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Ophthalmology Flashcards

1
Q

What is drusen?

A

Yellow round spots in Brusch’s membrane

Seen in age related macular degeneration

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2
Q

Investigations for subconjunctival haemorrhage

A

Check blood pressure

Bloods if recurrent/bilateral for bleeding disorder

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3
Q

When does a subconjunctival haemorrhage need imaging?

A

If can’t see whole border of haemorrhage

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4
Q

Central retinal artery occlusion - presentation

A

Sudden unilateral visual loss

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5
Q

Central retinal artery occlusion - cause

A

Thromboembolism

Arteritis (e.g. temporal arteritis)

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6
Q

Central retinal artery occlusion - examination findings

A

Afferent pupillary defect

Cherry red spot on a pale retina

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7
Q

What does myopia mean?

A

Short sighted

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8
Q

What does hyperopia mean?

A

Long sighted

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9
Q

Presentation of corneal abrasion

A

Eye pain

Photophobia

Reduced visual acquity

Foreign body sensation

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10
Q

Management of corneal abrasion

A

Topical antibiotics to prevent bacterial superinfection

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11
Q

Features of corneal ulcer

A 
Eye pain
Photophobia
Watering
foreign body sensation
Focal fluorescein staining of cornea
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12
Q

What is the official word for squint?

A

Strabismus

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13
Q

What does strabismus mean?

A

Squint

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14
Q

How to manage squint in children?

A

Refer to secondary care

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15
Q

What is a chlazaion?

A

Retention cyst of meibomian gland

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16
Q

Chlazaion - presentation

A

Firm painless lump in the eyelid

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17
Q

Chlazaion - management

A

Most resolve spontaneously

Some require surgical removal

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18
Q

Stye - management

A

Hot compress and analgesia

Topical antibiotics only if associated conjunctivitis

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19
Q

Features of central retinal vein occlusion

A

Sudden, painless reduction in or loss of visual acuity

Usually unilateral

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20
Q

Central retinal vein occlusion on fundoscopy

A

Severe retinal haemorrhages

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21
Q

Features of scleritis

A

VERY painful red eye

Photophobia

Reduced visual acuity

Associated with autoimmune disease e.g. RA, SLE

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22
Q

Scleritis - impact of phenylephrine drops

A

No blanching

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23
Q

Episcleritis - impact of phenylephrine drops

A

Blanching

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24
Q

Scleritis - management

A

NSAIDS, immunosuppressants

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25
Q

Scleritis - complications

A

Perforation of the globe

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26
Q

Scleritis - associations

A

Autoimmune conditions e.g. SLE, RA

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27
Q

Screening for primary open angle glaucoma

A

Patients with a first degree relative with open angle glaucoma should be screened every year from age 40

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28
Q

Herpes simplex keratitis - features

A

Dendritic corneal ulcer on fluroescein staining
Red painful eye
Reduced visual acuity

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29
Q

Horner’s syndrome - features

A

Miosis (small pupil)

Ptosis

Enophthalmos (sunken eye)

Anhidrosis

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30
Q

Papilloedema - fundoscopy findings

A

Venous engorgement
Blurring of optic disc margin
Loss of optic cup

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31
Q

Papilloedema - causes

A

SOL

Malignant hypertension

Idiopathic intracranial HTN

Hydrocephalus

Hypercapnia

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32
Q

Central retinal artery occlusion - findings

A

Afferent pupillary defect

Cherry red spot on pale retina

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33
Q

Central retinal artery occlusion - causes

A

Thromboembolism from atherosclerosis

Arteritis e.g. temporal arteritis

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34
Q

What is entropion?

A

In turning of the eyelids

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35
Q

What is in turning of the eyelids called?

A

Entropion

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36
Q

What is ectropion?

A

Out turning of the eyelis

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37
Q

What is out turning of the eyelids called?

A

Ectropion

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38
Q

Foreign body in the eye - indications to refer

A

Suspected penetrating eye injury

Significant trauma

Chemical injury

Foreign body of organic material

Foreign body in/near centre of cornea

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39
Q

What does a gradual onset history of straight lines appearing crooked suggest?

A

Age related macular degeneration

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40
Q

Contraindication for antioxidant dietary supplements in macular degeneration?

A

Smoking

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41
Q

Causes of tunnel vision

A

Papilloedema

Glaucoma

Retinitis pigmentosa

Choroidoretinitis

Optic atrophy secondary to tabes dorsalis

Hysteria

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42
Q

Types of stye

A

Hordeloum externum

Hordeloum internum

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43
Q

How do patients get certified as blind or partially sighted?

A

Consultant ophthalmologist completes certificate of vision impairment

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44
Q

Criteria for severely sight impaired

A

VA < 3/60

VA <6/60 with reduction in field of vision

VA over 6/60 with very reduced field of vision

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45
Q

Criteria for sight impaired

A

VA 6/60

VA up to 6/24 with reduced field of vision

VA of 6/18 or better but missing lots of field of vision

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46
Q

Holmes-Adie pupil - features

A

Dilated pupil

Once pupil constricted it remains small for a long time

Slowly reactive to accommodation but very poorly to light

Absent ankle/knee reflexes

Unilateral in 80%

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47
Q

Additional finding in congenital horner’s syndrome

A

Heterochromia (difference in iris colour)

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48
Q

Ocular manifestations of RA

A

Keratoconjunctivitis sicca

Episcleritis

Scleritis

Corneal ulceration

Keratitis

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49
Q

What is keratoconjunctivitis sicca?

A

Dry eyes

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50
Q

Argyll-Robertson pupil features

A

Small irregular pupils

No response to light but able to accommodate

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51
Q

Argyll-Robertson pupil causes

A

Diabetes mellitus

Syphilis

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52
Q

What does mydriasis mean?

A

Large pupil

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53
Q

Causes of mydriasis/large pupil

A

Third nerve palsy

Homes-Adie pupil

Traumatic irdoplegia

Phaeochromocytoma

Congenital

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54
Q

School exclusion in conjunctivitis

A

No exclusion

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55
Q

What does miosis mean?

A

Small pupil

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56
Q

Causes of relative afferent pupillary defect

A

Retinal detachment

Optic neuritis

57
Q

Treatment of amaurosis fugax

A

As TIA - 300mg aspirin

58
Q

Vitreous haemorrhage - features

A

Sudden or subacute visual loss
Dark spots
Floaters

59
Q

Vitreous haemorrhage - causes

A

Diabetes

Bleeding disorders

Anticoagulants

Ocular trauma

60
Q

Retinal detachment - features

A

Dark spots, floaters

Dense shadow starts peripherally then over central vision

Veil/curtain over vision

Straight lines appear curved

61
Q

Posterior vitreous detachment - features

A

Flashes of light in peripheral field

Floaters

62
Q

Features of acute angle closure glaucoma

A 
Severe pain
Reduced visual acuity
Haloes
Semi-dilated pupil
Cloudy cornea
63
Q

Features of anterior uveitis

A

Pain

Blurred vision

Photophobia

Pupil small, fixed and irregular

Red eye

Ciliary flush (ring of red spreading out)

64
Q

Which condition should a small, fixed, irregular shaped pupil and red eye make you think of?

A

Anterior uveitis

65
Q

Endophthalmitis features

A

After intraocular surgery

Red eye, pain, visual loss

66
Q

Management of anterior uveitis

A

Cycloplegics - atropine, cyclopentolate

Steroid eye drops

67
Q

Associations with anterior uveitis

A

HLA B27

  • Ankylosing spondylitis
  • IBD
  • Reactive arthritis
  • Sarcoidosis
68
Q

Main cause of keratitis in non-contact lense wearers

A

Staphylococcus aureus

69
Q

Main cause of keratitis in contact lense wearers

A

Pseudomonas aeruginosa

70
Q

Keratitis - features

A

Red eye and pain

Photophobia

Foreign body/gritty sensation

Hypopyon

71
Q

Keratitis - management

A

Stop using contacts
Topical antibiotics
Cycloplegic for pain relief

72
Q

Examples of cycloplegics

A

Atropine

Cyclopentolate

73
Q

Age related macular degeneration - risk factors

A

Age

Smoking

Female

FHx

HTN

Dyslipidaemia

Diabetes

74
Q

Age related macular degeneration - features

A

Reduced visual acuity

Difficult dark adaptation

Glare around objects

Flickering/flashing lights

Straight lines appear curved

75
Q

Age related macular degeneration - Classification

A

1) Dry (90%) now called EARLY

2) Wet now called LATE

76
Q

Age related macular degeneration - features of dry/early ARMD

A

Atrophic

Non-exudative

Drusen

77
Q

Age related macular degeneration - features of wet/late ARMD

A

Exudative

Choroidal neovascularisation

78
Q

Which type of age related macular degeneration has the worse prognosis?

79
Q

Management of DRY age related macular degeneration

A

Antioxidants

80
Q

Management of WET age related macular degeneration

A

Anti-VEGF (vascular endothelial growth factor)

81
Q

Primary open angle glaucoma - risk factors

A

Age

Family history

Black ethnicity

Myopia

HTN

Diabetes

Steroids

82
Q

Primary open angle glaucoma - features

A

Insidious onset found at routine appointment

Peripheral visual field loss progressing to tunnel vision

Reduced visual acuity

83
Q

Primary open angle glaucoma - fundoscopy findings

A

Optic disc cupping

Optic disc pallor

Bayonetting of vessels

Cup notching

84
Q

Primary open angle glaucoma - first line management

A

Latanoprost

A prostaglandin analogue

85
Q

How does lantanoprost work?

A

Increases uveosleral outflow

86
Q

Side effects of lantanoprost

A

Brown pigmentation of iris

Periocular pigmentation

Increased eye lash length

87
Q

Primary open angle glaucoma - second line options

A

Timolol

Dorzolamide

Brimonidine

Pilocarpine

88
Q

What type of drug is timolol?

A

Beta blocker

89
Q

Contraindications for timolol

A

Asthma

Heart block

90
Q

How does timolol work?

A

Reduces aqueous production

91
Q

What type of drug is dorzolamide?

A

Carbonic anhydrate inhibitor

92
Q

Side effects of dorzolamide

A

Sulphur like reactions e.g. anaphylaxis

93
Q

How does dorzolamide work?

A

Reduces aqueous production

94
Q

What type of drug is brimonidine?

A

Sympathomimetics

95
Q

What medication contraindications starting brimonidine?

A

MAOI

Tricyclics

96
Q

How does brimonidine work?

A

Reduces aqueous production AND increases outflow

97
Q

What type of drug is pilocarpine?

A

Muscarinic receptor agonist

98
Q

Side effects of pilocarpine

A

Constricted pupil
Headache
Blurred vision

99
Q

How does pilocarpine work?

A

Increased uveoscleral outflow

100
Q

Primary open angle glaucoma - management in advanced disease

A

Surgery or laser therapy

101
Q

What is dacryocystitis?

A

Infection of lacrimal sac

102
Q

Dacryocystitis - features

A

Watering eye

Swelling and erythema at inner canthus

103
Q

Dacryocystitis - management

A

Oral antibiotic

104
Q

Congenital lacrimal duct obstruction - features

A

Watering eye

May have secondary infection

105
Q

Congenital lacrimal duct obstruction - management

A

99% resolve spontaneously by age 1 year

Teach lacrimal duct massage

106
Q

Retinitis pigmentosa - features

A

Night blindness

Tunnel vision

107
Q

Retinitis pigmentosa - fundoscopy

A

Black bone spindles

108
Q

Optic neuritis - causes

A

MS
Diabetes
Syphilis

109
Q

Optic neuritis - likelihood of MS

A

If >3 white matter lesions on MRI then 50% of MS in 5 years

110
Q

Optic neuritis - management

A

High dose steroids

Recovery takes 4-6 weeks

111
Q

Optic neuritis - features

A

Eye pain, worse on movement

Unilateral decrease in visual acuity

Poor colour discrimination ‘red desaturation’

Relative afferent pupillary defect

112
Q

Diabetic retinopathy - risk factors

A 
Length of diabetes
Glycaemic control
HTN
Renal disease
Pregnancy can cause rapid progression
113
Q

Mild non-proliferative diabetic retinopathy

A

≥ 1 microaneurysm

114
Q

Moderate non-proliferative diabetic retinopathy

A

Microaneurysms

Blot haemorrhages

Hard exudates

Cotton wool spots

Venous beading

115
Q

Severe non-proliferative diabetic retinopathy

A

Blot haemorrhage and microaneurysms in 4 quadrants

Venous beading in 2 quadrants

Intraretinal microvascular abnormalities in 1 quadrant

116
Q

Proliferative diabetic retinopathy

A

Neovascularisation

117
Q

Diabetic retinopathy - maculopathy classification

A

Based on location not severity

Hard exudates and other changes on macular

118
Q

Diabetic retinopathy - management

A

Control: blood sugar, BP, lipids
Stop smoking
Laser treatment
Intravitreal steroids

119
Q

Acute angle closure glaucoma - predisposing factors

A

Hypermetropia (long sighted)
Pupil dilation
Lens growth associated with age

120
Q

Acute angle closure glaucoma - drug causes

A

Anticholingerics

Tricyclic antidepressants e.g. amitriptyline

121
Q

Acute angle closure glaucoma - features

A 
Severe pain
Reduced visual acuity
Hard, red eye
Halos
Semi-dilated non-reactive pupil
Dull/hazy cornea
Systemic features
122
Q

Acute angle closure glaucoma - immediate emergency management

A

IV acetazolamide
Topical pilocarpine
Topical timolol

123
Q

Acute angle closure glaucoma - definitive management

A

Laser peripheral iridotomy

124
Q

Herpes zoster ophthalmicus - features

A

Vesicular rash around eye

125
Q

Herpes zoster ophthalmicus - what suggests ocular involvement?

A

Rash on tip or side of nose

This is called Hutchinson’s sign

126
Q

Herpes zoster ophthalmicus - management

A

Oral antivirals for 7-10 days

IV antivirals in severe disease or immunocompromised

127
Q

Cataracts - features

A

Reduced vision
Faded colour vision
Glare
Halos

128
Q

Cataracts - examination findings

A

Defect in red reflex

129
Q

Cataracts - management

A

Conservative: stronger glasses, bright lighting

Definitive: surgical replacement of lens with an artificial one

130
Q

Cataracts - complications after surgery

A

Posterior capsule opacification
Retinal detachment
Posterior capsule rupture
Endophthalmitis

131
Q

Cataracts - causes

A 
Normal ageing
Smoking
Alcohol
Diabetes
Long term steroids
Radiation exposure
Myotonic dystrophy
Hypocalcaemia
Down's syndrome
Uveitis
132
Q

Blepharitis - causes

A

Meibomian gland dysfunction

Seborrhoeic dermatitis

Staphylococcal infection

Rosacea

133
Q

Blepharitis - features

A

Bilateral
Grittiness around eyelid margin
Eyes sticky in morning

134
Q

Blepharitis - management

A

Twice daily soft compress
Lid hygiene
Artificial tears

135
Q

Blepharitis - when to refer urgently

A

Symptoms of corneal disease - pain, blurred vision
Sudden onset visual loss
Acutely red and painful eye

136
Q

DVLA - visual field defects

A

Stop driving until can confirm meet national guidelines for visual fields

137
Q

DVLA - monocular vision

A

Notify DVLA

May drive if acuity and visual field is normal in the remaining eye

138
Q

DVLA - blepharospasm

A

Consultant opinion required

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