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AA Y4 Finals cards NE > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Why are topical steroids contraindicated in dendritic ulcers secondary to herpetic infection?

A

They may lead to localised immunosuppression and subsequent enlargement of the ulcer

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2
Q

In macular degeneration, what does the onset of metamorphopsia suggest?

A

Suggests that dry ARMD is progressing to wet MD

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3
Q

What are the differences in trabeculectomies and iridotomies?

A

Trabeculectomies are indicated for patients with raised IOP

Iridotomies are indicated in patients who are at risk of acute angle closure glaucomas

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4
Q

Which nerve palsy causes eye to appear “down and out, ptosis and dilated pupil”

What is the most common underling cause of this palsy?

A

3rd (oculomotor) nerve palsy

Most commonly a result of aneurysm

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5
Q

Which nerve palsy causes eye to “look in and not be able to abduct”

What is a common underlying cause of the palsy?

A

CN6 (abducens) nerve palsy

Increased ICP

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6
Q

Which palsy results in patients sitting with their head tilted, diplopia on looking downwards and an “up and out pupil”

What is the most common cause of this nerve palsy?

A

CN 4 (Trochlear) nerve palsy

Most commonly due to congenital abnormalities or trauma

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7
Q

Which nerve innervates the orbicularis oculi muscle and therefore the efferent limb of the corneal/blink reflex?

A

CN 7 (facial)

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8
Q

Is pilocarpine a miotic or mydratic drug?

A

Miotic (it causes pupillary constriction)

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9
Q

Is tropicamide a miotic or mydratic drug?

A

mydratic drug (causes pupillary dilation)

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10
Q

Which CN is most at risk of compression or stretch due to raised ICP?

A

CN 6 - it is the longest cranial nerve, which makes it most susceptible

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11
Q

How is a subconjunctival haemorrhage managed?

A

No active management, self limiting

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12
Q

What ocular symptoms are caused by a subconjunctival haemorrhage

A

Painless

No ocular symptoms other than red eye

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13
Q

Differentiate anterior and posterior blepharitis based on causative factors

A

Anterior: usually caused by staph aureus

Posterior: strongly associated with acne rosacea

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14
Q

How is blepharitis treated?

A

Hot compress twice daily

Artificial tears for those with dry eyes

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15
Q

What is the main cause of red eye

A

Conjunctivitis

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16
Q

How can herpes zoster and herpes simplex be differentiated as causatives of viral conjunctivitis?

A

Herpes zoster: presents with ophthalmic shingles

Herpes simplex: usually unilateral with a risk of a corneal ulcer

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17
Q

What causative is likely to be responsible in bacterial conjunctivitis in those who wear contact lenses?

A

Pseudomonas

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18
Q

1st line treatment for bacterial conjunctivitis?

A

Chloramphenicol

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19
Q

Name 2 potential side effects of chloramphenicol?

A
  1. Aplastic anaemia

2. Grey baby syndrome

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20
Q

What cause of red eye presents with severe needle like pain, photophobia, reduced visual acuity, profuse lacrimination and a foreign body sensation?

A

Keratitis (a corneal ulcer)

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21
Q

In cases of keratitis, what underlying cause must you rule out initially, before treatment? Why?

A

HSV causing a dendritic ulcer

If you treat this with topical steroids, it will progress to infection and corneal melting

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22
Q

Which 2 antibiotics can be given in bacterial keratitis?

A
  1. topical ofloxacin

2. topical gentamicin

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23
Q

Which cause of red eye is associated with HLA B27 gene

A

Anterior uveitis (iritis)

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24
Q

In addition to pain, red eye and photophobia, which cause of red eye has a dull ache that is worse on reading and a visual acuity that deteriorates from initially normal to impaired?

A

Anterior uveitis

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25
Q

Name 3 clinical signs found on examination in anterior uveitis

A
  1. Hyponypon
  2. Hazy anterior chamber
  3. Synechiae - an irregular shaped pupil (small and oval)
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26
Q

How is anterior uveitis managed?

A
  1. Steroids - reduce inflammation

2. pupil dilation - reduce pressure and pain on the eye

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27
Q

What is the most common cause of gradual visual loss worldwide?

A

Posterior uveitis (chorioretinits )

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28
Q

Name the 3 causes of chorioretinits?

A
  1. Viral - CMV (seen in HIV)
  2. Protozoal - Toxoplasmosis Gondii
  3. Worms: toxocara
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29
Q

In addition to red eye, photophobia and pain, which underlying cause also presents with floaters?

A

Chorioretinits (posterior uveitis)

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30
Q

Compare the underlying pathology of episcleritis and scleritis

A

Episcleritis - not associated with any serious underlying pathology

Scleritis - usually associated with a connective tissue disease/ autoimmune disease

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31
Q

Which is more common? Episcleritis or scleritis?

A

Episcleritis is more common

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32
Q

Which rheum condition is episcleritis linked with?

A

Gout

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33
Q

What key clinical test allows episcleritis to be differentiated from scleritis?

A

Episcleritis - blanching of blood vessels with phenylepinephrine

Scleritis - NO BLANCHING of blood vessels with phenylepinephrine

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34
Q

Compare the pain felt in episcleritis v scleritis

A

Episcleritis: mild discomfort rather than pain

Scleritis: severe pain that would wake you from sleep

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35
Q

Describe the changes in vision and acuity in episcleritis and scleritis

A

Episcleritis: no change in vision and acuity

Scleritis: gradually reduced vision

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36
Q

Out of scleritis an episcleritis, which is associated with uveitis?

A

Scleritis

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37
Q

Which area is inflamed in anterior uveitis?

A

The cilliary body and iris

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38
Q

How is scleritis managed?

A
  1. Investigate for underlying cause
  2. Oral steroids
  3. Oral NSAIDs
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39
Q

What is the name for sight threatening infection of the interior eye?

A

Endophthalmitis

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40
Q

When does endophthalmitis usually occur?

A

After a penetrating trauma or surgery (esp cataract)

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41
Q

What are the 2 main causatives in endophthalmitis?

A
  1. Propionibacterium

2. Skin commensals (staph epidermidis)

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42
Q

Describe the presentation of endophthalmitis?

A

Intense red eye
Severe pain
Loss of vision
Post intraocular surgery

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43
Q

Which intravitreal antibiotics are used to treat endophthalmitis?

A
  1. Amikacin

2. Vancomycin

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44
Q

Where does orbital cellulitis develop

A

Behind the orbital septum

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45
Q

What are 2 common causatives of orbital cellulitis?

A

Strep pneumonia

Staph Aureus

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46
Q

Describe the ocular symptoms seen in orbital cellulitis?

A
  1. Proptosis
  2. Reduced vision
  3. Reduced eye movements (Othalmoplegia)
  4. Painful eye movements
  5. Fever/malaise
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47
Q

How is orbital cellulitis investigated?

A

CT sinus and orbit

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48
Q

How is orbital cellulitis managed?

A
  1. Urgent admission to ENT/opthalmology
  2. IV ceftriaxone, fluclox, metronidazole 10-14 days
  3. +/- surgical drainage of abscess
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49
Q

How can peri-orbital cellulitis be differentiated from orbital cellulitis?

A

Peri-orbital cellulitis has:

  1. No proptosis
  2. No reduction in vision
  3. No opthalmaplegia or pain on eye movement
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50
Q

How does peri-orbital cellulitis present?

A

Present with acute swollen, painful red eye and an associated fever

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51
Q

How does diagnosis and management of peri-orbital cellulitis compare to orbital cellulitis?

A

Diagnosis- also by CT sinus and orbit

Tx - Co-amoxiclav 7-10 days

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52
Q

Which 3 causes of sudden vision loss present with a +ive RAPD

(relative afferent pupil defect)

A
  1. Central retinal artery occlusion
  2. Optic neuritis
  3. Retinal detachment
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53
Q

Which causes of sudden vision loss present as painful?

A
  1. Optic neuritis
  2. GCA
  3. Acute angle closure glaucoma
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54
Q

Does sudden visual loss usually occur unilaterally or bilaterally?

A

Sudden visual loss occurs unilaterally

Gradual vision loss more commonly presents bilaterally

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55
Q

Describe how the blood supply to the eye differs from the retina?

A

The eye is supplied by the ophthalmic artery

The retina is supplied by the retinal artery

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56
Q

Name 4 causes of CRAO?

A
  1. Giant cell arteritis
  2. Arteriosclerosis (VTE)
  3. Emboli - due to carotid artery disease
  4. Occlusion of the central artery of the retina
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57
Q

Which cause of sudden, painless visual loss presents with a cherry red spot on the macula?

A

Central retinal artery occlusion

The rest of the retina is pale and oedematous with thread like vessels

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58
Q

What is the likely diagnosis in a patient who presents with sudden, painless, unilateral vision loss?

A

Central retinal artery occlusion

59
Q

How is a CRAO managed?

A

> 12 hours: nothing

<12 hours: ocular massage to convert central branch occlusion to branch occlusion
IV acetazolamide

60
Q

What is amaurosis fugax?

A

Essentially a TIA of the eye. There is transient blockage of the retinal artery

“A curtain coming down over the eye that lasts for less than 5 minutes.”

61
Q

How does a CRVO compare to a CRAO?

A

Findings specific to CRVO:

  1. Swollen optic disk
  2. Retinal flame haemorrhages - “stormy sunset”
  3. Dilated tortuous veins
  4. Metamorphopsia
62
Q

What is more common? CRAO or CRVO?

A

CRVO tends to be more common

63
Q

How is CRVO managed?

A

Observe and allow time to heal

If there is ischemia, give anti-VEGF

64
Q

What is the underlying cause of arteritic ischemic optic neuropathy?

A

Giant cell arteritis

65
Q

In addition to sudden, profound vision loss, what else does arteritic ION present with?

A
  1. Jaw claudication
  2. Headache
  3. Scalp tenderness
  4. Absent temporal pulse
66
Q

Describe broadly ischemic optic neuropathy

A

Disease of the blood vessels of the optic disk which cause sudden and profound vision loss

67
Q

Is visual loss in arteritic ION reversible?

A

No - it’s an irreversible cause of vision loss

It is treated with prednisolone to try and prevent loss of vision in the other eye

68
Q

How is arteritic ION investigated?

A

Bloods - ESR

Temporal artery biopsy

69
Q

How does the underlying aetiology of non-arteritic ION differ from arteritic?

A

Non-arteritic ION is due to atherosclerosis of the blood vessels supplying the optic disk

70
Q

Describe the 2 ways in which bleeding occurs in vitreous haemorrhage?

A
  1. Retinal tears

2. Neovascularisation (weak vessels grow in response to ischemia)

71
Q

Other than the sudden and painless loss of vision, what 4 findings help identify vitreous haemorrhage?

A
  1. Presence of flashing and floaters
  2. Loss of red reflex
  3. Red hue to vision
  4. No RAPD
72
Q

How is vitreous haemorrhage managed?

A

Observe and allow to heal

If there are signs of neovascularisation:

  • treat underlying cause
  • anti-VEGF injections
73
Q

Retinal detachments are more likely to occur in people with which sight defect?

A

Short sighted people (myopia)

74
Q

Which cause of sudden painless vision loss can be described as “a curtain coming down over the eye”

A

Retinal detachment

75
Q

Whats the prognosis like for retinal detachment?

A

Good prognosis - vision usually returns as long as the macula hasn’t detached

76
Q

What is optic neuritis

A

Inflammation of the optic disk

77
Q

What is the primary cause of optic neuritis?

What are other common causes?

A

Multiple Sclerosis

Other: diabetes, syphilis

78
Q

Which cause of vision loss presents with:

  • variable unilateral vision loss over a few days
  • painful eye movements and a dull ache behind the eye
A

Optic neuritis

79
Q

How is visual acuity affected in optic neuritis?

A
  1. Central scotoma

2. Reduced colour vision - especially red desaturation

80
Q

Describe 3 things found O/E in optic neuritis

A
  1. RAPD
  2. Central scotoma/ enlarged blind spot
  3. Swollen optic disk
81
Q

How is optic neuritis managed?

A
  1. Investigate for multiple sclerosis
  2. Self- resolving mostly

Oral steroids may actually worsen the outcome

82
Q

What is the most common cause of blindness in the UK?

A

Dry age related macular degeneration

83
Q

Describe 3 common presenting symptoms in ARMD?

A
  1. Seeing halos/glare round streetlamps
  2. Difficulty switching from light to dark environments
  3. Reduced visual acuity to near-field objects
84
Q

Describe the main differences between dry and wet ARMD?

A

Wet ARMD occurs as a result of dry ARMD

Wet ARMD has exudative and neovascular components

Dry ARMD can’t really be treated - it is just monitored

Wet ARMD can be treated with anti-VEGF injections

85
Q

How does the neovascualrisation in wet ARMD cause vision loss

A

Leakage from the new, weak vessels separate the macula from the underlying choroid layer

86
Q

What is the tell tale sign that dry ARMD is progressing to wet ARMD?

A

Metamorphopsia

straight lines appearing wavy

87
Q

How is red reflex affected in cataracts?

A

Loss of the red reflex - the opaque lens lets less light through to the retina

88
Q

What is gold standard management for cataracts?

A

Phacoemulsification

89
Q

Describe 4 complications of phacoemulsification?

A
  1. Posterior capsule rupture
  2. Thickening of the lens capsule
  3. Retinal detachment
  4. Endophthalmitis
90
Q

What is the most common cause of internuclear ophthalmoplegia?

A

MS

91
Q

What is internuclear ophthalmoplegia? What structure is at fault?

A

When the eyes fail to move together due to failure of the medial longitudinal fasciculus

92
Q

Describe what happens in internuclear opthalmaplegia when the affected eye looks towards the unaffected side

A

The affected eye fails to adduct

The unaffected eye adducts, but with nystagmus

93
Q

What is Horner’s syndrome caused by?

A

Interruption of the sympathetic innervation of the eye

94
Q

Name 4 causes of Horner’s syndrome?

A
  1. Pancoast tumours
  2. Ideopathic
  3. Carotid artery aneurysms
  4. Congenital
95
Q

Describe 4 presenting features of Horner’s syndrome

A
  1. Miosis (constricted pupil)
  2. Sunken eye (enopthalmos)
  3. Mild ptosis
  4. Anhydrosis
96
Q

Which part of the optic tract has a lesion if there is a bithemporal hemianopia?

A

Optic chiasm

97
Q

Give 3 causes of a bitempral hemianopia

A
  1. Craniopharyngioma
  2. Pituitary tumours
  3. Meningioma
98
Q

Where is the only area of a tract where there is macular sparing if a lesion occurs?

A

The occipital lobe

99
Q

What is the difference in optic field defect in the optic tract compared with the optic radiations?

A

In both, the macula isn’t spared

Optic tract - homonymus hemianopia

Optic chiasm - quadrangular hemianopia

100
Q

How is visual acuity affected in occipital lobe leisons causing visual field defects?

A

Visual acuity is not affected as the macula is spared

101
Q

Is increased IOP diagnostic of glaucoma?

What is the definition of glaucoma?

A

No!

Glaucoma is a group of disorders characterised by progressive optic nerve damage

Raised IOP is a prominent, but not diagnostic feature

102
Q

Name the 3 fundamental changes that occur in glaucoma?

A
  1. Raised IOP
  2. Visual field defects
  3. Optic disk cupping
103
Q

How is raised IOP investigated?

A

Applanation tomography

104
Q

What does the cup:disk ratio have to be in order to diagnose glaucoma?

A

Cup to disk ratio >0.7 suggestive of glaucoma

105
Q

What class of drug is latanoprost?

A

Prostaglandin analogue

106
Q

Describe the differences in MOA of latanoprost and timolol

A

Latanoprost INCREASES drainage of AH by increasing uveoscleral outflow

Timolol DECREASES AH production

107
Q

How do Alpha adrenergic agonists, beta blockers and carbonic anhydrase inhibitors affect AH?

A

They reduce production of AH

108
Q

How do parasympathomimetics work in glaucoma?

A

They constrict the pupil which pulls the lens away from the meshwork

This reduces resistance to AH flow

109
Q

Describe the typical management of open angle glaucoma

A

1st line: Prostaglandin analogue (latanoprost)

2nd line: Beta-blocker, carbonic anhydrase inhibitor or parasympathomimetic

110
Q

What environment makes symptoms in acute closed angle glaucoma worse

A

Sitting in a dark room

Due to the mydriasis (pupil relaxation)

111
Q

Describe the emergency management in acute closed angle glaucoma

A
  1. Urgent referral to ophthalmologist
  2. IV acetazolidamide

A combination of topical beta blockers, alpha agonists and parasympathomimetics

Mannitol if none of the above have worked

112
Q

What is the definitive management for acute closed angle glaucoma?

A

Laser peripheral iridotomy

113
Q

In which systemic disease are retinal changes such as ‘silver wiring’ and AV nipping present on ophthalmoscope?

A

Hypertensive eye disease

114
Q

Which disease causes blue sclera?

A

Ehler’s danlos syndrome

115
Q

Which systemic disease causes Roth spots on the retina?

A

Infective endocarditis

116
Q

Describe an EXOtropia squint?

A

A DIVERGENT squint

117
Q

Describe an ESOtropia squint?

A

A CONVERGENT squint

118
Q

When an eye with an exotropia squint is covered, what happens to the other one?

A

Eye moves from outwards to inwards

Exotrophia = divergent

119
Q

When an eye with an esotrophia squint is covered, what happens to the other one

A

Eye moves from inwards to outwards

Esotrophia = convergent

120
Q

What is hypermetropia (long sighted) a risk factor for?

A

Acute angle closure glaucoma

121
Q

Describe an Argyll Robertson pupil?

A

Unilateral constricted pupil
Accommodation
No response to light

122
Q

What is the most common intraocular tumour in children?

A

A retinoblastoma

123
Q

how can herpes simplex keratitis be differentiated from bacterial conjunctivitis, using fluorescein staining?

A

both cause a painful red eye

herpes simplex keratitis stains fluorescein- typical appearance is a linear branching corneal ulcer

bacterial conjunctivitis does not cause staining of fluorescein

124
Q

in a patient with herpes simplex keratitis, what is contraindicated?

A

topical corticosteroids

125
Q

how is orbital cellulitis treated?

A

IV antibiotics

they require admission to hospital for IV antibiotics due to risk of cavernous sinus thrombosis and intracranial spread

126
Q

what is the role of IV acetazolamide? which condition is it used in?

A

reduces aqueous secretions

used to manage acute angle closure glaucoma

127
Q

how is anterior uveitis most likely to be Tx’d?

A

steroid and cycloplegic eye drops

cycloplegics relieve the pain felt by the spasm of the muscles controlling the pupil. they will also help prevent the formation of synechiae

128
Q

what is diagnostic of herpes simplex keratitis?

A

dendritic ulcer seen on slit lamp examination with fluorescein stain

129
Q

which ophthalmic condition causing sudden vision loss is sometimes compared to a cheese and tomato pizza on fundoscopy?

A

CRVO - due to the severe haemorrhages

130
Q

what is another name for a meibomian cyst?

A

chalazion

presents as a firm painless lump in the eyelid

131
Q

why is a pinhole occluder used during a visual acuity assessment?

A

it is used to identify refractive errors as the cause of blurred vision

132
Q

what on fundoscopy would signify transition from dry ARMD to wet ARMD?

what does this change represent?

A

presence of red patches on the retina

they represent leakage of serous fluid and blood (WET!)

133
Q

how is diabetic proliferative retinopathy treated? §

A

pan retinal laser photocoagulation

thermal burns are made using a laser to prevent abnormal blood vessel development

134
Q

how is anterior uveitis most likely to be treated?

A

a topical steroid and cycloplegic (mydriatic) eye drops

mydriatic eye drops are ones that cause pupillary dilation

135
Q

which condition is the only one that can cause a red hue to the vision?

A

vitreous haemorrhage

136
Q

name 2 conditions that are risk factors for vitreous haemorrhage?

A

diabetic retinopathy

hypertenisve retinopathy

basically any condition which risks the formation of Neo vasculature is a risk factor for vitreous haemorrhage

137
Q

how is vitreous haemorrhage managed?

A

it resolves with time on its own

138
Q

name the 4 features seen in Horner’s syndrome?

A
  • miosis (small pupil)
  • ptosis
  • anhidrosis
  • enophthalmos (sinking of the eyeball into the bony cavity)
139
Q

what causes Horner’s syndrome?

A

compression of the cervical sympathetic ganglia

a squamous cell cancer of the lung that occurs at the apex or close to the mediastinum can cause it

140
Q

name the 2 features seen in retinitis pigmentosa?

A

night blindness + tunnel vision

primarily affects the peripheral retina

141
Q

what combination of eye drops are given in the 1st instance in acute closed angle glaucoma?

A

direct parasympathomimetic (pilocarpine)
+
beta blocker eye drops

cause pupillary constriction and widening of the iridocorneal angle

142
Q

name 2 causes of an argyll Robertson pupil?

A

neurosyphilis

diabetes mellitus

143
Q

describe an argyll Robertson pupil?

A

bilaterally dilated pupils that accommodate but dont respond to light

“the prostitiutes pupil” - accommodates but doesnt react

144
Q

compare initial treatment for open and closed angle glaucomas?

A

open: prostaglandin analogue eyedrops
closed: myadratic eye drop + beta blocker

AA Y4 Finals cards NE (40 decks)

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