Ophthalmology Flashcards
What are the 4 serious causes of a red eye?
Scleritis, acute angle glaucoma, anterior uveitis, corneal ulcer
How can you differentiate a serious red eye from a non-serious red eye in history?
Serious causes are usually unilateral and will cause PAIN
What kind of visual loss is present in cataracts?
Gradual generalised reduction in visual acuity with starbursts around lights
What kind of visual loss is present in chronic glaucoma?
Peripheral loss of vision with halos around lights, worse at night
What kind of visual loss is present in macular degeneration?
Central loss of vision with crooked/wavy appearance to straight lines
What are the 5 causes of sudden onset visual disturbance?
Central retinal artery occlusion, retinal vein occlusions, optic neuritis, retinal detachment, giant cell arteritis
What is glaucoma?
Optic nerve damage that is caused by a significant rise in intraocular pressure due to blockage in the aqueous humour
What is a normal intraocular pressure?
10-21mmHg
What is seen in the retina in glaucoma?
Cupping of the optic disc
What are the risk factors for glaucoma?
Increased age, family history, black ethnic origin, near-sightedness (myopia)
What is used to measure intraocular pressure?
Tonometry
Gold standard = Goldmann applanation tonometry
When is treatment started from open angle glaucoma?
When the pressure is >24mmHg
What is the 1st line treatment for open angle glaucoma and its common side effects?
Prostaglandin analogue eye drops = latanoprost
Side effects = eyelash growth, eyelid pigmentation
What are the non-1st line options for treating open angle glaucoma?
Timolol (beta blockers)
Dorzolamide (carbonic anhydrase inhibitor)
Trabeculectomy surgery
When does acute open angle glaucoma occur?
Occurs when the iris bulges forwards and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from escaping
What are the risk factors for acute angle closure glaucoma?
Increased age, family history, females, East Asian, anticholingeric medications, recent pupil dilation, cataracts, long sightedness
How will a patient with acute closure angle glaucoma present?
Unwell in themselves, severely pain red eye, blurred vision, halos around lights, headache, N+V, hazy cornea, fixed pupil
What is the initial management of acute angle closure glaucoma?
Immediate referral to ophthalmology
Lie patient on their back
Pilocarpine eye drops - causes ciliary muscle contraction
Analgesia and antiemetics
Acetazolamide 500mg PO
What is the definitive treatment for acute angle closure glaucoma?
Laser iridotomy
What are the two types of macular degeneration, which is more common and which has better prognosis?
Dry (90%) and wet (10%)
Wet has worse prognosis
What is found on the retina of those with macular degeneration?
Drusen - yellow deposits of proteins and lipids
What’s the difference between wet and dry macular degeneration?
In wet there is development of new vessels
Causing a more acute loss of vision over weeks-months as opposed to dry which takes 2-3 years
What can be used to diagnose macular degeneration?
Slit lamp biomicroscopic fundus examination
Optical coherence tomography - for wet AMD
What is the management of dry macular degeneration?
No treatment
Avoid risk factors - smoking, control BP, vitamin supplementation
What can be used to manage wet macular degeneration?
Anti-VEGF injections into the eye stops the development of new vessels
e.g. ranibizumab
What are the features on fundoscopy in diabetic retinopathy?
Cotton wool spots
Microaneurysms (1st sign)
Hard exudates
Blot haemorrhages
Neovascularisation (in proliferative)
What are the complications associated with diabetic retinopathy?
Retinal detachment
Vitreous haemorrhage
Rebeosis iridis (new vessel formation in iris)
Optic neuropathy
Cataracts
What is vitreous haemorrhage and how does it presnt?
Bleeding into the vitreous humour
Sudden complete loss of vision in one eye usually in someone with known diabetes
What is the management of diabetic retinopathy?
Laser photocoagulation - prevents vessels leaking
Anti-VEGF injections
Vitreoretinal surgery if severe
What is hypertensive retinopathy?
Damage to the small blood vessels in the retina relating to systemic hypertension
What are the findings on fundoscopy with hypertensive retinopathy?
Cotton wool spots
Retinal haemorrhages
Papilloedema
Arteriovenous nipping (1st sign)
Hard exudates
Silver wiring
How can you differentiate between hypertensive retinopathy and diabetic retinopathy?
In hypertensive retinopathy there is disc swelling (papilloedema) whereas in diabetic there is no swelling of the disc
What is the management of hypertensive retinopathy?
Control BP, control lipids, stop smoking
What are the key features of cataracts?
Very slow reduction in vision, progressive blurring, starbursts around lights at night-time, loss of the red reflex, lens can appear grey/white when testing red reflex
What are the risk factors for developing cataracts?
Increased age, smoking, alcohol, diabetes, steroids, hypocalcaemia
How are cataracts diagnosed?
Slit lamp
How are cataracts managed?
May require no intervention
Cataract surgery to correct
What are the symptoms of blepharitis?
Gritty, itchy, dry sensation in the eyes
How is blepharitis treated?
Hot compresses and gentle cleaning of eyelid margins, lubricating eye drops can be used to relieve dry eye symptoms
What is the presentation of a stye?
Tender red lump along the eyelid that may contain pus
How are styes treated?
Hot compress and analgesia, consider topical antibiotics if persistent
What is a chalazion and how does it present?
Occurs when a meiomian gland becomes blocked and swells up
Presents as swelling in eyelid - typically not tender
What is the management of chalazion?
Hot compress and analgesia
If acutely inflamed topical antibiotics can be used
What are the complications associated with entropion?
Can result in corneal damage and ulceration due to lashes being against the eyeball
What are the complications of ectropion and how is it managed?
Can result in exposure keratopathy as eyeball is exposed and not adequately lubricated
Regular lubricating eye drops are required
What the key features that differentiate orbital cellulitis from periorbital cellulitis?
Pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forwards movement of the eyeball (proptosis)
What are the complications of orbital cellulitis?
Blindness, death
What investigation is used to diagnose orbital cellulitis?
CT orbit with contrast
What is the treatment of orbital cellulitis?
Admission and IV antibiotics
What is the treatment of periorbital cellulitis?
Systemic antibiotics - usually oral
N.B. can develop into orbital cellulitis so vulnerable patients may require admission
What bacteria and viruses cause conjunctivitis?
Staph, gonococcus, adenovirus
What is the presentation of conjunctivitis?
Can be unilateral or bilateral, red eye, blood shot, itchy/gritty sensation but not painful, discharge from eye
How can you tell bacterial from viral conjunctivitis?
Bacterial = purulent discharge, worse in morning, more likely to be unilateral
Viral = more common, clear discharge, other symptoms of viral infection, more likely to be bilateral
What is the management of conjunctivitis?
Usually resolve without treatment after 1-2 weeks, hygiene advise
If bacterial can give chloramphenicol and fuscidic acid eye drops but will get better without
What can be used to treat allergic conjunctivitis?
Antihistamines (topical or oral), topical mast-cell stabilisers can be used in those with chronic seasonal symptoms
What diseases are associated with anterior uveitis?
Ankylosing spondylitis, IBD, reactive arthritis and other autoimmune conditions
What are the presenting features of optic neuritis?
Dull aching painful red eye, reduced visual acuity, floaters and flashes, unequal shaped pupil, photophobia, excessive lacrimation
What investigation is done in those with suspected anterior uveitis?
Slit lamp assessment
What is the management of anterior uveitis?
Steroids and cycloplegic mydriatic medications e.g. cyclopentolate or atropine eye drops
What are the presenting symptoms of episcleritis?
Unilateral symptoms, not painful, segmental red eye, foreign body sensation, watering of eye
What is the management of episcleritis?
Self limiting - will recover in 1-4 weeks
Can use lubricating eye drops to relieve symptoms
What drops can be used to differentiate episcleritis and scleritis?
Phenylephrine drops
What is the presentation of scelritis?
Severe pain, pain on eye movement, can be unilateral or bilateral, watering eye, tenderness on palpation, reduced visual acuity, abnormal pupil reaction to light
What diseases are associated with scelritis?
Rheumatoid arthritis, SLE, IBD, sarcoidosis, granulomatosis with polyangitis
What is the treatment of scleritis?
NSAIDs, steroids, immunosuppression
What are the common causes of corneal abrasion?
Contact lenses, foreign bodies, fingernails, eyelashes
What is the presentation of corneal abrasion?
Painful red eye, foreign body sensation, watering eye, blurring vision, photophobia
How is corneal abrasion diagnosed?
Fluorescein stain applied to the eye highlights areas of abrasion
What is the management for corneal abrasion?
Remove any foreign bodies, analgesia, lubricating eye drops, antibiotic eye drops
What is the most common form of keratitis?
Herpes simplex infection (herpes keratitis)
What is the presentation of herpes keratitis?
Painful red eye, photophobia, vesicles around eye, watering eye, foreign body sensation
What investigations are done in herpes keratitis?
Fluorescein stain will show dendritic corneal ulcer
Slit lamp examination required to find and diagnose keratitis
What is the management of herpes keratitis?
Topical or oral aciclovir
What are the risk factors for retinal detachment?
Posterior vitreous detachment, diabetic retinopathy, trauma to the eye, retinal malignancy, older age, family history
What is the presentation of retinal detachment?
NO PAIN, peripheral vision loss (like a shadow coming across vision), blurred or distorted vision, flashes and floaters
What is the 1st line management for retinal detachment?
Vitrectomy surgery
What is central retinal vein occlusion?
When a thrombus forms in the retinal veins and blocks drainage of blood from the retina
What is the presentation of retinal vein occlusion
Including fundoscopic appearance
Sudden painless loss of vision, flame and blot haemorrhages and optic disc/macula oedema on fundoscopy
How is central retinal vein occlusion managed?
Laser photocoagulation, intravitreal steroids, anti-VEGF therapies
What are the two main causes of central retinal artery occulsion?
Atherosclerosis and giant cell arteritis
What is the presentation of central retinal artery occlusion?
Sudden painless loss of vision, RAPD, pale retina with cherry red spot
What is the management of central retinal artery occlusion?
If GCA is suspected IV methylprednisolone
Try and dislodge the thrombus
What is retinitis pigmentosa and what are the features?
Genetic condition that leads to night blindness and tunnel vision
Fundoscopy shows black pigmentation in peripheries and mottling of retinal pigment epithelium
What imaging should be done in foreign body and why?
CT orbits
Cannot use MRI in case foreign body is metal
