ophthalmology Flashcards
first line management for pt with AAU (new presentations of and recurrent acute anterior uveitis)
urgent referral to ophthalmologists within 24hrs
then afterwards may be given prednisolone eyedrops and cylcoplegic eyedrops to dilate the pupil eg atropine
epislceritis vs scleritis
episcleritis
- inflammation of episclera which is the outer layer of the sclera
- painless, doesnt affect vision
- episcleral vessels are mobile in response to phenylephrine drops
scleritis
- pain, photophobia and reduced vision
- the vessels in the eye are not moveable and will show no response to phenylephrine drops
what is the name for the condition which causes inflammation at the eyelid margins / base of eyelashes
blepharitis
tx for blepharitis
there is no cure, just do conservative management eg cleaning the area
painful red eye
pain is worse when moves eye
photophobia
PMH of RA
diagnosis?
scleritis
what is chemosis
swelling of conjunctiva
which 3 features point to a diagnosis of orbital cellulitis over periorbital cellulitis
opthalmoplegia
pain with eye movements
proptosis
effect of hydroxychloroquine on the eye
bulls eye maculopathy - irreversible damage to macula
which medication can cause raised IOP (intraocular pressure)
steroids
what is corneal arcus
a white, blue or grey opaque ring around edge of iris
gradual visual loss tat affects the peripheral visual fields at first
diagnosis
retinitis pigmentosa
hereditary
black pigmentaion on the retina
in which condition are bright yellow deposits (called “drusen” - deposits of protein) seen on the macula / retina
Dry age related macular degeneration (Dry AMD)
nausea
headaches
servere ocular pain
blurred vision
haloes around lights
pupil in fixed dilated position
diagnosis
acute angle closure glaucoma
He reports seeing bright flashing lights and a curtain in his right visual field
diagnosis
retinal detachment
what are new onset flashers and floaters followed by loss of vision indicative of
retinal detachment
Her headaches are worse in the morning and worse when she lays down to go to sleep at night.
what is this indicative of
raised inter cranial pressure
what is used to treat raised intracranial hypertension secondary to intracerebral malignancy
dexamethasone
which 2 medications are used in emergency only for acutely raised intercranial pressure, due to their risk of causing electrolyte disturbances
mannitol
hypertonic saline
which medication can be used to relieve idiopathic intracranial hypertension
acetazolamide (+weight loss, lifestyle adjustments, optic nerve fenestration if vision is threatened and ventriculo-peritoneal shunting if headaches are refractory to medical management)
which med causes red coloration of secretions
rifampicin
what is the main side effect of ethambutol
optic neuropathy
initial Tx for GCA to minimise permanent visual loss
no vision loss: high-dose steroids such as oral prednisolone
vision loss: IV methylprednisolone
elderly female presenting with sudden, painless, monocular loss of vision usually on a background of scalp tenderness, headaches, or jaw claudication
diagnosis?
GCA
what are cyclopentolate or cycloplegc eyes drops used for
uveitis
gradual history of unilateral blurred vision, haloes around light sources
loss of the red light reflex
worse vision at night
myopic shift (patient becomes more short sighted due to the increased refractive index of the cataract)
suggests a diagnosis of what?
cataracts
definitive mx of cataracts
surgical removal of the cloudy lens and replacement with an artificial one
main modifiable risk factor for age related macular degeneration
smoking
what does central visual loss (straight lines appear wavy) , esp in dim light (night blindness) indicate
age related macular degeneration
what is a gonioscopy
an eye test that checks for signs of glaucoma
vision loss
reduced visual acuity
peri orbital pain, exacerbated by eye movements
colour desaturation
RAPD
diagnosis?
optic neuritis
what is the main cause of corneal arcus
hyperlipidaemia
which examination can confirm a diagnosis of refractive error?
Pinhole-aided visual acuity
retinal oedema, retinal pigment epithelium detachment and macular exudates
is this dry or wet age-related macular degeneration
wet
drusen, chorioretinal atrophy
is this dry or wet age-related macular degeneration
dry
what symptoms does diabetic macular oedema cause
reduced visual acuity
straight lines appear wavy
what is a myopic shift
patient becomes more short sighted due to the increased refractive index of the cataract
classic triad of Horners syndrome
mitosis
partial ptosis
anhidrosis
what is posterior synechiae and which condition can it be seen in
adhesions between the lens and iris causing an irregularly shaped pupil
this occurs in anterior uveitis
which type of uveitis can cause exudative retinal detachment
posterior uveitis
in which type of uveitis can vitreous cells be visualised
intermediate uveitis
sudden painless vision loss in ONE eye
optic disc swelling
RAPD
TIAs of visual loss prior to the sudden visual loss
RFs = age, htn, dm, sleep apnoea
diagnosis
ischaemic optic neuropathy (ION)
what eye manifestation is associated with infective endocarditis
Roth spots
which vision field is affected first in glaucoma
peripheral
what is cupping of the optic disc a feature of
glaucoma
what is AV nipping a feature of
hypertensive retinopathy
what is cherry red spot a feature of
central retinal artery occlusion
Retinal hyperaemia and haemorrhages, sometimes called the ‘stormy sunset’ appearance
what is this a typical fundoscopy appearance of
central retinal vein occlusion
what is photopsia
flashers
pain on eye movement and visual loss
diagnosis
optic neuritis
(scleritis and orbital cellulitis don’t present with visual loss)
what is the cause of Horners syndrome
loss of innervation of the sympathetic chain
what eye position does fourth cranial nerve palsy cause
up and in
what eye position does third cranial nerve palsy cause
down and out
what eye position does sixth cranial nerve palsy cause
abduction - double vision
what is a central scotoma
blind spot in the middle of your vision
what are the 4 signs of acute optic neuropathy
monocular visual field defect - usually central scotoma
reduced colour vision
RAPD
optic disc swelling, or if chronic, atrophy of optic nerve fibres –> pale optic disc
what are latanoprost eye drops used for
treat high pressure in the eye , and treat glaucoma
which eye condition is associated with RA
scleritis
which eye condition is associated with MS
optic neuritis
blurry vision
difficulty driving at night due to glare from street lights
diagnosis?
cataracts
if child has an eye that drifts to the side they look forwards, what complication could this lead to if not treated
amblyopia
what is entropion
the eyelid turns inwards with the lashes against the eyeball, subsequently causing corneal damage and ulceration
what is keratitis sicca
“dry eyes” - chronic, bilateral desiccation of the conjunctiva and cornea due to an inadequate tear film.
what is entropion and ectropion
entropion- inward curling of the eyelid
ectropion - outward turning of the eyelid
which peripheral facial neuropathy is caused by varicella zoster virus
Ramsay hunt syndrome
how does a sub conjunctival haemorrhage present
bright red eye
common causes include sneezing, coughing, eye trauma
no pain
what are Lid retraction (Dalrymple’s sign) and lid lag on down gaze (Von Graefe’s sign) classic signs of
thyroid eye disease
what condition are Anti-acetylcholine receptor antibodies tested to check for
myasthenia gravis
what is posterior lens capsule opacification
relatively common complication of cataract surgery that usually occurs a few weeks following the operation
patient complains of blurry vision as if their cataract has returned, and a white opacity may be visible on observation
what condition does cupping of the optic disc indicate
chronic open angle glaucoma
what condition does bone spicule pigmentation indicate
retinal defect found in patients with retinitis pigmentosa
what condition is eczema on the eyelids seen in
allergic conjunctivitis
what condition is pre-auricular lymph nodes, watery, gritty eyes, symptoms of an upper respiratory tract infection associated with
viral conjunctivitis
what visual field loss is caused by left optic neuritis affecting left optic nerve
left monocular blindness
what visual field loss is caused by a right-sided optic tract lesion
Left homonymous hemianopia
what visual field loss is caused by a left-sided optic tract lesion
Right homonymous hemianopia
progressive loss of vision over past few days
central vision worse
trouble reading
retinal oedema / grey-green macula
diagnosis
wet age-related macular degeneration
tx for wet age-related macular degeneration
anti VEGF injections
what is sumatriptan used to treat
migraines
what condition is associated with poor contact lens hygiene
microbial keratitis
what is microbial keratitis
infection of the cornea
painful
photophobia
sticky discharge
hypoyon (pus in anterior chamber)
main risk factors for developing cataracts
age
smoking
diabetes
systemic corticosteroid use
mx of cataracts
surgical intervention called “pseudophakia”
removal of affected lens by using “phacoemulsification” then replacing it w an artificial lens
2 main complications of cataract surgery
endophthalmitis
- pain, vision loss, red, within DAYS, emergency
posterior lens capsule opacification
- blurry vision, white opacity, within WEEKS
Ix for cataract
slit-lamp biomicroscopy
reveals a brown/white appearance of the lens
cataract signs and symptoms
difficulty seeing at light
halos around lights esp at night
blurred vision
difficulty reading and recognising faces
gradual PAINLESS Visual loss
loss of red reflex
brown/white lens on slit-lamp bio microscopy
what is ptosis
eyelid drooping
proptosis
severe pain
restricted eye mouvements
rapid deterioration in vision
all following trauma
diagnosis?
retrobulbar haemorrhage - requires urgent lateral canthotomy
night blinds and tunnel vision are indicative of what
retinitis pigmentosa
what do flashers and floater suggest
retinal detachment
what does visual fluctuations suggest
Age related macular degeneration
what does glare from bright light
cataracts
what is hypermetropia
long-sightedness
what is myopia
short-sightedness
what is enopthalmos
eyes sinking deeper into socket
what treat meant is C/I in thyroid eye disease
radioactive iodine ablation therapy
immediate next step after suspicion of temporal arteritis
high dose steroids, confirm w temporal artery biopsy later
what could cause bilateral central field of visual loss
retinal disease eg AMD or diabetic maculopathy
fundoscopy appearance of central retinal artery vs being occlusion
central retinal artery occlusion
- pale retina with cherry red spot on macula
central retinal vein occlusion
- stormy sunset appearance
what does crusting at eyelid margins suggest
blepharitis
what does purulent discharge suggest
bacterial conjunctivitis
what do pupils which constrict on convergence but do not constrict in response to light suggest
argyll-roberston pupil
- suggests neurosyphilis
tx for scleritis
URGENT REFERRAL
1) NSAIDs
2) systemic glucocorticosteroids
3) azathioprine / methotrexate
tx for uveitis
URGENT REFERRAL
corticosteroid eye drops eg prednisolone
cycloplegic eye drops eg atropine
tx for optic neuritis
high dose prednisolone
peri orbital cellulitis mx
oral co-amoxiclav
secondary career referral
orbital cellulitis
IV vancomycin + cefotaxime
hospital admission
