Ophthalmology Flashcards
What effect can improving diabetic control have on diabetic retinopathy?
Initial worsening, this will wear off
What are the four stages of diabetic retinopathy?
Mild non proliferative
Moderate non proliferative
Severe non proliferative
Proliferative
What is seen in mild non proliferative diabetic retinopathy?
Microaneurysms
What is seen in moderate non proliferative diabetic retinopathy?
Mild +
Hard exudates
Flame shaped haemorrhages
What is seen in severe non proliferative diabetic retinopathy?
Microaneurysms + one of:
- >4 per quadrantt dot + blot haemorrhages
- >2 quadrants with venous changes
- IRMA
What does IRMA stand for?
Intra-retinal microvascular abnormalities
What characterises proliferative diabetic retinopathy?
Neovascularisation
What is the leading cause of blindness in diabetics?
Diabetic macular oedema (DME)
When is treatment done for DME?
When vision is reduced
What are the treatment options for DME?
Anti-VEGF injections
Focal laser
When is management done for diabetic retinopathy?
If proliferative
What is the management for proliferative diabetic retinopathy?
Panretinal photocoagulation
What causes glaucoma?
Blockage of aqueous outflow across the trabecular meshwork
Name three signs of glaucoma
Raised IOP
Visual field defects
Optic disc cupping
How can you assess someones IOP in glaucoma?
Applanation tonometry
How do most cases of primary open angle glaucoma present?
Incidental finding at routine optician appointments
How do prostaglandins work in glaucoma?
Open up the meshwork to increase uveoscleral outflow
Name a prostaglandin that may be used in glaucoma
Xalatan
What are some possible side effects of prostaglandins in glaucoma?
Increased pigmentation of the irises
Lengthened eyelashes
What is the first line management of glaucoma?
Prostaglandins
Name a parasympathominetic used for glaucoma
Pilocarpine
What side effect can pilocarpine have?
Pupillary constriction = can be painful and can cause dimmed vision
State the order of treatments for glaucoma
1st line = prostaglandin
2nd line = add a beta blocker or carbonic anhydrase inhibitor
3rd line = laser treatment
4th line = ANS influencing drugs
5th line = surgery
What surgery can be done for glaucoma?
Trabeculectomy
How does optic neuritis present?
Loss of colour vision
Dull ache on eye movements
What is the most common cause of optic neuritis and what investigation should be offered in the first episode?
Multiple sclerosis
Offer an MRI
What is the concern when patients have bilateral optic disc swelling?
Papilloedema
What is the direct pupillary response?
Constriction of the pupil light is being shone on
What is the consensual pupillary response?
Constriction of the pupil the light is not being shone on
What is the accommodation response?
Constriction of the pupil when looking at an object up close
What is Horner’s syndrome?
Paralysis of the sympathetic supply to the eye
How does Horner’s syndrome present?
Mild ptosis
Constricted pupil
Reduced sweating
