Ophthalmology Flashcards
What are the features of acute closed-angle glaucoma?
Acute, severe unilateral eye pain, systemic features. A fixed dilated pupil, enlarged conjunctival blood vessels and a hazy cornea. Pain worse in the dark, due to angle closure increasing intra-ocular pressure
What does hypermetropia mean?
Long-sightedness
What are cotton wool spots in the eye?
pre-capillary arteriolar occlusion - part of diabetic retinopathy
What is the management of visual loss secondary to temporal arteritis?
IV methylprednisolone
What is the management of acute angle closure glaucoma?
timolol/pilocarpine eye drops and IV acetazolomide
What is the management of primary open angle glaucoma?
laser trabeculopathy
consider lanatoprost eyedrops
What is the management of anterior uveitis?
steroid and cycloplegic eye drops
What are the features on fundoscopy of anterior ischaemic optic neuropathy?
swollen pales disc with blurred margins
What are the features of diabetic retinopathy on fundoscopy?
cotton wool spots, hard exudates and blot haemorrhages
What are the features of papilloedema on fundoscopy?
elevated optic disc with blurred margins
What is keratitis?
Inflammation of the cornea - can be sight threatening
What are the risk factors for retinal detatchment?
diabetes mellitus, myopia (near-sightedness), age, previous surgery, eye trauma
What are the symptoms of retinal detatchment?
new onset floaters/flashes, sudden onset painless, progressive vision loss
What are the features of keratitis?
red eye, pain, photophobia, foreign body/gritty sensation, hypopyon may be seen. usually in contact lens wearers
What are the common causes of keratitis?
staph aureus
pseudomonas aeruginosa in contact-lens wearers
acanthoamoebic keratitis - much more painful, seen after exposure to soil or water
What is the management of keratitis?
topical quinolones, cycloplegic for pain relief (cyclopentolate)
What are the three main risk factors for macular degeneration?
advancing age, smoking, family history
What is the difference between wet and dry macular degeneration?
Dry: most common. Gradual vision loss over years. accumulation of drusen (lipid and protein deposits)
Wet: abnormal growth of blood vessels under the retina, leaks fluid, sudden severe visual loss
What are the features of macular degeneration?
reduction in visual acuity for near objects, difficulty with night vision, and glare. May have charles bonnet syndrome
What is the first line investigation for macular degeneration?
Slit-lamp microscopy. After can do fluorescein angiography or optical coherence tomography
What is the treatment of age related macular degeneration?
wet: anti-vascular endothelial growth factor, laser (2nd line)
dry: zinc, vit A, C, E
What is a central scotoma?
an area of depressed central vision - often seen in MS optic neuritis
What are the features of optic neuritis?
unilateral decrease in visual acuity over hours/days, poor colour discrimination, pain worse on eye movement, relative afferent pupillary defect, central scotoma
How do you diagnose MS?
MRI of brain and orbits with gadolinium contrast
What are the features of acute angle-closure glaucoma?
severe pain around/in eye, decreased visual acuity, worse in the dark, hard, red eye, semi-dilated non-reacting pupil, hazy cornea. systemic upset
how do you investigate acute angle-close glaucoma?
tonometry - assess for IOP
gonioscopy - look at angle with special slit-lamp
What is the immediate management of acute angle-closure glaucoma?
Refer to emergency eye
parasympathomimetic (pilocarpine, causes contraction of ciliary muscles allowing drainage of aqueous humor), beta-blocker (timolol, decreases aqueous humour production)
alpha-2-agonist (apraclonidine, decreases production)
IV acetazolomide (carbonic anhydrase inhibitor, reduces secretions)
What is the definitive management of acute angle-closure glaucoma?
Laser peripheral iridotomy - allows humour flow
what are the characteristic features of a vitreous haemorrhage?
Usually history of diabetes, painless visual loss or haze, red hue in the vision, dark floaters
What investigations can be done in a vitreous haemorrhage?
Dilated fundoscopy, slit-lamp, US - can be used to rule out retinal detachment, fluorescein angiography (neovascularisation), orbital CT if open globe injury
What is the management of a vitreous haemorrhage?
Urgent referral to ophthalmology, consider vitreoretinal surgery
What is the word for dilated pupils?
myDriasis
What is the difference in presentation between scleritis and episcleritis?
Scleritis is painful, episcleritis is not, it can be a bit sore and gritty
