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Phase 3A Revision > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the causes of a painful acute red eye?

A

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

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2
Q

What are the causes of a painless acute red eye?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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3
Q

What is glaucoma?

A

Damage to the optic nerve due to raised intraocular pressure due to a blockage as aqueous humour tries to escape the eye

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4
Q

What are the anterior and posterior borders of the anterior chamber of the eye?

A

Cornea anteriorly
Iris posteriorly

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5
Q

What are the anterior and posterior borders of the posterior chamber of the eye?

A

Iris anteriorly
Lens posteriorly

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6
Q

What is the normal physiological route of aqueous humour?

A

Produced by ciliary body
Supplies the cornea with nutrients
Flows through the posterior chamber and iris into the anterior chamber
Drains through the trabecular meshwork into the canal of Schlemm
Enters the general circulation

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7
Q

What is normal intraocular pressure?

A

10-21 mmHg

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8
Q

How does open-angle glaucoma happen?

A

Gradual increase in resistance to flow through the trabecular meshwork
Pressure slowly builds in the eye

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9
Q

What can be seen on fundoscopy in open-angle glaucoma?

A

Increased cupping of the optic disc (cup-disc ratio of greater than 0.5)

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10
Q

What are risk factors for open-angle glaucoma?

A

Increasing age
Family history
Black ethnic origin
Myopia (nearsightedness)

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11
Q

How does open-angle glaucoma present?

A

May be asymptomatic for a long time before diagnosis on routine eye test
Affects peripheral vision first, causing tunnelling
Fluctuating pain
Headaches
Blurred vision
Halos around lights, particularly at night

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12
Q

What is the first-line medical management for open-angle glaucoma?

A

Prostaglandin analogue eye drops (e.g., latanoprost) –> Increase uveoscleral outflow

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13
Q

What other medications can be used to treat open-angle glaucoma?

A

Beta-blockers (e.g., timolol) –> reduce production of aqueous humour
Carbonic anhydrase inhibitors (e.g., dorzolamide) –> reduce production of aqueous humour
Sympathomimetics (e.g., brimonidine) –> reduce production of humour and increase uveoscleral outflow

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14
Q

What is the NICE guidelines’ first line management for all open-angle glaucoma patients requiring treatment?

A

360° selective laser trabeculoplasty

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15
Q

What is the intraocular pressure treatment threshold in open angle glaucoma?

A

24mmHg

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16
Q

What is the pathophysiology of acute angle-closure glaucoma?

A

Increased pressure causes iris to bulge forward, closing the trabecular meshwork
This causes pressure to continue to build, further worsening the angle closure

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17
Q

What are the risk factors for acute angle-closure glaucoma?

A

Increasing age
Family history
Female
Chinese and east Asian ethnic origin
Shallow anterior chamber
Medication e.g., noradrenaline, anticholinergics, tricyclic antidepressants

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18
Q

How does acute angle-closure glaucoma present to the patient?

A

Severely painful red eye
Blurred vision
Halos around light
Associated headaches, nausea and vomiting

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19
Q

What are the signs of acute angle-closure glaucoma?

A

Red eye
Hazy cornea
Decreased visual acuity
Mid-dilated, fixed size pupil
Hard eyeball on palpation

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20
Q

What is the initial management of acute angle-closure glaucoma?

A

Immediate blue light admission
Lie patient on their back
Pilocarpine eye drops (2% for blue, 4% for brown)
Acetazolamide 500mg
Analgesia and antiemetic if required

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21
Q

How is acute angle-closure glaucoma managed in secondary care?

A

Pilocarpine eye drops
Acetazolamide
Hyperosmotic agents (e.g., IV mannitol) –> increase the osmotic gradient between blood and eye, aiming to draw fluid out of the eye
Timolol –> reduce humour production
Carbonic anhydrase inhibitors (e.g., dorzolamide) –> reduce production of aqueous humour
Sympathomimetics (e.g., brimonidine) –> reduce production of humour and increase uveoscleral outflow

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22
Q

What is the definitive management of acute angle-closure glaucoma?

A

Laser iridotomy –> hole is made in the iris to allow aqueous humour to move from the posterior to anterior chamber, relieving the pressure

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23
Q

What is blepharitis?

A

Inflammation of the eyelid margins

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24
Q

What is the presentation of blepharitis?

A

Gritty, dry sensation of the eyes

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25
Q

What is the management of blepharitis?

A

Warm compression and gentle cleaning

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26
Q

What is a stye?

A

Infection of the glands in the eyelids

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27
Q

What is the management of a stye?

A

Hot compression and analgesia
Topical antibiotics (e.g., chloramphenicol if symptoms present or conjunctivitis

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28
Q

What is a chalazion?

A

Blockage of the meibomian gland

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29
Q

What is an entropion?

A

When the eyelid turns inwards and lashes are against the eye

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30
Q

What is an ectropion?

A

When the eyelid turns outwards, exposing the inner aspect

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31
Q

What is trichiasis?

A

Inwards growth of eyelashes

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32
Q

What is periorbital cellulitis?

A

Eyelid infection anterior to orbital septum

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33
Q

How does periorbital cellulitis present?

A

Swollen, red, hot skin around eyelid and eye

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34
Q

What is the management of periorbital cellulitis?

A

Systemic antibiotics
Monitor progression to orbital cellulitis (medical emergency)

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35
Q

What is orbital cellulitis?

A

Eyelid infection posterior to orbital septum
Medical emergency

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36
Q

How does orbital cellulitis present?

A

Painful and reduced eye movement
Vision changes
Abnormal pupil reactions
Bulging of the eyeball

37
Q

What is the management of orbital cellulitis?

A

Emergency admission
IV antibiotics
Surgical drainage if abscess forms

38
Q

What are cataracts?

A

Progressive increasing of opaqueness of the lens, reducing the light entering the eye and reducing visual acuity

39
Q

How are congenital cataracts screened for?

A

Red reflex test

40
Q

What are risk factors for cataracts?

A

Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia

41
Q

How do cataracts present?

A

Slow reduction in visual acuity
Usually asymmetrical
Progressive vision blurring
Fading of colour vision
Starbursts around light

42
Q

How are cataracts managed?

A

No intervention necessary if symptoms are manageable
Cataract surgery

43
Q

What is a rare but serious complication of cataract surgery?

A

Endophthalmitis = Inflammation of the inner contents of the eye

Managed with intravitreal antibiotics

44
Q

Where does the central retinal artery branch from?

A

Ophthalmic artery, which branches from the internal carotid artery

45
Q

What are causes of central retinal arterial occlusion?

A

Atherosclerosis
Giant cell arteritis

46
Q

What are risk factors for central retinal arterial occlusion?

A

(From atherosclerosis)
Smoking
Hypertension
Diabetes
Hypercholesterolaemia

(From GCA)
White ethnicity
Older age
Female
Polymyalgia rheumatica

47
Q

How does central retinal arterial occlusion present?

A

Sudden painless loss of vision (“curtain coming down”)

48
Q

What are the differentials of sudden painless vision loss?

A

Retinal detachment
Central retinal arterial occlusion
Central retinal vein occlusion
Vitreous haemorrhage
Amaurosis fugax

49
Q

What are the signs of central retinal arterial occlusion?

A

Relative afferent pupillary defect (pupil in affected eye constricts more when light is shone in the other eye than when light is shone in the affected eye)
Pale retina with cherry red spot on fundoscopy

50
Q

What is the management of central retinal arterial occlusion?

A

Immediate referral
High-dose prednisolone if suspected due to GCA

51
Q

What are the causes of conjunctivitis?

A

Bacterial –> Staphylococcus, strep pneumoniae, haemophilus influenzae
Viral –> Adenovirus, HSV, VZV
Allergic

52
Q

How does conjunctivitis present?

A

Red, bloodshot eye
Itchy or gritty sensation
Discharge –> purulent if bacterial, clear if viral

53
Q

What symptoms suggest that a red eye is NOT conjunctivitis?

A

Pain
Photophobia
Reduced visual acuity

54
Q

What is the management of conjunctivitis?

A

Usually resolves in 1-2 weeks without treatment
Hygiene measures to prevent spreading as it is highly contagious
Clean the eye with cooled boiled water and cotton wool
Chloramphenicol or fusidic acid eye drops if indicated in bacterial cause

55
Q

How can diabetes cause retinopathy?

A

Hyperglycaemia damages the retinal small vessels and endothelial cells
Increased vascular permeability causes leaking blood vessels and hard exudates
Damage to vessel walls causes microaneurysms and venous beading
Damage to nerve fibres forms cotton wool spots to form on the retina
Intraretinal dilated and tortuous capillaries form, acting as a shunt between arterial and venous vessels
The release of growth factors stimulates neovascularisation

56
Q

What are the complications of diabetic eye disease?

A

Vision loss
Retinal detachment
Vitreous haemorrhage
Rubeosis iridis –> new blood vessels form in the iris, causing neovascular glaucoma
Optic neuropathy
Cataracts

57
Q

What features on fundoscopy suggest background diabetic eye disease?

A

Microaneurysms
Retinal haemorrhage
Hard exudates
Cotton wool spots

58
Q

What features on fundoscopy suggest pre-proliferative diabetic eye disease?

A

Venous beading
Multiple blot haemorrhages
Intraretinal microvascular abnormality

59
Q

What features on fundoscopy suggest proliferative diabetic eye disease?

A

Neovascularisation
Vitreous haemorrhage

60
Q

What is the management of non-proliferative diabetic eye disease?

A

Close monitoring
Careful diabetic control

61
Q

What is the management of proliferative diabetic eye disease?

A

Pan-retinal photocoagulation (laser treatment to suppress new vessels)
Intravitreal anti-VEGF medication
Surgery e.g., vitrectomy

62
Q

What are some complications of pan-retinal photocoagulation?

A

Reduction in visual fields
Decrease in night vision
General decrease in visual acuity
Macular oedema

63
Q

What is infective keratitis?

A

Inflammation of the cornea

64
Q

What are the causes of infective keratitis?

A

Viral –> herpes simplex
Bacterial –> pseudomonas, staphylococcus
Fungal –> candida, aspergillus
Contact lens induced red eye (CLARE)
Exposure –> e.g., with ectropion

65
Q

What is the most common cause of infective keratitis?

A

Herpes simplex virus

66
Q

How does infective keratitis present?

A

Primary –> Mild inflammation of the eyelid margins and conjunctiva
Recurrent –> Painful red eye, photophobia, vesicles, foreign body sensation, watery discharge, reduced visual acuity

67
Q

What is the management of infective keratitis?

A

Referral for urgent assessment
Topical or oral antivirals –> aciclovir or ganciclovir
Corneal transplant to treat permanent scarring and vision loss

68
Q

What are the 2 subtypes of macular degeneration?

A

Wet/neovascular –> 10%
Dry/non-neovascular –> 90%

69
Q

What are the risk factors for macular degeneration?

A

Older age
Smoking
Family history
Cardiovascular disease
Obesity
Poor diet

70
Q

How does macular degeneration present?

A

Unilateral, gradual loss of central vision
Reduced visual acuity
Crooked or wavy appearance of straight lines

71
Q

What is the management of macular degeneration?

A

Dry –> No treatment, manage risk factors
Wet –> Anti-vascular endothelial growth factor medication intravitreally

72
Q

What is the pathophysiology of retinal detachment?

A

Retinal tear allows vitreous fluid to get under the neurosensory retina and separate it from the retinal pigment epithelium and choroid
The neurosensory retina relies on the choroid for blood supply, so detachment disrupts the blood supply

73
Q

What are the risk factors for retinal detachment?

A

Lattice degeneration (retinal thinning)
Posterior vitreous detachment
Trauma
Diabetic retinopathy
Retinal malignancy
Family history

74
Q

How does retinal detachment present?

A

Painless
Peripheral vision loss
Blurred or distorted vision
Flashes/floaters

75
Q

What is the management of retinal detachment?

A

Immediate referral
Retinal tears –> Aim to re-adhere the retina and choroid with cryotherapy or laser therapy
Retinal detachment –> Reattach the retina and reduce any pressure that could cause it to re-detach

76
Q

What is scleritis?

A

Inflammation of the sclera (the connective tissue that surrounds the eye)

77
Q

What are the causes of scleritis?

A

Idiopathic
Associated with underlying systemic inflammatory cause e.g., rheumatoid arthritis and vasculitis (granulomatosis with polyangiitis)
Infection –> pseudomonas or staph aureus

78
Q

How does scleritis present?

A

Gradual onset
Red inflamed sclera
Severe pain, including with eye movement
Photophobia
Excessive tear production
Reduced visual acuity

79
Q

What is the management of scleritis?

A

Urgent referral
Screen for underlying systemic inflammatory cause
NSAIDs
Steroids
Immunosuppression
Antimicrobials if infective

80
Q

What is episcleritis?

A

Benign, self-limiting inflammation of the episclera (the outermost layer of the sclera just below the conjunctiva)

81
Q

What is episcleritis often associated with?

A

Inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease

82
Q

How does episcleritis present?

A

Acute onset and unilateral
Redness
No pain
Dilated episcleral blood vessels
No photophobia
Normal visual acuity

83
Q

How can episcleritis be distinguished from scleritis?

A

Episcleritis does not cause pain, photophobia or reduced visual acuity
Phenylephrine drops blanch the episcleral vessels but do not affect scleral vessels

84
Q

What is the management of episcleritis?

A

Self limiting and will resolve in 1-2 weeks
Severe cases may require steroid drops

85
Q

What is anterior uveitis?

A

Inflammation of the iris, ciliary body and choroid

86
Q

What conditions are associated with anterior uveitis?

A

Seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, reactive arthritis)

87
Q

How does anterior uveitis present?

A

Painful red eye (redness that spreads from the iris)
Reduced visual acuity
Photophobia
Excessive lacrimation

88
Q

What is the management of anterior uveitis?

A

Urgent assessment
Steroids
Cycloplegics (e.g., cyclopentolate or atropine eye drops) –> dilate the pupil and reduce ciliary spasm
Recurrent cases may required DMARDs or anti-TNF medications

Phase 3A Revision (23 decks)

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