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Clinical > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

How can you differentiate episcleritis from scleritis?

A

Episcleritic vessels will blanch under pressure or with use of 10% phenylephrine.

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2
Q

What is the classic presentation of episcleritis/scleritis?

A
  • pain that keeps them up at night
  • red eye
  • hx of inflammatory disease
  • loss of vision
  • possible hx of trauma
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3
Q

How do you manage episcleritis/scleritis?

A
  • Epi is mostly self resolving
  • Scleritis is with PO NSAIDs such as flurbiprofen for mild cases, corticosteroids may be needed for more severe/necrotising cases
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4
Q

A pt presenting with a foreign body sensation in the eye associated with discharge, pain, and O/E you see a green lesion under fluorescein has likely got what?

A

Bacterial Keratitis - pseudomonas is most common.

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5
Q

Contact wearing people who wash their lenses under tap water are at risk for what?

A

Acanthamoeba keratitis

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6
Q

What type of ulcers develop in herpes simplex keratitis?

A

Dendritic.

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7
Q

What is marginal keratitis?

A

Ulcer hasn’t quite developed but has a keratitic picture.

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8
Q

How does a pt with retinal detachment present?

A

Hx of photopsia and floaters followed by painless loss of vision (like a curtain being pulled across).
May have a background of myopia.

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9
Q

Who is vitreous haemorrhage common in? How does it present?

A

Diabetic retinopathy.
Floaters if minor, painless vision loss if severe.

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10
Q

What are the sx of posterior vitreous detachment? How is it managed?

A

Photopsia and floaters.
Mx - see ophthalmology to check for retinal tears/detachment, then just monitor as this is thought to be a natural part of aging.

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11
Q

How does CRVO present?

A

Gradual painless loss of vision which, fundoscopy shows stormy sky (retinal hyperaemia and haemorrhages).

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12
Q

How does CRAO present?

A

Sudden (over seconds) painless loss of vision, fundoscopy shows cherry red spot and pale retina.

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13
Q

How does anterior ischaemic optic neuropathy present? What is it caused by?

A

Sudden onset monocular blindness/colour blindness. Fundoscopy shows optic disc swelling in the acute phase and a pale optic disc in the chronic phase. Often get an RAPD.
Infarct to the ciliary arteries which supply the head of the optic nerve.

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14
Q

What are the signs/sx of optic neuritis?

A

Loss of vision over hours/days, pain on ocular movement, red desaturation.
Pale optic disc on fundoscopy.

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15
Q

What is hypermetropia?

A

long sighted - small eyeball

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16
Q

What is myopia?

A

short sighted (large eyeball)

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17
Q

What is an astigmatism?

A

Mismatched curves of the eyeball (not a perfect shape) causing refractory error. Usually gives a myopic error.

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18
Q

What are the two types of oculomotor palsy? How can you differentiate them?

A

Medical: vascular disease, demyelination, etc
Surgical: compression ie, tumour, aneurysm
Surgical involves pupil, medical does not.

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19
Q

What are the signs of Oculomotor Palsy?

A

Down and out palsy, cannot adduct eye, look up or look down, in surgical the pupil is permanently dilated and is unresponsive to light (in medical pupil is unaffected).

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20
Q

What are the signs of internuclear ophthalmoplegia? Who is most at risk?

A

ipsilateral failure of adduction, contralateral nystagmus.
Vasculopaths.

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21
Q

Where is the lesion in internuclear ophthalmoplegia?

A

Median longitudinal fasciculus

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22
Q

What are the eye signs in myasthenia gravis?

A

diplopia, ptosis, fatigability

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23
Q

What are the manifestations of wet age-related macular degeneration? How is it managed?

A

Neovascularisation (vessels then leak fluid and bleed causing oedema and scarring). Rapid progression, less common.
Intravitreal VEGF inhibitors stop signalling of growth factors to prevent formation of new vessels and therefore prevent leakage/scarring and retinal damage.

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24
Q

What are the RFs of dry age-related macular degeneration?

A

RFs: age, sunlight exposure, poor diet, smoking.

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25
Q

What are the symptoms of dry age-related macular degeneration?

A

Difficulty recognising faces and reading texts and difficulty with vision in dim lighting.

26
Q

What do you see on examination of the eye in dry age-related macular degeneration?

A
  • Drusen (yellow deposits on macula)
  • Thin macula
27
Q

A carotid cavernous fistula is a connection between what? What nerves does it affect? What are the signs/sx?

A

Carotid artery and cavernous sinus.
CNs III, IV, V1, V2, and VI.
Sudden onset red eye, whooshing noise, diplopia, headache, loss of vision, injected conjunctiva, proptosed eye, pulsatile eye.

28
Q

What is the cause of a retro-bulbar haemorrhage?

A

Direct eye trauma causing fracture of the orbital bones/involvement of the ye muscles. This causes a build-up of blood behind the eye, this increase in pressure behind the eye causes orbital compartment syndrome).

29
Q

How do you manage raised intraocular pressure?

A

Prostaglandin (e.g., Latanoprost) drops to increase outflow of the eye, thereby reducing pressure.

30
Q

What is Keratoconus? Mx?

A

Front of the eye becomes cone shaped. This causes vision disturbance.
Mx: corneal graft.

31
Q

What is the triad of optic neuritis?

A

Visual loss, periocular pain, dyschromatopsia (colour desaturation).

32
Q

What are the causes of optic neuritis?

A

Inflammation (e.g., herpes, CMV), demyelination (MS)

33
Q

What is drusen?

A

protein/calcium deposition within the eye

34
Q

What is Primary open angle glaucoma?

A

A form of optic neuropathy, it is chronic.
Increasing intraocular pressure due to increased resistance to the aqueous outflow but the anterior chamber angle remains open.

35
Q

What are the manifestations of Primary open-angle glaucoma?

A

Optic nerve head changes, peripheral vision loss followed by central vision loss, arcuate or parasternal scotomas, and widening of cup: dic ratio.

36
Q

What are the risk factors for primary open angle glaucoma?

A

advancing age, afro-Caribbean ethnicity, family history, myopia, raised intraocular pressure.

37
Q

What is the mainstay of managing primary open angle glaucoma?

A

Reducing intraocular pressure

38
Q

What is acute angle closure glaucoma?

A

Blockage of aqueous outflow from trabecular meshwork, resulting from the complete closure of the angle.

39
Q

What are the signs/sx of Acute angle closure glaucoma?

A

Sudden pain, headache, nausea, loss of vision, fixed and mid-dilated pupil, cloud cornea (oedema).

40
Q

What are the risk factors for Acute angle closure glaucoma?

A

Asian ethnicity, hypermetropia, use of antimuscarinics (amitriptyline),

41
Q

How do you manage Acute angle closure glaucoma?

A

Give topical pilocarpine to help increase the trabecular meshwork flow and oral acetazolamide to reduce aqueous humour.
Refer to ophthalmology who will perform laser iridotomy.

42
Q

What are the signs of cataracts?

A

Light appears as halos which worsens at night, cloudy lens, if they are mature cataracts you may not be able to see through to the back of the eye.

43
Q

What is the pathophysiology behind diabetic retinopathy?

A

Endothelial cell loss causing capillary dilation, increased vascular permeability, oedema, and protein leakage (exudates).

44
Q

How to we categorise diabetic retinopathy?

A

R0: no retinopathy
R1: mild, only microaneurysms
R2: moderate, nonproliferative
R3: severe nonproliferative (4-2-1 rule)
Proliferative retinopathy: new vessels forming
M1: clinically significant maculopathy

45
Q

What is anterior uveitis? What are the signs/sx?

A

Inflammation of ciliary body and iris.
Sx: small and unreactive pupil, red eye, painful, blurred vision (protein and fluid leakage), photopsia, floaters, lacrimation, hypopyon, synechiae (iris sticking to lens).

46
Q

What can help to prevent/break apart synechiae in anterior uveitis?

A

Mydriatic (dilating) eye drops such as cyclopentolate.

47
Q

Who is at an increased risk for anterior uveitis?

A

HLA-B27 antigen +ve, and other autoimmune patients such as UC, Crohn’s, JIA, AS, Bechet’s, reactive arthritis

48
Q

What is Endophthalmitis? Sx? Mx?

A

Inflammation of the interior eye after intraocular procedure (cataract surgery).
Sx: blurred vision, pain, redness, hypopyon.
Mx: intravitreal abx, may need vitrectomy

49
Q

What is the Keith-Wagner Baker System?

A

Classification of hypertensive retinopathy, graded 1-4.

50
Q

What is a Kayser-Fleischer ring indicative of?

A

Copper coloured ring around the iris indicating Wilson’s disease (inability for the body to break down copper).
Decreased serum copper, increased urinary copper, decreased ceruplasmin.

51
Q

What is a corneal arcus indicative of?

A

Hyperlipidaemia, it is a blue grey ring around iris due to lipid deposition.

52
Q

What is Charles-Bonnet Syndrome?

A

Visual hallucinations on a background of bilateral vision loss (glaucoma, cataracts), occurring for seconds at a time. Patients can identify that they are not real.

53
Q

What is retinitis pigmentosa? Inheritance? Signs/sx?

A

chronic hereditary condition whereby there is gradual degeneration of the retina.
Autosomal dominant, recessive, or X-Linked.
Night-time blindness, reduced visual fields, family history.

54
Q

What mutation is most commonly associated with retinoblastoma?

A

50% children have the RB1 gene mutation on chromosome 13.

55
Q

What is a chalazion? Presentation? Mx?

A

Cyst secondary to obstruction of Meibomian gland, it is non-tender and non-fluctuant as it is non-infective.
Presents as firm red nodule within the tarsal plate of the upper eyelid, palpation produces oil discharge.
Mx: conservative-warm compress

56
Q

Someone presenting with a temperature, erythema surrounding the eye, painful ocular movements, and proptosis is suffering from what?

A

Orbital cellulitis.

57
Q

Orbital cellulitis vs preseptal cellulitis?

A

Preseptal is infection confined to the anterior portion of the eyelid, so doesn’t cause the painful ocular movements that orbital does.

58
Q

What is blepharitis? Mx?

A

Chronic inflammation around the eyelid:
Painful, gritty, itchy eyes, eyelids stick together, dry eyes, crusting/scaling at the margins.
Manage supportively as this is a chronic condition but simple steps such as using warm compresses can help.

59
Q

How do you manage macular oedema in a diabetic patient?

A

Anti-VEGF

60
Q

How do you manage proliferative diabetic retinopathy?

A

PRP- pan-retinal photocoagulation.

61
Q

What is a Pterygium?

A

Wedge shaped collagenous conjunctival degeneration causing vision shadowing, itchy eyes and a foreign body sensation.

62
Q

What is used to investigate acute angle closure glaucoma?

A

Slit lamp + goniolens to view angle between iris and cornea

Clinical (27 decks)

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