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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
Herpes simplex keratitis mx
topical aciclovir
26
Central retinal artery occlusion mx
If temporal arteritis - IV steroids Intraarterial thrombolysis may be attempted but currently, trials show mixed results.
27
cherry red spot appearance
CRAO and temporal arteritis
28
Subconjunctival haemorrhage
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
29
Mx of stye
pain relief and warm compresses Topical antibiotics are only recommended for stye if associated conjunctivitis
30
Blurring of vision again years after cataract surgery
posterior capsule opacification
31
Vitreous and Retinal detachment
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
Vitreous haemorrhage sx
features may include sudden visual loss, dark spots RF- DM, bleeding disorders
33
Painless, monocular loss of vision in Marfan's syndrome
Lens dislocation
34
Keratitis
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
Best method to slow ARMD
Stop smoking
36
Causes of papilloedema
space-occupying lesion: neoplastic, vascular malignant hypertension idiopathic intracranial hypertension hydrocephalus hypercapnia
37
Mydriatic drops are applied and fundoscopy reveals pre-proliferative diabetic retinopathy, later has reduced vision
The use of mydriatic drops in a predisposed individual can precipitate acute angle closure glaucoma by dilating the pupil,
38
Optic neuritis sx
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
Ix and mx of optic neuritis
Investigation MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases Management high-dose steroids
40
Primary open angle glaucoma mx
360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg Prostaglandin analogues (e.g. latanoprost)
41
Mx of entropion
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
Eye trauma, eye pain/swelling proptosis 'rock hard' eyelids relevant afferent pupillary defect
orbital compartment syndrome
43
Orbital compartment syndrome mx
immediate canthotomy
44
Mx of corneal abrasion
Topical chloramphenicol
45
Sx and Ix of corneal abrasion
eye pain lacrimation photophobia foreign body sensation and conjunctival injection decreased visual acuity in the affected eye fluorescein staining
46
Mx of dry and wet ARMD
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
Shadow in red reflex
Cataracts
48
Chronic open-angle glaucoma
peripheral vision loss that comes on slowly Increased cup to disc ratio
49
Mx of blepharitis
softening of the lid margin using hot compresses twice a day 'lid hygiene' - mechanical removal of the debris from lid margins
50
How does low Ca affect vision
Causes cataracts
51
Conjunctivitis vs blepharitis vs keratitis
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
Squints
the nose: esotropia temporally: exotropia superiorly: hypertropia inferiorly: hypotropia On covering non affected eye- eye will move opposite direction
53
Hypertensive retinopathy classification
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
Persistent watery eye in an infant- no infective sx
Nasolacrimal duct obstruction symptoms resolve in 95% by the age of one year Unresolved cases should be referred to an ophthalmologist
55
Mx of squint
Referral to ophthalmology
56
Chorioretinitis
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
Cause of chorioretenitis
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
Mx of chorioretinitis
infectious pyrimethamine and sulfadiazine for toxoplasmosis ganciclovir or valganciclovir for CMV autoimmune systemic corticosteroids
59
Mx of bacterial conj in preg
Topical fusidic acid
60
Ocular manifestation of rheumatoid arthritis
Keratoconjunctivitis sicca, also known as dry eye syndrome
61
Retinal detachment vs ischamaeic LOV
Retinal- flashers, Peripheral to central shadow Curtain- ischaemic
62
What test must you do if patient has chorioretinitis
HIV
63
SE of eye medication
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
Reactive arthritis sx
Arthraglia Dysuria Ant uveitis
65
Adenoviral conjunctivitis
Highly contagious chemosis in both eyes and conjunctival follicles.
66
Orbital lymphoma sx
Slowly progressing, painless orbital process red, painless and constantly teary right eye. Decreased visual acuity and mild proptosis
67
Meibomian blepharitis
bilateral dry, gritty and sore eyes orifices on bilateral lids were plugged with oily material.
68
Anterior uveitis mx
steroid + cycloplegic (mydriatic) drops
69
Corneal abrasion mx
a topical antibiotic is recommended for these patients in order to prevent secondary bacterial infection.
70
Criteria for blindness
is <3/60 with a full visual field and wearing glasses or contact lenses as prescribed.
71

MSRA (11 decks)

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