Ophthalmology Flashcards
1
Q
Features of anterior uveitis (6)
A
Anterior uveitis = iritis = iridocyclitis
- acute onset
- irregular pupil
- photophobia
- red eye
- lacrimation
- flares and cells in anterior chamber
2
Q
Associates conditions to anterior uveitis (4)
A
Ankylosing spondylitis
Reactive arthritis
Ulcerative colitis
Crohn’s disease
3
Q
What eye condition is associated with rheumatoid arthritis?
A
Scleritis
4
Q
Management of anterior uveitis
A
Urgent ophthal review
1.Cycloplegics - cyclopentate
=dilates pupil to prevent adhesion between lens and iris
= relieves pain and photophobia
2.prednisolone drops - reduce inflammation
Atropine
5
Q
Anterior uveitis vs acute angle closure glaucoma (AACG)
A
AU = marked photophobia Cells + flares in anterior chamber Irregular* pupil - distorted , sluggish reaction Variable IOP Keratitis precipitates on cornea
AACG = Mild photophobia, shallow anterior chamber w/ hard globe on palpating Fixed semi-dilated oval pupil High IOP Hazy/cloudy dull cornea Nausea + vomiting +**dark room.
6
Q
Treatment of AACG
A
Pilocarpine Acetazolamide Beta blockers - timolol Steroids Analgesics Antiemetic Surgery - peripheral iridotomy
7
Q
Stages of diabetic retinopathy
A
- Non proliferative
- Pre proliferative
- Proliferative
8
Q
Non proliferative retinopathy features
A
Dots + blots + hard exudates
9
Q
Pre - proliferative retinopathy features
A
Dots + blots + hard exudates + cotton wool spots *
10
Q
Proliferative retinopathy features
A
Dots+ blots + hard exudates + Cotton wool spots
+ neovascularisation**
11
Q
Treatment of proliferative retinopathy
A
Laser photo coagulation
12
Q
Hypertensive retinopathy on fundoscopy
A
Macular oedema + hard exudates + dots + blots
AV nipping + copper/silver wiring +flame shaped haemorrhage
13
Q
Management of hypertensive retinopathy
A
Control HTN
14
Q
What eye condition is associated to multiple sclerosis
A
Optic neuritis
15
Q
Features of optic neuritis
A
Swollen pale optic disc
Eye pain esp on movement
Reduced vision
Reduced colour vision * RED first
16
Q
Affected structure in optic neuritis
Management
A
Optic nerve
Corticosteroids
17
Q
Management of multiple sclerosis
Acute
Long term
A
Acute = initial methyl pred oral or IV
Long term = Glatiramer acetate or interferon beta
18
Q
Central retinal artery occlusion CRAO
Features
A
CRA - branch of ophthalmic - branch of Internal carotid a.
Sudden painless unilateral loss of vision
Fundo - pale/white retinue + cherry red spot at macula + vessel attenuation
19
Q
Treatment of CRAO
A
<100 mins of symptoms = firm ocular massage to dislodge occlusion
+ refer
20
Q
CRAO is associated with?
A
Giant cell arteritis / temporal arteritis
21
Q
CRVO features
A
Sudden painless loss of vision
Hemorrhagic retina - flame shaped
Swollen macula
Engorged tortuous veins
22
Q
RF for cataracts
A
High myopia
Long term ORAL steroid use - asthma , COPD, RA, DM
Significant exposure to UV light
Eye trauma
23
Q
Features of cataracts
A
Glare at night - lights appear brighter
Dazzling halos
Frequent change of glasses - refraction changes
24
Q
Fundoscopy of cataract
A
Dense opacities - cloudy lens
25
Features of viral conjunctivitis
Commonest organism
Treatment
Redness , no pain
No discharge or serous discharge
Commonly after URTI
Adenovirus
Reassure + supportive (artificial tears)
26
Treatment of bacterial conjunctivitis
Self care , clean
```
If longer than week - topical antibiotics = chloramphenicol drops
Fusidic acid ( choice for pregnant women )
```
27
Features + Treatment of allergic conjunctivitis
Bilateral redness + chemo sis + itching
Swollen eyelids/conjuctiva
Topical antihistamines
28
Transient loss of vision , sudden + painless
“Curtain falling down”
Dx?
Amaurosis fugax - transient occlusion of central retinal a.
Resolves in 5-30 mins
29
Sudden painless loss of vision + curtain fall + grey opaque retina ballooning forwards
Dx?
Tx?
Retinal detachment
- flashers. Floaters , visual field loss
Tx - scleral buckling.
Tilt head backwards , surgical/mechanical reattachment
30
Night blindness + peripheral vision loss (tunnel vision)
Hereditary
Dx?
Next step?
Retinitis pigmentosa - X linked
Referral (routine) to ophthalmologist
- progressive - eventually ends in central blindness
31
HIV + visual deterioration + retinal haemorrhage and white -yellow **exudates
Dx?
CMV retinitis
32
Treatment of orbital cellulitis
Admit
| IV antibiotics
33
What nerve is involved in herpes zoster ophthalmicus
Trigeminal (5) - ophthalmic branch
34
Features of herpes zoster ophthalmicus
Treatment
Complications
Conjunctivitis + keratitis
Pain around eye + painful vesicles/rash
Acyclovir
C- keratitis - dendritic corneal ulcer = treat with topical acyclovir
35
Fundoscopy findings of retinitis pigmentosa
Black bone spicule shaped pigmentation
| Mottling of retinal pigment epithelium
36
What is papilloedema?
Causes
First sign
Optic disc swelling caused by raised ICP
Almost always bilateral
Space occupying lesions , malignant HTN
1st sign = venous engorgement
37
Affected part in papilloedema
Optic DISC
38
Risk factors of retinal detachment
Myopia
Extraction of cataracts surgically
History of trauma
39
Opportunistic infections in HIV positive
CD4 > 200
(4)
Thrush - Candida albicans
Shingles - herpes zoster
Hairy leukoplakia - EBV
Kaposi sarcoma - HHV-8 human herpes virus 9
40
Opportunistic infections in HIV positive
CD4 <200 cells/mm3
(4)
Pneumocystis jirovecii (Carini) pneumonia
Cerebral toxoplasmosis
Oesophageal candidiasis - C. Albicans
CMV retinitis - esp if CD4 < 50
41
Subconjunctival hemorrhage
Features
Management
No symptoms
Small bleed - spontaneous or post trauma
Check BP. - R/O systemic HTN
if on anticoagulant - check INR
If spontaneous, no trauma = reassure
42
Eye signs of graves
| Most appropriate investigation
```
Lid lag
Lid retraction
Exophthalmos
Diplopoda
Ophtlamoplegia
```
TFT!
43
3rd nerve palsy features
| Investigation of choice
Diplopoda
Ptosis
Mydriasis - fixed dilated pupil
Out + down deviation
Ct angio
44
What is a Marcus Gunn pupil
RAPD - relative afferent pupillary defect
Caused by lesion *anterior to optic chiasm* e.g. optic n, retina
Light to intact eye = both constrict
Light to affected eye - both dilate
45
Cause of RAPD
Retinal detachment
| Optic neuritis
46
Optic neuritis with RAPD
| Type of visual field loss?
Monocular visual field loss
(Also seen in amaurosis fugax)
**usually optic neuritis associated with central scotoma
47
Where is central scotoma seen?
Optic neuritis
| Macular degeneration
48
Vision loss in acromegaly and pituitary adenoma
Bitemporal hemianopia
49
What kind of halos are seen in AACG
Coloured halos
50
Schirmers test < 10 mm
Dx?
Tx?
Keratoconjunctivitis sicca
| Artificial tears - hypromellose /NaCl / sodium hyaluroanate
51
Treatment of acute dacryocystitis
Systemic antibiotics
| IV if there’s associated periorbital cellulitis
52
CRAO vs BRAO
CRAO - complete loss of vision + other features
BRAO - no complete loss of vision , areas of loss correspond with affected branch
Fundoscopy - wedge shaped area of pallor, rest of retina spared
Treatment for BOTH is firm ocular massa
53
Cause of glaucoma
| Risk factors
Impaired aqueous outflow - increased IOP
RF - hypermetropia + pupillary dilatation
54
Medical management of Glaucoma (AACG)
IV acetazolamide - reduces aqueous secretions
Pilocarpine - pupillary constrictions
Beta blocker (timolol)
, steroids , analagesia
Once stable — refer urgently to ophthalmologist
55
Surgical management of AACG
Peripheral iridotomy
| Surgical iridectomy
56
Management of cluster headache
Acute phase
Prophylaxis
Acute phase - 100% Oxygen 10 -20 mins
Sumatriptan - nasal or subcutaneous
If 1st time - refer to specialist for CT to r/o other ddx
P- verapamil (calcium channel blocker)
57
Preseptal vs orbital cellulitis
Preseptal - no reduced VA, proptosis to ophthalmoplegia/pain with eye movements
58
Ddx for seeing halos
Cataract - dazzling halos
| AACG - coloured halos
59
Commonest eye association in rheumatoid arthritis
Keratoconjunctivitis sicca
60
What happens when the following nerves are affected
| 3rd, 4th, 6th
3rd - occulomotor
Same side - dilated pupils +ptosis
4th - trochlear
Opp Side, Diplopia on downgaze
6th - Abducens
Same side - diplopia later gaze
61
Progressive decrease in VA + peripheral field vision in elderly short sighted person
Dx?
Open angle glaucoma
62
Features of open angle glaucoma (7)
```
Nasal scotoma - Tunnel vision
Decreased VA
Optic disk cupping **
>60
Family Hx +black people + myopia
```
63
What can myopia cause?
Open angle glaucoma
Cataract
Retinal detachment
64
What can hypermetropia cause ?
AACG
65
Name the degenerative corneal diseases
```
Kill The Blue Parrot
K - keratoconus
T- terrier marginal degeneration
B- band keratopathy
P- pellucid marginal degeneration
```
66
What is mooren’s ulcer
| Management
Painful peripheral corneal ulceration + absence of scleritis/ systemic autoimmune disorder
Progressive in nature
Tx - topical corticosteroid , conjunctival resection
67
D- shaped pupil seen in
Iridodialysis
68
Management of chalazion
Most resolve spontaneously
Warm compress
If after 4 weeks conservative management it is still present
= refer to ophthalmologist
69
What ocular side effects do citalopram citalopram and fluoxetine have?
AACG
Citalopram - SSRI
TCA - clomipramine
70
What is Ramsay hunt syndrome?
Features
Treatment
Herpes zoster oticus
- reactivation of VZV in geniculate ganglion of *facial* nerve
== ipsilateral facial palsy, loss of taste
- otalgia - 1st symptom, painful rash on auditory canal
Oral acyclovir + corticosteroids + amitriptyline
71
Most common bacteria causing orbital cellulitis
Streptococcus
Staph aureus
HiB
72
What is Charles bonnet syndrome?
| Initial investigation
```
Visual hallucinations (only visual) - not real
- caused by failing eyesight
```
Slit lamp exam
73
What are the 2 types of hallucination in Charles bonnet syndrome
1. Simple repeated patterns - grids, shapes, lines
2. Complex images of people object and landscapes
Last for few minutes
74
Left homonymous hemianopia
| Where is the lesion?
Right optic tract
75
Homonymous quadrantopias
| Lesions
PITS
Parietal- inferior, temporal-superior
```
Superior = inferior optic radiations in Meyers loop (temporal lobe)
Inferior = superior optic radiations in parietal lobe
```
76
Incongruous defects - lesion is on
Optic tract
Incongruous defect = incomplete or asymmetrical visual field loss
77
Congruous defect - lesion is on
Optic radiation or occipital cortex
Congruous defect = complete or symmetrical visual field loss
78
Macula sparing homonymous hemianopia
| Lesion is -
On the occipital cortex
79
Bitemporal hemianopia is a lesion on
Optic chiasm
If upper > lower defect - inferior chiasm compression - pituitary tumour
If lower > upper - superior chiasm - craniopharyngioma
80
Most common cause of blindness in the uk
| Features (6)
Age related macular degeneration (irreversible)
>70 mostly
Loss or visual disturbance - night mostly
Loss of contrast vision
Difficulty recognising faces
Micropsia - objects appear smaller
Metamorphopsia- straight lines appear wavy
81
Key feature of Age related macular degeneration
Degeneration of the central retina (macula)
Changes are usually bilateral
Degeneration of retinal photoreceptors — drusen formation (seen on fundoscopy)
82
Initial investigation for age related macular degeneration
Slit lamp
| Colour fundus photography - to provide baseline for comparison
83
Traditional 2 types of macular degeneration
1. Dry = 90% — geographic atrophy -DRUSEN (yellow round spots in bruch’s membrane)
2. Wet = 10% - exudative, neovascular
- choroid also neovascularisation
- serous fluid + blood leakage — rapid loss of vision - worst prognosis
84
Updated 2 types of age related macular degeneration
1. Early — non exudative
= drusen and alterations to retinal pigment epithelium
2. Late - exudative, neovascularisation
85
What do you if tip of nose is involved in herpes zoster ophthalmicus?
What is it called?
+ve Hutchinson sign
Occurs in immunosuppressed , immunocompromised
Admit for IV acyclovir
86
Dendritic ulcers on cornea sen on fluorescein dye
| Dx?
HSV keratitis
