Ophthalmology Flashcards
Amaurosis fugax
Sudden, painless loss of vision
Can be large artery disease, small artery occlusive disease (e.g. temporal arteritis), venous disease or hypoperfusion
May represent a form of TIA
Often described as curtain coming down over vision
Central retinal vein occlusion
Sudden painless loss of vision
Caused by glaucoma, polycythaemia, hypertension
Optic disc swelling, multiple flame and blot haemorrhages
Central retinal artery occlusion
Sudden painless loss of vision
Due to thromboembolism or arteritis
Afferent pupillary defect, cherry red spot on pale retina
Vitreous haemorrhage
Causes - diabetes, bleeding disorders, anticoagulants
Sudden painless loss of vision or have dark spots/floaters if smaller bleeds
Retinal detachment
Sudden painless loss of vision
May have flashes or floaters preceding
Dense shadow starting peripherally and progresses towards centre of vision
Veil/curtain over vision
Straight lines appear curved
Posterior vitreous detachment
Flashes of light in peripheral vision
Floaters - often temporal side of central vision
Acute angle-closure glaucoma presentation
Unilateral eye pain and visual loss
Headache
Red eye
Fixed and dilated pupil with hazy cornea
Anterior uveitis presentation
Painful red eye with photophobia
Variable vision loss
Constricted pupil
More common with HLA-B27 or autoimmune conditions
Keratitis presentation
Infection of the cornea
Painful red eye
Photophobia
Watery eye
Eyelid oedema
Risk factors - contact lenses, trauma
(Emergency)
Scleritis
Associated with women and systemic autoimmune disease
Painful red eye
Blurred vision
Photophobia
Watery eye
Risk factors for acute angle closure glaucoma
Hypermetropia (long-sightedness)
Pupillary dilatation
Lens growth associated with age
Acute angle closure glaucoma management
Emergency - refer to ophthal
Direct parasympathomimetic eye drops e.g. pilocarpine
Beta blocker eye drops e.g. timolol
Alpha 2 agonist eye drops e.g. apraclonidine
IV acetazolamide
Definitive management - laser peripheral iridotomy
Retinitis pigmentosa
Inherited
Night blindness and tunnel vision
Vitelliform macular dystrophy
Accumulation of yellow deposits on macula
Distortion or loss of central vision
Diabetic retinopathy fundoscopy findings
Microaneurysms
Dot and blot haemorrhages
Hard exudates
Cotton wool spots
Pituitary tumour visual defect
Bitemporal hemianopia, upper quadrant defect more than lower
Homonymous quadrantanopias cause
PITS - parietal-inferior, temporal-superior
Lesion in parietal lobe causes inferior homonymous quadrantanopia
Lesion in the temporal lobe causes superior homonymous quadrantanopia
Dry macular degeneration
90% of ARMD
Drusen - yellow spots on macula
Wet macular degeneration
10% of ARMD
Choroidal neovascularisation
Leakage of serous fluid and blood - can cause rapid loos of vision
Worse prognosis
ARMD presentation
Reduction of visual acuity - especially near field objects
Difficulty seeing in the dark
Fluctuating visual disturbance
Photopsia (perception of flickering or flashing lights) and glare around objects
Charles-Bonnet syndrome - visual hallucinations
Distortion of line perception
Management of ARMD
Dry:
- Zinc with vitamin A C and E to reduce progression
Wet:
- Anti-VGEF injections
- Laser photocoagulation
- Photodynamic therapy
