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MSRA > ophthalmology > Flashcards

ophthalmology Flashcards

1
Q

optic neuritis causes (3)

A

MS
DM
syphilis

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2
Q

optic neuritis features: (5)

A

unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma

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3
Q

optic neuritis mgt

A

high dose steroids
(usually resolved in 4-6 weeks)

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4
Q

sinister cause of chronic unilateral conjunctivitis

A

orbital lymphoma

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5
Q

bacterial conjunctivitis features:

A

Purulent discharge
Eyes may be ‘stuck together’ in the morning)

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6
Q

viral conjunctivitis features:

A

Serous discharge
Recent URTI
Preauricular lymph nodes

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7
Q

bacterial conjunctivitis mgt:

& mgt if pregnant

A

chloramphenicol
fusidic acid in pregnant

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8
Q

sudden loss of vision causes: (4)

A

ischaemic/vascular
vitreous haemorrhage
retinal detachment
retinal migraine

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9
Q

HSV keratitis presentation: (5)

A

DENDRITIC CORNEAL ULCER

red, painful eye
photophobia
epiphora (watery eyes)
visual acuity may be decreased
fluorescein staining may show an epithelial ulcer

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10
Q

HSV keratitis mgt

A

topical aciclovir
immediate ophthalmology r/v

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11
Q

rheumatoid arthritis ocular manifestations (5)

A

keratoconjunctivitis sicca (= dry eyes, most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis

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12
Q

acute angle closure glaucoma

what happens?

A

rise in IOP secondary to an impairment of aqueous outflow

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13
Q

acute angle closure glaucoma predisposing factors: (3)

A

hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age

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14
Q

acute angle closure glaucoma

features: (7)

A

severe pain: may be ocular or headache
decreased visual acuity
sx worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil
corneal oedema (dull or hazy cornea)

nausea/vomiting/ abdo pain

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15
Q

acute angle closure glaucoma mgt

A
  1. offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg
  2. prostaglandin analogue (PGA) eyedrops should be used next-line
  3. BB eye drops
    carbonic anhydrase inhibitor eye drops
    sympathomimetic eye drops
  4. surgery in the form of a trabeculectomy may be considered in refractory cases.
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16
Q

prostaglandin analogues
example:

A

lantoprost

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17
Q

prostaglandin analogues
SE:

A

brown pigmentation of the iris
increased eyelash length

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18
Q

BB
examples:

A

timolol
betaxolol

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19
Q

groups to avoid BB in:

A

asthmatics
heart block

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20
Q

Sympathomimetics
examples:

A

e.g. brimonidine, an alpha2-adrenoceptor agonist)

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21
Q

Sympathomimetics
who should avoid:

A

Avoid if taking MAOI or tricyclic antidepressants

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22
Q

Carbonic anhydrase inhibitors

example:

A

Dorzolamide

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23
Q

Carbonic anhydrase inhibitors
SE:

A

Systemic absorption may cause sulphonamide-like reactions

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24
Q

miotics
e.g.

A

pilocarpine, a muscarinic receptor agonist

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25
Q

miotics adverse effects:

A

constricted pupil
headacheblurred vision

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26
Q

Sympathomimetics
adverse effect:

A

hyperaemia

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27
Q

age related macular degeneration presentation (5)

A

a reduction in visual acuity, particularly for near field objects
- gradual in dry ARMD
- subacute in wet ARMD

poor night vision/ dark adaptation
fluctuations in visual disturbance
Charles Bonnet syndrome
‘flickering’

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28
Q

age related macular degeneration signs

A

distortion of line perception may be noted on Amsler grid testing
drusen (yellow areas of pigment deposition in the macular area) which may become confluent in late disease to form a macular scar.
in wet ARMD well demarcated red patches (intra-retinal or sub-retinal fluid leakage or haemorrhage)

29
Q

wet macular degeneration mgt:

A

anti-VEGF

30
Q

anterior uveitis (aka irisitis)

associations

A

HLA-B27 associated conditions:
-ankylosing spondylitis
-reactive arthritis
-ulcerative colitis, Crohn’s disease
-Behcet’s disease
-sarcoidosis: bilateral disease may be seen

31
Q

anterior uveitis

features

A

acute onset
ocular discomfort & pain (may increase with use)
pupil may be small +/- irregular due to sphincter muscle contraction
photophobia (often intense)
blurred vision
red eye
lacrimation
ciliary flush: a ring of red spreading outwards
hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
visual acuity initially normal → impaired

32
Q

anterior uveitis mgt (3)

A

urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
steroid eye drops

33
Q

Argyll-Roberston pupil (who is she?)

A

ARP (Argyll Robertson pupil)

Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)

i.e.
small, irregular pupils
no response to light but there is a response to accommodate

34
Q

ARP (Argyll Robertson pupil)
causes: (2)

A

DM
syphilis

35
Q

cataracts causes:

A

normal ageing

Smoking
Increased alcohol consumption
Trauma
Diabetes mellitus
Long-term corticosteroids
Radiation exposure
Myotonic dystrophy
Metabolic disorders: hypocalcaemia

36
Q

cataracts presentation: (5)

A

Reduced vision
Faded colour vision: making it more difficult to distinguish different colours
Glare: lights appear brighter than usual
Halos around lights

ABSENT RED REFLEX

37
Q

cataract surgery cx: (4)

A

Posterior capsule opacification: thickening of the lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis: inflammation of aqueous and/or vitreous humour

38
Q

central retinal a. occlusion

features: (3)

A

sudden, painless unilateral visual loss
relative afferent pupillary defect
‘cherry red’ spot on a pale retina

39
Q

central retinal a. occlusion causes: (2)

A

thromboembolism (from atherosclerosis)
arteritis (e.g. temporal arteritis)

40
Q

central retinal vein occlusion
RF (5)

A

age
HTN
CVD
glaucoma
polycythaemia

41
Q

central retinal vein occlusion
features (3)

A

sudden, painless reduction or loss of visual acuity, usually unilaterally

fundoscopy:
- widespread hyperaemia
- severe retinal haemorrhages - ‘stormy sunset’

42
Q

central retinal vein occlusion key ddx:

A

branch retinal vein occlusion (BRVO)

  • when a vein in the distal retinal venous system is occluded and is thought to occur due to blockage of retinal veins at arteriovenous crossings.
  • results in a more limited area of the fundus being affected.
43
Q

central retinal vein occlusion
mgt (3):

A

conservative

if macular oedema: aanti-VEGF
if retinal neovascularisation - laser photocoagulation

44
Q

chorioretinitis features:

A

unilateral
blurred vision
scotomas (blind spots)
floaters
ophthalmoscopic finding
- focal or diffuse areas of retinal whitening
‘- pizza pie’ fundus: retinal spots (superficial retinal infarction + flame-shaped haemorrhages

45
Q

chorioretinitis mgt:

A

if infectious:
- pyrimethamine and sulfadiazine for toxoplasmosis
- ganciclovir or valganciclovir for CMV
if autoimmune:
steroids

46
Q

how to differentiate episcleritis/ scleritis:

A

phenylephrine drops

  • if eye redness improves following drops = episcleritis
47
Q

scleritis mgt

A

PO NSAIDs

48
Q

scleritis RF

A

rheumatoid arthritis: the most commonly associated condition
systemic lupus erythematosus
sarcoidosis
granulomatosis with polyangiitis

49
Q

herpes zoster opthalmicus features:

A

vesicular rash around the eye
Hutchinson’s sign:
= rash on the tip or side of the nose. Indicates nasociliary involvement, strong RF for ocular involvement

50
Q

Homes-Adie pupil

A

benign
- dilated pupil
- once the pupil has constricted it remains small for an abnormally long time
- slowly reactive to accommodation but very poorly (if at all) to light
- associated with absent knee/ ankle reflex

51
Q

Horner’s syndrome
features:

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

52
Q

hypertensive retinopathy signs:

A

I silver wiring of the arterioles

II AV nipping

III cotton-wool exudates, flame and blot haemorrhages (collect round fovea to make “macular star”

IV papilloedema

53
Q

keratitis
what is it?

A

inflammation of the cornea

(unlike conjunctivitis can be potenitially sight threatening so needs rx)

54
Q

keratitis causes:

A

bacterial
- s. aureus most commonly
- pseudomonas aeruginosa in contact lens wearers
fungal
amoebic
- acanthamoebic keratitis (typically pain is out of proportion with findings)
parasitic
- onchoceral keratitis (river blindness)
viral
- HSV keratitis

55
Q

keratitis features:

A

red eye + pain
photophobia
foreign body, gritty sensation
+/- hypopyon (white milky fluid layer)

56
Q

bacterial keratitis mgt

A

topical abx
- usually quinolones

+cycloplegic for pain relief e.g. cyclopentolate

57
Q

keratitis cx

A
  • corneal scarring
  • perforation
  • endophthalmitis
  • visual loss
58
Q

lens dislocation causes:

A

Marfan’s syndrome: upwards
homocystinuria: downwards
Ehlers-Danlos syndrome
trauma
uveal tumours
autosomal recessive ectopia lentis

59
Q

lens discolation
direction in Marfans

A

upwards

60
Q

lens dislocation: direction in homocystinuria

A

downwards

61
Q

causes of mydriasis

A

(large pupil)

CN III palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital

62
Q

drug causes of mydriasis

A

topical mydriatics: tropicamide, atropine
sympathomimetic drugs: amphetamines, cocaine
anticholinergic drugs: tricyclic antidepressants

63
Q

orbital compartment syndrome
features:

A

eye pain/swelling
proptosis
‘rock hard’ eyelids
relevant afferent pupillary defect

64
Q

orbital compartment syndrome

mgt

A

urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit

65
Q

Marcus Gunn pupil
what is it?

A

relative afferent pupillary defect

caused by lesion of anterior optic chiasm i.e. optic n/ retina

66
Q

Marcus Gunn pupil causes:

A

retinal detachment
optic neuritis

67
Q

retinitis pigmentosa

features:

A

initial sign = night blindness
tunnel vision (as primarily affects peripheral retina)
black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

68
Q

occular manifestations of RA:

A

keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis

Iatrogenic
steroid-induced cataracts
chloroquine retinopathy

69
Q

tunnel vision causes

A

papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria

MSRA (16 decks)

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