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Ophthalmology Flashcards

1
Q

Hordeolum (“stye”)

A

Acute inflammation of the tear gland or eyelash follicles

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2
Q

Dacryocystitis

A

Acute or chronic infection resulting in inflammation of the lacrimal sac

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3
Q

Blepharitis

A

Chronic/recurrent inflammation of the eyelids.

Characterized by red, swollen eyelids, irregular eyelid margins with crusty, scaly plaques on the lid margin and eyelashes

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4
Q

Chalazion

A

A focal granulomatous swelling of the meibomian gland.

Presents as a chronic, slow-growing nodule on the eyelid that is often better seen on eversion of the eyelid.

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5
Q

Role of the choroid

A

Vascular - blood and oxygen supply to the eye

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6
Q

Role of the fovea

A

Sharp central vision

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7
Q

Role of the ciliary body

A

Produces aqueous/ vitreous humour

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8
Q

Conjunctivitis

A

Inflammation of the conjunctiva (covering of the sclera)

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9
Q

Bacterial v Viral v Allergic conjunctivitis

A

Bacterial - purulent
Viral - serous/ mucoid
Allergic - mucoid

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10
Q

Acute Iritis - features

A

pain, photophobia, blurred vision, small pupil

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11
Q

Keratitis

A

Corneal ulcer

+ pain, photophobia, may have blurry vision

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12
Q

What is the cornea?

A

Outermost part of the lens

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13
Q

Herpes simplex keratitis

A

HSV

Painful red eye, photophobia, watery discharge

Fluorescein staining - dendritic ulcers on cornea

Mx:
urgent referral ophthalmologist
TOP/ PO antivirals

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14
Q

What is the value on Snellen for legal blindess

A

20/200

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15
Q

Exophthalmos (proptosis)

Causes (5)

A

Anterior displacement of the eye

(distinguish from lid retraction)

Causes:
Graves’
Orbital cellulitis
Orbital tumour
Orbital retrobulbar haemorrhage
Cavernous sinus thrombosis

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16
Q

Enophthalmos

Causes (4)

A

Posterior displacement (retraction) of the globe

Causes:
Trauma
Fat atrophy
Congenital
Metastatic disease

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17
Q

Orbital Cellulitis

A

Emergency

Not always distingushable from preseptal cellulitis

Systemically unwell

Red flag symptoms -
loss of visual acuity
exophthalmos
RAPD
painful eye movements
diplopia

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18
Q

Complications of orbital cellulitis

A

optic nerve inflammation
cavernous sinus thrombosis
brain abscess

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19
Q

Treatment of orbital cellulitis

A

IV antibx - ceftriaxone + vanc
surgical drainage of abscess

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20
Q

Dry eye syndrome (keratoconjunctivitis sicca)
- aqueous deficient
- evaporative

A

Aqueous deficient
- Sjogren’s
- lacrimal gland scarring
- CN VII palsy, medications

Evaporative
- Meibomian gland dysfunction
- vitamin a deficiency
- eyelid abnormalities
- contact lenses / allergic

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21
Q

What condition does cherry red spot indicate?

A

Central retinal artery occlusion

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22
Q

Causes of optic neuritis? (3)

A
  1. Multiple sclerosis
  2. Diabetes
  3. Syphilis
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23
Q

What is Hutchinson’s sign?

A

Rash on the tip or side of nose (herpes zoster ophthalmicus)
Affecting trigeminal nerve

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24
Q

Treatment of conjunctivitis in pregnancy?

A

TOP fusidic acid BD

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25
Visual field defect in prolactinoma?
Bi-temporal hemianopia
26
Signs of malignant eyelid tumour? (4)
1. Distortion of the eyelid 2. Loss of eyelashes 3. Ulceration 4. Bleeding 2WW
27
Condition with flame shaped retinal haemorrhages?
Central retinal vein occlusion
28
Features of diabetic retinopathy? (6)
1. Microaneurysms 2. Hard exudates 3. Cotton wool spots 4. Neovascularization 5. Roth spots 6. Haemorrhages
29
Causes of lens dislocation? (3)
1. Ehlers-Danlos syndrome 2. Marfan's syndrome 3. homocystinuria
30
HLA allele associated with anterior uveitis?
HLA B27
31
Nerve affected causing fixed dilated pupil?
Oculomotor nerve (CN III)
32
Condition associated with white-grey patch on cornea?
Keratitis
33
Drug causing amaurosis fugax?
Quinine
34
Rare side affect of sertraline? (SSRI's)
Acute angle glaucoma
35
Dacryocystitis
Inflammation of the lacrimal sac Mx: warm compress, top antibiotics
36
Dacryoadenitis
Inflammation of the lacrimal gland Affecting the upper outer third of the eye Supportive treatment
37
Stye versus chalazion
Stye are due to infectious aetiology and chalazions are granulomatous tissue
38
Hordeolum (stye) - clinical features and management
Acute inflammation of eyelid gland Painful, red swelling of the lid Mx: hot compress, lid care, I+D if not resolving
39
Chalazion
Inflammation of the Meibomian gland Recurrent lesion may be biopsied to rule out malignancy. Other causes: seborrheic dermatitis, rosacea
40
Blepharitis
Inflammation of the lid margin. S/S: itching, tearing, foreign body sensation, crusting, discharge with pressure on lids "toothpaste sign" Mx: warm compresses, lid massage, lid washing, consider antibiotics
41
Complications of blepharitis
Recurrent stye Conjunctivitis Keratitis Corneal ulceration and neovascularization
42
Subconjunctival haemorrage
Blood beneath the conjunctiva. No other symptoms. Risk factors: trauma, HTN, bleeding disorders, anticoagulation Mx: reassurance, self-limiting
43
Conjunctivitis - clinical features
Red eye Itching Foreign body sensation Discharge Crusting of the lid margin in the morning Lid oedema
44
Allergic conjunctivitis
Associated with atopy and is often seasonal Mx: avoid allergens, cool compress, antihistamines
45
Atopic conjunctivitis
peak age 30-50yr intense ocular itching, tearing, burning, redness, swelling of eyelids, conjunctival hyperemia Mx: tacrolimus (calcineurin inhibitor ointment), cyclosporine and corticosteroid eye drops
46
Giant papillary conjunctivitis
Immune reaction due to mucus debris in contact lens users Mx: corticosteroid drops, change or discontinue contact lenses
47
Viral Conjunctivitis
Pink eye Lid pain and swelling, serous discharge, sub-epithelial corneal infiltrates Mx: normally self limiting
47
Main causative microbe in pink eye?
Adenovirus
48
Trachoma
Caused by chlamydia trachomatis Severe keratoconjunctivitis leading to blindness Mx: PO azithromycin and TOP tetracycline
49
Episcleritis
Discomfort, pain, redness Self-limiting Ix: blanched vessels with phenylephrine Associated with: collagen vascular diseases, infection, IBD, rosacea, atopy
50
Scleritis
Anterior or posterior --> posterior can cause rapidly progressive blindness S/S: severe pain, photophobia, red eye, decreased vision Mx: treat underlying aetiology (collagen disorders, granulomatous conditions, infection, chemical or physical agents) NSAIDs, steroids, immunomodulators
51
Functions of the cornea? (3)
Transmission of light Refraction of light Barrier
52
Corneal abraision
Causes: trauma, foreign body, contact lenses Clinical features: pain, redness, photophobia, de-epithelialized area when stained with fluorescein Mx: topical antibiotic, conservative management
53
Corneal ulcer - investigation and management
Ix: Seidel test - fluorescein stain under blue filter Tx: urgent ophthalmology referral, culture, TOP antibiotics
54
Herpes zoster ophthalmicus
Dermatitis in the dermatomal distribution of CN V1 May have Hutchinson's sign Mx: oral antiviral, topical steroid
55
Keratoconus
Bulging and thinning of the cornea Tx: corrective glasses/ lenses, surgery
56
Munson's sign
Bulging of the eye lid and cornea when looking downwards Positive for keratoconus
57
Kayser-Fleischer Ring
Brown/yellow/green pigment in peripheral cornea due to copper deposition Does not cause any symptoms or eye complications, treat underlying condition (Wilson's disease)
58
Anterior uveitis
Clinical features: photophobia, ciliary flush, pain, tenderness, lacrimation Associated with: IBD, arthritis, syphilis, sarcoidosis Treatment: mydriatics, steroids, systemic analgesia
59
Posterior uveitis
PAINLESS
60
Cataracts - risk factors
Risk factors: DM, homocystinuria, Wilson's disease, hypocalcaemia, steroid use, high myopia
61
Posterior vitreous detachment - clinical features
Floaters and flashes of light
62
Vitreous haemorrhage
Bleeding into the vitreous cavity Clinical features: sudden loss of visual acuity, preceding floaters or flashes Mx: expectant or surgical (vitrectomy)
63
Central retinal artery occlusion
Causes: emboli from carotid arteries, thrombus, GCA/ temporal arteritis Clinical features: sudden, painless loss of vision, RAPD, cherry red spot on fundoscopy Mx: decrease IOP - timolol, IV acetazolamide, laser embolectomy
64
Central retinal vein occlusion
Clinical features: sudden, painless loss of vision, +/-RAPD, flame haemorrhages on fundoscopy Mx: retinal laser photocoagulation, anti-VEGF, corticosteroid injection
65
Retinal detachment
Clinical features: sudden vision loss, flashes/ floaters, hazy spots in line of vision Tx: surgical - scleral bulking, laser/cryotherapy for flashes and floaters
66
Retinitis pigmentosa
Familial degenerative eye disease of retina - mainly AR inheritance Clinical features: night blindness, decreased peripheral vision, glare, decreased central vision Ix: fundoscopy - pale optic disc, narrow retinal arterioles, bone-spicule pigment
67
Age related macular degeneration - dry versus wet
Dry - slow, progressive vision less drusen geographic atrophy Wet - less common (10%) choroidal neovascularization progresses more to vision loss
68
ARMD clinical features and management
Clinical features: progressive central vision loss Ix: Amsler grid, fluorescein angiography Tx: Dry - monitor, low vision aids, anti-oxidants (AREDS2) Wet - anti-VEGF, Verteporfin (Visudyne)
69
Primary open angle glaucoma
Restriction in aqueous flow --> increased IOP Clinical features: gradual painless vision loss, mainly peripheral vision Mx: 1. Increase aqueous flow - latanoprost, topical a2 adrenergics (brimonidine) 2. Decrease aqueous production - carbonic anhydrase inhibitors (acetazolamide) 3. Surgical - trabeculectomy, shunt
70
Primary angle closure glaucoma
Clinical features: painful, red eye, decreased visual acuity, N+V, abdominal pain, halos, fixed mid-dilated pupil Mx: aqueous suppressants, IV mannitol, miotics - pilocarpine, surgery
71
Definitive treatment for primary angle closure glaucoma
Laser iridotomy
72
Adie's pupil
Postganglionic nerve damage causes dilation of the pupil and slow reactivity to light
73
Horner's pupil
Pupil smaller than normal, does not dilate with light
74
Argyll-Robertson Pupil
Bilateral small pupils that fail to constrict in response to bright light but exhibit constriction during near vision tasks. Brisk constriction for near tasks. Abnormal pupil shape - oval Seen in tertiary syphilis
75
CN III palsy
Down and out
76
CN IV palsy
Up and out
77
Canadian screening guidelines for diabetic retinopathy (Type 1, Type 2, Pregnancy)
T1DM: annually five years after onset, or annually from over 12 years T2DM: annually Pregnancy: ocular exam in 1st trimester
78
Hypertensive retinopathy
Clinical features: blurred vision, decreased colour vision, central scotoma Treatment: blood pressure control, steroids for optic neuritis
79
Classification of hypertensive retinopathy
Modified Scheie classification 0: no changes 1: mild arterial narrowing 2: obvious arterial narrowing with focal abnormalities 3: grade 2 + retinal haemorrhages +/- exudate 4: grade 3 + swollen optic nerve (malignant HTN)
80
Treatment optic neuritis
IV steroids then taper to PO
81
TIA/ amaurosis fugax
Sudden transient blindness from vascular compromise
82
Strabismus
Misalignment between eyes Refer to ophthalmology
83
Amblyopia (lazy eye)
Progressive suppression of visual input from eye Normally unilateral Most common cause of vision loss in children, half secondary to strabismus Mx: corrective lenses for strabismus, surgery
84
Leukocoria
White pupillary reflex (absent red reflex) URGENT referral to ophthalmology r/o retinoblastoma
85
Retinoblastoma
arising from immature cells of the retina often presents with leukocoria, strabismus, red eye, eye enlargement Mx: local laser/chemo, genetic counselling
86
Blow out fracture features
Restricted extraocular movement, diplopia, sunken eye (enophthalmos)
87
Ethmoid fracture feature
Emphysema of the lid subcutaneously
88
Hyphema
Blood in the anterior chamber/ around iris
89
Chorioretinitis
Inflammation of the choroid and retina Caused by infections: TB, CMV, HIV, autoimmune diseases Clinical features: blind spots, flashers and floaters, blurred vision On fundoscopy: "pizza pie" appearance Management: treat underlying infection/ cause

Medicine (16 decks)

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