ophthalmology Flashcards
1
Q
glaucoma
A
optic nerve damage due to increased intraocular pressure due to blocked aqueous humour
2
Q
what is aqueous humour
A
in anterior and posterior chambers
supplies nutrients
3
Q
where is aqueous humour produces
A
by ciliary body
4
Q
how does aqueous humour circulate
A
anterior chamber ->trabecular meshwork -> canal of schlemm -> general circulation
5
Q
open angle glaucoma
A
gradual increase in resistance through trabecular meshwork
6
Q
acute angle-closure glaucoma
A
iris bulges forward and seals of trabecular meshwork from anterior chamber
7
Q
what happens to the optic disc in increased pressure
A
cupping (indent)
8
Q
RF open angle glaucoma
A
age
fhx
black
myopia
9
Q
sx open angle glaucoma
A
tunnel vision
pain
headaches
blurred vision
halos
10
Q
diagnosis open angle glaucoma
A
goldmann applanation tonometry
fundoscopy
visual field assessment
11
Q
mx open angle glaucoma
A
if pressure >24mmHg: prostaglandin analogue eyedrops - latanoprost (increases uveoscleral outflow), timolol (BB, reduces aquous humour), trabeculectomy
12
Q
RF acute angle closure glaucoma
A
age
F
fhx
china and east asian
shallow anterior chamber
meds: noradrenaline, oxybutynin, amytriptyline
13
Q
presentation acute angle closure glaucoma
A
painful red eye
blurred vision
halos
headache
N+V
14
Q
findings O/E acute angle closure glaucoma
A
red eye
teary
hazy cornea
reduced visual acuity
dilated fixed pupil
firm eyeball
15
Q
mx acute angle closure glaucoma
A
lie on back
pilocarpine eye drops - pupil constriction
acetazolamide 500mg - reduce aqueoues humour
other: glycerol/mannitol, timolol
definitive: laser iridotomy
16
Q
macula layers
A
bottom=chorid (blood vessels)
bruchs membrane
retinal pigment epithelium
photoreceptors
17
Q
wet AMD
A
new vessels from choroid leading to oedema
stimulated by VEG-F
18
Q
RF age related macular degeneration
A
age
smoking
white
chinese
fhx
CVD
19
Q
presentation AMD
A
gradual worsening visual field loss (scotomer)
reduced visual acuity or wavy appearance to straight lines (amsler grid test)
wet AMD more acute
20
Q
O/E AMD
A
fundoscopy=drusen (yellow protein)
slit lamp biomicrosopic fundus exam
optical coherence tomography
21
Q
mx dry AMD
A
none specific
mx RF - smoking, CVD, vitamins
22
Q
mx wet AMD
A
anti VEGF injections e.g. ranibizumab
23
Q
how does hyperglycaemia damage eyes
A
damages retinal vessels and endothelial cells -> increased vascular permeability, blot haemorrhages, hard exudates (lipid)
24
Q
types diabetic retinopathy
A
non-proliferative
proliferative
diabetic maculopathy
25
stages non-proliferative diabetic retinopathy
mild=mincroaneurysm
moderate=microaneurysm, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding
severe= blot haemorrhages and microaneurysm in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormality
26
features proliferative diabetic retinopathy
neovascualrisation
vitreuous haemorrhage
27
features diabetic maculopathy
macular oedema
ischaemic
maculopathy
28
complications diabetic retinopathy
retinal detachment
vitreous haemorrhage
rebeosis iridis
optic neuropathy
cataracts
29
mx diabetic retinopathy
laser photocoag
anti VEGF - ramibizumab
vitreoretinal surgery
30
keith wagener classification hypertensive retinopathy
1=mild narrowing arterioles
2=focal constriction of blood vessels and AV nipping
3= cotton-wool patches, exudates, haemorrhage
4=papilloedema
31
cataracts
cloudy and opaque lens
32
RF cataracts
age
smoking
alcohol
DM
steroids
hypocalcaemia
33
presentation cataracts
asymmetrical
slow decrease in vision
blurred vision
colour ->brown/yellow
starbursts around lights
O/E=loss red reflex
34
mx cataracts
surgery - artificial lens to replace
35
pupil contstriction
parasympathetic - CN3
36
pupil dilation
sympathetic NS
37
causes abnormal pupil shape
trauma to sphincter muscles
adhesions from anterior uveitis
acute angle closure glaucoma=vertical oval
rubeosis iridis
coloboma
tadpole pupil - migraines
38
causes mydriasis (pupil dilation)
3rd nerve palsy
holmes adie
increased ICP
congenital
trauma
cocaine
anticholinergics
39
causes miosis
horners syndrome
cluster headaches
argyll robertson pupil
opiates
nicotine
pilocarpine
40
features CN3 palsy
ptosis
dilated pupil
divergent strabismus (down and out)
41
causes CN3 palsy
pupil (parasympathetic) sparing = DM, HTN, ischaemia
surgical/full = tumour, trauma, cavernous sinus thrombosis, posterior communicated artery aneurysm, increased ICP
42
horner syndrome
damage to sympathetic NS
43
features horners syndrome
ptosis
miosis
anhidrosis
44
causes horners syndrome
central lesion (anhidrosis in arms and trunk): stroke, MS, swelling, tumour, syringomyelia
pre-ganglionic: tumour, trauma, thyroidectomy,
post-ganglionic (no anhydrosis): carotid aneurysm, carotid artery dissection, cavernous sinus thrombosis, cluster headaceh
45
holmes adie pupil features
unilateral dilated and slow rxn to light
pupil size reduces over time
46
causes holmes adie pupil
damage to post ganglionic parasympathetic fibres
47
features argyll robertson pupil
constricted and accommodates to llight but doesnt react to light
48
when is argyll robertson pupil present
neurosyphilis
49
blepharitis
inflamamtion eyelid margins
50
features blepharitis
gritty
itchy
dry
51
mx blepharitis
hot compress
gentle clean
lubricating drops (hypromellose)
52
types od stye
hordeolum externum
hordeolum internum
53
hordeolum externum stye
glands of zeis/moll
red lump along eyelid
54
hordeolum internum stye
meibomian glands
deeper, may point in
55
mx stye
hot compress
+/- topical abx - chloramphenicol
56
chalazion
meibomian cyst = blocked gland
57
features chalazion
non tender swelling
58
mx chalazion
hot compress
+/-chloramphenicol
59
entropion
eyelid turns in
60
risks entropion
pain
corneal damage
61
mx entropion
tape eyelid down
surgery
62
extropion
eyelid turns out
63
risks extropion
exposure keratopathy
64
mx extropion
lubricating drops
surgery
65
trichiasis
inward growth eyelashes
66
risks trichiasis
pain and corneal damage
67
mx trichiasis
remove inward growing eyelashes
68
sx periorbital/preorbital cellulitis
red, hot, swollen
69
ix preorbital cellulitis
CT to differentiate from orbital cellulitis
70
mx periorbital cellulitis
abx
71
sx orbital cellulitis
pain on eye movements
visual changes
proptosis
72
mx orbital cellulitis
IV abx
73
sx conjunctivitis
red eye,
bloodshot
itchy
gritty
74
causes conjunctivitis
bacterial
viral
allergic
75
features bacterial conjunctivitis
purulent discharge
stuck together in moning
76
mx bacterial conjunctivitis
chloramphenicol or fusidic acid eye drps
77
features viral conjunctivitis
clear discharge
78
mx viral conjunctivitis
hygiene
clean
79
features allergic conjunctivitis
watery discahrge
itch
80
mx allergic conjunctivitis
antihistamines
81
causes painless red eye
conjunctivits
episcleritis
subconjunctical haemorrhage
82
causes painful red eye
glaucoma
anterior uveitis
scleritis
corneal abrasions
keratitis
foreign body
trauma
83
causes anterior uveitis
usually AI
infection
trauma
ischaemia
malignancy
84
associations anterior uveitis
acute: HLA B27 (ankylosing spondylitis, IBD, reactive arthritis)
chronic: sarcoidosis, syphilis, lyme disease, TB, herpes
85
presnetation anterior uveitis
unilateral
aching
ciliary flush
reduced acuity
floaters
miosis
lacrimation
hypopyon
photophobia
86
mx anteuror uveitis
steroids
cyclopentolate
DMARDs
87
associations episcleritis
RA
IBD
88
sx episcleritis
unilateral
red
watery
mild pain
89
mx episcleritis
lubricating drops
cold compress
if severe: NSAIDs, topical steroid
90
what is severe scleritis
necrotising scleritis
91
associations scleritis
RA
SLE
IBD
sarcoidosis
granulomatosis with polyangitis
92
sx scleritis
pain on eye movement
photophobia
watering
reduced acuity
abnormal rxn to light
93
mx slceritis
NSAIDs
sterodis
94
how is corneal abrasion diagnosed
fluorescein stain
95
mx corneal abrasion
lubrication
chloramphenicol
if chemical irrigate 20-30m
96
sx herpes keratitis
red
photophobia
vesicles
watery
dendritic corneal ulcer with fluorescein
(only effects epithelium)
97
mx herpes keratitis
aciclovir
ganiciclovir
98
cause subconjunctival haemorrhage
HTN
thrombosytopenia
whooping cough
warfarin
idiopathic
99
sx conjunctival haemorrhage
bright red patch
100
mx conjunctival haemorrhage
non
resolves 2w
101
sx posterior vitreous detachment
painless
spots vision loss
floaters
flashing lights
102
mx posterior vitreous detachment
none
rule out retinal tear or detachment
103
retinal detachment
separates from choroid
104
RF retinal detachment
posterior vitreous detachment
DM
trauma
malignanct
age
fhx
105
sx retinal detachment
peripheral visual loss
blurring
flashers and floaters
no pain
106
mx retinal detachment
surgical repair
107
sx retinal vein occlusion
sudden painful vision loss
108
RF retinal vein occlusion
HTN
cholesterol
DM
smoking
glaucoma
SLE
109
fundoscopy findings retinal vein occlusion
flame and blot haemorrhages
optic disc oedema
macula odema
110
mx retinal vein detachment
laser photocoag
steroids
anti VEGF
111
cause central retinal artery occlusion
atehrosclerosis
GCA
112
sx central retinal artery occlusion
sudden painless loss vision
RAPD
113
fundoscopy central retinal artery occlusion
pale retina
cherry red spot
114
mx central retinal artery occlusion
ocular massage
inhaling carbogen
sublingual isosorbide dinitrate
115
RAPD
constricts more when light shone in other eye than it
116
retinitis pigmentosa
congenital degeneration rods and cones
117
sx retinitis pigmentosa
night blindness
peripheral vision lost first
118
fundocopy retinitis pigmentosa
bone spicule pigmentation
119
associations retinitis pigmentosa
ushers
bassen-kornzweig
120
mx retinitis pigmentosa
visual aids
vitamins
121
causes central scotoma
problem with retina
122
cause monocular vision loss
optic nerve
123
cause bitemporal hemianopia
problem with optic chiasm
124
cause contralateral homonymous hemianopia`
problemm with optic tract (lesion in R affets L)
125
cause contralateral superior quadrantopia
problem with inferior radiation
126
cause contralateral inferior quadrantopia
problem with superior radiation
127
cause contralateral homonymous hemianopia with macular sparing
problem with visual cortex in occipial lobe
128
difference between open and closed acute angle glaucoma
in closed the iris covers the trabecular meshwork and the angle narrows, in open the iris is clear of the trabecular meshwork but the trabecular meshwork has increased resistance
129
clinical signs anterior uveitis
slit lamp=red eye
hypopyon: white cellc/pus in AC
flare (protein)
posterior synechiae: causes an unequal shaped pupil
keratic precipitates
130
sx ophthalmic shingles
vesicualr rash around eyes, neuralgia, rash on tip of nose (hutchinsons sign)
V1 branch affected
131
sign associated with ophthalmic shingles
hutchinsons sign
132
cause acute CN3 palsy
posterior communicating artery aneurysm
133
common sx 4th CN palsy
stiff neck as turns head to counteract
134
what cause to rule out CN 6 palsy
increased intracranial pressure
135
cause of horners syndrome
damage to sympathetic chain
pre-ganglionic lesion: pancoast tumour (lung ca)
post-ganglionic lesio: carotid dissection (usually painful)
136
Mx foreign body
Urgent ophthalmology referral - needs urgent surgery
Keep patient NBM
tetanus booster
NO MRI
+/- CT scan
Vision assessment
Plastic shield over eye
137
How to find corneal abrasion
Use fluorescein stain and shows up yellow/green
138
Red eye with norm/ near norm vision
Painless: subconjunctical haemorrhage
Pain/discomfort: conjunctivitis, blepharitis, dry eyes, episcleritis, scleritis
139
Red eye with impaired vision
Normal IOP: corneal abrasion, keratitis, anterior uveitis, endophthalmitis
High IOP: acute angle closure glaucoma
