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Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the 4 serious causes of a red eye?

A

Scleritis, acute angle glaucoma, anterior uveitis, corneal ulcer

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2
Q

How can you differentiate a serious red eye from a non-serious red eye in history?

A

Serious causes are usually unilateral and will cause PAIN

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3
Q

What kind of visual loss is present in cataracts?

A

Gradual generalised reduction in visual acuity with starbursts around lights

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4
Q

What kind of visual loss is present in chronic glaucoma?

A

Peripheral loss of vision with halos around lights, worse at night

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5
Q

What kind of visual loss is present in macular degeneration?

A

Central loss of vision with crooked/wavy appearance to straight lines

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6
Q

What are the 5 causes of sudden onset visual disturbance?

A

Central retinal artery occlusion, retinal vein occlusions, optic neuritis, retinal detachment, giant cell arteritis

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7
Q

What is glaucoma?

A

Optic nerve damage that is caused by a significant rise in intraocular pressure due to blockage in the aqueous humour

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8
Q

What is a normal intraocular pressure?

A

10-21mmHg

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9
Q

What is seen in the retina in glaucoma?

A

Cupping of the optic disc

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10
Q

What are the risk factors for glaucoma?

A

Increased age, family history, black ethnic origin, near-sightedness (myopia)

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11
Q

What is used to measure intraocular pressure?

A

Tonometry

Gold standard = Goldmann applanation tonometry

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12
Q

When is treatment started from open angle glaucoma?

A

When the pressure is >24mmHg

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13
Q

What is the 1st line treatment for open angle glaucoma and its common side effects?

A

Prostaglandin analogue eye drops = latanoprost

Side effects = eyelash growth, eyelid pigmentation

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14
Q

What are the non-1st line options for treating open angle glaucoma?

A

Timolol (beta blockers)
Dorzolamide (carbonic anhydrase inhibitor)
Trabeculectomy surgery

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15
Q

When does acute open angle glaucoma occur?

A

Occurs when the iris bulges forwards and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from escaping

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16
Q

What are the risk factors for acute angle closure glaucoma?

A

Increased age, family history, females, East Asian, anticholingeric medications, recent pupil dilation, cataracts, long sightedness

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17
Q

How will a patient with acute closure angle glaucoma present?

A

Unwell in themselves, severely pain red eye, blurred vision, halos around lights, headache, N+V, hazy cornea, fixed pupil

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18
Q

What is the initial management of acute angle closure glaucoma?

A

Immediate referral to ophthalmology

Lie patient on their back
Pilocarpine eye drops - causes ciliary muscle contraction
Analgesia and antiemetics
Acetazolamide 500mg PO

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19
Q

What is the definitive treatment for acute angle closure glaucoma?

A

Laser iridotomy

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20
Q

What are the two types of macular degeneration, which is more common and which has better prognosis?

A

Dry (90%) and wet (10%)
Wet has worse prognosis

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21
Q

What is found on the retina of those with macular degeneration?

A

Drusen - yellow deposits of proteins and lipids

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22
Q

What’s the difference between wet and dry macular degeneration?

A

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

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23
Q

What can be used to diagnose macular degeneration?

A

Slit lamp biomicroscopic fundus examination

Optical coherence tomography - for wet AMD

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24
Q

What is the management of dry macular degeneration?

A

No treatment
Avoid risk factors - smoking, control BP, vitamin supplementation

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25
Q

What can be used to manage wet macular degeneration?

A

Anti-VEGF injections into the eye stops the development of new vessels

e.g. ranibizumab

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26
Q

What are the features on fundoscopy in diabetic retinopathy?

A

Cotton wool spots
Microaneurysms (1st sign)
Hard exudates
Blot haemorrhages
Neovascularisation (in proliferative)

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27
Q

What are the complications associated with diabetic retinopathy?

A

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

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28
Q

What is vitreous haemorrhage and how does it presnt?

A

Bleeding into the vitreous humour

Sudden complete loss of vision in one eye usually in someone with known diabetes

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29
Q

What is the management of diabetic retinopathy?

A

Laser photocoagulation - prevents vessels leaking

Anti-VEGF injections

Vitreoretinal surgery if severe

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30
Q

What is hypertensive retinopathy?

A

Damage to the small blood vessels in the retina relating to systemic hypertension

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31
Q

What are the findings on fundoscopy with hypertensive retinopathy?

A

Cotton wool spots
Retinal haemorrhages
Papilloedema
Arteriovenous nipping (1st sign)
Hard exudates
Silver wiring

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32
Q

How can you differentiate between hypertensive retinopathy and diabetic retinopathy?

A

In hypertensive retinopathy there is disc swelling (papilloedema) whereas in diabetic there is no swelling of the disc

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33
Q

What is the management of hypertensive retinopathy?

A

Control BP, control lipids, stop smoking

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34
Q

What are the key features of cataracts?

A

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

35
Q

What are the risk factors for developing cataracts?

A

Increased age, smoking, alcohol, diabetes, steroids, hypocalcaemia

36
Q

How are cataracts diagnosed?

A

Slit lamp

37
Q

How are cataracts managed?

A

May require no intervention
Cataract surgery to correct

38
Q

What are the symptoms of blepharitis?

A

Gritty, itchy, dry sensation in the eyes

39
Q

How is blepharitis treated?

A

Hot compresses and gentle cleaning of eyelid margins, lubricating eye drops can be used to relieve dry eye symptoms

40
Q

What is the presentation of a stye?

A

Tender red lump along the eyelid that may contain pus

41
Q

How are styes treated?

A

Hot compress and analgesia, consider topical antibiotics if persistent

42
Q

What is a chalazion and how does it present?

A

Occurs when a meiomian gland becomes blocked and swells up

Presents as swelling in eyelid - typically not tender

43
Q

What is the management of chalazion?

A

Hot compress and analgesia
If acutely inflamed topical antibiotics can be used

44
Q

What are the complications associated with entropion?

A

Can result in corneal damage and ulceration due to lashes being against the eyeball

45
Q

What are the complications of ectropion and how is it managed?

A

Can result in exposure keratopathy as eyeball is exposed and not adequately lubricated

Regular lubricating eye drops are required

46
Q

What the key features that differentiate orbital cellulitis from periorbital cellulitis?

A

Pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forwards movement of the eyeball (proptosis)

47
Q

What are the complications of orbital cellulitis?

A

Blindness, death

48
Q

What investigation is used to diagnose orbital cellulitis?

A

CT orbit with contrast

49
Q

What is the treatment of orbital cellulitis?

A

Admission and IV antibiotics

50
Q

What is the treatment of periorbital cellulitis?

A

Systemic antibiotics - usually oral

N.B. can develop into orbital cellulitis so vulnerable patients may require admission

51
Q

What bacteria and viruses cause conjunctivitis?

A

Staph, gonococcus, adenovirus

52
Q

What is the presentation of conjunctivitis?

A

Can be unilateral or bilateral, red eye, blood shot, itchy/gritty sensation but not painful, discharge from eye

53
Q

How can you tell bacterial from viral conjunctivitis?

A

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

54
Q

What is the management of conjunctivitis?

A

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

55
Q

What can be used to treat allergic conjunctivitis?

A

Antihistamines (topical or oral), topical mast-cell stabilisers can be used in those with chronic seasonal symptoms

56
Q

What diseases are associated with anterior uveitis?

A

Ankylosing spondylitis, IBD, reactive arthritis and other autoimmune conditions

57
Q

What are the presenting features of optic neuritis?

A

Dull aching painful red eye, reduced visual acuity, floaters and flashes, unequal shaped pupil, photophobia, excessive lacrimation

58
Q

What investigation is done in those with suspected anterior uveitis?

A

Slit lamp assessment

59
Q

What is the management of anterior uveitis?

A

Steroids and cycloplegic mydriatic medications e.g. cyclopentolate or atropine eye drops

60
Q

What are the presenting symptoms of episcleritis?

A

Unilateral symptoms, not painful, segmental red eye, foreign body sensation, watering of eye

61
Q

What is the management of episcleritis?

A

Self limiting - will recover in 1-4 weeks

Can use lubricating eye drops to relieve symptoms

62
Q

What drops can be used to differentiate episcleritis and scleritis?

A

Phenylephrine drops

63
Q

What is the presentation of scelritis?

A

Severe pain, pain on eye movement, can be unilateral or bilateral, watering eye, tenderness on palpation, reduced visual acuity, abnormal pupil reaction to light

64
Q

What diseases are associated with scelritis?

A

Rheumatoid arthritis, SLE, IBD, sarcoidosis, granulomatosis with polyangitis

65
Q

What is the treatment of scleritis?

A

NSAIDs, steroids, immunosuppression

66
Q

What are the common causes of corneal abrasion?

A

Contact lenses, foreign bodies, fingernails, eyelashes

67
Q

What is the presentation of corneal abrasion?

A

Painful red eye, foreign body sensation, watering eye, blurring vision, photophobia

68
Q

How is corneal abrasion diagnosed?

A

Fluorescein stain applied to the eye highlights areas of abrasion

69
Q

What is the management for corneal abrasion?

A

Remove any foreign bodies, analgesia, lubricating eye drops, antibiotic eye drops

70
Q

What is the most common form of keratitis?

A

Herpes simplex infection (herpes keratitis)

71
Q

What is the presentation of herpes keratitis?

A

Painful red eye, photophobia, vesicles around eye, watering eye, foreign body sensation

72
Q

What investigations are done in herpes keratitis?

A

Fluorescein stain will show dendritic corneal ulcer
Slit lamp examination required to find and diagnose keratitis

73
Q

What is the management of herpes keratitis?

A

Topical or oral aciclovir

74
Q

What are the risk factors for retinal detachment?

A

Posterior vitreous detachment, diabetic retinopathy, trauma to the eye, retinal malignancy, older age, family history

75
Q

What is the presentation of retinal detachment?

A

NO PAIN, peripheral vision loss (like a shadow coming across vision), blurred or distorted vision, flashes and floaters

76
Q

What is the 1st line management for retinal detachment?

A

Vitrectomy surgery

77
Q

What is central retinal vein occlusion?

A

When a thrombus forms in the retinal veins and blocks drainage of blood from the retina

78
Q

What is the presentation of retinal vein occlusion

Including fundoscopic appearance

A

Sudden painless loss of vision, flame and blot haemorrhages and optic disc/macula oedema on fundoscopy

79
Q

How is central retinal vein occlusion managed?

A

Laser photocoagulation, intravitreal steroids, anti-VEGF therapies

80
Q

What are the two main causes of central retinal artery occulsion?

A

Atherosclerosis and giant cell arteritis

81
Q

What is the presentation of central retinal artery occlusion?

A

Sudden painless loss of vision, RAPD, pale retina with cherry red spot

82
Q

What is the management of central retinal artery occlusion?

A

If GCA is suspected IV methylprednisolone

Try and dislodge the thrombus

83
Q

What is retinitis pigmentosa and what are the features?

A

Genetic condition that leads to night blindness and tunnel vision

Fundoscopy shows black pigmentation in peripheries and mottling of retinal pigment epithelium

84
Q

What imaging should be done in foreign body and why?

A

CT orbits
Cannot use MRI in case foreign body is metal

Finals (21 decks)

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