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Its the final countdown > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

presentation of acute glaucoma

A

unwell w/ short history
- severely painful red eye
- blurred vision
- halo around lights
- associated headache, nausea, vom

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2
Q

presentation of acute glaucoma in examination

A
  • Red-eye
  • Teary
  • Hazy cornea
  • Decreased visual acuity
  • Dilatation of the affected pupil
  • Fixed pupil size
  • Firm eyeball on palpation
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3
Q

Ix for primary angle closure glaucoma

A

measuring intraocular pressure
ophthalmological exam

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4
Q

presentation of cute glaucoma

A

62 yo woman with a one day hx of pain around her right eye. She feels nauseated and has vomited once. On examination her right eye is red

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5
Q

open angle glaucoma develops insidiously, how does it first present

A

peripheral field loss –> tunnel vision

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6
Q

what eye conditions present with pain

A

anterior uveitis (acute painful red eye w/ photophobia & reduced visual acuity)

bacterial/viral conjunctivitis (sore red eye w purulent/ serous discharge)

scleritis (subacute red eye, w. pain, exacerbated by eye movement)

orbital cellulitis ( ocular pain & pain on mvmt w/ redness & swelling around eye )

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7
Q

what differentiates scleritis from episcleritis

A

episcleritis - painless ( has p in it)

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8
Q

what group of people are most commonly affected by episcleritis

A

young, middle-aged adults
with inflammatory coinditions ( RA, IBD)

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9
Q

presentation of episcleritis

A

segmental redness (a patch, not diffuse)
non painful( or mild) w/ foreign body sensation
dilated vessels
watery eye
no discharge

cause: not typically infective

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10
Q

Mx episcleritis

A

self-limiting ( recovers 1-4wks)

mild- no tx necessary
Symptomatic:
- lubricating eye drops
- simple analgesia
- scold compress

more severe
- systemic NSAID
- topical steroid eye drops

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11
Q

presentation of scleritis

A

like episcleritis, but: redness is diffuse (not segmental) eye mvmt painful, photophobia

  • Severe pain
  • Pain with eye movement
  • Photophobia
  • Eye watering
  • Reduced visual acuity
  • Abnormal pupil reaction to light
  • Tenderness to palpation of the eye
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12
Q

what is necrotising scleritis

A

most severe type of scleritis
presents: visual impairment , painless

complication: sclera perforation

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13
Q

what conditions are associated with scleritis

A

RA*, SLE, IBD, Sarcoidosis, Granulomatosis with polyangiitis

*RA is most commonly associated

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14
Q

Mx scleritis

A

secondary care - same day assessment
1st line NSAIDs ( topical/systemic)
2nd line steroids (oral glucocorticouids -topical/systemic)
immunosuppression according to underlying condition

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15
Q

what investigation is used to dx wet age-related macular degeneration

A

fluorescein angiography - used to capture images of bloodflow in retina & choroid. macular neovascularisation = wet AMD

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16
Q

most common cause of blindness ( UK )

A

age-related macular degeneration

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17
Q

what are the types of age-related macular degeneration

A

dry (90%) - better prognosis
wet (10%) - worse prognosis

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18
Q

what are the 4 layers of the macular

A

photoreceptors ( top most)
retinal pigment epithelium
bruchs membrane
choroid ( contains blood supply) - bottom layer

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19
Q

drusen are found in what condition

A

age-related macular degeneration

drusen - yellow (protein& lipid) deposits between retinal pigment epithelium & Bruch’s membrane

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19
Q

features of normal drusen

A
  • small (< 63 micrometres)
  • hard.

Larger & greater numbers of drusen - early sign of macular degeneration.

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20
Q

3 features in both wet & dry AMD

A

drusen ( large, more than normal)
atrophy of retinal pigment epithelium (2nd layer of macular)
degeneration of photoreceptors ( 1st layer of macular)

gradual reduction in vision- blindness

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21
Q

what differentiates wet AMD from dry

A

wet
- new vessels grow from choroid into retinna –> leak fluid/blood –> oedema —> more rapid vision loss

in both
- drusen
- atrophy of retinal pigment epithelium
- degeneration photoreceptors

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22
Q

what protein is associated with neovascularisation into the retina in wet AMD

A

VEGF - vascular endothelial growth factor

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23
Q

risk factors of macular degeneration

A

age
white/ chinese

FHx
smoking
CVD

24
Q

key features in presentation of AMD

A

gradual worsening CENTRAL visual field loss ( peripheral - open-angle glaucoma)
reduced visual acuity
lines appear crooked/wavy

wet
- more acute presentation
- loss of vision over days –> full loss in 2–3 yrs
- progresses to bilateral disease

25
Q

findings on examination in AMD

A
  • Reduced acuity -Snellen chart
  • Scotoma (central patch of vision loss)
  • Amsler grid test - distortion of straight lines
  • Fundoscopy - Drusen
26
Q

Ix used in AMD
- Dx
- initial Ix for wet MD
- second line Ix for wet MD

A

Dx: slit-lamp biomicroscopic fundus exam

wet
-1st line: optical coherence tomography ( cross-sectional view of retina layers) - 2nd line: blood supply & oedema in retina)

27
Q

Mx in AMD
- general
- dry
- wet

A

general - ophtho referral
dry: avoid smoking, BP control, Vit supplements
wetL anti-VEF meds (ranibizumab, bevacizumab, pegaptanib )

28
Q

what artery does the central retinal artery branch off?

A

ophtalmic artery

internal carotid –> ophthalmic –> central retinal

29
Q

causes of central arterial occlusion (x2)

A

atherosclerosis ( most common)
GCA - vasculitis of ophthalmic/ central retinal

30
Q

risk factors for central renal aerterial occlusion

A

risk factors from atherosclerosis, and GCA

31
Q

presentation of central retinal arterial occlusion

A

sudden painless vision loss
afferent pupillary defect (more constriction in affected pupil when light is shone in it

32
Q

appearance of central retinal arterial occlusion

A

Ix - fundoscopy

appearance
- pale retina/ retinal opacification ( lack of perfusion)
- cherry -red spot ( macula) - thinner surface shows red coloured choroid

33
Q

Mx in central retinal artery occlusion

A

immediate optho referral

  • GCA suspected, test ( ESR & temporal artery biopsy) & tx ( 60mg pred)
  • thrombus: o Ocular massage
    o Removing fluid from the anterior chamber (reduce intraocular pressure.)
    o Inhaling carbogen (a mixture of 5% CO2 & 95% O2) to dilate the artery
    o Sublingual isosorbide dinitrate (dilate the artery)

long term - Mx reversible risk factors

34
Q

cause of central retinal vein occlusion

A

thrombus

thrombus –> no drainage –> blood pooling in retina –> leakage of fluid & blood –> macular oedema & retinal haemorrhages –> damaged tissue –> vision loss

35
Q

presentation of central retinal vein occlusion

A

sudden painless loss of vision

36
Q

risk factors for central retinal vein occlusion

A

thrombus risk factors
glaucoma
systemic inflammatory conditions e.g. SLE

37
Q

Appearance of central retinal vein occlusion on funduscopy

A

flame & blot haemorrhages
optic disc oedema
macula oedema

38
Q

Mx central retinal vein occlusion

A

laser photocoagulation
intravitreal steroids (dex)
anti-VEGF - ranibizumab aflibercept, bevacizumab

39
Q

cause of orbital cellulitis

A

URTI (from sinuses)
preseptal ( periorbital ) cellulitis which progressed to orbital celllulitis

40
Q

how does cataracts affect vision

A

reduces vision
blurs vision

41
Q

a pt presents with worsening redness and swelling around her right eye for the past 2 days.

On examination of the child, there is tenderness and erythema over the right eyelid and during the assessment of her eye movements, she complains of pain and ‘seeing double’. Her temperature is 38°C

is this preseptal cellulitis or orbital cellulitis

A

orbital as
- reduced visual acuity (diplopia)
-proptosis
- pain w/ eye movement

painful eye movements and visual disturbance (‘seeing double’ referring to diplopia) in the context of a red, swollen, tender eye is concerning for orbital cellulitis

42
Q

Mx orbital cellulitis

A

IV cefotaxime / clindamycin

43
Q

Mx presptal cellulitis

A

oral co-amox

44
Q

risk factors for orbitak cellulitis (5)

A

Childhood (7-12 years)
Hx sinus infection
No Hib vaccination
Recent eyelid infection/ insect bite on eyelid (periorbital cellulitis)
Ear or facial infection

45
Q

how does orbital cellulitis present

A

Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis

46
Q

most common bacterial causes of orbital cellulitis ( 3)

A

Streptococcus
Staph. aureus
HiB.

47
Q

give one potential complication fof preseptal cellulitis

A

devloping into orbital cellulitis

so Adx for observation in severe cases/ vulnerable pts (e.g. children)

48
Q

most common causative organisms of preseptal cellulitis

A

Staph. aureus, Staph. epidermidis, streptococci and anaerobic bacteria.

49
Q

presentation of preseptal cellulitis

A
  • Erythema and oedema of the eyelids, which can spread onto the surrounding skin
  • Partial or complete ptosis of the eye (swelling)
  • Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) - ABSENT
50
Q

light and accommodation reflex findings in Horners syndrome

A

not affected

51
Q

the location of Horners syndrome can be determined by the anhidrosis. what is the presentation of anhidrosis in
- central lesions (spinal cord )
- preganglionic lesions ( chest)
- Postganglionic lesions ( base of neck)

A

central lesions (e.g. stroke) - anhidrosis of arm, trunk & face
Pre-ganglionic (e.g. pancoast’s tumour) - anhidrosis of face)
post-ganglionic (e.g. carotid artery dissection) - no anhidrosis

52
Q

causes of central ( x4), pre-ganglionic (x4) and post-ganglionic (x4) Horners

A

4Ss (Sentral) , 4Ts (Torso - pre-), 4Cs (Cervical post-)

Sentral ( anhidrosis face, arm, trunk)
S-Stroke,
S- multiple Sclerosis
S- Swelling ( tumour)
S- syringomyelia (cyst in spinal cord)

Torso ( anhidrosis of face)
T- tumour (panoast’s tumour)
T-Trauma
T-Thyroidectomy
T - Top rib ( cervical rib growing above clavicle)

Post-ganglionic lesion ( 4Cs)
C- Carotid aneurysm
C - Carotid artery dissection
C - Cavernous sinus thrombosis
C - Cluster headache

53
Q

what eye finding is associated with congenital Horner syndrome

A

heterochromia

54
Q

what eye drops can be used to test for Horners

A

Cocaine eye drops
- cocaine stops noradrenaline re-uptake in NMJ
- so in normal eye: dilate
- Horners: no noradrenal being released anyway, so no pupillary change

Low conc adrenalin eye drop (0.1%)
- Normal pupil: won’t dilate
- Horner syndrome: pupil dilates

55
Q

apart from miosis, ptosis, anhidrosis, hat other finding is associated with horners

A

enophthalmos* (sunken eye)

56
Q

mx in diabetic retinopathy

A

laser photocoagulation
anti-VEGF meds ( ranibizumab, bevacizumab)
Vitreoretinal surgery

57
Q

unilateral eye pain, photophobia and ciliary congestion suggest which condition?

A

anterior uveitis

Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
uveitis: small, fixed oval pupil, ciliary flush

58
Q
A

Its the final countdown (23 decks)

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