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Medicine > Ophthalmology > Flashcards

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
Q

Visual field defect in prolactinoma?

A

Bi-temporal hemianopia

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26
Q

Signs of malignant eyelid tumour? (4)

A
  1. Distortion of the eyelid
  2. Loss of eyelashes
  3. Ulceration
  4. Bleeding

2WW

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27
Q

Condition with flame shaped retinal haemorrhages?

A

Central retinal vein occlusion

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28
Q

Features of diabetic retinopathy? (6)

A
  1. Microaneurysms
  2. Hard exudates
  3. Cotton wool spots
  4. Neovascularization
  5. Roth spots
  6. Haemorrhages
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29
Q

Causes of lens dislocation? (3)

A
  1. Ehlers-Danlos syndrome
  2. Marfan’s syndrome
  3. homocystinuria
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30
Q

HLA allele associated with anterior uveitis?

A

HLA B27

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31
Q

Nerve affected causing fixed dilated pupil?

A

Oculomotor nerve (CN III)

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32
Q

Condition associated with white-grey patch on cornea?

A

Keratitis

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33
Q

Drug causing amaurosis fugax?

A

Quinine

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34
Q

Rare side affect of sertraline? (SSRI’s)

A

Acute angle glaucoma

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35
Q

Dacryocystitis

A

Inflammation of the lacrimal sac

Mx: warm compress, top antibiotics

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36
Q

Dacryoadenitis

A

Inflammation of the lacrimal gland
Affecting the upper outer third of the eye
Supportive treatment

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37
Q

Stye versus chalazion

A

Stye are due to infectious aetiology and chalazions are granulomatous tissue

38
Q

Hordeolum (stye) - clinical features and management

A

Acute inflammation of eyelid gland
Painful, red swelling of the lid

Mx: hot compress, lid care, I+D if not resolving

39
Q

Chalazion

A

Inflammation of the Meibomian gland

Recurrent lesion may be biopsied to rule out malignancy.

Other causes: seborrheic dermatitis, rosacea

40
Q

Blepharitis

A

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
Q

Complications of blepharitis

A

Recurrent stye
Conjunctivitis
Keratitis
Corneal ulceration and neovascularization

42
Q

Subconjunctival haemorrage

A

Blood beneath the conjunctiva.
No other symptoms.
Risk factors: trauma, HTN, bleeding disorders, anticoagulation

Mx: reassurance, self-limiting

43
Q

Conjunctivitis - clinical features

A

Red eye
Itching
Foreign body sensation
Discharge
Crusting of the lid margin in the morning
Lid oedema

44
Q

Allergic conjunctivitis

A

Associated with atopy and is often seasonal
Mx: avoid allergens, cool compress, antihistamines

45
Q

Atopic conjunctivitis

A

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
Q

Giant papillary conjunctivitis

A

Immune reaction due to mucus debris in contact lens users

Mx: corticosteroid drops, change or discontinue contact lenses

47
Q

Viral Conjunctivitis

A

Pink eye
Lid pain and swelling, serous discharge, sub-epithelial corneal infiltrates

Mx: normally self limiting

47
Q

Main causative microbe in pink eye?

A

Adenovirus

48
Q

Trachoma

A

Caused by chlamydia trachomatis
Severe keratoconjunctivitis leading to blindness

Mx: PO azithromycin and TOP tetracycline

49
Q

Episcleritis

A

Discomfort, pain, redness
Self-limiting

Ix: blanched vessels with phenylephrine

Associated with: collagen vascular diseases, infection, IBD, rosacea, atopy

50
Q

Scleritis

A

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
Q

Functions of the cornea? (3)

A

Transmission of light
Refraction of light
Barrier

52
Q

Corneal abraision

A

Causes: trauma, foreign body, contact lenses

Clinical features: pain, redness, photophobia, de-epithelialized area when stained with fluorescein

Mx: topical antibiotic, conservative management

53
Q

Corneal ulcer - investigation and management

A

Ix: Seidel test - fluorescein stain under blue filter

Tx: urgent ophthalmology referral, culture, TOP antibiotics

54
Q

Herpes zoster ophthalmicus

A

Dermatitis in the dermatomal distribution of CN V1
May have Hutchinson’s sign

Mx: oral antiviral, topical steroid

55
Q

Keratoconus

A

Bulging and thinning of the cornea

Tx: corrective glasses/ lenses, surgery

56
Q

Munson’s sign

A

Bulging of the eye lid and cornea when looking downwards
Positive for keratoconus

57
Q

Kayser-Fleischer Ring

A

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
Q

Anterior uveitis

A

Clinical features: photophobia, ciliary flush, pain, tenderness, lacrimation

Associated with: IBD, arthritis, syphilis, sarcoidosis

Treatment: mydriatics, steroids, systemic analgesia

59
Q

Posterior uveitis

A

PAINLESS

60
Q

Cataracts - risk factors

A

Risk factors: DM, homocystinuria, Wilson’s disease, hypocalcaemia, steroid use, high myopia

61
Q

Posterior vitreous detachment - clinical features

A

Floaters and flashes of light

62
Q

Vitreous haemorrhage

A

Bleeding into the vitreous cavity

Clinical features: sudden loss of visual acuity, preceding floaters or flashes

Mx: expectant or surgical (vitrectomy)

63
Q

Central retinal artery occlusion

A

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
Q

Central retinal vein occlusion

A

Clinical features: sudden, painless loss of vision, +/-RAPD, flame haemorrhages on fundoscopy

Mx: retinal laser photocoagulation, anti-VEGF, corticosteroid injection

65
Q

Retinal detachment

A

Clinical features: sudden vision loss, flashes/ floaters, hazy spots in line of vision

Tx: surgical - scleral bulking, laser/cryotherapy for flashes and floaters

66
Q

Retinitis pigmentosa

A

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
Q

Age related macular degeneration - dry versus wet

A

Dry -
slow, progressive vision less
drusen
geographic atrophy

Wet -
less common (10%)
choroidal neovascularization
progresses more to vision loss

68
Q

ARMD clinical features and management

A

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
Q

Primary open angle glaucoma

A

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
Q

Primary angle closure glaucoma

A

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
Q

Definitive treatment for primary angle closure glaucoma

A

Laser iridotomy

72
Q

Adie’s pupil

A

Postganglionic nerve damage causes dilation of the pupil and slow reactivity to light

73
Q

Horner’s pupil

A

Pupil smaller than normal, does not dilate with light

74
Q

Argyll-Robertson Pupil

A

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
Q

CN III palsy

A

Down and out

76
Q

CN IV palsy

A

Up and out

77
Q

Canadian screening guidelines for diabetic retinopathy (Type 1, Type 2, Pregnancy)

A

T1DM: annually five years after onset, or annually from over 12 years
T2DM: annually
Pregnancy: ocular exam in 1st trimester

78
Q

Hypertensive retinopathy

A

Clinical features: blurred vision, decreased colour vision, central scotoma

Treatment: blood pressure control, steroids for optic neuritis

79
Q

Classification of hypertensive retinopathy

A

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
Q

Treatment optic neuritis

A

IV steroids then taper to PO

81
Q

TIA/ amaurosis fugax

A

Sudden transient blindness from vascular compromise

82
Q

Strabismus

A

Misalignment between eyes
Refer to ophthalmology

83
Q

Amblyopia (lazy eye)

A

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
Q

Leukocoria

A

White pupillary reflex (absent red reflex)
URGENT referral to ophthalmology
r/o retinoblastoma

85
Q

Retinoblastoma

A

arising from immature cells of the retina
often presents with leukocoria, strabismus, red eye, eye enlargement
Mx: local laser/chemo, genetic counselling

86
Q

Blow out fracture features

A

Restricted extraocular movement, diplopia, sunken eye (enophthalmos)

87
Q

Ethmoid fracture feature

A

Emphysema of the lid subcutaneously

88
Q

Hyphema

A

Blood in the anterior chamber/ around iris

89
Q

Chorioretinitis

A

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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