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02F > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

causes of optic neuritis?

A
  • MS (most common)
  • DM
  • syphilis
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2
Q

features of optic neuritis?

A
  • unilateral reduction in visual acuity
  • relative afferent pupillary defect
  • loss of colour discrimination
  • “red desaturation”
  • central scotoma
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3
Q

management of optic neuritis? how long does it take to fully recover?

A
  • high-dose steroids

- 4-6 weeks

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4
Q

prognosis of optic neuritis?

A

if >3 white matter lesions seen on MRI, very high risk of developing MS

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5
Q

describe the pathophysiology of (all types of) glaucoma

A
  • blockage in aqueous humour drainage from eye
  • causes rise in intraocular pressure
  • this raised pressure damages the optic nerve (CN2)
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6
Q

which fluid fills the anterior chamber? vitreous chamber?

A
  • aqueous humour

- vitreous humour

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7
Q

which structure produces aqueous humour?

A

ciliary body

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8
Q

what is normal intraocular pressure?

A

10-21 mmHg

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9
Q

pathophysiology of open-angle glaucoma?

A
  • gradual increase in resistance through trabecular meshwork
  • pressure slowly builds in eye
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10
Q

pathophysiology in acute angle-closure glaucoma?

A
  • iris bulges forward
  • completely seals off trabecular meshwork
  • continual build up of pressure
  • emergency
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11
Q

how does increased intraocular pressure affect the optic disc?

A
  • causes “cupping”

- optic cup in centre of disc gets wider and deeper

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12
Q

risk factors for open angle glaucoma?

A
  • ageing
  • FHx
  • Black ethnic origin
  • myopia (short-sightedness)
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13
Q

presentation of open angle glaucoma?

A
  • often asymptomatic, picked up on screening
  • loss of peripheral vision first
  • eventually gives “tunnel vision”
  • gradual onset
  • fluctuating pain
  • headaches
  • blurred vision
  • halos around light, esp at night
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14
Q

how can intraocular pressure be measured in suspected glaucoma?

A
  • non-contact tonometry (puff of air, useful for screening)

- goldmann applanation tonometry (gold standard)

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15
Q

investigations and findings in open angle glaucoma?

A
  • goldmann applanation tonometry (high intraocular pressure)
  • fundoscopy (disc cupping)
  • visual field assessment (peripheral vision loss)
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16
Q

at what intraocular pressure should treatment be started in open angle glaucoma?

A

24mmHg or above

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17
Q

management of open angle glaucoma?

A
  • 1st: latanoprost (prostaglandin analogue) eye drops
  • timelol (BB)
  • dorzolamide (carbonic anhydrase inhibitor)
  • brimonidine (sympathomimetic)
  • trabeculectomy surgery if eye drops fail
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18
Q

notable SEs of latanoprost?

A
  • eyelash growth
  • eyelid pigmentation
  • iris browning
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19
Q

risk factors for acute angle closure glaucoma?

A
  • ageing
  • being female
  • FHx
  • Chinese / East Asian ethnic origin
  • drugs
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20
Q

which drugs can precipitate acute angle closure glaucoma?

A
  • noradrenaline
  • oxybutynin / solifenacin
  • amitriptyline
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21
Q

presentation of acute angle closure glaucoma?

A
  • pt feels generally unwell
  • severely painful, red eye
  • blurred vision
  • halos around lights
  • headache
  • N+V
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22
Q

findings O/E of acute angle closure glaucoma?

A
  • red-eye
  • teary eye
  • hazy cornea
  • decreased visual acuity
  • affected pupil is dilated and fixed in size
  • eyeball is firm on palpation
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23
Q

initial management of acute angle closure glaucoma?

A
  • same day ophthalmology assessment
  • lay on back w/ pillow
  • pilocarpine eye drops
  • PO acetazolamide 500mg
  • analgesia / antiemetics if needed
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24
Q

drug class of acetazolamide?

A

carbonic anhydrase inhibitor

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25
Q

secondary care management of acute angle closure glaucoma? hint: similar to open angle

A
  • pilocarpine
  • PO / IV acetazolamide
  • glycerol / mannitol
  • timolol
  • dorzolamide
  • brimonidine
  • laser iridotomy
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26
Q

definitive treatment of acute angle closure glaucoma?

A

laser iridotomy

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27
Q

most common cause of blindness in the UK?

A

age-related macular degeneration (ARMD)

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28
Q

key finding on fundoscopy in ARMD?

A

drusen

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29
Q

how can ARMD be classified? which type is most common?

A
  • dry (90%)

- wet (10%)

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30
Q

which type of ARMD carries a worse prognosis?

A

wet

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31
Q

feature common to both dry and wet ARMD?

A

drusen on fundoscopy

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32
Q

risk factors for ARMD?

A
  • ageing
  • smoking
  • White / Chinese ethnic origin
  • FHx
  • CVD
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33
Q

presentation of ARMD?

A
  • gradually worsening central visual field loss
  • reduced visual acuity
  • straight lines look crooked / wavy
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34
Q

how might wet ARMD present slightly differently to dry ARMD?

A
  • more acute
  • vision is lost over days
  • full blindness after 2-3 years
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35
Q

findings O/E of ARMD?

A
  • reduced acuity
  • scotoma on visual fields test
  • distorted straight lines on amsler grid test
  • drusen on fundoscopy
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36
Q

what is a scotoma?

A

a central patch of vision loss

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37
Q

specialist investigations used in ARMD?

A
  • slit-lamp biomicroscopic fundus exam
  • optical coherence tomography
  • fluoroscein angiography
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38
Q

management of dry ARMD?

A
  • refer to ophthalmology
  • stop smoking
  • control BP
  • vitamin supplements
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39
Q

management of wet ARMD?

A
  • refer to ophthalmology

- anti-VEGFs (ranibizumab, bevacizumab, pegaptanib)

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40
Q

describe the pathophysiology and examination findings in diabetic retinopathy

A
  • repeated exposure to hyperglycaemia causes increased vascular permeability of retina, causing:
  • blot haemorrhages
  • hard exudates
  • microaneurysms
  • venous beading
  • “cotton wool spots”
  • neovascularisation
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41
Q

how can diabetic retinopathy be classified?

A

based on fundoscopy findings:

  • proliferative
  • non-proliferative
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42
Q

signs on fundoscopy in mild / moderate non-proliferative diabetic neuropathy?

A
  • mild: microaneurysms

- moderate: microaneurysms, blot haemorrhages, hard exudates, cotton wool spots and venous beading

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43
Q

signs on fundoscopy in severe non-proliferative diabetic retinopathy?

A
  • blot haemorrhages
  • microaneurysms in 4 quadrants
  • venous beading in 2 quadrants
  • IRMA in any quadrant (intraretinal microvascular abnormality)
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44
Q

signs on fundoscopy in proliferative diabetic retinopathy?

A
  • neovascularisation

- vitreous haemorrhage

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45
Q

signs on fundoscopy in diabetic maculopathy?

A
  • macular oedema

- ischaemic maculopathy

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46
Q

complications of diabetic retinopathy?

A
  • retinal detachment
  • vitreous haemorrhage
  • rebeosis iridis (new blood vessels in iris)
  • optic neuropathy
  • cataracts
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47
Q

management of diabetic retinopathy?

A
  • laser photocoagulation
  • anti-VEGF (ranibizumab, bevacizumab)
  • vitreoretinal surgery (keyhole in eye)
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48
Q

how could hypertensive retinopathy develop?

A

2 ways:

  • very slowly from chronic HTN
  • quickly in malignant HTN
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49
Q

signs on retina on fundoscopy in hypertensive retinopathy?

A
  • silver / copper wiring (arterioles compressing veins)
  • AV nicking
  • cotton wool spots
  • hard exudates
  • retinal haemorrhages
  • papilloedema (end stage sign)
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50
Q

how can hypertensive retinopathy be classified?

A

keith-wagener classification

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51
Q

management of hypertensive retinopathy?

A
  • control BP
  • stop smoking
  • control lipids
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52
Q

what is a cataract?

A
  • when the lens becomes cloudy and opaque

- causes loss of visual acuity

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53
Q

how are congenital cataracts picked up?

A

screened for using red reflex in NIPE

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54
Q

risk factors for cataracts?

A
  • ageing
  • smoking
  • alcohol
  • DM
  • steroids
  • hypocalcaemia
55
Q

presentation of cataracts?

A
  • asymmetrical
  • very slow vision loss
  • progressive blurring
  • change of colour vision (more yellow / brown)
  • “starbursts” in light, esp at night
56
Q

finding O/E of cataracts?

A
  • loss of red reflex

- might be picked up in flash pics

57
Q

management of cataracts?

A
  • if asymptomatic, nothing

- surgically breaking less and replacing with artificial lens

58
Q

why might someone get cataract surgery and still have poor visual acuity afterwards?

A

cataracts can mask other eye conditions (e.g. macular degeneration, DM retinopathy)

59
Q

important complication of cataract surgery?

A

endophthalmitis, secondary to infection

60
Q

management of endophthalmitis?

A

intravitreal ABx

61
Q

causes of abnormal pupil shape?

A
  • trauma from cataract surgery
  • anterior uveitis
  • acute angle closure glaucoma
  • rubeosis iridis
  • coloboma
  • tadpole pupil
62
Q

what is the difference between rubeosis iridis and coloboma?

A
  • RI is caused by neovascularisation secondary to DM (retinopathy)
  • coloboma is congenital
63
Q

key associated condition of tadpole pupil?

A

migraines

64
Q

causes of mydriasis (dilated pupil)?

A
  • CN3 palsy
  • holmes-adie syndrome
  • RICP
  • congenital
  • trauma
  • stimulants (e.g. cocaine)
  • anticholinergics
65
Q

causes of miosis (constricted pupil)?

A
  • horner syndrome
  • cluster headaches
  • argyll-robertson pupil (neurosyph)
  • opiates
  • nicotine
  • pilocarpine
66
Q

how does CN3 palsy affect the eye?

A
  • ptosis
  • dilated, non-reactive (mydriasis) pupil
  • divergent squint
  • “down and out” position
67
Q

which unique feature is found in congenital horner syndrome?

A

heterochromia (different coloured irises)

68
Q

how can you test for horner syndrome?

A
  • cocaine eye drops
  • normal eye will dilate but not in horner syndrome
  • alt: adrenalin eye drops (opposite results)
69
Q

describe the holmes-adie pupil

A
  • unilateral dilated pupil
  • slow light responses
  • pupil gets smaller over time
70
Q

features of holmes-adie syndrome?

A
  • HA pupil
  • absent ankle reflexes
  • absent knee reflexes
71
Q

describe the argyll-robertson pupil

A
  • “prostitute’s pupil”
  • constricted
  • accommodates when focussing on object
  • does not react to light
72
Q

what is blepharitis? what does it predispose to?

A
  • inflammation of eyelid margins
  • styes
  • chalazions
73
Q

management of blepharitis?

A
  • hot compresses
  • gentle cleaning with cotton wool
  • hypromellose drops
  • polyvinyl alcohol drops
  • carbomer drops
74
Q

what is a stye?

A

infection of the sebaceous / sweat glands at base of eyelashes

75
Q

management of a stye?

A
  • hot compress
  • analgesia
  • topical chloramphenicol if conjunctivitis present / persistent
76
Q

what is a chalazion? how does it present?

A
  • blocked meibomian gland

- non-tender swelling

77
Q

management of chalazion?

A
  • hot compress
  • analgesia
  • consider chloramphenicol
  • surgery (last line)
78
Q

what is an entropion? does it hurt?

A
  • eyelid turns in on itself and eyelashes touch the eyeball

- painful

79
Q

complications arising from entropion?

A
  • corneal damage

- ulceration

80
Q

management of entropion?

A
  • taping eyelid down to prevent it turning in on itself
  • lubricating eye drops (to stop dryness)
  • same-day referral if risk to sight
81
Q

what is an ectropion?

A
  • eyelid turning outwards, exposing inner eyelid mucosa

- usually bottom lid affected

82
Q

complication of ectropion?

A

exposure keratopathy, due to dryness

83
Q

management of ectropion?

A
  • mild cases may need nothing
  • regular lubricating eye drops
  • same-day referral if risk to sight
84
Q

what is trichiasis?

A
  • inward growth of eyelashes

- causes pain

85
Q

complications of trichiasis?

A
  • corneal damage

- ulceration

86
Q

management of trichiasis?

A
  • specialist epilation of lashes
  • electrolysis if recurrent cases
  • crytherapy
  • laser treatment
  • same-day referral if risk to sight
87
Q

what is periorbital cellulitis?

A

infection of eyelid and skin in front of eye

88
Q

presentation of periorbital cellulitis?

A
  • swelling around eye
  • redness
  • skin hot to touch
89
Q

key differential of periorbital cellulitis? how can these be distinguished?

A
  • orbital cellulitis

- CT

90
Q

management of periorbital cellulitis?

A
  • PO / IV systemic ABx

- admit and observe if severe

91
Q

what is orbital cellulitis?

A

infection around eyeball involving tissue behind orbital septum

92
Q

features of orbital cellulitis NOT found in peri-orbital cellulitis?

A
  • pain on movement
  • reduced eye movement
  • changes in vision
  • abnormal pupil reactions
  • proptosis
93
Q

management of orbital cellulitis?

A
  • emergency!
  • admit
  • IV ABx
  • surgical drainage if abscess present
94
Q

What is Retinitis pigmentosa?

A

congenital inherited condition where there is a degeneration of rods and cones in the retina

95
Q

Presentation of Retinitis Pigmentosa

A

Night Time blindness

tunnel vision

96
Q

Presentation of Retinitis Pigmentosa

A

Night Time blindness

tunnel vision

97
Q

Investigations for Retinitis Pigmentosa

A

Fundoscopy- bone spicule

98
Q

management of retinitis pigmentosa

A 
Refer to opthal
genetic counselling 
vision aids 
sun glasses 
dvla
99
Q

What is the retinal artery a branch of?

A

Branch of the ophthalmic artery which is a branch of internal carotid artery

100
Q

what is retinal artery occlusion

A

when central retinal artery is blocked usually by atherosclerosis

101
Q

RF for central artery occlusion?

A 
Older age
Family history
Smoking
Alcohol consumption
Hypertension
Diabetes
Poor diet
Inactivity
Obesity

GCA AND PMR

102
Q

most common association for central retinal artery occlusion

A

GCA and PMR

103
Q

Presentation of retinal artery occlusion

A

sudden painless loss of vision

RAPD

104
Q

Investigation for RAO

A

fundoscopy - pale retina with a cherry red spot

105
Q

management for central retinal artery occlusion

A

occular massage
removing fluid from anterior chamber
Carbogen inahllation- dialates artery
sublingual isosorbite nitrate- dialate the artery

IF GCA THEN HIGH DOSE STEROIDS

106
Q

Function of retinal vein

A

drainage of blood from the retina

107
Q

what causes retinal vein occlusion

A

thrombus

108
Q

rf for retinal vein occlusion

A 
Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
Systemic inflammatory conditions such as systemic lupus erythematosus
109
Q

Investigation for retinal vein occlusion

A 
Fundoscopy 
flame and blot haemorrhages 
optic disc oedema 
macula oedema 
FBC 
ESR
CRP
glucose
110
Q

features of retinal vein occlusion

A 
sudden painless loss of vision 
blot haemorrhages 
optic disc oedema 
macula oedema
Neovascularisation due to VEGF release
111
Q

management of retinal vein occlusion

A

REFER
laser photocoagulation
Intra vitreal steroids
anti vegf medication-ranibizumab, aflibercept or bevacizumab

112
Q

What is retinal detatchment?

A

whenb retina separates from chorid underneath allowing for vitreous fluid to get in the space

113
Q

What is posterior vitreous detachment

A
114
Q

RF for retinal detachment

A 
Posterior vitreous detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
Family history
115
Q

presentation of retinal detatchment

A

peripheral vision loss
blurred vision
flashes and floaters

116
Q

management of retinal detachment

A

laser therapy
cryotherapy
vitrectomy
scleral bulking

117
Q

What is the vitreous body?

A

Gel inside the eye that maintains the structure of the eye ball

118
Q

What is posterior vitreous detachment

A

when the membrane that contains the vitreous gel comes away from retina leading to detachment

119
Q

features of posterior vitreous detachment

A 
Painless
Spots of vision loss
Floaters
Flashing lights
Cob web vision 
can progress to retinal detachment in which there is a curtain hanging on the eyes
120
Q

management of posterior vitreous detachment

A

no treatment brain will adjust just exclude retinal tear

121
Q

nb

A
122
Q

what is subconjuctival haemorrhages

Causes

A

rupture of small blood vessels in the conjunctiva causing bleeds between sclera and conjuctiva, appears as bright red patch on eye does nto affect vision and is painless, resolve spontaneously
Heavy lifting, htn, bleeding disorders

123
Q

what is herpes keratitis

A

inflammation of the cornea causes by
Viral infection with herpes simplex
Bacterial infection with pseudomonas or staphylococcus
Fungal infection with candida or aspergillus
Contact lens acute red eye (CLARE)
Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropion)

124
Q

presentation of herpes keratitis

A 
Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced visual acuity. This can vary from subtle to significant.
125
Q

diagnosis for herpes keratitis

A

Staining with fluorescein will show a dendritic corneal ulcer. Dendritic describes the appearance of branching and spreading of the ulcer.

Slit-lamp examination is required to find and diagnose keratitis.

126
Q

management of keratitis

A 
refer 
Aciclovir (topical or oral)
Ganciclovir eye gel
Topical steroids may be used alongside antivirals to treat stromal keratitis
CORNEAL TRANSPLANT
127
Q

TELL ME ABOUT EPISCLERITIS

A

INFLAMMATION OF OUTER LAYER OF SCLERA
NOT PAINFUL, RED WATERING OF EYE
MANAGEMENT- ANALGESIA COLD PRESS MORE SEVRE= NSAIDS

128
Q

TALK TO ME ABOUT SCLERITIS

A 
inflammation of full thickness sclera can lead to necrotising scleritis 
Severe pain
Pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation of the eye
Managment NSAIDS, steroiuds and immunosupression.
129
Q

anterior uveitis

A

inflammation of the iris cilliary body and choroid common with
Ank spond, reactive arthritis and sarcoidosis

130
Q

symptoms of anterior uveitis

A 
dull aching painful red eye 
cilliary flush 
floaters 
photophobia 
excessive tear production 
abnormal shaped eye due to adhesions pulling the iris 
hypopyon
131
Q

management of anterior uveitis

A

steroids
Cycloplegic-mydriatic, paralysing and duialating the pupils- Cyclopentolate and atropine are antimuscarinic medications that blocks to the action of the iris sphincter muscles and ciliary body.

132
Q

What is conjuctivitis
What are its causes
Features?
management

A

inflammation of th econjuctiva- thin layer of skin that covers the sclera
3 types, bacterial viral and allergic
bacterial has purpulent discharge and viral has clear discharge
Unilateral red eye
blood shot
gritty sensation
discharge

bacterial management- chloramphenicol + fusidic acid
allergic- antihistamines

133
Q

Painless red eye VS Painful red eye

A

Painless
Conjunctivitis
Episcleritis
Subconjunctival Haemorrhage

Painful red eye
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury

02F (18 decks)

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