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MSRA > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Episcleritis sx

A

Red eye
classically not painful
Feels sore or gritty
The redness often appears in a focal or segmental pattern

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2
Q

Herpes zoster ophthalmicus tx

A

oral antiviral treatment for 7-10 days
ideally started within 72 hours

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3
Q

Acute angel closure glaucoma SX

A

fixed dilated pupil with conjunctival injection

Ocular pain, decreased visual acuity, worse with mydriasis(dark rooms), haloes around lights

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4
Q

AACG mx

A

initial medical treatment emergency treatment.

combination of eye drops, for example:
a direct parasympathomimetic - pilocarpine,

a beta-blocker (e.g. timolol,

an alpha-2 agonist apraclonidine,

intravenous acetazolamide
reduces aqueous secretions
some guidelines also recommend the use of topical steroids to reduce inflammation

Definitive management
laser peripheral iridotomy

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5
Q

Herpes zoster ophthalmicus

A

blistering rash in the distribution of the ophthalmic division of the trigeminal nerve. It is caused by reactivation of latent varicella-zoster virus

Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

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6
Q

Sx of Orbital cellulitis

A

Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis

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7
Q

Differentiating orbital from preseptal cellulitis

A

reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis

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8
Q

Mx of orbital cellulitis

A

admission to hospital for IV antibiotics

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9
Q

Retinitis pigmentosa

A

night blindness + tunnel vision
fundoscopy: black bone spicule-shaped pigmentation

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10
Q

Anterior uveitis sx

A

painful red eye with photophobia
uveitis: small, fixed oval pupil, ciliary flush
Pain worse when using the eye, such as when reading or moving the eye.

hypopyon- white cells in ant chamber

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11
Q

Analgesia for corneal ulcer

A

Oral
Topical delays healing

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12
Q

Diabetic maculopathy

A

hard exudates and other ‘background’ changes on macula
check visual acuity

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13
Q

Non-proliferative diabetic retinopathy

A

Mild NPDR
1 or more microaneurysm

Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots (‘soft exudates’ - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

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14
Q

Proliferative diabetic retinopathy features

A

retinal neovascularisation - may lead to vitrous haemorrhage
fibrous tissue forming anterior to retinal disc
more common in Type I DM, 50% blind in 5 years

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15
Q

Scleritis vs episcleritis

A

The main method of differentiating the two presentations is the use of phenylephrine or neosynephrine eye drops. These drops will cause blanching (go away) of the blood vessels in episcleritis, but not in scleritis.

Scleritis is often painful
Epi- is not

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16
Q

Eyelid conditions

A

blepharitis: inflammation of the eyelid margins typically leading to a red eye

stye: infection of the glands of the eyelids
firm painless lump in the eyelid.
hordeolum externum- external
hordeolum internum- internal

chalazion (Meibomian cyst)
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids

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17
Q

Central retinal vein occlusion vs central artery occlusion

A

Vein - sudden painless vision loss, optic disc swelling, and multiple flame-shaped and blot haemorrhages

Artery
sudden painless vision loss and a pale retina with a cherry-red spot at the fovea on examination.

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18
Q

Age-related macular degeneration

A

dry macular degeneration
90% of cases
also known as atrophic
characterised by drusen - yellow round spots

wet macular degeneration
10% of cases
also known as exudative or neovascular macular degeneration
characterised by choroidal neovascularisation
leakage of serous fluid and blood can subsequently result in a rapid loss of vision
central scotoma

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19
Q

Mx of allergic conjunctivitis.

A

Non pharma- avoid allergen, cold compress
Then topical or systemic antihistamines

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20
Q

Endophthalmitis sx and mx

A

Red eye, pain and visual loss following intraocular surgery

urgent ophthalmic review

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21
Q

Argyll-Robertson pupil

A

Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus

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22
Q

Horner syndrome

A

Miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating)

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23
Q

Marcus-Gunn pupil

A

Relative afferent pupillary defect, seen during the swinging light examination of pupil response.

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24
Q

Adie pupil

A

Tonically dilated pupil, slowly reactive to light with more definite accommodation response

Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection. Commonly seen in females, accompanied by absent knee or ankle jerks.

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25
Q

Herpes simplex keratitis mx

A

topical aciclovir

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26
Q

Central retinal artery occlusion mx

A

If temporal arteritis - IV steroids

Intraarterial thrombolysis may be attempted but currently, trials show mixed results.

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27
Q

cherry red spot appearance

A

CRAO and temporal arteritis

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28
Q

Subconjunctival haemorrhage

A

Flat, red patch on the conjunctiva. Normal vision, not painful

Self limiting

If the cause is traumatic consider a referral to the ophthalmologist to ensure no other damage has been caused to the eye

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29
Q

Mx of stye

A

pain relief and warm compresses

Topical antibiotics are only recommended for stye if associated conjunctivitis

30
Q

Blurring of vision again years after cataract surgery

A

posterior capsule opacification

31
Q

Vitreous and Retinal detachment

A

Flashes and floaters

associated with hypertension and diabetes mellitus in older patients. Retinal detachment can occur following vitreous detachment and is typically referred to in questions as a ‘dense shadow’ or curtain

32
Q

Vitreous haemorrhage sx

A

features may include sudden visual loss, dark spots

RF- DM, bleeding disorders

33
Q

Painless, monocular loss of vision in Marfan’s syndrome

A

Lens dislocation

34
Q

Keratitis

A

red eye: pain and erythema
photophobia
foreign body, gritty sensation
contact lens wearers

stop using contact lens until the symptoms have fully resolved
topical antibiotics

35
Q

Best method to slow ARMD

A

Stop smoking

36
Q

Causes of papilloedema

A

space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia

37
Q

Mydriatic drops are applied and fundoscopy reveals pre-proliferative diabetic retinopathy, later has reduced vision

A

The use of mydriatic drops in a predisposed individual can precipitate acute angle closure glaucoma by dilating the pupil,

38
Q

Optic neuritis sx

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

39
Q

Ix and mx of optic neuritis

A

Investigation
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases

Management
high-dose steroids

40
Q

Primary open angle glaucoma mx

A

360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg

Prostaglandin analogues (e.g. latanoprost)

41
Q

Mx of entropion

A

If left untreated this patient may develop a corneal ulcer. The definitive management of entropion is surgical although eye lubricants and tape (to pull the eyelid outwards) may be used whilst awaiting surgery.

42
Q

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

A

orbital compartment syndrome

43
Q

Orbital compartment syndrome mx

A

immediate canthotomy

44
Q

Mx of corneal abrasion

A

Topical chloramphenicol

45
Q

Sx and Ix of corneal abrasion

A

eye pain
lacrimation
photophobia
foreign body sensation and conjunctival injection
decreased visual acuity in the affected eye

fluorescein staining

46
Q

Mx of dry and wet ARMD

A

Dry- combination of zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by around one third.

Wet- intravitreal anti vascular endothelial growth factor (VEGF)

Referral to ophthalmology urgently within 1 week if suspecting AMD

47
Q

Shadow in red reflex

A

Cataracts

48
Q

Chronic open-angle glaucoma

A

peripheral vision loss that comes on slowly

Increased cup to disc ratio

49
Q

Mx of blepharitis

A

softening of the lid margin using hot compresses twice a day
‘lid hygiene’ - mechanical removal of the debris from lid margins

50
Q

How does low Ca affect vision

A

Causes cataracts

51
Q

Conjunctivitis vs blepharitis vs keratitis

A

Conjunctivitis
red, itchy eye with sticky discharge.

Blepharitis
grittiness and sticky eyes, especially in the morning. Symptoms are usually bilateral.

Keratitis
red eye, photophobia, pain and gritty sensation

52
Q

Squints

A

the nose: esotropia
temporally: exotropia
superiorly: hypertropia
inferiorly: hypotropia

On covering non affected eye- eye will move opposite direction

53
Q

Hypertensive retinopathy classification

A

I
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

II
Arteriovenous nipping

III
Cotton-wool exudates
Flame and blot haemorrhages
These may collect around the fovea resulting in a ‘macular star’

IV
Papilloedema

54
Q

Persistent watery eye in an infant- no infective sx

A

Nasolacrimal duct obstruction

symptoms resolve in 95% by the age of one year

Unresolved cases should be referred to an ophthalmologist

55
Q

Mx of squint

A

Referral to ophthalmology

56
Q

Chorioretinitis

A

patients with chorioretinitis often present with unilateral vision changes
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

57
Q

Cause of chorioretenitis

A

infectious
toxoplasmosis: most prevalent cause worldwide
cytomegalovirus: particularly in immunocompromised individuals such as HIV patients
syphilis
tuberculosis

autoimmune
sarcoidosis
Behçet’s disease
systemic lupus erythematosus

58
Q

Mx of chorioretinitis

A

infectious
pyrimethamine and sulfadiazine for toxoplasmosis
ganciclovir or valganciclovir for CMV

autoimmune
systemic corticosteroids

59
Q

Mx of bacterial conj in preg

A

Topical fusidic acid

60
Q

Ocular manifestation of rheumatoid arthritis

A

Keratoconjunctivitis sicca, also known as dry eye syndrome

61
Q

Retinal detachment vs ischamaeic LOV

A

Retinal- flashers,
Peripheral to central shadow

Curtain- ischaemic

62
Q

What test must you do if patient has chorioretinitis

A

HIV

63
Q

SE of eye medication

A

latanoprost- brown pigments, longer eyelashes

Avoided in patients taking MAOI drugs- symps- brimonidine

Miotics- pilocarpine- constricted pupil, headache and blurred vision

Beta blocker- timolol- Should be avoided in asthmatics and patients with heart block

64
Q

Reactive arthritis sx

A

Arthraglia
Dysuria
Ant uveitis

65
Q

Adenoviral conjunctivitis

A

Highly contagious
chemosis in both eyes and conjunctival follicles.

66
Q

Orbital lymphoma sx

A

Slowly progressing, painless orbital process
red, painless and constantly teary right eye.
Decreased visual acuity and mild proptosis

67
Q

Meibomian blepharitis

A

bilateral dry, gritty and sore eyes
orifices on bilateral lids were plugged with oily material.

68
Q

Anterior uveitis mx

A

steroid + cycloplegic (mydriatic) drops

69
Q

Corneal abrasion mx

A

a topical antibiotic is recommended for these patients in order to prevent secondary bacterial infection.

70
Q
A

MSRA (8 decks)

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