Ophthalmology Flashcards
Features of acute angle closure glaucoma
Severe pain (ocular or headache)
Decreased visual acuity
Symptoms worse with mydriasis
Hard, red eye
Haloes around lights
Semi dilated non reacting pupil
Corneal oedema results in dull or hazy cornea
Acute angle closure glaucoma investigations
Tonometry for IOP
Gonioscopy (special slit lamp for looking at angle)
Management of acute angle closure glaucoma
Pilocarpine
Timolol
Apraclonidine
IV acetazolamide
Definitive management is laser peripheral iridotomy
Risk factors for ARMD
Age
Smoking
Family history
Causes of sudden visual loss
Ischaemic/vascular
Vitreous haemorrhage
Retinal detachment
Retinal migraine
Retinal vein occlusion causes
Glaucoma
Polycythaemia
Hypertension
Central retinal artery occlusion features
Afferent pupillary defect
Cherry red spot on a pale retina
Causes of vitreous haemorrhage
Diabetes
Bleeding disorders
Anticoagulants
Vitreous haemorrhage features
Sudden visual loss
Dark spots
Posterior vitreous detachment features
Flashes of light in periphery
Floaters in temporal central vision
Retinal detachment features
Dense shadow that starts peripherally then spreads to central vision
Veil/curtain over vision
Straight lines appear curved
Anginoid retinal streaks appearance
Irregular dark red streaks radiating from the optic nerve head
Causes of anginoid retinal streaks
Pseudoxanthoma elasticum
Ehler-Danlos
Paget’s
Sickle cell
Acromegaly
Classification of dry ARMD
90% of cases
Drusen - yellow round spots
Classification of wet ARMD
Choroidal neovascularisation
Leakage of serous fluid
Worst prognosis
Symptoms of ARMD
Reduction in visual acuity
Difficulties in dark adaptation
Photopsia (flickering/flashing light)
Hallucinations leading to Charles-Bonnet
Signs of ARMD
Distortion of light perception
Drusen on fundoscopy
Well demarcated red patches in wet
Management of ARMD
Zinc with vit A C & E
VEGF - randizumab, bevacizumab
Laser photocoagulation
What is a relative afferent pupillary defect
When the affected and normal eye appear to dilate when light is shone in the affected eye
Causes of relative afferent pupillary defect
Retina - detachment
Optic nerve - optic neuritis (MS)
Causes of optic neuritis
MS
Diabetes
Syphilis
Features of optic neuritis
Unilateral decrease in visual acuity over days
Poor discrimination of colours
Pain worse on eye movement
Relative afferent pupillary defect
Central scotoma
Optic neuritis investigation
MRI of brain and orbits with gadolinium contrast
Management of optic neuritis
High dose steroids
Signs of orbital cellulitis vs pre-septal cellulitis
Painful eye movement
Restricted eye movement
Reduction in colour vision
Abnormal pupillary responses to light
Reduced visual acuity
Reduced visual fields
Chemosis
Features of retinitis pigmentosa
Night blindness
Tunnel vision
Fundoscopy - black bone scipule-shaped pigmentation in the peripheral retina, mottling of retinal pigment epithelium
Diseases associated with retinitis pigmentosa
Refsum
Ushers
Alports
Kearns-Sayre
Features of Horner’s syndrome
Miosis
Ptosis
Enophthalmos
Anhidrosis
Horner’s of face arm and trunk causes
Stroke
Syringomelia
MS
Tumour
Horners of face only causes
Pancoasts
Tumour
Thyroidectomy
Trauma
Horners with no anhidrosis causes
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache
Hypertensive retinopathy stage 1 features
Arteriolar rowing and tortuosity
Increased light reflex
Silver wiring
Hypertensive retinopathy stage 2 features
Arteriovenous nipping
Hypertensive retinopathy stage 3 features
Cotton wool exudates
Flame and blot haemorrhages
Hypertensive retinopathy stage 4 features
Papilloedema
Holmes-Adie pupil features
Women
Unilateral
Dilated pupil
Slow to accommodation
Absent ankle/knee reflex
Dacryocystitis features
Watering eye
Swelling and erythema to inner canthus
Dacryocystitis management
Systemic antibiotics
Causes of mydriasis
Third nerve palsy
Holmes-Adie
Traumatic iridoplegia
Phaeochromocytoma
Congenital
Atropine
Cocaine/amphetamines
TCA’s
When do you get bilateral occipital lobe infarcts and what signs do you get.
Period of hypotension - cardiac arrest
Cortical blindness with preservation of pupils reaction to light.
Lesions at the chiasm have what signs?
Bitemporal hemianopia
If they spread up from below the defect is worse in the upper fields (pituitary tumours)
If they spread down from above the defect is worse in the lower fields (craniopharyngioma)
Lesions before the chiasm produce what defect
Visual defect in the ipsilateral eye
Optic nerve damage - central, asymmetrical and unilateral
Acuity often affected
Causes - optic neuritis, optic atrophy, glaucoma, trauma
