Ophthalmology Flashcards
How does dry age-related macular degeneration present?
Patients suffer a progressive loss of central vision over years/decades.
The typical patient presents complaining of difficulty in reading text, recognizing faces and problems with vision in dim light.
Visual fluctuation is a classic feature, day by day vision may appear to deteriorate and improve unpredictably.
Fundoscopy shows drusen (protein deposits) at the macula.
How does wet age-related degeneration present?
Patients suffer a progressive loss of central vision over months.
The typical patient may complain of difficult reading text, recognizing faces and seeing in dim light.
Visual fluctuation is another feature that may present.
Fundoscopy shows macular oedema.
When do we need to treat amblyopia by?
Treatment of amblyopia must be started at an early age and the critical period is up to 8 years old. The good eye is normally patched. Amblyopia treatment is rarely successful in the second decade of life.
How does keratitis present?
Keratitis presents with an acute-onset of eye pain, watering, photophobia and reduced vision. It is commonly caused by trauma or viral infection e.g. herpes simplex.
How do we manage keratitis?
Keratitis requires rapid treatment to reduce the risk of permanent visual loss. Keratitis caused by viral infection may be treated with topical antiviral drops. Traumatic keratitis requires referral to ophthalmology for consideration of corticosteroid treatment.
How does Bell’s Palsy present?
It is characterised by:
Acute (but not sudden) onset, unilateral, lower motor neuron facial weakness, sparing the extraocular muscles and muscles of mastication.
Mild-moderate postauricular otalgia (which may precede paralysis).
Hyperacusis (actually quite uncommon).
Nervus intermedius symptoms (altered taste and dry eyes/mouth).
It should be noted that, while there are no objective facial somatosensory disturbances, patients may describe “numbness” or “heaviness”.
What is blepharitis? How does it present?
Blepharitis is a common condition describing eyelid inflammation.
Common causes are Staphylococcus, Seborrheic dermatitis and Rosacea.
Patients often present with sore, itchy eyelid margins with a crusty appearance at the base of the eyelashes.
The condition cannot be cured, but it very rarely causes damage to eyesight.
Treatment is aimed at controlling the symptoms with good eyelid hygiene.
Warm compresses should be applied twice daily to clean debris from the eyelid margins.
Give two complications of cataract surgery
Endophthalmitis is the most dangerous complication and the first thing any doctor should rule out when presented with a patient complaining of visual symptoms following intraocular surgery. Patients typically present within days of surgery with severe pain, loss of vision and hyperaemia. They should be admitted and seen immediately by an ophthalmologist.
Posterior lens capsule opacification is a relatively common complication of cataract surgery that usually occurs a few weeks following the operation. The typical patient complains of blurry vision as if their cataract has returned, and a white opacity may be visible on observation. The condition can be treated easily with a simple laser procedure which can be carried out as an outpatient.
How does central retinal vein occlusion present?
Sudden, painless loss of vision
How does central retinal vein occlusion appear on fundoscopy?
The classic view on fundoscopy is that of widespread hyperaemia and haemorrhages, often likened to a ‘stormy sunset’
What is chronic open-angle glaucoma? How does it present?
Chronic open angle glaucoma refers to optic neuropathy with death of optic nerve fibres, with or without raised intraocular pressure.
Assessment of visual fields reveals loss of peripheral fields as well as a central scotoma in advanced disease. Fundoscopy may reveal optic disc cupping, where the cup appears large in relation to the optic disc.
What is corneal acrus?
Corneal arcus occurs as a result of lipid deposition in the periphery of the cornea and appears as a white, blue or grey opaque ring.
Common in hyperlipidaemia or hypercholesterolaemia
How does diabetic retinopathy present on fundoscopy?
The fundoscopy signs are important to recognise.
Signs that signify milder disease are: ‘dots’ (microaneurysms), hard exudates (lipid deposits) and ‘blots’ (haemorrhages).
Signs that signify significant ischaemia and thus more severe disease are: engorged tortuous veins, cotton wool spots, and large ‘blot’ haemorrhages.
Give five differentials of gradual visual loss
Cataract
AMD
Chronic open angle glaucoma
Diabetic maculopathy
How do we treat endopthalmitis?
IV vanc as most common causative bugs are gram positive
How do we distinguish between episcleritis and scleritis?
Clinical features include a deep boring pain that wakes the patient up at night combined with a severely red eye.
As the inflammation affects the superficial episcleral as well as the deep scleral vessels, topical vasoconstrictors such as 10% phenylephrine do not cause blanching of the eye and this can be used to help distinguish episcleritis from scleritis.
In what condition do you see dendritic ulcers?
Pathognomonic for herpes simplex keratitis
Presents with pain, photophobia and epiphora
What are the four grades of hypertensive retinopathy?
Grade I – Vascular attenuation (or narrowing of the retinal arteries)
Grade II – Above + AV nipping
Grade III – Above + retinal haemorrhages, hard exudates and cotton wool spots
Grade IV – Above + optic nerve oedema
Who is idiopathic intracranial htn most common in? How do we treat it?
Most common in obese women
First line management of idiopathic intracranial hypertension (and the only intervention supported by good evidence) is weight loss.
Failing this, patients often try carbonic anhydrase inhibitors, such as acetazolamide, but its extensive profile of side effects (peripheral paraesthesia, anorexia and metallic dysgeusia) mean that it is poorly tolerated. Topiramate and furosemide are also commonly tried.
What is the first line ix for an intra-ocular foreign body?
CT scan
How does ischaemic optic neuropathy present?
Generally, patients present with sudden onset monocular vision loss and colour blindness.
On examination, a relative afferent pupillary defect is often elicited.
Optic disc swelling or pale optic disc on fundoscopy
What is the most common cause of arteritic anterior ischaemic optic neuropathy (AION)
GCA
Where do you see a classic “pizza pie” appearance on fundoscopy?
Cytomegalovirus retinitis, most common ocular opportunistic infection seen in HIV
Give four important differentials of ocular pain
Acute angle closure glaucoma
Anterior uveitis
Scleritis
Corneal ulcer
