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GP FELLOWSHIP RNZGP > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Management of Macular degeneration (prior to seeing ophthal)

A
  • Monitoring with Amsler grid at home
  • Smoking cessation
  • 5-10% weight loss
  • Nutritional supplementation: Copper, vitamin c, vitamin E & zinc
  • vigorous exercise daily
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2
Q

Gradual vision loss in the elderly ddx

A
  • Aged related macular degeneration
  • Glaucoma
  • Diabetic retinopathy
  • Hypertensive retinopathy
  • refractive error
  • Cataract

NOTE:
To differentiate refractive error: pinhole helps? then refractive
Abmormal red reflex: Cataract

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3
Q

Most common cause of monocular vision loss (transient)

A

Amaurosis Fugax
(embolic from plaque in carotid artery)

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4
Q

Most common cause of binocular vision loss

A

Migraine

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5
Q

Causes of monocular vision loss
(and symptom clues)

A
  • Central retinal vein or artery occulsion
  • GCA
    temporal tenderness, jaw claudication
  • Tumor compressing optic nerve
    gaze-evoked
  • Acute angle- closure glaucoma
    Pain, redness
  • Papilloedema
    Postural changes
  • Internal carotid artery dissection
    Neck trauma
    horners syndrome
  • Amaurosis Fugax
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6
Q

Binocular vision loss

A

Migraine

Occipital tumour /AV malformation
- Blurred vision after headache onset

Papilloedema
-Valsalva or postural

Vertebrobasillar insufficiency
- Neurology: vertigo, balance, dysphagia

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7
Q

Allergic Conjunctivitis pharmacology

A

Azelastine 0.05% 1 drop BE up to QID

or

Olopatadine (patanol) 0.1% 1 drop BE BD

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8
Q

Syte management

A

Warm compresses QID
Simple analgesia
Gentle cleaning with soap and water

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9
Q

Giant cell arteritis / Temporal arteritis Signs and symptoms

A
  • Jaw claudication (pathognomonic)
  • Visual loss or diplopia
  • Scalp tenderness
  • Malaise
  • PMR (50%)
  • Severe headache
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10
Q

Initial investigations for Temporal Arteritis ?

A

ESR
CRP

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11
Q

Temporal artery physical findings

A

Temporal artery tenderness, enlarged or difficult to compress, nodular

PULSELESS

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12
Q

Temporal arteritis management (if visual loss)
HINT: Think acute and longer term

A

1) Methylprednisolone 0.5-1g IV

Then:

2) Oral prednisolone 50mg daily for 4 weeks then taper

ADD
Aspirin 100mg daily

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13
Q

Temporal arteritis management if no visual loss

A

Prednisone 40-60mg daily for 4 weeks
AND
Aspirin 100mg daily

Then very slow taper (by 10mg every 2 weeks to 20mg, then by 2.5 every 2-4 weeks to 10 then reduce by 1mg every 4-8 weeks

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14
Q

Long term management of temporal arteritis

A
  • Serial ESR/CRP monitoring (monthly for 3 months then 2-3 monthly)
  • Slow wean of prednisone to avoid relapse
  • Monitor for signs of proximal limb weakness (PMR)
  • Monitor for vision change (recurrence)
  • Educate on side effect of prednisone
    (bone density, weight gain)
  • Review for side effects of prednisone
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15
Q

Signs/Symptoms of Cataracts

A
  • Cloudy vision
  • Low light issues
  • Halo around lights
  • Fading colours
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16
Q

Signs/Symptoms of Macular Degeneration

A
  • Decreased central vision
  • Visual distortion
  • Scotoma (blind spot)
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17
Q

Signs/Symptoms of Diabetic retinopathy

A

Usually asymptomatic until severe

  • Floaters (due to micro haemorrhages),
  • Reduced VA
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18
Q

Signs/Symptoms of Vitreous Detachment

A
  • Sudden flashes, floaters
  • VA usually NORMAL
19
Q

Strabismus (namely esotropia - turning in),
What is normal?

A

Intermittent/variable before 3 months

20
Q

Strabismus (namely esotropia or turning in)
When to refer?

A
  • Intermittent but >3MONTHS
    (semi-urgent)
  • Constant any age
    semi-urgent)
  • Acute onset –> Urgent referral
21
Q

Differentials for Posterior Vitreous Detachment

A
  • Retinal tear or detachment
  • Vitreous haemorrhage
  • Diabetic vitreous detachment
  • Migraine
22
Q

Blepharitis management

A
  • Warm compresses 2-5 mins with eyes closed
  • Gentle scrubbing of the lashes with sodium bicarb solution
  • Chloramphenicol 1% ointmentBD 2 weeks (anterior)
  • Doxycycline 100mg for 8 weeks (posterior)
23
Q

What is this?

A

Occular rosacea

24
Q

Orbital fracture: signs of severe eye injury

A
  • Tear shaped pupil
  • Afferent pupillary defect
  • Proptosis
  • Painful extraocular motility
  • Reduced visual acuity
  • Evidence of orbital compartment syndrome
  • Signs of reduced level of consciousness
25
Q

Orbital bone management (no red flags)

A
  • CT orbital bones
  • No nose blowing for 2 weeks
  • Ice to the area 10 mins every 1-2 hours
  • Sleep with head of bed elevated
  • no air travel for 2 weeks
26
Q

Pupil behaviour in Acute Glaucoma

A

Fixed mid dilated pupil

27
Q

Iritis features (one is a medical condition)

A
  • Ciliary flush (Redness in a ring around the iris)
  • Small pupil
  • history of ulcerative colitis
28
Q

Acute Glaucoma features

A
  • Fixed semi-dilated pupil
  • +/- N&V
  • Hazy cornea
  • Haloes around lights
  • Pain
  • Impaired vision
29
Q

Acute Glaucoma exam findings

A

***Indicate which side

  • Fixed mid dilated pupil
  • Poor pupillary reaction to light
  • Reduced VA
  • Conjunctival injection
  • Clouded cornea
  • Rasied IOP
30
Q

Acute anlge- closure glaucoma Immediate emergency management

A
  • TRANSFER
  • Supine
  • NBM
  • Morphine IV/IM
  • Ondansetron (sublingual)
  • Avoid patching eye
31
Q

A) What am I
B) What do you treat this with?

A

Dacryocystitis
Cephalexin 500mg QID

32
Q

Pharacological management to reduce progression of Diabetic retinopathy

A

Fenofibrate 145mg PO daily

33
Q

Trachoma treatment

A

Azithromycin 1g (20mg/kg up to 1g) stat

34
Q

Anterior uveitis same as….

A

Iritis

35
Q

Temporal arteritis (GCA) physical findings

A

Tender temporal artery (side)
Pulseless temporal artery (side)
Reduced VA (side)
Proximal limb weakness

36
Q

Risk factors for open angle glaucoma

A

Fam hx
age >65
Myopia
Vasospastic conditions (migraine or reynauds)
OSA
Diabetes
HTN

37
Q

Risk factors for angle closure glaucoma

A

Asian
Age (middle age or older)
Fam hx
Women
Hypermetropia
Cataracts

38
Q

Classes of drugs used for Glaucoma (4)

A

Prostaglandin analogues: Latanoprost

Beta blockers: Timolol

Alpha-2 agonists: Brimonidine

Carbonic anhydrase inhibitors: Dorzolamide

39
Q

What is this (minimal discomfort)

A

Episcleritis

40
Q

(painful) what am I?

A

Scleritis

41
Q

Eye down and out…. which CN palsy?
(plus ptosis & enlarged pupil)

A

3rd

42
Q

What am I ?

A

Marginal keratitis

43
Q

What am I & what to do? (bluish hue)

A

Dacrocystocoele

Ophthal emergency- refer to ophthal via ED

GP FELLOWSHIP RNZGP (20 decks)

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