Ophthalmology Flashcards
1
Q
Difficulty in reading text and recognising faces, and problems with vision in dim light are typical features of which condition
A
Dry AMD
“Old people like to read the newpaper and thus they notice if they cant anymore (age related)”
2
Q
Difficulty driving at night is a typical feature of which condition
A
Cataracts
3
Q
Patients often complain of knocking over objects is a typical feature of which condition
A
Chronic open angle glaucoma
In chronic OAG the peripheral visual fields is affected first so patients often complain of knocking over objects.
4
Q
Likely Dx
Painful ear, purulent discharge and keen swimmer
A
Otitis externa
5
Q
Potential complication of otitis externa
A
Malignant otitis externa
6
Q
Likely Dx
Otalgia (ear pain) worse at night
Otorrhoea (ear discharge)
Granulation tissue seen in the external auditory canal on otoscopy
+/- facial palsy
A
Malignant otitis externa
7
Q
Likely Dx
Acute-onset otalgia +/- fever which often precedes an upper respiratory tract infection
A
Acute otitis media
8
Q
What is the otoscopic features of an acute otitis media
A
Hyperaemic, bulging and featureless tympanic membrane
9
Q
Acute mastoiditis is a complication of what condition
A
Acute otitis media
10
Q
Likely Dx
Retro-auricular pain
Conductive hearing loss
Fever
On examination, the tympanic membrane is protruding forwards
Recent Hx of acute otitis media
A
Acute mastoiditis
11
Q
What are the two most common organisms that causes otitis externa?
A
Pseudomonas spp
Staphylococcus aureus
12
Q
What is the best treatment for blepharitis
A
Hot compress and mechanical removal of the debris +/- artificial tears if patients report dry eyes
Hot compresses to soft the eyelid margin
Removal of debris with cotton buds dipped in cooled boiled water
13
Q
Dendritic ulcers seen under slit lamp with fluorescein applied is pathognomonic for which condition?
A
Herpes simplex keratitis
14
Q
What causes Herpes Simplex Keratitis
A
Caused by reactivation of the herpes simplex virus type 1 (HSV1) which lies dormant in the trigeminal ganglion
15
Q
How is Herpes Simplex Keratitis managed
A
Topical acyclovir
16
Q
Likely Dx:
Eye pain out of proportion to the findings
Eye redness
Decreased visual acuity
Contact lens wearer
A
Acanthamoeba keratitis
17
Q
In contact lens wearers, the causative organism in Acanthamoeba keratitis
A
Pseudomonas
18
Q
A painful red eye with photophobia, foreign body sensation and blurring of vision is highly suspicious for what?
A
Keratitis (inflammation of the cornea)
19
Q
Dendritic ulcer with a shingles rash in the ophthalmic dermatome is pathognomonic of which condition?
A
Herpes Zoster Ophthalmicus
20
Q
Management of bacterial keratitis
A
Immediate ophthalmologist referral as it is an emergency
Management involves stopping the use of contact lenses, intensive topical (and sometimes oral) antibiotics – in severe infections, patients need to be admitted
21
Q
Feature of mild non-proliferative diabetic retinopathy
A
Microaneurysms only on fundus
22
Q
Features of moderate non-proliferative diabetic retinopathy
A
One of the following features:
Retinal haemorrhages
Hard exudates
Cotton wool spots
Venous changes (beading/looping)
23
Q
Features of severe non-productive diabetic retinopathy
A
4-2-1 rule
4 quadrants with haemorrhage
OR
2 quadrants with venous beading
OR
1 quadrant with IRMA (intra-retinal microvascular abnormality - an abnormal new vessel between a venule and arteriole that is weak and prone to haemorrhage)
24
Q
What are the features of proliferative diabetic retinopathy seen on fundoscopy
A
New vessels at the retina or optic disc
25
Exudates seen on fundoscopy is pathognomonic for what condition
Diabetic retinopathy
26
What are the two treatment options for proliferative retinopathy
Panretinal laser photocoagulation ( intentional scarring of peripheral retinal tissue)
AND/OR
Intravitreal VEGF inhibitors
If severe or vitreous haemorrhage: vitreoretinal surgery
27
Likely Dx:
Severe unilateral eye pain, redness and reduced vision.
Pain worsen on eye movement and at night
Photophobia
Background Hx of rheumatological conditions
Scleritis
28
What is the distinguishing feature between episcleritis and scleritis
Episcleritis:
No pain
No photophobia
No unilateral reduction in vision
29
Scleritis causes severe unilateral eye pain that is worse at what time?
At night
30
First line management for mild scleritis
Oral NSAIDs
31
First line management for severe or necrotising scleritis
Corticosteroids
Either daily oral prednisolone or pulsed IV methylprednisolone
32
Likely Dx:
PMH of diabetic retinopathy
Fundoscopy of the eye shows a red opacity lying in front of it
Vitreous haemorrhage
Proliferative diabetic retinopathy is one of the causes of vitreous haemorrhage as the new blood vessels are weak and prone to damage and haemorrhage, which then accumulates in the vitreous
33
Fundoscopy shows serrated area of grey retina.
Diagnosis?
Retinal detachment
Detached retina. It is possible to have a concomitant vitreous haemorrhage and retinal detachment and of course, the obscured fundal view because of the haemorrhage makes the detachment difficult to diagnose clinically. As a result, B-scan ultrasound is indicated to check the retina is not detached
16%
34
Define myopia
Short-sightedness
35
Define hyperopia
Far-sightedness
36
Curtain or shadow progressing to the centre of the visual field from the periphery is pathognomonic of what condition
Retinal detachment
37
What kind of the pupillary defect may be detected in retinal detachment
Relative afferent pupillary defect if the optic nerve is involved
38
Fundoscopy showing drusen (poorly defined, heterogenous, cloudy-yellow deposits) within the macula is pathognomonic of what condition
Dry Age-related macular degeneration (dry-ARMD)
39
Pilocarpine 4% eye drops function
Reduces the intraocular pressure
Useful in acute angle closure glaucoma to prevent further damage to the optic nerve and preserve vision.
Other drugs that can be used to reduce the IOP include: oral Acetazolamide, Timolol 0.25% eye drops and Brimonidine 0.1% eye drops
40
Likely Dx:
Severe eye pain
Blurred vision
Haloes around lights
Fixed-dilated pupil
Acute angle closure glaucoma
41
What is the definitive treatment for acute angle closure glaucoma
Laser peripheral iridotomy
42
Prednisolone (1%) eye drops is used to treat what eye condition
Acute anterior uveitis
43
What is the immediate management of acute angle closure glaucoma
Reducing the intraocular pressure most commonly with eye drops that can reduce the IOP e.g. Pilocarpine 4% eye drops, oral Acetazolamide, Timolol 0.25% eye drops and Brimonidine 0.1% eye drops
The intraocular pressure must be reduced as soon as possible to prevent further damage to the optic nerve and preserve vision.
44
Patients with acute angle closure glaucoma is started on a triad of medications.
What is that triad
Beta blockers eye drops e.g. Timolol (to reduce aqueous production)
Pilocarpine eye drops (to increase uveoscleral outflow)
IV acetazolamide (to reduce aqueous production)
45
Pale retina with a cherry red spot at the macula on ophthalmoscopy is a characteristic feature of what condition
Central retinal artery occlusion (CRAO)
Pale retina as it no longer receives blood from the retinal artery
Cherry red spot as the retina now receives blood from the choroidal circulation, which lies behind the macula. This relative hyperaemia of the macula compared to the rest of the retina gives CRAO the characteristic 'cherry red spot' appearance
46
Drusen at the macular on ophthalmoscopy is a characteristic feature of what condition
Dry age related macular degeneration (Age AMD)
47
Optic disc cupping on ophthalmoscopy is a characteristic feature of what condition
Chronic open angle glaucoma
48
Likely Dx:
Sudden, painless unilateral visual loss
'Cherry red' spot on a pale retina
Central retinal artery occlusion
49
Drusen in the macula on fundoscopy is a hallmark of what condition?
Dry age-related macular degeneration (ARMD)
DRusen = DRy
50
'stormy sunset' on fundoscopy is pathognomonic of what condition
Central retinal vein occlusion (CRVO)
Stormy sunset is caused by retinal hyperaemia & haemorrhages
51
flame haemorrhages are characteristics of what condition
Central retinal vein occlusion (CRVO)
52
What are the two complications of diabetic retinopathy that can develop if not managed
Vitreous haemorrhage
Retinal detachment
53
Toxoplasma retinitis is a parasite that is transmitted via the faecal-oral route from faeces from what animal
Cat
54
Chorioretinitis (a single, hazy white/yellow lesion) seen on fundoscopy with an adjacent area of hyper-pigmentation of the retina is characteristic of what condition
Toxoplasma retinitis
55
'pizza pie fundus' on fundoscopy is characteristic of what condition
Cytomegalovirus (CMV) retinitis
Typically presents in immunocompromised patients with a CD4 count < 50
56
What is the mainstay of management of wet AMD
Intravitreal injection with vascular endothelial growth factor inhibitors (anti-VEGF)
Vascular disease leads to oedema beneath the macula. To stop the oedema progressing, neovascularisation needs to be blocked through the use of anti-vascular endothelial growth factor injections. A laser cannot be used on the macula as it may damage the photoreceptors which are responsible for most of our functional vision
57
What is the the biggest risk factor for developing age related macular degeneration
Age
58
Drusen, macular thinning (geographic atrophy) is features of what kind of age related macular degeneration
Dry AMD
59
Neovascularisation, bleeding, leakage of fluid is features of what kind of age related macular degeneration
Wet AMD
60
What is an important lifestyle change for patients with age related macular degeneration
Smoking cessation
61
Red eye post-eye surgery should prompt the diagnosis of what?
Endophthalmitis (infection inside the patient's eye)
62
Hypopyon, described in the stem as a 'white fluid level', which is a collection of pus in the anterior chamber is indicative of what?
Intraocular inflammation
63
How is endophthalmitis managed
It is treated with intravitreal vancomycin as the most common causative bugs are gram positive
64
How is endophthalmitis managed
Intravitreal vancomycin as the most common causative organisms are gram positive
65
Pts with Bells palsy are advised to tape their affected eye at night and apply artificial tears daily until the palsy has resolved.
What condition are these measures preventing?
Exposure keratopathy i.e. damage to the corneal epithelium which may become infected leading to sight-threatening keratitis
66
How are suspected orbital fractures are best assessed
Computed tomography (CT) orbits, brain, sinus
67
Blunt force trauma to the face with subsequent eye pain can be caused a fracture to what bone most commonly
Fracture of the ethmoid bone - the pressure from the force causes fracture of the orbital floor. The ethmoid bone forms the medial wall of the orbit, which is commonly fractured as it is very thin.
Another feature is enophthalmos (sunken in affected eye)
68
What is a common side effect of prostaglandin analogue eye drops e.g. latanoprost
Eyelash thickening/lengthening
69
Fundoscopic/slit-lamp features of chronic open angle glaucoma
Pale optic disc – indicates optic nerve atrophy
Optic disc cupping – a cup:disc ratio of >0.7 suggests cupping
70
What is the aim of management in chronic open angle glaucoma
The aim of management is to prevent progression of glaucoma and preserve visual fields and acuity.
This is done by reducing the intraocular pressure by either reducing aqueous production or increasing uveoscleral outflow.
71
What is the first line management option of chronic open angle glaucoma
Surgery with selective laser trabeculoplasty (SLT)
72
Latanoprost is an example of what kind of eye drop drug class
Prostaglandin analogues
73
Latanoprost eye drop is an example of prostaglandin analogues.
What effect does prostaglandin analogues have in the eye
Increases uveoscleral outflow
74
Timolol is an example of what kind of eye drop drug class
Beta blocker
75
Timolol eye drop is an example of a beta blocker eye drop.
What effect does beta blockers have in the eye
Reduces aqueous production
Beta BLOCKer = BLOCK the production
76
What two patient groups are Beta blocker eye drops contraindicated in
Asthma
Heart block
77
What is the second line management option for chronic open angle glaucoma
(used when selective laser trabeculoplasty (first line) is not possible and for patients who have chosen not to have SLT or who has progression of glaucoma despite first line treatment)
Medical management with eye drops to reduce the intraocular pressure
First line: Prostaglandin analogues e.g. Latanoprost
Second line: Topical beta blockers e.g. Timolol
78
Likely Dx:
Young patient
'Tunnel vision'
Reduced visual acuity in dim light.
Retinitis pigmentosa
79
What features would be noticed in the cerebrospinal fluid (CSF) in multiple sclerosis
Oligoclonal bands - which are IgG clones produced in the CSF as a result of the T-cell mediated inflammation
80
There are 4 diagnoses requiring urgent referral that must be ruled out for any patient presenting with ocular pain.
What are these four conditions?
Acute angle closure glaucoma
Anterior uveitis
Scleritis
Corneal ulcer
81
Likely Dx:
Ocular pain
Red eye
Blurred vision
Photophobia
Irregular shaped pupil
Anterior uveitis
The pupil may be irregular due to adhesions between the lens and iris (termed synechiae)
82
What eye condition is the commonest initial feature of multiple sclerosis
Optic neuritis
83
Sudden onset monocular vision loss with relative afferent pupillary defect (RAPD) implies a lesion where in the eye?
Optic nerve
Hence, this is usually a feature of a central retinal vein/artery occlusion as these blood vessels are the sole source of blood supply to the retina
84
In otosclerosis, the bone around the base of the stapes becomes thickened and eventually fuses with the bone of the cochlea. The result is bilateral conductive hearing loss and tinnitus.
What is its inheritance pattern for otosclerosis
Autosomal dominant condition
85
If a patient presents with anterior uveitis to the GP what is the management option
Urgent specialist referral i.e. ophthalmologist
86
Small, pink nodules with a central umbilication that occur in clusters in the eyelids is the classical description of what infection
Molluscum contagiosum (sexually transmitted virus)
87
Molluscum contagiosum is caused by what virus
Poxvirus - often sexually transmitted
Small, pink nodules with a central umbilication that occur in clusters in the skin including the eyelids
"MOLE = FOX"
88
Treatment for molluscum contagiosum
Usually conservative as the lesions are self resolving over a period of 18 months.
Check for other STIs
89
An external hordeolum, commonly called a stye, is an abscess at an eyelash follicle is caused by infection of what organism
Staphylococcus.
90
An external hordeolum, commonly called a stye, is an abscess where
At an eyelash follicle
91
An internal hordeolum is an abscess of what
Meibomian gland
92
Hordeolum (or stye) are often tender to palpation and may emit what kind of discharge
Purulent discharge
93
Internal hordeolum is an abscess of the Meibomian gland is often tender to palpation. If blockage of the gland occurs they can leave behind a non-tender swelling known as?
Chalazion
Chalazions typically 'point' inwards and tend to resolve by themselves over several weeks
94
Chalazion are often non-tender to palpation and may emit what kind of discharge
Oily discharge
95
Chalazion are non-tender is a result of an obstruction of the Meibomian gland secondary to what kind of infection
Internal hordeolum
96
Likely Dx:
Pulsatile proptosis
Bruit
Severely injected conjunctiva
Carotid cavernous fistula (abnormal communication between the carotid artery and the cavernous sinus).
The cranial nerves that run through the cavernous sinus may be affected i.e. CN 3, 4, 5 and 6
97
What signs or symptoms would suggest a diagnosis of orbital cellulitis rather than pre-septal cellulitis?
Pain on eye movements, proptosis, chemosis
98
What is the gold standard investigation to distinguish orbital cellulitis from preseptal cellulitis
CT orbit
99
How is orbital cellulitis managed
Admission for IV antibiotics and close monitoring with input from the ophthalmology, ear, nose and throat and medical teams.
100
How is preorbital cellulitis managed
Oral antibiotics and daily outpatient review.
Young or systemically unwell children should be admitted for IV antibiotics.
101
What is the name of the clinical sign displayed in this image?
Corneal arcus - white, blue or grey opaque ring
102
What is the name of the clinical sign displayed in the above image?
Kayser-Fleischer ring - copper coloured
103
Young women with central retinal artery occlusion (CRAO) and recurrent miscarriage should be investigated for what condition?
Antiphospholipid syndrome
This is done by checking for anti-cardiolipin antibodies, anti-beta2-GP I antibodies and a functional assay for lupus anticoagulant phenomenon
104
Name the antibodies that are positive in antiphospholipid syndrome
Anti-cardiolipin antibodies
Anti-beta2-GP I antibodies
Functional assay for lupus anticoagulant phenomenon
105
antiphospholipid syndrome is associated with which eye condition
Central retinal vein occlusion (CRVO)
106
How is proliferative diabetic retinopathy managed
Urgent laser photocoagulation (completed within 72 hours) prevent further neovascularisation
The premise of laser photocoagulation is that by sacrificing the peripheral retina, which has minimal visual utility, one can reduce the production of vascular endothelial growth factor produced by this ischaemic retina and thus prevent neovascularisation. If left untreated, vitreous haemorrhage can lead to blindness.
107
What is the next step in management if you notice an absent red reflex in one of the eyes at baby check
Urgent referral (within 2 weeks) for ophthalmological assessment as it could indicate a retinoblastoma (malignant tumour of the retina)
108
What is an important complication of childhood strabismus (eye squint) if left untreated
Amblyopia (lazy eye)- occurs when there is reduced visual stimulation to the right eye.
Treatment of amblyopia must be started at an early age (the critical period is up to 8 years old). The good eye is normally patched.
109
What is the pattern of visual field loss in optic nerve pathology
Monocular visual loss
110
What is the pattern of visual field loss in optic tract pathology
Contralateral homonymous hemianopia
111
What is the pattern of visual field loss in optic chiasm pathology
Bitemporal hemianopia
112
What is the pattern of visual field loss in optic radiation pathology
Contralateral homonymous hemianopia
113
What is a normal cup:disc ratio
< 0.3
114
Myopia (short sightedness) is a risk factor for what kind of glaucoma
Primary open angle glaucoma
myOPia = OPen
115
Hypermetropia (far sightedness) is a risk factor for what kind of glaucoma
Acute angle closure glaucoma
116
In what condition is Argyll-Robertson pupil seen in
Tertiary syphilis and diabetes
It presents with a palsy of the parasympathetic fibres i.e. the eyes would not react to light
117
What is the gold standard test for measuring intra-ocular pressure
Goldman’s tonometry
Thus very important investigation for glaucoma to see if the angle is closed (seen as a raised IOP)
118
What is the first line investigation for optic neuritis
MRI head
Optic neuritis – an inflammatory demyelinating condition of the optic nerve. A
MRI is used to investigate for any further demyelinating plaques in the CNS that may suggest multiple sclerosis
119
What is the first line treatment for optic neuritis
Intravenous (IV) methylprednisolone
120
Likely Dx:
Painless sudden visual loss
Peripheral to central
Flashes of lights, dots and lines in the vision
Retinal detachment
The danger is that if the detachment progresses to the macula, sight may be irreparably lost.
121
Management of retinal detachment
There are various surgical and non-surgical treatments available depending on the extent of the detachment. These include laser therapy, cryotherapy, vitrectomy, scleral buckling and pneumatic retinopexy.
122
Myopia (near sightedness) is a risk factor for what two conditions
Retinal detachment
Primary open angle glaucoma
"OR"
123
Hyper-metropia (far sightedness) is a risk factor for which condition
Acute angle closure glaucoma
124
What ocular sign may be associated with infective endocarditis
Roth spots
Roth spots are retinal haemorrhages on the retina
Caused by septic emboli
125
If patients symptoms of bacterial conjunctivitis is not managed supportively what is the first line medication used?
Topical Chloramphenicol eyedrops
126
On fundoscopy, the appearance of ‘dots’, large ‘blots’, engorged tortuous veins and cotton wool spots are diagnostic of what condition
Severe non-proliferative diabetic retinopathy
127
How is cytomegalovirus (CMV) retinitis treated
Oral Valganciclovir
128
Vision loss in a HIV patient is pretty much always going to be?
Cytomegalovirus (CMV) retinitis
Typically will have retinal haemorrhages and retinal necrosis describe the classical "pizza pie retinopathy"
129
What kind of eye cancer is associated with HIV
Kaposi's sarcoma (although not found only in the eye. It affects the skin and mouth, and sometimes the internal organs)
130
Management of Chalazion
Forms due to blockage of the oil producing Meibomian glands. Often secondary to internal
They are the most common cause of an eyelid nodule. They are benign and resolve with conservative measures such as warm compresses
68%
131
Management of Chalazion
Forms due to blockage of the oil producing Meibomian glands. Often secondary to internal hordeolum.
Resolve with conservative measures such as warm compresses
132
What type of stroke presents with bilateral painless loss of vision
Middle cerebral artery stroke
The stroke causes vision loss via ischaemia of the optic tract and thus would present with an incongruous homonymous hemianopia on the contralateral side to the stroke
133
Management of allergic conjunctivitis
Treatment is conservative, aimed at avoiding the allergen and advising the use of artificial tears (dilutes the allergen).
Topical antihistamines or mast cell stabilisers may be prescribed if conservative measures fail for moderate allergic conjunctivitis.
134
Arteriovenous nipping is a characteristic feature of what eye condition
Hypertensive retinopathy
135
Hutchinson’s sign
Hutchinson’s sign refers to involvement of the nasociliary branch of the trigeminal nerve by herpes zoster virus.
This is seen clinically as vesicles on the tip of the nose.
This nerve also supplies the globe, making ophthalmic involvement of the virus likely
136
Hutchinson’s sign
Hutchinson’s sign refers to involvement of the nasociliary branch of the trigeminal nerve by herpes zoster virus. This is seen clinically as vesicles on the tip of the nose. This nerve also supplies the globe, making ophthalmic involvement of the virus likely
77%
137
What clinical sign is present that predicts a higher risk of corneal involvement of the herpes zoster virus making herpes zoster ophthalmicus most likely
Hutchinson’s sign
Seen clinically as vesicles on the tip of the nose. This nerve also supplies the globe, making ophthalmic involvement
138
Kayser-Fleischer rings are associated with what condition
Wilson’s disease
139
What is the main aetiology for corneal arcus
Hyperlipidaemia
Other signs of hyperlipidaemia include xanthelasma (yellow deposits over the eyelids) and xanthomata (yellow deposits over the tendons, especially over the wrist)
140
Name two complications of cataracts operation
Endophthalmitis
Posterior lens capsule opacification
141
Posterior lens capsule opacification is a relatively common complication of cataract surgery that usually occurs a few weeks following the operation.
How is it treated
Simple laser procedure that can be carried out as an outpatient
142
What is the mainstay of management of cataracts
Cataract surgery most commonly phacoemulsification.
involves breaking down the existing lens with ultrasound waves, removing it and then replacing it
143
What eye condition is strongly associated with giant cell arteritis
Ischaemic optic neuropathy - inflammation of the arteries supplying the optic nerve
Presents with sudden painless vision loss
Also known as amaurosis fugax
144
Topical phenylephrine is used to determine if the affect vessels in episcleritis/scleritis blanches and can be used to distinguish between them.
What one of these conditions do you expect the blood vessels to blanch
Episcleritis
145
Topical phenylephrine is used to determine if the affect vessels in episcleritis/scleritis blanches and can be used to distinguish between them.
What one of these conditions do you expect the blood vessels to NOT blanch
Scleritis as the vessels are too deep
146
Management of scleritis
NSAIDs for mild scleritis
Corticosteroids for severe or necrotising scleritis (either daily oral prednisolone or pulsed IV methylprednisolone)
147
Palsy of what cranial nerve results in the pt being unable to abduct their eye
6th cranial nerve palsy
SO4LR6
148
Palsy of what cranial nerve results in the eye being in a down and out position
3rd cranial nerve palsy
149
Palsy of what cranial nerve results in the patient being unable to look down
4th cranial nerve palsy
SO4LR6
150
Rash localised to the ophthalmic division of the trigeminal nerve
Herpes zoster ophthalmicus
Varicella zoster virus
151
Likely Dx:
Headache
Red watery eye
Onset whilst in the dark
Acute closed angle glaucoma
May so have a fixed, mid-dilated pupil and corneal oedema
152
Topical pilocarpine should be used in the meantime in acute closed angle glaucoma whilst waiting to be seen by the ophthalmology team.
What effect does topical pilocarpine have?
Constricts the pupil and increases trabecular outflow
153
Diagnostic investigation for orbital cellulitis
CT sinus and orbits with contrast
154
What examination is used to confirm a diagnosis of refractive error?
Pinhole-aided visual acuity
Confirms a misshapen cornea
The cornea becomes misshapen, such that rays of light that enter the cornea in different places are refracted differently and as a result, are not focused on the same point at the fovea, causing blurry vision. A pinhole directs all of the available light through one point on the patient's cornea and lens. As a result, the differences in refraction caused by a misshapen cornea are nullified and the patient's visual acuity improves
155
What fundoscopy feature may be seen in raised intracranial pressure
Optic disc swelling
156
What classification tool is used to stage hypertensive retinopathy
Keith-Wagner classification
157
Caeruloplasmin level low
Diagnosis and hallmark eye examination finding
Wilson's disease
Kayser-Fleischer rings
158
Management of Dry ARMD
Smoking cessation
Zinc and antioxidant vitamin A, C and E supplements have been shown to reduce progression
159
An oculomotor nerve palsy with pupil involvement (sometimes called a surgical 3rd nerve palsy) is considered to be due to what until proven otherwise
Posterior communicating artery aneurysm
The pupil becomes fixed and dilated due to paralysis of sphincter pupillae
160
What is a surgical 3rd nerve palsy
CN 3 palsy with pupil involvement
the pupil becomes fixed and dilated due to paralysis of sphincter pupillae
161
Investigation of choice for suspected optic neuritis
MRI of the brain and orbits with contrast
162
In diabetic retinopathy, cotton wool spots represents
Areas of retinal infarction
163
Central scotoma is recognised as a characteristic visual field defect pattern for what condition
Optic neuritis
164
First-line treatment for allergic conjunctivitis
topical antihistamines
165
Likely Dx:
Temporary monocular painless loss of vision which returns to normal after a short period of time e.g. minutes
'Black curtain coming down'
Amaurosis fugax (translated to 'transient darkening')
Common causes include retinal ischaemia due to an embolic or thrombotic event
166
Slit-lamp microscopy is the initial investigation of choice to diagnose ARMD.
If wet-ARMD is suspected, what is the next best investigation
Fluorescein angiography as this can guide intervention with anti-VEGF therapy
167
How to tell what eye the fundoscopic image is from
Wherever the optic disc sits is the side of the eye (as the optic disc sits on the nasal side of the retina)
i.e. if the optic disc is on the left it is a picture of the left eye
if the optic disc is on the right (as with this image) then it is a right eye
168
night blindness + tunnel vision is hallmark features of?
Retinitis pigmentosa
169
new-onset floaters in vision is a hallmark of what condition
Retinal detachment
"Rats Float"
170
Management of anterior uveitis (once referred to ophthamology)
Steroid + cycloplegic (mydriatic) drops
171
Management of herpes zoster ophthalmicus
Oral antiviral treatment for 7-10 days
ideally started within 72 hours
Example: oral aciclovir
172
Likely Dx
Dense shadow that starts peripherally progresses towards the central vision:
A) Retinal detachment
B) Vitreous haemorrhage
A) Retinal detachment
"starts Right on the edge = Retinal"
173
Likely Dx:
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
A) Retinal detachment
B) Vitreous haemorrhage
B) Vitreous haemorrhage
"V = Very black"
174
What features would be more in keeping with conjunctivitis over blepharitis
Conjunctivitis = unilateral, associated with discharge
Blepharitis = bilateral
175
Fundoscopy looks like a giant jellyfish is characteristic of?
Retinal detachment
176
What are the 4 key characteristics of optic neuritis
Optic neuritis is CRAP:
Central scotoma
Reduced red vision
Acuity (reduced)
Painful eye movement
177
What is the most common cause of abnormal tearing in infants and children, particularly during the first year of life
Nasolacrimal duct obstruction
Self-resolves by 1 year of age
178
What examination features are present for Argyll-Robertson Pupil
Accommodation Reflex Present (ARP)
Pupillary Reflex Absent (PRA)
"Argyll-Robertson Pupil (ARP) = Accommodation Reflex Present (ARP)"
179
Name the two causes of Argyll-Robertson Pupil
Diabetes mellitus
Tertiary syphilis
180
Complications of scleritis if left untreated
Perforation of the globe
Glaucoma
Cataracts
Raised intraocular pressure
Retinal detachment
Uveitis
181
What is the aim of acute angle closure glaucoma treatment?
Reducing aqueous production
Increasing the outflow of aqueous
Inducing pupillary constriction
182
Those with a positive family history of glaucoma should be screened annually from what age
40 years
183
ankylosing spondylitis is associated with what eye disorder
Anterior uveilitis
HLAB27 associated conditions
184
Treatment for herpes simplex keratitis
Topical aciclovir
185
Dark spots and red hue in vision is pathognomonic of what condition
Vitreous haemorrhage
186
What kind of eye drops can lead to fungal infections
Steroid eye drops
187
unilateral blurry vision and halos surrounding light sources are strongly suggestive of a diagnosis of?
Cataract
188
Ptosis + dilated pupil =
third nerve palsy
189
ptosis + constricted pupil =
Horner's
190
Mydriatic drops are a known precipitant of
acute angle closure glaucoma
191
Features of hypertensive retinopathy
Cotton-wool spots (widespread white-ish areas resulting from ischaemia)
Retinal haemorrhages (red blotches around the centre of the image)
A 'macular star' composed of intraretinal lipid exudates (sunburst pattern of white streaks around the macular)
The optic nerve head is swollen
192
Anisocoria worse in bright light implies a problem with what pupil
Dilated pupil
Anisocoria means the pupils are not the same size
193
Damage to the ciliary ganglion results in?
Constricted pupil
This is because damage to the ciliary ganglion results in a reduction in the parasympathetic innervation to the eye
"SIRI being a GANG member is very CONSTRICTING but they are Powerful' (Ganglion + constricting pupil + problem with parasympathetic innervation)
194
Anisocoria worse in bright light implies a problem with the ___ pupil
A) Dilated
B) Constricted
Anisocoria worse in bright light implies a problem with the DILATED pupil
195
Damage to the cervical ganglion results in?
Dilated pupil
This is because damage to the cervical ganglion results in a reduction in the sympathetic innervation to the eye
"you'd be SYMPATHETIC if someone DId Serve time"
Sympathetic = DIlated pupils
196
Likely Dx:
Dilated pupil i.e. no direct or consensual light reflex
Females
Absent leg reflexes
Accommodation is intact
Holmes Adie syndrome
Usually idiopathic and benign
197
In-turning of the eyelids is known as?
Entropion
198
Out-turning of the eyelids is known as?
Ectropion
199
Subcapsular cataracts may be associated with the use of what medication
Steroid use
200
Urgent management of orbital compartment syndrome
Urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit
