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Neurology and Special Senses > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is chronic (open angle) glaucoma?

A

resistance to draining of aqueous fluid in the eye, causing an increase in IOP, leading to damage to the optic nerve.

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2
Q

Risk factors for chronic glaucoma? (4)

A
  1. old age
  2. black ethnicity
  3. diabetes
  4. near-sightedness
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3
Q

Classical presentation of chronic glaucoma? (5)

A
  1. initially asymptomatic, then develop painful red eye
  2. halo around lights (worst at night)
  3. peripheral vision loss (tunnel vision)
  4. headache
  5. nausea and vomiting
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4
Q

Investigations for chronic glaucoma?

A
  1. visual fields
  2. fundoscopy - cupping
  3. tonometry - assess pressure in eye
  4. geniometry - assess draining system in the eye
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5
Q

Management of chronic glaucoma

A
  1. Prostaglandin analogue (latanoprost) - increase uveoscleral outflow
  2. Beta blockers (reduce fluid)
  3. Sympathomimetics
  4. Acetazolamide (reduce fluid)
  5. Surgery: trabeculoplasty
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6
Q

Side effects of prostaglandin analogues (e.g. Latanoprost)

A
  1. lid irritation
  2. iris pigmentation
  3. lid pigmentation
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7
Q

Action of prostaglandin analogues in chronic glaucoma?

A

Increase the uveoscleral outflow to reduce the fluid in the eye.

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8
Q

What is cataracts?

A

Opacification of the lens

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9
Q

Cause of cataracts?

A

Unknown. Believed to be due to environmental damage (e.g. UV lights) and normal ageing making the lens susceptible to damage.

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10
Q

Clinical presentation of cataracts? (5)

A
  1. gradual vision loss
  2. starbursts
  3. colour changes (appearing more yellow/brown)
  4. blurred vision
  5. loss of red reflex (white/grey pupil)
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11
Q

Diagnosis of cataracts? (3)

A
  1. Reduced visual acuity
  2. Absent red reflex
  3. further investigations with slit lamp
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12
Q

Management of cataracts? (mild and severe)

A

mild - no management

severe - surgical lens replacement

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13
Q

Complication of surgical lens replacement for cataracts? (2)

A
  1. endophthalmitis (infection of the fluid in the eye)

2. scar tissue behind the lens implant

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14
Q

What is congenital cataracts? How is it diagnosed?

A
  1. Cataracts arising in newborns.

2. Screened for during the newborn examination using the red-reflex.

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15
Q

Risk factors for cataracts? (6)

A
  1. age
  2. smoking
  3. diabetes
  4. trauma
  5. infection
  6. steroids
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16
Q

What is age related macular degeneration?

A

Degeneration to the macula.

17
Q

What are the risk factors of AMD?

A
  1. age
  2. family history
  3. white/Chinese ethnicity
18
Q

Clinical presentation of AMD? (4)

A
  1. painLESS gradual loss of vision
  2. central scotoma
  3. straight lines appear wavy
  4. reduced visual acuity
19
Q

Diagnosis of AMD?

A
  1. visual fields testing
  2. fundoscopy - drusen, neovascularisation (wet)
  3. Amsler grid
20
Q

2 main types of AMD? What do they mean?

A
  1. wet - neovascularisation (vessels from the choroid penetrate through the retina)
  2. dry - no new vessels
21
Q

Characteristic features of AMD on fundoscopy?

A
  1. Drusen
  2. neovascularisation
  3. retinal oedema
  4. atrophy
22
Q

Management of AMD? (wet and dry)

A

Dry - no management. Lifestyle advice (stop smoking, control bp, vitamins)
Wet - anti-VEGF once a month

23
Q

What is drusen?

A

Yellow deposits seen on fundoscopy caused by build up of proteins and lipids between Bruch’s and RPE. Small amounts can be normal.

24
Q

What causes retinal detachment?

A

Tears in the retina causes vitreous fluid to separate the retina from the underlying choroid.

25
Q

Risk factors for retinal detachment? (5)

A
  1. diabetes
  2. short-sightedness
  3. Family history
  4. trauma
  5. cancer
26
Q

Clinical presentation of retinal detachment? (4)

A
  1. shadow in the peripheral vision
  2. floaters/flashers
  3. blurred/distorted vision
  4. painless
27
Q

Diagnosis of retinal detachment?

A
  1. fundoscopy
  2. CT/MRI to rule out cancer/foreign body
  3. slit lamp
28
Q

Management of retinal detachment?

A
  1. Laser photocoagulation (to reattach the retina)
  2. Vitrectomy (insertion of gas, silicon oil or air into vitreous body)
  3. Silicon buckle (around the eye to reattach)
29
Q

Complications of retinal detachment?

A

Sight threatening

30
Q

What is central retinal artery occlusion?

A

Occlusion of a retinal artery commonly due to thrombosis, causing retinal ischaemia.

31
Q

Central retinal artery occlusion is commonly associated with what condition?

A

Giant Cell Arteritis

32
Q

Clinical presentation of Central retinal artery occlusion?

A
  1. complete acute loss of vision (grey curtains)
  2. painLESS
  3. RAPD
33
Q

What is seen during the swinging light test in a patient with Central retinal artery occlusion?

A

RAPD - pupil dilates when light is shone and no consensual reflex

34
Q

Risk factors for Central retinal artery occlusion?

A

Same as cardiovascular disease risk factors

35
Q

Management of Central retinal artery occlusion?

A
  1. High dose steroids (IV methylprednisolone) - GCA associated
  2. Intra-arterial Tissue plasminogen activator (tPA) (e.g. Alteplase)
  3. surgical management
36
Q

Which vessel is the tPA injected into for Central retinal artery occlusion?

A

Ophthalmic artery

37
Q

Classical features of Central retinal artery occlusion on fundoscopy?

A
  1. cherry red spot

2. pale retina

38
Q

Long term management of Central retinal artery occlusion?

A

Address cardiovascular risk factors and start secondary prevention (e.g., antiplatelets, statins, antihypertensives)

Neurology and Special Senses (9 decks)

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