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Specialities > Ophthalmology 4 > Flashcards

Ophthalmology 4 Flashcards

1
Q

Name some important investigations to do into someone you suspect has cataracts:

A

Visual acuity test

Red reflex*

Fundoscopy

Intra-ocular pressure
- differential open angle

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2
Q

What are some differentials for diploia?

A

Orbital causes:

  • Grave’s
  • Trauma
  • Tumour

Neuromuscular:
- Myasthenia gravis

Palsies:

  • 3rd
  • 4th
  • 6th
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3
Q

What is the function of the muscles of the eye?

A

Medial and lateral: one function.

The rest can be remember with the pneumonic: SIN RAD, which stands for:

- Superiors - intort 
- Rectus - adduct

Superior Rectus: Elevates, Intorts, Adducts
Inferior Rectus: Depresses, Extorts, Adducts

Superior Oblique: Intorts, Abducts
Inferior Oblique: Extorts, Abducts

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4
Q

What is the most common causes of 3rd nerve palsies?

A

Neuropathy

  • diabetes mellitus
  • this will spare the pupil

Posterior communicating artery aneurysm

Tumour

Vasculitis

Demylination

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5
Q

What type of diplopia does 4th nerve palsy get?

A

Vertical

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6
Q

What is an improtant aspect of 6th nerve palsy?

A

False localising sign

- raised ICP

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7
Q

How is diplopia investigated?

A

Bloods:

  • glucose
  • inflammatory

Imaging:

  • CT angiogram (fi suspect posterior communicating artery aneurysm)
  • CT head (tumour)

Referral to neurosurgery
- posterior aneurysms can involve so important to refer

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8
Q

If there is a medical management for diplopia how should they be managed?

A

Treat underlying cause

Inform DVLA
- all patients with diplopia must inform

Prisms
Botulism injection

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9
Q

What are the signs on fundoscopy of retinal vein occlusion?

A

Vessel tortuosity

Optic disc swelling

Retinal haemorrhages

Cotton wool spots

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10
Q

What are the major causes of central retinal vein occlusion?

A

Hypertension
Hypercholesteromia
Diabetes
Smoking

Coagulative conditions

  • polycythaemia
  • factor V Leiden

SLE

COCP

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11
Q

How is a central vein occlusion investigated?

A
  • *Blood pressure
  • *Glucose

Bloods:

  • FBC
  • CRP
  • ESR
  • Coagulation screen

X-rays:

  • OCT Scan
  • Fluorescent angiogram
If there is suggestion of underlying pathology then: 
Autoimmune screen: 
- RF 
- ANCA
- ANA 
- Anti-cardiolipin 
- ACE
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12
Q

What investigations are done into a central arterial occlusion?

A

Rule out GCA

Then:
Sent to TIA clinic
- CT head
- carotid doppler

Treatment:

  • aspirin
  • Clopidogrel

No driving for 1 month

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13
Q

What type of optic neuropathy does GCA cause?

A

Anterior Ischemic Optic Neuropathy

This specifically relates to disruption of the posterior ciliary arteries

  • reduced visual acuity
  • RAPD
  • loss of colour vision
  • disc swelling
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14
Q

When checking vision acuity in someone with glasses, what two ways should it be checked?

A

Normal Snellen chart
+
Pinholes

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15
Q

How can you differentiate between an ulcer and abrasion of the cornea?

A

Ulcer penetrates into the stroma which will turn complete green with fluorescein straining

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16
Q

Outline the differences in different types of corneal ulcers:

A

Bacteria:

  • acute onset
  • Painful with photophobia
  • round lesion
  • 7 days worth
  • contact wearers

Viral:

  • Insidious onset
  • painful with irritation
  • dendritic shape
  • <7 days

Fungal

  • delayed on set
  • painful +photophobia
  • feathery edges
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17
Q

What are the key symptoms of uveitis?

A

Red eye

Painful eye
- especially on movement

Photophobia

+/-
Visual acuity changes

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18
Q

What are the causes of uveitis and what are some of the longer sequalae?

A

Causes:
Idiopathic

Infection (TB, STIs)

Autoimmune (HLAB27)

Sequalae:

  • Glaucoma
  • Clouding of the cornea
  • Cataracts
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19
Q

What is the main defect in corneal abrasions?

A

Epithelium

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20
Q

What signs may make you think there has been globe rupture?

A

Irregular shape to iris - iris may ruptured out
360 subconjunctiva haemorrhage
Flat Anterior chamber

Management:

  • Visual assessment
  • CT - if suspect foreign body

Analgesia
Antibiotics
Tetanus

21
Q

What are the symptoms of a retrobulbar haemorrhage?

A 
Pain
Sub-Conjunctival Haemorrhage
Reduced vision 
RAPD 
Proptosis Reduced mobility 
Reduced mobility

*reduced vision and movements as the blood compresses on the optic nerves

22
Q

What is the complication that can occur with a sub-orbital fracture?

A

Trap door
- where the inferior intraocular muscles get trapped preventing eye movements

When the patient tries to move their eye they can get a reflex bradycardia

23
Q

What are the main causes of a traumatic red eye?

A

Corneal ulcer/ abrasion

Retrobulbar Haemorrhage

Penetrating injury

Chemical injury

24
Q

What are the main causes of a non-traumatic red eye?

A

Conjunctivitis

Uveitis

Acute angle closure glaucoma

Scleritis / episcleritis

Cellulitis

25
Q

What is astigmatism?

A

Refractive error where there light focuses on different areas due to irregular shape of the eye
- usually described as a rugby ball shape

26
Q

What is the distortion seen in ARMD?

A

Metamorphopsia

- blurring of straight lines

27
Q

What are the major risk factors for retinal detachment?

A

Previous retinal detachment

Recent surgery

Myopia
- long spaced eye

Trauma

Family history

28
Q

What is the first branch to come off the internal carotid?

A

Central retinal branch

29
Q

What drug is given for GCA which is causing vision loss? and what is the underlying cause to GCA?

A

Methylprednisolone

*mainstay to reduce vision loss in the other eye

Underlying disease:
- Anterior Ischemic Optic Neuropathy due to disruption of the posterior ciliary arteries

30
Q

What are structures which hold the lens in place - and what conditions are associated with them breaking causing dislocation?

A

Zonules

Marfan’s syndrome
Ehrler’s Danlos syndrome

31
Q

What are the risk factors for cataracts?

A

Traumatic
- blunt force - think boxer

Diabetes

Steroid use

Advancing age

Congenital

32
Q

What are the stages of checking vision?

A

Snellen

Counting fingers

Hand motions

Light and dark

33
Q

What are some red flags in the history of eye examination?

A

Flashers/ floaters

Headache

  • N&V
  • Jaw/ temporal

Transient vision loss

Halos

34
Q

What is the different type of chart that can be used for assessing visual acuity?

A

DRSET

- type of logmar

35
Q

What is Fluorescein angiography?

A

A dye which is injected to the arm.
Passes up through the system into the eye which will give details on the vasculature of the eye.

Helps for macular degeneration, neovascularisation (as you can see where the dye does not go, where it leaks etc)

36
Q

What are the risk factors for ARMD and what is the pathophysiology?

A

Age
Smoking
Hypertension
Family history

Patho:
build up of debris (drusen) between the choroid and retina leading to atrophy of pigmented epithelium and rods and cones

*remember only affects macula as it receives its blood supply from the choroid exclusively

37
Q

What are the main investigations conducted into ARMD?

A

OCT

Fluorescein Angiography

Amsler’s grid

38
Q

In primary open angle glaucoma what can be seen on fundoscopy? and what are your diagnostic investigations?

A

> 0.7 cup to disc ratio
Optic disc pallor (atrophy occurring)

Investigations:

  • Automated perimetry
  • Tonometry
  • Gonioscopy - to assess angle
  • Slit lamp examination

*over 40 should be screened annually if family history

39
Q

What are the most common pathogens to cause keratitis?

A

Staph Aureus

Pseudomonas

40
Q

What are the major complications that can occur with the eye when in ICU?

A

Corneal abrasion

Exposure keratopathy

Chemosis

  • due to ventilation pressures
  • too tight endotrachael tubing
  • causes keratitis but exposing the eye

Conjunctivitis

Ischaemic optic neuropathy

  • same position
  • poor blood pressure

Acute Angle Glaucoma
- due lying prone

41
Q

What is the diagnostic investigation into retrobulbar haemorrhage? Management?

A

CT Scan of orbits

Canthotomy/ canthyolysis

42
Q

What is the normal pressure in the anterior chamber?

A

10-21mmHg

43
Q

What are the diagnostic investigations into primary open angle glaucoma?

A

Goldmann Application tonometry

Visual field testing
- perimetry

Fundoscopy
- optic disc to cup size >0.5 is abnormal

44
Q

What is the management of open angle glaucoma?

A

Latanoprost

  • side effects include eye lash elongation
  • eyelid pigmentation and iris pigmentation
  • increases outflow

Timolol
- reduce production

Dorzolamide
- carbonic anhydrase inhibitor

Surgical:

  • trabeculectomy
  • creates a small plebe
45
Q

Outline the pathophysiology of diabetic retinopathy, how likely is to to cause blindness? and how is it treated?

A

Basement membrane dysfunction which initially causes leaks and aneurysms (Dots)
These can the leak (blots)

The fluid leaked is reabsorbed and leaves behind debris (hard exudates)

Eventually the basement membrane pericytes close up causing ischemia and micro-infarcts (cotton wool spots)
- this then triggers VEGF release

The mixture of fluid from new vessels and aneurysms accumulates in the macula causing macula oedema

Treatment:

  • control of BP and glucose
  • pan-retinal photocoagulation
  • Anti- VEGF
46
Q

What are some of the factors which can make diabetic retinopathy worse?

A 
Smoking 
Poor glycaemic control 
Smoking 
Pregnancy
Failing to comply with annual check up
47
Q

What are in the investigations done into diabetic retinopathy?

A

Photographs of fundus
OCT (source macular oedema)
Fluorescein angiography (source leakage)

48
Q

Outline tests done into open angle glaucoma:

A

Applanation tonometry

Slit lamp examination
- check cup to disc ratio

Automated perimetry visual assessment

Measurement of corneal thickness

Gonioscopy measurement

49
Q

What are the complications of diabetic retinopathy?

A

Retinal detachment

Vitreous haemorrhage

Optic neuropathy

Cataracts

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