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PLAB 1 August 2024 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

DDx between:
- Bacterial conjuntivictis
- Viral conjuntivictis
- Alergic conjuntivictis

A

Bacterial conjuntivictis
- Purulent sticky discharge (eyes stuck together upon waking up);
- Delayed Rx strategy (topical antibiotics if symptoms not resolved within 3 weeks);

Viral conjuntivictis
- Serous discharge;
- Preauricular lymphadenopathy;
- H/o of recent URTI (adenovirus);
- Rx is symptomatic (cold presses & artificial tears);

Alergic conjuntivictis
- Bilateral red eye;
- Itching;
- H/o of atopy
- Rx is antihistamines, avoidance of allergen, topical mast cell stabilizers.

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2
Q

Describe what is ophthalmia neonatorum and its cause.

A
  • Conjuctivitis in a newborn within 28 days of birth.

➔ Most common cause:
- Chlamydia trachomatis
- N. gonorrhoeae

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3
Q

What are the symptoms of ophthalmia neonatorum?

A
  • Purulent or mucopurolent discharge;
  • Injected conjunctiva;
  • Lid swelling.
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4
Q

What is the management of ophthalmia neonatorum?

A

➜ Refer to secondary care (same day)

➜ Treatment
◆ Chlamydial infection:
- Oral erythromycin for 14 days
Or
- Oral azytrhromycin for 3 days

◆ Gonorrhoeal infection:
- IV or IM ceftriaxone (single dose)

◆ Viral infection:
- IV acyclovir for 14 days

➜ Prevention
- Screening of mother for STI

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5
Q

What are the symptoms of nasolacrimal duct obstruction?

A
  • Purulent discharge;
  • Child is otherwise well.
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6
Q

What is the management of nasolacrimal duct obstruction?

A
  • Reassurance;
  • Massage of lacrimal duct;
  • Clean with sterile cotton;
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7
Q

Describe what is anterior uveitis (iritis).

A

Inflammation of the iris.

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8
Q

What are the symptoms of anterior uveitis?

A
  • Unilateral (usually);
  • Pain;
  • Redness;
  • Photophobia;
  • Blurring of vision;
  • Iris spasm causing abnormal shape of pupil;
  • Presence of cells on anterior chamber.
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9
Q

What are the associated conditions of anterior uveitis?

A
  • Crohn’s disease / Inflammatory bowel disease;
  • Ankylosing spondylitis
  • Reactive arthritis
  • Saircoidosis
  • Behcet’s disease
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10
Q

What is the Rx of anterior uveitis?

A
  • Corticosteroids;
  • Cyclopentolate (pain and to prevent adhesions)
  • Ciclosporin (if recurrent and affects visual acuity)
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11
Q

Describe the physiology of acute angle closure glaucoma.

A

Impairment of aqueous outflow ⟶ ↑ IOP.

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12
Q

What are the risk factors for acute angle closure glaucoma?

A
  • Hypermetropia / long-sightedness
  • Pupillary dilation
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13
Q

What are the features of acute angle closure glaucoma?

A
  • Acute painful red eye;
  • Semi-dilated non-reactive pupil;
  • H/o coloured halos;
  • H/o of watching TV in dark room (pupillary dilation ➝ ↓ decreases outflow)
  • Globe is hard on palpation
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14
Q

What is the Rx of acute angle closure glaucoma?

A

Acute Rx:
- Pilocarpine drops;
- Acetazolamide IV;
- Prednisolone drops;
- Timolol drops (B-blocker).

Long term Rx:
- Peripheral iridotomy;
- Surgical iridotomy;

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15
Q

What are the complications of acute angle closure glaucoma?

A

If not treated immediately:
- Damage of the optic nerve (due to ⬆︎ IOP);
- Permanent vision loss.

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16
Q

Describe the physiology of PRIMARY open-angle glaucoma.

A

Progressive optic nerve damage due to ⬆︎ IOP.

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17
Q

What are the symptoms of PRIMARY open-angle glaucoma?

A
  • Gradual visual field loss
  • Bilateral
  • Painless
  • Disc cupping: optic neuropathy
  • Open iridocorneal angle
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18
Q

What are the risk factors for PRIMARY open-angle glaucoma?

A
  • Myopia
  • Ocular hypertension
  • > 65 years
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19
Q

What is the Rx of PRIMARY open-angle glaucoma?

A

Medical
- Prostaglandin analogues
- B-blockers topical
- Acetazolamide

Laser & surgical
- Trabeculoplasty
- Laser cycloablation
- Artificial shunts

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20
Q

DDx between:
- Acute angle closure glaucoma
- Anterior uveitis

A

Acute angle closure glaucoma
- Oval pupil
- Nausea
- Vomiting
- Abdominal pain

Anterior uveitis
- Irregular shape pupil
- Ankylosing spondylitis
- Inflammatory bowel disease
- Reactive arthritis

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21
Q

What are the symptoms of acute dacryocystitis?

A
  • Excess tears;
  • Pain;
  • Redness;
  • Swelling of the lacrimal sac.
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22
Q

What are the symptoms of thyroid eye disease?

A
  • Diploplia;
  • Lid lag;
  • Restricted eye movements;
  • Tachychardia.

➔ Investigation: thyroid function test.

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23
Q

Describe what is cytomegalovirus retinitis.

A

Visual deterioration on an HIV patient.

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24
Q

What is the management of chalazion (meibomiam cysts)?

A

➔ Non-infectious obstruction of the meibomiam gland

  • Warm compresses
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25
What are the **symptoms** `retinitis pigmentosa`?
➔ **Inherited disorder of photoreceptors** - Night blindeness - Tunnel vision
26
What is the **management** of `retinitis pigmentosa`?
`Routine` referral to opthalmology. | No need for urgent referral.
27
What are the `symptoms` and `management` of **subconjuctival haemorrhage**?
**Symptoms** - Bloodshot eye - Painless - Doesn't affect the vision **Management** - Reassurance
28
What are the `symptoms` of **herpes zoster ophthalmicus**?
`➜ Reactivation of varicella zoster virus in the area innervated by the ophtalmic division of the trigemial nerve.` - Preherpetic neuralgia; - Rash on the forehead and eyelid swelling; - Eye pain and photphobia - **Hutchinson's sign:** tip of the nose involvement.
29
What is the `Rx` of **herpes zoster ophthalmicus**?
- Oral aciclovir - Oral corticosteroids
30
What are the **cause organisms** of `orbital cellulitis`?
- S. aureus; - Streptococcus pneumoniae; - Streptococcus pyogenes.
31
What are the **symptoms** of `orbital cellulitis`?
- Proptosis; - Pain on eye movement; - Blurred vision; - Diploplia; - Swelling of conjuctiva and lids.
32
What are the **investigations** done in `orbital cellulitis`?
**Initial:** - CT scan of orbit and brain (rule ot intracranial abscess)
33
What is the **Rx** of `orbital cellulitis`?
➜ **Emergency referral to higher center** - IV Co-amoxiclav.
34
**DDx between:** - Orbital cellulitis; - Periorbital cellulitis.
**Orbital cellulitis** - Inflammation of conjuctiva + eyelid **Periorbital cellulitis** - Inflammation of eyelid
35
What are the **risk factors** for `retinal detachment`?
- Advancing age; - Extreme myopia; - Cataract surgery; - Trauma.
36
What are the **symptoms** of `retinal detachment`?
- Flashes (lights) - Floaters - Field loss - Fall in acuity
37
What is the **investigation** done in `retinal detachment`?
**Ophthalmoscopy** - Grey / opaque retina - Retina that balloons forward.
38
What is the **Rx** for `retinal detachment`?
- Vitrectomy - Scleral buckling - Pneumatic retinoxepy - Retinal tears and holes by cryoteraphy
39
What are the **features** of `cataracts`?
- Old age - Gradually ⬇︎ vision - Glare especially at night - Use of steroids (COPD/asthma) - ⬆︎ exposure to UV - DM - Smoking ► **Congenital cataracts:** caused by `Rubella`.
40
What is the **Rx** of `cataracts`?
Lens extraction and intraocular lens implantation.
41
Describe what is **optic neuritis**.
`Inflammation of the optic nerve.` ➜ **Associated with:** - Multiple sclerosis - Neuromyelites optica
42
What are the `symptoms` in **optic neuritis**?
**Triad** - Pain on eye movement; - Unilateral ⬇︎ vision; - Impaired colour vision (initially red); **Multiple sclerosis** - Woman - Fatigue - Paresthesia - Weakness - `Relative afferent pupillary defect` ## Footnote **Relative afferent pupillary defect:** dilated pupils when light is swung from the normal eye to the affected eye.
43
What is the `Rx` of **optic neuritis**?
Methylprednisolone.
44
Describe what is **retrobulbar neuritis**.
Inflammation of the optic nerve `behind the globe of the eye`.
45
What are the `symptoms` in **retrobulbar neuritis**?
- Unilateral, sudden vision loss; - Eye pain; - ⬇︎ colour vision; - Relative afferent pupillary defect ► **Fundoscopy:** optic disk may appear normal initially *(inflammation behind the eye)*.
46
Describe the **fundoscopy features** of `cytomegalovirus retinitis`.
- Retinal haemorrhages; - Yellow-white areas (pizza)
47
What is the **Rx** of `cytomegalovirus retinitis`?
`Ganciclovir` - Intravitreal and IV.
48
What are the `symptoms` of **central retinal `artery` occlusion**?
- **Acute painless loss of vision**; - H/o of amaurosis fugax in the past; - Relative afferent pupillary defect.
49
What are the `investigations` done in **central retinal `artery` occlusion**?
**Ophthalmoscopy** - Pale retina - Cherry red spot
50
What are the `Rx` of **central retinal `artery` occlusion**?
◆`If within 90 minutes of onset` - Firm occular massage to dislodge the clot ◆ Topical timolol / IV acetazolamide
51
What are the `symptoms` of **central retinal `vein` occlusion**?
- **Unilateral painless loss of vision**; - Blurred vision
52
What are the `investigations` done in **central retinal `vein` occlusion**?
**Ophthalmoscopy** - Dot-blot and `flame haemorrhage` (stormy sunset) - Macular oedema
53
What are the `Rx` of **central retinal `vein` occlusion**?
- Panretinal photocoagulation - Intravitreal anti-VEGF
54
What are the **causes** of `sudden painless vision loss`?
- Retinal detachment - Vitreous haemorrhage - Central retinal artery occlusion - Central retinal vein occlusion - Occipital cortex stroke
55
**DDx between:** - Central retina artery occlusion - Branch retinal artery occlusion - Central retina vein occlusion - Branch retina vein occlusion
**Central retina artery occlusion** - Acute unilateral painless loss of vision - Pale retina except the macula which is bright red **Branch retinal artery occlusion** - Acute unilateral painless loss of vision - Paleness of the retinal quadrant **Central retina vein occlusion** - Unilateral sudden painless loss of vision - Flame shaped haemorrhage **Branch retina vein occlusion** - Unilateral sudden painless loss of vision - Flame shaped haemorrhage in the retinal quadrant
56
Describe the **features** of `hypertensive retinopathy`.
- Uncontrolled hypertension **Fundoscopy:** - `A / V nicking (where artery crosses a vein)` - `Copper or silver wiring (attenuation of artery)` - Cotton wool spots - Optic disk oedema - Ischaemic changes
57
**DDx between:** - Diabetic retinopathy - Hypertensive retinopathy
**Diabetic retinopathy** - `Neovascularization` (formation of new vessels) - Cotton wool spots (⬆︎⬆︎) - Haemorrhages **Hypertensive retinopathy** - `A / V nicking (where artery crosses a vein)` - `Copper or silver wiring (attenuation of artery)` - Cotton wool spots - Optic disk oedema - Haemorrhage
58
Describe the **lesions** in `optic pathway`: - One eye vision loss?
Injury to optic nerve.
59
Describe the **lesions** in `optic pathway`: - Bitemporal heteronymous hemianopsia (tunnel vision) | `High yield`
Optic chiasm. | Ex: pituitary tumour
60
Describe the **lesions** in `optic pathway`: - Homonymous hemianopsia?
- Optic tract - Optic radiation - Occipital lobe
61
What are the `symptoms` of **age-related macular degeneration**.
- Elderly patient - Central vision loss - Difficulty in recognising faces - Micropsia (objects appear smaller than they are) - Metamorphosia (straight lines appear wavy)
62
Name the **conditions** that `cause`: - Central vision loss - Periheral vision loss
**Central vision loss first** - Age related macular degeneration **Periheral vision loss first** - Retinitis pigmentosa - Open angle glaucoma
63
Describe the use of **fluorescein dye** in the eye
- Herpes simples keratitis (dentric ulcers are seen) - Corneal abrasions - Corneal ulcers
64
# Ophthalmology Describe the **Charles bonnet syndrome**.
- An elderly patient that **has lost partial or total vision**; - Without features of dementia or mental health issues; - `Visual hallucinations` that can be simple (lines) or complex (people).
65
What are the `investigations` done in **Charles bonnet syndrome**?
**1st line**: Visual acuity test **Others:** - Slit lamp - Optical tomography
66
What are the **ocular manifestations **of `rheumatoid arthritis`?
- `Keratoconjuctuvitis sicca` - Episcleritis - Scleritis - Iatrogenic steroid induced cataracts

PLAB 1 August 2024 (32 decks)

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