Ophthalmology Flashcards
Symptoms of acute closed angle glaucoma
Severe pain
Reduced acuity
Haloes around light
Semi-dilated non reactive pupil
Hazy pupil
Hypermetropia
Pain worse with mydriasis- may be caused by mydriasis drop
Management of acute closed angle glaucoma
Urgent referral
IV acetazolamdie
Eyedrops
Beta blockers and para agonist
Pilocarpine- contract ciliary muscle- cholinergic agonist
Timolol- decrease production - beta blocker
Brimonidine
Definitive- laser iridotomy
Primary open angle glaucoma symptoms
Peripheral vision loss- nasal scotoma
Decreased acuity
Optic disc cupping- larger centre (cup)
Can have normal pressure
Increased cup to disc ratio
Myopia
Risk factors for POAG
Family history- need screening from 40
Steroids
DM
Tx of POAG
Beta blocker- timolol
Prostaglandin analogue- Iatanoprost
Causes of gradual vision loss
Common- DM, open able glaucoma, age related macula degeneration, cataracts
Rare- retinitis pigmentosa, HTN, optic atrophy
Symptoms of ARMD
Central vision loss
Worse at nigh t
Blurring of small words
Straight lines curvy
Dry- white fluffy spots- fat deposits
Causes of sudden vision loss
Anterior ischaemic optic neuropathy
Optic neuritis
Vitreous haemorrhage
Retinal detachment
Retinal vessel occlusion
Anterior ischaemic optic neuropathy symptoms and causes
Posterior ciliary arteries damaged
Artieritic- GCS
Non- HTN, DM, lipids
Sudden visual loss, RAPD
Key questions of sudden loss of vision
Headache- GCA
Eye movements - optic neuritis
Lights- detached retina
Like curtain- vessel occlusion
Poorly controlled DM- vitreous bleed
Key questions of sudden loss of vision
Headache- GCA
Eye movements - optic neuritis
Lights- detached retina
Like curtain- vessel occlusion or retinal
Poorly controlled DM- vitreous bleed
Photophobia- anterior uveitis
Optic neuritis sx
CRAP
Centeal scotoma
RAPD
Acuity Loss
Pain on Eye movements
Cause of optic neuritis
MS
Vitreous haemorrhage sx
Small bleed- small black dots in vision
Large- loss of red reflex- retina not visualised- redness obscuring fundoscopy
Worse when lying flat
Fundoscopy- red with bleed
Caused by new vessels in DM
No pain
Retina detachment sx
Caused from DM- due to scarring
Curtain coming down
Peripheral to central vision loss- gradual
Floaters
Flashes
Field loss
Fall in acuity
Painless
Fundoscopy- tear and half is one yellow colour
Fundoscopy showing of AION, optic neuritis, vitreous haemorrhage, retinal detachment
AION- pale optic disc
Optic neuritis- swollen optic disc - oedema around it
VH- bleed- red
RD- macula lifts off retina
Types of retinal vessel occlusion
CRAO- sudden painless, total loss of vision+ RAPD
BRAO- sudden painless- partial LOV
Cherry red spot
Occurs centrally
CRVO- ischaemic- Suden painless, TLOV +RAPD
Non- ischaemic- mild-mod LOV
BRVO- asymptomatic unless involving macula
Diabetic retinopathy stages
Background- hard exudates, micro aneurysms, blot haemorrhages
Pre-prolif- cotton will spots- patch of ischameia
Proliferative- angiogenesis
Maculopathy- hard exudates near macula
Mx of DM retinopathy
Background- glycemic and BP control
Proliferative- pan retinal photocoagulation and inftervitreal anti VEGF
Maculopathy- grid/focal retinal photocoagulation
Cataracts symptoms
Haloes
Blurred vision
Increased myopia- near sighted
Loss of red reflex
Near vs far sighted
Near- see near objects- myopia- good at concentrating or eye too long
Far objects infant of retina
Need Concave lens
Far sighted- hyperopia , see far away, Cant concentrate near objects, eye too short
Give convex lens
Red flags
Photophobia, poor vision, fluorescing staining, abnormal pupil, haloes
Anterior uveitis sx
Pain, photophobia, reduced acuity- worse pain when using eye
Uvea- iris, ciliary body, choroid
Irregular small pupil
Ciliary flush
Conditions with acute uveitis
IBD, sarcoid, behcets, seronegative arthopathies
Mx of anterior uveitis
Refer
Prednisilone drops and cycloplegics drops
Anterior uveitis vs glaucoma
Both painful and reduced acuity
Photophobia with AU
Hazy cornea with glaucoma
Pupil large in glaucoma but small in AU
High IOP in glaucoma- tonometry
Scleritis vs conjunctivitis
Scleritis- severe pain, worse on movement , blue tinge
Conjunctivitis- discharge , discomfort
Corneal abrasion sx
Pain, photophobia, blurred vision
Caused by trauma
Corneal ulcer sx
eye pain
photophobia
watering of the eye
Caused by bacteria, viral- HSV
Visual loss- emergency
Ix for corneal damage
Fluorescein staining
Mx of corneal ulcer
Referral to ophthalmology
Topical Abs
Different type of vessel occlusion on fundoscopy
Artieral- pale
Central- all
Branch- patch
Venous- haemorrhage- cheese and tomato pizza
Central- all
Branch- patch
orbital cellulitis Sx
Inflammation of orbit
Lid swelling
Pain on movement
Tx of orbital cellulitis
Referral to opthalmo
IV ABx
Dx between periorbital and orbital cellulitis
No pain
No acuity loss
No proptosis
Cause of floaters
Retinal detachment
Vitreous haemorrhage
Innervation of the pupil
Parasympathetic- oculomotor- constriction
3rd nerve palsy- dilatation
Sympathetic- dilation
Mx of age related macular degeneration
Dry- vitamin and zinc
Wet- Anti VEGF
Ix of ARMD
Ampler grid
Fundoscopy- yellow deposits
Types of ARMD and how they differ
Dry- yellow spots, chronic - Drusen- over years
Wet- fluid leak, haemorrhage, more acute- over months
Choroidal neovascularisation
Latanoprost SE
Increase in eye lash length
RF for retinal detachment
Myopia- due to large eye more pressure
DM
Age
Trauma
Episcleritis vs scleritis vs conjunctivitis
Scleritis- pain, worse With movement, associated with inflammatory conditions
Injected vessels do not move, blue tinge
Episcleritis- painless, injected vessels move, eye redness improves with phenylephrine
Conjunctivitis- sore, with discharge
RF of cataracts
DM
long term CS
Hypocalcaemia
Organism for keratitis
Staph
Pseudomonas aeruginosa if contact lens
Hypopyon
Leukocytes in anterior chamber due to severe inflammation
Sx of keratitis
Red eye
Photophobia
Gritty sensation
Hypopyon
Mx of stye
Analgesia and warm compress
Mx of foreign body in eye
Refer to opthalmo
Due to infection risk
Red eye after surgery
Endophthalmitis
Screening for ophthalmology chronic glaucoma
Screening from 40
Cream-coloured swirl with the bright red on fundosscooy
Retinal detachment
RF for glaucoma
Hypermetropia, old age, female FHx
If shingles goes to nose what is patient at risk of
Anterior uveitis
RF for retinal detachment
Myopia
Prev eye surgery
Trauma
Bilateral grittiness in both eyes
Blepharitis
Herpes zoster ophthalmicus
Varicella reactivation in opthalmic distribution
Endophthalmitis sx
Inflammation of the aqueous and/or vitreous humour, is a rare but recognised complication of cataract surgery
Periphlebitis, pain, red eye,
Definitive management of ACAG
laser peripheral iridotomy
Stages of HTN retinopathy
I Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II Arteriovenous nipping
III Cotton-wool exudates
Flame and blot haemorrhages- dark
IV Papilloedema
Causes of Horners syndrome
anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery- usually painful
Squint Mx
Refer to secondary care
Eye patch to prevent amblyobia
Fresh water swimming with contact lens can cause
acanthamoebic keratitis
Elderly patient dizzy on extension of neck
Vertebrobasilar ischaemia
Scleritiis mx
Urgent referral
Corneal ulcer mx
Topical acyclovir and referal
Argyll Robertson vs Holmes pupil
Argyll- bilateral small pupils
React poorly to light
But briskly to accommodation
Midbrain or syphillis
Holmes- reacts slowly to light and accommodation
Absent leg reflexes
Anisocoria worse in bright light implies a problem with the dilated pupil
Ix of refractive error
Pin hole occluder
Scleritis risks to eye
Globe perforation
Papiloedema fundoscopy
Blurring of optic disc margin
Herpes zoster ophthalmicus mx
Herpes on eye- or on tip of nose
Oral aciclovir
Firm painless lump in eyelid
chalazion
Dx of squint
Cover test
Look at object and cover one eye and observe movement
Tx of blepharitis
Warm compress and clean debris
Stye can be present
Latanoprost moa
Increase uveoscleral outflow
Contact lens wearing with red gritty eyes mx
Contact lens wearers who present with a red painful eye should be referred to eye casualty to exclude microbial keratitis
New flashes or floaters mx
Same day opthalmo assessment
Retinopathy due to hydroxy px
Painless reduction in acuity
Entropion
inward turning of the eyelid margin
Tx of cataracts
Surgery- if visual impairment
Unilateral decrease in visual acuity over days and has poor discrimination of colours, red desaturation.
Optic neuritis
Change in colours- red in one eye and washed out in the other
Assocaited with scleritis
rheumatoid arthritis: the most commonly associated condition
systemic lupus erythematosus
sarcoidosis
granulomatosis with polyangiitis
Classifying diabetic retinopathy
Non-proliferative diabetic retinopathy
Mild NPDR (background)
1 or more microaneurysm
Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots, venous beading/looping
Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
Proliferative- neovascularisations
