Ophthalmology Flashcards
What are the main causes of sudden loss of vision?
Non-arteritic anterior ischaemic optic neuropathy (NAION)
Giant cell arteritis
Acute angle-closure glaucoma
Retinal detachment
What causes acute angle-closure glaucoma?
Blocked drainage of aqueous humour from anterior chamber via canal of Schlemm
- iris could be pushed forward against trabecular meshwork
- pupil block
What are the signs and symptoms of acute angle-closure glaucoma?
Unilateral sudden vision loss PAIN Unilateral red eye Haloes around lights Headache N+V Fixed, dilated, oval-shapedpupil Eye may feel hard Cloudy cornea (due to oedema) Raised IOP (greter than 60mmHg) Hypermetropia Closed angle Symptoms worse in dark
What are the risk factors for acute angle-closure glaucoma?
Hypermetropia Family Hx Narrow anterior chamber Middle aged Race (Asian) Female
What is the treatment for acute angle-closure glaucoma?
Pilocarpine (to cause miosis) Acetazolamide (reduces formation of aqueous) Timolol (to reduce pressure) Apraclonidine (to reduce pressure) Peripheral iridotomy
What are the 3 types of retinal detachment?
- Serous (fluid collects between neurosensory retina and retinal pigment epithelium)
- Rhegmatogenous (retinal tear when vitreous passes through tear and separates retinal layers)
- Tractional (retinal scar tissue contracts and pulls retina off retinal pigment epithelium)
What are the signs and symptoms of retinal detachment?
Floaters
Photopsia (flashing lights)
Visual field loss
Visual acuity loss (if fovea affected)
What are the risk factors for retinal detachment?
Myopia
Retinal detachment in other eye
Poorly controlled diabetes
Trauma
What are the ophthalmological signs and symptoms of giant cell arteritis?
Sudden painful monocular vision loss Swollen optic disc RAPD Flame haemorrhages Cotton wool spots
What are the risk factors for giant cell arteritis?
Female
Polymyalgia rheumatica
Over 50 years old
Scandinavian
What are the signs and symptoms of non-arteritic anterior ischaemic optic neuropathy?
PAINLESS, monocular sudden loss of vision Swollen optic disc RAPD Splinter haemorrages Altitudinal visual field defect
How is NAION treated?
Treat CV risk factors
What are the risk factors for NAION?
Male Hypermetropia Hypertension 40-60 years old Diabetes
What are the common causes of acute red eye?
Infection:
- Corneal ulcer, infective keratitis
- Conjunctivitis
- Endophthalmitis
Inflammation:
- allergic conjunctivitis
- episcleritis
- scleritis
- anterior uveitis
Trauma:
- Corneal abrasion
- Subconjunctival haemorrhage
Other:
-Acute angle closure glaucoma
What is the anterior uvea?
The iris and the ciliary body
What are the signs and symptoms of anterior uveitis?
PAIN Photophobia Blurred vision Circumcorneal redness Small pupil (initially)
Which investigations are done in anterior uveitis?
Talbot’s test: Increased pain on convergence of eyes
Slit lamp test: Hypopyon (sterile anterior chamber pus)
Which conditions are associated with anterior uveitis?
Ankylosing spondylitis
Inflammatory bowel syndrome
Sarcoidosis
Infections (syphilis, TB, HSV, HZV)
What is the treatment for anterior uveitis?
Prednisolone drops
Cyclopentolate (to dilate pupil to prevent adhesions between lens and iris)
What is visual acuity like in:
1) conjunctivitis
2) anterior uveitis
3) acute glaucoma
1) normal
2) reduced
4) reduced
What is the pupil size in
1) conjunctivitis
2) anterior uveitis
3) acute glaucoma
1) normal
2) small
3) large
What is the IOP like in
1) conjunctivitis
2) anterior uveitis
3) acute glaucoma
1) normal
2) normal
3) increased
What is the cornea like in
1) conjunctivitis
2) anterior uveitis
3) acute glaucoma
1) normal
2) normal
3) hazy
Is photophobia present in:
1) conjunctivitis?
2) anterior uveitis?
3) acute glaucoma?
1) Yes
2) Yes (lots)
3) No
Is there pain in:
1) conjunctivitis?
2) anterior uveitis?
3) acute glaucoma?
1) Yes/No
2) Yes
3) Yes (lots)
How is keratitis identified?
A white area on the cornea (collection of WBCs in corneal tissue)
What kind of keratitis is there?
Bacterial
Viral (HSV)
What can keratitis lead to?
Corneal perforation
How is corneal ulceration identified?
Fluorescin drops (corneal lesions stain green) Blue light shone tangentially across eye
What can corneal ulceration be caused by?
Bacteria Viruses (herpes) Fungi Protozoa (acanthamoeba) Vasculitis (in RA)
What is the treatment for corneal ulceration?
Chloramphenicol
Aciclovor
What is a dendritic ulcer?
HSV corneal ulcer
Signs: Photophobia, eye watering
What is episcleritis?
Inflammation below conjunctiva in episclera
Engorged vessels can be moved over the area
Sclera may look blue under engorged vessels
What is the cause of episcleritis?
Usually idiopathic
May occur in rheumatic fever or SLE
What are the symptoms of episcleritis?
Acute onset of grittiness
Normal visual acuity
Localised redness of eye
No discharge
What are the signs and symptoms of scleritis?
Localised diffuse scleral hyperaemia
Tender
Pale areas within red zone= necrotising scleritis
Oedema of conjunctiva
What is the cause of scleritis?
50% idiopathic
50% with systemic associations (SLE, RA..)
How do bacterial conjunctivitis, viral conjunctivitis and allergic conjunctivitis differ in presentation?
Bacterial: mucopurulent discharge
Viral: Follicles, watery discharge
Allergic: Papillae
Is conjunctivitis usually unilateral or bilateral?
Bilateral
What is the most common cause of neonatal conjunctivitis?
Chlamydial
What is chalaizon?
Condition caused by inflammation of meibonium glands with secondary lipogranulomatous inflammation
More common in pts with seborrheic dermatitis and acne rosacea
How should corneal ulcers be managed?
- Smear for Gram stain
- Conjunctival swab to blood agar
- Corneal scrape
- Request cultures
Which questions to ask a patient with sudden loss of vision?
Headache associated?
Eye movements hurt (optic neuritis)
Lights/flashed before vision loss (retinal detachment)
Like a curtain descending (amaurosis fugax)
Poorly controoled diabetes?
What are the causes of gradual loss of vision?
Cataracts Age-related macular degeneration Open-angle glaucoma Diabetic retinopathy Hypertension Optic atrophy Slow retinal detachment Choroidal melanoma
What is the difference between wet and dry macular degeneration?
Dry- drusen and degenerative changes at the macula
Wet- vessels grow from choroid into neurosensory retina and leak. Visual distortion=key feature. Rapid visual deterioration.
What are the risk factors for age-related macular degeneration?
Old age Smoking Hypertension UV Hypercholesterolaemia
Does age-related macular degeneration affect central vision or peripheral vision?
Central
Which investigations are done to diagnose age-related macular degeneration?
Fluorescin angiography
Optical coherence tomography
What is the treatment and management of age-related macular degeneration?
Laser photocoagulation
Intravitreal anti-VEGF treatment (Ranibizumab, Pegaptanib, Bevacizumab)
Intravitreal steroids (Triamcinolone)
Vitamin C+E supplements
What does central retinal artery occlusion or retinal vein occlusion cause?
Sudden painless loss of vision
What are the risk factors for the development of open angle glaucoma?
Raised IOP Family history of glaucoma Age Diabetes Myopia Race- Afro-Caribbean
What are the signs and symptoms of open angle glaucoma?
Gradual painless loss of peripheral visual field Optic nerve head damage (disc cupping) Raised IOP Bilateral, but often asymmetric Normal blind spot with scotomas
How is IOP measured?
Tonometry
What is the treatment for open-angle glaucoma?
Suppressing aqueous formation
- Beta blockers
- carbonic anhydrase inhibitors
- alpha antagonists
Increasing aqueous outflow
-prostaglandin analogues
Laser therapy to open up trabecular meshwork
Claucoma filtration surgery
What are the signs and symptoms of CHRONIC angle-closure glaucoma?
Raised IOP
Cupped optic disc
Arcuate scotoma
What is the treatment of chronic angle-closure glaucoma?
Surgery to strip peripheral anterior synechiae
Betablocker eye drops= first line
What are risk factors for cataracts?
Diabetes
Steroid use
What is the treatment for cataracts?
Phacoemulsification surgery
What are congenital cataracts linked to?
Maternal infection
Familial
What are early-onset cataracts linked to?
Systemic disorders e.g. diabetes Trauma Corticosteroids Inflammatione e.g. uveitis Down's syndrome, Dystrophia myotonica
What are the 3 different types of cataract?
- Nuclear
- Posterior sub capsular
- Cortical
What are dendritic ulcers associated with?
Corneal ulceration
What is the treatment for a chalaizon
Apply heat and massage
What are the possible causes of monocular diplopia (i.e. patient complins of diplopia when looking to the left. Dipolopia persists when closing the right eye but resolves when the left eye is closed)
Cataract
Corneal scar
What are the causes of proptosis?
Grave’s disease (can be bilateral or unilateral)
Retro orbital tumours
Aneurysms
Trauma
What is the most common cause of sudden onset diplopia?
6th nerve palsy
What are the signs of esotropia (convergent strabismus)?
eye will turn outwards when the other eye is covered
What are the signs of exotropia (divergent strabismus)
eye will turn in wards when the other eye is covered
Which drugs can induce angle closure glaucoma in presdisposed individuals?
Nebulised ipratropic
Antidepressants (anti-muscarinic effect–> pupil dilatation)
