Ophthalmology Flashcards
What is a Kayser-Fleischer ring?
A dark ring in the eye that appears to encircle the iris
Cause of Kayser-Fleischer rings
Copper deposition in the iris
Usually secondary to Wilson’s disease
Other causes: cholestasis, primary biliary cirrhosis, cryptogenic cirrhosis
What is corneal arcus/arcus senilis?
A white, grey, or blue ring in the corneal margin/at the periphery of the iris
What causes arcus senilis (AKA corneal arcus)?
Cholesterol deposits
i.e. caused by hypercholeseterolaemia
Signs in Grave’s ophthalmopathy
Chemosis
Conjunctival oedema
Exophthalmos
Proptosis
Differentials for a painless acute red eye
Blepharitis Ectropion/Entropion Chalazion Trichiasis Subconjunctival haemorrhage Pterygium Foreign body/trauma
Differentials for a painful acute red eye
Erosion Keratitis Allergic/bactieral/viral conjunctivitis Dry eues Acute angle closure glaucoma Iritis Scleritis
Definition of blepharitis
Inflammation of the eyelid margin
Clinical features of blepharitis
Itching Burning Mild foreign body sensation Tearing Crusting around eyes on waking Eythematous, thickened eyelid margins Crusts and debris within lashes Conjunctival injection or mild mucous discharge
Management of blepharitis
Warm compresses 15 minutes BD (melts oil produced by meibomian glands occluding the orrifice)
Followed by eyelid scrub
May need antibiotic ointment
Definition of a stye
An acute lesion arising from an infected meibomian gland or other sebaceous cyst under the eyelid
AKA hordeola
Definition of a chalazinon
A chronic lesion caused by blockage of meibomain gland leading to granulation tissue formation etc.
Conditions predisoposing to recurrent chalazia
Rosacea
Seborrheic dermatitis
Blepharitis
Diabetes
Management of chalazia and styes
Warm compresses BD
Massage in direction of lashes
Oral antibiotics if associated cellulitis
(conservative measures resolve 50%)
Second-line: intralesional steroid injections
Incision and curettage
Definition of ectropion
eversion of the lower eyelid
Definition of entropion
Inversion of an eyelid
Causes of ectropion
Age-related tissue relaxation
CN VII palsy
Posttraumatic or postsurgical changes
Causes of entropion
Age-related tissue relaxation
Postinfectious or post traumatic changes
Blepharospasm
Management of entropion/ectorpion
Entropion: surgery
Ectropion: tear supplements, occular lubricants at night, surgery for definitive treatment
Definition of subconjunctival haemorrhage
A collection of blood between the sclera and the conjunctiva
Clinical features of subconjunctival haemorrhage
History of trauma or contact (often)
Focal flat red region on ocular surface
Red-brown-yellow-clear natural development
Often no symptoms (may have foreign body sensation)
Definition of pterygium
A triangular wedge of fibrovascular conjunctival tissue that typically starts mediall on the nasal conjunctiva and extends laterally onto the cornea (can cross the iris and pupil)
Definition of pinguecula
A yellow-white appearing lesion on the nasal portion of the eye that does not cross the cornea due to degeneration of collagen fibres in the eye
Definition of keratitis
A general term used to describe corneal inflammation
How many layers are there of the corena
5
Clinical features of keratitis
Pain or sensation of FB
photophobia
Lacrimation
Vision may be reduced if ulcer in visual axis
Herpetic: dendritic ulcer (with terminal bulbs) stained with fluorescein
Management of keratitis
Herpetic: acyclovir ointment hourly for 24h then 5x per day for 14 days
Contact lens-associated: referral to ophthal for scraping of ulcer and commencement of antibiotic treatment
Definition of acute uveitiis
Inflammation of the uveal tract, including the iris, ciliary body and choroid
Conditions predisposing to acute uveitis
Wegener granuomatosis Sarcoidosis Ankylosing spondylitis IBD Behcet's syndrome Use of oral bisphosphonates
Symptoms of iritis (acute anterior uveitis)
Deep pain Redness Photophobia Blurred vision Tearing
Red. visual acuity Constricted, nonresponsibe pupil Leukocytes or flare in anterior chamber KERATIC PRECIPITATES (WBC stuck to posterior surface in cornea) Synechiae (iris adhesions to lens/anterior chamber angle AKA scar) Hypopyon Raised intraocular pressure Band keratopathy
Definition of hypopyon
Pus in anterior chamber
Posterior uveitis presentation
Blurred vision
Floaters
Raised IOP
Disc or macular oedema
Management of iritis
REFER TO OPHTHAL within 24h Mydriatics (red. formation of posteirior synechiae + red. pain from ciliary spasm) Topical steroids Systemic analgesia Work up to rule out secondary causes