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Finals Revision > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the key features of age-related macular degeneration?

A

Drusen on examination
Neovascularisation of the retina= wet ADM

Central scotoma- progressive loss of central vision
Blurring and curving of straight lines
Peripheral vision preserved
No pain in the eye

Wet AMD= faster progressing
Dry AMD= slow progressing

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2
Q

What is the management for wet AMD?

A

Refer urgently to ophthalmology
Fluorescein angiogram to confirm
Intravitreal VEGF injections

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3
Q

Which sight disorders predispose you to which types of glaucoma?

A 
Myopia = open angle glaucoma
Hypermetropia = closed angle glaucoma
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4
Q

What visual field defect is associated with open angle glaucoma?

A

Upper, outer scotoma which progresses to tunnel vision

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5
Q

How should you investigate suspected glaucoma?

A

Optic disk examination for signs of pathological cupping
Goldmann’s tonometry
Gonioscopy to confirm angle patency/closure

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6
Q

What is the treatment for open angle glaucoma?

A

1st line- prostaglandin analogue e.g. latanoprost

Additional:
Pilocarpine
B-blocker - timolol
Carbonic anhydrase inhibitor- acetazolamide
a-blocker- doxazosin

Laser trabeculectomy to improve aqueous flow

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7
Q

What are the symptoms of acute angle closure glaucoma?

A 
Acutely painful eye
Loss of vision
Headache, nausea, vomiting
Seeing haloes around lights
Photophobia and eye watering
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8
Q

How is acute closed angle glaucoma managed?

A

Lie flat and give pilocarpine drops
IV or oral acetazolamide +/- mannitol
Pressure lowering eye drops: timolol, pilocarpine, apraclonidine
Laser iridotomy

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9
Q

What are the symptoms of cataracts?

A 
Clouding of the cornea
Loss of contrast in colour
Increased glare
Blurring of vision- change in eye refraction
Double vision
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10
Q

How are cataracts managed?

A

Surgery to remove lens and replace with prosthetic

- ability to accommodate is lost so all patients become hypermetropic

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11
Q

What ocular emergency is associated with cataract surgery?

A

Infective endophthalmitis

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12
Q

What are the signs of cranial nerve 3 palsy?

A

Horizontal and vertical diplopia
Down and out pupil
Ptosis
Mydriasis (dilation) on the affected side (loss of efferent limb of pupil reflex)

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13
Q

What are the signs of cranial nerve 4 palsy?

A

Diplopia- especially when looking down and in e.g. reading, walking down stairs
Inability to adduct eye
Head tilt
Eye rolled up slightly

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14
Q

What are the signs of cranial nerve 6 palsy?

A

Inability to abduct affected eye
Horizontal diplopia
Head tilt (move head to face affected side)

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15
Q

What are the features of blow-out fractures?

A

Surgical emphysema around the orbit
Bruising around the orbit
Loss of sensation beneath the orbital rim
Subconjunctival haemorrhage
Limited eye movement- often trapping of inferior rectus meaning that hardest to look down and up
Vertical diplopia
Eye recession or depression

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16
Q

How are blowout fractures managed?

A

Cover the eye
Do not blow nose
Broad spectrum antibiotics
Max fax surgical referral

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17
Q

What are the symptoms of conjunctivitis?

A

Eye irritation/grittiness
Conjunctival injection
Conjunctival discharge- may be purulent
Surrounding erythema

No pain, photophobia, change in vision or pupil reactivity

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18
Q

How should conjunctivitis be managed?

A

Eye lubricants
Cold compress
No contact lenses
Topical chloramphenicol in bacterial causes

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19
Q

How should you treat chlamydial eye disease?

A

Same as treatment for general chlamydia

Oral azithromycin or doxycycline

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20
Q

What are the symptoms of herpes simplex keratitis?

A 
Painful eye- incl pain on movement
Photophobia
Eye watering
Blurring of vision
Red eyes
Fever

May have vesicular lesions on the eyelids or pre-auricular lymphadenopathy

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21
Q

What is the key sign of HS keratitis and on which test does it present?

A

Dendritic ulcers

Fluorescein staining and slit lamp

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22
Q

How is HS keratitis managed?

A

14 day course of topical aciclovir drops
Apply 5 times a day
Analgesia, cold compress, topical lubricant, no contacts

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23
Q

What is the most common bacterial cause of keratitis?

A

Staphylococcus epidermidis

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24
Q

What are the symptoms of bacterial keratitis?

A 
Eye pain and redness
Photophobia
Pain on eye movement
Eye watering
Purulent discharge +/- hypopyon
Corneal ulcers
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25
Q

What is the biggest risk factor for bacterial keratitis?

A

Wearing contact lenses

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26
Q

What treatment is contraindicated in bacterial keratitis?

A

Steroid eye drops

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27
Q

What sign suggests herpes zoster ophthalmicus?

What are the other features?

A

Hutchinson’s sign: vesicles on the end of the nose

Vesicles in distribution of ophthalmic division of trigeminal nerve
Photophobia
Eyelid swelling
Keratitis/iritis
General malaise and fever
Pre-auricular lymphadenopathy
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28
Q

How is herpes zoster ophthalmicus managed?

A

Oral course of aciclovir

Topical steroids

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29
Q

What are the symptoms of anterior uveitis?

A

Painful, red eyes- pain on eye movement
Photophobia and mitosis
Blurred vision
Eye watering
May have pupil distortion due to posterior adhesions
Ciliary injection- from the cornea outwards
Floaters

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30
Q

What conditions are most strongly associated with anterior uveitis?

A

Ankylosing spondylitis and other inflammatory
Ulcerative Colitis
TB

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31
Q

How is anterior uveitis managed?

A

Steroid eyedrops
Dilate pupil to relieve ciliary spasm and break adhesions (atropine or cytopentolate)
Management of systemic condition

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32
Q

What is the diabetic retinopathy screening programme?

A

Annual checks: visual acuity, full eye exam, retinal photography

Children screened after having suffered for 5 years
Additional screening in pregnancy

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33
Q

What are the features of background retinopathy (R1)

A

Microaneurysms
Blot haemorrhages
Exudates
Venous loops

34
Q

What are the features of pre-proliferative retinopathy (R2)?

A 
Intra-retinal microvascular anomalies
Blot haemorrhages
Cotton wool spots
Flame haemorrhages
Venous beading
35
Q

What are the features of proliferative retinopathy (R3)?

A

Venous malformation
Retinal proliferative neovascularisation
Pale macula + macular oedema
Hard exudates

36
Q

What are the potential complications of diabetic retinopathy?

A

Vitreous haemorrhage
Retinal detachment
Cataracts
Optic neuropathy

37
Q

How is diabetic retinopathy managed?

A

Optimisation of glycemic control
Anti-VEGF injections
Intra-vitreal steroid injections
Pan-retinal photocoagulation

38
Q

What are the symptoms of CRAO?

What would you see on fundoscopy?

A

Sudden painless loss of vision
Poor direct pupil response but brisk indirect

Pale macula with cherry red spot
Weeks later, atrophic and pale disk

39
Q

How is CRAO managed?

A

IV acetazolamide
Digital massage
Hyperventilation
Surgical/laser embolectomy

Steroids if caused by GCA/temporal arteritis

40
Q

What is amaurosis fugax?

A

transient, fleeting loss of vision due to passing of fibrin embolus through CRA

41
Q

What are the symptoms of CRVO?

What would you see on fundoscopy?

A

Sudden, painless loss of vision
Less acute than CRAO
May only be partial loss of vision
May have blurring initially

Swollen, tortuous veins
Swollen optic disk
Neovascularisation

42
Q

How is CRVO managed?

A

Pan-retinal photocoagulation
Anti-VEGF agents
Management of increased coagulation

43
Q

What are symptoms of retinal detachment?

A

Floaters and flashing lights
Progressive development of a visual field defect- like a curtain coming down
Reduced visual acuity, especially if macula affected

44
Q

What are the symptoms of orbital cellulitis?

A 
Periorbital swelling and erythema
Inability to open eye
Painful eye movements + gaze restriction
Raised IOP
Diplopia
RAPD
Eye discharge
Proptosis 
Fever
45
Q

What investigations should be done in orbital cellulitis?

A

Swabs of the eyes
Sepsis 6 / blood cultures
CT / MRI orbit WITH contrast to look for any collections behind the eye
Continual checks on visual acuity

46
Q

How is orbital cellulitis managed?

A

Oral/IV co-amoxiclav = first line
IV ceftriaxone in severe infection
May need surgical drainage of any abscesses

47
Q

What are the symptoms of infective endopthalmitis?

A

Hypopyon/fluid level in the eye
Painful, red eye
Reduced visual acuity
Loss of red reflex and pupil reactivity

48
Q

How should infective endophthalmitis be managed?

A

Urgent sampling of aqueous and vitreous fluid

Concurrent intra-vitreal injection of broad spectrum antibiotics (vanc, Ceph)

49
Q

What are the symptoms of retrobulbar haemorrhage?

A 
Severely painful, proposed eye
Subconjunctival haemorrhage 
Periorbital swelling and haematoma
Loss of vision
Reduced eye movements
RAPD
N&V
50
Q

How is retrobulbar haemorrhage managed?

A

Lateral canthotomy ASAP to decompress pressure on optic nerve
Surgical evacuation of haematoma

<2hrs of onset

51
Q

What is the inheritance pattern of inherited retinoblastoma?

A

Autosomal dominant

RB1 gene

52
Q

What are the symptoms of retinoblastoma?

A 
Leukocoria
Strabismus
Vision problems- complaining of blurred/reduced vision
Loss of pupil reactivity
May have eye pain, bleeding or proptosis
53
Q

What are differentials for leukocoria in a child?

A

Retinoblastoma
Congenital cataracts
Retinopathy of prematurity

54
Q

What are the risk factors for retinopathy of prematurity?

A

Babies born < 31 weeks
Birthweight <1500g

These should have screening at 4-7 weeks

55
Q

How is retinopathy of prematurity managed?

A

Laser photocoagulation

56
Q

What is amblyopia?

A

Lazy eye

57
Q

Which medications can precipitate closed angle glaucoma?

A

Adrenergic medication e.g. noradrenaline
Anticholinergic medication e.g. oxybutynin
TCAs e.g. amitriptyline

58
Q

What are the signs of hypertensive retinopathy?

A

Silver/copper wiring
AV nipping
Cotton wool spots (Ischaemia and infarction)
Hard exudates
Retinal haemorrhages
Papilloedema- indicates end stage disease and ischaemia to the optic nerve

59
Q

Which branch of the nervous system is responsible for pupil constriction?

A

Parasympathetic

CN3 - hence palsy causes mydriasis on affected side

60
Q

What are the causes of mydriasis?

A 
Third nerve palsy
Holmes-Adie syndrome
Raised ICP
Congenital
Trauma
Stimulants such as cocaine, MDMA
Anticholinergic
61
Q

What is Holmes-Adie syndrome?

A

Loss of direct pupil reflex
Accommodation in-tact
Slightly oval-shaped pupil
Absent or sluggish deep tendon reflexes

Can sometimes cause blurred vision/photophobia

62
Q

Causes of miosis

A 
Horner's syndrome
Cluster headaches
Argyll-Robertson pupil (syphillis)
Opiates
Nicotine
Pilocarpine
63
Q

How do you differentiate between Horner’s syndrome and CN 3 palsy?

A

Horner’s - pupil constriction
CN3 palsy- pupil dilation

Down + out pupil in CN3

Anhydrosis in Horner’s + facial flushing

64
Q

What are the causes of Horner syndrome?

A

4 Ss, 4Ts, 4Cs

Central
Stroke
MS
Swelling (tumours)
Syringomelia
Peripheral
Tumour (Pancoast)
Trauma
Thyroidectomy
Top rib (cervical rib)

Carotid aneurysm
Carotid artery dissection
Cluster headache
Cavernous Sinus Thrombosis

65
Q

What is an Argyll-Robertson pupil?

A

Associated with neurosyphilis

Constricted pupil which does not react to light but will accommodate on focusing.
Often irregularly shaped

66
Q

What is Blepharitis?

A

Inflammation of the eyelid margins
Causes itchy, gritty, dry sensation in the eyes and can lead to styes and chalazions.
Management is with hot compresses and gentle cleaning of the eyelid margins to remove debris.
Lubricating eye drops can also be useful in management

67
Q

What is a stye?

A

Infection of the glands of Zeis/Moll on the lash line
This causes a tender red lump along the eyelid which may contain puss and can be painful

Managed with hot compresses and analgesia.
Consider chloramphenicol if associated with conjunctivitis

68
Q

What is a chalazion?

A

Occurs when a meibomian gland becomes blocked and swells up

Causes swelling of the eyelid that is not usually tender- but can become tender and red

69
Q

What is an entropion?

A

Where eyelid turns in on itself with the lashes against the eyeball.

This can cause corneal damage and ulceration. Requires SAME DAY referral to ophthalmology.

Initially: tape eyelid down to prevent it turning inwards + lubricating eye drops

Definitive mamagement = surgical intervention

70
Q

What is an ectropion?

A

Eyelid turns out, with the inner aspect of the eyelid exposed.
This usually affects the bottom lid, and can result in exposure keratopathy if not managed.

Mild: regular lubricating eye drops
More severe: may require surgical correction

Same-day referral to ophthalmology required if there is a risk to sight.

71
Q

What are differentials for painless red eye?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

72
Q

What are differentials for painful red eye?

A 
Glaucoma
Anterior uveitis
Scleritis
Keratitis
Corneal abrasion or ulceration
Foreign body 
Traumatic or chemical injury
73
Q

Why is neonatal conjunctivitis more urgent?

A

If <1 month and presenting with conjunctivitis, babies should have an urgent ophthalmology review. Can be associated with gonococcal infection and can cause loss of sight, pneumonia etc.

74
Q

How is allergic conjunctivitis managed?

A

Antihistamines - topical or oral

Topical mast cell stabilisers

75
Q

What conditions are often associated with episcleritis?

A

Rheumatoid arthritis

Inflammatory bowel disease

76
Q

How does episcleritis usually present?

A 
Usually not painful
Segmental redness of the sclera
Foreign body sensation
Dilated episcleral vessels
Watering of the eye
No discharge
77
Q

How is episcleritis managed?

A

Usually self limiting within 1-4 weeks
Lubricating eyedrops can help symptoms
Simple analgesia, COLD compresses and safety netting.
More severe cases may benefit from systemic NSAIDs or topical steroids.

78
Q

How does scleritis usually present?

A

50% bilateral, 50% unilateral

Severe eye pain
Redness of the whole eye
Pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reactivity
Tenderness to palpation
79
Q

How should scleritis be managed?

A

Referral for same day assessment by an ophthalmologist.

NSAIDs
Steroids
Immunosuppression for underlying condition

80
Q

How are corneal abrasions diagnosed?

A

Fluorescein staining and slit lamp examination

Finals Revision (23 decks)

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