Ophthalmology Flashcards

1
Q

What is the cause of diabetic retinopathy?

A
  • blood vessels damaged by hyperglycaemia causing damage to the retina
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2
Q

Describe the pathophysiology of diabetic retinopathy

A
  • increased vascular permeability leads to leakage from the blood vessels, causing blot haemorrhages and the formation of hard exudates
  • damage to the blood vessel wall leads to microaneurysms and venous beading
  • damage to nerve fibres in the retina causes fluffy white patches to form on the retina called cotton wool spots
  • intracranial microvascular abnormalities is where there are dilated and tortuous capillaries in the retina. Act as a shunt between the arterial and venous vessels in the retina
  • neovascularisation
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3
Q

What are the different types of retinopathy and how can we classify them?

A
  • non proliferative and proliferative
  • Non-proliferative is microaneurysms, blot haemorrhages, hard exudates and if severe can also have cotton wool spots and venous beading
  • proliferative is when there is also neovascularisation
  • diabetic maculopathy is specifically when the macula is affected
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4
Q

Complications of diabetic retinopathy

A
  • retinal detachment
  • vitreous haemorrhage
  • rebeosis iridis (new blood vessel formation)
  • optic neuropathy
  • cataracts
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5
Q

How is diabetic retinopathy managed?

A
  • laser photocoagulation
  • anti-VEGF (ranibizumab, bevacizumab)
  • vitreoretinal surgery for severe disease
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6
Q

What is uveitis?

A
  • inflammation of the iris and ciliary body and choroid
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7
Q

What causes uveitis?

A
  • infection (e.g. herpes simplex), trauma, ischaemia or malignancy
  • can occur as a manifestation of systemic inflammatory conditions (reactive arthritis, ankylosing spondylitis, inflammatory bowel disease, sarcoidosis)
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8
Q

What associations does uveitis have?

A
  • Anterior is associated with HLA B27 conditions (ankylosing spondylitis, IBD, reactive arthritis)
  • Chronic anterior uveitis (sarcoidosis, syphilis, lyme disease, tuberculosis, herpes virus)
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9
Q

Presenting symptoms of uveitis

A
  • unilateral symptoms
  • may occur with a flare of an associated disease such as reactive arthritis
  • dull, aching, painful red eye
  • ciliary flush
  • reduced visual acuity
  • miosis
  • photophobia
  • pain on movement
  • excessive lacrimation
  • abnormally shaped pupil
  • hypopyon
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10
Q

How should uveitis be managed?

A
  • steroids (oral, topical or IV)
  • cyclopentolate
  • immunosuppressants such as DMARDS or TNF inhibitors
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11
Q

What is scleritis?

A

inflammation of the full thickness of the sclera

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12
Q

What are the associated symptoms of scleritis

A
  • RA
  • SLE
  • IBD
  • sarcoidosis
  • granulomatosis with polyangiitis
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13
Q

How does scleritis present?

A
  • severe pain
  • pain with movement
  • photophobia
  • eye watering
  • reduced visual acuity
  • abnormal pupil reaction to light
  • tenderness to palpation of the eye
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14
Q

How is scleritis managed?

A
  • NSAIDs
  • Steroids
  • Immunosuppression
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15
Q

What are the 3 types of conjunctivitis?

A
  • bacterial
  • viral
  • allergic
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16
Q

How does conjunctivitis present?

A
  • unilateral or bilateral
  • red eyes
  • bloodshot
  • itchy or gritty sensation
  • discharge from the eye
17
Q

Difference between viral and bacterial conjunctivitis?

A

Bacterial = purulent discharge, worse in morning where eyes may be stuck together, starts in one eye and can spread to others

Viral = clear discharge, dry cough, sore throat and blocked nose, preauricular lymph nodes

18
Q

How should conjunctivitis be managed?

A
  • usually resolves without treatment after 1-2 weeks
  • good hygiene
  • stop contacts
  • clean eyes

Bacterial = consider antibiotic eyedrops (chloramphenicol)

Under 1s = urgent review as it can be associated with gonococcal infection

Allergic = antihistamines, topical mast-cell stabilisers

19
Q

Why is neonatal conjunctivitis an urgent issue?

A
  • associated with gonococcal infection and can cause loss of sight and more severe complications such as pneumonia