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WFH > Ophthalmology 18/05/20 > Flashcards

Ophthalmology 18/05/20 Flashcards

1
Q

symptoms of blepharitis

A
  • usually bilateral - due to meibomian body dysfunction or infection
  • gritty, burny eyes
  • often eyelid margin redness, swelling suggestive of infection (most common = S epidermidis)
  • change in eyelashes (ingrowth/loss)
  • association with ROSACEA and increased chance of developing styes/chalazia
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2
Q

management of blepharitis

A 
Lid hygiene:
- remove any debris
- chloramphenicol ointment to eyelash bases
- lid massage with warm compress
- artificial tears for dry eyes
~ Treat rosacea ~
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3
Q

COMMON causes of conjunctivitis

A

VIRAL - systemic illness/sore throat/lymphadenopathy
ALLERGIC - acute allergy/hay fever/topical medication
BACTERIAL - usually staph, consider neisseria/chlamydia in neonates

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4
Q

symptoms of conjunctivitis (ALLERGIC)

A
  • bilateral chemosis and watery
  • prominent itch
  • may be atopy/seasonal history
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5
Q

symptoms of conjunctivitis (VIRAL)

A
  • biateral chemosis and watery
  • recent URTI/systemic illness
  • lymphadenopathy (pre-auricular LNs)
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6
Q

symptoms of conjunctivitis (BACTERIAL)

A
  • purulent discharge

- eyes stuck together in mornings

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7
Q

treatment of conjunctivitis

A
  • history (allergic)
  • topical/systemic antihistamines (sodium cromoglicate if unresponsive to AHs in allergy)
  • viral usually self-limiting (1-2 wks) - don’t share towels, school excl not necessary
  • chloramphenicol as an antibiotic topically (fusidic acid in preg)
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8
Q

what produces lipid layer of tear film?

A

meibomian glands

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9
Q

what produces aqueous layer of tear film?

A

lacrimal glands

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10
Q

what produces mucin layer of tear film?

A

goblet cells

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11
Q

episcleritis symptoms

A
  • UNILATERAL
  • mild irritation
  • no pain
  • intense localised redness (confused with haemorrhage)
  • self-resolving within 2 wks
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12
Q

scleritis symptoms

A
  • UNILATERAL
  • darker red area (due to deeper layer than EPIscleritis)
  • typically painful (can be mild-severe)
    REFERRAL REQUIRED as can lead to loss of vision
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13
Q

treatment of stye

A
  • self-limiting but often recurrent
  • warm compress
  • lash removal/stye drainage
  • topical antibiotic if necessary
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14
Q

treatment of chalazion

A
  • warm compress
  • lid massage
  • referral if chronic
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15
Q

common causes of GRADUAL vision disturbance

A
  • cataracts
  • chronic glaucoma
  • optic nerve compression
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16
Q

common causes of SUDDEN vision disturbance

A
  • VASCULAR (e.g. thrombosis, embolism, temporal arteritis, including CRA/CRV occlusion)
  • vitreous haemorrhage
  • papilloedema
  • retinal detachment
  • acute glaucoma
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17
Q

VARIABLE ONSET vision disturbance causes

A
  • optic/retrobulbar neuritis

- diabetic retinopathy

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18
Q

optic/retrobulbar neuritis symptoms/signs

A

progressive over days

  • pain worse on eye movement
  • RAPD
  • colour (red) desaturation
  • central scotoma
  • other symptoms of demyelination (association with MS)
19
Q

management of optic neuritis

A
  • treat underlying cause, commonly MS so high dose steroids
20
Q

symptoms of vitreous haemorrhage

A 
smaller bleed =
- cobwebs/shadows/floaters/hazy vision
- may be redness to vision
- usually unilateral
moderate bleed = 
- multiple dark spots
big bleed = 
- can cause sudden total visual disturbance
21
Q

symptoms of retinal detachment

A
  • peripheral shadow that progressively moves centrally (sudden onset floaters commonly)
  • flashes of light (photopsia)
  • straight lines appearing curved
22
Q

symptoms of cataracts

A

gradual onset of:

  • reduced vision (faded colour vision)
  • glare and halos around lights
  • NO red reflex
23
Q

fundoscopy findings in primary open angle glaucoma (chronic simple)

A
  1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7)
  2. Optic disc pallor - indicating optic atrophy
  3. Bayonetting of vessels - vessels have breaks as they go into the deep cup and re-appear at the base
24
Q

RFs for primary open angle glaucoma

A
  • age
  • genetics
  • ethnicity (black population at increased risk)
  • myopia (near-sightedness)
  • diabetes
  • hypertension
25
Q

RFs for ACUTE ANGLE CLOSURE glaucoma

A
  • age
  • hypermetropia (long-sightedness)
  • pupillary dilation (eg. 3rd nerve palsy)
26
Q

symptoms of chronic simple glaucoma

A

often insidious, picked up on routine optometry

  • peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
  • decreased visual acuity
  • optic disc cupping
27
Q

symptoms of acute angle closure glaucoma

A
  • severe pain: may be ocular or headache
  • hard, red-eye
  • decreased visual acuity
  • halos around lights
  • semi-dilated non-reacting pupil on RAPD
  • corneal oedema results in dull or hazy cornea
  • nausea and vomiting
  • symptoms worse with mydriasis (e.g. watching TV in a dark room)
28
Q

common red flag for 3rd nerve palsy

A

post. communicating artery aneurysm

tumour

29
Q

features of iritis/anterior uveitis

A

acute onset

  • red, watery eye (with ciliary flush)
  • pain
  • irregular/small pupil
  • photophobia
  • blurred vision (visual acuity initially normal → impaired)
  • hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
30
Q

management of iritis/ant. uveitis

A

urgent review by ophthalmology

  • dilate pupil to relieve acute symptoms eg. atropine
  • steroid eye drops
31
Q

corneal ulcer symptoms (similar presentation to HSV keratitis)

A 
more common in contact lense users
- pain and irritation (watery)
- photophobia
- focal fluorescein staining of the cornea 
can lead to vision loss if not treated
32
Q

management of corneal ulcer

A
  • antimicrobials
  • steroid eye drops
  • cornea transplant if severe scarring/vision loss
33
Q

entropion/ectropion

A
  • entropion: in-turning of the eyelids

- ectropion: out-turning of the eyelids

34
Q

(Holmes-)Adie pupil features

A

benign condition, mostly affecting women

  • unilateral in 80% of cases
  • dilated pupil - efferent pupil defect
  • once the pupil has constricted it remains small for an abnormally long time
  • slowly reactive to accommodation but barely to light
35
Q

management of open-angle glaucoma

A
  • prostaglandin analogue drops (eg. latanoprost)
  • can then offer beta-blocker (eg. timolol), carbonic anhydrase inhibitor (eg. acetazolamide) or sympathomimetic eyedrop (eg. brimonidine)
  • surgery (trabeculectomy) or laser treatment
  • follow up!
36
Q

explanation of glaucoma management

A

prostaglandin analogue (eg. latanoprost)

  • increased uveoscleral outflow
  • AEs = brown pigmentation of iris, extra eyelash length

beta blocker (eg. timolol)

  • reduced aqueous production
  • avoid in asthmatics/heart block

carbonic anhydrase inhibitors (eg. acetazolamide)
- reduced aqueous production

sympathomimetics (eg. brimonidine - alpha2 adrenoceptor agonist)

  • reduced aqueous production
  • increased uveoscleral outflow
  • avoid in those on MAOIs/TCAs
  • AEs = hyperaemia

miotics (eg. pilocarpine - muscarinic recetptor agonist)

  • increased uveoscleral outflow
  • AEs = constricted pupil, blurred vision, headache
37
Q

management of acute closed angle glaucoma

A

urgent referral to ophthalmology
management options include:
- inducing pupillary constriction with topical pilocarpine
- timolol (BB)
- apraclonidine
- reducing aqueous secretions with IV acetazolamide
- laser or surgery

38
Q

anterior ischaemic optic neuropathy features

A

risk factors of atheroscerosis increase risk

  • sudden, painless loss or blurring of vision in one eye
  • usually noticed upon waking from sleep (it is believed that the normal drop in blood pressure during sleep triggers an interruption of blood flow to the optic nerve)
39
Q

anterior ischaemic optic neuropathy FUNDOSCOPY features

A
  • central flame haemorrhages localised around optic disc
  • cotton wool infarcts localised to disc
  • peripheral retina clear (if not then consider retinal vein occlusion)
40
Q

age-related macular degeneration (AMD) features

A

subacute onset of visual loss with:

  • reduced visual acuity, particularly close objects - may have distortion (eg. bent lines)
  • night blindness
  • day to day fluctuations in visual disturbance
  • photopsia (flashing lights/glare)
41
Q

dry vs wet AMD signs

A

90% AMD = dry

  • dry = geographic atrophy, drusen
  • wet = neovascularisation, haemorrhage
42
Q

retinitis pigmentosa features

A

associations with various rare diseases, including Alport’s

  • night blindness often first
  • tunnel vision due to loss of the peripheral retina
  • fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina
43
Q

what is Hutchinson’s sign?

A
  • vesicles extending to the tip of the nose

- this is strongly associated with ocular involvement in shingles (anterior uveitis)

WFH (18 decks)

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