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4 - Med > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

what is the function of the trabecular mesh ? another name for this ?

A

canal of schlemm
- drains aqueous humour, helps reduce pressure of eye

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2
Q

what does the lens separate in the eye ?

A

separates anterior + posterior compartments of the eye

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3
Q

what is found in anterior chamber ? what in posterior ?

A
  • anterior: aqueous humour
  • posterior: vitreous humour
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4
Q

what is the cornea - function ?

A

outer most layer of the eye
- helps with light refraction

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5
Q

what produces the aqueous humour ?

A

ciliary body

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6
Q

what forms the uvea ? (3)

A
  • iris
  • ciliary body
  • choroid
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7
Q

which structures involved in anterior uveitis ?

A

iris and ciliary body

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8
Q

what is a normal intraocuular pressure ?

A

10 - 21 mmHg

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9
Q

name some causes of acute painful red eye ? (6)

A
  • acute angle closure glaucoma
  • anterior uveitis
  • scleritis
  • corneal abrasion
  • keratitis
  • foreign body
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10
Q

name some causes of acute painless red eye ? (3)

A
  • conjunctivitis
  • episcleritis
  • sub-conjunctival haemorrhage
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11
Q

what is keratitis ?

A

inflammation of the cornea

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12
Q

keratitis aetiology ? most common ?

A

viral (more common): HSV
bacterial (more common in lens wearers)

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13
Q

viral keratitis px ?

A
  • red, painful eye
  • photophobia
  • tears
    (can present as recurrent infections )
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14
Q

dendrites shape ulcer seen on fluorescent dye test. what is causing it ?

A

HSV keratitis

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15
Q

viral keratitis mx ?

A
  • urgen opthal r/v
  • topical aciclovier
  • coreanal transplant (if permanent scarring and vision loss after keratitis)
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16
Q

bacterial keratitis mx ?

A

topical Obx (ofloxacin)
(common in lens wearers)

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17
Q

bacterial conjunctivitis px ? what features does it not have ?

A

acute onset: red eye (can be painful, but not usually)
- eyes sticking
- yellowy mucus
(no photophobia or reduced visual acuity)

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18
Q

bacterial conjuncitivial common pathogen ? mx ?

A

commonly s.aureus
- tx: topical chloramphenicol
- good hygiene

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19
Q

neonatal conjunctivitis mx ?

A

urgen opthal r/v (as can be gonococcal infection)

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20
Q

allergic conjunctivitis mx ?

A

antihistamines (oral of topical)

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21
Q

what can cause scleritis ? (3)

A
  • idiopathic (no clear cause)
  • underlying systemic inflammation condition
  • infection (s.aureus)
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22
Q

RA has associated with what condition ?
sero negative spondyloarthropathies have association with what condition ?

A
  • RA/vasulitits (GPA): scleritis
  • seronegative spondyloarthropathies): anterior uveitis
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23
Q

whith which other conditions is scleritis often associated with ? (2)

A
  • RA
  • vasculitis (often GPA)
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24
Q

scleritis ps x ? (5)

A

more gradual onset, uni or bilateral
- very painful (wake up at night) red eye
- pain with eye movement
- photophobia
- associated with vision loss
- excessive tear production

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25
scleritis mx ?
- urgent opthal r/v - steroids - consider immunosuprresions if due to underlying systemic condition
26
how to distinguish between epi vs scleritis ? (2)
- scleritis has pain - scleral vessels don't blanch with phenylephrine drops whereas epi vessels do
27
what is open angle glaucoma ? pathophys
optic nerve damage caused by raised intraocular pressure - caused by blockage to aqueous humour trying to escape eye due to gradual increase in resistance through trabecular meshwork
28
how does open angle glaucoma affect optic disc ?
leads to cupping of optic disc => optic cup > 0.5 size of optic disc
29
open angle glaucoma RF ? (3)
- increasing age - FHx - near sightedness
30
open angle glaucoma px ? (5)
often asx for a long time - affects peripheral vision first: progressive constraint visual field over months => tunnel vision - visual acuity remains good - headaches - halos around lights - fluctuating pain (peripheral vision loss + halos)
31
open angle glaucoma ix ? what would they show ?
- non contact tonomtery (raised pressure - funcdoscopy (cupping of optic disc)
32
open angle glaucoma mx ? what definitive procedure ?
aim to reduce intraocular pressure - prostaglandin analgye (first line): latanoprost eye drop - BB: topic timolol - surgery: (when eye drops ineffective): trabeculectomy
33
eye prostaglandin analogue SE ?
- luscious eye lashes - eyelash pigmentation - iris pigmentation
34
what is acute angle closure glaucoma ? pathosphsy
ophthalmology emergency optic nerve damage caused by increased intraoccqular pressure caused by blockage of aqueous humour form the eye - iris bulges forward (closed angle) => blacks trabecular meshwork -
35
acute angle glaucoma complciaiton
opthalmology emergency - can cause permanent loss of vision
36
acute angle glaucoma px ?
ps appears unwell - severely painful red eye - blurred vision - hallos - headache - headache - N+V (peripheral vision loss + halos)
37
acute angle glaucoma O/E ? (3)
- red teary eye - reduced visual acuity - mid dilated non-active pupil
38
acute angle glaucoma mx ? immediate ? definitive ?
acetazolamide and ambulance - once in secondary care: laser iridotomy (hole in iris)
39
What is age related macular degeneration ?
progressive condition affecting macula of the eye - most common cause of blindness in UK (often unilateral, can be bilateral)
40
what are the types of age related macular degeneration ?
wet (10%) dry (90%) Drusen !
41
age related macular degeneration RF ? (4)
- age - smoking - FHx - obesity
42
age related macular degeneration px ?
- unilateral gradual vision loss (central scotoma) - poor visual acuity - things appearing small + wavy (metamorphopsia)
43
age related macular degeneration O/E ? (4)
- reduced visual acuity - central scotoma - amsler grid test (distortion of straight lines) - drusens (seen on fundosocpy)
44
age related macular degeneration Mx ? for the 2 types ?
- dry: not much you can do - wet: anti VEGF (ranibizumab) injected into eye once a month (intravitreal injection)
45
describe general px of: - glaucoma - AMD - cataracts
- glaucoma: peripheral vision loss + halos - AMD: central vision loss + wavy appearance to straight lines - cataracts: generalised reduction in visual acuity + starburst around light
46
What is central retinal artery occlusion ?
occurs due to obstruction to blood flow through central retinal artery
47
causes of central retinal artery occlusion ? (2)
- atherosclerosis - GCA
48
central retinal artery occlusion RF ? (4)
(CVD RF) - smoking - HTN - DM - high cholesterol
49
central retinal artery occlusion px ?
sudden painless loss of vision (like curtain over vision)
50
central retinal artery occlusion O/E ? fundoscopy ?
- relative afferent pupillary defect (absent direct but normal consensual reflex) - fundoscopy: pale retina with a cherry red spot (due to lack of blood perfusion)
51
central retinal artery occlusion mx ? (3)
emergency (attempt to dislodge or dissolve occlusion) - if GCA suspected: high dose steroids - topical timolol (reduce intraoccqular pressure) - secondary prevention of CVD
52
causes of sudden painless vision loss ? (4)
- central retinal artery occlusion - retinal detachment - central retinal vein occlusion - vitreous haemorrhage
53
what is amaurosis fugax ?
temporary loss of vision due to temporary interruption to blood supply
54
What is retinal vein occlusion ?
thrombus forms in retinal vein => blocks drainage of blood from retina - can be central retinal vein or branched retinal veins
55
retinal vein occlusion px ?
painless blurred vision/vision loss
56
retinal vein occlusion O/E ? (4)
- tortuous dilated retinal veins (pizza pie) - flame + blot haemorrhages - retinal oedema - cotton wool spots
57
retinal vein occlusion mx ?
immediate opthal r/v - anti VEGF
58
what is posterior vitreous detachment ?
when vitreous body comes away form the retina - common in older age (becomes less firm with age)
59
posterior vitreous detachment px ? (4)
- can be asx - painless - floaters - blurred vision
60
posterior vitreous detachment mx ?
no tx needed
61
posterior vitreous detachment complication ?
can increase risk of retinal tears + detachment
62
what is retinal detachment ?
retina separates from retinal pigment epithelium (usually due to retinal tears) - sight threatening condition
63
retinal detachment px ?
painless - peripheral vision loss - blurred distorted vision - flashing/floaters
64
retinal detachment mx ?
vitrectomy
65
What are cataracts ?
when lens of the eye becomes progressively opaque => reduced visual acuity
66
cataracts RF ? (5)
- old age - smoking - alcohol - DM - steroids
67
cataracts px ?
- asymmetrical slow reduction in acuity - faded colours - starburst around light
68
cataracts O/E ? (2)
- loss of red refelx - lens appears grey/white with ophthalmoscope
69
catatracts mx ?
cataract surgery
70
what is hypertensive retinopathy ?
damage to small blood vessels in retina relating to HTN (slowly due to chronic HTN, or quickly due to malignant HTN)
71
hypertensive retinopathy features ? (4)
- cotton wool spots (due to ischaemia + infarction) - retinal haemorrhages - flame haemorrhages - papiloedema
72
what is blepharitis ? can lead to what ?
inflammation of eyelid margins (can lead to styes
73
blepharitis px ?
- gritty - itchy - dry sensation to eyes
74
blepharitis mx ?
- warm compress - cleaning eyelid margin to remove debris
75
what are styes ?
tender red lump along eyelid that may contain pus
76
syte mx ?
- warm compress + analgesia - if sx persist or sx of conjunctivitis: topical abx (chloramphenicol)
77
what is entropion ?
when eyelid turns inwards + lashes presses against eye
78
entropion px ? (2)
- pain - corneal damage
79
entropion mx ?
taping eyelid down
80
what is periorbital cellulitis ? where exactly ? needs to be differentiated form what ?
eyelid + skin inferno in form of orbital septum - needs to be differentiated form orbital (sigh + life threatening)
81
what can distinguish peri from orbital cellulitis ?
CT scan
82
periorbital cellulitis px ?
swollen, red, hot skin
83
periorbital cellulitis mx ?
systemic abx - can develop to orbital cellulite so consider admission for monitoring
84
orbital cellulitis px ?
- pain with eye movement - visual changes - abnormal pupil reactions - proptosis
85
orbital cellulitis mx ?
- emergency admission - IV Abx - consider surgical drainage if abscess forms
86
What is diabetic retinopathy ? pathophys
it is damage to retinal blood vessels due to prolonged high blood super levels - hyperglycaemia damages retinal small vessels => leaky blood vessels => blot haemorrhages + hard exudates (yellow deposits on retina)
87
what are the types of diabetic retinopathy ?
- proliferative (new blood vessel dev - neovascularisation) - non-proliferative
88
diabetic retinopathy mx ?
- anti VEGF - PRP (pan-retinal photocongenlation)
89
diabetic retinopathy complications ?
- blindness - retinal detachment - vitreous haemorrhage
90
what is anterior uveitis ?
it is inflammation of anterior part of urea (iris and ciliary body)
91
what causes anterior uveitis ? (3)
- usually caused by autoimmune process - though can be infection - or trauma
92
anterior uveitis px ? (3)
- painful red eye - reduced visual acuity - photophobia
93
anterior uveitis O/E ? (3)
- ciliary flush (redness coming out from in) - miosis + abnormally shaped pupil - hypopyon (inflammation cells collected as white fluid in anterior chamber)
94
anterior uveitis mx ?
- urgent opthal r/v - steroids: topical, oral, IV - atropine eye drops
95
optic neuritis px ? key features ? (4)
unilateral reduced vision - central scotoma - pain with eye movement - impaired colour vision - relative afferent pupillary defect

4 - Med (21 decks)

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