Ophthalmology 2 Flashcards
What is blepharitis?
Inflammation of eyelid margins
Meibomian gland dysfunction
What is a stye?
Infection of the glands of the eyelid
What is a chalazion?
Meibomian cyst
What is entropion?
In-turning of eyelids
What is ectropion?
Out turning of eyelids
Mx stye (2)
Hot compress and analgesia
A dendritic corneal ulcer is a common presentation of what condition?
Herpes simplex keratitis
Herpes simplex keratitis features (5)
Red, painful eye,
Epiphora - excessive tear production
Photophobia
Reduced vision
Fluorescein staining for herpes simplex keratitis may show?
Epithelial ulcer
Rx herpes simplex keratitis (2)
Urgent ophthalmology referral
Aciclovir
Vesicular rash around eye = which condition?
Herpes zoster ophthalmicus
What is Hutchinson’s sign?
Which condition?
Rash on the tip or side of the nose
Herpes zoster ophthalmicus
Mx herpes zoster ophthalmicus (3)
When should treatment start?
Urgent ophthalmology review if eye involvement
Oral aciclovir for 7-10 days
Topical steroids if any inflammation of the eye
Start within 72 hours
Hypertensive retinopathy classification (4)
I - arterial narrowing + tortuosity, silver wiring
II arteriovenous nipping
III - cotton wool exudates, flame and blot haemorrhages
IV - papilloedema
Bacterial (2) versus viral conjunctivitis (3)
Bacterial - purulent discharge, eyes tuck together
Viral - serous discharge, recent URTI, pre-auricular lymph nodes
Mx infective conjunctivitis
How long will it last?
Rx for non pregnant and pregnant people
Normally self limiting 1-2 weeks
Chloramphenical drops 2-3 hourly or ointment QDS
Pregnant - Fusidic acid rx BD
What is keratitis?
Inflammation of the cornea
Pseudomonas aeruginosa causing keratitis is seen in what kind of patients?
Contact lens wearers
Most common bacteria causing keratitis
Staph Aureus
Amoebic keratitis more common with exposure to?
Soil or contaminated water
Keratitis features (4)
Red painful eye
Grittiness
Hypopyon - pool of white cells
Photophobia
Mx keratitis (2)
Topical quinolones
Cycloplegic for pain relief
What is epiphora?
Watering eye
What is dacryocystitis?
Infection of the lacrimation sac
Dacryocystitis features (2)
Epiphora
Swelling and erythema at the inner canthus of the eye
Congenital lacrimal duct obstruction usually resolves at what age?
12 months
Causes of mydriases (dilated pupil) (3)
Third nerve palsy
Phaeo
Holmes adie
What is the most common cause of a persistent watery eye in an infant?
Nasolacrimal duct obstruction
Nasolacrimal duct obstruction mx (1)
Majority resolve in how long?
When do you refer?
Massage of lacrimal duct
Majority resolve by 1 year
Otherwise ophthalmology referral
What is hyphema?
Mx (3)
Blood in the anterior chamber of the eye
Strict bed rest + daily ophthal review + daily IOP checks
Rock hard eyelids
RAPD
Proptosis
Eye pain
=
Orbital compartment syndrome
Orbital compartment syndrome mx
Urgent lateral canthotomy
Causes of optic neuritis (3)
MS
Diabetes
Syphyillis
Pain worse on eye movement
RAPD
Central scotoma
Red desaturation (poor differentiation of colours)
Unilateral decrease in visual acuity over hours or days
= which condition?
Optic neuritis
Mx optic neuritis
Recovery length
High dose steroids
4-6 weeks
Features of papilloedema (6)
Venous engorgement
Loss of venous pulsation
Optic disc blurring
Elevation of optic disc
Loss of optic cup
Paton’s lines
VELLOP
Papilloedema causes (8)
Hydrocephalus
Idiopathic intracranial hypertension
Malignant hypertension
Vitamin A toxicity
Hypoparathyroidism
Space occupying lesions
Hypercapnia
Hypocalcaemia
What is glaucoma?
Optic neuropathies associated with raised IOP which in turn damages the optic nerve
Raised IOP =
IOP >24mmHg
Open angle glaucoma Mx
1st line (1)
2nd line (3)
1st line
PG analogue
2nd line
BB
Carbonic anhydrase inhib
Sympathomimetic eyedrop
Example of PG analogue
Latanoprost
Example (2) of BB in context of eye drops
Timolol
Betaxolol
Sympathomimetics example
Brimonidine
Carbonic anhydrase example (1)
Dorzolamide
Miotics examples (1)
Pilocaripine
All except which two medications reduce aqueous production?
(Medications for the management of primary open angle glaucoma)
Miotics
PG analogues
RF glaucoma (7)
Age
FH
Afro Caribbean
Myopia (near sightedness)
HTN
DM
Steroids
Open angle glaucoma features
Onset
(2 further features)
Insidious
Peripheral visual field loss (tunnel vision)
Optic disc cupping
Name five fundoscopy signs of POAG
Optic disc cupping
Optic disc pallor
Bayonetting of vessels
Cup notching
Disc haemorrhages
Severe pain, red eye
Vision loss
Haloes
Semi-dilated pupil
Hazy cornea
= which condition?
Acute angle closure glaucoma
Red eye, pain, visual loss following intraocular surgery =
Endophthalmitis
Purulent discharge, clear discharge =
Bacterial/ viral conjunctivitis
Trauma + coughing bouts + red eye + normal vision =
How long till it resolves?
Subconjunctival haemorrhage
2-3 weeks
Severe pain, worse on movement, underlying autoimmune condition =
Scleritis
Small, fixed, oval pupil, ciliary flush
Pain, red eye, blurred vision and photophobia =
Anterior uveitis
What is RAPD?
AKA
Swinging light test
Pupil dilates when light is shone
Marcus Gunn pupil
RAPD causes (2)
Retinal detachment
Optic neuritis
Pupillary light reflex
Nerves
In on two out on three
Retina –> optic nerve –> lateral geniculate body –> midbrain
Edinger Westphal nucleus (midbrain) –> occulomotor nerve
New onset floaters or flashers
Sudden onset, painless progressive visual field loss
Curtain or shadow
Loss of red reflex =
Retinal detachment
Retinal detachment RF (5)
Diabetes
Myopia (near sightedness)
Age
Prev surgery for cataracts
Eye trauma
Tunnel vision
Night blindness is the initial sign
Black bone spicule shaped pigmentation =
Retinitis pigmentosa
RA ocular manifestations (x5 total)
Most common =
Keratoconjunctivitis sicca
Episcleritis
Scleritis
Corneal ulceration
Keratitis
What is the cover test in identifying the nature of a squint?
Mx
Ask the child to focus on an object
Cover one eye
Observe movement of the other eye
Cover other eye and repeat test
Mx refer to secondary care
