ophthalmology Flashcards

1
Q

what is retinitis pigmentosa

A

inherited condition causing retinal degeneration. most common

primarily affects the peripheral retina

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2
Q

presentation retinitis pigmentosa

A

tunnel vision
night blindness often initial sign

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3
Q

fundoscopy of retinitis pigmentosa

A

black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

(looks like black bits around the edges)

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4
Q

what nerve is affected in loss of corneal reflex

A

CN V1 (trigeminal)
- ophthalmic branch

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5
Q

CN III (oculomotor) palsy

A

ptosis
‘down and out’ eye
dilated, fixed pupil

as III controls MR, IO, SR, I

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6
Q

CN IV (trochlear) palsy

A

defective downward gaze → vertical diplopia

as IV controls SO

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7
Q

CN VI (abducens) palsy

A

defective abduction → horizontal diplopia
eye deviates inwards

as VI controls LR

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8
Q

what is glaucoma

A

optic nerve damage caused by a significant increase in intraocular pressure

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9
Q

what is acute angle-closure glaucoma

A

iris bulges forward + seals off trabecular meshwork from anterior chamber preventing the aqueous humour from being able to drain

-> continual build up of pressure in eye (particularly in posterior chamber which in turn worsens angle closure)

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10
Q

risk factors for acute angle-closure glaucoma

A

chinese/east-asian

increased age

female

FHx

shallow anterior chambre

pupil dilation
catacracts
hypermetropia (long sited)

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11
Q

meds that can increase risk of acute angle-closure glaucoma

A

adrenergic e.g. noradrenaline
anticholinergic e.g. oxybutynin
tricyclic antidepressants

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12
Q

presentation of acute angle-closure glaucoma

A

severely painful red eye
blurred vision
halos around lights
assoc headache, N&V

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13
Q

clinical examination in acute angle-closure glaucoma

A

red eye
hazy cornea
teary
fixed, dilated pupil

decreased visual acuity

firm eyeball on palpation

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14
Q

tx acute angle-closure glaucoma

A

same day ophthalmology assessment - med emergency as can lose vision

lie px back - no pillow

PILOCARPINE eye drops (causes pupil to contract)

acetazolamide 500mg oral (decreases production of aqueous humour), can be given IV

definative tx = Laser peripheral iridotomy

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15
Q

what is open angle glaucoma

A

where there is a gradual increase in resistance through the trabecular meshwork making it more diff for aqueous humour to flow through + exit eye

slow + chronic onset

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16
Q

RFs open angle glaucoma

A

age
FHx
black
nearsighted (myopia)

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17
Q

presentation open angle glaucoma

A

asx for a long time
ofen found at routine screening in eye checks
affects peripheral vision first -> tunnel vision
pain, headaches, blurred, halos

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18
Q

ix of intraocular pressure

A

goldmann applanation tonometry GS

non-contact tonometry

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19
Q

mx open angle glaucoma

A

Latanoprost - prostaglandin analogue eye drops
- increase uveoscleral outflow
- increases eyelash length

B-blocker eye drops - timolol
- reduces aqueous production
- CI asthma, heart block

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20
Q

SEs of prostaglandin analogue eye drops e.g. latanoprost

A

eyelash growth
eyelid pigmentation
iris pigmentation (browning)

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21
Q

most common cause of blindness in UK

A

age-related macular degeneration

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22
Q

findings assoc w age-related macular degeneration

A

drusen seen in fundoscopy (paler dots) - espesh around macular in DRY

neovascularisation in WET

atrophy of retinal pigment epithelium

degeneration of photoreceptors

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23
Q

what happens in wet age-related macular degeneration

A

neovascularisation
dev of new vessels growing from the choroid layer of macular into the retina. These can leak -> oedema -> vision loss

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24
Q

RFs age-related macular degeneration

A

age
smoking
white or chinese
FHx
CVD

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25
presentation of age-related macular degeneration
gradual worsening of central visual field loss reduced visual acuity crooked/wavy appearance to straight lines wet is more acute than dry
26
what test is used to dx age-related macular degeneration
slit-lamp biomicroscopic fundus exam
27
tx wet age-related macular degeneration
refer all age-related macular degeneration to opthal anti-VEGF meds - inject to eye monthly
28
Rfs for retinal detachment
posterior vitreous detachment diabetic retinopathy trauma to eye retinal malignancy older age FHx
29
presentation of retinal detachment
painless peripheral vision loss - sudden, SHADOW coming across vision blurred vision flashes + floaters
30
how does GCA cause vision loss
Ischaemia to the anterior optic nerve
31
what is positive afferent pupillary defect
pupils respond differently to light
32
what is scotoma
visual field abnormality, or a blind spot
33
causes of optic neuritis
multiple sclerosis: the commonest associated disease diabetes syphilis
34
optic neuritis presentation
unilateral decrease in visual acuity over hrs/days poor discrimination of colours (red desaturation) pain worse on eye movement relative afferent pupillary defect central scotoma
35
optic neuritis ix
MRI of brain + orbits w gadolinium contrast
36
mx optic neuritis
high dose steroids 4-6 wks recovery
37
what happens in central retinal artery occlusion
sudden painless loss of vision due to blockage of BF to the retina
38
how does anterior uveitis present
unilat sx starting spontan acute onset redness pain (increasing w movement of eye) photophobia decreased vision floaters + flashes miosis, abnormally shaped pupil pus in AC lacrimation ciliary flush - ring of red spreading out hypopyon - pus + inflam cells in anterior chamber -> visible fluid level
39
what is anterior uveitis
inflammation affecting the anterior portion of the uvea (iris, ciliary body + choroid) usually an AI process also called iritis
40
difference between acute and chronic anterior uveitis
chronic is more granulomatous (more macrophages) less severe + longer duration of > 3 mths
41
what is acute anterior uveitis assoc w
HLA B27 related conditions ie Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis
42
what is chronic anterior uveitis assoc w
Sarcoidosis Syphilis Lyme disease Tuberculosis Herpes virus
43
mx anterior uveitis
urgent same day assessment w opthlamologist cycloplegics (dilate pupil) - atropine, cyclopentolate steroid eye drops
44
causes of central retinal artery occlusion
atherosclerosis (most common) GCA
45
RFs central retinal artery occlusion
same as for CVD: Older age Family history Smoking Alcohol consumption Hypertension Diabetes Poor diet Inactivity Obesity GCA risk: >50 females prev polymyalgia rheumatica
46
what pupil defect in central retinal artery occlusion
relative afferent pupillary defect - where the pupil in the affected eye constricts more when light is shone in the other eye compared to when it is shone in the affected eye (This occurs because the input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex.)
47
fundoscopy in central retinal artery occlusion
pale retina with a cherry red spot (pale as lack of blood perfusion, spot is macula)
48
mx central retinal artery occlusion
immediate referral to ophthalmology older px tested + tx for GCA (IV steroids)
49
what is a cataract
progressively opaque (cloudy) eye lens reducing light entering eye + visual acuity
50
screening for congenital cataracts
red reflex (If no red reflex, or a weak one, is seen, it may mean there's cloudiness in the lens.)
51
Rfs cataracts
Increasing age Smoking Alcohol Diabetes Steroids Hypocalcaemia Downs syndrome
52
presentation cataracts
usually asymmetrical, eyes affected separately - slow reduction in visual acuity - progressive vision blurring - colours becoming more faded/brown/yellow - starbursts can appear around lights (espesh at night)
53
key exam finding in cataracts
Loss of the red reflex The lens can appear grey or white using an ophthalmoscope
54
mx cataracts
no mx if sx ok surgery - drilling + breaking lens, artificial lens = phacoemulsification
55
what is endophthalmitis
inflam of inner contents of the eye rare complication of cataract surgery tx intravitreal abx
56
what is scleritis
inflam of full thickness of the sclera (white bit)
57
most signif comp of scleritis
necrotising scleritis -> sclera perforation
58
systemic conditions assoc w scleritis
RA SLE IBD sarcoidosis granulomatosis with polyangiitis
59
scleritis presentation
acute onset 50% bilateral pain -w movement photophobia eye watering reduced visual acuity abnormal pupil reaction to light tender to eye palpation red /blue sclera
60
mx scleritis
same-day assessment by an ophthalmologist oral NSAIDs are typically used first-line oral glucocorticoids may be used for more severe presentations immunosuppressive drugs for resistant cases
61
what is episcleritis
self-limiting inflammation of the episclera, the outermost layer of the sclera. The episclera is situated just underneath the conjunctiva.
62
episcleritis presentation
acute onset unilateral symptoms: Typically not painful but there can be mild pain Segmental redness (rather than diffuse like scleritis). There is usually a patch of redness in the lateral sclera. Foreign body sensation Dilated episcleral vessels Watering of eye No discharge
63
mx episcleritis
If in doubt about the diagnosis, refer to ophthalmology. Episcleritis is usually self limiting and will recover in 1-4 weeks. In mild cases no treatment is necessary. Lubricating eye drops can help symptoms. Simple analgesia, cold compresses and safetynet advice
64
what is blepharitis
inflam of eyelid margins can be assoc w dysfunc of meibomian glands (secrete oil to surface of eye) can lead to styes + chalazions
65
presentation blepharitis
gritty, itchy, dry sensation in eyes
66
mx blepharitis
warm compresses and gentle cleaning of the eyelid margins to remove debris
67
what is a stye
a tender red lump along the eyelid that may contain pus
68
what is Hordeolum externum
type of stye infection of the glands of Zeis (sebaceous) or Moll (sweat) (at the base of eyelashes)
69
what is Hordeolum internum
type of stye infection of the meibomian glands (oil) deeper, more painful + may point towards the eyeball under the eyelid
70
stye tx
Hot compresses and analgesia Topical antibiotics (e.g., chloramphenicol) may be considered if it is associated with conjunctivitis or if sx are persistent
71
what is a chalazion
occurs when a meibomian gland becomes blocked + swells can be called meibomian cyst
72
chalazion presentation
swelling in the eyelid not typically tender usually slightly above upper eyelid
73
tx chalazion
warm compresses + gentle massage towards the eyelashes to encourage drainage
74
what is entropion
when the eyelid turns inwards with the lashes pressed against the eye causes pain + can result in corneal damage + ulceration
75
mx entropion
taping eyelid down (lubricating eye drops) definitive mx is surgical same day referral if risk to sight
76
what is ectropion
when the eyelid turns outwards exposing inner aspect usually affects bottom lid -> exposure keratopathy
77
tx ectropion
mild cases nothing regular lubricating eye drops surgery
78
what is trichiasis
inward growth of eyelashes
79
mx trichiasis
remove affected eyelashes recurrent cases may need electrolysis, cryotherapy or laser treatment
80
what is periorbital cellulitis
an eyelid + skin infection in front of the orbital septum (in front of eye) swollen, red, hot skin around eyelid + eye
81
tx periorbital cellulitis
(need to differentiate from orbital which is a sight + life threatening emergency) systemic abx admit vulnerable px
82
what is orbital cellulitis
infection around the eyeball involving tissues behind the orbital septum
83
sx orbital cellulitis
pain w eye movement reduced eye movements vision changes abnormal pupil reactions proptosis
84
tx orbital cellulitis
emergency admission under opthalmology + IV abx
85
what is keratitis
infection of the cornea
86
causes of keratitis
bacterial - typically Staphylococcus aureus - pseudomonas aeruginosa is seen in contact lens wearers fungal amoebic - acanthamoebic keratitis (5%) - increased incidence if eye exposure to soil or contaminated water - pain is classically out of proportion to the findings parasitic: onchocercal keratitis ('river blindness') viral: herpes simplex keratitis environmental - photokeratitis: e.g. welder's arc eye - exposure keratitis - contact lens acute red eye (CLARE)
87
where does herpes keratitis usually affect
the epithelial layer of the cornea if there is stroma inflam (layer between epithelium + endothelium) = stromal keratitis + has lots of comps
88
presentation herpes keratitis
Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced visual acuity. This can vary from subtle to significant.
89
ix herpes keratitis
FLUORESCEIN staining = DENDRITIC CORNEAL ULCER SLIT-LAMP examination req to find + dx corneal swabs/scrapings to isolate the virus
90
mx keratitis
(red-eye say patients with potentially sight-threatening causes of red eye should be referred for same-day assessment by an ophthalmologist - always refer if they wear contacts) - Aciclovir (topical or oral) - Ganciclovir eye gel - Topical steroids may be used alongside antivirals to treat stromal keratitis corneal transplant
91
what is retinal detachment
the retina separates from the choroid underneath usually due to a retinal tear that allows vitreous fluid to get under the retina sight-threatening emergency as outer retina relies on BVs of choroid
92
mx of retinal tears + detachment
Any suspicion requires immediate referral to ophthalmology Mx of retinal tears aims to create adhesions between retina + choroid: - Laser therapy - Cryotherapy Mx of detachment aims to reattach the retina and reduce any traction or pressure that may cause it to detach again: - Vitrectomy - Scleral buckling - Pneumatic retinopexy
93
conjunctivitis presentation
Red, bloodshot eye Itchy or gritty sensation Discharge (purulent if bacterial, clear if viral + other sx viral infect) NO pain NO vision change NO photophobia Contagious
94
list causes of acute painful red eye
Acute angle-closure glaucoma Anterior uveitis Scleritis Corneal abrasions or ulceration Keratitis Foreign body Traumatic or chemical injury
95
list causes of acute painless red eye
Conjunctivitis Episcleritis Subconjunctival haemorrhage
96
mx conjunctivitis
usually resolves 1-2 wks no tx hygiene measures to avoid spread cleaning the eyes with cooled boiled water and cotton wool can help clear the discharge. Chloramphenicol or fusidic acid eye drops are options for bacterial conjunctivitis if necessary. If neonate = urgent assess (may be gonococcal)
97
what is allergic conjunctivitis
caused by contact with allergens. It causes swelling of the conjunctival sac and eyelid with itching and a watery discharge.
98
tx allergic conjunctivitis
Antihistamines Topical mast-cell stabilisers - need several wks of use b4 benefit
99
eye drops that dilate pupil
Cyclopentolate
100
tx for macular oedema
An intravitreal implant containing dexamethasone
101
what is nasolacrimal duct obstruction
most common cause of a persistent watery eye in an infant caused by an imperforate membrane, usually at the lower end of the lacrimal duct 1 in 10 infants have symptoms at around one month of age
102
tx nasolacrimal duct obstruction
teach parents to massage the lacrimal duct symptoms resolve in 95% by the age of one year- leave it Unresolved cases should be referred to an ophthalmologist for consideration of probing, which is done under a light general anaesthetic
103
horner's syndrome
triad of ptosis (drooping of the upper eyelid), miosis (constricted pupil) and anhidrosis (lack of sweating) on the affected side
104
what is the macula
the central part of the retina responsible for sharp, detailed vision. The fovea is a small, central pit located in the macula.
105
Central retinal vein occlusion
decrease in central vision typically presents with retinal haemorrhages, venous dilation, and tortuosity (stormy sunset appearance)
106
diabetic maculopathy
most common cause of vision loss in people with diabetes (often preceded by diabetic retinopathy) BV changes in the macular (central area of retina) - hard exudates + oedema
107
fundoscopy features of papilloedema
venous engorgement: usually the first sign loss of venous pulsation: although many normal patients do not have normal pulsation blurring of the optic disc margin elevation of optic disc loss of the optic cup Paton's lines: concentric/radial retinal lines cascading from the optic disc almost always bilateral
108
causes of papilloedema
space-occupying lesion: neoplastic, vascular malignant hypertension idiopathic intracranial hypertension hydrocephalus hypercapnia
109
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 (the radial, sunburst pattern of white streaks around the macular) The optic nerve head is swollen, which is the feature that separates grade 3 and grade 4 hypertensive retinopathy retinal changes w high BP + dic swelling (papilloedema)
110
Keith-Wagener classification of hypertensive retinopathy
I = Arteriolar narrowing and tortuosity, Increased light reflex - silver wiring II = Arteriovenous nipping III = Cotton-wool exudates, Flame and blot haemorrhages IV = Papilloedema When you earn SILVER (1), you get a NIP and tuck (II), then you trade your clothes made of COTTON and WOOL to something more hot/FLAME (III). When you start dressing hot you get a new PAPI (IV)
111
what is herpes zoster ophthalmicus (HZO)
reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve
112
features of herpes zoster ophthalmicus (HZO)
vesicular rash around the eye, which may or may not involve the actual eye itself Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
113
mx herpes zoster ophthalmicus (HZO)
oral antiviral treatment for 7-10 days - start within 72 hours - IV antivirals may be given for v severe infection or if px is immunocompromised topical corticosteroids may be used to treat any secondary inflammation of the eye ocular involvement requires urgent ophthalmology review
114
what is Argyll-Robertson pupil + what causes it
Bilaterally small pupils that accommodate but don't react to bright light. neurosyphilis diabetes mellitus
115
ix for acute angle closure glaucoma
tonometry to assess for elevated IOP gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle
116
Endophthalmitis
typically red eye, pain and visual loss following intraocular surgery
117
presentation of vitreous haemorrhage
subacute onset: - painless visual loss or haze (commonest) - red hue in the vision - floaters or shadows/dark spots in the vision
118
most common cause of vitreous haemorrhage
proliferative diabetic retinopathy (over 50%) in children + young adults: ocular trauma
119
Key things to remember in eye trauma
Urgent refer to opthal - suspect foreign body in eye Keep px NMB NO MRI! Might do CT Do they need a tetanus shot Tape plastic shield over eye
120
myiadratic eye drops + examples
DILATE the eye e.g. cycloplegic eye drops Atropine, cyclopentolate
121
what eye drops constrict the eye
pilocarpine
122
complication of panretinal photocoagulation
decrease in night vision