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Finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Where does the aqueous humor drain?

A

Via the trabecular meshwork near the anterior chamber at the base of the cornea

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2
Q

What is the role of aqueous humor?

A

To nourish and protect the eye

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3
Q

What is the choroid?

A

Made up of connective tissue and blood vessels. Nourishes the outer layers of the retina

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4
Q

What is the ciliary body made up of and what is its role?

A
  1. Ciliary muscle which controls the shape of the lens
  2. Ciliary processes which attach the body to the ciliary muscle
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5
Q

What is the role of the iris?

A

Alters the diameter of the pupil

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6
Q

What is presbyopia?

A

Refractive error making it difficult to see up close. Caused by ageing due to loss of elasticity of the crystalline lens

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7
Q

What is the treatment of presbyopia?

A

Corrective lenses or surgery

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8
Q

What are cataracts?

A

Opacity of the lens causing blurred or reduced vision

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9
Q

What are the symptoms of cataracts?

A
  • Reduced visual acuity
  • glare
  • halos around light
  • faded colour vision
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10
Q

What are the signs of cataracts?

A
  • defect in red reflex due to light not getting to the retina
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11
Q

Investigations for cataracts

A
  • Ophthalmoscopy
  • slit lamp examination
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12
Q

What is the management of cataracts

A

Lens replacement surgery

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13
Q

What are the complications of cataract surgery?

A
  • posterior capsule opacification
  • retinal detachment
  • posterior capsule rupture
  • endopthalmitis
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14
Q

What is primary open angle closure glaucoma?

A

Chronic, progressive optic neuropathy resulting in degeneration of the retinal ganglion cells and axons leading to irreversible visual field loss

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15
Q

What are the features of primary open angle glaucoma?

A
  • peripheral field vision loss
  • Reduced acuity
  • Optic disc cupping
  • pallor of optic disc
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16
Q

What are the investigations for primary open angle glaucoma?

A
  • Automated perimetry (to test visual field vision loss)
  • slit lamp examination
  • applanation tonometry (to measure IOP)
  • gonioscopy (to assess fluid in ant chamber)
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17
Q

What is the management of primary open angle glaucoma?

A
  • First line: 360 degrees selective laser trabeculoplasty if IOP ≥24mmHg
  • Second line: prostaglandin analogue eye drops to increase uveoscleral flow
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18
Q

What is angle closure glaucoma?

A

Ophthalmic emergency. Rapid rise in IOP due to the obstruction of the aqueous humor

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19
Q

What are the risk factors of angle closure glaucoma?

A
  • Hypermetropia
  • Pupilary dilatation
  • lens growth associated with age
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20
Q

What are the symptoms of angle closure glaucoma?

A
  • Severe pain
  • Reduced visual acuity
  • red eye
  • halos around light
  • may have systemic upset
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21
Q

What are the signs of angle closure glaucoma?

A
  • Hard, red eye
  • Semi dilated, non-reacting pupil
  • corneal oedema causing a hazy cornea
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22
Q

What are the investigations for angle closure glaucoma?

A
  • Ocular exam: acuity, pupils
  • slit lamp examination
  • tonometry
  • gonioscopy
  • funds examination
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23
Q

What is the management of acute closure glaucoma?

A
  • Prompt ophthalmology referral
  • Medical management: topical beta blockers, topical alpha agonists, PGA eyedrops, carbonic anhydrase, systemic hyper osmotic agents (acetazolamide)
  • Definitive: laser peripheral iridotomy
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24
Q

What are the types of diabetic eye diseases?

A
  • non proliferative
  • proliferative
  • Maculopathy
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25
Q

What are the types of NPDR?

A
  • Mild: 1+ microvascularisation
  • Moderate: micro aneurysm, blot haemorrhages, hard exudates, cotton wool spots
  • Severe: Blot haemorrhages and micro aneurysms in 4 quadrants, venous bleeding in 2 quadrants, IRMA in at least 1
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26
Q

What are the key features of proliferative diabetic retinopathy?

A
  • Retinal neovascularisation
  • fibrous tissue formation
  • more common in type 1
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27
Q

What are the features of diabetic maculopathy?

A
  • hard exudates
  • background changes on macula
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28
Q

What is the management of diabetic maculopathy?

A

-anti VEGF

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29
Q

What is the management of proliferative diabetic retinopathy?

A
  • Panretinal laser photocoagulation
  • can also use VEGF
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30
Q

What are the risk factors for age related macular degeneration

A
  • Age
  • smoking
  • family history
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31
Q

Wet vs Dry ARMD

A
  • Dry is more common
  • Dry is characterised by drusen (yellow round spots)
  • Wet is characterised by choroidal neovascularisation
  • Wet can cause leakage of serous fluid and blood
  • Wet has a worse prognosis
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32
Q

Symptoms of wet ARMD

A
  • subacute onset of visual loss (often bilaterally,centre of the vision)
  • worsening night night vision
  • glare around lights, photopsia (percerption of flickering or flashing)
  • visual hallucinations may also occur resulting in Charles-Bonnet syndrome
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33
Q

Symptoms of dry ARMD

A
  • chronic onset of visual loss (often bilaterally)
  • worsening night night vision
  • glare around lights, photopsia (percerption of flickering or flashing)
  • visual hallucinations may also occur resulting in Charles-Bonnet syndrome
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34
Q

Signs of dry ARMD

A
  • fundoscopy reveals drusen in the macular area, which may form a macular scar
  • amsler grid testing may note distortion of line perception
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35
Q

Signs of wet ARMD

A
  • well demarcated red patches (represent intra-retinal or sub-retinal fluid leakage or haemorrhage)
  • amsler grid testing may note distortion of line perception
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36
Q

Investigation for ARMD

A
  • slit lamp exam
  • colour fundus photography
  • fluorescein angiography is utilised if neovascular ARMD is suspected
  • ocular coherence tomography (to visualise eye in 3D to see areas that may otherwise be missed)
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37
Q

Management of dry ARMD

A

zinc with anti-oxidant vitamins A,C and E

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38
Q

Management of wet ARMD

A

anti vascular endothelial growth factor (VEGF)

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39
Q

Symptoms of central retinal vein occlusion

A
  • sudden painless reduction or loss of visual acuity, usually unilateral
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40
Q

What are the signs on fundoscopy of central retinal vein occlusion?

A
  • Optic nerve head oedema
  • Macular oedema
  • Flame-shaped haemorrhages
  • Cotton wool spots
  • Venous tortuosity
41
Q

What is the management of central retinal vein occlusion?

A
  • anti VEGF
  • if neovascularisation is seen then urgent pan-retinal photocoagulation (ischaemic CRVO)
42
Q

What are the symptoms of central retinal artery occlusion?

A
  • unilateral, painless visual loss in seconds
  • may have experienced amaurosis fugax caused by retinal ischaemia
43
Q

Investigations for central retinal artery occlusion

A
  • complete or relative afferent pupillary defect
  • fundoscopy demonstrates a cherry red spot on the macula
  • For aetiology: CRP and ESR, carotid artery duplex USS/doppler, echo or holter monitoring
44
Q

What are the risk factors for retinal detachment?

A
  • age
  • previous cataract surgery
  • myopia
  • eye trauma i.e. boxing
  • family history
  • previous history of retinal break/detachment
45
Q

What are the symptoms of retinal detachment?

A
  • floaters or flashes
  • sudden, painless, and progressive visual loss described like a curtain coming from the periphery to the central field of vision
46
Q

Investigations retinal detachment

A
  • fundoscopy: red reflex is lost and retinal folds may appear as pale, opaque or wrinkled forms
  • may be a RAPD if optic nerve involved
47
Q

What is strabismus?

A

Squint

48
Q

What are the two types of strabismus

A
  • concomitant (more common)
  • paralytic
49
Q

Concomitant strabismus

A

Due to an imbalance in the extra ocular muscles

50
Q

paralytic strabismus

A

Due to paralysis of the extraocular muscles

51
Q

Investigations strabismus

A
  • corneal light reflection test
  • cover test
52
Q

Management of strabismus

A
  • referral
  • patches to prevent amblyopia (the brain fails to fully process inputs from one eye and over time favours the other eye)
53
Q

Entropion

A

In turning of the eyelid

54
Q

Extropion

A

out turning of the eyelid

55
Q

blepharitis

A

Inflammation of the eyelid margins typically leading to a red eye

56
Q

Stye

A

Infection of the eyelid glands

57
Q

chalazion

A

Retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid

58
Q

What is the management of blepharitis?

A

Warm compress, remove debris from the eye

59
Q

What is the management of a stye?

A

Hot compress and analgesia

60
Q

What are the features of bacterial conjunctivitis?

A
  • purulent discharge
  • eyes might be stuck together in the morning
61
Q

What are the features of viral conjunctivitis?

A
  • Serous discharge
  • Recent URTI
  • Preauricular lymph nodes
62
Q

What is the management of bacterial conjunctivitis?

A
  • antibiotic eye drops e.g. Chloramphenicol
  • don’t wear contact lenses until fully resolved
  • fusdic acid in pregnant women
63
Q

Symptoms of scleritis

A
  • severe pain
  • red eye
  • swelling
  • watering eye
  • photophobia
  • may have reduced vision
64
Q

What are the risk factors for scleritis?

A
  • rheumatoid arthritis: the most commonly associated condition
  • systemic lupus erythematosus
  • sarcoidosis
  • granulomatosis with polyangiitis
65
Q

What is the management of scleritis?

A
  • same day assessment by ophthalmology
  • oral NSAIDs
66
Q

Symptoms of episcleritis

A
  • non painful red eye
  • watering eye
  • photophobia
67
Q

Signs of episcleritis

A
  • injective vessels are mobile when pressure is applied
  • if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made rather than scleritis
68
Q

What is the management of episcleritis?

A
  • conservative
  • artificial tears can be used
69
Q

Signs of conjunctival haemorrhage

A
  • red eye: flat, red patch on the conjunctiva
  • vision and fundoscopy normal
70
Q

What is the management of subconjunctival haemorrhage

A
  • conservative, should heal within 2-3 weeks
  • can consider artificial tears
71
Q

Symptoms of corneal abrasion

A
  • red eye, conjunctival injection
  • reduced acuity
  • feeling of a foreign body
  • pain
  • photophobia
72
Q

Signs of corneal abrasion

A

Fluorescein demonstrates yellow stained abrasion

73
Q

Management of corneal abrasion

A

topical antibiotic

74
Q

Symptoms of corneal foreign body

A
  • eye pain
  • foreign body sensation
  • photophobia
  • watering eye
  • red eye
75
Q

When to refer to ophthalmology for corneal foreign body

A
  • suspected penetrating injury due to high velocity object
  • significant orbital or periorbital trauma
  • chemical injury
  • organic material
  • material near the centre of cornea
  • any red flags: severe pain; irregular, dilated or non-reactive pupils; significant reduction in visual acuity
76
Q

symptoms of keratitis

A
  • red eye: pain and erythema
  • photophobia
  • foreign body, gritty sensation
  • hypopyon may be seen
77
Q

What is keratitis?

A

inflammation of the cornea

78
Q

Bacterial causes of keratitis

A
  • Staph aureus
  • pseudomonas aeruginosa in contact lens wearers
79
Q

cause of keratitis with pain out of proportion

A

acanthamoebic keratitis

80
Q

Management of keratitis

A
  • same day referral in contact lens wearers
  • stop wearing contact lenses
  • topical antibiotics - quinolones
  • cycloplegic for pain relief
81
Q

Complications of keratitis

A
  • corneal scaring
  • perforation
  • endopthalmitis
  • visual loss
82
Q

Symptoms of anterior uveitis

A
  • acute onset, red, painful eye
  • pupil may be small +/- irregular due to sphincter muscle contraction
  • photophobia (often intense)
  • blurred vision
  • lacrimation
83
Q

Signs of anterior uveitis

A
  • ciliary flush: a ring of red spreading out
  • hypopyon; pus and inflammatory cells in the anterior chamber
  • visual acuity initially normal → impaired
84
Q

Associated conditions of anterior uveitis

A

HLA-B27
- ankylosing spondylitis
- reactive arthritis
- ulcerative colitis, Crohn’s disease
- Behcet’s disease
- sarcoidosis: bilateral disease may be seen

85
Q

Management of anterior uveitis

A
  • urgent ophthalmology review
  • cycloplegics to dilate pupil e.g. atropine
  • steroid eye drops
86
Q

Hyphema

A

Blood in the anterior chamber of the eye

87
Q

In ocular trauma what is the greatest risk?

A

Raised intra ocular pressure

88
Q

Features of orbital compartment syndrome

A
  • eye pain/swelling
  • rock hard eyelid
  • proptosis RAPD
89
Q

What is the management of orbital compartment syndrome?

A

urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit

90
Q

What is the difference between preseptal/periorbital cellulitis and orbital cellulitis?

A
  • Preseptal: less serious superficial infection anterior to the orbital septum, resulting from a superficial tissue injury
  • orbital: result of an infection affecting the fat and muscles posterior to the orbital septum, often from URTI
91
Q

symptoms of orbital cellulitis

A
  • redness and swelling
  • severe pain
  • visual disturbance
  • proptosis
  • ophthalmoplegia
  • eyelid oedema and ptosis
  • drowsiness/nausea/vomiting
92
Q

Investigations orbital cellulitis

A
  • FBC
  • CT with contrast
  • blood cultures and swab
93
Q

What is the management of orbital cellulitis?

A

Admission for IV antibiotics

94
Q

What do cotton wool spots represent?

A

Retinal infarction

95
Q

What is retinitis pigmentosa?

A

Inherited retinal disorder

96
Q

Symptoms of retinitis pigmentosa

A

tunnel vision and worsening night vision

97
Q

Retinitis pigmentosa on fundoscopy

A

Black pigmentation in the peripheral retina

98
Q
A

Finals (37 decks)

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