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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
Q

What are some side effects of prostaglandin analogue eye drops ?

A

Eyelash growth
Eyelid pigmentation
Iris pigmentation

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26
Q

What happens in a trabeculectomy ?

A

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.

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27
Q

Why is aunt angle closure glaucoma important to not miss ?

A

It is an ophthalmological emergency requiring rapid treatment to prevent permanent vision loss.

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28
Q

What are some risk factors of angle closure glaucoma ?

A

Increasing age
Family history
Female
Shallow anterior chamber

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29
Q

What medications can precipitate acute angle closure glaucoma ?

A

Adrenergic medications ( noradrenaline )
Anticholinergic medications ( oxybutynin )
Tricyclic antidepressants ( amitriptyline )

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30
Q

How does acute angle closure glaucoma present ?

A

Severely painful red eye
Blurred vision
Halos around lights
Headache, nausea and vomiting

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31
Q

On examination what are some signs of acute angle closure glaucoma ?

A

Red eye
Hazy cornea
Decreased visual acuity
Mid dilated with a fixed size pupil

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32
Q

What are some measures to take for acute angle closure glaucoma before an ambulance turns up ?

A

Lying the patient on their back without a pillow
Pilocarpine eye drops
Acetazolamide
Analgesia

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33
Q

How does pilocarpine work ?

A

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.

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34
Q

How does acetazolamide work ?

A

It is a carbonic anhydrase inhibitor that reduces the production of aqueous humour.

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35
Q

What is the definitive treatment of acute angle closure glaucoma ?

A

Laser iridotomy

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36
Q

What does laser iridotomy work in the management of acute angle closure glaucoma ?

A

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.

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37
Q

What are the 2 types of age related macular degeneration ?

A

Wet - neovascular
Dry - non-neovascular

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38
Q

What are the 4 layers of the macula ( base to surface ) ?

A

Choroid layer
Bruch’s membrane
Retinal pigment epithelium
Photoreceptors

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39
Q

What is Drusen ?

A

Yellowish deposits of proteins and lipids between the retinal pigment epithelium and bruch’s membrane.

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40
Q

How does wet age related macular degeneration cause oedema ?

A

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.

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41
Q

What are some risk factors of age related macular degeneration ?

A

Older age
Smoking
Family history
CVD
Obesity
Poor diet

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42
Q

How does age related macular degeneration present ?

A

Tends to be unilateral
Gradual loss of central vision
Reduced visual acuity
Crooked or wavy appearance to straight lines ( metamorphopsia )

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43
Q

What is used to assess distortion of straight lines seen in age related macular degeneration ?

A

Amsler grid test

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44
Q

How can Drusen be seen ?

A

Fundoscopy

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45
Q

What is used for diagnosing and monitoring age related macular degeneration ?

A

Optical coherence tomography

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46
Q

How can dry age related macular degeneration be managed ?

A

Avoid smoking
Controlling blood pressure
Vitamin supplementation - slows progression

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47
Q

What is used to treat wet age related macular degeneration ?

A

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.

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48
Q

What is diabetic retinopathy ?

A

Involves damage to the retinal blood vessels due to prolonged high blood sugar levels.

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49
Q

What is the pathophysiology of diabetic retinopathy ?

A

Hyperglycaemia damages the retinal small vessels and endothelial cells.
Increases vascular permeability leads to leaking blood vessels, blot haemorrhages and hard exudates.

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50
Q

In diabetic retinopathy what can damage to the blood vessel walls lead to ?

A

Microaneurysm - small bulges
Venous bleeding

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51
Q

In diabetic retinopathy what can damage to the nerve fibres in the retina lead to ?

A

Causes fluffy white patches called cotton wool spots

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52
Q

What are some complications of diabetic retinopathy ?

A

Vision loss
Retinal detachment
Vitreous haemorrhage
Optic neuropathy
Cataracts

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53
Q

What is the management of diabetic retinopathy ?

A

Close monitoring - non-proliferative

Proliferative -
Pan-retinal photocoagulation ( PRP )
Anti-VEGF
Surgery

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54
Q

What is hypertensive retinopathy ?

A

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

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55
Q

What are some features of hypertensive retinopathy ?

A

Silver wiring or copper wiring
AV nipping
Cotton wool spots
Hard exudates
Retinal haemorrhages
Papilloedema

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56
Q

What are some silver wiring or copper wiring ?

A

Where the walls of the arterioles become thickened and sclerosed and reflect more light on examination.

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57
Q

What is AV nipping ?

A

Where the arterioles cause compression of the veins where they cross due to sclerosis and hardening of the arterioles.

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58
Q

What is the management of hypertensive retinopathy ?

A

Controlling blood pressure
Managing risk factors ( smoking and blood lipids )

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59
Q

What is cataracts ?

A

Describes a progressively opaque eye lens which reduces the light entering the eye and visual acuity.

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60
Q

What is a risk factor for cataracts ?

A

Increasing age
Smoking
Alcohol
DM
Steroids
Hypocalcaemia

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61
Q

How does cataracts present ?

A

Asymmetrical
Slow reduction in visual acuity
Progressive blurring of the vision
Colours become more faded
Starbursts
Loss of red reflex

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62
Q

What is the management of cataracts ?

A

No intervention may be necessary
Cataract surgery

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63
Q

What is involved in cataract surgery ?

A

Involves drilling and breaking the lens to pieces, removing the pieces and implanting an artificial lens.

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64
Q

What is responsible for pupil constriction ?

A

The circular muscles in the iris are responsible for pupil constriction. They are stimulated by the parasympathetic nervous system using acetylcholine as a neurotransmitter.

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65
Q

What is responsible for pupil dilation ?

A

The dilator muscles in the iris are responsible for pupil dilation. They are stimulated by the sympathetic nervous system using adrenaline as a neurotransmitter.

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66
Q

What are some causes of abnormal pupil shape ?

A

Trauma to sphincter muscles
Anterior uveitis ( causes adhesions )
Acute angle closure glaucoma
Rubeosis iridis
Coloboma

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67
Q

What is mydriasis ?

A

Dilated pupils

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68
Q

What are some causes of mydriasis ?

A

Congenital
Stimulants such as cocaine
Anticholinergics such as oxybutynin
Trauma
Third nerve palsy
Acute angle closure glaucoma

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69
Q

What is Miosis ?

A

Constricted pupils

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70
Q

What are some causes of Miosis ?

A

Horner syndrome
Cluster headaches
Opiates
Nicotine
Pilocarpine

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71
Q

What does a third nerve palsy cause ?

A

Ptosis
Dilated non-reactive pupils
Divergent strabismus ( down and out gaze )

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72
Q

Which intra-ocular muscles are supplied by the oculomotor nerve ?

A

Superior rectus
Medial rectus
Inferior rectus
Inferior oblique

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73
Q

What may cause a full third nerve palsy ?

A

Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised ICP

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74
Q

What is the triad of Horner syndrome ?

A

Ptosis
Miosis
Anhidrosis

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75
Q

What are some causes of Horner’s syndrome ?

A

Stroke
Tumours - pancoast
Thyroidectomy
Carotid aneurysm
Carotid artery dissection
MS

76
Q

How can Horner’s syndrome be tested ?

A

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
Q

What is blepharitis ?

A

Inflammation of the eyelid margins

78
Q

How does blepharitis present ?

A

A gritty, itchy, dry sensation in the eyes.

79
Q

What is blepharitis associated with ?

A

It can be associated with dysfunction of the Meibomian glands which are responsible for secreting meibum onto the surface of the eye.

80
Q

How can blepharitis be managed ?

A

Warm compresses and gentle cleaning of the eyelid margins to remove debris.

81
Q

What is a stye ?

A

It is a tender red lump along the eyelid that may contain pus.

82
Q

How can a stye be managed ?

A

Treated with hot compresses and analgesia
Topical abx

83
Q

What is a chalazion ?

A

It occurs when a Meibomian gland becomes blocked and swells.
Often called a Meibomian cyst

84
Q

How does a chalazion present ?

A

A swelling in the eyelid that is typically not tender

85
Q

how is a chalazion managed ?

A

Warm compresses and gentle massage towards the eyelashes

86
Q

What is entropion ?

A

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
Q

What is the initial management of entropion ?

A

Taping the eyelid down to prevent it from turning inwards.

88
Q

What is the definitive management of entropion ?

A

Surgical

89
Q

What is ectropion ?

A

Refers to when the eyelid turns outwards exposing the inner aspect
Usually the bottom lid

90
Q

What is the management of ectropion ?

A

Regular eye drops
Surgery to correct the defect

91
Q

What is periorbital cellulitis ?

A

An eyelid and skin infection in front of the orbital septum
It presents with swollen, red, hot skin around the eyelid.

92
Q

What is the management of peri-orbital cellulitis ?

A

Systemic abx

93
Q

What can periorbital cellulitis develop into ?

A

Orbital cellulitis

94
Q

What is orbital cellulitis ?

A

An infection around the eyeball involving tissues behind the orbital septum.

95
Q

How can orbital cellulitis present ?

A

Pain with eye movement
Reduced eye movements
Vision changes
Abnormal pupil reactions
Proptosis

96
Q

what is the management of orbital cellulitis ?

A

Emergency admission
IV abx
Surgical drainage if abscess forms

97
Q

What is conjunctivitis ?

A

Inflammation of the conjunctiva.
Can be bacterial, viral and allergic.

98
Q

What is conjunctiva ?

A

A thin layer of tissue that covers the inside of the eyelids and the sclera.

99
Q

How does conjunctivitis present ?

A

Red, bloodshot eye
Itchy or gritty sensation
Discharge

100
Q

What are some differences between viral and bacterial conjunctivitis ?

A

Discharge is purulent in bacterial and clear in viral
Bacterial - eyes get stuck together

101
Q

What are some causes of an acute painful red eye ?

A

Acute angle closure glaucoma
Anterior uveitis
Scleritis
Keratitis
Foreign body

102
Q

What are some causes of an acute painless red eye ?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

103
Q

What is the management of conjunctivitis ?

A

Self resolving
Hygiene measures
Chloramphenicol or fusidic acid

104
Q

What is allergic conjunctivitis ?

A

Caused by contact with allergens.
It causes swelling of the conjunctival sac and eyelid with itching and watery discharge.

105
Q

What is the management of allergic conjunctivitis ?

A

Antihistamines
Topical mast cell stabilisers

106
Q

What is anterior uveitis ?

A

Involves inflammation of the anterior uvea.

107
Q

What is the uvea ?

A

It consists of the iris, ciliary body and choroid.

108
Q

What is the choroid ?

A

The layer between the retina and the sclera.

109
Q

What are some causes of anterior uveitis ?

A

Autoimmune process
Infection
Trauma
Ischaemia
Malignancy

110
Q

What are some symptoms of anterior uveitis ?

A

Painful red eye
Reduced visual acuity
Photophobia
Excessive lacrimation

111
Q

What are some examination findings of anterior uveitis ?

A

Ciliary flush
Miosis
Abnormally shaped pupils
Hypopyon

112
Q

What is ciliary flush ?

A

A ring of red spreading from the cornea outwards

113
Q

What is Hypopyon ?

A

Inflammatory cells collected as a white fluid in the anterior chamber

114
Q

What is the management of anterior uveitis ?

A

Steroids - eye drops, oral or IV
Cycloplegics ( cyclopentolate or atropine )

115
Q

How do cycloplegics work in anterior uveitis ?

A

Dilate the pupil and reduce pain associated with ciliary spasm.
Paralyse ciliary muscle

116
Q

What is episcleritis ?

A

Involves benign and self limiting inflammation of the episclera, the outermost layer of the sclera.

117
Q

What is episcleritis associated with ?

A

RA
IBD

118
Q

How does episcleritis present ?

A

Unilateral
- localised and diffuse redness
- no pain
- dilated episcleritis vessels

119
Q

How can you differentiate between episcleritis and scleritis ?

A

Applying phenylephrine eye drops

120
Q

What is the management of episcleritis ?

A

Self limiting
Resolution in 1-2 weeks
Symptom relief - analgesia and lubricating eye drops

121
Q

What is scleritis ?

A

Involves inflammation of the sclera ( outer layer of the connective tissue.

122
Q

What is the most severe type of scleritis ?

A

Necrotising scleritis which can lead to perforation of the sclera.

123
Q

What conditions are associated with scleritis ?

A

RA
Vasculitis

124
Q

How can scleritis present ?

A

Gradual
Red, inflamed sclera
Congested vessels
Severe pain
Pain with eye movement
Photophobia
Epiphora

125
Q

What is the management of scleritis ?

A

NSAIDs
Steroids
Immunosuppression

126
Q

What are corneal abrasions ?

A

Scratches or damage to the cornea
They cause a red, painful eye and photophobia.

127
Q

What are some common causes of corneal abrasions ?

A

Damaged contact lenses
Fingernails
Foreign bodies
Tree branches
Entropion

128
Q

How can corneal abrasions present ?

A

Painful red eye
Photophobia
Foreign body sensation
Epiphora
Blurred vision

129
Q

What are some management options for corneal abrasions ?

A

Removing foreign bodies
Simply analgesia
Lubricating eye drops
Abx eye drops
Close follow up

130
Q

What is keratitis ?

A

Inflammation of the cornea

131
Q

What are some common causes of keratitis ?

A

Viral infection
Bacterial infection
Fungal infection
Contact lens-induced acute red eye

132
Q

What is the most common cause of keratitis ?

A

Herpes simplex virus

133
Q

How can herpes keratitis present ?

A

Painful red eye
Photophobia
Vesicles - fluid filled blisters
Foreign body sensation
Watery discharge
Reduced visual acuity

134
Q

What is used to diagnose keratitis ?

A

Slit lamp examination

135
Q

What is the management of herpes keratitis ?

A

Urgent assessment
Topical or oral antivirals
Corneal transplant is an option if there is permanent scarring

136
Q

What is a Subconjunctival haemorrhage ?

A

It occurs when a small blood vessel within the conjunctiva ruptures, releasing blood into the space between the sclera and the conjunctiva.

137
Q

What could be some causes of Subconjunctival haemorrhage ?

A

Strenuous activity such as :
- heavy coughing
- weight lifting
- straining when constipated

Or trauma

138
Q

What are some conditions which can predispose someone to Subconjunctival haemorrhages ?

A

HTN
Bleeding disorders
Whooping cough
Medications - anti platelets, DOACs or warfarin
Non-accidental injury

139
Q

How does a Subconjunctival haemorrhage present ?

A

A patch of bright red blood underneath the conjunctiva.
Painless and vision is unaffected

140
Q

What is the management of a Subconjunctival haemorrhage ?

A

Check BP
Check INR

Spontaneously resolves
Lubricating eye drops if irritation

141
Q

What is a posterior vitreous detachment ?

A

It is when the vitreous body comes away from the retina.

142
Q

What is the function of the vitreous humour ?

A

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
Q

How does posterior vitreous detachment present ?

A

Can be asymptomatic
Floaters
Flashing lights
Blurred vision

144
Q

What is the management of posterior vitreous detachment ?

A

No treatment
Symptoms will improve as the brain adjusts

145
Q

What can posterior vitreous detachment predispose to ?

A

Retinal tears
Retinal detachment

146
Q

What is retinal detachment ?

A

Involves the neurosensory layer of the retina ( containing photoreceptors and nerves ) separating from the retinal pigment epithelium.

147
Q

What is the cause of retinal detachment ?

A

A retinal tear allowing vitreous fluid to get under the neuro sensory retina and fill the space between layers.

148
Q

How can retinal detachment be sight threatening ?

A

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
Q

What are some risk factors of retinal detachment ?

A

Lattice degeneration
Posterior vitreous detachment
Trauma
Diabetic retinopathy
Retinal malignancy
FH

150
Q

What is lattice degeneration ?

A

Thinning of the retina

151
Q

How does retinal detachment present ?

A

Peripheral vision loss
Blurred or distorted vision
Flashes or floaters

152
Q

What is the management of retinal tears ?

A

Laser therapy
Cryotherapy

153
Q

What are some management options for retinal detachment ?

A

Vitrectomy
Scleral buckle
Pneumatic retinopexy

154
Q

What is a vitrectomy ?

A

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
Q

What is a retinal vein occlusion ?

A

When a blood clot forms in the retinal veins blocking the drainage of blood from the retina.

156
Q

Where may a thrombus form if there is a retinal vein occlusion ?

A

Central retinal vein
Branch retinal veins

157
Q

What can a retinal vein occlusion lead to vision loss ?

A

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
Q

What are some risk factors for retinal vein occlusion ?

A

HTN
High cholesterol
DM
Smoking
High plasma viscosity ( myeloma )
Inflammatory conditions

159
Q

How does retinal vein occlusion present ?

A

Painless blurred vision or vision loss

160
Q

What are the characteristic findings of retinal vein occlusion on fundoscopy ?

A

Dilated tortuous retinal veins
Flame or blot haemorrhages
Retinal oedema
Cotton wool spots
Hard exudate

161
Q

What is the management of retinal vein occlusion ?

A

Anti-VEGF therapies
Dexamethasone intravitreal implant
Laser photocoagulation

162
Q

What is central retinal artery occlusion ?

A

Occurs due to obstruction to blood flow through the central retinal artery.

163
Q

What is the central retinal artery a branch of ? And what is that a branch of ?

A

Ophthalmic artery
Internal carotid artery

164
Q

What is the most common cause of central retinal artery occlusion ?

A

Atherosclerosis

165
Q

What are some risk factors of central retinal artery occlusion ?

A

CVD - smoking, HTN, DM, raised cholesterol
Giant cell arteritis

166
Q

How does central retinal artery occlusion present ?

A

Sudden painless loss of vision - curtains coming down

167
Q

What is seen on fundoscopy in central retinal artery occlusion ?

A

Pale retina with a cherry red spot

168
Q

What are some management options for central retinal artery occlusion ?

A

Ocular massage
Anterior chamber paracentesis
Inhaled carbogen
IV mannitol

169
Q

What is retinitis pigmentosa ?

A

A genetic condition causing degeneration of the photoreceptors in the retina particularly the rods.

170
Q

How does retinitis pigmentosa present ?

A

Night blindness
Peripheral vision loss

171
Q

What is seen on fundoscopy in retinitis pigmentosa ?

A

Bone spicule pigmentation

172
Q

What is bone spicule pigmentation ?

A

Refers to the similarity to the networking appearance of the bone matrix

173
Q

What is the management of retinitis pigmentosa ?

A

Referral to ophthalmologist
Vision aids
Sunglasses to protect the retina
Driving limitations and inform DVLA

174
Q

What is a squint ?

A

Characterised by misalignment of the visual axes.

175
Q

What are some tests for a squint ?

A

Corneal light reflection test
Cover test

176
Q

What is a corneal light reflection test ?

A

Holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils

177
Q

How is a cover test performed ?

A

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
Q

What is the management of a squint ?

A

Eye patches

179
Q

What is tunnel vision ?

A

The concentric diminution of the visual fields

180
Q

What are some causes of tunnel vision ?

A

Papilloedema
Glaucoma
Retinitis pigmentosa

181
Q

What are some causes of optic neuritis ?

A

Multiple sclerosis
DM
Syphilis

182
Q

What are some features of optic neuritis ?

A

Unilateral decrease in visual acuity over hours to days
Poor discrimination of colours
Pain worse on eye movements
Relative afferent pupillary defect

183
Q

What is the diagnostic test for optic neuritis ?

A

MRI of brain and orbits with contrast

184
Q

What is the management of optic neuritis ?

A

High dose steroids
Recovery is usually 4-6 weeks

185
Q

What is the most common cause of a persistent watery eye ?

A

Nasolacrimal duct obstruction

Y4 Neuro and special senses (6 decks)

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