Ophthalmology Flashcards
Acute Angle is linked to what eye shape?
Hypermetropia - Long Sighted
Primary Open Angled Glaucoma is linked to.
Myopia
Short Sighted
Night Blindness + Tunnel Vision
Retinal Pigmentosum
Management of a Lacrimal Sac infection
Warm Compress plus Oral Cephalaxin 14 days
Differentiating periorbital and orbital cellulitis
In Peri Orbital cellulitis there is no
Pain on movement
Diplopia
Visual Impairment
Painful third nerve palsy + mydriatic pupil
Posterior Communicating Artery Aneurysm
Proptosis + Absent corneal reflex
Cavernous Sinus Syndrome
What passes through the cavernous sinus?
Occulomotor Carotid Abducens Trochlear Opthalmic V1 Maxiliiary V2
Contact lenses, severe pain but no clinical findings, recent freshwater swimming
Acanthamoeba
Contact lenses + keratitis
Pseudomonas Aeurginosa
In Eso and Exo tropia what does left or right refer to
When using both eyes in an exotropion the affected eye is deviated to the lateral side.
Esotropion - eye is deviated medially
What happens in an eso or exotropion when the unaffected eye is covered up?
In both cases the affected eye will move too centre and focus on whatever the person is looking at.
Esotropion will move laterally
Exotropion will move medially
Mild Neonatal Conjunctivitis
Swab for sensitivity
Chloramphenicoll eye drops
Azithromycin is used if chlamydia
Severe neonatal conjunctivitis
Oral erythromycin
Management of Primary open angled glaucoma
1st - Prostaglandin Analogue Latanoprost
2nd - Beta Blocker (Timolol) + Carbonic Anhydrase Inhibitor ( Dorzolamide)
- Sympathimometic - Brimonidine
Severe pain
Reduced visual acuity
Haloes around light
Semi dilated pupil
Acute Angled Glaucoma
Acute onset
Blurred vision
Small fixed pupil
Conjunctival ciliary flush
Anterior Uveitis
Severe pain
Worse on eye movement
Non blanching
Rheumatological PMH
Scleritis
Mild pain
Blanches
Episcleritis
Red eye
Reduced vision
Painful vision loss
After intraocular surgery
Endopthalmitis
Management of Anterior Uveitis
Urgent referral to ophthalmology
Topical Steroids and cycloplegics (mydriatic)
Vitreous detachment
Flashers floaters
If someone has a positive family history of glaucoma what do they need?
Annual Screening from 40 years old
How is Herpes Zoster Opthalmicus managed?
Urgent ophthalmology referral
Oral Aciclovir - 7 to 10 days
IV Acyclovir if severe
Topical steroids if secondary inflammation
Investigation of Macular Degeneration
Slit Lamp is first line
- wet - fluorescene angiogram
- both - ocular coherence tomography
Management of Dry macular degeneration
Zinc + Anti oxidant Vitamin A,C,E
Management of Wet Macular degeneration
Anti VEGF 4 weekly injections
Laser phototherapy
What may happen if a squint is left untreated?
Amblyopia - brain ignores input from one eye
What is the commonest cause of a squint?
Concomitant - imbalanced extraoccular muscles is commonest
Paralytic - paralysis of extraoccular muscles is much rarer
How can a concomitant squint be subdivided?
Convergent - looks towards midline - commonest
Divergent - looks away from midline
Management of a squint
Corneal reflection test - screening
Refer to secondary care
Can contact lenses be warn in conjunctivitis?
No
Latanoprost MOA
Prostaglandin analogue
Increases uveosacral
Brown pigmentation of iris and thick eyelashes
Timolol and betoxolol
Beta Blockers
Reduce aqueous production
Avoid in asthmatics and heart block
Brimonidine MOA
Sympathithometic
Reduce production and increase uveosacral outflow
Avoid with TCA and MAOi
Pilocarpine MOA
Miotics
Increase outflow
Constrict pupil, headache, blurred vision
Reduced vision
Faded colours
Glare and halo around headlights
Cataracts - defective red reflex on examination
Cataracts investigations
Fundoscopy - shows normal optic disc and retina
Slit Lamp - cataracts is observable
Types of cataracts
Nuclear - commonest in old age
Polar - inherited
Subcapsular -steroid use
Dot opacities - diabetes and myotonic dystrophy
Management of cataract
Refer for surgery if affecting QOL + brighter lights and glasses
In turned eyelid
Entropion
Out turned eyelid
Ectropion
Management of a Stye
Warm compress and analgaesia
Antibiotics only used if concurrent conjunctivitis
Management of a Chalazia
Most resolve spontaneously over a few months but some need surgery
Stye vs Chalazion
Stye = infected gland in the eyelid - erythematous red and painful
Chalazion - painless lump in the eyelid
Purulent conjunctivitis <5 days from birth
Hyperaemia, Swollen eyelids, chemosis
N.Gonorrhoea
Purulent conjunctivitis >5 days from birth
Hyperaemia, Swollen eyelids, chemosis
Chlamydia
Management for bacterial keratitis
Quinilones - ciprofloxacin topical
Cyclopentolate - for pain relief
New onset flashers or floaters
24 hour ophthalmology review
Binocular vision post trauma - what is the likely injury?
Depressed zygomatic fracture
Commonest cause of blindness in the world
Trachoma - Caused by chlamydia trachomatis
Trachoma presentation and management
Purulent conjunctivitis + entropion
Surgery and antibiotics
What are the subtypes of diabetic retinopathy?
Non Proliferative diabetic retinopathy
Proliferative retinopathy
Maculopathy
Non proliferative Diabetic Retinopathy
Microaneurysm Blot haemorrhages Hard exudate Cotton wool spots Venous beading
Proliferative retinopathy
Retinal neovascularisation
Common in T1DM
Diabetic Maculopathy
Neovasculariation occurring on or over the macula
Common in T2DM
Management of Diabetic retinopathy
All should optimise blood glucose control, BP, Hyperlipidaemia
Maculopathy - Anti-VEGF
NPDR - Regular observation - pan retinal photocoagulation if severe
Proliferative retinopathy - Anti VEGF. Vitreoretinal surgery if haemorrhage
How does GCA cause blindness?
Anterior Ischaemic Optic neuropathy
If someone presents within 100 minutes with a central retinal artery occlusion what can be used?
Firm ocular massage - to dislodge clot.
Management of a branched retinal artery occlusion
Observe and manage conservatively if no macula oedema
VEGFi Intravitreal if signs of macular oedema
Acute Angle drugs
Pilocarpine + Acetazolamide - Make pupil smaller and reduce production
