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ophthalmology Flashcards

1
Q

what is acute angle closure glaucoma

A

rapid rise in intraocular pressure due to sudden obstruction to the flow of aqueous humor within the eye

obstruction from iris pushed or pulled forward so obstructs the trabecular network

pressure leads to compression of the optic nerve and visual loss

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2
Q

risk factors of acute angle closure glaucoma

A 
family history
older age
female
ethnicity - Chinese
anatomy - long sighted
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3
Q

symptoms of acute angle closure glaucoma

A

blurred vision /halo around lights
headache (not relived by analgesia)
vomiting
watering eyes

red eye
fixed mid-dilated pupil
globe hard to touch
corneal oedema - cloudy cornea

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4
Q

investigations for acute angle closure gluacoma

A

measure intra-ocular pressure (digital or tonometry)

gonioscopy by ophthalmology to assess angle

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5
Q

management of acute angle closure glaucoma

A

pilocarpine eye drops
acetaxolamide to reduce production of aqueous humour
analgesia +/- antiemetic

laser iridotomy - make hole in iris to re-establish drainage

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6
Q

chemical eye injuries

A

can produce extensive damage to ocular surface and anterior segment leaidng to visual impairment and disfigurement

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7
Q

severity of chemical eye injuries depends on

A

toxicity of the chemical
how long in contact with eye
depth of penetration
area of involvement

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8
Q

symptoms of chemical eye injury

A

severe pain
epiphora (excessive eye watering)
blepharospasm
reduced visual acuity

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9
Q

investigations for chemical eye injury

A

pH of the eye

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10
Q

management of chemical eye injurys

A 
irrigation 
topical anaesthetic
topical antibiotic
cycloplegic agents for comfort
lubricating eye drops
steroid drops
may need surgical treatment
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11
Q

irrigation in chemical eye injurys

A

remove offending substance and restore physiologic pH

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12
Q

penetrating eye injury

A

injuries that penetrate the eye but not through (no exit wound)

full thickness rupture of the cornea and/or sclera

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13
Q

risk factors for penetrating eye injury

A 
risk behaviour
men
30s
home and workplace
failure to wear eye protection
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14
Q

symptoms of penetrating eye injury

A 
pain
double vision
foreign body sensation
blurred vision
subconjunctival haemorrhage, peaked pupil., hyphema, iris deformities, lens distruption, virteous haemorrhage, retinal tears
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15
Q

conjunctivitis

A

inflammation of the conjunctiva

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16
Q

causes of conjunctivitis

A

infectious bacterial

infectious viral

noninfectious (allergic)

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17
Q

pathophysiology of conjunctivitis

A

infection inflammation

dilatation of conjunctival vessels

conjunctival hyperemia and oedema

inflammatory discharge

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18
Q

risk factors of conjunctivits

A

exposure to causative AGENT, immunocompromised state and atopy

contact lens wear

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19
Q

presentation of conjunctivits

A

itching eye + redness and purulent discharge (if bacterial) - unilateral

unaffected vision

eyelid oedema, chemosis, excessive lacrimation

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20
Q 
discharge in conjunctivitis:
bacterial
gonococcal
viral
allergic
nonallergic
A 
bacterial = purulent, white/yellow/green
gonococcal = hyperpurulent, profuse
viral = watery, stringy
allergic = watery, mucoid
nonallergic = mucoid
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21
Q

management of conjunctivitis

  • in general
  • allergic
  • chlamydia
  • bacterial
A

ocular lubricant drops/ophthalmic ointment

allergic conjunctivitis = antihistamine drops

systemic therapy to eradicate chlamydia infection

bacterial conjunctivitis = topical antibiotics

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22
Q

corneal ulcers

A

inflammatory condition of the cornea = open corneal sore

many causes - bacterial, fungi, viruses, protozoa

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23
Q

risk factors for corneal ulcers

A 
improper contact lens use
corneal abrasions
eye burns
xerophthalmia (dry eyes)
eyelid disors
steroid eye drops
vitamin A deficiency
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24
Q

presentation of corneal ulcers

A 
red eye
severe pain
soreness
discharge (tearing, pus)
eyelid swelling
blurred vision
vision loss 
photophobia
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25
investigations for corneal uclers
slit lamp fluorescein dye - ulcer margins herpes simplex ulcers - typical dendritic/geographic pattern history + decreased visual acuity
26
management of corneal ulcers
meds - antimicrobial eye drops, analgesic for pain control steroid eye drops (after infection irradiation to reduce swelling and prevent scarring) surgery - corneal transplantation to reduce damaged cornea if scarring decreases vision
27
giant cell arteritis
inflammation of the lining of the arteries in head
28
causes of giant cell arteritis
inflammation of artery walls --> swelling --> narrowing of vessels --> reduced O2/nutrient supply genetic and environmental factors increase suseptibility to inflammation
29
risk factors for giant cell arteritis
``` age 70-80 women 2x more white northern european or scandinavian polymyalgia rheumatica family history ```
30
presentation of giant cell arteritis
unilateral head pain/tenderness - affecting temples scalp tenderness jaw pain when chew or open wide fever, fatigue, unintended weight loss vision loss or double vision sudden permanent loss of vision in one eye
31
giant cell arteritis is related to
polymyalgia rheumatica
32
complications of giant cell arteritis
blindness aortic aneurysm stroke
33
investigations of giant cell arteritis
reduced pulse and hard cord like feel and appearance of temporal arteires on examination blood tests - ESR and CRP imaging - USS, MRA, PET biopsy of temporal atery
34
management of giant cell arteritis
high dose corticosteroids for one to 2 years (lower dose) methotrexate keep an eye on bone density, prescribe calcium and vit D supplements
35
retinal detachment
emergency situ where retina pulls away from its normal position - separating from layer of blood vessels
36
types of retinal detachment
rhegmatogenous - hole or tear allowing fluid out traction - scar tissue on retina surface exudative - fluid accumulates, no whole or tear
37
risk factors for retinal detachment
``` aging prev retinal detachment in one ey family history extreme near sightedness prev eye surgery prev eye injury prev eye disease or disorder ```
38
presentation of retinal detachment
painless but warning signs include:: - sudden appearance of many floaters - photopsia (flashes of light) - blurred vision - gradually reduced peripheral vision - curtain like shadow over visual feild
39
investigations for retinal detachment
retinal examination -look for tears | USS - look for bleeding
40
management of retinal detachment
before detached - laser surgeyr and cryopexy to secure retina down after detached - pneumatic retinopexy + cryopexy, scleral buckling or vitrectomy
41
vitrectomy
draining and replacing fluid in the eye
42
orbital cellulitis
infection of the fat and muscles around the eye - affecting the eyelids, eyebrows and cheeks
43
causes of orbital cellulitis
children - often bacterial sinus infection in beginning more in <7yo
44
risk factors for orbital cellulitis
``` recent URTI sinus infection younger foreign bodies in orbit trauma immunosuppression systemic infection dental infection ```
45
presentation of orbital cellulitis
``` painful swelling in upper and lower eyelid bulging eyes decreased vision pain when moving eye fever generally ill feeling difficult eye movements, perhaps double vision shiny, red or purple eyelid ```
46
investigations of orbital cellulitis
bloods - FBC, blood culture and spinal tap xray of sinuses, CT or MRI of sinuses and orbit, culture of eye and nose drainage, throat culture
47
management of orbital cellulitis
intravenous antibiotics | surgeyr to drain abscess ir relieve pressure
48
meibomian cyst
chalazion = sterile inflammatory granuloma caused by obstruction of sebaceous gland
49
cause of meibomian cyst
obsturction of meibomian gland can cause to enlarge and rupture triggers inflammatory reaction against lipid content
50
risk factors for meibomian cysts
pregnant women with - chronic belpharitis - seborrheic dermaittis - rosacea - pregnancy - diabetes mellitus - elevated cholesterol - chronic hordeola (styes)
51
presentation of meibomian cyst
firm, painless, localised eyelid swellings that develop over several weeks more common in upper than lower eyelid unilateral
52
management of meibomian cyst
warm compres 10-15min + masage 5 times a dya urgent referral if malignancy suspected refer to ophthalmologist if vision affected, discomfort or cosmetic issues
53
blepharitis
chronic condition - inflammation of the eyelids affects both eyes when oil glands at the base of eyelashes get clogged = irritation and redness
54
causes/risk factors of blepharitis
``` seborrhoeic dermatitis infection clogged or malfunctioning oil glands in eyelids rosacea allergies eyelash mites or lice dry eyes ```
55
presentation of blepharitis
``` watery, red eyes gritty, uring or stinging sensation in the eyes eyelids appear greasy itchy eyelids flaking of skin around the eyes crusted eyelashes sensitivity to light blurred vision improving when blinking ```
56
investigaitons for belpharitis
examination of the eye | swabbing skin for testing
57
management of blepharitis
fight infection - eyedrops, creams etc inflammation - steorid eyedrops immune systen - cyclosporine (symptom relief) treat underlying cause clean eyes daily, lubricate eyes, control dandruff and mites
58
cataract
clouding of the normally clear lens of the eye protein and fibres in lens break down and clump together --> clouding the lens --> cataract scatters and blocks the light as it passes --> blurred vision
59
causes of cataract
``` aging injury inherited genetic disorders eye conditions, past surgery or diabetes long term steroid use ```
60
risk factors of cataract
``` older diabetes excessive exposure to sunlight smoking obesity high blood pressure prev eye injury or inflammation prev eye surgeyr prolonged use of corticosteroid meds drinking excessive alcohol ```
61
presentation of cataract
``` clouded, blurred vision or dim vision increasing difficulty with vision at night sensitivity to light and glare need for brighter light for reading and other activities seeing halos and lights frequent changes in eyeglasses fading or yellowing of colours double vision in a single eye both eyes ```
62
investigations for cataract
visual acuity test slit lamp examination retinal exam applanation tonometry
63
management of cataract
``` regular eye exams quit smoking manage other health problems sunglasses reduce alcohol surgery ```
64
open angle glaucoma
drainage from cornea and iris remains open but trabecular meshwork is partially blocked intraocular pressure increase damage to optic nerve
65
risk factors of open angle glaucoma
``` high intraocular pressure >60yo black, Asian, Hispanic family history diabetes, heart disease, HTN, sickle cell anaemia cornea thin in centre extreme vision (near/far) prev eye surgery corticosteroids - espec. eye drops ```
66
clinical presentation of open angle glaucoma
patchy blind spots in peripheral or central vision, freq bilateral tunnel vision in lateral stages if untreaded = blindness
67
investigations of open angle glaucoma
measure intraocular pressure (tonometry) test optic nerve damage check for areas of vision loss (visual feild loss) measure corneal thickness inspect drainage angle
68
treatment of open angle glaucoma
lower intraocular pressure - prostaglandin eyedrops, beta blockers eyedrops, alpha adrenergic agonist eyedrops, carbonic anhydrase inhbitor eyedrops, rho kinase inhibitor, miotic or cholinergic agents srugery - laser therapy, filtering surgery, drainage tubes, minimally invasive glaucoma surgery
69
macular degenration
age related damage to the macula 2 types - wet and dry
70
dry macular degernation
dry = macula gets thinner with age - progressive and develops over several years - no treatment
71
wet macular degernation
abnormal blood vessels grow in the back of the eye and damage macula - treatment available
72
risk factors of macular degeneration
family hsitory >55yo caucasian smoke
73
presentation of macular degeneration - early, intermediate and late
early dry AMD - no symptoms intermediate dry AMD - either no symptoms or mild blurriness in central vision, trouble seeing in low light later AMD (wet or dry type - straight lines look wavy or crooked, blurry area near centre of vision, blank spots appear and blurry area enlarges, colours seem less bright, trouble seeing in low light
74
investigations of macular degeneration
eye exam | optical coherence tomography - pictures of inside of eye
75
management of macular degeneration
prevention - stop smoking, exercise, maintain good BP and cholesteral treatment - vitamins and minerals to prevent further degeneration, anti VEGF drugs to inject into eye (if wet AMD), photodynamic therapy - injections and laser treatment
76
causes of red eye
``` acute close angle glaucoma penetrating/perforating eye injury chemical eye injury conjunctivitis corneal ulcers corneal abrasion corneal foreign body uveitis episcleritis and scleritis ```
77
neurological conditons thar may present with ocular signs
cranial nerve palsy's - CN III, IV and VI horners syndrome papilloedema
78
causes of acute/subacute vision loss
``` giant cell arteritis retinal detatchment amaurosis fugax posterior vitreous detachment vitreous haemorrhage vaascular occlusion of retinal circulation retinal artery occlusion retinal vein occlusion optic neuritis ```
79
cuases of gradual loss of vision
cataract open angle glaucoma macular degeneration refractive issues- myopia/hypermetropia/presbyopia
80
oculoplastics/eyelid conditopns
``` orbital cellulitis meibomian cyst aka chalazion blepharitis dry eyes blocked nasolacrimal duct skin cancer of the eyelid ```
81
paediatric eye conditions
amblyopia squints congenital/paediatric cataracts inherited diseases
82
inherited paediatric eye diseases
retinitis pigmentosa petinoblastoma keratoconus
83
general medical conditons affecting the eye
diabetes hyeprtension thyroid eye disease
84
define corneal abrasion
superficial scratch to the cornea
85
what increases risk of corneal abrasion
``` dry or weak cornea wearing contact lenses working in settings with eye hazards sports w eye injuries bells palsy - lid closure ```
86
presentation of corneal abrasion
``` pain gritty feeling in the eye tearing redness sensitivity to the light headache ```
87
if left untreated corneal abrasion can become
corneal ulcer
88
investigations of corneal abrasion
fluorescein drops to highlight imperfections in cornea
89
initial management of corneal abasion - patient
rinse eye - water/saline blinking pull upper lid over lower
90
treatment of corneal abrasion
not deep - antibiotic ointment singular dose and pain relief deep - dilating drop to relax eye and ease pain, antibitoic ointment 1 week, eye pad, pain releif and rest
91
red flag symptoms for corneal abrasion
sudden pain in eye of injury, often on waking in morning watering and sensitivity to light blurred vision
92
define corneal foreign body
object in eye that should not be there | either conjunctival, corneal, subtarsal (under eyelid)
93
presentation of corneal foreign body
foreign body entering eye through wind blowing/hgh velocity etc unilateral ocular irritation, red eye, watering, blurred vision
94
investigations for corneal foreign body
slit lamp examination or torch examination evert eye lids to check for subtarsal FB fluorescein staining siedels test for penetrating globe injury
95
siedels test
looks for fluprescein stained aqueous running down ocular surface if eye penetrated = penetrating globe injury
96
management of corneal foreign body
removal of FB - (loose can be irrigated with saline, conjunctival removed by sterile cotton bud, corneal needs referral to ophthal and removal using green needle with slit lamp) 7 days topical chloramphenical post removal
97
uevitis
eye inflammation affecting the uvea = iris, ciliary body and choroid
98
causes of uevitis
autoimmune or inflammatory disroder e.g. sarcoidosis, SLR, crohns, akylosing spondylitis infection - cat scratch disease, herpes, syphilis, toxoplasmosis, tuberculosis medication side effect eye injury or surgery cancer- lymphoma
99
risk factor for difficult to control uevitis
smoking
100
presentation of uevitis
eye redness, pain, light sensitivity, blurred vision, floaters, decreased vision symptoms sudden and get worse quickly
101
investigations of uevitis
assessment of vision and response to light tonometry slit lamp examination fundoscopy
102
management of uevitis
``` drugs that reduce inflammation - corticosteroids drugs to control spasms and relieve pain drugs to fight bacteria or viruses immunosuppressants surgery - vitrectomy ```
103
define episcleritis
idiopathic inflammation of the superficial episcleral layer of the eye. relatively common, benign and self limiting
104
define scleritis
autoimmune dysrefulation causing inflammation of the whole thickness of the sclera with ocular complications requiring systemic treatment
105
presentation of episcleritis vs scleritis
episcleritis = acute onset, mild pain, redness and irritation scleritis - subacute onset of severe pain with eye movement, blurred vision, vision loss and photophobia
106
examination of episcleritis vs scleritis
episcleritis = mobile vessels, blanch with phenylephrine drops, reddish hue scleritis = adherent vessels, not blanching with phenylephrine drops, bluish, hue, slit lamp reveals nodules, scleral thinning and corneal changes, systemic inflammation
107
episcleritis management
self limiting normally | can consider topical steroids in refractory cases
108
treatment of scleritis
systemic steroids/NSAIDS/topical antibiotics
109
what is posterior vitreous detachment (PVD)?
when vitreous gel separates from the retina - normal part of ageing
110
how does PVD occur?
vitreous gel becomes liquird and condenes due to age eventually cannot fill entire vitreous cavity, hence gel separates from retina sometimes abnormal adhesion occurs between vitreous gel and retina = tear in retina or retinal blood vessel
111
presentation of PVD
Floaters flashes symptoms become less intense over several weeks
112
investigations of PVD
optical coherence tomography or ocular ultrasound
113
management of PVD
no specific treatment needed since symptoms subside in 3 months complications are rare but serious vitrectomy surgery to remove floaters if persist
114
what is vitreous haemorrhage
bleeding into the vitreous humour - from blood vessels at back of eye caused by trauma or fragility of vessels
115
causes of vitreous haemorrhage
bleeding from abnormal blood vessels - metastatic disease, diabetic eye disease, macular degeneration, retinal vein occlusion, Sickle cell disease bleeding from tears in retina from PVD trauma to eye
116
risk factors for vitreous haemorrhage
``` diabetes >60 smoking HTN high risk activities ```
117
presentation of vitreous haemorrhage
mild floaters and haziness to complete vision loss painless comes on quickly unilateral red tint to vision
118
investigations for vitreous haemorrhage
slit lamp examination to see if blood in vitreous ultrasound if cant see source of bleeding angiogram to look at abnormal blood vessels CT if suspected penetrating injury
119
management of vitreous haemorrhage
find source of bleeding stop bleeding - lazer treatment, avoid exercise repair damage to retina to prevent permanent vision loss vitrectomy if vitreous obscures view and prevents treatment
120
retinal artery occlusion
blockage of retinal artery - carrying oxygen to nerve cells at back of eye = severe vision loss
121
causes of retinal artery occlusion
embolus | thrombolus
122
presentation of retinal artery occlusion
sudden painless loss of vision in one eye - CRAO (central retinal artery occlusion) = severe loss of vision - BRAO (branch retinal artery occlusion) = loss of section of vision, may go unnoticed
123
investigations for retinal artery occlusion
dilated eye examination shows cherry red spot centre of macula appears red with surrounding retina pale fluorescein angiography shows delay in retinal artery filling optical coherence tomography shows swelling in inner layers of retina which atrophy over time and
124
management of retinal artery occlusion
hyperventilation to dilate retinal arteries allowing clot to dislodge paracentesis to lower intraocular pressure to dislodge embolus lowering intraocular pressure with medication ocular massage with thumb to dislodge clot
125
`retinal vein occlusion
when blood clot blocks the vein so blood cannot drain from retina leading to haemorrhage and leakage of fluid from blocked blood vessels
126
CRVO vs BRVO
central retinal vein occlusion = blcokage to main retinal vein BRANCH retinal vein occlusion = blockage of one of the smaller branch veins
127
risk factors of retinal vein occlusion
diabetes, HTN, hypercholesterolaemia
128
clinical presentation of retinal vein occlusion
causes vision loss due to macular oedema, neovascularisation, neovascular glaucoma painless vision loss or blurring - gets worse over hrs-days complete visio loss almost immediately sometimes
129
investigations of retinal vein occlusion
OCT ophthalmoscopy flurescein angiography
130
management of retinal vein occlusion
cant unblock veins but treat problems related to the occlusion - VEGF - intravitreal injection of corticosteroid drugs - focal laser therapy - pan retinal photocoagulation therapy
131
optic neuritis
infalmmation of the optic nerve
132
causes of optic neuritis
not always clear infection MS
133
risk factors for optic neuritis
MS high altitudes caucasian
134
clinical presentation of optic neuritis
``` diminished vision trouble distinguishing colours blurry vision inability to see out of one eye abnormal reaction of pupil to light pain in eye on movement ```
135
investigations of optic neuritis
``` examination response to direct light visual acuity MRI brain ability to differentiate colour fundocsopy ```
136
management of optic enuritis
can resolve my itself | breif course of steorids injected into vein to improve inflammation and swelling
137
dry eyes
common condition when tears arent able to provide adequate lubrication to eyes tear instability leads to inflammation and damage to surface of the eyes
138
causes of dry eyes
decreased tear production - aging, medical conditions, medications, corneal nerve desensivity increased tear evaporation - blocked meibomian glands
139
risk factors for dry eyes
older women low vit A or omega 3 wearing contact lenses or having refractive surgery
140
presentation of dry eyes
``` stinging, burning or scratchy sensation of eyes stringy mucus sensitivity to light eye redness diffculty wearing contact lenses difficulty night time driving watery eyes blurred vision or eye fatigue ```
141
investigations of dry eyes
``` eye exam blotting strips to measure tears tear quality test tear osmolarity test tear samples for markers of dry eyes = matrix metalloproteinase-9 or decreased lactoferrin ```
142
treatment of dry eyes
medications - antibiotics, eyedrops for inflammation, eye inserts (artificial tears), tear stimulaters (choinergics), eye drops from own blood closing tear ducts to reduce tear loss using speicial contact lenses unblocking oil glands - warm compresses using light therapy and eye lid massage
143
blocked nasolacrimal duct
means tears cannot drain normally = watery, irritated eyes
144
causes of blocked nasolacrimal duct
Congenital blockage Age-related changes Infection or inflammation Injury or trauma Tumor Eyedrops Cancer treatment
145
presentation of bloocked nasolacrimal duct
``` excessive tearing redness of white of eye recurrent eye infection or inflammation painful swelling near the inside corner of eye crusting of eyelids mucus or pus discharge from lids blurred vision ```
146
investigations of blocked nasolacrimal duct
tear drianage test irrigation and probing eye imaging - XRAY, CT, MRI to find location of blockage
147
treatment of blocked nasolacrimal duct
``` medications to fight infection - antibiotic eyedrips watch and wait or massafe dilation, probing and flushing stenting or intubation balloon catheter dilation ```
148
most common types of eye lid cancer
basal cell carcinoma - lower eyelid, pale skin squamous cell carcinoma - sun exposure, more aggressive and metastatic melanoma - deepest layer of epidermis, most serious
149
presentation of eyelid cancer
``` change in appearance of eyelid eyelid swelling/thickening chronic infection non healing eyelid ulceration spreading, colourless mass ```
150
treatment of eyelid cancer
surgery, eye removal, radiation therapy, chemotherapy
151
types of diabetic retinopathy
early diabetic retinopathy/non-proliferating diabetic retinopathy advanced diabetic retinopathy
152
early diabetic reitnopathy
``` new blood vessels arent proliferating walls of vessel in retina weaken larger vessels dilate and become irregular leads to oedema of reitna (macula) can affect vision ```
153
advanced diabetic retinopathy
progresses from earlt damaged blood vessels close off = growth of abnormal blood vessels which are fragile and leak into vitreous fluid scar tissue from growth of new blood vessels can cause retinal detachment can cause glaucoma
154
risk factors for diabetic retinopathy
``` duration of DM poor control of DM high BP smoking pregnancy ```
155
presentation of diabetic retinopathy
spots or dark strings floating in vision blurred vision dark or empty areas of vision vision loss
156
complications of diabetic retinopathy
vitreous haemorrhage retinal detachment glaucoma blindness
157
investigations of diabetic reitnopathy
fundoscopy intravenous fluorescein angiogram optical coherence tomography
158
management of diabetic retinopathy
retinal screening control diabetes if advanced - vascular endothelial growth factor inhibitors injected into vitreous, macular oedema treated with ranibixumab, photocoagulation to stop leakage of blood and fluid, panretinal photocoagulation to shrink blood vessels, vitrectomy
159
what is thyroid eye disease
autoimmune disorder characterised by lymphocyte infiltrate of the orbit causing muscle and fatty tissues to become inflamed in extremes can cause compartment syndrome, compromsing optic nerve and signigicant proptosis may compromise cornea= urgent orbital decompression
160
presentation of TED
proptosis (bluging eyes) red, swollen or retracted eyelids corneal irritation extraocular muscle compression and inflammation = diplopia/restricted eyemovement optic nerve compromise = vision loss, blurred vision, reduced colour vision
161
investigations of TED
TFT - but can be euthyroid with evidence of TED (past hyperthyroid)
162
management of TED
symptomatic management during active disease - ocular lubricatns, prisms for diplopia, good thyroid hormone control if evidence of optic nerve compression or residual symptoms - orbital decompression (surgery) life style = stop smoking, selenium supplements
163
causes of CN III palsy
aneurysm - posterior communicating artery = PAINFUL vasculitis = mononeuritis in diabetes and hypertension pathology near cavernous sinus in sof or orbit
164
clinical presentation of CNIII palsy
DOWN AND OUT ptosis dilated pupil - pupil involvement = bad pain = aneurysm ipsilateral to side of lesion
165
investigations for cranial nerve palsys
MRI or CT to determine cause | full CN exam
166
management of CN III palsy
surgery if tumor or aneurysm to releive pressure on nerve and promote healing eliminate double vision and improvement eye alignment - vision therapy, patching one eye, prism lenses, eye muscle surgery, eyelid surgery to correct ptosis
167
CNIV palsy causes
trauma affecting orbit (longest cranial nerve so vulnerable to damage) vasculiitis (DM, HTN) congenital tumor
168
presentation of CNIV palsy
incomplete depression in adducted position torsion of eye in orbit compensatory head tilt towards shoulder ipsilateral bhypertrophy and excyclotorsion double vision when try to read book
169
CNVI palsy cause
vasculitis (DM HTN) | high intracranial pressure
170
presentation of CNVI palsy
double vision when look to side of lesion inturning of eye and double vision in primary position compensatory head turning to the right no abduction in the eye
171
causes of horners syndrome
damage to sympathetic nervous system pathway | first order, second order and third order neurons
172
things causing damage to first order neurons (hypothalamus to spinal cord)
Stroke Tumour Diseases causing loss of myelin Neck trauma Cyst or cavity in spinal colum (syingomyelia)
173
things causing damage to second order neurons (spinal column to neck)
Lung cancer Tumour of the meylin sheath (schwannoma) Damage to aorta Surgery in chest cavity Traumatic injury
174
things causing damage to third order neurons (side of neck to facial skin and muscles of iris and eyelid)
Dmaage to carotid artery along side of neck Damage to jugular vein Tumour or infection near base of skull Migraines Cluster headache
175
presentation of horners syndrome
miosis, ptosis and anhydrosis
176
cause of papilloedema
optic disc swelling secondary to elevated intracranial pressure
177
presentation of papilloedema
raised ICP symptoms - headache, nausea, vomiting chronicity, blurring of vision and loss of visual feild transient eppisodes of visual loss diplopia if VI crannial nerve palsy
178
myopia
nearsightedness - near objects = clear, far = blurry focus image in front of retina
179
causes of myopia
long eyeball | cornea over curved
180
causes of hypermetropia
short eyeball | cornea too little curved
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hypermetropia
long sightedness distances = clear, close = blurry focuses images behind the retina
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presbyopia
gradual loss of eyes ability to focus on nearby objects
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cause of presbyopia
hardening of the lens with aging, less flexible and no longer changes shape to focus on close images
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risk factors for presbyopia
age DM, MS, CVD drugs
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presentation of presbyopia
hold reading material far away blurred vision at normal reading distance eyestrain or headahces after reading or doing close up work
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management of myopia
concave lenses | laser eye surgery
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management of hypermyopia
convex lenses | laser eye surgery
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treatment of presbyopia
``` eyeglasses contacts refractive surgery to change cornea shape corneal implants corneal inlays ```
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amblyopia
lazy eye | reduced vision in one eye caused by abnormal visual development early in life
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causes of amblyopia
muscle imbalance (stabrismus ambylopia) refractive differences deprivation - problem with one eye such as cataract
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risk factors for ambylopia
premature birth small size at birth family history of lazy eye developmental disabilities
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presentation of ambylopia
``` eye wanders inwards or outwards eyes dont appear to work together poor depth perception squinting or shutting an eye head tilting ```
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treatment of amblyopai
``` corrective eywear eyepatches bangerter filter glasses eyedrop (temp blur vision) surgery activity based treatments ```
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squint/strabismus
misalignment of the visual axis
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causes of squint
refractive errors causes of poor acuity in one or both eyes neurodevelopmental conditions
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management of squinty
glasses to correct refractive error occlusion or penalization therapy to treat amblyopia surgery to correct misalignment
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congenital/paediatric cataracts
congenital clouding of lens
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risk factors for congenital cataracts
infection before or soon after birth family history premature
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management of congenital cataracts
referral to ophthal and removal 6-8 weeks of age put in flexible palstic artifical lens instead will need contacts or glasses to help focus
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retinitis pigmentosa
inherited degenerative disease involving breakdown and loss of cells in the retina slowly affects retina and causes loss of night and side vision inherited
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retinoblastoma
eye cancer that begins in retina affecting young children = poor vision eye redness, swelling of eye, higher risk of other cancers inherited
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keratoconus
occurs when cornea thins and gradually bulges outwards into cone
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presentation of keratoconus
``` blurred vision sensitivity to light and glare frequent changes to prescription sudden worsenign or clouding of vision both eyes 10-25 yo slow progression 10 years ```
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Presentation of retinoblastoma
``` white colour in pupil when light shone on it eyes appear to look in diff directions poor vision eye redness eye swelling ```
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presentation of retinitis pigmentosa
early stages = night blindness and progressive loss of visual feild late stages = more loss of visual field = tunnel vision
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preseptal vs orbital cellulitis ocular motility
preseptal cellulitis has intact ocular motility orbital cellulitis has restricted ocular motility and has pain on eye movement
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orbital cellulitis management
urgent admission and imaging (ct) IV antibiotics surgical draINAGE untreated = 40% mortality - intracranial infection and cavernous sinus thrombosis
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giant cell arteritis
life threatening inflammation of medium and large vessels immediate systemic steroids and refer to rheumatology
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symptoms of giant cell arteritis
``` new onset headache jaw claudication constitutional symptoms PMR visual symptoms fever limb claudication ```
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acute 3rd nerve palsy | outcomes and causes
life threatening - aneurysm (PCA which ruptures in 2/3 untreated cases = 50% fatal) microvascular tumour demyelination vasculitis
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painless, sponataneous bleeding no treatment if recurrent check clotting, FBC, BP remember base of skull if history of trauma refer if- proptosed, pulsatile, painful or poor vision
subjunctival haemorrhage
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Common! Normally strep. Pneumoniae, H. influenzae or staph. Aureus/epidermis Signs/Symptoms: • Bilateral (usually) • Mucopurulent or purulent (if +++ consider Gonococcal) • FB sensation (burning / stinging) • No photophobia • Lids and conjunctiva may be oedematous Investigations: • ? Swab Treatment: Topical abx e.g. Chloramphenicol QDS 5-7
bacterial conjunctivitis
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conjunctival follicles
viral e.g. chlamydial 'grains of rice' appearance hyperplastic lymphoid tissue most prominent in fornices
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conjunctival papillae
allergic or bacterial velvety cone shaped elevations hyperplastic epithelium with vascular tuft most prominent in palpebral and limbal conjunctiva
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``` Symptoms/Signs: Bilateral Watery (no discharge) Soreness, FB sensation No photophobia ``` Examination: Conjunctiva is often intensely hyperaemic ``` May be associated: Follicles, Haemorrhages Inflammatory membranes Lymphadenopathy (esp.preauricular node) ``` Aetiology is normally adenoviral ?recent URTI No treatment needed but advice as very contagious (note topical antivirals if herpes)
viral conjunctivitis
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``` Signs/Symptoms: Itch Bilateral Watery discharge Chemosis (oedema) Papillae ?Hayfever, atopy, family history ``` ``` Treatment: Cold compress Reduce/remove allergen Antihistamines NSAIDS Mast cell stabilizers Topical corticosteroids ?immunosuppression ```
allergic conjunctivitis
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Normally idiopathic (rarely RA, Polyarteritis nodosa, SLE, IBD, Sarcoid, GPA, Herpes Zoster, Syphilis) ``` Signs/Symptoms: Often asymptomatic Mild tearing/irritation Tender to touch Localised or diffuse ``` ``` Treatment: Self limiting but can last for months Lubricants NSAIDs Sometimes steroids Phenylephrine drops? ```
episcleritis
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Deeper layers affected Signs/Symptoms: Much more painful – intense boring pain in eye, worse on eye movement Ocular tenderness Watering and photophobia More commonly has medical associations (Note RA and scleromalacia perforans) Does NOT blanche with vasoconstrictors such as phenylephrine Can be localised, diffuse or nodular. Treatment: Frequent steroids, refer to ophthalmology.
scleritis
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70% Idiopathic but can be: Systemic associations: Sarcoid, AS, IBD, Reiter’s, Psoriatic arthritis, Behcets) Infection Trauma Post-op Masquerade (retinal detachment, retinoblastoma, lymphoma) ``` Signs/Symptoms: Pain/ache Photophobia Perilimbal conjunctival injection Blurred vision ?Miotic pupil AC flare/calls, KPs, hypopyon, Posterior synechiae ``` Treatment: Topical steroids and mydriatic/cycloplegics Investigate if recurrent or atypical
anterior uveitis
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``` Signs/Symtoms: Unilateral (trigeminal nerve distribution) Painful ?Hutchinson sign Eye not always involved in V1 HZ ``` Treatment: Oral antivirals e.g. acyclovir PO 5x per day for 10/7.
herpes zoster ophthalmicus
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hutchinsons sign
Hutchinson's pupil, an unresponsive and enlarged pupil on the side of an intracranial mass
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Most commonly: Bacterial (Staph, strep, pseudomonas) Viral (Herpes simplex and zoster) Often associated CL use or trauma but may be secondary to lid/conjunctival disease ``` Signs/Symptoms: Ocular pain Watering and discharge (bacterial) Decreased vision Photophobia Visible lesion – note size/shape and staining ``` ``` Treatment: Intensive antibiotics e.g. levofloxacin, exocin. Anti-virals Mydriatics (steroids?) Avoid CL use ```
microbial keratitis - inflammation of the cornea
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Signs/Symptoms: Extreme pain in orbit and head, ?worse when reading/in reduced light Nausea, vomiting, abdominal pain Vision loss Injected eye Hazy, oedematous cornea Pupil often oval, non-reactive and mid dilated ?History of narrow angles ?FH ?Hypermetrope ?Pseudophakic Treatment: Urgent referral! Pain relief +/- anti-emetics as required Diamox 500mg IV, pilo 2% stat, timolo 0.25%, iopidine 0.5% stat, pred forte, lie supine, analgesia and antiemetic, ?PI ?admit ?diode
acute angle closure gluacoma
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Intra-ocular inflammation and progressive vitritis Infective vs sterile 85% exogenous Surgery (?complicated/prolonged), FBs, Penetrating injury, Injections 15% endogenous Eg haematogenous spread Mortality of 4% Timeframe: 1-2/7 = toxic reaction <6/52 = bacterial (normally 7-14 days) >6/52 = chronic, 90% are propionibacterium acnes. Refer urgent for tap and inject
endophthalmitis
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ocular emergencies that may lead to blindness
``` acute angle closure glaucoma penetrating/perforating eye injury orbital cellulitis giant cell arteritis chemical injuries ```
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acute neurological conditions that may present with ocular signs
painful third nerve palsy | painful horners syndrome
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the red eye
``` conjunctivitis - all causes corneal ulcers acute angle closure glaucoma uveitis episcleritis/scleritis ```
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trauma
corneal abrasion foreign bodies chemical injuries blunt/penetrating injury
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drusen spots
found in macular degeneration found in choroid naevi - benign
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HLA B27
ankylosing spondylitis
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how does diabetes affect the eye - pathphysiology
cant use up sugars due to hyperglycaemia water comes into blood vessels weakens walls of blood vessels (leaky) therefore affects end blood vessels first - feet and eyes
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flames
retinal arteries weak = bleed and leak
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cotton wool spots
reitnopathy - parts of retna die off due to ischamia - diabetes
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makes new blood vessels - immature and week leading to more bleeding
VEGF
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Treatment of diabetic retinopathy with neovascularisation
anti VEGF injections
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esotropia vs exotropia
eso = eyes point inwards exo = eyes point outwarda
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latent squint
phoria
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mulberry sign on retina
astrocytic hamartoma
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endopthalmitis
Endophthalmitis is infection inside the globe and most commonly occurs after surgery (although rarely endogenous infections can seed to the eye).

Year 3 core conditions (15 decks)

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