Ophthalmology Flashcards
contact lense wearer + red eye, photophobia and gritty sensation (1)
bacteiral causes (2)
Keratitis (inflammation of cornea)
- typically Staphylococcus aureus
- Pseudomonas aeruginosa is seen in contact lens wearers
- Other: Herpes
Bacterial conjunctivitis in pregnancy
fusidic eye drops (can’t have chloramphenicol)
recurrent watery or sticky eye in neonates - doesn’t respond to Abx
Congenital tear (lacrimal) duct obstruction, resolves by 1 year
REASSURANCE until 1 year
cotton wool spots represent areas of…
RETINAL INFARCTION
Corneal abrasion: treatment
cholcamphenicol to prevent infection
Orbital compartment: what to do ((blood in the anterior chamber, proptosis, stiff eyelid, and a relative afferent pupillary defect)
URGENT decompression PRE imaging
immediate canthotomy
mydriatic
large pupil
Argyll-Robertson pupil
Argyll-Robertson pupil is one of the classic pupillary syndromes. It is sometimes seen in neurosyphilis. Typically the pupil accommodates but doesn’t react. A mnemonic used for the Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
Features
small, irregular pupils
no response to light but there is a response to accommodate
Causes
diabetes mellitus
syphilis
Punctate fluorescein staining of the cornea
dry eyes
Ptosis + dilated pupil =;
ptos§is + constricted pupil =
Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner’s
Phenylephrine drops can be used to distinguish between
episcleritis and scleritis
. It blanches the redness in episcleritis but doesn’t in scleritis.
positive Chvostek and Trousseau signs.
hypocalcaemia
what metabolic disorder causes cataract
hypocalceamia
Lens dislocation
Causes
Marfan’s syndrome: upwards
homocystinuria: downwards
Ehlers-Danlos syndrome
trauma
uveal tumours
autosomal recessive ectopia lentis
A 32-year-old man with known Marfan’s syndrome presents to the emergency department with sudden, painless loss of vision in the left eye. There were no preceding symptoms and no trauma.
lens dislocation
cheese and tomato pizza fundoscopy
central retinal vein occlusion
chronic unilateral conjunctivitis resistant to treatment
Orbital lymphoma
Argyll-Robertson causes
diabetes
syphilis
what type of vision loss do you get in optic neuritis
Central scotoma is a classic finding in optic neuritis where patients experience a central visual field defect. This occurs because the papillomacular bundle, which serves central vision, is preferentially affected by the inflammatory process. The central scotoma may be absolute or relative and is typically demonstrated on visual field testing.
SUBACUTE visual loss
black bone-spicule pigmentation on fundoscopy
Retinitis pigmentosa
opaque retina with a cherry-red spot seen in CRAO.
Central retinal artery occlusion
most common eye manifestation of RA
Keratoconjunctivitis sicca
What is blepharitis?
Blepharitis is a common eye condition that makes your eyelids red, swollen, irritated, and itchy. It can cause crusty dandruff-like flakes on your eyelashes. Blepharitis can be uncomfortable. But it isn’t contagious, and it usually doesn’t cause any lasting damage to your eyes.
stye (hordeolum external) VS chalazion
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.
Causes
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
hypertensive retinopathy stages: Keith-Waganer classifcaiton
1= arteriolar narrowing and tortuosity
increased light
II= AV nipping
III= cotton wool
flame and blot
IV= papilloedema
First they start to twist and turn [silver wiring], then they nip about the place [AV nipping], afterwards they play with cotton wool and fire [cotton wool spots, flame and blot haemorrhages], finally they swell up [papilloedema].
a firm painless lump in the eyelid
meibomian cyst (chalazion)
temporal arteritis managemtnet
high dose prednisolone
IF visual symptoms/ fungus changes= IV Methylpred
On fundus examination, you can see a mixture of white and red retinal lesions.
PIZZA PIE = chorioretinitis
inflammation of the choroid and the retina.
Causes
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
Management
infectious
pyrimethamine and sulfadiazine for toxoplasmosis
ganciclovir or valganciclovir for CMV
autoimmune
systemic corticosteroids are the mainstay of treatment, often in combination with other immunosuppressive agents like methotrexate or azathioprine for more severe or refractory cases
dendritic ulcer on eye exam management
topic acyclovir (HERPES SIMPLEX)
shingles eye involvement
ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
ptosis
post-herpetic neuralgia
Retinitis pigmentosa is a classically inherited retinal disorder, characterised by tunnel vision and night blindness due to its effect on the peripheral retina. Fundoscopy reveals ‘bone-spicule’ pigmentation in the peripheral retina.
retinitis pigments
AMD management
REFER to opthal within 1 week
Blurring of vision again years after cataract surgery can occur due to
posterior capsule opacification
fluctuating vision
particularly at night
accusations iof extracellular material between rential pigment epithelium and Bruch’s membrane
dry age related macular degeneration
when to give antibiotics for stye (hordeolum)
if conjunctivitis too
recurrent sticky eyes <1 year
Congenital tear (lacrimal) duct obstruction is a cause of recurrent watery or sticky eye in neonates and usually, self-resolves by 1 year of age
Chorioretinitis suspected = must do..
HIV test (common in cytomegalovirus which affects 40% of pts with AIDS)
holmes adie pupil
Holmes-Adie pupil is a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.
Overview
unilateral in 80% of cases
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
Holmes-Adie syndrome
association of Holmes-Adie pupil with absent ankle/knee reflexes
Key features
based on location rather than severity, anything is potentially serious
hard exudates and other ‘background’ changes on macula
check visual acuity
more common in Type II DM
maculopathy
(Since there is no evidence of any abnormality outside the macula in the rest of the retina, options 1-3 (background, pre-proliferative and proliferative diabetic retinopathies) are incorrect.)
A 70 year old woman complains that her left eye is acutely watering, painful and red with some
blurring of her vision. Her visual acuity is reduced, but the pupillary reaction is normal.
dendritic ulcer
A 64 year old man having a routine blood pressure check whose pulse rate is 68. The rate is
noted to increase during inhalation and decrease during exhalation.
Sinus arrhythmia
