Ophthalmology Flashcards
What type of drug (eye drop) causes pupil constriction?
Miotic
Give an example of a miotic drug (eye drop)?
Pilocarpine
What type of drug (eye drop) causes pupil dilation?
Mydriatic
Give an example of a mydriatic drug (dye drop)?
Tropicamide
How long before you can drive after receiving a mydriatic eye drop?
3-4 hours
What is the purpose of fluorescein (orange dye, blue light) in eye examinations?
Looks for corneal damage and foreign bodies
What are names of eye drops for dry eyes from mild to strong?
Hypermellose 0.3% (most mild)
Carmellose (Evolve, Systane)
Hypotears 0.1-0.3% (last 3 x as long as other drops) (most potent)
VitA-P-OS (ointment) good for overnight use
Eye drop preservatives
Benzalkonium Chloride
(also acts as a detergent)
Conjuctivitis - what do you know?
- Inflammation of conjunctiva:
1. thin transparent membrane on the eye surface
2. If cornea also involved → keratoconjunctivitis - Symptoms include ‘gritty’, ‘burning’ watery, red eye, sometimes discharge - NO pain
- Exam: Conjunctival injection (dilated conjunctival vessels), conjunctival oedema, follicles and papillae, preauricular lymphadenopathy
1.
Viral conjunctivitis
- Usually self-limiting within 1-2 weeks
- Most common virus cause is adenovirus
- Bathing eye eg cotton wool soaked in boiled water, cool compresses
- Separate towels, wash hands regularly
- No school exclusion
- If persistent ie 7-10 days can consider an ophthalmology review
- If recurrent consider herpes simplex conjunctivitis
How many days do viral conjunctivitis last?
7-14 days
What is the common cause of viral conjunctivitis?
Adenovirus
Bacterial conjunctivitis
- Usually self-limiting within 5-7 days
- Sometimes causes purulent discharge + crusting
- Most common strep pneum, staph aureus, haem influenza
- Antibiotic options (e.g if severe):
- 1st line - Chloramphenicol 0.5% drops / 1% ointment (7d)
- 2nd line: Fusidic acid 1% drops (7d)
- Can consider a delayed prescription to start in 3 days if no improvement
- Swab if initial treatment fails
- No school exclusion
How long does bacterial conjuctivitis typically last for?
5-7 days
What are the 3 most common causes of bacterial conjutivitis?
Staph aureus, Strep pneum, Haem influenzae
Allergic conjunctivitis
- Includes seasonal (eg hayfever conjunctivitis), perennial (eg due to house dust mites, animal dander etc)
- Think of it, if bilateral, itching++
- Caused by an IgE response to an allergen
- Can be linked with other atopic conditions eg asthma, rhinitis, eczema
- Allergen avoidance (eg mould, animal dander), surface lubricants, cold compresses
- Can try topical antihistamine/mast cell stabilizer e.g. azelastine which is dual
What eye drops can you offer to treat allergic conjuctivits due to hayfever and how long to thye take to work?
Opatanol (Olopatadine) - works within hours
Sodium cromoglicate - take 2-3 weeks to work
Chronic Visual Impairment – Causes & Complications
- Many causes, e.g.:
o ARMD
o Cataract
o Retinopathy
o Chronic glaucoma
o Presbyopia
o Refractive error
- Complications:
o Depression
o Falls and fractures
o Limitations in mobility, activities of daily living, and physical performance
o Reduced quality of life
Ulcerating eye conditions
Shingles: Herpes Zooster Ophthalmicus
Dendritic ulcer: HSV Keratitis
Corneal Ulcer: contact lenses wearers
If a contact lens wearer attends with a red eye. What condition are you worried about and what examination do they need?
Corneal ulcer / keratits
Slit lamp examination with fluorescein eye drops
What is the cause of acute close angle glaucoma?
Is caused by a rapid increase in intraocular pressure (IOP) due to a sudden blockage of the drainage canals in the eye
O/E you will see a fixed dilated pupil
Drops for glaucoma to reduce the IOP
- Prostaglandin Analogues (increase the outflow of aqueous humor): Latanoprost (Xalatan), Bimatoprost (Lumigan)
- Beta-blockers (decrease the production of aqueous humor): Timolol (Timoptic)
- Alpha Agonists (decrease aqueous humor production & increase its outflow: Brimonidine (Alphagan P), Apraclonidine (Iopidine).
- Carbonic Anhydrase Inhibitors (reduce the production of aqueous humor: Dorzolamide (Trusopt), Brinzolamide (Azopt).
List causes of an enlarged pupil?
- Deadly Nightshave
- ICP
- Drugs (SSRI, Amphetamines, Ecstasy, Cocaine, LSD)
- Argyll Robertson pupil (syphillis)
- Adie syndrome / Holmes–Adie syndrome
- 3rd nerve palsy / Berry aneurysm
- Iritis
List possible causes of visual disturbance in uncontrolled DM:
1. Sudden
2. Gradual
3. Fluctuating
- Sudden: Vitrous haemorrhage
- Gradual: Retinopathy, Cataracts
- Fluctuating: Sugar in the lens
Age Related Macular Degeneration (ARMD)
Wet v Dry
Reactive arthritis signs
Hypertensive retinopathy
Diabetic retinopathy
Graves disease eye signs
Visual Field Defects:
Central causes?
Peripheral causes?
What is bitemporal harm & its causes?
What is
Diabetic retinopathy
Diabetic retinopathy - Stage 1 (Background)
Diabetic retinopathy - Stage 2 (Pre-Proliferative)
Diabetic retinopathy - Stage 3 (Proliferative)
Diabetic retinopathy - Management
Trichiasis
Trichiasis is a condition where the eyelashes grow inward toward the eye instead of outward.
Preseptal cellulitis management
Orbital cellulits management
What is a ectopion?
A condition where the lower eyelid rolls outward, away from the eye.
What is a
?What are the muscle that control the eye, what is their nerve supply and what movement do they control
