Ophthalmology Flashcards
causes of afferent pupil defect?
CNII lesion
causes of RAPD defect /marcus gunn
optic neuritis
optic atrophy
retinal disease
causes of efferent defect?
3rd nerve palsy
causes of fixed and dilated pupil?
mydriatrics
iris trauma
acute glaucoma
CNIII compression
causes of horners syndrome?
central: MS, lateral medullary syndrome
pre-ganglionic: pan coast tumour, CVA insertion
post-ganglionic: cavernous sinus thrombus, CN3-6 palsy
what causes holmes adie pupil?
viral/bacterial infection of ANS
what causes argyll-robertson pupil?
DM
syphilis
what causes hutchinsons pupil?
compressed 3rd nerve
intracranial mass/raised ICP head trauma
features of optic atrophy?
reduced acuity reduced colour vision central scotoma pale optic disc RAPD
causes of optic atrophy?
commonly MS or glacuoma
CAC VISION
Congenital Alcohol/toxins Compression Vascular Inflammatory - DM, GCA,stroke Sarcoid infection - VZV,TB, Syphilis Oedema Neoplastic infiltration
Ix acute closed angle glaucoma?
fundsocopy (cloudy cornea, fixed dilated pupil)
tonometry (high IOP)
GOLD STANDARD: GONIOSCOPY with slit lamp
Mx acute closed angle glaucoma?
- reduce aqueous formation
- mitosis -> open outflow
REFERRAL
meds: acetazolamide, timolol, pilocarpine (ATP)
laser peripheral iridotomy
lens extraction
what is the uvea?
iris, ciliary body, choroid
anterior uvea = iris + ciliary
S/S anterior uveitis?
acute pain
photophobia
blurred vision/reduced acuity
hypopyon (pus in anterior chamber)
Ix anterior uveitis?
fundoscopy (irregular and small pupil)
circumcorneal injection
hypopyon
Mx anterior uveitis?
prednisolone drops cyclophentolate drops (mydriatrics/cycloplegics - dilate and prevent adhesions between iris and lens)
what is episcleritis?
subconjuctival haemorrhage - typically non painful and associated with trauma or coughing bouts
inflammation below conductiva in episcleral layer
S/S episcleritis?
asymptomatic, associated with RhA, SLE or idiopathic
different from scleritis as NO PAIN
Ix episcleritis?
blanches vessel on pressure
(scleritis does not blanche)
phenylephrine drops - episcleritis goes white
Mx episcleritis?
topical/systemic NSAIDS
What is scleritis?
vasculitis of sclera
S/S scleritis?
severe pain, worse on eye movement
Associations scleritis?
GPA, RhA, SLE, vasculitis
complications scleritis?
scleromalacia (thinning of sclera) - perforation of globe
Ix scleritis?
fundoscopy (conjunctival oedema more diffuse than episcleritis)
phenylephrine drops - scleritis stays red
Mx scleritis?
REFERRAL URGENTLY <24h
corticosteroids/immunosuppressants, phenylephrine
S/S conjunctivitis?
viral - watery unilateral
bacterial - sticky unilateral
allergic - pruritic bilateral
bacteria commonly causing viral conjunctivitis?
adenovirus
bacteria commonly causing bacterial conjunctivitis?
staph
strep
HiB
Ix conjuctivitis
history
if contact lens wearer refer for same day ophthalmic review as difficult to determine between conjunctivitis and microbial keratitis
What is a corneal abrasion?
epithelial breech without keratitis
S/S corneal abrasion?
pain, photophobia
blurred vision
visible defect
Ix corneal abrasion?
slit lamp fluorescing staining defect green
Mx corneal abrasion?
infection prophylaxis (chloramphenicol ointment)
causes of keratitis?
bacteria (S.aureus, P.aeruginosa) fungi amoeba (Acanthamoeba keratitis) Virus (herpes simplex) - 'dendritic ulcer' Environmental (contact lenses)
S/S keratitis?
pain photophobia blurred vision visible defect/grittiness white corneal opacity
Complications of keratitis?
scarring
visual loss
EMERGENCY
Ix keratitis?
slit lamp-> fluorescin staining defect green
done by ophthalmologist
Mx keratitis?
referral
topical Abx/aciclovir
cycloplegics/mydriatics
what is ophthalmic shingles/herpes zoster ophthalmicus?
CNV1 reactivation of VZV (10% all shingles)
S/S of ophthalmic shingles?
pain
blistering rash
40% associated keratitis/uveitis
Ix ophthalmic shingles
fundoscopy
slit lamp fluorescin staining
Hutchinson’s sign = nose tip zoster, ophthalmic involvement
- ophthalmic involvement = keratitis +/- corneal ulceration +/- iritis
Mx ophthalmic shingles?
referral oral acyclovir (7-10 days) +/- topical corticosteroids if inflammation
Cx ophthalmic shingles?
ptosis
post-herpetic neuralgia
ocular (conjunctivitis, keratitis, episcleritis, anterior uveitis)
When should you refer for urgent ophthalmology assessment?
anyone with red eye and loss of visual acuity: Acute glaucoma Corneal ulcer, foreign body Contact lens related red eye Anterior uveitis Scleritis Trauma, chemical injuries Neonatal conjunctivitis
what is anterior ischaemic optic neuropathy?
aion
optic nerve damage from posterior ciliary artery blockage (inflammation or atheroma)
Types of AION?
Arteritic (caused by GCA)
Non-arteritic? (DM, HTN, hypercholesterolaemia, smoking)
S/S AION?
Visual loss
RAPD
visual fiel defect
Ix AION?
fundoscopy (pale, swollen optic disc, peripheral micro aneurysms)
ESR - raised in aAION, normal in naAION
S/S optic neuritis?
CRAP Central scotoma RAPD Acuity loss (central and colour vision) Pain on movement
optic disc normal, swollen or blurred
Causes optic neuritis?
MS
DM
drugs (ethambutol, chloramphenicol)
infection (VZV, lyme)
Mx optic neuritis?
methylprednisolone IV for 72 hours
prednisolone oral for 11 days
S/S vitrous haemorrhage?
small bleed - small black dots/floaters
large bleed - loss of red reflex, retina not visualised
Causes of vitreous haemorrhage?
angiogenesis (DM accounts for 50%)
retinal tear, detachment or trauma
warfarin
Ix vitreous haemorrhage?
B scan (brightness scan) ultrasonography
Mx vitreous haemorrhage?
smaller - spontaneous reabsorption
larger - vitrectomy
causes of retinal detachment?
cataract surgery
trauma
DM
S/S retinal detachment?
4Fs floaters (numerous, acute onset, spiders webs) flashes field loss fall in acuity
PAINLESS
Ix retinal detachment
grey, opalescent retina ballooning forwards
Mx retinal detachment?
urgent surgery
vitrectomy + gas tamponade with laser coagulation
What causes retinal artery occlusion?
thrombo-embolic
nb any hx amaurosis fugax
Ix retinal artery occlusion?
CVS RF hx (echo, carotid dopplers)
temporal artery biopsy
ESR
Mx retinal artery occlusion?
eyeball massage
carbon therapy, haemodilution, vasodilators, decrease intraocular pressure
S/s in central retinal artery occlusion?
sudden painless total loss of vision + RAPD
cherry red macula