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Y4 medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

how can you demonstrate a shallow anterior chamber?

A

oblique flashlight test

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2
Q

what can fluorescein drops be used for?

A
  • highlight defects in corneal epithelium
  • assess tear drainage in children with congenital nasolacrimal duct obstruction
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3
Q

what is ciliary flush?

A

present in corneal inflammation, iritis or acute glaucoma
(not seen in conjuctivitis!)
indicative of intraocular inflammation

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4
Q

how are tears produced and where do they drain into/via?

A

produced by the lacrimal gland in the lateral superior portion of orbit - drain through the cannaliculi into the lacrimal sac - then through nasolacrimal duct into inferior meatus to nose

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5
Q

what is the role of tear film? (2)

A

to lubricate the cornea (prevent gritttiness, dryness)
and has antibacterial properties

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6
Q

what muscles move the eyelids and what are they innervated by?

A

orbicularis oculi (palpebral and orbital) -> facial nerve
levator palpebrae superioris -> oculomotor nerve

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7
Q

what is teh ocoulomotor nevres parasympathetic function?

A

innervated the sphincter pupillae - causing miosis

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8
Q

what is a chalazion?

A

painless swelling of eyelid cuased by obstruction to the tarsal glands

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9
Q

what is a stye?

A

infection of the eyelash follicle, sebaceous glands of eye or sweat glands of eye

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10
Q

what is the uvea made up of?

A

the ciliary body, iris and choroid

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11
Q

what are te three roles of the cornea?

A
  1. maintaining transparency
  2. ocular portection (corneal reflex)
  3. refraction of incomign light (along with overlying tear film)
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12
Q

what is a hypopyon?

A

collection of fluid (pus/exudate) in lower anterior chamber

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13
Q

what are cataracts?

A

loss of transparency to the lens from disruption to the lens fibre, capsule or epithelium

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14
Q

what are the commonest cuases for cataracts?

A
  • OLD AGE !
  • trauma - injury to lens
  • drugs - steroids, amiodarone
  • systemic disease - DM, myotonic dystrophy, neurofibromatosis type 2
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15
Q

what is the treatment fro cataracts?

A
  • phacoemulsification - entry to eye via limbus, circular incision made to anterior lens capsule, cataractous lens in removed using US and replaced with a plastic lens calculated to correct patients refractive error
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16
Q

symptoms fo anterior uveitis?

A

photophobia, pain, reduced vision, watery eye

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17
Q

what are the signs of anterior uveitis?

A

circum-corneal injection, cellular deposits on corneal endothelium (keratic ppts), cells and flare in anterior chamber derived from leaky iris blood vessels, posterior synechiae,

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18
Q

name some of teh conditions that would present with an RAPD

A
  • optic neuritis
  • CRAO
  • macular degenration
  • trauma
  • tumour compressing optic nerve
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19
Q

name some of teh conditions that would present with an RAPD

A
  • optic neuritis
  • CRAO
  • macular degenration
  • trauma
  • tumour compressing optic nerve
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20
Q

what is the immediate managemnt for acute angle closure glaucoma?

A

IV Acetazolamide

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21
Q

what is blepharitis?

A

inflammation fo teh lid margin chracterised by lid crusting, redness, telangectasia, misdirected lashes

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22
Q

treatment for blepharitis?

A
  • lid hygeine
  • topical ABx
  • lubricants
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23
Q

what is trichiasis?

A

inward turnign lashes

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24
Q

what can cuase trichiasis?

A
  • idiopathic
  • secondary to chronic blepharits
  • herpes zoster opthalmicus
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25
Q

what are the symptoms of trichiasis?

A

foreign body sensation
tearing

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26
Q

Tx for trichiasis?

A
  • lubricants
  • epilation
  • electrolysis - few lashes
  • cryotherapy - many lashes
27
Q

Tx of an acute chalazion?

A

hot compresses
topical antibiotic ointment
incision and drainage once the infection subsided

28
Q

difference between a style and chalazion?

A

both staph infections but chalazium is ifnection of meibomian gland and stye is staph infection of lash follicle

29
Q

Tx of stye?

A
  • hot compresses
  • epilatoin of lash associated with the infection follicle
  • topical antibiotic ointment
30
Q

symptoms of bacterial conjuctivits?

A
  • subacute onset
  • redness
  • grittiness
  • burning
  • mucopurulent discharge
  • often bilateral
  • no photophobia
31
Q

signs of bcaterial conjuctivitis?

A
  • crusty lids
  • conjunctival hyperaemia
  • mild papillary reaction
  • lids and ocnjuctive may be oedematous
32
Q

Tx of bcaterial conjuctivitis?

A

topical antibiotics effectvie in 2-7 days (except in severe infections)
chloramphenicol or fusidic acid appropriate frist line treatments

33
Q

Tx for allergic conjuctivits?

A
  • cold compresses
  • remove (reduce) allergen
  • NSAIDs
  • antihistamines oral/topical (olapatanol)
  • mast cell stabilisers
  • topical corticosteroids
  • immunosupressants (cyclosporin) fro steroid resistant cases
34
Q

symptoms/signs of episcleritis?

A
  • often symptomatic
  • mild tearing/irritation
  • tender to touch
  • vessels blanch with phenylephrine
35
Q

Tx for episcleritis?

A
  • lubricants
  • NSAIDs
  • rarely low dose steroids (predsol)
36
Q

symptoms and signs of scleritis

A

pain
significant ocular tenderness to movement and palpation
watering and photophobia
apperance bluish-red - difference to episcleritis which appears red/pink (localised, diffuse, nodular)

37
Q

Tx for scleritis?

A
  • treat underlyign condition
  • NSAIDs
  • corticosteroids
  • immunosuppression
38
Q

what is a pterygium?

A

fibrovascular growth from the conjuctiva onto the cornea

39
Q

Tx for a pterygium?

A

excision of pterygium - covering of defect with a conjuctival autograft or amniotic membrane
adjuvant mitomycin - reduce recurrent

40
Q

symptoms of a pt with a corneal abrasion/foreign body?

A
  • severe pain esp with blinking
  • increased watering
41
Q

how to treat a pt wth a corneal foreign body?

A
  • remove FB with cotton bud if able under topical aneasthetic
  • chloramphenicol ointment, cyclopenate, double pad

(if abrasion crossing visual axis then refer)

42
Q

what is bacterial keratitis?

A

infection of the cornea

43
Q

what are teh common organisms cuasing bacterial keratitis?

A
  • staph aureus
  • strep pyogenes
  • strep pneumoniae
  • pseudomonas aeruginosa
44
Q

what are the predispositions whihc increase your chance of developing bacterial keratitis

A
  1. contact lens wear - extended wear - soft lenses
  2. pre existing chronic corneal disease e.g. neurotophic keratopathy
45
Q

signs and symptoms of bacterial keratitis?

A
  • ocular pain
  • watering and discharge
  • foreign body sensation
  • decreased vision
  • photophobia
  • corneal lesion (ulceR) may be visible
  • corneal oedema
  • hypopyon
46
Q

what Ix are done to test for bacterial keratitis?

A
  1. blood agar (for most fungi and bacteria except neisseria)
  2. chocolate agar (for neisseria and moraxella)
  3. sabourand agar (for fungi)
47
Q

Tx for bacterial keratitis?

A
  • ofloxacin eye drops (initally hourly then 2 hourly)
  • cyclopentolate tds
  • steroids when culture become sterile and evidence of improvement (7-10 days after initiation of treatment)
48
Q

what si herpes simplex keratitis?

A

infection of cornea as a result of reactviation of latent herpes siples virus type I
migrates down branch of the trigeminal nerve to cornea

  • hx of cold sores and rundown/stress
49
Q

Tx for herpes simplex keratitis

A
  • topical aciclovir ointment 10-14 days
  • cyclopentolate
    (- 1st episode aciclovir for up to 1 year as prophylaxis)
    (- topical steroids to minmise scarring)
50
Q

Tx for herpes zoster?

A
  • oral aciclovir within 48 hrs of onset of vesicles (for 7 days)
  • aciclovir oitment within 5/7 days of vesicles
51
Q

what is anterior uveitis?

A

inflammation of the anterior uveal tract
- associated with systemic disease (e.g. IBD), caused by infection or post trauma, post-op

52
Q

Tx of anterior uveitis (iritis)?

A
  • mydriatric/cycloplegics to break synechiae, comfort
  • topical steroids, depending on severity, initially can be 1/2/ hourly
  • may need sub conjuctival steroid if very severe

complete CXR, lumbar XR, autoimmune serology, HLA B27 for bilateral or severe cases

53
Q

name some predisposing and anatomical factors for acute angle closure?

A
  • age average 60 yrs
  • F:M 4:1
  • 1/1000 caucasian, 1/100 asians
  • hypermetropia (long sighted)
  • FHx
  • anterior location of iris-lens diaphragm
  • shallow anterior chamber
  • floppy iris
54
Q

signs and symptoms of acute angle closure?

A
  • severe ocular pain
  • headache
  • N+V
  • decreased vision
  • coloured haloes around lights
  • photophobia
  • semi dilated non reactive pupil
  • corneal oedema
  • shallow AC
  • flare in AC
  • raised IOP
  • tense on palpation
55
Q

what is the treatment for acute angle closure?

A
  • medical: to lower the IOP
  • topical steroid
  • iopidine
  • pilocarpine
  • IV acetazolamide

surgery: laser iridotomy
- prophylactic to other eye

56
Q

difference btween pre septal cellulitis and orbital cellulitis?

A
  • preseptal: infection of subcut tissues anterior to orbital septum
  • orbital cellulitis: infection and inflammation within the orbital cavity producing orbital signs and symptoms
57
Q

signs and symptoms of preseptal cellulitis?

A
  • erythema
  • induration
  • tenderness of eyelid
  • swelling
58
Q

signs and symptoms of orbital cellulitis?

A

all the signs and symptoms of preseptal cellulitis +
proptosis
chemosis
ophthalmoplegia
decreased visual acuity

59
Q

Tx of preseptal cellulitis?

A

augmentin or cephalosporin
warm compresses
topical ABx fro concurrent conjuctivitis
(admit paeds pts)

60
Q

Tx of orbital cellultis?

A

immediate referral
needs admission for iv ABx
+/- imaging

61
Q

Tx of chemical injuries of the eye

A
  1. copious irrigation asap
  2. instill a drop of topical anaesthetic if available (proparicaine)
  3. squeeze copious amounts of solution into eye and direct towards the temple away from unaffected eye
  4. irrigate under teh lids
  5. after several mins of irrigation - check pH of eye by placing litmus paper into inferior fornix
  6. if pH not neutral then continue irrigation until pH neutralised
  7. recheck pH 30 mins after neutralisation as pH can rise again after irrigation stopped
  8. requires emergent referral to opthalmologist
62
Q

what is a hypema?

A

blood in anterior chamber - requires emrgent referral to an opthalmologist fro treatment

63
Q

what is the treatment for a hyphaema?

A

strict bedrest
topical steroids
topical cycloplegic agents
admit to hosp if young
need daily exams for 5 days including measurement of intraocular pressure

64
Q

which eye muscle can get trapped with an orbital blowout fracture?

A

inferior rectus muscle trapped inferiorly - prevents eye moving superiorly

Y4 medicine (18 decks)

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