Ophthalmology Flashcards
What is the definitive management of acute angle-closure glaucoma?
laser peripheral iridotomy
What is the medical management of acute angle-closure glaucoma?
Combination of:
Direct parasympathetic (e.g. pilocarpine
A beta-blocker (e.g. timolol)
Alpha-2 agonist
OR IV Acetazolamide
What is the management of age-related macular degeneration?
Urgent ophthalmologist referral (1 week)
Wet: anti-VEGF
Dry: antioxidants
What conditions are associated with anterior uveitis?
HLA-B27
- ankylosing spondylitis
- reactive arthritis
- ulcerative colitis, Crohn’s disease
- Behcet’s disease
- sarcoidosis: bilateral disease may be seen
What is the management of anterior uveitis?
URGENT ophthal review
Cycloplegics (e.g. atropine and cyclopentolate)
Steroid eye drops
What is the management of blepharitis?
1) Hot compresses BD
2) Lid hygiene
3) Artificial tears
What is the management of retinal vein occlusion?
1) macular oedema - intravitreal anti-vascular endothelial growth factor (VEGF) agents
2) retinal neovascularization - laser photocoagulation
What are fundoscopy findings for central retinal vein occlusion?
1) widespread hyperaemia
2) severe retinal haemorrhages - ‘stormy sunset’
What are fundoscopy findings for central retinal artery occlusion?
‘cherry red’ spot on a pale retina
What is the management of a corneal abrasion?
a topical antibiotic (prevent infection)- chloramphenicol ointment
What is the management of diabetic retinopathy?
Maculopathy:
intravitreal VEGF
Non-proliferative:
- Regular observation
- if severe/very severe consider panretinal laser photocoagulation
Proliferative:
- panretinal laser photocoagulation
- intravitreal VEGF
- if severe or vitreous haemorrhage: vitreoretinal surgery
How can you differentiate between scleritis and episcleritis?
1) phenylephrine drops: phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels
2) Episcleritis is classically not painful whereas scleritis is
What is the management of episcleritis?
1) conservative- artificial tears may sometimes be used
How does HSV keratitis present?
Dendritic corneal ulcer
What is the management of HSV keratitis?
Topical aciclovir
What is the management of Herpes zoster ophthalmicus?
PO antivirals for 7-10 days +/- topical corticosteroids
What are the features of Horners syndrome?
Miosis
Anhidrosis
Ptosis
Enopthalmos
What is the management of keratitis?
1) Stop using contacts
2) Topical abx
3) cycloplegic for pain relief
e.g. cyclopentolate
What are the causes of optic neuritis?
1) MS (most common)
2) Diabetes
3) Syphilis
NOTE: of prognosis MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%
What is the investigation for optic neuritis?
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases
What is the management of optic neuritis?
high dose steroids
How do you differentiate orbital from pre-septal cellulitis?
reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
What is the management of primary open angle glaucoma?
1st line: offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg
next-line: prostaglandin analogue (PGA) eyedrops
the next line of treatments includes:
- beta-blocker eye drops
- carbonic anhydrase inhibitor eye drops
- sympathomimetic eye drops
What are the fundoscopy signs of primary open angle glaucoma?
- Optic disc cupping
- Optic disc pallor
- Bayonetting of vessels
- Additional features - Cup notching, Disc haemorrhages
What are the causes of Relative afferent pupillary defect?
1) retina: detachment
2) optic nerve: optic neuritis e.g. multiple sclerosis
What are the ocular manifestations of rheumatoid arthritis?
1) keratoconjunctivitis sicca (most common)
2) episcleritis (erythema)
3) scleritis (erythema and pain)
4) corneal ulceration
5) keratitis
also some Iatrogenic
1) steroid-induced cataracts
2) chloroquine retinopathy
What are the risk factors for scleritis?
1) rheumatoid arthritis (most commonly)
2) SLE
3) sarcoidosis
4) granulomatosis with polyangiitis
What is the management of scleritis?
1) Same day ophthalmologist assessment
2) PO NSAIDS 1st line
3) PO glucocorticoids if severe
4) immunosuppressive drugs if resistant
How does orbital lymphoma present?
Orbital lymphoma could present like a chronic unilateral conjunctivitis resistant to treatment
What is the other term for stye?
hordeolum externum/inturnum
What is drusen?
yellow round spots in Bruch’s membrane- small accumulations of extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye
What test must you do in someone with chorioretinitis?
HIV test- most common cause CMV which affects up to 40% of AIDS pts
What are causes of tunnel vision?
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
What is the most common cause of blurring of vision again years after cataracts surgery?
posterior capsule opacification
What is the management of orbital compartment syndrome?
urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit
What is the criteria for the certification of blindness?
The criteria for the certification of blindness (severely sight impaired) is <3/60 with a full visual field
How is someone certified as legally blind?
Only consultant ophthalmologists (rather than GPs) are allowed by law to certify patients as legally blind or partially sighted in the UK
