Ophthalmology Flashcards
Cataracts: risk factors
- Ageing / Senility
- Corticosteroid therapy
- Diabetes
- Hypoparathyroidism
- Dystrophia myotonia
- Trauma (may be delayed)
- Ocular disease (e.g. glaucoma)
- Smoking
Cataracts features
– Reading Difficulty
– Difficulty in recognising faces
– Problem with driving especially at night
– Difficulty with television viewing
– Reduce ability to see in bright light (glaring)
– May see haloes around light
Traumatic cataract features
- under 45 years of age
- injury to the lens by foreign body or direct impact
Cataracts management
- Intraocular lens
-phaecoemulsification to replace intraocular lens
Hyphaema causes
Trauma (squash ball, rugby)
- Blood clotting disturbances
- Medications (anticoagulants)
- Neovascularisation (diabetic retinopathy, previous eye surgery0
- melanoma or retinoblastoma
- abnormal vasculature
Hyphaemia features
- presence of blood in the anterior chamber
- ## impaired visual acuity
Hyphaemia management
- Urgent referral to the ophthalmologist
- bed rest with the head elevated 30 to 45° with eye shield
Unilateral cataract features
– A progressive blurring of vision.
– Glare, especially in bright light or when driving at night
– Monocular double vision
Nasolacrimal duct obstruction features
- Clear eye discharge & crusting of the eyelashes
- No redness or irritation
- 6 to 20% of newborns
Nasolacrimal duct obstruction management
- resolves spontaneously
- requires antibiotics only when
complicated conjunctivitis or dacryocystitis - Ophthalmologic consultation if persists past 12 months of age or earlier if complicated by recurrent infection
Diabetic retinopathy screening
2 yearly by either optometrist or ophthalmologist unless:
- Aboriginal and Torrens Islanders
- Non-English-speaking backgrounds
- Visual loss
- Poor diabetic control
- hypertension
-hyperlipidaemia - anaemia
- renal disease
-long duration of diabetes
Diabetic retinopathy predictors
- Non-English-speaking backgrounds
- Duration of diabetes
- Control of diabetes
Diabetic retinopathy screening in diabetic pregnant women
1st trimester
Diabetic retinopathy screening in children
Puberty
Diabetic retinopathy screening in gestational diabetes
diabetes persists after pregnancy
Diabetic retinopathy screening in Non proliferative diabetic retinopathy
Screen every 3–6 months
Diabetic retinopathy risk factors
-Poor glycemic control.
-Longer duration diabetes.
-Poor lipid or blood pressure control.
-Aboriginal and Torrens Islanders
Diabetic retinopathy management
Prophylactic photocoagulation
Base orbital fracture features
- Damage to infraorbital nerve failing to “push” the eyeball up
1. Diplopia when gazing upwards
2. enophthalmos (eye receding into the orbit)
3. Numbness (cheek, upper lip, or upper gingiva) - Blurry vision
Superior orbital fracture features
- vertical diplopia when gazing downwards
- no numbness
Zygomatic fracture features
- horizontal diplopia
- Mallar flattening
-difficulty in opening mouth
Hyphaemia complications
- recurrent bleeding
- glaucoma
- blood staining of the cornea
- all leading to permanent vision loss
Nasal bone fracture features
- horizontal diplopia
- cerebrospinal fluid leakage
- epistaxis
Glaucoma risk factors
-The family history of glaucoma.
-Myopia.
-Diabetes Mellitus.
– Migraine.
– History of trauma to the eyes
– Abnormal blood pressure
Tripod fracture features
- vertical/horizontal/oblique diplopia
- difficulty in mastication
Open angle glaucoma treatment
- STAMP
-Supine Position - Timolol topical (carteolol)
- Acetazolamide IV
- Mannitol
-Pilocarpine topical
Long term treatment of acute closed-angle glaucoma
Laser iridotomy
Long term treatment of chronic open-angle glaucoma
Laser trabeculectomy
Difference between hypermetropia & presbyopia
Age 40 and is completed at 60
Contraindication to timolol
– severe hypotension
– chronic obstructive airways disease
– Moderate to severe asthma
– uncontrolled cardiac failure
– bradycardia or second or third-degree atrioventricular block
Eye corticosteroid side- effects
– Microbial keratitis
– Corneal thinning
– Delayed corneal healing
– Corneal perforation
– Cataract formation
– Raised intraocular pressure
– Glaucomatous optic neuropathy
Acute closed angle glaucoma features
- rapidly increased IOP
- pain
- nausea
- blurred vision
- eye redness
- hazy cornea
-pupils partially or fully dilated and unresponsive to light (anisocoria) - NO photophobia
Indications for referral of Ophthalmologist
– Penetrating eye injury or intraocular foreign body
– Incomplete removal or practitioner uncertainty
– Persisting foreign body symptoms
– Persisting rust ring
– Persisting vision loss
– Keratitis
– Endophthalmitis
– Paediatric or uncooperative patients that may require examination under anaesthesia
Features of retinal detachment
- Hx of trauma, diabetic retinopathy, myopia and cataract surgery
- sudden onset of floaters, flashes and field defects
- painless loss of vision
- dark shadow (curtain closing) of affected eye
Features of Posterior Vitreous detachment
- Age >70 years (66%)
-Vision acuity preserved
Unilateral exophthalmos features
- most common Graves’s disease (Thyrotoxicosis)
- orbital pseudotumor
- orbital cellulitis
- cavernous sinus
- thrombosis
- retrobulbar
- retro-orbital tumours
- Congenital glaucoma
Nasopharyngeal tumours
Retinal artery occlusion fundoscopic features
- Cherry red spot
- Retinal whitening
Chronic simple glaucoma fundoscopic features
- increased ratio of the optic cup to the
optic disc - retinal vessels seem to be cut/ broken upon entering optic disk
external hordeolum (stye) pathogen
Staphylococcus aureus
external hordeolum (stye)
Warm compresses
Strabismus cut-off point
- 5 to 6 months to align by itself
- Correcting strabismus before 4-6 years
dacryocystitis management
- flucloxacillin
- amoxicillin
- clavulanate
- cephalexin
Macular degeneration features
- blurry centre of her vision
- distortion of objects (straight lines wavy)
Types of age related macular degeneration
Dry
- slow progression
- 90% of AMD cases
- drusen, pigmentation and
sometimes haemorrhages at macula
Wet
- rapid deterioration
- abnormal vessels grow from the choroid into the neurosensory retina &leak macula
- rapid deterioration
Hypertensive retinopathy features
- papilloedema
- straightening of the vessels
- thickened opacified vessel walls
- arteriovenous nicking
Bacterial conjuctivitis treatment
Chloramphenicol
inflammation of meibomian glands
Internal hordeolum
Features of viral conjunctivitis
- adenovirus
- watery eyes
- uni or bilateral affection
- contact lenses
- usually painless
- vision preserved
Features of allergic conjunctivitis
- can be watery
- bilateral
-history of contact hypersensitivity (changing contact lenses), hay fever - usually painless
- vision preserved
Features of keratitis
- herpes simplex/zoster infection
- circumcorneal dendritic ulceration
- eye pain and redness
- grittiness (foreign body)
-photophobia - lacrimation
- vision and pupillary reflex normal
Features of acute uveitis (iritis)
- eye pain and redness
- visual acuity may be decreased
- photophobia
- hypopyon (white cells precipitating in anterior chamber)
-irregular constricted pupil (reflex abnormal)
-history of prior surgery (phacoemulsification) - also associated with seronegative arthropathies (ankylosing spondylitis, RA, IBD)
Traumatic cataract features
- under 45 years of age
- injury to the lens by foreign body or direct impact
Conditions that require urgent referral to Ophthalmologist
- Significant eye trauma, burns, embedded foreign body in cornea, intraocular foreign body
- Hyphaemia (>3mm)/hypopyon
- Corneal ulcer
- Severe conjunctivitis
- Uveitis/ acute iritis
- Behcet syndrome
- acute glaucoma
- giant cell arteritis
- acute dacryocystitis
- endophthalmitis
- herpes zoster ophthalmicus
features of retinal artery occlusion
unilateral + sudden onset of significant vision loss
- preceded by transient monocular blindness
Types of retina artery occlusion
attach pics
Hypopyon
sign not diagnosis
indicates uveitis
Management of subconjunctival haemorrhage
- red discolouration NOT crossing the limbus = warm compress
- red discoloration CROSSING the limbus = find underlying cause (Orbit CT)
- AVOID NSAID’s
Management of episcleritis
- Hypromellose (artificial tears) 4-6 times/day
- Topical NSAID’s diclofenac
NOTE: Topical steroids (prednisolone) if all above not helping
Difference between subconjunctival haemorrhage & episcleritis
Subconjunctival haemorrhage:
- micro tears in the sclera that cause haemorrhages, eyes appears dark red due to the accumulation of blood, but could also turn blue/purple/yellow after
- no discomfort with the exception of trauma
Episcleritis:
- Patchy pinkish/redness of the eye usually found in the corner
- no discharge, itchiness
- mild discomfort
-
Difference between episcleritis & scleritis
- If a patient’s eye redness improves after phenylephrine instillation = episcleritis
- scleritis is painful
