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Ophthalmology Flashcards

1
Q

What is drusen?

A

Yellow round spots in Brusch’s membrane

Seen in age related macular degeneration

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2
Q

Investigations for subconjunctival haemorrhage

A

Check blood pressure

Bloods if recurrent/bilateral for bleeding disorder

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3
Q

When does a subconjunctival haemorrhage need imaging?

A

If can’t see whole border of haemorrhage

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4
Q

Central retinal artery occlusion - presentation

A

Sudden unilateral visual loss

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5
Q

Central retinal artery occlusion - cause

A

Thromboembolism

Arteritis (e.g. temporal arteritis)

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6
Q

Central retinal artery occlusion - examination findings

A

Afferent pupillary defect

Cherry red spot on a pale retina

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7
Q

What does myopia mean?

A

Short sighted

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8
Q

What does hyperopia mean?

A

Long sighted

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9
Q

Presentation of corneal abrasion

A

Eye pain

Photophobia

Reduced visual acquity

Foreign body sensation

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10
Q

Management of corneal abrasion

A

Topical antibiotics to prevent bacterial superinfection

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11
Q

Features of corneal ulcer

A 
Eye pain
Photophobia
Watering
foreign body sensation
Focal fluorescein staining of cornea
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12
Q

What is the official word for squint?

A

Strabismus

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13
Q

What does strabismus mean?

A

Squint

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14
Q

How to manage squint in children?

A

Refer to secondary care

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15
Q

What is a chlazaion?

A

Retention cyst of meibomian gland

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16
Q

Chlazaion - presentation

A

Firm painless lump in the eyelid

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17
Q

Chlazaion - management

A

Most resolve spontaneously

Some require surgical removal

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18
Q

Stye - management

A

Hot compress and analgesia

Topical antibiotics only if associated conjunctivitis

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19
Q

Features of central retinal vein occlusion

A

Sudden, painless reduction in or loss of visual acuity

Usually unilateral

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20
Q

Central retinal vein occlusion on fundoscopy

A

Severe retinal haemorrhages

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21
Q

Features of scleritis

A

VERY painful red eye

Photophobia

Reduced visual acuity

Associated with autoimmune disease e.g. RA, SLE

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22
Q

Scleritis - impact of phenylephrine drops

A

No blanching

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23
Q

Episcleritis - impact of phenylephrine drops

A

Blanching

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24
Q

Scleritis - management

A

NSAIDS, immunosuppressants

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25
Scleritis - complications
Perforation of the globe
26
Scleritis - associations
Autoimmune conditions e.g. SLE, RA
27
Screening for primary open angle glaucoma
Patients with a first degree relative with open angle glaucoma should be screened every year from age 40
28
Herpes simplex keratitis - features
Dendritic corneal ulcer on fluroescein staining Red painful eye Reduced visual acuity
29
Horner's syndrome - features
Miosis (small pupil) Ptosis Enophthalmos (sunken eye) Anhidrosis
30
Papilloedema - fundoscopy findings
Venous engorgement Blurring of optic disc margin Loss of optic cup
31
Papilloedema - causes
SOL Malignant hypertension Idiopathic intracranial HTN Hydrocephalus Hypercapnia
32
Central retinal artery occlusion - findings
Afferent pupillary defect | Cherry red spot on pale retina
33
Central retinal artery occlusion - causes
Thromboembolism from atherosclerosis Arteritis e.g. temporal arteritis
34
What is entropion?
In turning of the eyelids
35
What is in turning of the eyelids called?
Entropion
36
What is ectropion?
Out turning of the eyelis
37
What is out turning of the eyelids called?
Ectropion
38
Foreign body in the eye - indications to refer
Suspected penetrating eye injury Significant trauma Chemical injury Foreign body of organic material Foreign body in/near centre of cornea
39
What does a gradual onset history of straight lines appearing crooked suggest?
Age related macular degeneration
40
Contraindication for antioxidant dietary supplements in macular degeneration?
Smoking
41
Causes of tunnel vision
Papilloedema Glaucoma Retinitis pigmentosa Choroidoretinitis Optic atrophy secondary to tabes dorsalis Hysteria
42
Types of stye
Hordeloum externum Hordeloum internum
43
How do patients get certified as blind or partially sighted?
Consultant ophthalmologist completes certificate of vision impairment
44
Criteria for severely sight impaired
VA < 3/60 VA <6/60 with reduction in field of vision VA over 6/60 with very reduced field of vision
45
Criteria for sight impaired
VA 6/60 VA up to 6/24 with reduced field of vision VA of 6/18 or better but missing lots of field of vision
46
Holmes-Adie pupil - features
Dilated pupil Once pupil constricted it remains small for a long time Slowly reactive to accommodation but very poorly to light Absent ankle/knee reflexes Unilateral in 80%
47
Additional finding in congenital horner's syndrome
Heterochromia (difference in iris colour)
48
Ocular manifestations of RA
Keratoconjunctivitis sicca Episcleritis Scleritis Corneal ulceration Keratitis
49
What is keratoconjunctivitis sicca?
Dry eyes
50
Argyll-Robertson pupil features
Small irregular pupils No response to light but able to accommodate
51
Argyll-Robertson pupil causes
Diabetes mellitus | Syphilis
52
What does mydriasis mean?
Large pupil
53
Causes of mydriasis/large pupil
Third nerve palsy Homes-Adie pupil Traumatic irdoplegia Phaeochromocytoma Congenital
54
School exclusion in conjunctivitis
No exclusion
55
What does miosis mean?
Small pupil
56
Causes of relative afferent pupillary defect
Retinal detachment Optic neuritis
57
Treatment of amaurosis fugax
As TIA - 300mg aspirin
58
Vitreous haemorrhage - features
Sudden or subacute visual loss Dark spots Floaters
59
Vitreous haemorrhage - causes
Diabetes Bleeding disorders Anticoagulants Ocular trauma
60
Retinal detachment - features
Dark spots, floaters Dense shadow starts peripherally then over central vision Veil/curtain over vision Straight lines appear curved
61
Posterior vitreous detachment - features
Flashes of light in peripheral field | Floaters
62
Features of acute angle closure glaucoma
``` Severe pain Reduced visual acuity Haloes Semi-dilated pupil Cloudy cornea ```
63
Features of anterior uveitis
Pain Blurred vision Photophobia Pupil small, fixed and irregular Red eye Ciliary flush (ring of red spreading out)
64
Which condition should a small, fixed, irregular shaped pupil and red eye make you think of?
Anterior uveitis
65
Endophthalmitis features
After intraocular surgery Red eye, pain, visual loss
66
Management of anterior uveitis
Cycloplegics - atropine, cyclopentolate Steroid eye drops
67
Associations with anterior uveitis
HLA B27 - Ankylosing spondylitis - IBD - Reactive arthritis - Sarcoidosis
68
Main cause of keratitis in non-contact lense wearers
Staphylococcus aureus
69
Main cause of keratitis in contact lense wearers
Pseudomonas aeruginosa
70
Keratitis - features
Red eye and pain Photophobia Foreign body/gritty sensation Hypopyon
71
Keratitis - management
Stop using contacts Topical antibiotics Cycloplegic for pain relief
72
Examples of cycloplegics
Atropine | Cyclopentolate
73
Age related macular degeneration - risk factors
Age Smoking Female FHx HTN Dyslipidaemia Diabetes
74
Age related macular degeneration - features
Reduced visual acuity Difficult dark adaptation Glare around objects Flickering/flashing lights Straight lines appear curved
75
Age related macular degeneration - Classification
1) Dry (90%) now called EARLY | 2) Wet now called LATE
76
Age related macular degeneration - features of dry/early ARMD
Atrophic Non-exudative Drusen
77
Age related macular degeneration - features of wet/late ARMD
Exudative | Choroidal neovascularisation
78
Which type of age related macular degeneration has the worse prognosis?
Wet/late
79
Management of DRY age related macular degeneration
Antioxidants
80
Management of WET age related macular degeneration
Anti-VEGF (vascular endothelial growth factor)
81
Primary open angle glaucoma - risk factors
Age Family history Black ethnicity Myopia HTN Diabetes Steroids
82
Primary open angle glaucoma - features
Insidious onset found at routine appointment Peripheral visual field loss progressing to tunnel vision Reduced visual acuity
83
Primary open angle glaucoma - fundoscopy findings
Optic disc cupping Optic disc pallor Bayonetting of vessels Cup notching
84
Primary open angle glaucoma - first line management
Latanoprost A prostaglandin analogue
85
How does lantanoprost work?
Increases uveosleral outflow
86
Side effects of lantanoprost
Brown pigmentation of iris Periocular pigmentation Increased eye lash length
87
Primary open angle glaucoma - second line options
Timolol Dorzolamide Brimonidine Pilocarpine
88
What type of drug is timolol?
Beta blocker
89
Contraindications for timolol
Asthma | Heart block
90
How does timolol work?
Reduces aqueous production
91
What type of drug is dorzolamide?
Carbonic anhydrate inhibitor
92
Side effects of dorzolamide
Sulphur like reactions e.g. anaphylaxis
93
How does dorzolamide work?
Reduces aqueous production
94
What type of drug is brimonidine?
Sympathomimetics
95
What medication contraindications starting brimonidine?
MAOI | Tricyclics
96
How does brimonidine work?
Reduces aqueous production AND increases outflow
97
What type of drug is pilocarpine?
Muscarinic receptor agonist
98
Side effects of pilocarpine
Constricted pupil Headache Blurred vision
99
How does pilocarpine work?
Increased uveoscleral outflow
100
Primary open angle glaucoma - management in advanced disease
Surgery or laser therapy
101
What is dacryocystitis?
Infection of lacrimal sac
102
Dacryocystitis - features
Watering eye | Swelling and erythema at inner canthus
103
Dacryocystitis - management
Oral antibiotic
104
Congenital lacrimal duct obstruction - features
Watering eye May have secondary infection
105
Congenital lacrimal duct obstruction - management
99% resolve spontaneously by age 1 year | Teach lacrimal duct massage
106
Retinitis pigmentosa - features
Night blindness | Tunnel vision
107
Retinitis pigmentosa - fundoscopy
Black bone spindles
108
Optic neuritis - causes
MS Diabetes Syphilis
109
Optic neuritis - likelihood of MS
If >3 white matter lesions on MRI then 50% of MS in 5 years
110
Optic neuritis - management
High dose steroids | Recovery takes 4-6 weeks
111
Optic neuritis - features
Eye pain, worse on movement Unilateral decrease in visual acuity Poor colour discrimination 'red desaturation' Relative afferent pupillary defect
112
Diabetic retinopathy - risk factors
``` Length of diabetes Glycaemic control HTN Renal disease Pregnancy can cause rapid progression ```
113
Mild non-proliferative diabetic retinopathy
≥ 1 microaneurysm
114
Moderate non-proliferative diabetic retinopathy
Microaneurysms Blot haemorrhages Hard exudates Cotton wool spots Venous beading
115
Severe non-proliferative diabetic retinopathy
Blot haemorrhage and microaneurysms in 4 quadrants Venous beading in 2 quadrants Intraretinal microvascular abnormalities in 1 quadrant
116
Proliferative diabetic retinopathy
Neovascularisation
117
Diabetic retinopathy - maculopathy classification
Based on location not severity | Hard exudates and other changes on macular
118
Diabetic retinopathy - management
Control: blood sugar, BP, lipids Stop smoking Laser treatment Intravitreal steroids
119
Acute angle closure glaucoma - predisposing factors
Hypermetropia (long sighted) Pupil dilation Lens growth associated with age
120
Acute angle closure glaucoma - drug causes
Anticholingerics | Tricyclic antidepressants e.g. amitriptyline
121
Acute angle closure glaucoma - features
``` Severe pain Reduced visual acuity Hard, red eye Halos Semi-dilated non-reactive pupil Dull/hazy cornea Systemic features ```
122
Acute angle closure glaucoma - immediate emergency management
IV acetazolamide Topical pilocarpine Topical timolol
123
Acute angle closure glaucoma - definitive management
Laser peripheral iridotomy
124
Herpes zoster ophthalmicus - features
Vesicular rash around eye
125
Herpes zoster ophthalmicus - what suggests ocular involvement?
Rash on tip or side of nose | This is called Hutchinson's sign
126
Herpes zoster ophthalmicus - management
Oral antivirals for 7-10 days | IV antivirals in severe disease or immunocompromised
127
Cataracts - features
Reduced vision Faded colour vision Glare Halos
128
Cataracts - examination findings
Defect in red reflex
129
Cataracts - management
Conservative: stronger glasses, bright lighting Definitive: surgical replacement of lens with an artificial one
130
Cataracts - complications after surgery
Posterior capsule opacification Retinal detachment Posterior capsule rupture Endophthalmitis
131
Cataracts - causes
``` Normal ageing Smoking Alcohol Diabetes Long term steroids Radiation exposure Myotonic dystrophy Hypocalcaemia Down's syndrome Uveitis ```
132
Blepharitis - causes
Meibomian gland dysfunction Seborrhoeic dermatitis Staphylococcal infection Rosacea
133
Blepharitis - features
Bilateral Grittiness around eyelid margin Eyes sticky in morning
134
Blepharitis - management
Twice daily soft compress Lid hygiene Artificial tears
135
Blepharitis - when to refer urgently
Symptoms of corneal disease - pain, blurred vision Sudden onset visual loss Acutely red and painful eye
136
DVLA - visual field defects
Stop driving until can confirm meet national guidelines for visual fields
137
DVLA - monocular vision
Notify DVLA | May drive if acuity and visual field is normal in the remaining eye
138
DVLA - blepharospasm
Consultant opinion required

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