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Medicine Finals > Ophthalmology > Flashcards

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
Q

What are causes of vitreous haemorrhage?

A

Diabetic retinopathy

Posterior vitreous detachment

Ocular trauma

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26
Q

What is posterior vitreous detachment and how does it present?

A

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

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27
Q

What is seen on fundoscopy in posterior vitreous haemorrhage?

A

Weiss ring

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28
Q

How is posterior vitreous detachment treated?

A

No treatment needed

Symptoms will improve over around 6 months

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29
Q

How does retinal detachment present?

A

New onset flashers and floaters

Painless, progressive peripheral vision loss

Curtain/shadow progressing to the centre

Straight lines appear curved

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30
Q

How is retinal detachment treated?

A

Urgent referral to ophthalmology for slit lamp assessment

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31
Q

How does retinal vein occlusion present?

A

Sudden painless loss of vision

Usually unilateral

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32
Q

What are risk factors for retinal vein occlusion?

A

Increasing age

Glaucoma

Polycythaemia

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33
Q

What is seen on fundoscopy in retinal vein occlusion?

A

Severe retinal haemorrhages - flame and blot

Optic disc oedema

Macular oedema

34
Q

In which eye condition is a Weiss ring seen?

A

Posterior vitreous detachment

35
Q

How does central retinal artery occlusion present and how is it seen on fundoscopy?

A

Sudden onset painless loss of vision

Relevant afferent pupillary defect

Central = Pale retina with cherry red spot

BRanch = pale patch on retina

36
Q

Which vasculitis is associated with retinal artery occlusion?

A

Temporal arteritis

37
Q

What is a relevant afferent pupillary defect?

A

Both unaffected and affected pupil constrict when light shone in unaffected eye

However when light shone in affected eye - neither pupil constrict

38
Q

What is the most common cause of retinal artery occlusion?

A

Atherosclerosis

39
Q

What is endopthalmitis and how is it managed?

A

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
Q

What are the two types of squint and what is the difference?

A

Concomitant and paralytic

Concomitant = imbalance of extraocular muscles (common)

Paralytic = paralysis of extra ocular muscles (rare)

41
Q

What is an Argyll-Robertson pupil? Which condition does it present in?

A

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
Q

What is a Holmes Adie pupil?

A

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
Q

What occurs in a third nerve palsy?

A

Ptosis

Dilated pupil (if surgical third nerve palsy)

Down and out

44
Q

What is Horner syndrome?

A

Miosis

Ptosis

Anhidrosis (lack of sweating)

sometimes: Exopthalmos

45
Q

How can you determine the site of the lesion in Horner syndrome?

A

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
Q

What is periorbital cellulitis and how does it present?

A

Infection of the eyelid/skin around the eye

Acute onset

Red, swollen, painful eye

Erythema + oedema of the eyelids

47
Q

What are the most common causative organism of periorbital cellulitis?

A

Staph aureus

48
Q

What is the antibiotic of choice for periorbital cellulitis?

A

Oral co-amoxiclav

Should be started by a specialist - urgent referral to ophthalmology required

49
Q

How can you differentiate between periorbital cellulitis and orbital cellulitis?

A

Head CT with contrast

50
Q

What is orbital cellulitis and how does it present?

A

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
Q

How is orbital cellulitis managed?

A

Urgent referral to ophthalmology

Admission for IV Abx

52
Q

How does conjunctivitis present and how can you differentiate between bacterial, viral and allergic?

A

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
Q

How is bacterial, viral and allergic conjunctivitis treated?

A

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
Q

What is anterior uveitis and how does it present?

A

Acute onset

Ocular pain

Red eye - red ring from the cornea spreading outwards (ciliary flush)

Small, irregular-shaped pupil

Hypopyon

Blurred vision

Photophobia

55
Q

How is anterior uveitis managed?

A

Urgent referral to ophthalmology

For cycloplegics + steroid

(e.g. Cylopentolate + Prednisolone)

56
Q

Which HLA-B27 conditions are associated with anterior uveitis?

A

Ankylosing spondylitis

Reactive arthritis

UC/Crohn’s

Behcet’s

57
Q

Eye presentation: acute onset painful red eye with irregular pupil and hypopyon. What is it and how is it managed?

A

Anterior uveitis

Urgent ophthalmology referral for cycloplegics + steroid

58
Q

What inflammatory conditions are associated with episcleritis and scleritis?

A

Rheumatoid arthritis

SLE

IBD

Sarcoidosis

GPA (Wegener’s)

59
Q

What is the difference between episcleritis and scleritis?

A

Both acute onset red eye

Episcleritis = not painful, segmental red eye (not diffuse)

Scleritis = severe pain, reduced visual acuity, diffuse redness

60
Q

What eyedrops can be given to differentiate episcleritis and scleritis?

A

Phenylephrine drops

If redness improves -> episcleritis

61
Q

How is a corneal abrasion diagnosed?

A

Fluorescin stain shows vertical line defect in corneal epithelium

62
Q

What are the different causes of keratitis?

A

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
Q

How does keratitis present?

A

Painful red eye

Photophobia

Gritty sensation

If herpes keratitis - vesicles around eye

64
Q

How is keratitis managed?

A

Urgent ophthalmology referral

Usually treated with topical quinolone e.g. Ciprofloxacin

Herpes keratitis - topical Aciclovir

65
Q

Which type of keratitis is common in HIV patients? What is seen on fundoscopy? How is it treated?

A
  1. Cytomegalovirus keratitis
  2. Retinal haemorrhages, necrosis. Termed ‘pizza retina’
  3. IV Ganciclovir
66
Q
  1. What is retinitis pigmentosa?
  2. How does it present?
  3. What is seen on fundoscopy?
  4. How is it managed?
A
  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
Q

How is papilloedema seen on fundoscopy?

A

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
Q

What is herpes zoster ophthalmicus? How does it present? How is it managed?

A

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
Q

What is Hutchinson’s sign?

A

Presence of vesicles on tip/side of nose in herpes zoster ophthalmicus

Indicates need for urgent referral

70
Q

What is optic neuritis and what is the most common cause?

A

Inflammation of the optic nerve

Most common cause = multiple sclerosis

71
Q

How does optic neuritis present?

A

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
Q

What is seen on fundoscopy in optic neuritis?

A

Pale optic disc

Optic disc swelling

73
Q

What is seen on fluorescin stain in herpes keratitis?

A

Dendritic corneal ulcer

74
Q

What is the definitive diagnostic test for diagnosing acute angle closure glaucoma?

A

Gonioscopy

75
Q

Which organism most commonly causes keratitis in people who wear contact lenses?

A

Psuedomonas/Acanthamoeba (from water)

76
Q

Causes of absence of red reflex?

A

Cataracts

Retinoblastoma

77
Q

Who should get annual glaucoma screening?

A

Anyone >40 with family history of glaucoma

Diabetics

78
Q

How to investigate primary open angle glaucoma?

A

Gonioscopy
Slit lamp exam
Applanation tonometry

79
Q

How to investigate age related macular degeneration?

A

Amsler grid testing - wavy lines

Fundoscopy

80
Q

Failure to correct a childhood squint - what are they at risk of in the future?

A

Amblyopia

Medicine Finals (32 decks)

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