Ophthalmology Flashcards
Acute angle closure glaucoma
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - closure of the anterior chamber angle resulting in elevation of intra-ocular pressure EMERGENCY
Epidemiology - 2nd leading cause of blindness
Pathogenesis - genetics, tricyclic antidepressants, reduced aqueous humour drainage
Presentation - bumping into objects, missing events in peripheries, painful teary eye, firm eyeball, decreased visual acuity, blurred vision, nausea, vomiting, headache
Urgent = IOP >30mmHg
Investigations - fundoscopy, cranial nerve examination, slit lamp examination
Differentials - open angle glaucoma, eye trauma, optic neuropathies
Risk Factors - female, hyperopia, shallow peripheral anterior chamber
Treatment - topical ocular hypotensive agents, selective laser trabeculopathy, glaucoma filtration surgery, DVLA must be informed
Optic Neuritis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammation of optic nerve
Epidemiology - 30-50, female
Pathogenesis - viral infection, MS, diabetes
Presentation - decreased acuity, periocular pain, dyschromatopsia, RAPD, central scotoma, loss of colour vision
Investigations - fundoscopy, slit lamp examination, FBC, ESR, CRP, MRI of optic nerves
Differentials - Lyme disease, syphillis, HIV
Risk Factors - female, HLA-DRB11501 genotype
Treatment - acute episode: methyl prednisolone and PPI consideration
Giant Cell Arteritis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - granulomatous vasculitis of large and medium arteries
Epidemiology - white female, >50
Pathogenesis - unknown
Presentation - headache, scalp pain, tenderness, aching, stiffness
Investigations - fundoscopy, CRP, ESR, FBC, vascular ultrasonography, temporal artery biopsy
Differentials - poly myalgia rheumatica, solid organ cancers, haematological malignancies
Risk Factors - age, genetics, smoking
Treatment - prednisolone, tocilizumab or methotrexate, aspirin
Eye Injury
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Risk Factors
Treatment
Definition - injury to the eye either mechanical or chemical
Epidemiology - anyone of any age
Pathogenesis - chemical or penetrating trauma
Presentation - hyphaema, ecchymosis, severe pain, blurred vision, excessive lacrimation
Investigations - visual assessment, head CT, MRI
Risk Factors - 18-45, male, no protective eyeware
Treatment- topical antibiotic, supportive care, hyphaema: cycloplegic, steroid
Macular Degeneration
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - progressive deterioration of vision
Epidemiology - leading cause of adult blindness, age>55
Pathogenesis - genetics
Presentation - wet: growth of new vessels, oedema, more extreme vision loss
Central visual field loss, reduced acuity, wavy appearance to straight lines
Investigations - visual assessment, optic topography, fluorescein angiography, amsler grid test
Differentials - idiopathic polypoidal choroidal vasculopathy, basal laminar drusen, myopic degeneration
Risk Factors - increased age, smoking, family history, previous cataract surgery
Treatment - observation and risk factor modification, antioxidant and mineral supplement
Anti-vascular endothelial growth factor (anti-VEGF) injections limit progression and can even reverse vision loss – typically administered in monthly injections.
Conjunctivitis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammation of conjunctiva
Epidemiology - anyone, young
Pathogenesis - bacteria, allergy, viruses, mechanical irritation
Presentation - red, itchy, discharge, swollen eyelids
Investigations - presence of symptoms;ptoms, fundoscopy
Differentials - dry eye, blepharitis, episcleritis
Risk Factors - exposure to infected person, infection in one eye, environmental irritants
Treatment - resolves 1-2 weeks,
Bacterial: antibiotic drops - chloramphenicol
Allergic: topical antihistamine
music acid if pregnant
Corneal Ulcers - Keratitis
Definition
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammation and damage to corneal epithelium
Pathogenesis - viral (HSV), bacterial (staphylococcus), fungal (Candida)
Presentation - painful, red eye, photophobia, foreign body sensation, watering, reduced visual acuity, ulcer present on eye
Investigations - slit lamp exam, fluroscein staining, corneal swabs, FBC, HIV test
Differentials - peripheral ulcerative keratitis, moron’s ulcer, corneal abrasion
Risk Factors - contact lens wear, corneal trauma, trichiasis
Treatment - topical acyclovir, steroids, antibiotics if bacterial
Retinal Detachment
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - neuro retina separates from retinal pigment
Epidemiology - 1 in 300 over lifetime
Pathogenesis - sub retinal fluid accumulates, retina loses function
Presentation - loss or deterioration of central vision, flashes of light, loss of peripheral vision loss, floaters
Investigations - visual acuity assessment, slit lamp examination, indirect opthalmoscopy, CT, MRI of orbit
Differentials - retroschisis, diabetic retinopathy, retinal vein occlusion
Risk Factors - posterior vitreous detachment, increased age, myopia exceeding 8D, previous cataract surgery
Treatment - scleral buckle/vitrectomy, treat underlying cause
Cataract
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - opacification of crystalline lens resulting from normal ageing process
Epidemiology - increased age
Pathogenesis - ageing, congenital problems, medications
Presentation - decreased vision, blurred/clouding, glare
Investigations - dilated fundus, IOP measurement, slit lamp exam, glare vision test
Differentials - refractive error, dry eye, glaucoma
Risk Factors - age>65, female, smoking, long term UV exposure
Treatment - surgical removal
Orbital Cellulitis
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - Infection of orbital soft tissue EMERGENCY
Epidemiology - children
Pathogenesis - infection from superficial source, recent sinus infection, orbital trauma
Presentation - opthalmaplegia, proptosis, reduced acuity, RAPD
Investigations - clinical examination, WBC, cultures, microbiology swab, lumbar puncture
Differentials - orbital pseudotimour, thyroid eye disease, panophthalmitis
Risk Factors - sinusitis, younger age, male, lack or HIB vaccine in children
Treatment - hospitalisation, targeted antibiotic/antifungal
Blepharitis
Definition
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammation of eyelid, chronic with intermittent exacerbation
Pathogenesis - rosacea, meibomian gland dysfunction, seborrheic dermatitis, staphylococcus epidermidis
Presentation - foreign body sensation, burning, itching, crusting lid erythema
Investigations - visual assessment, lid biopsy, lid bargain culture, microscopic evaluation of epilated eyelashes
Differentials - dry eye, chalazoin, squamous cell carcinoma
Risk Factors - age>50, female, dermatological disease, intraoccqular or lid surgery/injury
Treatment - eyelid hygiene, treat underlying disease
Uveitis
Definition
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - inflammation of uvea (cilliary body and sclera) or vascular area between retina and sclera of eye
Pathogenesis - autoimmune, HLAB27 conditions: ankylosing spondylitis, IBD, reactive arthritis, Chronic conditions: sarcoidosis, syphilis, Lyme disease, TB, herpes
Presentation - pain, decreased vision, synechiae, tearing, photophobia, floaters, eye redness without discharge
Investigations - clinical examination, FBC, ESR, CRP, fluorescent treponemal antibody, vitreous biopsy
Differentials - ocular lymphoma, leukaemia, intraoccqular solid tumours
Risk Factors - inflammatory disease of joints, bowel or skin, HLA-B27 positive
Treatment - corticosteroid eyedrops, management of underlying disease, cycloplegic paralysis of ciliary muscles and dilate muscles - cyclopentolate
