Ophthalmology Flashcards
Give 3 causes of a painful red eye
Acute glaucoma
Anterior uveitis
Conjunctivitis
Define conjunctivitis and give 3 possible causes
Inflammation of the conjunctiva
Causes;
Viral - Adenovirus
Bacterial - Staph, chlamydia, gonococcus
Allergic
Give 4 clinical features of conjunctivitis
Often bilateral
Purulent discharge (sticky = bacterial, watery = viral)
Red, bloodshot eyes
Itchy, gritty sensation
How is conjunctivitis managed? (3)
Resolves without treatment in 1-2 weeks
Bacterial = Chloramphernicol/ fusidic acid eye drops
Allergic = Antihistmaines (oral/topical)
What causes a corneal abrasion and how may it present? (3)
Cause = Trauma
Presentation;
Pain, foreign body sensaiton
Photophobia
Blurred vision, watering eye
How is corneal abrasion investigated? (1)
Slit lamp, fluorescein stains defect yellow/orange
How is corneal abrasion managed? (1)
Cyclopentolate to dilate pupil
Define episcleritis and give 2 causes
Inflammation of the episclera (outermost layer of the sclera, just below the conjunctiva)
Causes;
Idiopathic
Associated with; RA, IBD, SLE
How may episcleritis present? (4)
Painless/mild pain
Mild photophobia
Localised redness
Dilated episcleral vessels
How is episcleritis managed? (3)
Self-limiting in 1-4 weeks
Analgesia, cold compress, safety net
Severe = Systemic NSAIDs (naproxen) or topical steroid eye drops (phenylephrine)
Define scleritis and give 3 causes
Inflammation of the full thickness of the sclera
Causes;
RA, SLE, Polymyalgia rheumatica
IBD (Ulcerative colitis)
Sarcoidosis, Granulomatosis with polyangitis
How may scleritis present? (4)
Severe pain, worse on movement
Blue sclera
Photophobia
Reduced visual acuity
How is scleritis managed? (3)
NSAIDs - Topical/systemic
Steroids
Immunosuppression for underlying condition
Define simple open angle glaucoma
Describes optic nerve damage due to raised IOP due to blockage from aqueous humour >24mmHg.
Nerve damage and decreased blood flow results in disc atrophy and cupping
Give 4 risk factors for chronic simple open angle glaucoma
Increasing age
Black ethnic origin
FHx
Steroids
Define Glaucoma
Describes optic neuropathy that occurs due to raised intraocular pressure
How may chronic simple open angle glaucoma present? (2)
Peripheral vision loss causing tunnel vision
Gradual onset of fluctuating pain, headaches, blurred vision and halos around lights
How is chronic simple open angle glaucoma investigated? (3)
Tonometry = non contact (puff of air on cornea) and Goldman applanation >24mmHg
Fundoscopy = Optic disc cupping
Visual field = Peripheral vision loss
How is chronic simple open angle glaucoma managed? (3)
Eye drops to decrease intraocular pressure
1st - Prostaglandin analogue eye drops (latanoprost)
Others;
BB - Timolol
Carbonic anhydrase inhibitor - Dorzolamide
Define acute angle-closure glaucoma
Describes a rise in intra-ocular pressure that impairs aqueous outflow.
Name 3 factors that predispose someone to acute angle closure glaucoma
Hypermetropia (long-sightedness)
Pupillary dilatation
Lens growth associated with age
Give 5 clinical features of acute angle-closure glaucoma
Severe pain (ocular or headache)
Decreased visual acuity
Hard, red eye
Semi-dilated non-reacting pupil
Corneal oedema > Dull/Hazy cornea
What investigations are performed to diagnose acute angle closure glaucoma? (2)
Tonometry - To assess for elevated intraocular pressure
Gonioscopy - Allows visualisation of the angle
How is acute angle closure glaucoma initially managed? (3)
Urgent referral to ophthalmologist
Combination of eye drops;
Pilocarpine, Timolol or Apraclonidine
IV acetazolamide
What is the definitive management for acute angle closure glaucoma?
Laser peripheral iridotomy
(Creates tiny hole in peripheral iris > Aqueous humour flowing to the angle)
How does pilocarpine treat relieve symptoms of acute angle closure glaucoma?
Direct parasympathomimetic (Muscarinic Receptor Agonist)
Causes contraction of ciliary muscle > opening the trabecular meshwork > increased outflow of the aqueous humour
How do beta blockers, like timolol, relieve symptoms of acute angle closure glaucoma?
Decrease aqueous humour production
How do alpha-2 agonists, like apraclonidine, help relieve symptoms of acute angle closure glaucoma?
Dual mechanism;
Decrease aqueous humour production and increase uveoscleral outflow
Define Blepharitis
Describes inflammation of the eyelid margins
Name 2 types of Blephraritis
Posterior Blepharitis - meibomian gland dysfunction (most common)
Anterior Blephraritis - Seborrhoeic dermatitis/staphylococcal infection
Blepharitis is more common in patients with what?
Rosacea
What is the function of the meibomian glands?
Secrete oil onto the surface of the eye to prevent rapid evaporation of the tear film.
Hence any problem with these glands can lead to irritation.
Give 5 clinical features of Blepharitis
Bilateral symptoms
Grittiness and discomfort around eye margins
Eyes may be sticky in the morning
Eyelid margins may be red
Styes and chalazions
What is the difference between a Chalazion and a Stye? (3)
Styes occur along the eyelash line
Chalazions occur further away from the eye on the top eyelid or under the bottom eyelash.
Styes are also more painful than chalazions
How is Blepharitis managed? (4)
Hot compress 2x per day
Lid hygiene - Mechanical removal of debris from lid margins (cotton wool bud dipped in cooled boiled water and baby shampoo)
Topical antibiotics (when bacterial infection is suspected)
Artificial tears
Give 2 risk factors for cataracts
Women > Men
Increasing age
Define cataracts
A common eye condition where the lens of the eye gradually opacifies (becomes cloudy).
Cloudiness makes it difficult for light to reach the retina, causing reduced/blurred vision.
Give 5 clinical features of cataracts
Gradual onset of;
Reduced vision
Faded colour vision
Glare (lights appear brighter than usual)
Halos around lights
Give 4 classifications of cataracts
Nuclear - Common in old age
Polar - Localised and inherited
Subcapsular - Occurs due to steroid use
Dot opacities - Diabetes and myotonic dystrophy
Give 1 clinical sign of cataracts observed using an opthalmoscope
Defective red reflex
(Red reflex = Light reflecting from retina. Cataracts prevents light reaching the retina, causing a defect in the red reflex.
How is cataracts managed non-surgically? (2)
Stronger glasses/contact lenses
Encourage using brighter light
Give 2 investigations performed to investigate cataracts
Opthalmoscopy (done after pupil dilation) (normal fundus and optic nerve)
Slit lamp examination (showing visible cataract)
How is cataracts managed surgically?
Removal of cloudy lens and replacement with artificial lens
Give 4 complications of cataracts surgery
Posterior capsule opacification (thickening of lens capsule)
Retinal detachment
Posterior capsule rupture
Endophthalmitis (inflammation of aqueous and/or vitreous humour)
Describe central retinal artery occulsion
Describes a sudden unilateral visual loss due to thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)
Give 3 clinical features of central retinal artery occlusion
Sudden, painless unilateral visual loss
Relative afferent pupillary defect
“Cherry red” spot on pale retina
How is central retinal artery occlusion managed?
Treat underlying cause (i.e IV methylprednisolone for temporal arteritis)
Give 3 classifications of diabetic retinopathy
Non Proliferative Diabetic Retinopathy (NPDR) (mild, moderate and severe)
Proliferative retinopathy (PDR)
Maculopathy
How is mild NPDR defined?
1 or more microaneurysm
How is moderate NPDR defined? (4)
Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots (represents retinal infarction)
How is severe NPDR defined? (3)
Blot haemorrhages and microaneurysms in 4 quadrants
Venous beading in at least 2 quadrants
Intraretinal microvascular abnormalities in at least 1 quadrant
How many proliferative diabetic retinopathy present? (3)
Retinal neovascularisiation - may lead to vitrous haemorrhage
Fibrous tissue forming anterior to retinal disc
More common in type 1 DM
How is maculopathy defined? (4)
Based on location rather than severity
Hard exudates and other changes on macula
Check visual acuity
More common in Type II DM
How are all patients with diabetic retinopathy managed? (2)
Optimise glycaemic control, blood pressure and hyperlipidaemia.
Regular review by ophthalmology
How is maculopathy managed?
If there is change in visual acuity - Give Intravitreal vascular endothelial growth factors (VEGF inhibitor) (Ranibizumab)
How is proliferative retinopathy managed?
Panretinal laser photocoagulation
Intravitreal VEGF inhibitor - Ranibizumab
Give 2 complications of panretinal laser photocoagulation
Reduction in visual fields (due to scarring of peripheral tissue)
Decreased night vision (due to reduction in rod cells)
Define keratitis
Describes inflammation of the cornea
Give 2 bacterial causes of Keratitis
Staphylococcus Aureus (most common)
Pseudomonas aeruginosa (in contact lens wearers)
Give 1 amoebic cause of keratitis
Acanthamoebic keratitis (5% of cases)
Give 4 clinical features of keratitis
Red eye (pain and erythema)
Photophobia
Foreign body, gritty sensation
Hypopyon (milky fluid in inferior part of anterior chamber)
How is keratitis diagnosed?
Slit-lamp + Same day referral to eye specialist to rule out microbial keratitis
How is keratitis managed? (3)
Stop using contact lenses until Sx have resolved
Topical antibiotics (quinolones)
Cyclopentolate (for pain relief)
Give 4 complications of keratitis
Corneal scarring
Perforation
Endophthalmitis
Visual loss
Define anterior uveitis
Describes inflammation of the anterior portion of the uvea (iris and ciliary body)
What gene is associated with anterior uveitis?
HLA-B27
Give 5 clinical features of anterior uveitis
Acute onset red eye
Ocular discomfort and pain
Small pupil/Irregular
Blurred vision
Lacrimation
Give 4 conditions associated with anterior uveitis
Ankylosing Spondylitis
Reactive arthritis
Ulcerative colitis and Crohn’s disease
Bechet’s disease
How is anterior uveitis managed? (3)
Urgent review by Ophthalmology
Cycloplegics (dilate pupil to relieve pain and photophobia) (Atropine, cyclopentolate)
Steroid eye drops
Describe macular degeneration
The most common cause of blindness in the UK.
Characterised by degeneration of retinal photoreceptors, leading to degeneration of the central retina (macula)
Changes are usually bilateral
Give 3 risk factors for macular degeneration
Increasing age (greatest risk factor)
Smoking
Positive Family History
Name and describe 2 forms of macular degeneration
Dry macular degeneration;
- 90% of cases
- Characterised by drusen - Yellow round spots in Bruch’s membrane
Wet macular degeneration
- 10% of cases
- Characterised by choroidal neovascularisation
- Aka exudative or neovascular macular degeneration
Give 4 clinical features of macular degeneration
Subacute vision loss with;
- A reduction in visual acuity (gradual in dry, subacute in wet
- Poor night vision
- Fluctuations in visual disturbance from day to day
- Visual hallucinations (Charles-Bonnet syndrome)
Give 3 examination findings for macular degeneration
Distortion of line perception on Amsler grid testing
Presence of drysen on fundoscopy
Demarcated red patches representing haemorrhage (in wet)
How is macular degeneration diagnosed? (3)
Slit lamp microscopy + Colour fundus photography (initial investigation of choice)
Fluorescein angiography (if neovascular ARMD is susected)
Optical coherence tomography
How is macular degeneration managed? (3)
Prevention (dry) - Zinc with antioxidant vitamins A, C and E can reduce progression
Anti-VEGR agents - Ranibizumab
Laser photocoagulation - slows progression but carries risk of acute visual loss after treatment
What is the commonest disease associated with optic neuritis?
Multiple Sclerosis
Give 5 clinical features of optic neuritis
Unilateral decrease in visual acuity over hours/days
Poor discrimination of colours (red desaturation)
Pain worse on eye movement
Central scotoma
Relative afferent pupillary defect
What investigation is used to diagnose optic neuritis?
MRI of brain and orbits with gadolinium contrast
How is optic neuritis managed? (2)
High dose steroids
Recovery usually takes 4-6 weeks
Describe orbital cellulitis
Describes infection affecting the fat and muscles posterior to the orbital septum.
Usually caused by URTI spreading from sinuses.
Medical emergency requiring hospital admission and urgent senior review.
Give 4 risk factors for orbital cellulitis
Childhood
Previous sinus infection
Lack of Hib Vaccination
Recent eyelid infection/insect bite on eyelid (periorbital cellulitis)
Give 5 presenting features for orbital cellulitis
Redness and swelling around eye
Severe ocular pain
Visual disturbance
Proptosis
Pain with eye movements
How is orbital cellulitis differentiated from preseptal cellulitis?
Reduced visual acuity, proptosis, eye ophthalmoplegia/pain with eye movements are NOT features of preseptal cellulitis
Give 4 investigations for orbital cellulitis
FBC - Raised WBC and CRP/ESR
Clinical examination (Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema)
CT with contrast
Blood culture - to determine organism
What are the most common bacterial causes of orbital cellulitis? (3)
Streptococcus
Staphylococcus aureus
Haemophilus influenzae B
Describe retinal detachment
Describes when neurosensory tissue that lines the back of the eye comes away from it’s underlying pigment epithelium
Reversible form of vision loss if recognised and treated before the macula is affected.
Give 5 risk factors for retinal detachment
Diabetes mellitus
Myopia
Age
Previous surgery for cataracts
Eye trauma (boxing)
How can diabetes mellitus cause retinal detachment
Occurs as a result of breaks in the retina due to traction by the vitreous humour.
Give 4 clinical features of retinal detachment
Now onset floaters/flashes
Sudden onset, painless and progressive visual field loss
Relative afferent pupillary defect (if optic nerve is affected)
Fundoscopy (loss of red reflex)
