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Y4 Neuro and special senses > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is glaucoma ?

A

Refers to the optic nerve damage caused by a rise in intraocular pressure.
Raised intraocular pressure is caused by a blockage in aqueous humour trying to escape the eye.

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2
Q

What are the types of glaucoma ?

A

Open angle glaucoma
Acute angle-closure glaucoma

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3
Q

What is the vitreous chamber filled with ?

A

Vitreous humour

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4
Q

What is the anterior and posterior chamber filled with ?

A

Aqueous humour

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5
Q

Where is the anterior chamber ?

A

Between the cornea and iris

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6
Q

Where is the posterior chamber ?

A

Between the lens and iris

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7
Q

What produces aqueous humour ?

A

Ciliary body

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8
Q

How does aqueous humour drain into the circulation ?

A

It drains through the trabecular meshwork to the canal of schlemm at the angle between the cornea and the iris. From the canal of schlemm it eventually enters the general circulation.

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9
Q

What is normal intraocular pressure ?

A

10-21 mmHg

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10
Q

How does open angle glaucoma occur ?

A

There is a gradual increase in resistance to flow through the trabecular meshwork. The pressure slowly builds in the eye.

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11
Q

What occurs in acute angle closure glaucoma ?

A

The iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from draining.
There is a continual build up of pressure and an acute onset of symptoms.

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12
Q

What does raised intraocular pressure cause ?

A

It causes cupping of the optic disc.
The optic cup becomes wider and deeper.
A cup-disk ratio greater than 0.5 is abnormal.

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13
Q

Where is the optic cup ?

A

In the centre of the optic disc

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14
Q

What are some risk factors of open angle glaucoma ?

A

Increasing age
Family history
Black ethnic origin
Myopia ( nearsightedness )

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15
Q

How does glaucoma initially present ?

A

It affects the peripheral vision first resulting in tunnel vision.

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16
Q

How can glaucoma present ?

A

Fluctuating pain
Headaches
Blurred vision
Halos around lights ( particularly at night )

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17
Q

How can intraocular pressure be measured ?

A

Non-contact tonometry
Goldmann applanation tonometry

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18
Q

How does non-contact tonometry work ?

A

It involves shooting a puff of air at the cornea and measuring the corneal response.
( general screening purpose ).

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19
Q

What is Goldmann applanation tonometry ?

A

Gold standard way to measure intraocular pressure.
It involves a device mounted on a slip lamp that makes contact with the cornea and applies various pressures.

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20
Q

How can the cup-disk ratio be measured ?

A

Slit lamp

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21
Q

How can the angle between the iris and cornea be measured ?

A

Gonioscopy

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22
Q

At what value of intraocular pressure is treatment started ?

A

24 mmHg

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23
Q

What is the management of glaucoma ?

A

360 degree laser trabeculoplasty
Prostaglandin analogue eye drops
Trabeculectomy

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24
Q

How does 360 degree selective laser trabeculoplasty ?

A

During the procedure, a laser is directed at the trabecular meshwork improving drainage. It may delay or prevent the need for eye drops.

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25
What are some side effects of prostaglandin analogue eye drops ?
Eyelash growth Eyelid pigmentation Iris pigmentation
26
What happens in a trabeculectomy ?
It involves creating a new channel from the anterior chamber through the sclera to a location under the conjunctiva causing a bleb on the conjunctiva. From here it is reabsorbed into the general circulation.
27
Why is acute angle closure glaucoma important to not miss ?
It is an ophthalmological emergency requiring rapid treatment to prevent permanent vision loss.
28
What are some risk factors of angle closure glaucoma ?
Increasing age Family history Female Shallow anterior chamber
29
What medications can precipitate acute angle closure glaucoma ?
Adrenergic medications ( noradrenaline ) Anticholinergic medications ( oxybutynin ) Tricyclic antidepressants ( amitriptyline )
30
How does acute angle closure glaucoma present ?
Severely painful red eye Blurred vision Halos around lights Headache, nausea and vomiting
31
On examination what are some signs of acute angle closure glaucoma ?
Red eye Hazy cornea Decreased visual acuity Mid dilated with a fixed size pupil
32
What are some measures to take for acute angle closure glaucoma before an ambulance turns up ?
Lying the patient on their back without a pillow Pilocarpine eye drops Acetazolamide Analgesia
33
How does pilocarpine work ?
It acts on the Muscarinic receptors in the sphincter muscles in the iris and causes pupil constriction. It also causes ciliary muscle contraction. This help open up the pathway for the flow of aqueous humour.
34
How does acetazolamide work ?
It is a carbonic anhydrase inhibitor that reduces the production of aqueous humour.
35
What is the definitive treatment of acute angle closure glaucoma ?
Laser iridotomy
36
What does laser iridotomy work in the management of acute angle closure glaucoma ?
It involves making a hold in the iris using a laser which allows the aqueous humour to flow directly from the posterior chamber to the anterior chamber. This relieves the pressure pushing the iris forward against the cornea and opens the pathway for the aqueous humour to drain.
37
What are the 2 types of age related macular degeneration ?
Wet - neovascular Dry - non-neovascular
38
What are the 4 layers of the macula ( base to surface ) ?
Choroid layer Bruch’s membrane Retinal pigment epithelium Photoreceptors
39
What is Drusen ?
Yellowish deposits of proteins and lipids between the retinal pigment epithelium and bruch’s membrane.
40
How does wet age related macular degeneration cause oedema ?
New vessels develop from the choroid layer and grow into the retina. This is due to the chemical vascular endothelial growth factor. These vessels can leak fluid or blood causing oedema.
41
What are some risk factors of age related macular degeneration ?
Older age Smoking Family history CVD Obesity Poor diet
42
How does age related macular degeneration present ?
Tends to be unilateral Gradual loss of central vision Reduced visual acuity Crooked or wavy appearance to straight lines ( metamorphopsia )
43
What is used to assess distortion of straight lines seen in age related macular degeneration ?
Amsler grid test
44
How can Drusen be seen ?
Fundoscopy
45
What is used for diagnosing and monitoring age related macular degeneration ?
Optical coherence tomography
46
How can dry age related macular degeneration be managed ?
Avoid smoking Controlling blood pressure Vitamin supplementation - slows progression
47
What is used to treat wet age related macular degeneration ?
Anti-VEGF medications - ranibizumab It blocks VEGF and slow the development of new vessels. Injected directly into the vitreous chamber of the eye once a month.
48
What is diabetic retinopathy ?
Involves damage to the retinal blood vessels due to prolonged high blood sugar levels.
49
What is the pathophysiology of diabetic retinopathy ?
Hyperglycaemia damages the retinal small vessels and endothelial cells. Increases vascular permeability leads to leaking blood vessels, blot haemorrhages and hard exudates.
50
In diabetic retinopathy what can damage to the blood vessel walls lead to ?
Microaneurysm - small bulges Venous bleeding
51
In diabetic retinopathy what can damage to the nerve fibres in the retina lead to ?
Causes fluffy white patches called cotton wool spots
52
What are some complications of diabetic retinopathy ?
Vision loss Retinal detachment Vitreous haemorrhage Optic neuropathy Cataracts
53
What is the management of diabetic retinopathy ?
Close monitoring - non-proliferative Proliferative - Pan-retinal photocoagulation ( PRP ) Anti-VEGF Surgery
54
What is hypertensive retinopathy ?
Damage to the small blood vessels in the retina relating to hypertension
55
What are some features of hypertensive retinopathy ?
Silver wiring or copper wiring AV nipping Cotton wool spots Hard exudates Retinal haemorrhages Papilloedema
56
What are some silver wiring or copper wiring ?
Where the walls of the arterioles become thickened and sclerosed and reflect more light on examination.
57
What is AV nipping ?
Where the arterioles cause compression of the veins where they cross due to sclerosis and hardening of the arterioles.
58
What is the management of hypertensive retinopathy ?
Controlling blood pressure Managing risk factors ( smoking and blood lipids )
59
What is cataracts ?
Describes a progressively opaque eye lens which reduces the light entering the eye and visual acuity.
60
What is a risk factor for cataracts ?
Increasing age Smoking Alcohol DM Steroids Hypocalcaemia
61
How does cataracts present ?
Asymmetrical Slow reduction in visual acuity Progressive blurring of the vision Colours become more faded Starbursts Loss of red reflex
62
What is the management of cataracts ?
No intervention may be necessary Cataract surgery
63
What is involved in cataract surgery ?
Involves drilling and breaking the lens to pieces, removing the pieces and implanting an artificial lens.
64
What is responsible for pupil constriction ?
The circular muscles in the iris are responsible for pupil constriction. They are stimulated by the parasympathetic nervous system using acetylcholine as a neurotransmitter.
65
What is responsible for pupil dilation ?
The dilator muscles in the iris are responsible for pupil dilation. They are stimulated by the sympathetic nervous system using adrenaline as a neurotransmitter.
66
What are some causes of abnormal pupil shape ?
Trauma to sphincter muscles Anterior uveitis ( causes adhesions ) Acute angle closure glaucoma Rubeosis iridis Coloboma
67
What is mydriasis ?
Dilated pupils
68
What are some causes of mydriasis ?
Congenital Stimulants such as cocaine Anticholinergics such as oxybutynin Trauma Third nerve palsy Acute angle closure glaucoma
69
What is Miosis ?
Constricted pupils
70
What are some causes of Miosis ?
Horner syndrome Cluster headaches Opiates Nicotine Pilocarpine
71
What does a third nerve palsy cause ?
Ptosis Dilated non-reactive pupils Divergent strabismus ( down and out gaze )
72
Which intra-ocular muscles are supplied by the oculomotor nerve ?
Superior rectus Medial rectus Inferior rectus Inferior oblique
73
What may cause a full third nerve palsy ?
Tumour Trauma Cavernous sinus thrombosis Posterior communicating artery aneurysm Raised ICP
74
What is the triad of Horner syndrome ?
Ptosis Miosis Anhidrosis
75
What are some causes of Horner’s syndrome ?
Stroke Tumours - pancoast Thyroidectomy Carotid aneurysm Carotid artery dissection MS
76
How can Horner’s syndrome be tested ?
Using cocaine eye drops It acts on the eye to stop noradrenaline re-uptake at the NMJ. This causes a normal eye to dilate as noradrenaline stimulates the dilator muscles of the iris. In horners syndrome the nerves are not releasing noradrenaline so there is no pupil reaction.
77
What is blepharitis ?
Inflammation of the eyelid margins
78
How does blepharitis present ?
A gritty, itchy, dry sensation in the eyes.
79
What is blepharitis associated with ?
It can be associated with dysfunction of the Meibomian glands which are responsible for secreting meibum onto the surface of the eye.
80
How can blepharitis be managed ?
Warm compresses and gentle cleaning of the eyelid margins to remove debris.
81
What is a stye ?
It is a tender red lump along the eyelid that may contain pus.
82
How can a stye be managed ?
Treated with hot compresses and analgesia Topical abx
83
What is a chalazion ?
It occurs when a Meibomian gland becomes blocked and swells. Often called a Meibomian cyst
84
How does a chalazion present ?
A swelling in the eyelid that is typically not tender
85
how is a chalazion managed ?
Warm compresses and gentle massage towards the eyelashes
86
What is entropion ?
Refers to when the eyelid turns inwards with the lashes pressed agains the eye. This causes pain and can result in corneal damage and ulceration.
87
What is the initial management of entropion ?
Taping the eyelid down to prevent it from turning inwards.
88
What is the definitive management of entropion ?
Surgical
89
What is ectropion ?
Refers to when the eyelid turns outwards exposing the inner aspect Usually the bottom lid
90
What is the management of ectropion ?
Regular eye drops Surgery to correct the defect
91
What is periorbital cellulitis ?
An eyelid and skin infection in front of the orbital septum It presents with swollen, red, hot skin around the eyelid.
92
What is the management of peri-orbital cellulitis ?
Systemic abx
93
What can periorbital cellulitis develop into ?
Orbital cellulitis
94
What is orbital cellulitis ?
An infection around the eyeball involving tissues behind the orbital septum.
95
How can orbital cellulitis present ?
Pain with eye movement Reduced eye movements Vision changes Abnormal pupil reactions Proptosis
96
what is the management of orbital cellulitis ?
Emergency admission IV abx Surgical drainage if abscess forms
97
What is conjunctivitis ?
Inflammation of the conjunctiva. Can be bacterial, viral and allergic.
98
What is conjunctiva ?
A thin layer of tissue that covers the inside of the eyelids and the sclera.
99
How does conjunctivitis present ?
Red, bloodshot eye Itchy or gritty sensation Discharge
100
What are some differences between viral and bacterial conjunctivitis ?
Discharge is purulent in bacterial and clear in viral Bacterial - eyes get stuck together
101
What are some causes of an acute painful red eye ?
Acute angle closure glaucoma Anterior uveitis Scleritis Keratitis Foreign body
102
What are some causes of an acute painless red eye ?
Conjunctivitis Episcleritis Subconjunctival haemorrhage
103
What is the management of conjunctivitis ?
Self resolving Hygiene measures Chloramphenicol or fusidic acid
104
What is allergic conjunctivitis ?
Caused by contact with allergens. It causes swelling of the conjunctival sac and eyelid with itching and watery discharge.
105
What is the management of allergic conjunctivitis ?
Antihistamines Topical mast cell stabilisers
106
What is anterior uveitis ?
Involves inflammation of the anterior uvea.
107
What is the uvea ?
It consists of the iris, ciliary body and choroid.
108
What is the choroid ?
The layer between the retina and the sclera.
109
What are some causes of anterior uveitis ?
Autoimmune process Infection Trauma Ischaemia Malignancy
110
What are some symptoms of anterior uveitis ?
Painful red eye Reduced visual acuity Photophobia Excessive lacrimation
111
What are some examination findings of anterior uveitis ?
Ciliary flush Miosis Abnormally shaped pupils Hypopyon
112
What is ciliary flush ?
A ring of red spreading from the cornea outwards
113
What is Hypopyon ?
Inflammatory cells collected as a white fluid in the anterior chamber
114
What is the management of anterior uveitis ?
Steroids - eye drops, oral or IV Cycloplegics ( cyclopentolate or atropine )
115
How do cycloplegics work in anterior uveitis ?
Dilate the pupil and reduce pain associated with ciliary spasm. Paralyse ciliary muscle
116
What is episcleritis ?
Involves benign and self limiting inflammation of the episclera, the outermost layer of the sclera.
117
What is episcleritis associated with ?
RA IBD
118
How does episcleritis present ?
Unilateral - localised and diffuse redness - no pain - dilated episcleritis vessels
119
How can you differentiate between episcleritis and scleritis ?
Applying phenylephrine eye drops
120
What is the management of episcleritis ?
Self limiting Resolution in 1-2 weeks Symptom relief - analgesia and lubricating eye drops
121
What is scleritis ?
Involves inflammation of the sclera ( outer layer of the connective tissue.
122
What is the most severe type of scleritis ?
Necrotising scleritis which can lead to perforation of the sclera.
123
What conditions are associated with scleritis ?
RA Vasculitis
124
How can scleritis present ?
Gradual Red, inflamed sclera Congested vessels Severe pain Pain with eye movement Photophobia Epiphora
125
What is the management of scleritis ?
NSAIDs Steroids Immunosuppression
126
What are corneal abrasions ?
Scratches or damage to the cornea They cause a red, painful eye and photophobia.
127
What are some common causes of corneal abrasions ?
Damaged contact lenses Fingernails Foreign bodies Tree branches Entropion
128
How can corneal abrasions present ?
Painful red eye Photophobia Foreign body sensation Epiphora Blurred vision
129
What are some management options for corneal abrasions ?
Removing foreign bodies Simply analgesia Lubricating eye drops Abx eye drops Close follow up
130
What is keratitis ?
Inflammation of the cornea
131
What are some common causes of keratitis ?
Viral infection Bacterial infection Fungal infection Contact lens-induced acute red eye
132
What is the most common cause of keratitis ?
Herpes simplex virus
133
How can herpes keratitis present ?
Painful red eye Photophobia Vesicles - fluid filled blisters Foreign body sensation Watery discharge Reduced visual acuity
134
What is used to diagnose keratitis ?
Slit lamp examination
135
What is the management of herpes keratitis ?
Urgent assessment Topical or oral antivirals Corneal transplant is an option if there is permanent scarring
136
What is a Subconjunctival haemorrhage ?
It occurs when a small blood vessel within the conjunctiva ruptures, releasing blood into the space between the sclera and the conjunctiva.
137
What could be some causes of Subconjunctival haemorrhage ?
Strenuous activity such as : - heavy coughing - weight lifting - straining when constipated Or trauma
138
What are some conditions which can predispose someone to Subconjunctival haemorrhages ?
HTN Bleeding disorders Whooping cough Medications - anti platelets, DOACs or warfarin Non-accidental injury
139
How does a Subconjunctival haemorrhage present ?
A patch of bright red blood underneath the conjunctiva. Painless and vision is unaffected
140
What is the management of a Subconjunctival haemorrhage ?
Check BP Check INR Spontaneously resolves Lubricating eye drops if irritation
141
What is a posterior vitreous detachment ?
It is when the vitreous body comes away from the retina.
142
What is the function of the vitreous humour ?
The vitreous humour is the gel inside the vitreous chamber of the eye. It maintains the structure of the eyeball and keeps the retina pressed on the choroid.
143
How does posterior vitreous detachment present ?
Can be asymptomatic Floaters Flashing lights Blurred vision
144
What is the management of posterior vitreous detachment ?
No treatment Symptoms will improve as the brain adjusts
145
What can posterior vitreous detachment predispose to ?
Retinal tears Retinal detachment
146
What is retinal detachment ?
Involves the neurosensory layer of the retina ( containing photoreceptors and nerves ) separating from the retinal pigment epithelium.
147
What is the cause of retinal detachment ?
A retinal tear allowing vitreous fluid to get under the neuro sensory retina and fill the space between layers.
148
How can retinal detachment be sight threatening ?
The neurosensory retina relies on the blood vessels of the choroid for its blood supply. Therefore retinal detachment can disrupt the blood supply and cause permanent damage to the photoreceptors making it sight threatening.
149
What are some risk factors of retinal detachment ?
Lattice degeneration Posterior vitreous detachment Trauma Diabetic retinopathy Retinal malignancy FH
150
What is lattice degeneration ?
Thinning of the retina
151
How does retinal detachment present ?
Peripheral vision loss Blurred or distorted vision Flashes or floaters
152
What is the management of retinal tears ?
Laser therapy Cryotherapy
153
What are some management options for retinal detachment ?
Vitrectomy Scleral buckle Pneumatic retinopexy
154
What is a vitrectomy ?
Involves a key hole surgery on the eye removing the vitreous fluid, fixing the tear and then insertion gas to hold the retina in place.
155
What is a retinal vein occlusion ?
When a blood clot forms in the retinal veins blocking the drainage of blood from the retina.
156
Where may a thrombus form if there is a retinal vein occlusion ?
Central retinal vein Branch retinal veins
157
What can a retinal vein occlusion lead to vision loss ?
Blockage of a retinal vein causes venous congestion in the retina. Increased pressure in the retinal veins results in fluid and blood leaking into the retina causing macular oedema and retinal haemorrhages. This results in retinal damage and vision loss.
158
What are some risk factors for retinal vein occlusion ?
HTN High cholesterol DM Smoking High plasma viscosity ( myeloma ) Inflammatory conditions
159
How does retinal vein occlusion present ?
Painless blurred vision or vision loss
160
What are the characteristic findings of retinal vein occlusion on fundoscopy ?
Dilated tortuous retinal veins Flame or blot haemorrhages Retinal oedema Cotton wool spots Hard exudate
161
What is the management of retinal vein occlusion ?
Anti-VEGF therapies Dexamethasone intravitreal implant Laser photocoagulation
162
What is central retinal artery occlusion ?
Occurs due to obstruction to blood flow through the central retinal artery.
163
What is the central retinal artery a branch of ? And what is that a branch of ?
Ophthalmic artery Internal carotid artery
164
What is the most common cause of central retinal artery occlusion ?
Atherosclerosis
165
What are some risk factors of central retinal artery occlusion ?
CVD - smoking, HTN, DM, raised cholesterol Giant cell arteritis
166
How does central retinal artery occlusion present ?
Sudden painless loss of vision - curtains coming down
167
What is seen on fundoscopy in central retinal artery occlusion ?
Pale retina with a cherry red spot
168
What are some management options for central retinal artery occlusion ?
Ocular massage Anterior chamber paracentesis Inhaled carbogen IV mannitol
169
What is retinitis pigmentosa ?
A genetic condition causing degeneration of the photoreceptors in the retina particularly the rods.
170
How does retinitis pigmentosa present ?
Night blindness Peripheral vision loss
171
What is seen on fundoscopy in retinitis pigmentosa ?
Bone spicule pigmentation
172
What is bone spicule pigmentation ?
Refers to the similarity to the networking appearance of the bone matrix
173
What is the management of retinitis pigmentosa ?
Referral to ophthalmologist Vision aids Sunglasses to protect the retina Driving limitations and inform DVLA
174
What is a squint ?
Characterised by misalignment of the visual axes.
175
What are some tests for a squint ?
Corneal light reflection test Cover test
176
What is a corneal light reflection test ?
Holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils
177
How is a cover test performed ?
Ask the child to focus on an object Cover one eye Observe movement of the uncovered eye Cover the other eye and repeat test
178
What is the management of a squint ?
Eye patches
179
What is tunnel vision ?
The concentric diminution of the visual fields
180
What are some causes of tunnel vision ?
Papilloedema Glaucoma Retinitis pigmentosa
181
What are some causes of optic neuritis ?
Multiple sclerosis DM Syphilis
182
What are some features of optic neuritis ?
Unilateral decrease in visual acuity over hours to days Poor discrimination of colours Pain worse on eye movements Relative afferent pupillary defect
183
What is the diagnostic test for optic neuritis ?
MRI of brain and orbits with contrast
184
What is the management of optic neuritis ?
High dose steroids Recovery is usually 4-6 weeks
185
What is the most common cause of a persistent watery eye ?
Nasolacrimal duct obstruction

Y4 Neuro and special senses (6 decks)

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