Ophthalmology 2 Flashcards
In addition to the ptosis, anhidrosis and miosis what other feature may be seen in Horner’s syndrome?
Enophthalmos
- posterior displacement of the eye
Iris heterochromia
How does fundoscopy of the eye appear when there is a central vein occlusion?
Like a Cheese and tomato pizza
- oedema
- Optic disc swelling
- Dilated vessels
- Haemorrhages
How is episcleritis differentiated from scleritis?
Pain
- scleritis is painful
*both may have watering and visual changes
Treated with NSAIDs
What investigation should be done into orbital cellulitis to assess degree of spread/ complications?
Contrast enhanced CT of:
- orbit
- sinuses
- Brain
What are the different types of amblyopia in children?
Strabismic
- esotropia
- Exotropia
Refractive
- long/ short sighted
Deprevitional
- cataracts
What is it called when there is a complete cure of the squint via glasses?
Fully accommodative squint
A partially accommodative squint is when there is still some squint even after glasses.
When is the red reflex carried out in babies, and list some differentials for leukocoria:
New-born baby check and 6 week baby check.
Cataracts
- most common
Retinoblastoma
Congenital syphilis - scarring of the cornea
Toxoplasmosis
- congenital cataracts
Uveitis
What eye pathology is seen in NF-1? and in Down syndrome?
Lisch nodules
- iris hamartomas
Down syndrome:
- Brushfield spots
What is the most common cause of viral keratitis and how does it present?
HSV -1
Dendritic pattern
*may be vesicular to begin with
List some symptoms the patient may experience with cataracts:
Blurring of vision
Dazzling of light
- especially at night
Myopia of vision
- use their reading glasses less
- the lens focuses the light more
Squint / nystagmus
Which medication given for acute angle glaucoma causes eye lashes to lengthen?
Latanoprost
What is the treatment for anterior uveitis and name a common disease it is associated with:
Topical steroids
+
Cycloplegics such as cyclopentolate
Associated with Ulcerative colitis
What is the definitive diagnostic investigation for acute closed angle glaucoma?
Tonometry will be the one that establishes pressure
Gonioscopy
- allows differentiation between open and closed angle glaucoma
What is surgery carried out for acute closed angle glaucoma?
Laser Iridotomy
- small hole into the iris allowing an alternative route for aqueous humor to leave
During a visual acuity testing, when the patient looks through the pinholes and vision improves - what is this suggestive of?
Refractive error
How should anisocoria be assessed? and what do some findings suggest?
Assessed in light and dark
Smallest in dark pupil in dark is pathological one
Largest in the light is the abnormal one
List some causes of absent light reflex on fundoscopy:
Dense cataracts
Retinal detachment
Vitreous haemorrhage
Tumour
How can you identify true strabismus in a child’s eye?
Where the light reflects
- it should reflect equally in the pupils.
*note you can get a pseudostrabismus where the reflection of light is equal but cause of epicanthal folds it may appear like stabismus
Cover test
What are some risk factors and investigations should be done into retinal detachment?
Risk factors:
- Trauma
- DM
- Previous cataract surgery
- Myopia
- Retinopathy of prematurity
Investigations:
Slit lamp examination
OCT
B-Scan - ultrasound scan
Define tropia and phoria:
tropias are when the eyes are squint even when trying to focus on the same target.
- can be brought on by cover test
phorias are misalignment brought on when the eyes stop synchronising together to focus on the same thing. in other words, the only reason they are no tropia is because the muscles are focusing it.
- brought on by cross cover test
Basically this demonstrates if the squint is paralytic or not. if when covering the good eye, the squint eye realigns - it tells you its not paralytic.
What is it called when the lens loses its accommodative capacity?
Presbyopia
What are the medical terms for lens, artificial lens and lens removal?
Phakic
Pseudophakic
Aphakic
Before dilating ones eyes what must first be checked?
Intraocular pressures
What is the surgery done for cataracts and what are some potential complications?
Phacoemulsion + intraocular lens inplacement
Complications:
- Endophthalmitis
- Posterior capsule thickening
- Acute angle glaucoma
- retinal haemorrhage
What does a vertical anopia suggest?
A neurological cause to the loss of vision
Horizontal vision occlusion is much more suggestive of a retinal defect. i.e. retinal detachment is more likely to cause horizontal vision loss
In a >40 year old with unilateral optic nerve swelling what is the biggest cause?
GCA
List some investigations that should be done into central artery occlusion:
Bloods: - CRP - ESR (thinking GCA) - lipids - coagulation *consider other causes of stroke
X-rays:
- temporal US
- Carotid US
- echocardiogram (clots thrown off)
ECG
- A fib?
What is the most common cause of central retinal vein occlusion and how is it managed?
HTN
Atherosclerosis
Glaucoma
polycaethemia
Investigation:
- Fluorescein Angiography
- OCT
- Slit lamp examination
Treatment: - control HTN - VEGF injections \+/- - intra-ocular steroids to control macular oedema
*it is the macular oedema which causes the vision loss
What is the diagnostic investigations for vitreous haemorrhage? and what are the two main causes?
B scan
- diabetes
- trauma
What is called when there is blood in the anterior chamber of eye?
Hyphema
What is the differentials for a fixed dilated pupil?
Mydriatics
- tropicamide
Iris trauma
Acute glaucoma
CN3 compression/ palsy
What is the condition associated with a non-responsive constriction to light and sluggish accommodative reflex? name some other features and the systemic syndrome:
Holme’s Adie - pupil.
- worm like movements of iris on slit lamp (small parts of iris trying to dilate) - Tonic
- failure to constrict to light and slow to accommodation
- usually unilateral becoming bilateral
Holme Adie Syndrome
- Holme’s adie pupil
- low BP
- loss of reflexes
What is the diagnostic investigation into glaucoma and what is the investigation to differentiate between open and closed?
Tonometry - goldman application
Gonioscopy - to differentiate
What are the features of anterior uveitis and what conditions is it associated with?
What is management?
Small - irregular shaped pupil Posterior synechia Keratic precipitates Hypopyon Ciliary flush
Causes:
- Seronegative arhropathies
- Bechets
- inflammatory bowel disease
- TB
- syphilis
Management:
- refer same day to ophthalmology
- investigate cause
- topical steroids
- cycloplegics to prevent iris and lens adherence (synechia)
What is seen on fundoscopy of a central retinal artery occlusion?
Pale retina with red cherry fovea - which retains its redness since it is usually avascular structure
What are the 4 F’s and P to retinal tear?
Floaters Flashes Field loss Fall in acuity Painless
What is the organism that causes keratitis in those with contact lenses, typically contracted from swimming pools?
Acanthamoeba
What is the management of central retinal artery occlusion?
If within the first 100mins then the aim is to increase ocular blood flow. This includes: - ocular massage - surgical removal of aqueous humour - Intraocular hypotensive treatment
What vision loss is expected in ARMD?
Central vision
- the macula is affected
What testing can be done to test for visual distortion in wet macular degeneration?
Amsler grid
What are the treatment options for wet Macular degeneration?
Photocoagulation
intra-ocular Anti-VEGF injections
Antioxidant vitamins - Vitamin C, + Zinc
What are the risk factors for chronic open angle glaucoma?
Family history Black afro Caribbean >35 years old Steroid use Myopia
What is the most common cause of blindness world wide?
Trachoma
- form chlamydia
followed by cataracts
What are the visual changes that occur in cataracts?
Increasing myopia
Blurring of vision
dazzling of light at night
Yellowing of vision
*children may have nystagmus
What is the surgery for cataracts and list some potential complications:
Phacoemulsion + lens replacement
Side effects 1%:
- anterior uveitis
- retinal detachment
- vitreous haemorrhage
- Endophthalmitis
Define entropion and ectropion:
Entropion
- lid turns inwards
Ectropion
- lid turns outwards risking keratitis
- usually lower lid, associated with aging and nerve palsies
In ptosis which muscle is weak?
Levator palpebrae superioris
What is the name of the tissue which can grow from the cornea across the eye obstructing vision?
Pterygium
Assocaitted with wind and sun exposure
What are the signs of a carotid- cavernous fistula?
Engorgement of eye vessels
Lid and conjunctiva oedema
Pusatile exophthalmos
eye bruit
What is the correction for myopia?
Concave lenses
List some causes of floaters and flashes:
Floaters:
- Retinal detachment
- Vitreous haemorrhage
- Hypertensive crisis
- Old retinal vein occlusion
Flashes:
- Retinal detachment
- migraine
- intracranial pathology
How is chlamydia trachoma spread and what is the treatment?
Spread by flies which causes infection under the lids causing scarring and entropion leading to blindness.
Treatment:
- Tetracycline ointment + oral tetracycline
Name some drugs used in ophthalmology which are anti-muscarinics and what is an important fact about them?
Tropicamide
Cyclopentolate - paralysing agent
there is loss of pupillary light reflex
*this drug is a mydriatic
Name some drugs used in ophthalmology which are sympathometics and name an important fact about them:
Para-hydroxyamphentamine
Phenylephrine
- there is no loss of pupillary light reflex.
- this drug is a mydriatic
Name some drugs which can be used to diagnose and localise horners syndrome:
Topical hydroxyamphetamine
- will promote release of noradrenaline. if the 3rd order neuron is not the one damaged it will release its noradrenaline and cause dilation. localising the lesion to the 1st or 2nd order neuron
Topical Apraclonidine
-alpha 2 agonist. Will cause dilation of the horner’s eye and constriction of the normal eye.
Name a miotic drug and its class:
Pilocarpine
- muscarinic agonist
What is the most common inherited cause of blindness, how does it present?
Retinitis Pigmentosa
- usually AR, but AD and x-linked exist
Loss of peripheral vision
Tunnel vision
Night blindness
