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Specialities > Ophthalmology 3 > Flashcards

Ophthalmology 3 Flashcards

1
Q

What are the signs of a retrobulbar haemorrhage? And what are the investigations? What is the treatment?

A

Severe pain
Proptosis
Reduced visual acuity
Subconjunctival haemorrhage

  • Periorbital ecchymosis and eyelid haematoma may also be seen if trauma related.

investigation:
- usually clinical diagnosis
- CT head
- Bloods - coagulation studies as this may be the cause

Treatment:
- lateral canthotomy with cantholysis

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2
Q

What are the signs of orbital cellulitis, what are the investigations and management?

A 
Proptosis 
Restricted movement 
Reduced visual acuity 
RAPD 
Diploia

Investigation:
- CT sinus and orbits with contrast

Management:

  • Ophthalmology referral
  • IV antibiotics
  • surgical drainage by ENT
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3
Q

Describe the management of corneal abrasions:

A

irragation
Check pH 20mins later to ensure no caustic damage

Discharge with chloramphenicol

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4
Q

Following an acid burn to the eye - what may be seen?

A

White patch over the area affected - instead of it being red as you would expect. this is because the vessels have been damaged along with the stem cells.
- needs follow up in ophthalmology

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5
Q

If there is a foreign body in the eye - where else should always be checked?

A

Under the eyelids

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6
Q

What important question should always be asked in the setting of a corneal ulcer and if the answer is yes, what should be asked for:

A

If they wear contact lenses

- if yes you should ask for them to bring it in so the lenses can be sent off for analysis

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7
Q

On examination what can differentiate an ulcer from an abrasion?

A

An ulcer can be seen as a white pale patch on the eye, whereas abrasion needs fluorescein to be seen

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8
Q

In the setting of a painful red eye, which symptom is always correlated with closed angle glaucoma?

A

Vomiting

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9
Q

What is the immediate management of endophthalmitis?

A

Intra-vitreous injection of antibiotics within the hour of onset

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10
Q

What are the risk factors for retinal detachment?

A 
Myopia 
Trauma 
Family history 
Marfan's syndrome and other connective disorders 
Previous surgery
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11
Q

Why is there a cherry red spot on pale retina in central retinal artery occlusion?

A

The cherry dot is the fovea which is non- vascularised and thus appears relatively normal

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12
Q

What is the management of central retinal artery occlusion?

A

Require Head CT
*referral to TIA clinic

300mg Aspirin for 2 weeks:
then: aspirin + Clopidogrel

Ocular massage

  • this is a TIA and should be treated as such
  • treat within 6 hours.
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13
Q

What is the antibiotics used for corneal ulcers?

A

Ciprofloxacin drops
+ / -
PO drops

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14
Q

How is pre-septal cellulitis treated in children?

A

IV ceftriaxone

This differs from adults which are usually treated with PO floxacillin.
this is because the septal orbit hasn’t fully formed in children.

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15
Q

Name some of the intracranial complications of orbital cellulitis:

A

Brain abcess

Meningitis

Cavernous sinus thrombosis

Retinal artery/ vein occulusion

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16
Q

What is the part of the conjunctivia which sits over the sclera and what is called when it swells?

A

Bulbar conjunctivia

Chemosis

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17
Q

What tests are needed in keratitis?

A

corneal scrapings

Fluorescein staining

Contact lens cultering

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18
Q

In contact wearers which infectious organisms should you suspect when keratitis is not improving?

A

Acanthamoeba

*should be thought about whenever someone wearing contacts goes swimming as well

19
Q

What is the most common cause of blindness in the UK, what are some signs and what investigations are done?

A

ARMD

Signs:

  • reduced central vision loss
  • distortion of lines (seen with Amsler grid testing)
  • Drusen spots on fundoscopy

Investigations:

  • slit lamp examination
  • Fluorescein angiography (if suspected wet ARMD)
  • OCT
20
Q

What are some risk factors for orbital cellulitis?

A

Childhood
Sinus infection
Non- vaccination of Hib
Facial infection

21
Q

If a contact lens wearer presents with symptoms of keratitis, how should they be managed?

A

Referral same day for assessment

- they can develop pseudomonas infection which can be sight threatening

22
Q

What are some risk factors for vitreous haemorrhage?

A 
Diabetes - neovascularisation can cause bleeding 
Trauma 
Anti-coagulation 
Bleeding disorders
Retinal tears

*vitreous haemorrhage is what it says, bleeding into the vitreous compartment which can obscure vision - not strictly a vitreous detachment

23
Q

How do you diagnose a tropia?

A

Cover test:

Cover the contra lateral eye and the problematic eye should move into position to take focus

24
Q

What are some of the complications of VZV infection of the eye and what is the classic sign?

A

Sign:
- Hutchison’s sign

Complications:

  • anterior uveitis
  • keratitis
  • ptosis
25
Q

How is visual acuity assessed in a baby/ toddler?

A

Gratings - 10 weeks old
*lines on a baord which a child will follow when compared to a grey board

Kay pictures
- 3 years old

26
Q

How is retinoblastoma inherited? how does it present? and how is it investgiated if suspected?

A

Autosomal dominant

Presentation:

  • Leukocoria
  • Strabismus

Eye examine under anaesthetic
RETcam + fluorescein
B scan

Treatment:
- enucleation of eye

27
Q

How are the zones of retinopathy of prematurity classified?

A

By the circumference they make moving into towards the macula
- the closer the higher the zone

28
Q

Which three people should be contacted when there is a case of orbital cellulitis?

A

Paediatrician
ENT
Ophthalmology

29
Q

What are the differences between pre-septal and orbital cellulitis?

A

Orital:

  • reduced visual acuity
  • exophthalmos
  • reduced movement
  • RAPD present
30
Q

When is the synaptic pathways from the optic nerve to the brain said to be finsihed by?

A

6-8 years old

31
Q

What are the causes of Uveitis?

A

Idiopathic

TB

Trauma

Autoimmune
- seronegative arthritis

Inflammatory bowel disease

VZV - herpes zoster opthalmicus

32
Q

What examinations do you want to do into someone presenting with a painful red eye?

A

Visual acuity test

Pupil examination

  • equal
  • RAPD
  • reactive to light

Fundoscopy

Measure IOP

Slit lamp examination

33
Q

What sign are seen in anterior uveitis?

A

Keratic precipitates

Posterior synechiae

Hypopyon

Conjunctival injection

White cells in the anterior chamber

34
Q

What is the treatment of anterior uveitis?

A

Topical steroids

Mydriatic eye drops

  • cyclopentolate
  • breaks the posterior synechia
35
Q

What does the uvea consist of?

A

iris, ciliary choroid

*choroid is bit between the sclera and retina

36
Q

What are the differentials for seeing flashing lights?

A

Posterior vitreous attachment

Retinal Tear

Retinal detachment

Ocular Migraine

37
Q

What sign may be seen if there has been a retinal break?

A

Shafer’s sign

38
Q

What is a sign that may be seen in the back of the eye which is suggestive that there may be a retinal detachment about to come in following weeks?

A

Weiss ring

- type of floater

39
Q

What type of refractive error is associated with retinal detachment?

A

Myopia

- eyeball is large

40
Q

What is the treatment for retinal tear?

A
  • *this is for a tear not a detachment
  • Laser Retinopexy

creates a scar around the tear preventing further from detaching

41
Q

Which sex is more likely to develop acute angel closure?

A

Females

42
Q

What sign may be seen on fundoscopy of acute angle closure?

A

Hazy to see
- due to cornea

High cup to disc ration

43
Q

Prior to giving Mannitol or carbonic anhydrase medication for acute angel glaucoma what do you want to check?

A

There is no renal issues.

44
Q

What is the general management of acute angle closure?

A 
Break the attack: 
- systemic Acetazolamide
or 
- Mannitol 
\+
- Timolol 
\+
- Pilocarpine

**treat both sides

Prevent further attack
- Laser iridotomy 
or 
- Cataract surgery (remove the bulky lens)
or 
- Trabeculectomy (creates a pleb)

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