Ophthalmology Flashcards
Which 4 muscles of the eye does the oculomotor nerve supply?
Superior rectus
Medial rectus
Inferior rectus
Inferior oblique
Which eye muscle does the trochlear nerve supply?
Superior oblique
Which eye muscle does the abducens nerve supply?
Lateral rectus
Define cataracts
Clouding of the lens which develops gradually with age
How does cataracts affect vision?
Blurred vision for distance and near
Give 4 risk factors for cataracts
- Age
- Diabetes
- Steroid use
- Congenital
How does cataracts present?
- Gradual painless blurred vision
- Glare at night
How will a cataract appear on examination?
Yellow/brown colour
When is cataract surgery carried out?
Only when patient is symptomatic and it affects their life
Give 3 post-op cataract surgery complications
o Uveitis
o Cystoid macular oedema
o Retinal detachment
Define glaucoma
Progressive, degenerative optic neuropathy
What is the difference between primary and secondary glaucoma?
Primary: no discernible cause
Secondary: a known causative factor
What is the general mechanism of pathology of glaucoma?
High pressure and damage to the optic nerve
Give 3 treatment options for glaucoma
- Drops
- Laser treatment
- Surgery
Give 4 important points when taking a loss of vision history
- Pain?
- Uni or bilateral?
- Sudden/gradual?
- complete/partial?
Give 4 causes of sudden vision loss
- Retinal detachment
- Wet ARMD
- Retinal artery occlusion
- Optic neuritis
Give 4 causes of gradual vision loss
- Cataract
- Glaucoma
- Dry ARMD
- Diabetes
Give 4 risks for ARMD
- Age
- Smoking
- Fx
- Female
Define dry ARMD
Progressive atrophy with loss of photoreceptors and development of drusen and atrophy
What is the treatment of dry ARMD?
Nothing
Define wet ARMD
Neovascular growth of capillaries from choroid into subretinal space causing leakage and bleeding
What is the treatment of wet ARMD?
Intravitreal anti-VEGF injection
How does retinal detachment present?
Sudden vision loss like a curtain coming down
Unilateral and painless
Flashes and floaters
Give 3 risks for retinal detachment
- Age
- Trauma
- Previous cataract surgery
Give 3 treatment options for retinal detachment
- Vitrectomy
- Laser/cryotherapy to seal the hole
- Gas/oil to tamponade the break
What is usually the cause of retinal artery occlusion?
Embolic
What are the signs of retinal artery occlusion?
Pale/swollen retina
Cherry red spot
Which condition is retinal artery occlusion associated with?
Giant cell arteritis
What is usually the cause of retinal vein occlusion?
Atherosclerosis
What should also be done in terms of follow-up for patients with retinal artery occlusion?
Referral to TIA clinic as usually embolic cause
Give 4 signs of retinal vein occlusion
o Torturous vessels
o Disc swelling
o “flame” haemorrhages
o Cotton wool spots
How does optic neuritis present?
Gradual onset reduced vision over 2 weeks
Pain on eye movement
Which drug hastens recovery of optic neuritis but doesn’t change outcome?
IV Methylprednisolone
Define anterior ischaemic optic neuropathy
Interruption of blood supply to optic nerve head
Give 4 ways in which anterior ischaemic optic neuropathy may present
o Reduced vision
o Reduced colour vision
o Visual field defect
o Disc swelling
How is anterior ischaemic optic neuropathy managed?
Urgently with IV methylprednisolone
Give 3 traumatic causes of red eye
- Abrasion
- Foreign body
- Chemical injury
Give 3 non-traumatic causes of red eye
- Conjunctivitis
- Corneal Ulcer
- Iritis
Give 3 causes of conjunctivitis
- Bacterial Infection
- Chlamydia
- Allergy
What is papillae and how does it appear on examination?
A vascular response, cobblestone arrangement of flattened nodules with a central vascular core
Define chemosis
Swelling/oedema of conjunctiva
What does gonococcal infection do to the eye and how is it treated?
Severe purulent discharge
Tx: Topical and systemic ABX, GUM referral
What affect does chlamydia have on the eye and what is the treatment?
Mucopurulent discharge and oedema
Tx: topical and systemic ABX, GUM referral
Give 3 risks for a corneal ulcer
Trauma
Contact lens user
Dry eyes
Give 4 clinical features of a corneal ulcer
- Pain
- Foreign body sensation
- Redness
- Photophobia
Which investigation can be used for a corneal ulcer?
Corneal scrape if ulcer >1mm
What is the management of a corneal ulcer?
Topical Ganciclovir ointment
Broad spectrum ABX before cultures back
Give 2 features and the treatment of scleritis
Acute red eye
Pain on eye movement
Tx: Oral steroid
Investigate for underlying vasculitis
What is Uveitis?
Inflammation of the uveal tract (iris, ciliary body and choroid)
Give 4 causes of uveitis
- Idiopathic
- Trauma
- Infection
- RA
In general, what is the treatment of uveitis?
Steroids
Give 2 risk factors for angle closure glaucoma
Older age
Long-sighted
Give 3 symptoms of angle closure glaucoma
- Severe pain
- Headache
- Photophobia
Give 3 management options while waiting for an urgent ENT review in angle closure glaucoma
IV mannitol
Topical steroid
Topical pressure lowering drops
Define hyphaema
Blood in the anterior chamber of the eye
Define Age-related macular degeneration
Atrophy of retinal pigment epithelium or growth of choroidal vessels due to atrophy
What will patient’s with ARMD describe seeing?
Loss of central vision and kinks in straight lines
What causes amblyopia (lazy eye)?
Halting of development of visual axis between eye and brain
Give 3 treatment options for amblyopia
- Glasses
- Patch over good eye
- Atropine penalization (into good eye which blurs vision of good eye forcing them to use bad eye)
What is the treatment for orbital cellulitis?
Immediate ABX
CT for abscesses
ENT input
Define strabismus
Incorrect positioning of the eye due to muscle positioning with no CN involvement
Define retinopathy of prematurity
<32 weeks or LBW, retina doesn’t fully develop and areas of ischaemia develop, new blood vessels try to grow which causes bleeds and scarring
Give 2 management options for retinopathy of prematurity
- Anti VEGF injections
- Surgery
Give 2 causes of an absent red reflex at a neonatal check
- Retinoblastoma
- Congenital cataracts
