Ophthalmology Flashcards
1
Q
Cataracts: risk factors
A
- Ageing / Senility
- Corticosteroid therapy
- Diabetes
- Hypoparathyroidism
- Dystrophia myotonia
- Trauma (may be delayed)
- Ocular disease (e.g. glaucoma)
- Smoking
2
Q
Cataracts features
A
– Reading Difficulty
– Difficulty in recognising faces
– Problem with driving especially at night
– Difficulty with television viewing
– Reduce ability to see in bright light (glaring)
– May see haloes around light
3
Q
Traumatic cataract features
A
- under 45 years of age
- injury to the lens by foreign body or direct impact
4
Q
Cataracts management
A
- Intraocular lens
-phaecoemulsification to replace intraocular lens
5
Q
Hyphaema causes
A
Trauma (squash ball, rugby)
- Blood clotting disturbances
- Medications (anticoagulants)
- Neovascularisation (diabetic retinopathy, previous eye surgery0
- melanoma or retinoblastoma
- abnormal vasculature
6
Q
Hyphaemia features
A
- presence of blood in the anterior chamber
- ## impaired visual acuity
7
Q
Hyphaemia management
A
- Urgent referral to the ophthalmologist
- bed rest with the head elevated 30 to 45° with eye shield
8
Q
Unilateral cataract features
A
– A progressive blurring of vision.
– Glare, especially in bright light or when driving at night
– Monocular double vision
9
Q
Nasolacrimal duct obstruction features
A
- Clear eye discharge & crusting of the eyelashes
- No redness or irritation
- 6 to 20% of newborns
10
Q
Nasolacrimal duct obstruction management
A
- resolves spontaneously
- requires antibiotics only when
complicated conjunctivitis or dacryocystitis - Ophthalmologic consultation if persists past 12 months of age or earlier if complicated by recurrent infection
11
Q
Diabetic retinopathy screening
A
2 yearly by either optometrist or ophthalmologist unless:
- Aboriginal and Torrens Islanders
- Non-English-speaking backgrounds
- Visual loss
- Poor diabetic control
- hypertension
-hyperlipidaemia - anaemia
- renal disease
-long duration of diabetes
12
Q
Diabetic retinopathy predictors
A
- Non-English-speaking backgrounds
- Duration of diabetes
- Control of diabetes
13
Q
Diabetic retinopathy screening in diabetic pregnant women
A
1st trimester
14
Q
Diabetic retinopathy screening in children
A
Puberty
15
Q
Diabetic retinopathy screening in gestational diabetes
A
diabetes persists after pregnancy
16
Q
Diabetic retinopathy screening in Non proliferative diabetic retinopathy
A
Screen every 3–6 months
17
Q
Diabetic retinopathy risk factors
A
-Poor glycemic control.
-Longer duration diabetes.
-Poor lipid or blood pressure control.
-Aboriginal and Torrens Islanders
18
Q
Diabetic retinopathy management
A
Prophylactic photocoagulation
19
Q
Base orbital fracture features
A
- Damage to infraorbital nerve failing to “push” the eyeball up
1. Diplopia when gazing upwards
2. enophthalmos (eye receding into the orbit)
3. Numbness (cheek, upper lip, or upper gingiva) - Blurry vision
20
Q
Superior orbital fracture features
A
- vertical diplopia when gazing downwards
- no numbness
21
Q
Zygomatic fracture features
A
- horizontal diplopia
- Mallar flattening
-difficulty in opening mouth
22
Q
Hyphaemia complications
A
- recurrent bleeding
- glaucoma
- blood staining of the cornea
- all leading to permanent vision loss
23
Q
Nasal bone fracture features
A
- horizontal diplopia
- cerebrospinal fluid leakage
- epistaxis
24
Q
Glaucoma risk factors
A
-The family history of glaucoma.
-Myopia.
-Diabetes Mellitus.
– Migraine.
– History of trauma to the eyes
– Abnormal blood pressure
25
Tripod fracture features
- vertical/horizontal/oblique diplopia
- difficulty in mastication
26
Open angle glaucoma treatment
- STAMP
-Supine Position
- Timolol topical (carteolol)
- Acetazolamide IV
- Mannitol
-Pilocarpine topical
27
Long term treatment of acute closed-angle glaucoma
Laser iridotomy
28
Long term treatment of chronic open-angle glaucoma
Laser trabeculectomy
29
Difference between hypermetropia & presbyopia
Age 40 and is completed at 60
30
Contraindication to timolol
– severe hypotension
– chronic obstructive airways disease
– Moderate to severe asthma
– uncontrolled cardiac failure
– bradycardia or second or third-degree atrioventricular block
31
Eye corticosteroid side- effects
– **Microbial keratitis**
– Corneal thinning
– Delayed corneal healing
– Corneal perforation
– Cataract formation
– Raised intraocular pressure
– Glaucomatous optic neuropathy
32
Acute closed angle glaucoma features
- rapidly increased IOP
- pain
- nausea
- blurred vision
- eye redness
- hazy cornea
-pupils partially or fully dilated and unresponsive to light (anisocoria)
- NO photophobia
33
Indications for referral of Ophthalmologist
– Penetrating eye injury or intraocular foreign body
– Incomplete removal or practitioner uncertainty
– Persisting foreign body symptoms
– Persisting rust ring
– Persisting vision loss
– Keratitis
– Endophthalmitis
– Paediatric or uncooperative patients that may require examination under anaesthesia
34
Features of retinal detachment
- Hx of trauma, diabetic retinopathy, myopia and cataract surgery
- sudden onset of floaters, flashes and field defects
- painless loss of vision
- dark shadow (curtain closing) of affected eye
35
Features of Posterior Vitreous detachment
- Age >70 years (66%)
-**Vision acuity preserved**
36
Unilateral exophthalmos features
- most common **Graves’s disease (Thyrotoxicosis)**
- orbital pseudotumor
- orbital cellulitis
- cavernous sinus
- thrombosis
- retrobulbar
- retro-orbital tumours
- Congenital glaucoma
Nasopharyngeal tumours
37
Retinal artery occlusion fundoscopic features
- Cherry red spot
- Retinal whitening
38
Chronic simple glaucoma fundoscopic features
- increased ratio of the optic cup to the
optic disc
- retinal vessels seem to be cut/ broken upon entering optic disk
39
external hordeolum (stye) pathogen
Staphylococcus aureus
40
external hordeolum (stye)
Warm compresses
41
Strabismus cut-off point
- 5 to 6 months to align by itself
- Correcting strabismus before 4-6 years
42
dacryocystitis management
- flucloxacillin
- amoxicillin
- clavulanate
- cephalexin
43
Macular degeneration features
- blurry centre of her vision
- distortion of objects (straight lines wavy)
44
Types of age related macular degeneration
Dry
- **slow progression**
- 90% of AMD cases
- drusen, pigmentation and
sometimes haemorrhages at macula
Wet
- **rapid deterioration**
- abnormal vessels grow from the choroid into the neurosensory retina &leak macula
- rapid deterioration
45
Hypertensive retinopathy features
- papilloedema
- straightening of the vessels
- thickened opacified vessel walls
- arteriovenous nicking
46
Bacterial conjuctivitis treatment
Chloramphenicol
47
inflammation of meibomian glands
Internal hordeolum
48
Features of viral conjunctivitis
- adenovirus
- **watery** eyes
- uni or bilateral affection
- contact lenses
- usually painless
- vision preserved
49
Features of allergic conjunctivitis
- can be watery
- bilateral
-history of contact hypersensitivity (changing contact lenses), hay fever
- usually painless
- vision preserved
50
Features of keratitis
- herpes simplex/zoster infection
- **circumcorneal dendritic ulceration**
- eye pain and redness
- grittiness (foreign body)
-photophobia
- lacrimation
- vision and pupillary reflex **normal**
51
Features of acute uveitis (iritis)
- eye pain and redness
- **visual acuity may be decreased**
- photophobia
- hypopyon (white cells precipitating in anterior chamber)
-irregular constricted pupil (reflex abnormal)
-history of prior surgery (phacoemulsification)
- also associated with seronegative arthropathies (ankylosing spondylitis, RA, IBD)
52
53
Traumatic cataract features
- under **45 years** of age
- injury to the lens by foreign body or direct impact
54
Conditions that require urgent referral to Ophthalmologist
- Significant eye trauma, burns, embedded foreign body in cornea, intraocular foreign body
- Hyphaemia (>3mm)/hypopyon
- Corneal ulcer
- Severe conjunctivitis
- Uveitis/ acute iritis
- Behcet syndrome
- acute glaucoma
- giant cell arteritis
- acute dacryocystitis
- endophthalmitis
- herpes zoster ophthalmicus
55
features of retinal artery occlusion
unilateral + sudden onset of significant vision loss
- preceded by transient monocular blindness
56
Types of retina artery occlusion
attach pics
57
Hypopyon
sign not diagnosis
indicates uveitis
58
Management of subconjunctival haemorrhage
- red discolouration NOT crossing the limbus = warm compress
- red discoloration CROSSING the limbus = find underlying cause (Orbit CT)
- AVOID NSAID's
59
Management of episcleritis
- Hypromellose (artificial tears) 4-6 times/day
- Topical NSAID's diclofenac
NOTE: Topical steroids (prednisolone) if all above not helping
60
Difference between subconjunctival haemorrhage & episcleritis
Subconjunctival haemorrhage:
- micro tears in the sclera that cause haemorrhages, eyes appears dark red due to the accumulation of blood, but could also turn blue/purple/yellow after
- no discomfort with the exception of trauma
Episcleritis:
- Patchy pinkish/redness of the eye usually found in the corner
- no discharge, itchiness
- mild discomfort
-
61
Difference between episcleritis & scleritis
- If a patient's eye redness improves after phenylephrine instillation = episcleritis
- scleritis is painful
