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Year 6 Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

causes of afferent pupil defect?

A

CNII lesion

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2
Q

causes of RAPD defect /marcus gunn

A

optic neuritis
optic atrophy
retinal disease

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3
Q

causes of efferent defect?

A

3rd nerve palsy

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4
Q

causes of fixed and dilated pupil?

A

mydriatrics
iris trauma
acute glaucoma
CNIII compression

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5
Q

causes of horners syndrome?

A

central: MS, lateral medullary syndrome
pre-ganglionic: pan coast tumour, CVA insertion
post-ganglionic: cavernous sinus thrombus, CN3-6 palsy

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6
Q

what causes holmes adie pupil?

A

viral/bacterial infection of ANS

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7
Q

what causes argyll-robertson pupil?

A

DM

syphilis

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8
Q

what causes hutchinsons pupil?

A

compressed 3rd nerve

intracranial mass/raised ICP head trauma

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9
Q

features of optic atrophy?

A 
reduced acuity
reduced colour vision
central scotoma
pale optic disc
RAPD
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10
Q

causes of optic atrophy?

A

commonly MS or glacuoma
CAC VISION

Congenital
Alcohol/toxins
Compression
Vascular
Inflammatory - DM, GCA,stroke
Sarcoid
infection - VZV,TB, Syphilis
Oedema
Neoplastic infiltration
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11
Q

Ix acute closed angle glaucoma?

A

fundsocopy (cloudy cornea, fixed dilated pupil)
tonometry (high IOP)
GOLD STANDARD: GONIOSCOPY with slit lamp

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12
Q

Mx acute closed angle glaucoma?

A
  1. reduce aqueous formation
  2. mitosis -> open outflow

REFERRAL
meds: acetazolamide, timolol, pilocarpine (ATP)
laser peripheral iridotomy
lens extraction

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13
Q

what is the uvea?

A

iris, ciliary body, choroid

anterior uvea = iris + ciliary

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14
Q

S/S anterior uveitis?

A

acute pain
photophobia
blurred vision/reduced acuity
hypopyon (pus in anterior chamber)

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15
Q

Ix anterior uveitis?

A

fundoscopy (irregular and small pupil)
circumcorneal injection
hypopyon

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16
Q

Mx anterior uveitis?

A 
prednisolone drops
cyclophentolate drops (mydriatrics/cycloplegics - dilate and prevent adhesions between iris and lens)
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17
Q

what is episcleritis?

A

subconjuctival haemorrhage - typically non painful and associated with trauma or coughing bouts

inflammation below conductiva in episcleral layer

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18
Q

S/S episcleritis?

A

asymptomatic, associated with RhA, SLE or idiopathic

different from scleritis as NO PAIN

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19
Q

Ix episcleritis?

A

blanches vessel on pressure
(scleritis does not blanche)
phenylephrine drops - episcleritis goes white

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20
Q

Mx episcleritis?

A

topical/systemic NSAIDS

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21
Q

What is scleritis?

A

vasculitis of sclera

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22
Q

S/S scleritis?

A

severe pain, worse on eye movement

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23
Q

Associations scleritis?

A

GPA, RhA, SLE, vasculitis

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24
Q

complications scleritis?

A

scleromalacia (thinning of sclera) - perforation of globe

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25
Q

Ix scleritis?

A

fundoscopy (conjunctival oedema more diffuse than episcleritis)
phenylephrine drops - scleritis stays red

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26
Q

Mx scleritis?

A

REFERRAL URGENTLY <24h

corticosteroids/immunosuppressants, phenylephrine

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27
Q

S/S conjunctivitis?

A

viral - watery unilateral
bacterial - sticky unilateral
allergic - pruritic bilateral

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28
Q

bacteria commonly causing viral conjunctivitis?

A

adenovirus

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29
Q

bacteria commonly causing bacterial conjunctivitis?

A

staph
strep
HiB

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30
Q

Ix conjuctivitis

A

history
if contact lens wearer refer for same day ophthalmic review as difficult to determine between conjunctivitis and microbial keratitis

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31
Q

What is a corneal abrasion?

A

epithelial breech without keratitis

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32
Q

S/S corneal abrasion?

A

pain, photophobia
blurred vision
visible defect

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33
Q

Ix corneal abrasion?

A

slit lamp fluorescing staining defect green

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34
Q

Mx corneal abrasion?

A

infection prophylaxis (chloramphenicol ointment)

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35
Q

causes of keratitis?

A 
bacteria (S.aureus, P.aeruginosa)
fungi
amoeba (Acanthamoeba keratitis)
Virus (herpes simplex) - 'dendritic ulcer'
Environmental (contact lenses)
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36
Q

S/S keratitis?

A 
pain
photophobia
blurred vision
visible defect/grittiness
white corneal opacity
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37
Q

Complications of keratitis?

A

scarring
visual loss
EMERGENCY

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38
Q

Ix keratitis?

A

slit lamp-> fluorescin staining defect green

done by ophthalmologist

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39
Q

Mx keratitis?

A

referral
topical Abx/aciclovir
cycloplegics/mydriatics

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40
Q

what is ophthalmic shingles/herpes zoster ophthalmicus?

A

CNV1 reactivation of VZV (10% all shingles)

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41
Q

S/S of ophthalmic shingles?

A

pain
blistering rash
40% associated keratitis/uveitis

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42
Q

Ix ophthalmic shingles

A

fundoscopy
slit lamp fluorescin staining
Hutchinson’s sign = nose tip zoster, ophthalmic involvement
- ophthalmic involvement = keratitis +/- corneal ulceration +/- iritis

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43
Q

Mx ophthalmic shingles?

A 
referral
oral acyclovir (7-10 days) +/- topical corticosteroids if inflammation
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44
Q

Cx ophthalmic shingles?

A

ptosis
post-herpetic neuralgia
ocular (conjunctivitis, keratitis, episcleritis, anterior uveitis)

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45
Q

When should you refer for urgent ophthalmology assessment?

A 
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
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46
Q

what is anterior ischaemic optic neuropathy?

A

aion

optic nerve damage from posterior ciliary artery blockage (inflammation or atheroma)

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47
Q

Types of AION?

A

Arteritic (caused by GCA)

Non-arteritic? (DM, HTN, hypercholesterolaemia, smoking)

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48
Q

S/S AION?

A

Visual loss
RAPD
visual fiel defect

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49
Q

Ix AION?

A

fundoscopy (pale, swollen optic disc, peripheral micro aneurysms)
ESR - raised in aAION, normal in naAION

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50
Q

S/S optic neuritis?

A 
CRAP
Central scotoma
RAPD
Acuity loss (central and colour vision)
Pain on movement

optic disc normal, swollen or blurred

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51
Q

Causes optic neuritis?

A

MS
DM
drugs (ethambutol, chloramphenicol)
infection (VZV, lyme)

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52
Q

Mx optic neuritis?

A

methylprednisolone IV for 72 hours

prednisolone oral for 11 days

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53
Q

S/S vitrous haemorrhage?

A

small bleed - small black dots/floaters

large bleed - loss of red reflex, retina not visualised

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54
Q

Causes of vitreous haemorrhage?

A

angiogenesis (DM accounts for 50%)
retinal tear, detachment or trauma
warfarin

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55
Q

Ix vitreous haemorrhage?

A

B scan (brightness scan) ultrasonography

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56
Q

Mx vitreous haemorrhage?

A

smaller - spontaneous reabsorption

larger - vitrectomy

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57
Q

causes of retinal detachment?

A

cataract surgery
trauma
DM

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58
Q

S/S retinal detachment?

A 
4Fs
floaters (numerous, acute onset, spiders webs)
flashes
field loss 
fall in acuity

PAINLESS

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59
Q

Ix retinal detachment

A

grey, opalescent retina ballooning forwards

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60
Q

Mx retinal detachment?

A

urgent surgery

vitrectomy + gas tamponade with laser coagulation

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61
Q

What causes retinal artery occlusion?

A

thrombo-embolic

nb any hx amaurosis fugax

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62
Q

Ix retinal artery occlusion?

A

CVS RF hx (echo, carotid dopplers)
temporal artery biopsy
ESR

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63
Q

Mx retinal artery occlusion?

A

eyeball massage

carbon therapy, haemodilution, vasodilators, decrease intraocular pressure

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64
Q

S/s in central retinal artery occlusion?

A

sudden painless total loss of vision + RAPD

cherry red macula

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65
Q

S/S branch retinal artery occlusion?

A

sudden painless partial loss of vision - RAPD

66
Q

S/S cilioretinal artery occlusion?

A

painless central vision loss

EQUALLY if CRA present and CRAO occurs then central vision may be retained

67
Q

What causes retinal vein occlusion?

A

DM
HTN
Hypercoagulable state
glaucoma

68
Q

Ix retinal vein occlusion?

A

fluorescin angiography (ischemic vs non ischemic CRVO)

69
Q

Mx retinal vein occlusion?

A

only ischaemic CRVO

pan-retinal photocoagulation

70
Q

S/S central retinal vein occlusion (CRVO)

A

ISCHAEMIC - sudden painless total loss of vision + RAPD
- stormy sunset on fundscopy
- haemorrhages
- cotton wool spots
- macular and papilloedema
Non-ischaemic - subacute mild-moderate loss of vision - RAPD
-haemorrhages in all 4 quadrants

71
Q

S/S branch retinal vein occlusion ?

A

asymptomatic unless involving macula

haemorrhage confide to retinal quadrants

72
Q

Causes of gradual vision loss?

A

Common: DM, open angle glaucoma, ARMD (most common cause >60), cataracts
Rare: retinitis pigments, HTN, optic atrophy

73
Q

RFs ARMD?

A

increased age
smoking
FHx

74
Q

S/S of ARMD?

A

central visual loss
old age
blurring of small words
straight lines appearing curvy

75
Q

types of ARMD?

A

wet - sub retinal neovascularisation

dry (90%) - geographic atrophy

76
Q

Features of dry ARMD?

A

Drusen white fluffy spots around the macula - fat deposits under retina
Degeneration of macula with slow decline over 1-2years

77
Q

Features of wet ARMd?

A

Aberrant vessel grow into the retina from the choroid and lead to haemorrhage
rapid visual decline with distortion and macular haemorrhage

78
Q

Ix wet ARMD?

A

Amsler grid

fundoscopy

79
Q

Mx wet ARMD?

A 
Photodynamic therapy
VEGF inhibitors (intravitreal) e.g. bevacizumab
antioxidant vitamins (A,C,E,zinc)
80
Q

Ix ARMD?

A

Urgent referral ophthalmology
1. slit lamp microscopy
wet ARMD -fluorescin angiography
optical coherence tomography

81
Q

Mx ARMD?

A

Stop smoking (slows degeneration)

dry: zinc + vitamin A, C, E
wet: anti-VEGF

82
Q

What are the drugs for chronic glaucoma?

A

BAC (reduce aqueous production)
beta blokcer
alpha 2 agonist
carbonic anhydrase inhibitor

PP (reduce uveoscleral outflow)
pilocarpine
prostaglandin analogue

83
Q

what are the S/S of tobacco-alcohol amblyopia?

A

optic atrophy
loss of red/green discrimination
scotoma

84
Q

MX tobacco-alcohol amblyopia?

A

vitamins may help

85
Q

Pathophysiology of chronic simple open angle glaucoma?

A

increase IOP >21, blood flow, damaged optic nerve, optic disc atrophy and cupping

86
Q

S/S of open angle glaucoma?

A

peripheral field loss (central vision maintained)

87
Q

RF open angle glaucoma?

A

myopia, FHx

88
Q

Ix open angle glaucoma?

A

those with strong FH have screening from 40
screening: >35, afro-carribean, FHx, steroid, DM, HTN, migraines, myopia
tonometry (>21mmHg), fundoscopy (cupped optic disc), visual fields

89
Q

Mx open angle glaucoma?

A

1st line: beta blocker (timolol), prostaglandin analogue (latanoprost)
2nd line: topical alpha 2 agonist (brimonidine tartrate), carbonic anhydrase inhibitor (acetazolamide), topical miotic (pilocarpine)
surgical: laser trabeculoplasty [new can be used 1st line if desired]

90
Q

SEs of prostaglandin analogies in eye?

A

iris pigmentation and eyelash growth

91
Q

Pathogenesis of diabetes mellitus in the eye?

A

cataracrts

retinopathy- microangiopathic vessel disease (occlusion + fragile neovascularisation)

92
Q

Screening for eye in diabetes?

A

annual screening + funds photography + fluorescin staining

93
Q

Management of diabetic retinopathy?

A

C: BP and glycaemic control
Proliferative retinopathy -> pan-retinal photocoagulation
Maculopathy -> grid/focal retinal photocoagulation

94
Q

Stages of diabetic retinopathy?

A
  1. hard exudates, micro aneurysms, blot haemorrhages (conservative)
  2. pre-proliferative: cotton wool spots, soft exudates (pan-retinal photocoagulation)
  3. proliferative: angiogenesis (pan-retinal photocoagulation)
  4. maculopathy: hard exudates heart macula (grid-retinal-photocoagulation)
95
Q

HTN retinopathy stages (Keith-Wagener)

A

Grade 1: silver wiring, arteriole tortuosity
Grade 2: AV nipping
Grade 3: Flame haemorrhages, cotton wool exudates
Grade 4: papilloedema

96
Q

S/S cataracts?

A

increasing myopia + blurred vision
dazzling bright lights, night vision loss
halos

97
Q

Causes of cataracts?

A 
age (30% >65yo have cataracts)
steroids 
smoking
DM
uveitis
hypocalcaemia
congenital: idiopathic, rubella infection, wilson's, Alpert's, galactoseamia, myotonic dystrophy, Downs
98
Q

Ix cataracts?

A

tonometry
fundoscopy (darkened red reflex)
acuity testing
BMs

99
Q

Mx cataracts?

A

C: Glasses and sunglasses, glycemic control
M: mydriatic eye drops (tropicamide)
S: cataract surgery

100
Q

Complications of cataract surgery?

A 
posterior capsular opacification (decreased acuity) -> laser surgery
posterior capsule rupture
retinal detachment glaucoma
endophthalmitis
anterior uveitis
vitreous haemorrhage
101
Q

What is the anatomy of the retina?

A

outer pigmented layer in contact with choroid
inner sensory layer in contact with vitreous
fovea at centre

102
Q

what is retinitis pigmentosa?

A

most common inherited degeneration of the macula

103
Q

inheritance of retinitis pigmentosa?

A

most common - AR
best prognosis - AD
worse prognosis - X linked

104
Q

S/S retinitis pigmentosa?

A

night blindness
tunnel vision
blind by mid 30s

105
Q

Associations retinitis pigmentosa?

A

Friedrich’s ataxia
Kearns-Sayre syndrom
Refsum’s disease
Usher’s syndrome

106
Q

Ix retinitis pigmentosa?

A

fundoscopy (pale optic disc/atrophy, macula sparing peripheral retinal pigmentation)

107
Q

What is the commonest intraocular tumour in children?

A

retinoblastoma

108
Q

S/S Retinoblastoma?

A

strabismus

leukocoria (white in eye with no red reflex)

109
Q

Associations retinoblastoma?

A

pineal tumours
osteosarcoma
rhabdomyosarcoma

110
Q

Ix retinoblastoma?

A

fundoscopy

111
Q

Mx retinoblastoma?

A

enucleation
chemotherapy
radiotherapy

depends on size

112
Q

Causes of blepharitis?

A

seborrhoea dermatitis

staphylococcus

113
Q

S/S blepharitis?

A

gritty itchy eyes with scales on the lashes

114
Q

Mx blepharitis?

A

compresss and clean +/- topical chloramphenicol

115
Q

what is entropion and ectropion?

A 
entropion = eyelid inversion - corneal irritation
ectropion = lower lid eversion - watering and exposure keratitis associated w ageing, CN7 palsy
116
Q

What is lagophthalmos?

A

difficulty closing the lid over the globe - exposure keratitis

117
Q

Causes of lagophthalmos?

A

exophthalmos, facial palsy

118
Q

Mx lagophthalmos?

A

lubrication (liquid paraffin)

tarrsorrhaphy

119
Q

What are pinguecula?

A

yellow vascular nodules either side of the cornea

120
Q

what are pterygium?

A

yellow vascular nodules growing over the cornea - decreased vision
benign growth of the conjunctiva
associations with dusty, wind blown lifestyles and sun exposure

121
Q

what can cause orbital cellulitis?

A

staphylococcus
pneumococcus
GAS

122
Q

S/S orbital cellulitis?

A 
inflammation of orbit
lid swelling
pain on movement of eyes
systemic symptoms
exophthalmos

n.b. periorbital does not have pain on eye movement, no systemic symptoms, no proptosis, no vision loss

123
Q

Ix orbital cellulitis?

A

CT scan w/contrast (orbits, sinuses and brain; assess for posterior spread

124
Q

Mx orbital cellulitis?

A 
referral to ophthalmology
IV Abx (cefuroxime)
125
Q

Complications orbital cellulitis?

A

local extension (meningitis, cavernous sinus thrombosis), optic nerve damage

126
Q

What is a carotid cavernous fistula?

A

carotid aneursym rupture leading to reflux of blood into cavernous sinus

127
Q

Causes of cavernous fistula?

A

spontaneous rupture or trauma?

128
Q

S/S carotid cavernous fistula?

A

engorgement of eye vessels
lid and conjunctival oedema
pulsatile exophthalmos
eye bruit

129
Q

Mx carotid cavernous fistula?

A

endovascular treatment

130
Q

Common causes exophthalmos?

A

Graves
orbital cellulitis
trauma

131
Q

What is squint/strabismus?

A

misalignment of visual axes

132
Q

types of squint?

A

concomitant (common) - imbalance of extra ocular muscles

paralytic (rare) - paralysis of extra ocular muscles

133
Q

What are the causes of CNIII palsy?

A

Medical: DM, MS, infarction
Surgical: raised ICP, cavernous sinus thrombosis, PCA aneurysm

134
Q

What are the causes of CNIV palsy?

A

peripheral: DM, trauma, compression
central: MS, SOL, vascular

135
Q

What are the causes of CNVI palsy?

A

peripheral: DM, trauma, compression
central: MS, SOL, vascular

136
Q

what is esotropia?

A

squints where eye deviates towards the nose (common in children)
caused: idiopathic, hypermetropia

137
Q

what is exotropia?

A

divergent squint
older children
often intermittent

138
Q

ix squint?

A

corneal light reflection test

cover test

139
Q

Management of squint?

A 
4Os
ophthalmological review
optical - correct refractive errors
orthoptic (eye patches to the good eye to prevent amblyopia)
operations (resection of rectus muscles)
140
Q

Ix foreign bodies?

A

XR eye

fluorescin

141
Q

Mx foreign bodies?

A

chloramphenicol drops
eyepatch
mydriatics/cycloplegics
refer to eye emergency - do not try and remove A&E

142
Q

what is hyphaema?

A

blood in anterior chamber

143
Q

What is the mx of intra-ocular haemorrhage?

A

small amounts clear spontaneously; large may need evacuation

144
Q

Complications intra-ocular haemorrhage?

A

acute closed angle glaucoma if restricts outflow

corneal staining

145
Q

Mx chemical injury?

A

irrigate

referral

146
Q

What is the aetiology of orbital blowout fracture?

A

blunt trauma, sudden increase IOP, orbital content herniate into maxillary/ethmoid sinus

147
Q

S/S orbital blowout fracture?

A

ophthalmoplegia + diplopia
loss of sensation to lower lid - infraorbital nerve injury
ipsilateral epistaxis - anterior ethmoidal artery rupture
decreased acuity
irregular pupil reacting slowly to light

148
Q

what are floaters?

A

small dark spots;

sudden showering one eye may be blood/retinal detachment

149
Q

causes of floaters?

A 
retinal detachment
vitreous haemorrhage
diabetic retinopathy/HTN retinopathy
old retinal branch occlusion
syneresis
150
Q

types of flashes?

A 
intraocular 
intracerebral (ie migraine)
151
Q

What are some causes of haloes?

A

haloes - cataract, corneal oedema, acute glaucoma
haloes + eye pain- acute glaucoma
jagged haloes - migraine

152
Q

Mx of trachoma?

A

tetracycline

153
Q

what causes trachoma?

A

chlamydia trachomatis

ulceration and blindness

154
Q

what causes onchocerciasis?

A

river blindness
microfilariae of nematode onchocerca
corneal opacities and synechiae

155
Q

Mx onchocerciasis?

A

ivermectin

156
Q

What is xerophthalmia?

A

manifestation of vitamin A deficiency
night blindness
dry conjunctiva
corneal ulceration/perforation

157
Q

Mx xerophthalmia

158
Q

anterior uveitis associated conditions

A 
ankylosing spondylitis
reactive arthritis
ulcerative colitis, Crohn's disease
Behcet's disease
sarcoidosis: bilateral disease may be seen
159
Q

Ocular manifestations of rheumatoid arthritis?

A 
keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis
160
Q

Indications to refer to ophthalmology for foreign body?

A
  • penetrating eye injury due to high-velocity injuries (e.g. drilling, lawn moving or hammering) or sharp objects
  • Significant orbital or peri-ocular trauma has occurred
  • Chemical injury has occurred (irrigate for 20-30 mins before referring)
  • Foreign bodies composed of organic material
  • Foreign bodies in or near the centre of the cornea

Any red flags e.g. severe pain; irregular, dilated or non-reactive pupils; significant reduction in visual acuity.

161
Q

Causes of tunnel vision?

A

papilloedema
retinitis pigmentosa
choroidoretinitis
glaucoma

Year 6 Medicine (18 decks)

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