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Ophthalmology Flashcards

1
Q

What are risk factors for age related macular degeneration?

A

Increasing age

Smoking

Family history

HTN

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2
Q

What are the two types of age related macular degeneration?

A

Dry and wet

Dry = most common

Dry = presence of drusen (yellow round spots)

Wet = more acute, neovascularisation, presents with a sudden deterioration in vision

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3
Q

How does age related macular degeneration present?

A

Gradual worsening of central field loss (Central scotoma)

Reduction of visual acuity (particularly near field objectives)

Difficulty seeing at night

Flashing lights

Distortion of line perception (crooked/wavy appearance)

Difficulty recognising faces

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4
Q

What is seen on fundoscopy in age related macular degeneration?

A

Dry = drusen (yellow areas of pigment deposition)

Wet = red patches (vascularisation)

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5
Q

How can age related macular degeneration be managed?

A

Wet = Intravitreal Anti-VEGF

Avoid smoking

Control BP

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6
Q

What is primary open angle glaucoma and how does it present?

A

Optic nerve damage due to raised intraocular pressure

Peripheral visual field loss –> Tunnel vision

Decreased visual acuity

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7
Q

What are risk factors for primary open angle glaucoma?

A

Increasing age

Family history

Myopia (short-sightedness)

Hypertension

Diabetes

Corticosteroid use

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8
Q

What is seen on fundoscopy in primary open angle glaucoma?

A

Optic disc cupping

Optic disc pallor

Bayoneting of vessels

Cup notching

Disc haemorrhage

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9
Q

How can primary open angle glaucoma be investigated?

A

Applanation tonometry - measures pressure

Slit lamp examination

Fundoscopy

Gonioscopy

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10
Q

How is primary open angle glaucoma managed?

A

1st line = Prostaglandin analogue eye drops (Latanoprost)

2nd line = Beta blocker eye drops (Timolol)

3rd line = Dorzolamide

4th line = Pilocarpine

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11
Q

What are side effects of Latanoprost eyedrops?

A

Brown pigmentation of iris

Increased eyelash length

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12
Q

What are side effects of Pilocarpine eyedrops?

A

Constricted pupil

Headache

Blurred vision

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13
Q

What is acute angle closure glaucoma and how does it present?

A

Aqueous humour can’t drain and intraocular pressure continues to increase - ophthalmological emergency

Acute onset severe pain

Nausea and vomiting

Decreased visual acuity

Hard firm eyeball

Red eye

Fixed dilated pupil

Haloes around light

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14
Q

What are risk factors/triggers for acute angle closure glaucoma?

A

Long sightedness (hypermetropia)

Increasing age

Family history

Female

Medication - noradrenaline, Anticholinergics (e.g. oxybutynin), tricyclic antidepressants

Mydratic drops (dilating drops)

Watching TV in a dark room

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15
Q

What is the emergency management of acute angle closure glaucoma? What is the definitive management?

A

Emergency management

Pilocarpine eyedrops - 2% for blue eyes and 4% for brown eyes

Beta blocker eyedrops - Timolol

IV Acetazolamide

Definitive management= laser peripheral iridotomy of both eyes

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16
Q

Which glaucoma medication increase uveoscleral outflow?

A

Prostaglandin analogue (Latanoprost)

Pilocarpine

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17
Q

Which glaucoma medications reduce aqueous humour production?

A

Beta blockers

Alpha agonists

Acetazolamide/Dorzolamide

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18
Q

What is a cataract and how does it present?

A

Lens of the eye becomes cloudy

Gradual loss of Generalised reduced vision

Faded colour vision

Glare

Haloes around light

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19
Q

What is the key finding in cataracts?

A

Loss of red reflex

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20
Q

How are cataracts managed?

A

Non-surgical = glasses

Surgery if affecting quality of life to replace lens

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21
Q

What are the four types of diabetic retinopathy?

A

Mild non-proliferative = 1 or more microaneurysm

Moderate non-proliferative = microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding

Severe non-proliferative = blot haemorrhages/microaneurysms in 4 quadrants, or venous bleeding in 2 or more quadrants

Proliferative = retinal neovascularisation. this can lead to vitreous haemorrhage.

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22
Q

How is diabetic retinopathy managed?

A

Anti-VEGF intravitreal injections

Panretinal photocoagulation

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23
Q

What are the four stages of hypertensive retinopathy?

A

Stage 1 = arteriolar narrowing, increased light reflex (silver wiring)

Stage 2 = Arteriovenous nipping

Stage 3 = Cotton wool spots, flame haemorrhages, blot haemorrhages

Stage 4 = Papilloedema

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24
Q

What is a vitreous haemorrhage and how does it present?

A

Bleeding into the vitreous humour

Causes a sudden painless loss of vision

Red hue in the vision

Floaters and dark spots

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25
What are causes of vitreous haemorrhage?
Diabetic retinopathy Posterior vitreous detachment Ocular trauma
26
What is posterior vitreous detachment and how does it present?
Separation of the vitreous membrane from the retina RF: Short-sightedness and ageing. Presents with sudden appearance of floaters and flashes Spots of vision loss Blurred vision Weiss ring on Fundoscopy
27
What is seen on fundoscopy in posterior vitreous haemorrhage?
Weiss ring
28
How is posterior vitreous detachment treated?
No treatment needed Symptoms will improve over around 6 months
29
How does retinal detachment present?
New onset flashers and floaters Painless, progressive peripheral vision loss Curtain/shadow progressing to the centre Straight lines appear curved
30
How is retinal detachment treated?
Urgent referral to ophthalmology for slit lamp assessment
31
How does retinal vein occlusion present?
Sudden painless loss of vision Usually unilateral
32
What are risk factors for retinal vein occlusion?
Increasing age Glaucoma Polycythaemia
33
What is seen on fundoscopy in retinal vein occlusion?
Severe retinal haemorrhages - flame and blot Optic disc oedema Macular oedema
34
In which eye condition is a Weiss ring seen?
Posterior vitreous detachment
35
How does central retinal artery occlusion present and how is it seen on fundoscopy?
Sudden onset painless loss of vision Relevant afferent pupillary defect Central = Pale retina with cherry red spot BRanch = pale patch on retina
36
Which vasculitis is associated with retinal artery occlusion?
Temporal arteritis
37
What is a relevant afferent pupillary defect?
Both unaffected and affected pupil constrict when light shone in unaffected eye However when light shone in affected eye - neither pupil constrict
38
What is the most common cause of retinal artery occlusion?
Atherosclerosis
39
What is endopthalmitis and how is it managed?
Inflammation of the interior cavity of the eye, usually caused by infection Complication of intraocular surgery Red eye, pain and vision loss after intraocular surgery Managed with intravitreal vancomycin
40
What are the two types of squint and what is the difference?
Concomitant and paralytic Concomitant = imbalance of extraocular muscles (common) Paralytic = paralysis of extra ocular muscles (rare)
41
What is an Argyll-Robertson pupil? Which condition does it present in?
A pupil which accommodates but does not react Meaning pupil constricts when focusing on a nearby object but does not constrict when exposed to light Specific finding in Neurosyphilis
42
What is a Holmes Adie pupil?
Unilateral dilated pupil Sluggish response to light, and slow to re-dilate Benign condition mostly seen in women Due to damage to post-ganglionic parasympathetic fibres
43
What occurs in a third nerve palsy?
Ptosis Dilated pupil (if surgical third nerve palsy) Down and out
44
What is Horner syndrome?
Miosis Ptosis Anhidrosis (lack of sweating) sometimes: Exopthalmos
45
How can you determine the site of the lesion in Horner syndrome?
Look at the location of the anhidrosis Face+arm+trunk = central lesion -> stroke, syringomyelia, multiple sclerosis Face only = pre-ganglionic lesion -> thyroidectomy, trauma, pancoast tumour NO Anhidrosis = post-ganglionic lesion -> carotid artery dissection, carotid aneurysm, cluster headache
46
What is periorbital cellulitis and how does it present?
Infection of the eyelid/skin around the eye Acute onset Red, swollen, painful eye Erythema + oedema of the eyelids
47
What are the most common causative organism of periorbital cellulitis?
Staph aureus
48
What is the antibiotic of choice for periorbital cellulitis?
Oral co-amoxiclav Should be started by a specialist - urgent referral to ophthalmology required
49
How can you differentiate between periorbital cellulitis and orbital cellulitis?
Head CT with contrast
50
What is orbital cellulitis and how does it present?
Infection of the orbit Usually due to a spreading URTI Redness and swelling around the eye Severe ocular pain Visual disturbance Exophthalmos (bulging of globe) Pain on eye movement
51
How is orbital cellulitis managed?
Urgent referral to ophthalmology Admission for IV Abx
52
How does conjunctivitis present and how can you differentiate between bacterial, viral and allergic?
Red bloodshot eyes Itchy/gritty sensation Discharge from the eye No pain If discharge is purulent - think bacterial, if discharge is clear think viral. In viral conjunctivitis - will often be other signs of a viral URTI Allergic - bilateral, may be seasonal, history of atopy
53
How is bacterial, viral and allergic conjunctivitis treated?
Viral = no treatment needed Bacterial = Chloramphenicol eye drops / Chloramphenicol ointment / Fusidic acid eye drops. If infant less than 1 year of age = referral to paeds Allergic = topical/systemic antihistamines
54
What is anterior uveitis and how does it present?
Acute onset Ocular pain Red eye - red ring from the cornea spreading outwards (ciliary flush) Small, irregular-shaped pupil Hypopyon Blurred vision Photophobia
55
How is anterior uveitis managed?
Urgent referral to ophthalmology For cycloplegics + steroid (e.g. Cylopentolate + Prednisolone)
56
Which HLA-B27 conditions are associated with anterior uveitis?
Ankylosing spondylitis Reactive arthritis UC/Crohn's Behcet's
57
Eye presentation: acute onset painful red eye with irregular pupil and hypopyon. What is it and how is it managed?
Anterior uveitis Urgent ophthalmology referral for cycloplegics + steroid
58
What inflammatory conditions are associated with episcleritis and scleritis?
Rheumatoid arthritis SLE IBD Sarcoidosis GPA (Wegener's)
59
What is the difference between episcleritis and scleritis?
Both acute onset red eye Episcleritis = not painful, segmental red eye (not diffuse) Scleritis = severe pain, reduced visual acuity, diffuse redness
60
What eyedrops can be given to differentiate episcleritis and scleritis?
Phenylephrine drops If redness improves -> episcleritis
61
How is a corneal abrasion diagnosed?
Fluorescin stain shows vertical line defect in corneal epithelium
62
What are the different causes of keratitis?
Bacterial - usually staph aureus but in contact lens wearers, pseudomonas Acanthamoebic keratitis in swimmers (esp if wearing contact lenses) Can also be viral - herpes keratitis (treated w/ oral Aciclovir)
63
How does keratitis present?
Painful red eye Photophobia Gritty sensation If herpes keratitis - vesicles around eye
64
How is keratitis managed?
Urgent ophthalmology referral Usually treated with topical quinolone e.g. Ciprofloxacin Herpes keratitis - topical Aciclovir
65
Which type of keratitis is common in HIV patients? What is seen on fundoscopy? How is it treated?
1. Cytomegalovirus keratitis 2. Retinal haemorrhages, necrosis. Termed 'pizza retina' 3. IV Ganciclovir
66
1. What is retinitis pigmentosa? 2. How does it present? 3. What is seen on fundoscopy? 4. How is it managed?
1. Congenital inherited condition causing degeneration of the rods and cones in the retina 2. first symptom = night blindness, also loss of peripheral vision 3. Bone-spicule pigmentation 4. Ophthalmology referral
67
How is papilloedema seen on fundoscopy?
Venous engorgement Loss of venous pulsation Blurring of optic disc margins Elevation of optic disc Loss of optic cup Paton’s lines - concentric/radial retinal lines
68
What is herpes zoster ophthalmicus? How does it present? How is it managed?
Reactivation of the varicella zoster virus in the ophthalmic division of the trigeminal nerve Vesicular rash around eye Hutchinson's sign - Rash on the tip/side of nose -> risk factor for ocular involvement -> urgent ophthalmology referral needed If no indication of ocular involvement - oral aciclovir
69
What is Hutchinson's sign?
Presence of vesicles on tip/side of nose in herpes zoster ophthalmicus Indicates need for urgent referral
70
What is optic neuritis and what is the most common cause?
Inflammation of the optic nerve Most common cause = multiple sclerosis
71
How does optic neuritis present?
Visual loss Poor discrimination of colours - esp. red desaturation Central scotoma - blind spot in line of sight Relative afferent pupillary defect Periocular pain Pain on eye movement Optic disc swelling
72
What is seen on fundoscopy in optic neuritis?
Pale optic disc Optic disc swelling
73
What is seen on fluorescin stain in herpes keratitis?
Dendritic corneal ulcer
74
What is the definitive diagnostic test for diagnosing acute angle closure glaucoma?
Gonioscopy
75
Which organism most commonly causes keratitis in people who wear contact lenses?
Psuedomonas/Acanthamoeba (from water)
76
Causes of absence of red reflex?
Cataracts | Retinoblastoma
77
Who should get annual glaucoma screening?
Anyone >40 with family history of glaucoma | Diabetics
78
How to investigate primary open angle glaucoma?
Gonioscopy Slit lamp exam Applanation tonometry
79
How to investigate age related macular degeneration?
Amsler grid testing - wavy lines | Fundoscopy
80
Failure to correct a childhood squint - what are they at risk of in the future?
Amblyopia

Medicine Finals (32 decks)

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