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Phase 3b/Finals revision > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Risk factors for age-related macular degeneration

A

Advancing age
Female > male
Smoking
FHx
Hypertension, dyslipidaemia + DM - cardiovascular disease
White or Chinese ethnic origin

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2
Q

Characteristic features of dry macular degeneration

A

Atrophics
Drusen - yellow round spots in Bruch’s membrane

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3
Q

Characteristic features of wet macular degeneration

A

Choroidal neovascularisation

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4
Q

Features of both wet + dry macular degeneration

A

Atrophy of retinal pigment epithelium
Degeneration of photoreceptors
Can have drusen in bot

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5
Q

Symptoms of ARMD

A

Gradual worsening central visual field loss
Reduced visual acuity
Crooked or wavy appearance to straight lines

More acute in wet

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6
Q

Signs of ARMD

A

Amsler grid test - distortion of straight ligns
Snellen chart - reduced acuity
Scotoma - central patch of vision loss
Fundoscopy –> Drusen

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7
Q

Managament of dry AMD

A

Lifestyle measures to slow progression:
- Avoid smoking
- Control blood pressure
- Vitamin supplementation

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8
Q

Management of wet AMD

A

Anti-VEGF (vascular endothelial growth factor) medications e.g.
- Ranibizumab
- Bevacizumab
- Pegaptanib
injected into vitreous chamber once a month

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9
Q

Risk factors for vitreous haemorrhage

A

Diabetes - proliferative diabetic retinopathy is most common cause
Trauma
Anticoagulants
Coagulation disorders
Severe short sightedness

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10
Q

Symptoms of vitreous haemorrhage

A

Painless visual loss or haze
Red hue in vision
Floaters or shadows/dark spots in vision

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11
Q

Signs of vitreous haemorrhage

A

Decreased visual acuity
Visual field defect if severe haemorrhage

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12
Q

Pathophysiology of acute angle-closure glaucoma

A

Rise in intraocular pressure, secondary to impairment of aqeuous outflow

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13
Q

Factors predisposing to acute angle-closure glaucoma//risk factors

A

Hypermetropia (long-sightedness)
Pupillary dilatation
Lens growth associated with age
Increasing age
Female
FHx
Chinese + East Asian ethnic origin
Shallow anterior chamber

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14
Q

Glaucoma

A

Optic nerve damage caused by significant rise in intraocular pressure

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15
Q

Medications that may precipitate acute angle-closure glaucoma

A

Adrenergic medications e.g. noradrenlaine
Anticholingeric medications e.. oxybutynin + solifenacin
Tricyclic antidepressants e.g. amitryptiline, due to anti-cholinergic effects

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16
Q

Symptoms of AACG

A

Severely painful red eye
Blurred vision
Halos around lights
Headache, N+V

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17
Q

Signs of AACG

A

Red-eye
teary
Hazy cornea
Decreased visual acuity
Dilatation of pupil
Fixed pupil size
Firm eyeball on palpation

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18
Q

Initial management of AACG

A

Lie on back without pillow
Pilocarpine eye drops - to constrict pupil
Acetazolamide 500mg oral
Analgesia + antiemetic

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19
Q

Medical options for secondary care management of AACG

A

Pilocarpine
Acetazolamide - oral or IV
Hyperosmotic agents e.g. glycerol or mannitol
Timolol = beta-blocker
Dorzolamide
Brimonidine

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20
Q

Definitive treatment for AACG

A

Laser iridotomy

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21
Q

Blepharitis

A

Inflammation of eyelid margins

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22
Q

Causes/associations with blepharitis

A

Meibomian gland dysfunction
Seborrhoeic dermatitis/staphylococcal infection
More common in rosacea

23
Q

Feature of blepharitis

A

Usually bilateral
Grittiness + discomfort - especially around eyelid margins
Eyes may be sticky in morning
Eyelid margins may be red
Can lead to styes + chalazions

24
Q

Management of blepharitis

A

Hot compresses twice daily
Gentle cleaning of eyelid margins - use cotton wool dipped in sterilised water + baby shampoo
Consider lubricating eye drops e.g. hypromellose, polyvinyl alcohol + carbomer

25
Q

Risk factors for retinal detachment

A

Posterior vitreous detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
Family History

26
Q

Presentation of retinal detachment

A

Flashes + floaters = key
Painless
Peripheral vision loss - sudden + like a shadow
Blurred or distorted vision

27
Q

Management of retinal detachment

A

Immediate ophthalmology referral
Reattach retina –>
- Vitrectomy
- Scleral buckling
- Pneumatic retinopexy

28
Q

Where is aqueous humour found

A

In the anterior chamber - between cornea + iris
In the posterior chamber - between lens + iris

29
Q

Normal intraocular pressure

A

10-21mmHg

30
Q

Open-angle glaucoma pathophysiology

A

Gradual increase in resistance through the trabecular meshwork –> aqueous humour cannot exit the eye easily –> gradual increase in pressure

31
Q

What causes cupping of the optic disc

A

Increased pressure in the eye –> pressure on indent, making it wider + deeper

32
Q

What is cupping of the optic disc

A

When optic cup (central indent in optic disc) > half size of optic disc

33
Q

Presentation of open-angle glaucoma

A

Often asymptomatic
Affects peripheral vision first –> tunnel vision
Gradual onset of fluctuating pain, headaches, blurred vision + halos around lights (esp. at night)

34
Q

Risk factors for open angle glaucoma

A

Increasing age
Family History
Afro-Caribbean ethnicity
Myopia
Hypertension
Diabetes Mellitus
Corticosteroids

35
Q

Signs of open angle glaucoma on fundoscopy

A

Optic disc cupping
Optic disc pallor (atrophy)
Bayonetting of vessels
Cup notching, disc haemorrhages

36
Q

First line management of open angle glaucoma

A

Started if intraocular pressure >24 mmHg
Prostaglandin analogue eye drops e.g. latanoprost

37
Q

Risk factors for central retinal artery occlusion

A

Same as for other cardiovascular disease as most common cause = atherosclerosis
Also caused by giant cell arteritis –> higher risk if white, >50, already affected by GCA or PMR

38
Q

Presentation of central retinal artery occlusion

A

Sudden, painless loss of vision
Relative afferent pupillary defect

39
Q

Fundoscopy findings in central retinal artery occlusion

A

Pale retina/opacified
Cherry-red spot (macula showing choroid below)

40
Q

Immediate management of central retinal artery occlusion

A

Immediate ophthalmology referral
Ocular massage
Remove fluid from anterior chamber
Inhaling carbogen to dilate artery
Sublingual isosorbide dinitrate
Treat + manage underlying condition e.g. GCA with high-dose steroids

41
Q

Stage I hypertensive retinopathy

A

Mild narrowing of arterioles
Increased light reflex

42
Q

Stage II hypertensive retinopathy

A

Arteriovenous nipping

43
Q

Stage III hypertensive retinopathy

A

Cotton-wool exudates
Flame and blot haemorrhages –> may collect around fovea, causing ‘macular star’

44
Q

Stage IV hypertensive retinopathy

A

Papilloedema

45
Q

What is silver wiring

A

aka copper wiring
Walls of arterioles become thickened + sclerosed –> increased reflection of light

46
Q

What is arteriovenous nipping

A

Arterioles cause compressions of veins when they cross, due to sclerosis + hardening of the arterioles

47
Q

Features of mild non-proliferative diabetic retinopathy

A

Microaneurysms

48
Q

Features of moderate non-proliferative diabetic retinopathy

A

Microaneurysms
Dot + blot haemorrhages
Hard exudates
Cotton wool spots
Venous beading

49
Q

Features of severe non-proliferative diabetic retinopathy

A

Blot haemorrhages + microaneurysms in 4 quadrants
Venous beading in 2 quadrates
Intraretinal microvascular abnormality in any quadrant

50
Q

Features of proliferative diabetic retinopathy

A

Neovascularisation
Vitreous haemorrhage

51
Q

Diabetic maculopathy

A

Macular oedema
Ischaemic maculopathy

52
Q

Complications of diabetic retinopathy

A

Retinal detachment
Vitreous haemorrhage
Rebeosis iridis - new vessel formation in iris
Optic neuropathy
Cataracts

53
Q

Management of diabetic retinopathy

A

Laser photocoagulation
Anti-VEGF medications
Vitreoretinal surgery

54
Q

Scleritis

A

Inflammation of full thickness of the sclera

Phase 3b/Finals revision (17 decks)

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