ophthalmology Flashcards
Herpes Zoster Ophthalmicus Mx
oral antiviral (aciclovir)
acute angle closure glaucoma Fx
optic neuropathy due to raise intraocular pressure
severe pain - occular, headache
decreased visual acuity
red eye
haloes around lights
semi dilated non reacting pupil
acute angle closure glaucoma Mx
urgent ophthalmology
1st - eye drops
Pilocarpine (muscarinic antagonist increase outflow)
Timolol (B blcoker reduce aqueous production)
Apraclonidine/ Brimonodine (alpha agonist - reduce aqueous production and increase uveoscleral outflow )
Latanoprost (prostaglandin analogue, increase uveoscleral outflow)
+ IV Acetazolamide
Definitive - laser peripheral iridotomy
Ischaemic/ Vascular loss of vision Causes
Amaurosis fugax - curtain coming down
large artery - thrombosis, embolis, dissection
small artery - anterior ischaemic optic neuropathy, temporal arteritis, hypoperfusion
TIA
central retinal vein occlusion Fx
older people
fundoscopy - severe retinal haemorrhages (flames, blot haemorrhage)
Fx - sudden painless loss of vision
causes - glaucoma, polycythemia, hypertension
central retinal artery occlusion Fx
causes - thromboembolism (atherosclerosis) or arteritis (temporal arteritis)
afferent pupillary defect, “cherry red” spot on retina
vitreous haemorrhage Fx
Causes - diabetes, bleeding disorder, anticoagulant
Fx - sudden loss of vision (large), dark spots (moderate), floaters (small haemorrhage)
retinal detachment Fx
dense shadow starts peripherally moves towards centre
central vision loss, painless
preceded by floaters
posterior vitreous detachment Fx
flashes of light
floaters in peripheral
Red eye DDx (6)
acute angle closure glaucoma - severe pain, decrease vision, DILATED fixed pupil
anterior uveitis - pain, decrease vision, SMALL fixed pupil
scleritis - pain
conjunctivitis - discharge
subconjunctival haemorrhage - Hx coughing/ trauma
endophthalmitis - post intraocular surgery
Stye (hordeolum) Fx
Hordeolum externa (external) - infection (usually staph) of Zeis (sebum) or Moll (sweat) glands
Hordeolum interna (internal) - infection of Meibomian glands
Dry eye syndrome
dry, gritty, sore BOTH eyes
if sticky eyelids, red eye lids - Meibomian gland dysfunction
commonly no abnormality on examination
Punctate fluorescein staining of the cornea is common
relative afferent pupillary defect causes
retina: detachment, artery occlusion
optic nerve: neuritis (eg Multiple sclerosis)
lens dislocation
painless, loss of vision
upwards: marfans
downwards: homocystinuria
ehlers danlos
macular degeneration causes
degeneration of retinal photoreceptors resulting in formation of drusen
older people, smoking, family Hx, cardiovascular disease
Wet vs dry macular degeneration
Dry: 90% cases, Drusen - yellow spots in Bruch’s membrane
Wet: choroidal neovascularisation, worse prognosis
Macular degeneration Fx
reduced visual acuity (particularly near field objects) - gradual loss (day), subacute (wet)
worse night vision
flashing lights
visual hallucinations - Charles-Bonnet syndrome
Macular degeneration Ix
1st - slit lamp
2nd - fluorescin angiography
3rd - ocular coherence
blepharitis Mx
1st - hot compress + mechanical removal of debris (lid hygiene)
2nd - artificial tears
Orbital compartment syndrome
secondary to retrobulbar haemorrhage (eye trauma)
Fx - eye pain, proptosis, rock hard eye lids, RAPD
Mx - emergency/ urgent canthotomy (done by ophthalmology)
Argyl Robertson pupil
Fx - small, irregular pupil, Accommodation reflex present (ARP), Pupilary reflex absent (PRA)
C - diabetes, syphillis
Horners syndrome Fx
miosis (small pupil)
ptosis (droopy eyelid)
enophthalmos (sunken eye)
anhidrosis (loss of sweating on ipsilateral side)
Horners syndrome causes
1. Anhidrosis face, arm trunk (central lesion)
2. Anhidrosis face (pre-ganglion)
3. No anhidrosis (post-ganglion)
- stroke, syringomyelia, MS, encephalitis
- Pancoast Tumour, thyroidectomy, trauma, cervical rib
- carotid artery dissection/ aneurysm, cavernous sinus thrombosis, cluster headache
Keratitis Fx
red eye, photophobia, gritty sensation
keratitis Mx
stop using contact lens
topic Abx (quinolones)
cyclopentolate for analgesia
retinitis pigmentosa Fx
night blindness, tunnel vision
hypertensive retinopathy classification
I Arteriolar narrowing and tortuosity, Increased light reflex - silver wiring
II Arteriovenous nipping
III Cotton-wool exudates, Flame and blot haemorrhages, These may collect around the fovea resulting in a ‘macular star’
IV Papilloedema
corneal abrasion Ix + Mx
Ix - fluorescein uptake (shows yellow stain abrasion)
Mx - topical antibiotic (eg chloramphenicol)
conjunctivities Mx
1st - watch and wait
2nd - topical chloramphenicol (unless pregnant, then topical fusidin)
Corneal abrasion Mx
Ix - Fluorescin stains abrasion GREEN
Mx - Chloramphenicol (abx eye drops)
Wet/ age related macular degeneration retinal changes
choroidal neovascularisation
hypertensive retinopathy retinal change
AV nicking
optic neuritis Fx
painful eye movement
visual loss (sub acute)
loss of colour vision
