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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
Q

presentation of age-related macular degeneration

A

gradual worsening of central visual field loss
reduced visual acuity
crooked/wavy appearance to straight lines

wet is more acute than dry

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26
Q

what test is used to dx age-related macular degeneration

A

slit-lamp biomicroscopic fundus exam

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27
Q

tx wet age-related macular degeneration

A

refer all age-related macular degeneration to opthal

anti-VEGF meds - inject to eye monthly

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28
Q

Rfs for retinal detachment

A

posterior vitreous detachment
diabetic retinopathy
trauma to eye
retinal malignancy
older age
FHx

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29
Q

presentation of retinal detachment

A

painless
peripheral vision loss - sudden, SHADOW coming across vision
blurred vision
flashes + floaters

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30
Q

how does GCA cause vision loss

A

Ischaemia to the anterior optic nerve

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31
Q

what is positive afferent pupillary defect

A

pupils respond differently to light

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32
Q

what is scotoma

A

visual field abnormality, or a blind spot

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33
Q

causes of optic neuritis

A

multiple sclerosis: the commonest associated disease
diabetes
syphilis

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34
Q

optic neuritis presentation

A

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

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35
Q

optic neuritis ix

A

MRI of brain + orbits w gadolinium contrast

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36
Q

mx optic neuritis

A

high dose steroids
4-6 wks recovery

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37
Q

what happens in central retinal artery occlusion

A

sudden painless loss of vision due to blockage of BF to the retina

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38
Q

how does anterior uveitis present

A

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

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39
Q

what is anterior uveitis

A

inflammation affecting the anterior portion of the uvea (iris, ciliary body + choroid)
usually an AI process

also called iritis

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40
Q

difference between acute and chronic anterior uveitis

A

chronic is more granulomatous (more macrophages)
less severe
+ longer duration of > 3 mths

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41
Q

what is acute anterior uveitis assoc w

A

HLA B27 related conditions
ie Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

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42
Q

what is chronic anterior uveitis assoc w

A

Sarcoidosis
Syphilis
Lyme disease
Tuberculosis
Herpes virus

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43
Q

mx anterior uveitis

A

urgent same day assessment w opthlamologist
cycloplegics (dilate pupil) - atropine, cyclopentolate
steroid eye drops

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44
Q

causes of central retinal artery occlusion

A

atherosclerosis (most common)
GCA

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45
Q

RFs central retinal artery occlusion

A

same as for CVD:
Older age
Family history
Smoking
Alcohol consumption
Hypertension
Diabetes
Poor diet
Inactivity
Obesity

GCA risk:
>50
females
prev
polymyalgia rheumatica

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46
Q

what pupil defect in central retinal artery occlusion

A

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.)

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47
Q

fundoscopy in central retinal artery occlusion

A

pale retina with a cherry red spot
(pale as lack of blood perfusion, spot is macula)

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48
Q

mx central retinal artery occlusion

A

immediate referral to ophthalmology
older px tested + tx for GCA (IV steroids)

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49
Q

what is a cataract

A

progressively opaque (cloudy) eye lens reducing light entering eye + visual acuity

50
Q

screening for congenital cataracts

A

red reflex
(If no red reflex, or a weak one, is seen, it may mean there’s cloudiness in the lens.)

51
Q

Rfs cataracts

A

Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia
Downs syndrome

52
Q

presentation cataracts

A

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
Q

key exam finding in cataracts

A

Loss of the red reflex
The lens can appear grey or white using an ophthalmoscope

54
Q

mx cataracts

A

no mx if sx ok

surgery - drilling + breaking lens, artificial lens = phacoemulsification

55
Q

what is endophthalmitis

A

inflam of inner contents of the eye
rare complication of cataract surgery

tx intravitreal abx

56
Q

what is scleritis

A

inflam of full thickness of the sclera (white bit)

57
Q

most signif comp of scleritis

A

necrotising scleritis -> sclera perforation

58
Q

systemic conditions assoc w scleritis

A

RA
SLE
IBD
sarcoidosis
granulomatosis with polyangiitis

59
Q

scleritis presentation

A

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
Q

mx scleritis

A

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
Q

what is episcleritis

A

self-limiting inflammation of the episclera, the outermost layer of the sclera.
The episclera is situated just underneath the conjunctiva.

62
Q

episcleritis presentation

A

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
Q

mx episcleritis

A

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
Q

what is blepharitis

A

inflam of eyelid margins

can be assoc w dysfunc of meibomian glands (secrete oil to surface of eye)

can lead to styes + chalazions

65
Q

presentation blepharitis

A

gritty, itchy, dry sensation in eyes

66
Q

mx blepharitis

A

warm compresses and gentle cleaning of the eyelid margins to remove debris

67
Q

what is a stye

A

a tender red lump along the eyelid that may contain pus

68
Q

what is Hordeolum externum

A

type of stye
infection of the glands of Zeis (sebaceous) or Moll (sweat) (at the base of eyelashes)

69
Q

what is Hordeolum internum

A

type of stye
infection of the meibomian glands (oil)
deeper, more painful + may point towards the eyeball under the eyelid

70
Q

stye tx

A

Hot compresses and analgesia
Topical antibiotics (e.g., chloramphenicol) may be considered if it is associated with conjunctivitis or if sx are persistent

71
Q

what is a chalazion

A

occurs when a meibomian gland becomes blocked + swells
can be called meibomian cyst

72
Q

chalazion presentation

A

swelling in the eyelid not typically tender
usually slightly above upper eyelid

73
Q

tx chalazion

A

warm compresses + gentle massage towards the eyelashes to encourage drainage

74
Q

what is entropion

A

when the eyelid turns inwards with the lashes pressed against the eye

causes pain + can result in corneal damage + ulceration

75
Q

mx entropion

A

taping eyelid down (lubricating eye drops)
definitive mx is surgical
same day referral if risk to sight

76
Q

what is ectropion

A

when the eyelid turns outwards exposing inner aspect
usually affects bottom lid -> exposure keratopathy

77
Q

tx ectropion

A

mild cases nothing
regular lubricating eye drops
surgery

78
Q

what is trichiasis

A

inward growth of eyelashes

79
Q

mx trichiasis

A

remove affected eyelashes
recurrent cases may need electrolysis, cryotherapy or laser treatment

80
Q

what is periorbital cellulitis

A

an eyelid + skin infection in front of the orbital septum (in front of eye)

swollen, red, hot skin around eyelid + eye

81
Q

tx periorbital cellulitis

A

(need to differentiate from orbital which is a sight + life threatening emergency)

systemic abx
admit vulnerable px

82
Q

what is orbital cellulitis

A

infection around the eyeball involving tissues behind the orbital septum

83
Q

sx orbital cellulitis

A

pain w eye movement
reduced eye movements
vision changes
abnormal pupil reactions
proptosis

84
Q

tx orbital cellulitis

A

emergency admission under opthalmology + IV abx

85
Q

what is keratitis

A

infection of the cornea

86
Q

causes of keratitis

A

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
Q

where does herpes keratitis usually affect

A

the epithelial layer of the cornea
if there is stroma inflam (layer between epithelium + endothelium) = stromal keratitis + has lots of comps

88
Q

presentation herpes keratitis

A

Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced visual acuity. This can vary from subtle to significant.

89
Q

ix herpes keratitis

A

FLUORESCEIN staining = DENDRITIC CORNEAL ULCER

SLIT-LAMP examination req to find + dx

corneal swabs/scrapings to isolate the virus

90
Q

mx keratitis

A

(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
Q

what is retinal detachment

A

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
Q

mx of retinal tears + detachment

A

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
Q

conjunctivitis presentation

A

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
Q

list causes of acute painful red eye

A

Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury

95
Q

list causes of acute painless red eye

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

96
Q

mx conjunctivitis

A

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
Q

what is allergic conjunctivitis

A

caused by contact with allergens. It causes swelling of the conjunctival sac and eyelid with itching and a watery discharge.

98
Q

tx allergic conjunctivitis

A

Antihistamines
Topical mast-cell stabilisers - need several wks of use b4 benefit

99
Q

eye drops that dilate pupil

A

Cyclopentolate

100
Q

tx for macular oedema

A

An intravitreal implant containing dexamethasone

101
Q

what is nasolacrimal duct obstruction

A

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
Q

tx nasolacrimal duct obstruction

A

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
Q

horner’s syndrome

A

triad of ptosis (drooping of the upper eyelid), miosis (constricted pupil) and anhidrosis (lack of sweating) on the affected side

104
Q

what is the macula

A

the central part of the retina responsible for sharp, detailed vision.

The fovea is a small, central pit located in the macula.

105
Q

Central retinal vein occlusion

A

decrease in central vision
typically presents with retinal haemorrhages, venous dilation, and tortuosity (stormy sunset appearance)

106
Q

diabetic maculopathy

A

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
Q

fundoscopy features of papilloedema

A

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
Q

causes of papilloedema

A

space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia

109
Q

features of hypertensive retinopathy

A

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
Q

Keith-Wagener classification of hypertensive retinopathy

A

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
Q

what is herpes zoster ophthalmicus (HZO)

A

reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve

112
Q

features of herpes zoster ophthalmicus (HZO)

A

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
Q

mx herpes zoster ophthalmicus (HZO)

A

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
Q

what is Argyll-Robertson pupil + what causes it

A

Bilaterally small pupils that accommodate but don’t react to bright light.

neurosyphilis
diabetes mellitus

115
Q

ix for acute angle closure glaucoma

A

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
Q

Endophthalmitis

A

typically red eye, pain and visual loss following intraocular surgery

117
Q

presentation of vitreous haemorrhage

A

subacute onset:
- painless visual loss or haze (commonest)
- red hue in the vision
- floaters or shadows/dark spots in the vision

118
Q

most common cause of vitreous haemorrhage

A

proliferative diabetic retinopathy (over 50%)

in children + young adults: ocular trauma

119
Q

Key things to remember in eye trauma

A

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
Q

myiadratic eye drops + examples

A

DILATE the eye

e.g. cycloplegic eye drops Atropine, cyclopentolate

121
Q

what eye drops constrict the eye

A

pilocarpine

122
Q

complication of panretinal photocoagulation

A

decrease in night vision

finals (27 decks)

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