema

110
Q

sx of hypertensive retinopathy

A

usually asymptomatic

sometimes reduced vision due to disc swelling

111
Q

tx hypertensive retinopathy

A

tx HTN

112
Q

differentials of optic disc swelling

A

Papilloedema (swelling with raised ICP):

  • space occupying lesions
  • infection
  • subdural/SAH
  • hydrocephalus
  • Idiopathic intracranial hypertension
  • Dural venous sinus hypertension

Optic Disc swelling

  • UL- optic neuritis
  • retinal vein occlusion
  • diabetic retinopathy
  • hypertensive retinopathy
  • non-arteritic anterior iscaemia optic neuropathy
113
Q

ix for optic disc swelling

A

CT head/MRI to rule out intracranila processes
BP- HTN
LP

114
Q

optic disc swelling sx and signs

A 
asymptomatic
visual acuity reduced
colour vision affected
headache, N+V sometimes
enlarged blind spot
115
Q

most common cause of sudden painless loss of visions

A
  • ischaemic/vascular- retinal vein/artery occ
  • Vitreous haemorrhage- vision of spots that are suspended in vision (floaters), blurred vision or complete and sudden loss of vision, red hue
  • retinal detachment- flashes, floater, visual loss
  • *- retinal migraine
  • *- GCA
  • *- TIA/stroke

NB: vitreous detachment doesnt cause loss of vision (only floaters/dark spots) unless then involves retina

116
Q

RF for vitreous haemorrhage

A

diabetes
bleeding disorders
anticoags

117
Q

contact lens wearer with a red, painful, gritty feeling eye. Watery discharge, systemically well- what do you do?

A

refer for same day ophthalmology assessment – could be conjunctivitis BUT contact lens wearer means bacterial keratitis must be ruled out

118
Q

RFs to cataracts

A 
hypocalcamia
downs
DM
LT steroid use-- strongest RF for subcapsular cataracts
uveitis
age
trauma
119
Q

presentation of endophthalmitis

A

red eye
reduced vision
very painful
following intraocular surgery

120
Q

what is endophthalmitis

A

inflammation to inraocular fluid due to infection

121
Q

differences on fundoscopy wet vs dry

A 
wet- 
- red patches on retina/subretinal haemorrhage (leakage of serous fluid/blood)
- neovasculariation
dry- 
- drusen are more common
- Retinal pigment epithelium atrophy
122
Q

when should you urgently refer a child with strabismus

A 
red flags:
nystagmus/oscillations
double vision
headaches
limited abduction
123
Q

what would you do as a GP for a child with strabismus

A

refer to ophthal . they will then have eye exercises, glasses, patches and maybe surgery

124
Q

Amsler chart- what is it used for

A

macular degen

125
Q

what does rhegmatogenous mean

A

a retinal detatchment with a clear retinal break on fundoscopy

126
Q

Risk of steroid eye drops

A

can lead to fungal infections- which can lead to corneal ulcers/microbial keratitis

LT -cataracts

127
Q

how does the hx and exmination of an acute glaucoma and anterior uveitis differ

A

Acute glaucoma- UL eye pain, haloing of light, fixed mild dilated pupil, hazy cornea!!!

ant uveitis- BL eye pain with photophbia, constricted pupils, may have hypopyon (pus in ant chamber)

128
Q

UL miosis with lagging eyelid and shoulder/arm pain- main differential?

A

pancoast syndrome

hx- smoker

129
Q

difference in presentation between vitreous haemorrhage and vitreous detachment

A

Haemorrhage- dark spots (loss of vision)/floaters with red hue to vision, painless, RF- diabetic

detachment- NO visual loss, flashes/floaters in peripheries. NO red hue

130
Q

O/E, as the light is moved from a pt’s left eye to right eye, both pupils dilate. Reaction to accomodation is normal, fundocsopy is normal- What is the name of this sign, waht does it mean?

A

Marcus-Gunn Pupil/relative afferent pupillary defect.

Means damage to the afferent pathway (reinta or optic nerve)

131
Q

What is an Adie pupil, whats is it caused by

A
  • Tonically dilated pupil (BL or UL)
  • slowly reactive to light
  • often with absent knee/ankle reflexes
    Causes: damage to parasympathetic due to viral or bacterial infection.
132
Q

What is the name of the syndrome with UL miosis, ptosis, enophthalmos, anihidrosis. Cause?

A

Horner’s syndrome

Damage to ipsilateral sympathetic branch (trauma, compression, infection, ischaemia)

Central

  • hypothal, brainstem, spinal cord
  • stroke, glioma, syringomyelia

Preganglionic- (CANCERS plus TOS, T spine)

  • *- thoracic outlet (cervical rib, subclav aneurysm
  • mediastinal tumours
  • pancoast tumour
  • thyroid malignancies
  • trauma to thoracic spinal cord
  • surgery

post ganglionic- (SKULL/SINUS plus endart, cluster)

  • trauma to cervical ganglion
  • *- lesions of ICA in cavernous sinus- thrombosis, aneurysm, inflam, tumours
  • skull base issues- dissection, thromosis, tumours
  • endarterectomy
  • cluster headaches

Anihidrosis is more pronounced in central and preganglionic causes

133
Q

What is Hutchinson’s pupil, cause

A

UL dilated pupil unreactive to light

compression of occulomotor nerve ipsilaterally by intracranial mass (tunour, haematoma)

134
Q

What is Argyll-Robertson pupil, causes?

A

BL small pupils that accommodate but dont react to light

cause- syphillis, DM

135
Q

management of man with vesicular rash on tip of his nose and eye pain

A

same day ophthalmology assessment- Hutchinson’s sign suggests pending eye inflammation, permanent corneal denervation and anterior uveitis !

136
Q

what would be found in R esotropia on cover test?

A

on covering the L eye, the R eye moves laterally to take up fixation

137
Q

what do you see on fundoscopy with ?raised ICP

A

papilloedema-

  • venous engorgement
  • optic disc margin blurring
  • loss of optic cup
  • loss of venous pulsation
  • elevation of disc
  • Paton’s lines (circumferential retinal folds around the optic disc)
138
Q

RF for retintal vein occlusion

A

diabetes

139
Q

a pt comes in following being hit in the face with a baseball bat- o/e, the r eye has blood in the anterior chamber- this puts him at increased risk of what?

A

Glaucoma

Blunt ocular trauma with hyphema is high risk scenario for raised intraocular pressure

140
Q

what complications are there following blunt trauma to the eye

A

Glaucoma (esp if hyphema)
cataract
ectopia lentis (dislocation of lens)

141
Q

what to cycloplegic drugs do

A

dilate the pupil (mydriatic)

142
Q

presentation and signs of subcapsular cataract

A

fast progression
glare from bright lights

central granular lens opacity O/E

143
Q

?orbital cellulitis- what imaging should be done to confirm the dx and evaluate further complicaitons

A

contrast enhanced CT scan of the orbits, sinuses and brain- to assess the posterior spread of the infection

144
Q

symptoms of retinitis pigmentosa

A

night blindness

tunnel vision

145
Q

which has the worst prognosis- wet or dry mac degen?

A

wet

146
Q

explain snellens visual acuity scoring

A

visual acuity = test distance (meters)/letter size (M)

letter sizes go from 0.5 (smallest) to 6 (largest)

eg 6/6 means 6 metres from chart, pt could see 6M sized letter

4/6 means from 4 metres from chart, pt could see 6M letter (reduced vision as pt needed to be closer to the chart

6/6 is equivalent to 20/20 vision

147
Q

vitreous vs retinal detatchment

A

vitreous- flashes, floaters, no visual loss

retinal- flashes, floater and visual loss

148
Q

how does timolol work

A

reduces aq production

TOP

149
Q

what class is acetazolamide and how does it work

A

MIDE- Carbonic anhydrase
reduces aq production

IV

150
Q

what class is latanoprost and how does it work

A

prostaglandin
increases uveosceral outflow

TOP

151
Q

what class is brimonidine and how does it work

A

DINE- alpha2 adrenoreceptor agonist
increases uveoscleral outflow

TOP

152
Q

screening for those with fam hx or of black african heritage for glaucoma

A

annually from 40yo

153
Q

eye conditions of tertiary syphillis

A

uveitis

optic neuritis

154
Q

what is an ectropion of the eye

A
  • eyelid droops away from eye and turns out
  • usually not serious
  • can be uncomfortable
  • eye watering
  • dry, grittiness
  • can increase risk to bacterial infections

tx

  • lubrication
  • tape at night
  • surgery
155
Q

difference between horners and CNIII palsy

A

horners- ptosis and constriction

CNIII- ptosis and dilation!!!!, out and down

156
Q

management of meningitis in hospital

A

ceftriaxone, cefotaxime or chloramphenicol

if less than 3-months old />50y

  • you would use cefotaxime instead of ceftriaxone.
  • +amoxicillin

dexamethasone

Finals (15 decks)

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