Ophthalmology Flashcards
What are the causes of sudden painful visual loss?
How do you differentiate them clinically
Closed angle glaucoma: Red eye, hazy cornea, dilated pupil
Anterior uveitis: flush, iris pus, fixed oval pupil
Optic neuritis: central loss, colour loss, RAPD, worse on movement
Giant cell arteritis: Painful jaw/ scalp
What are causes of painless sudden visual loss?
How do you distinguish them?
Amaurosis fugax: ‘curtain coming down’,
Central retinal artery occlusion: RAPD, ‘cherry red’ spot on pale retina
Central retinal vein occlusion: retinal haemorrhages
Vitreous haemorrhage: Dark spots, diabetics, anticoagulants
Posterior vitreous detachment: Flashes and floaters
Retinal detachment: Dense shadows peripheral to central; curtain over visual field
Name and distinguish the causes of gradual visual loss?
Cataracts: ‘starbursts’ at night, red reflex loss
ARMD: central field loss, wavy appearance to straight lines
Diabetic retinopathy: blurred, blotched vision, ‘cotton wool’ spots
Chronic open angle glaucoma: peripheral loss, halos, can be painful
How do you manage acute angle closure glaucoma?
Urgent referral to ophtho
Improve flow: pilocarpine and apraclonidine
Reduce secretions: B-blocker IV acetazolamide
*Blockers/inhibitors block production, agonists improve flow, a–agonists do both)
How do you manage anterior uveitis
Urgent Ophtho review
Dilate eye with atropine, cyclopentate
Steroid eye drops for inflammation
How do you manage optic neuritis
Give high dose steroids
MRI for white matter lesions (>3 measns 50% MS risk in 5 yrs)
How do you treat giant cell arteritis?
Give high dose glucocorticoids (IV methylprednisilone if evolving changes prior to pred)
Optho review same day
Artery biopsy
How do you treat amaurosis fugax?
Aspirin 300mg as per stroke
How do you manage
CRVO
CRVO
Macular oedema: Anti-VEGF
Neovascularisation: Lasering
How are vitreous haemorrahge and retinal detachment managed?
Urgent Ophtho review
How are cataracts managed?
If visual impairment, QOL and patient choice are fitting, lens replacement
How is age related macular degeneration investigated and managed?
Investigations
1st: Slit lamp
+ fluoreiscin angiography if neovascular suspected
Management
vitamins A, C, E
VEGF if wet/neovascular
+ laser photocoagulation to slow progression
How is diabetic retinopathy categorised?
Non-proliferative
Mild: >=1 microaneurysm
Moderate: Cotton wool spots, hard exudates
Severe: Blot haemorrhages in 4 quadrants, venous bleeds in 2
Proliferative
neovascularisation
Maculopathy
How do you manage diabetic retinopathy?
All: Optimise cardiac risk factors, regular review
Non-proliferative: Observe, laser photocoag if severe
Proliferative: laser coagulation
Maculopathy: VEGF if visual acuity change
How do you investigate primary open angle glaucoma?
Fundoscopy: cup/disc 0.7 pallor and bayonetting of vessels
Slit lamp, tonometry to confirm
How do you tell the difference between keratitis and conjunctivitis?
Keratitis // Conjuncitvitis
hypopyon, contact lense // discharge if infective, seasonal, atopic history if allergic
How do you manage keratitis?
Refer to Ophtho same day for slit lamp
Stop contact lenses
Quinilone antibiotics
Cycloplegics for pain
How do you investigate and treat herpes simplex keratitis?
Immediate referral to Ophtho
Fluoreiscin staining shows corneal ulcer
give oral aciclovir
What organism is responsible for keratitis that is
Bacterial
Fungal
Viral
Bacterial: S. aureus, P. aeringuosa (contacts)
Fungal: Acanthomoebic (soil, contaminated water)
Viral: Herpes simplex
How do viral, bacterial and allergic conjunctivitis differ
Demographic
Symptoms
Treatment
Pathogen
Viral // Bacterial // allergic
Adults // Children // equal
Watery discharge, URTI // Thick discharge // watery discharge, itch
Self-limiting 1-2w // if 5-7d, chloramphenicol // antihistamine –> mast cell stabilisers
adeno, HSV // S. aureus, chlamydia, gonorrhea // NA
What is the difference between esophoric and exophoric ambylopia?
How are they managed
Eso: Inward, Exo: Outwards
Covering good eye causes other to move opposite way
Refer for Ophtho
Specs/patch good eye/corrective surgery
*tropia if all the time, phoria if sometimes*
Which ophtho meds cause
brown pigmentation, eyelash growing
Hyperaemia, adversity in MAOIs or TCAs
Headaches, blurred vision
PGE analogues (lantaprost)
sympathomimetics (brimonidine)
pilocarpine
What nerve damage causes the following
Down + out eye, dilated eye
Up and outward rotation, vertical diplopia
Eye cannot abduct
3rd nerve (oculomotor)
4th nerve (superior oblique)
6th nerve (abducens)
What is the difference between a Holmes-Adie pupil and Argyll-Robertson?
HA: Unilateral dilation, slow dilation following constriction; will get smaller over time. +/- ankle and knee reflex loss
AR: Constricted pupil that accomodates but does not react. Neurosyphilis.
Name the location of the lesion and the associated pathologies
- Optic nerve: ipsilateral loss (neuritis, ischaemia, trauma)
- Optic chiasm central: bitemporal hemianopia (adenoma, suprasellar aneurysm)
- Optic chiasm lateral: ipsilateral monocular hemianopia (3rd ventricle distension, IC/PCA atheroma)
4. Optic tract: contralateral homonymous hemianopia (MCA stroke and tumours)
5. Occipital cortex: contralateral homonymous hemianopia with macular sparing (PCA stroke, trauma)
Contralateral homonymous quandrantopia is associated with
MCA stroke, tumour and trauma
What’s this?
Normal retina
Whats this?
Central retinal artery occlusion
Whats this
Central retinal vein occlusion
Whats this?
Maculopathy
Advanced diabetic retinopathy
Whats this?
ARMD
