Ophthalmology Flashcards
What conditions are associated with Episcleritis?
Inflammatory Bowel Disease
Rheumatoid Arthritis
What are the features of episcleritis?
Red eye that is classically not painful (may be mild irritation/pain) with watering and mild photophobia. The injected vessels move when gentle pressure is applied.
What is the treatment for episcelritis?
Conservative
Artificial tears are sometimes used.
What can be used to differentiate between scleritis and episcleritis?
Phenylephrine, blanches the conjunctival and episcleral vessels but not the scleral vessels.
What is scleritis?
Full thickness inflammation of the sclera which generally has a non-infective cause and causes a painful red eye.
Rheumatoid arthritis and SLE are two risk factors for the development of scleritis, name two more.
Sarcoidosis
Granulomatosis with polyangitis
Red and painful eye are two of the main features of scleritis, name 3 more.
Photophobia
Watering
Gradual decrease in vision.
What is the management of scleritis?
Same-day ophthalmology review.
Oral NSAIDs
Oral glucocorticosteroids may be used for more severe presentations.
Immunosuppressive drugs for resistant cases - which can also be used to treat the underlying condition.
What are the features of central retinal artery occlusion?
Sudden painless, unilateral vison loss.
Relative afferent pupillary defect
What are the risk factors for CRAO?
Cardiovascular risk factors (smoking, hypertension, hypercholesterolaemia, diabetes).
Risk factors for GCA: white, older age, female and polymalgia rheumatica.
What is seen on fundoscopy in CRAO?
Cherry red spot on a pale retina.
Cherry red spot = fovea
What is the management of CRAO?
Treat any underlying conditions (e.g. GCA)
Attempt to dilate artery: inhaled carbogen, sublingual isosorbide dinitrate, oral pentoxifylline.
Decreased IOP: Acetazolamide IV, IV mannitol, topical timolol.
Acute presentation = intraarterial thrombolysis may be attempted.
Family history is a risk factor for Acute angle-closure glaucoma, name 5 more.
Hypermetropia
Lens growth (age realated)
Female
Shallow anterior chamber
Pupil dilatation
Severe pain (ocular or headache), decreased visual acuity and red eye are 3 features of acute angle-closure glaucoma, name 5 more.
Pain worse with mydriasis
Fixed semi-dilated pupil
Haloes around lights
Corneal oedema = hazy cornea
Systemic upset = nausea, vomiting, abdominal pain.
What investigations are carried out for AACG?
Tonometry = raised IOP
Gonioscopy = angle between the cornea and the iris.
Which medications can precipitate AACG?
Adrenergic medications - noradrenaline
Anticholingergic medications - oxybutynin and solifenacin
TCAs - amitriptyline
What medications are involved in treatment of AACG?
Pilocarpine
Acetazolamide (IV/oral)
Timolol
Dorzolamide
Brimonidine
What is the definitive treatment for AACG?
Laser iridotomy - hole in the iris which allows the aqueous fluid to drain.
What is the most common complication following panretinal laser photocoagulation?
Decrease in night vision.
Recent eyelid infection is a risk factor for the development of orbital cellulitis, name 4 more.
Ear or facial infection
Previous sinus infection
Childhood
Lack of Hib vaccine
Redness and swelling around the eye, severe ocular pain and visual disturbance are 3 features of orbitial cellulitis, name 4 more.
Proptosis
Ophthalmoplegia
Eyelid oedema and ptosis
Dowsiness, nausa and vomiting in meningeal involvement (rare)
What features of orbital cellulitis are not seen in periorbital cellulitis?
Reduced visual acuity
Proptosis
Ophthalmoplegia
Haemophilus influenzae B is a common bacterial cause of orbital cellulitis, name 2 more.
Streptococcus
Staphylococcus aureus
What is the management of orbital cellulitis?
Admission
IV antibiotics
