Ophthalmology Flashcards
How does retinitis pigmentosa present?
Retinitis pigmentosa - night blindness + tunnel vision
How does Horner’s syndrome present?
Horner’s syndrome, also known as oculosympathetic paresis, is a rare condition characterised by a triad of ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (lack of sweating) on the affected side of the face.
How does Argyll-Robertson pupil present?
bilateral small pupils that constrict when the patient focuses on a near object but do not react to direct or consensual light stimulation. They are often referred to as ‘prostitute’s pupils’ because they ‘accommodate but do not react’. It is seen primarily in patients with neurosyphilis, which does not fit with the presented case.
How does sixth nerve palsy present?
A sixth cranial nerve palsy would present with horizontal double vision that increases when looking towards the affected side due to paralysis of the lateral rectus muscle, which abducts the eye.
How does third nerve palsy present?
third nerve palsy is incorrect as it typically presents with drooping of the eyelid (ptosis), dilation of the pupil (mydriasis), upward and outward deviation of the eye (‘down & out’ appearance) and inability to move eye inward and downward due to paralysis of the medial rectus and inferior rectus muscles respectively.
How does Holmes-Adie pupil present?
This condition presents with a unilateral dilated pupil that reacts poorly to light but shows slow constriction on accommodation. It may be associated with absent reflexes elsewhere in the body such as the ankle-jerk reflex. Holmes-Adie syndrome doesn’t cause ptosis which was observed in our patient.
How does Herpes Zoster Ophthalmicus present?
This condition presents with a painful, blistering rash in the distribution of the ophthalmic division of the trigeminal nerve. It is caused by reactivation of latent varicella-zoster virus (the same virus that causes chickenpox) within the sensory ganglion. The patient’s age and presentation with a burning sensation around his right eye followed by an erythematous blistering rash are typical features of this condition.
Where do you see drusen?
Drusen = Dry macular degeneration
What is the biggest risk factor for macular degeneration?
Smoking
How does fundoscopy differ in retinal central vein vs artery occlusion?
Artery - fundoscopic findings of a pale and opaque retina with a cherry-red spot are classic features of central retinal artery occlusion (CRAO)
Vein - diffuse retinal haemorrhages (‘blood and thunder’ appearance), venous dilation and tortuosity
How does optic neuritis present?
Colour vision is affected in optic neuritis and typically there is periocular pain associated with eye movement. Visual field defects can also occur, most commonly in the form of a central scotoma. There is typically a relative afferent pupillary defect if the other eye is uninvolved.
What is amsler grid testing?
Amsler grid testing (to check for distortion of line perception) may be useful in testing patients with suspected age related macular degeneration
How do we treat herpes zoster ophthalmicus?
Oral steroids
How does keratitis present?
red eye, photophobia and gritty sensation
How do episcleritis and scleritis differ?
Episcleritis is typically asymptomatic or presents with a mild grittiness sensation, but scleritis usually presents with frank pain and tenderness.
Where do you see bone-spicule pigmentation on fundoscopy?
Retinitis pigmentosa classically presents with black bone-spicule pigmentation on fundoscopy
Which kind of eye drops can be used to differentiate scleritis and episcleritis?
Phenylephrine 10% eye drops can be used to distinguish between episcleritis and scleritis. It blanches the redness in episcleritis but doesn’t in scleritis.
What is Hutchinson’s sign?
Seen in herpes zoster ophthalmicus, Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
How does anterior uveitis present?
Anterior uveitis is characterised by symptoms of a painful red eye with photophobia. Visual loss is more variable and can include reduced visual acuity, blurred vision, or reduced peripheral fields. Anterior uveitis is associated with a constricted pupil. Patients with a history of HLA-B27 positivity or autoimmune conditions are more likely to develop anterior uveitis.
What is chorioretinitis?
Chorioretinitis is an inflammatory condition affecting the choroid and retina of the eye. This dual inflammation can be precipitated by infectious or autoimmune aetiologies, leading to the potential for significant visual impairment if not promptly and effectively managed.
Where would you see pizza pie appearance on fundoscopy?
When the moon hits your eye like a big pizza pie that’s chorioretinitis
Why do you see an irregular pupil in anterior uveitis?
An irregular pupil is found in anterior uveitis because of the formation of posterior synechiae due to inflammation within the eye and they stick the iris to the anterior lens surface causing irregularity of the pupil.
What is the definitive treatment for acute angle closure glaucoma?
Laser peripheral iridotomy is the definitive treatment for acute angle-closure glaucoma. Produces an extra pathway in the iris for aqueous to flow from the posterior chamber into the anterior chamber in order to be drained into the angle.
How do we treat herpes simplex keratitis?
Topical aciclovir
Where do you see a central scotoma?
Optic neuritis
What is a hypopyon?
pus in the anterior chamber
A 68-year-old man with a history of type 2 diabetes mellitus presents with worsening eye sight. Mydriatic drops are applied and fundoscopy reveals pre-proliferative diabetic retinopathy. A referral to ophthalmology is made. Later in the evening whilst driving home he develops pain in his left eye associated with decreased visual acuity. What is the most likely diagnosis?
Acute angle closure glaucoma
Where would you see positive Chvostek and Trousseau signs
Hypocalcaemia
Which ophthalmological condition is associated with hypocalcaemia
Cataracts
