Ophthalmology Flashcards
Meaning of amblyopia, anisocoria, miosis, mydriasis, myopia, hyperopia?
Amblyopia = “lazy eye”
Anisocoria = difference in pupil size
Miosis = small pupil
Mydriasis = large pupil
Myopia = short sighted
Hyperopia = far sighted
Nervous control of extraocular muscles?
Lateral rectus (CN VI)
Superior oblique (CN IV)
Superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae superioris (CN III)
Homonymous hemianopia lesion sites?
Occipital lobe
Optic tract
Optic radiations
Bitemporal hemianopia lesion site?
Optic chiasm
Homonymous quadrantanopia lesion site?
Superior quadrantanopia = inferior optic radiation (temporal lobe)
Inferior quadrantanopia = superior optic radition (parietal lobe)
Features and main cause of CN III palsy?
Eye “down and out”
Ptosis
Mydriasis
Main cause = cranial aneurysm
N.B. painful CN III palsy is indicative of a posterior communicating artery aneurysm
Features and main cause of CN IV palsy?
Eye “up and in”
Vertical diplopia
Head tilt to compensate
Main cause = trauma
Features and main cause of CN VI palsy?
Eye turned inwards
Horizontal diplopia
Main cause = raised ICP
Classification of strabismus?
Direction of deviation:
→ nasally = esotropia
→ temporal = exotropia
→ superiorly = hypertropia
→ inferiorly = hypotropia
Investigation and management of strabismus (squint)?
Corneal light reflection test
Management = ophthalmology referral, eye patch to prevent amblyopia
Features and management of infective conjunctivitis?
Sore, itchy, red eyes
Excessive discharge
No change in visual acuity
Management = usually self-resolving, chloramphenicol (non-pregnant), fusidic acid (pregnant)
Red flag in suspected conjunctivitis and why?
Photophobia (suggests corneal involvement)
Features and management of allergic conjunctivitis?
Sore, itchy, red eyes
Eyelid involvement
Seasonal symptoms
PMH atopy e.g. eczema
Management = antihistamines (1st line), mast cell stabilisers (2nd line)
Most common cause of keratitis in contact lens wearers vs non-contact lens wearers?
Wearers = pseudomonas auerginosa
Non-wearers = staphylococcus aureus
Keratitis organism in soil or contaminated water?
Acanthomoeba
Features and management of keratitis?
Acute red eye
Gritty sensation
Loss of visual acuity
Photophobia
Hypopyon, corneal ulcer
Anterior chamber reaction (cells and flare)
Management = topical quinolone + cycloplegic drops
Main cause of a corneal ulcer?
Infection e.g. keratitis
HSV keratitis feature and management?
Dendritic ulcer on fluorescein stain
Management = topical aciclovir
Most common condition associated with scleritis vs episcleritis?
Scleritis = rheumatoid arthritis
Episcleritis = IBD
Features and management of episcleritis?
Acute red eye
Classically not painful
Increased lacrimation
Management = supportive e.g. artifical tears
Features and management of scleritis?
Acute red eye
Classically painful
Increased lacrimation
Loss of visual acuity
Management = NSAID (1st line), steroid (2nd line)
Test to differentiate scleritis from episcleritis and explain?
Phenylephrine eye drops
→ blanches conjunctival and episcleral vessels but not scleral
→ if redness improves, episcleritis diagnosed
Most common causes of blepharitis?
Meibomian gland dysfunction
Seborrhoeic dermatitis
Staphylococcal infection
Features and management of blepharitis?
Gritty, sore eyes
Eyes stuck together on waking
Styes and chalazions
Management = hot compress + lid hygeiene
Features and management of anterior uveitis (iritis)?
Acute red eye
Photophobia
Ciliary flush
Small, oval pupils
Hypopyon
Loss of visual acuity
HLA-B27 associations
Anterior chamber reaction (cells and flare)
Management = steroid + cycloplegic drops
Features and management of periorbital cellulitis?
Generally unwell e.g. fever
Red and swollen eye
Ptosis
Management = admission + oral antibiotics
Features and management of orbital cellulitis?
Generally unwell e.g. fever
Red and swollen eye
Proptosis
Pain on eye movement
Management = admission + IV antibiotics
Investigation for suspected orbital cellulitis?
Contrast CT head
What are glaucomas?
Optic neuropathies associated with raised ICP
Features, investigations and management of acute angle-closure glaucoma?
Acute, severe pain
Loss of visual acuity
Haloes around lights
Nausea and vomiting
Dilated, nonreactive pupil
Investigations = tonometry (IOP), gonioscopy
Management = timolol + pilocarpine + acetazolamide (acute), laser peripheral iridotomy (definitive)
Features and management of primary open-angle glaucoma?
Insidious onset
Peripheral visual loss
Loss of visual acuity
Optic disc cupping
Management = treat if IOP ≥24 mmHg, SLT surgery (1st line), medication (2nd line)
Normal cup-to-disc ratio?
0.4-0.7
Mechanism of action of latanoprost vs pilocarpine vs acetazolamide vs timolol?
Latanoprost, pilocarpine = increases uveoscleral outflow
Acetazolamide, timolol = reduced aqueous humour production
Features and management of central retinal artery occlusion?
Sudden painless vision loss
“Cherry red” spot on a pale retina
Management = treat underlying cause
Features and management of central retinal vein occlusion?
Sudden painless vision loss
Widespread hyperaemia
Severe retinal haemorrhages
“Stormy sunset” appearance
Management = supportive
Most common cause of blindness in the UK?
Age-related macular degeneration
Features and management of dry vs wet macular degeneration?
Dry = gradual visual loss, drusen
→ zinc + vitamin A, C and E
Wet = subacute visual loss, neovascularisation, haemorrhages
→ anti-VEGF
Tool used to assess line distortion in macular degeneration?
Amsler grids
Features and management of cataracts?
Gradual visual loss
Haloes around lights
Glare from lights
Loss of red reflex
Management = cataract surgery
Serious complication of cataract surgery and management?
Endophthlamitis
Management = intravitreal vancomycin
Investigation to differentiate refractive error vs other pathology causing blurred vision?
Pinhole occluders when reading Snellen chart
→ improvement indicates refractive error
Pathwway of pupillary light reflex?
Afferent = retina → CN II → lateral geniculate body → midbrain
Efferent = Edinger-Westphal nucleus (midbrain) → CN III
RAPD clinical finding and causes?
Affected and normal eye dilate when light is shone on the affected
→ retinal pathology e.g. detachment
→ CN II pathology e.g. optic neuritis
Features, investigation and management of optic neuritis?
Loss of visual acuity
Poor colour discrimination
Pain on eye movement
Central scotoma
Investigation = MRI with gadolinium contrast
Management = IV methylprednisolone
Classification of diabetic retinopathy?
Non-proliferative diabetic retinopathy (NPDR)
Proliferative diabetic retinopathy (PDR)
Maculopathy
Features and management of NPDR vs PDR?
NPDR = microaneurysms, blot haemorrhages, hard exudates, cotton wool spots
Management = observation
PDR = as above + neovascularisation
Management = panretinal laser photocoagulation + anti-VEGF
Staging of hypertensive retinopathy?
I = arteriole narrowing, silver wiring
II = arteriovenous nipping
III = cotton wool spots, flame and blot haemorrhages
IV = papilloedema
Features of posterior vitreous detachment?
Sudden flashes floaters
Loss of visual acuity
Features of retinal detachment?
Shadow peripheral → central
“Curtain” over visual field
Flashes and floaters
Loss of visual acuity
Features of vitreous haemorrhage?
Multiple dark spots
Floaters
Red hue
Loss of visual acuity
