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Ophthalmology Flashcards

1
Q

What are the 2 types of glaucoma ?

A

Open-angle glaucoma
Acute angle-closure glaucoma

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2
Q

What causes glaucoma ?

A

optic nerve damage caused by a rise in intraocular pressure caused by a blockage in aqueous humour

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3
Q

What is the pathophysiology of open-angle glaucoma?

A

gradual increase in resistance to flow through the trabecular meshwork

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4
Q

What is the pathophysiology of acute angle-closure glaucoma?

A

iris bulges forward and seals off the trabecular meshwork from the anterior chamber, preventing aqueous humour from draining.

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5
Q

Raised intraocular pressure causes what to happen to the optic disc?

A

cupping of the optic disc

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6
Q

State 3 risk factors for open-angle glaucoma

A

Increasing age
Family history
Black ethnic origin
Myopia (nearsightedness)

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7
Q

What is the presentation of open-angle glaucoma?

A

gradual onset of peripheral vision loss (tunnel vision). It can also cause:

Fluctuating pain
Headaches
Blurred vision
Halos around lights, particularly at night

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8
Q

How can intraocular pressure be measured?

A

Non-contact tonometry
Goldmann applanation tonometry is the gold-standard

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9
Q

How is a diagnosis of open-angle glaucoma made?

A

Goldmann applanation tonometry for the intraocular pressure
Slit lamp assessment for the cup-disk ratio and optic nerve health
Visual field assessment for peripheral vision loss
Gonioscopy to assess the angle between the iris and cornea
Central corneal thickness assessment

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10
Q

What are the management options of open-angle glaucoma?

A

360° selective laser trabeculoplasty
Prostaglandin analogue eye drops (e.g., latanoprost) are the first-line
Trabeculectomy surgery may be required where other treatments are ineffective.

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11
Q

State 3 risk factors for acute angle-closure glaucoma

A

Increasing age
Family history
Female (four times more likely than males)
Chinese and East Asian ethnic origin
Shallow anterior chamber

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12
Q

What medications may precipitate acute angle-closure glaucoma?

A

Adrenergic medications (e.g., noradrenaline)
Anticholinergic medications (e.g., oxybutynin and solifenacin)
Tricyclic antidepressants (e.g., amitriptyline), which have anticholinergic effects

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13
Q

What are the symptoms of acute angle-closure glaucoma?

A

Appear generally unwell
Severely painful red eye
Blurred vision
Halos around lights
Associated headache, nausea and vomiting

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14
Q

What are some signs on examination of acute angle-closure glaucoma?

A

Red eye
Hazy cornea
Decreased visual acuity
Mid-dilated pupil
Fixed-size pupil
Hard eyeball on gentle palpation

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15
Q

What measure can be taken whilst waiting for an ambulance with a patient with acute angle-closure glaucoma?

A

Lying the patient on their back without a pillow
Pilocarpine eye drops (2% for blue and 4% for brown eyes)
Acetazolamide 500 mg orally
Analgesia and an antiemetic, if required

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16
Q

What is the secondary care management of acute angle-closure glaucoma?

A

Medical:
Pilocarpine eye drops
Acetazolamide
Hyperosmotic agents
Timolol
Dorzolamide
Brimonidine

Definitive = Laser iridotomy

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17
Q

What is the most common cause of blindness in the UK?

A

Age-related macular degeneration

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18
Q

what are the 2 types of age-related macular degeneration?

A

Wet (also called neovascular), accounting for 10% of cases
Dry (also called non-neovascular), accounting for 90% of cases

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19
Q

What are the 4 layers of the macula?

A

Choroid layer (at the base), which contains the blood vessels that supply the macula
Bruch’s membrane
Retinal pigment epithelium
Photoreceptors (towards the surface)

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20
Q

What are an important finding in age-related macular degeneration?

A

Drusen

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21
Q

What is the pathophysiology of wet age related macular degeneration?

A

new vessels develop from the choroid layer and grow into the retina. These vessels can leak fluid or blood, causing oedema and faster vision loss. Stimulated by vascular endothelial growth factor

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22
Q

State 3 risk factors for age-related macular degeneration

A

Older age
Smoking
Family history
Cardiovascular disease (e.g., hypertension)
Obesity
Poor diet (low in vitamins and high in fat)

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23
Q

What visual changes are associated with age-related macular degeneration?

A

Gradual loss of central vision
Reduced visual acuity
Crooked or wavy appearance to straight lines (metamorphopsia)

Patients often present with a gradually worsening ability to read small text.

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24
Q

Which type of age-related macular degeneration presents most acutely?

A

wet

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25
Q

What are some key examination findings of age-related macular degeneration ?

A

Reduced visual acuity using a Snellen chart
Scotoma (an enlarged central area of vision loss)
Amsler grid test can be used to assess for the distortion of straight lines seen in AMD
Drusen may be seen during fundoscopy

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26
Q

How is dry age-related macular degeneration managed?

A

no treatment, reduce progression
Avoiding smoking
Controlling blood pressure
Vitamin supplementation has some evidence in slowing progression

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27
Q

What medications are used in wet age-related macular degeneration?

A

Anti-VEGF medications

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28
Q

What are the features of the 3 grades of diabetic retinopathy?

A

Background – microaneurysms, retinal haemorrhages, hard exudates and cotton wool spots
Pre-proliferative – venous beading, multiple blot haemorrhages and intraretinal microvascular abnormality (IMRA)
Proliferative – neovascularisation and vitreous haemorrhage

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29
Q

What are some complications of diabetic retinopathy?

A

Vision loss
Retinal detachment
Vitreous haemorrhage
Rubeosis iridis (new blood vessel formation in the iris) – this can lead to neovascular glaucoma
Optic neuropathy
Cataracts

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30
Q

How is non-proliferative diabetic retinopathy managed?

A

close monitoring and careful diabetic control.

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31
Q

What are the features of hypertensive retinopathy?

A

silver/copper wiring
AV nipping
Cotton wool spots
Hard exudates
retinal haemorrhages
Papilloedema

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31
Q

How is proliferative diabetic retinopathy manged?

A

Pan-retinal photocoagulation (PRP) – extensive laser treatment across the retina to suppress new vessels
Anti-VEGF medications by intravitreal injection
Surgery (e.g., vitrectomy) may be required in severe disease

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32
Q

What is the Keith-Wagener Classification of Hypertensive retinopathy?

A

Stage 1: Mild narrowing of the arterioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema

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33
Q

What is the management of hypertensive retinopathy?

A

controlling blood pressure and managing risk factors (e.g., smoking and blood lipids)

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34
Q

What is the test for congenital cataracts at birth?

A

red reflex

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35
Q

State 3 risk factors for cataracts

A

Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia

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36
Q

What are the presenting symptoms of cataracts ?

A

usually asymmetrical
Slow reduction in visual acuity
Progressive blurring of the vision
Colours becoming more faded, brown or yellow
Starbursts can appear around lights, particularly at night
loss of red reflex

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37
Q

What are the management options for cataracts

A

conservative
Cataract surgery (artificial lens)

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38
Q

What are 3 causes of an abnormal pupil shape

A

Trauma to the sphincter muscles
Anterior uveitis
Acute angle-closure glaucoma
Rubeosis iridis .
Coloboma (congenital malformation)
Tadpole pupil

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38
Q

What is a rare but serious complication of cataract surgery?

A

Endophthalmitis = inflammation of the inner contents of the eye

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39
Q

State 3 causes of Mydriasis (dilated pupil)

A

Congenital
Stimulants (e.g., cocaine)
Anticholinergics (e.g., oxybutynin)
Trauma
Third nerve palsy
Holmes-Adie syndrome
Raised intracranial pressure
Acute angle-closure glaucoma

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40
Q

State 3 causes of Miosis (constricted pupil)

A

Horner syndrome
Cluster headaches
Argyll-Robertson pupil (neurosyphilis)
Opiates
Nicotine
Pilocarpine

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41
Q

What are the signs of a third nerve palsy?

A

Ptosis (drooping upper eyelid)
Dilated non-reactive pupil
Divergent strabismus (squint) in the affected eye, with a “down and out” position of the affected eye

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42
Q

What does a 3rd nerve palsy that does not affect the pupil sugest?

A

microvascular cause: diabetes, hypertension, ischaemia

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43
Q

What are some causes of a full third nerve palsy ?

A

Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised intracranial pressure

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44
Q

What is the triad of Horner syndrome?

A

Ptosis
Miosis
Anhidrosis (loss of sweating)

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45
Q

Damage to what causes Horner’s syndrome?

A

sympathetic nerves

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46
Q

How can you tell apart central and pre-ganglionic lesions of Horner’s syndrome ?

A

central = anhidrosis
pre-ganglionic = no anhidrosis

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47
Q

What are some central causes of Horner’s syndrome?

A

S – Stroke
S – Multiple Sclerosis
S – Swelling (tumours)
S – Syringomyelia (cyst in the spinal cord)

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48
Q

What are some pre-ganglionic causes of Horner’s syndrome?

A

T – Tumour (Pancoast tumour)
T – Trauma
T – Thyroidectomy
T – Top rib (a cervical rib growing above the first rib and clavicle)

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49
Q

What are some post-ganglionic causes of Horner’s syndrome?

A

C – Carotid aneurysm
C – Carotid artery dissection
C – Cavernous sinus thrombosis
C – Cluster headache

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50
Q

What eye drops can be used to test for Horner’s syndrome?

A

Cocaine eye drops

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51
Q

What causes a Holmes-Adie Pupil?

A

damage to the post-ganglionic parasympathetic fibres

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52
Q

What are the features of a Holmes-Adie pupil?

A

Dilated
Sluggish to react to light
Responsive to accommodation (the pupils constrict well when focusing on a near object)
Slow to dilate following constriction (“tonic” pupil)

syndrome -> absent ankle and knee reflexes

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53
Q

What is an Argyll-Robertson pupil a specific sign of?

A

neurosyphilis.

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54
Q

What are the features of an Argyll-Robertson pupil?

A

constricted pupil that accommodates when focusing on a near object but does not react to light

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55
Q

What is Blepharitis?

A

inflammation of the eyelid margins

56
Q

What are the symptoms of blepharitis?

A

gritty, itchy, dry sensation in the eyes

57
Q

What can blepharitis be associated with?

A

dysfunction of the Meibomian glands

58
Q

What is the management of Blepharitis?

A

warm compresses and gentle cleaning of the eyelid margins to remove debris (e.g., using a cotton bud and baby shampoo)

59
Q

What is a hordeolum externum an infection of?

A

glands of Zeis or glands of Moll.

60
Q

What are the features of a stye?

A

tender red lump along the eyelid that may contain pus

61
Q

What is a Hordeolum Internum an infection of?

A

Meibomian glands

62
Q

What is the management of a stye?

A

hot compresses and analgesia. Topical antibiotics (e.g., chloramphenicol) may be considered if it is associated with conjunctivitis or if symptoms are persistent.

63
Q

What causes a chalazion?

A

Meibomian gland becomes blocked (also called a Meibomian cyst)

64
Q

How does a chalazion present?

A

a swelling in the eyelid that is typically not tender (however, it can be tender and red)

65
Q

What is the management of a chalazion?

A

warm compresses and gentle massage towards the eyelashes (to encourage drainage). Rarely, surgical drainage may be required

66
Q

What is an Entropion?

A

when the eyelid turns inwards with the lashes pressed against the eye

67
Q

What are the complications of an entropion?

A

causes pain and can result in corneal damage and ulceration

68
Q

what is the management of an entropion?

A

taping the eyelid down + lubrication
taping the eyelid down
definitive = surgery

69
Q

What is an ectropion?

A

when the eyelid turns outwards, exposing the inner aspect

70
Q

What is a key complication of an ectropion?

A

exposure keratopathy

71
Q

what are the management options of an ectropion?

A

lubricating eyedrops
surgery

72
Q

What is Trichiasis?

A

inward growth of the eyelashes

73
Q

What are the complications of trichiasis?

A

corneal damage and ulceration

74
Q

What is the management of trichiasis?

A

Removing the affected eyelashes.
Recurrent cases may require electrolysis, cryotherapy or laser treatment

75
Q

what is periorbital cellulitis?

A

eyelid and skin infection in front of the orbital septum

76
Q

How does periorbital cellulitis present?

A

swollen, red, hot skin around the eyelid and eye

77
Q

What can help distinguish between periorbital and orbital cellulitis?

A

CT scan

78
Q

What is the treatment of periorbital cellulitis?

A

systemic antibiotics (oral or IV)

79
Q

What is Orbital cellulitis?

A

infection around the eyeball involving the tissues behind the orbital septum

80
Q

What are the symptoms of orbital cellulitis?

A

pain with eye movement, reduced eye movements, vision changes, abnormal pupil reactions, and proptosis (bulging forward of the eyeball).

81
Q

what is the management of orbital cellulitis?

A

Emergency admission under ophthalmology and intravenous antibiotics.
Surgical drainage may be needed if an abscess forms.

82
Q

What are the presenting features of conjunctivitis?

A

Red, bloodshot eye
Itchy or gritty sensation
Discharge

83
Q

What type of discharge is present in bacterial conjunctivitis?

A

purulent discharge. It is typically worse in the morning when the eyes may be stuck together

84
Q

State 3 causes of an acute painful red eye

A

Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury

85
Q

state 3 causes of an acute painless red eye

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

86
Q

What is the management of conjunctivitis ?

A

usually resolves without treatment in 1-2weeks
hygiene measures to prevent spreading
Chloramphenicol or fusidic acid eye drops for bacterial if necessary
Allergic = antihistamines, topical mast-cell stabilisers

87
Q

what can cause anterior uveitis?

A

Autoimmune
infection
trauma
ischaemia
malignancy

88
Q

What can be seen in the anterior chamber on inspection of anterior uveitis?

A

Hypopyon (fluid collection of inflammatory cells)

89
Q

What autoimmune conditions are associated with anterior uveitis?

A

Seronegative spondyloarthropathies (e.g., ankylosing spondylitis, psoriatic arthritis and reactive arthritis)
Inflammatory bowel disease
Sarcoidosis
Behçet’s disease

90
Q

What are the presenting symptoms of anterior uveitis?

A

Painful red eye (typically a dull, aching pain)
Reduced visual acuity
Photophobia (due to ciliary muscle spasm)
Excessive lacrimation (tear production)

91
Q

What are the examination findings of anterior uveitis?

A

Ciliary flush (a ring of red spreading from the cornea outwards)
Miosis (a constricted pupil due to sphincter muscle contraction)
Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)

92
Q

What is the management of anterior uveitis?

A

referred for urgent assessment and management by an ophthalmologist
Steroids (eye drops, oral or intravenous)
Cycloplegics (e.g., cyclopentolate or atropine eye drops)

93
Q

What is Episcleritis?

A

Benign and self-limiting inflammation of the episclera, the outermost layer of the sclera, just below the conjunctiva

94
Q
A
95
Q
A
96
Q

What is episcleritis often associated with?

A

inflammatory disorders e.g. RA, IBD

96
Q

How does episcleritis usually present?

A

Localised or diffuse redness (often a patch of redness in the lateral sclera)
No pain (or mild pain)
Dilated episcleral vessels

97
Q

What can you use to differentiate between episcleritis and scleritis?

A

phenylephrine eye drops
(blanching of the episcleral vessels, causing the redness to disappear. It will not affect scleral vessels and will not impact the redness in scleritis)

98
Q

What is the management of episcleritis?

A

usually self-limiting and will resolve in 1-2 weeks
analgesia (e.g., ibuprofen) and lubricating eye drops.
More severe cases may be treated with steroid eye drops.

99
Q

what can cause scleritis?

A

idiopathic (no clear cause) or associated with an underlying systemic inflammatory condition.
Less commonly, it can be due to infection (e.g., Pseudomonas or Staphylococcus aureus).

100
Q

What conditions are associated with scleritis?

A

Rheumatoid arthritis
Vasculitis, particularly granulomatosis with polyangiitis)

101
Q

What are the features of scleritis?

A

Red, inflamed sclera (localised or diffuse)
Congested vessels
Severe pain (typically a boring pain)
Pain with eye movement
Photophobia
Epiphora (excessive tear production)
Reduced visual acuity
Tenderness to palpation of the eye

102
Q

What is the management of scleritis?

A

NSAIDs (oral)
Steroids (topical or systemic)
Immunosuppression appropriate to the underlying systemic condition (e.g., methotrexate in rheumatoid arthritis)

103
Q

What is the most severe type of scleritis?

A

necrotising scleritis, which can lead to perforation of the sclera

104
Q

what are some common causes of corneal abrasions?

A

Damaged contact lenses
Fingernails
Foreign bodies (e.g., metal fragments)
Tree branches
Makeup brushes
Entropion (inward turning eyelid)

105
Q

How does a corneal abrasion present?

A

Painful red eye
Photophobia
Foreign body sensation
Epiphora (excessive tear production)
Blurred vision

106
Q

What can be used to diagnose corneal abrasions?

A

fluorescein stain

107
Q
A
108
Q
A
109
Q

What is the management of a corneal abrasion?

A

Removing foreign bodies
Simple analgesia (e.g., paracetamol)
Lubricating eye drops
Antibiotic eye drops (e.g., chloramphenicol)
Close follow-up

109
Q

What are the main causes of keratitis?

A

Viral infection (e.g., herpes simplex)
Bacterial infection (e.g., Pseudomonas or Staphylococcus)
Fungal infection (e.g., Candida or Aspergillus)
Contact lens-induced acute red eye (CLARE)
Exposure keratitis, caused by inadequate eyelid coverage (e.g., ectropion)

110
Q

What is the most common cause of keratitis?

A

Herpes simplex virus (HSV)

111
Q

How may Herpes keratitis present?

A

Primary infection often involves mild symptoms of blepharoconjunctivitis

Recurrent infection may present with:
Painful red eye
Photophobia
Vesicles (fluid-filled blisters)
Foreign body sensation
Watery discharge
Reduced visual acuity

112
Q

What is used to diagnose keratitis?

A

Slit lamp examination
fluorescein staining shows dendritic corneal ulcer
corneal scrapings for viral testing

113
Q

how is Herpes Keratitis managed?

A

topical or oral antivirals (e.g., aciclovir or ganciclovir)

114
Q

Subconjunctival haemorrhages usually occur after episodes of what?

A

strenuous activity, such as heavy coughing, weight lifting or straining when constipated. They can also be caused by trauma to the eye.

115
Q

What factors may predispose someone to having a subconjunctival haemorrhage?

A

Hypertension
Bleeding disorders (e.g., thrombocytopenia)
Whooping cough
Medications (e.g., antiplatelets, DOACs or warfarin)
Non-accidental injury

116
Q

What is the presentation of subconjunctival haemorrhage?

A

patch of bright red blood underneath the conjunctiva. It covers the white of the eye
painless, does not affect vision

117
Q

What is the management of a subconjunctival haemorrhage?

A

harmless and will resolve spontaneously without treatment, usually in around two weeks. Lubricating eye drops may be helpful if there is mild irritation

check BP and INR if on warfarin

118
Q

What is posterior vitreous detachment?

A

when the vitreous body comes away from the retina

119
Q

What are the presenting symptoms of posterior vitreous detachment?

A

Floaters
Flashing lights
Blurred vision

120
Q

What can posterior vitreous detachment predispose patients to?

A

retinal tears and retinal detachment

121
Q

What is retinal detachment?

A

neurosensory layer of the retina (containing photoreceptors and nerves) separating from the retinal pigment epithelium (the base layer attached to the choroid). This is usually due to a retinal tear, allowing vitreous fluid to get under the neurosensory retina and fill the space between the layers

122
Q

What are some risk factors for retinal detachment?

A

Lattice degeneration (thinning of the retina)
Posterior vitreous detachment
Trauma
Diabetic retinopathy
Retinal malignancy
Family history

123
Q

How can retinal detachment present?

A

Peripheral vision loss (often sudden and described as a shadow coming across the vision)
Blurred or distorted vision
Flashes and floaters

124
Q

What is the management of retinal tears and detachment?

A

Tears: Laser therapy, Cryotherapy
detachment: vitrectomy, scleral buckle, pneumatic retinopexy

125
Q

What are some risk factors for retinal vein occlusion?

A

Hypertension
High cholesterol
Diabetes
Smoking
High plasma viscosity (e.g., myeloma)
Myeloproliferative disorders
Inflammatory conditions (e.g., SLE)

126
Q

How does retinal vein occlusion present?

A

painless blurred vision or vision loss

127
Q

What are the fundoscopy findings of retinal vein occlusion?

A

Dilated tortuous retinal veins
Flame and blot haemorrhages
Retinal oedema
Cotton wool spots
Hard exudates

128
Q

What is the management of retinal vein occlusion?

A

Anti-VEGF therapies (e.g., ranibizumab and aflibercept)
Dexamethasone intravitreal implant (to treat macular oedema)
Laser photocoagulation (to treat new vessels)

129
Q

What are 2 causes of central retinal artery occlusion?

A

atherosclerosis
GCA

130
Q

How does central artery occlusion present?

A

sudden painless loss of vision
relative afferent pupillary defect

131
Q

What will fundoscopy show in central retinal artery occlusion?

A

pale retina with a cherry red spot

132
Q

What are the key differentials for sudden painless vision loss?

A

retinal detachment, central retinal artery occlusion, central retinal vein occlusion or vitreous haemorrhage

133
Q

What is the management of central retinal artery occlusion?

A

GCA = high dose steroids
ocular massage, anterior chamber paracentesis, inhaled carbogen ect

134
Q

What is Retinitis Pigmentosa?

A

genetic condition causing degeneration of the photoreceptors in the retina, particularly the rods

135
Q

What are the presenting symptoms of retinitis pigmentosa?

A

Night blindness (often the first symptom)
Peripheral vision loss (before the central vision is affected)

136
Q

What does fundoscopy show in retinitis pigmentosa ?

A

Pigmentation described as “bone-spicule” pigmentation.

137
Q

What are some associated systemic disease of retinitis pigmentosa?

A

Usher syndrome also causes hearing loss
Bassen-Kornzweig syndrome also causes progressive neurological impairments
Refsum disease also causes peripheral neuropathy, hearing and ichthyosis (scaly skin)

138
Q

What is the management of retinitis pigmentosa?

A

Referral to an ophthalmologist for assessment, diagnosis and follow-up
Genetic counselling
Vision aids
Sunglasses to protect the retina from accelerated damage
Driving limitations and informing the DVLA

Finals (21 decks)

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