Ophthalmology Flashcards
Optic disc cupping associated with what?
Open angle glaucoma?
What ocular manifestations of RA are there?
keratoconjunctivitis sicca (most common) episcleritis (erythema) scleritis (erythema and pain) corneal ulceration keratitis
Presenting features of retinitis pigmentosa?
Night blindness is often the initial sign
Tunnel vision
fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
How does holmes-aide pupil present?
Unilateral dilated pupil
Slowly reactive to accommodation and light
Holmes-aide pupil prognosis?
Benign
When should you prescribe topical abx for someone with a stye?
if conjunctivitis
Difference in administering phenylephrine or neosynephrine eye drops in scleritis and episcleritis
Blanch in episcleritis
Pain in scleritis or episcleritis?
Pain in scleritis not episcleritis
Typical presentation for open angle glaucoma?
Typically through routine IOP measurement.
What IOP needs to be measured for diagnosis of glaucoma?
> 24
Medical management of glaucoma - and the adverse effects of these meds?
prostaglandin analogue (PGA) eyedrop (latanoprost)
second line: beta-blocker (Timolol), carbonic anhydrase inhibitor (dorzolamide), or sympathomimetic eyedrop (Bimonidine)
if more advanced: surgery or laser treatment can be tried
Prostaglandin analogues (e.g. latanoprost) - Adverse effects include brown pigmentation of the iris, increased eyelash length
Beta-blockers (e.g. timolol, betaxolol)
- Should be avoided in asthmatics and patients with heart block
Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
- Avoid if taking MAOI or tricyclic antidepressants
- Adverse effects include hyperaemia
Carbonic anhydrase inhibitors (e.g. Dorzolamide)
- Systemic absorption may cause sulphonamide-like reactions
Miotics (e.g. pilocarpine, a muscarinic receptor agonist)
- Adverse effects included a constricted pupil, headache and blurred vision
How does acute angle closure glaucoma present?
Characterised by ocular pain, decreased visual acuity, worse with mydriasis (such as in the cinema), haloes around lights. It can also present with a systemic upset.
Definitive management for Acute angle closure glaucoma?
laser peripheral iridotomy
- creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle
Causes of RAPD?
retina issues - e.g. detachment, artery occulusion, infection
optic nerve e.g. optic neuritis, direct trauma, glaucoma
Dry eye associated with what finding on fluorescein staining?
Punctate
On examination of eyes in adenoviral conjunctivitis would would you expect to see?
Conjunctival follicles and chemosis (swelling)
How does argyll robertson pupil present?
Small, non reactive pupils (bilateral) to light. (will react to accommodation)
Management of anterior uveitis?
Refer to ophthal
steroid drops + mydriatic (dilating) drops e.g. Atropine, cyclopentolate
Management of allergic conjunctivitis?
first-line: topical or systemic antihistamines
second-line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
Signs of macular degen on examination?
distortion of line perception may be noted on Amsler grid testing
fundoscopy reveals the presence of drusen, yellow areas of pigment deposition in the macular area, which may become confluent in late disease to form a macular scar.
in wet ARMD well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage.
Preauricular lymph nodes in opthal question?
Viral aetiology
Preauricular lymph nodes in opthal question?
Viral aetiology
Most common cause of argyll robertson pupil in UK?
Diabetes
Most common cause of argyll robertson pupil in UK?
Diabetes
Painless, monocular loss of vision in Marfan’s syndrome?
Lens dislocation
Most common causes of sudden painless visual loss?
ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine
Difference in third nerve palsy and horners?
Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner’s
Do you give topical pain relief for corneal abrasions?
No - it delays healing
Difference in chalazion and internal stye?
Chalazion - blocked meibonian gland.
- painless swellign of upper eyelid
Stye - infected gland - painful
Management of blepharitis?
Hot compresses and hygeine
If doesn’t work could try chloramphenicol drops
Anti-VEGF for dry or wet AMD
Wet
How quick referral if worried about AMD?
within 1 week
Fundoscopy findings of central retinal vein occlusion?
haemorrhages
Blurring of vision again years after cataract surgery?
Posterior capsule opacification
Treatment for corneal abrasion?
Topical antibiotic
treatment for zoster ophthalmicus?
Oral aciclovir
Presentation of posterior vitreous detachment?
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
Difference in zoster ophthalmicus and herpes simplex keratitis?
zoster ophthalmicus
- vesicular rash around the eye, which may or may not involve the actual eye itself
- Hutchinson’s sign
- Use oral aciclovir
Simplex keratitis:
- red, painful eye
- photophobia
- visual acuity may be decreased
- fluorescein staining may show an epithelial ulcer - feathery/dendritic
Most common ocular manifestation of RA?
keratoconjunctivitis sicca
Intermittent squint in newborns less than 3 months?
No need to worry normal
Hypertensive retinopathy stages?
I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II Arteriovenous nipping
III Cotton-wool exudates
Flame and blot haemorrhages
IV Papilloedema
Management of scleritis?
Urgent ophthal referral
Bacterial conjunctivitis treatment in pregnant women?
Topical fusidic acid
Stages of diabetic retinopathy?
Mild NPDR
1 or more microaneurysm
Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots ('soft exudates' - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
Proliferative diabetic retinopathy
Key features
retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM, 50% blind in 5 years
Maculopathy
Key features
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM
