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MD2 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is the circulatory pathway of aqueous humour?

A

Produced by the ciliary body, circulates within the anterior chamber, and is filtered back into venous system through trabecular meshwork

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2
Q

Where is central vision best?

A

Fovea, the central most part of the macula, which is the central retina

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3
Q

Where does the optic nerve enter the retina?

A

Optic disc

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4
Q

Components of an eye exam

A 
History
Exam:
- general inspection
- visual acuity (best corrected)
- Slit lamp (anterior segment of eye)
- Pupils 
- Fundoscopy 
- Other tests (H test, CT scan, orbital x-ray, bloods)
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5
Q

Characteristic signs of iritis

A

Pain and photophobia
Red eye with CILIARY FLUSH
Slight blurred vision

Pain in contralateral eye on direct light exposure
Irregular pupil with synaechiae

Pupil may not be reactive to light

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6
Q

Characteristic signs of acute angle closure glaucoma

A

Mid-dilated, very poorly responsive to light

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7
Q

What does fluorescein stain check?

A

Corneal pathology

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8
Q

Most common causes of chronic vision loss

A 
Refractive error
Lens: Cataract
Macula: AMD
Retinal: Diabetic retinopathy
Optic nerve: Glaucoma (open-angle)
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9
Q

Common causes of acute vision loss

A

Transient - Amaurosis Fugax

Persistent:
- Vaso-occlusive: central retinal artery/vein occlusion

  • Optic nerve: Optic neuritis OR giant cell arteritis
  • Retinal detachment
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10
Q

Causes of BILATERAL vision loss

A

Central:

  • Pituitary apoplexy
  • Stroke

Ocular:
- Quinine or methanol poisoning

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11
Q

Causes of unilateral vision loss if eye is:

  • Sore or red
  • Not sore or red: flashes or floaters vs. none
A

Sore or red (pathology in anterior chamber)

  • ACUTE IRITIS
  • CLOSED ANGLE GLAUCOMA

Not sore/red
Flashes or floaters:
- RETINAL DETACHMENT
- VITREOUS HAEMORRHAGE

No floaters

  • CRA occlusion
  • CRV occlusion
  • Vasospasm

Visual field distortion
- AMD

Swollen optic disk

  • Optic neuritis
  • Giant cell arteritis
  • Anterior ischaemic optic neuropathy
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12
Q

Causes of vasospasm that can cause visual loss

A

Migraine
SA haemorrhage
Hypertensive crisis

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13
Q

Where is the lesion:

  • homonymous hemianopia
  • bitemporal hemianopia
A

Homonymous: behind optic chasm

Bitemporal: at optic chasm (pituitary tumour)

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14
Q

Myopia vs hyperopia: what are they and where are light rays focussed in each case?

A

Myopia - short sighted; light rays focused anterior to fovea

Hyperopia - far sighted; light rays focussed posterior to fovea

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15
Q

What is presbyopia and what causes it?

A

Age-related loss of near vision (onset around 40s)

Due to diminished accomodation power

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16
Q

Diseases of refractive error and treatment

A

Hyperopia
Myopia
Astigmatism
Presbyopia

Correct w glasses/ contact lenses
LASIK - laser surgery alters corneal surface

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17
Q

Cataract - what is it?

  • Causes?
  • Clinical picture?
  • Treatment?
A

Opacification of lense

Causes: age-related; steroids; diabetes; previous inflammation or scarring (surgery, trauma)

Clinical picture:
Bilateral, asymmetric, slowly progressive
SX: Blurred vision with glare especially at night, difficulty driving
Signs: Impaired VA, clouding of sense on slit lamp exam (decr red light reflex, hard to see optic disk and retina)

TX:
Glasses + surgery

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18
Q

What is a chalazion?

what is it often associated with?

A

ABSCESS beneath lid resulting from focal noninfectious blockage of meibomian gland -> non-tender lump in eyelid

Assoc w Rosacea

Non-tender swelling of lid

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19
Q

What is a hordeolum ?

Aetiology?

A

Abscess at corner of eye, can be internal (on conjunctival side of eyelid) or external (=sty)

Painful focal lid erythema often accompanied by blepharitis

Staph aureus infection commonly

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20
Q

What common viral infection can spread to the eye?

how do you investigate for it?

Treatment?

A

HSV infection of trigeminal nerve can spread to eye, causing keratitis, uveitis, scleritis, retinitis

Fluroscene stain -> classic dendritic ulcer with BULB end

Antivirals - DO NOT give steroids

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21
Q

What is blepharitis and what causes it?

A

Clogging of meibomian glands within tarsal plate, leading to chronic irritation and inflammation of eyelid

-> dry, watery, itchy eyes

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22
Q

How do you treat corneal abrasions and ulcers?

A

Abrasion: lubrication and prophylactic erythromycin

Small ulcers: erythromycin

Large ulcers >3mm: MCS (sensitivities) and vancomycin

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23
Q

Different types of conjunctivitis

A

Viral: watery discharge, swollen pre-auricular nodes
- most common form in adults
- adenovirus and rhinovirus are common causes (HSV is more severe)
- recent flu-like illness
TX: self-limiting; good heigine to limit spread

Bacterial: mucus discharge

  • most common form in kids
  • follicles and papilla on inner surface of lid
  • treat with erythromycin gel

Allergic: itchy, watery, chemosis (swelling of sclera)
+/- dark area underneath eyes
- antihistamines

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24
Q

What is endopthalmitis?

A

Severe infection WITHIN the eye, often post-surgical procedures

With hypopion (pus forms fluid level at bottom of iris)

Needs aggressive treatment -> vitrectomy to eject pus from eye -> send for MCS -> antibiotics

25
Q

What infective agents cause conjunctivitis?

A

Staph aureus, strep in kids

H influenza in adults

Neisseria gonorrhoea in sexually active adults (needs urgent referral because sigh threatening)

26
Q

What is a hyphaemia?

A

Blood in anterior chamber of eye, forms fluid level at bottom of iris
Requires urgent ophthalmologist referral

27
Q

what are the 2 broad categories of causes/risk factors for scleritis?

A

Autoimmune
- RA, UC, SLE, ankylosing spondylitis, psoriatic arthritis, Wegener’s granulomatosis

Granulomatous disease
- Tb, syphilis, sarcoid, leprosy

28
Q

Clinical presentation of scleritis

TX?

A

Red/purple discolouration of sclera and conjunctivae
Ocular pain that is tender to palpation
Photophobia

TX: NSAIDs and systemic corticosteroids

29
Q

CN3 palsy

  • causes
  • presentation
A

Causes

  • Vasculitic (HTN, DM) - pupil sparing
  • Aneurysm/tumours - pupil dilated

Presentation:

  • Eye is down and out
  • Ptosis
  • If pupil is dilated, suspect aneurysmal cause
30
Q

CN6 palsy

  • causes
  • presentation
A

Causes

  • Vasculitic
  • Incr ICP/Idiopathic intracranial HTN

Presentation:

  • Cross eyed
  • Double vision when looking towards affected side
  • bilateral papilloedema if Incr ICP
31
Q

CN4 palsy

  • causes
  • presentation
A

Causes:

  • Vasculitis
  • Trauma
  • Congenital
  • Tumour

Presentation

  • Hypertropia
  • Head tilts away from affected side (to offset extortion)
  • Double vision when READING or walking down stairs
  • eye shoots up when looking towards affected side
32
Q

Neovascular vs non-neovascular AMD

A

Wet/ Neovascular/exudative: - Break in the Brux membrane (layer between PRs and choroid) allows choroidal neovascularisation under retina, leading to QUICK and permanent vision loss. Wet because vessels can bleed.

Dry/non-neovacular/non-exudative

  • ~90 of AMD
  • ‘Drusen’ on ophthalmoscopy are small deposits in the macula
  • HTN is RF for progression of dry to wet AMD
33
Q

Risk factors for AMD

A

Old age
Family HX
Smoking HTN predicts progression from wet to dry

34
Q

Clinical picture of AMD

  • SX and signs
  • Fundoscopy
A

Blurred central vision

Metamorphopsia: distortion of straight lines centrally (occurs early)

Scotoma (blind spots) with progression

No pain/redness
Peripheral vision intact

Fundoscopy:

  • Dry: druse deposits
  • Wet: choroidal haemmhorage
35
Q

Treatment for wet and dry AMD

A

Dry: antioxidants, zinc, vitamin C and E and carotenoid supplements
HTN control, stop smoking

Wet:

  • anti VEGF +/- IV steroids or laser therapy
  • laser photocoagulation
36
Q

Features of Diabetic retinopathy: pre-proliferative and prolferative/end-stage

A

Pre-proliferative

  • cotton wool spots
  • hard exudates
  • blot haemorrhages
  • micro aneurysms
  • venous beading
  • retinal oedema

Proliferative

  • Neovascularisation
  • Vitreous haemorrhage
  • Angle closure neovascularisation glaucoma

End-stage
- vessel fibrosis and retinal detachment

37
Q

treatment for Diabetic retinopathy

A

Diabetic, HTN, hyperlipidaemia control

Grid or pan-retinal laser photocoagulation
Intra-vitreal VEGF antagonist injections
Surgical repair if vitreous haemorrhage or retinal detachment

38
Q

Primary chronic open angle glaucoma: what is a characteristic feature?

What is the underlying pathophys?

A

Slowly progressive optic neuropathy

Optic disc cupping

Due to excess glycosaminoglycan deposition in trabecular meshwork, blocking aqueous outflow -> incr IOP damages optic nerve fibres

39
Q

Acute angle closure glaucoma

What is the underlying pathophys

A

aqueous cannot get through the space between the pupil and iris from the posterior chamber into anterior chamber, so pressure gradient forms within the posterior chamber, pushing the iris forwards and closing it to block off the entrance to the trabecular meshwork so aqueous cannot drain.

40
Q

RF for open angle glaucoma

A 
Genetic
Incr age
Family history
Thin cornea
African, latino ethnicity
41
Q

RF for closed angle glaucoma

A

Asian
Small eyes, hyperopia
big cataracts
Shallow chamber

42
Q

Clinical features of open angle glaucoma

  • Sx and signs
  • ophthalmoscopy findings
A

SX and signs:

Asymptomatic until late stage

Visual field is end-stage

  • Initially upper arcuate scotoma
  • progresses to full visual field loss with sparing of small central field +/- small temporal field

No eye pain or tenderness
Headache rare except when IOP is v high

Ophthalmoscopy:

  • Enlarged cup: disc ratio (>=0.5)
  • Elevated IOP
43
Q

Treatment for chronic open angle glaucoma

A

Surgical

  • Drainage trabeculectomy
  • Laser trabeculoplasty

Medical

  • PGE analogues
  • Topical beta blockers
  • Topical carbonic anhydrase inhibitors
  • Adrenergic agonists
  • Cholinergic agonists (pilocarpine)
44
Q

Clinical features of acute closed angle glaucoma

Signs and SX
exam findings

A

Rapid elevation in IOP and ischaemic tissue damage resulting in:

  • painful red eye
  • photophobia
  • haloes
  • pain on eye movement
  • watering of eye
  • rapidly decreasing visual acuity

+/- headache, nausea and vomiting

Exam:

  • red eye
  • cloudy cornea
  • oval, fixed, dilated pupil
45
Q

Treatment for acute closed angle glaucoma

A

Medical:
IV Acetazolamide (carbonic anhydrase inhibitor)
+ PO topical pilocarpine (cholinergic agonist)
+ PO beta blockers

Surgical:
Laser iridotomy in BOHT eyes (prophylactic in opposite eye)

46
Q

Non-painful diffuse red eye conditions
With eyelid involvement
without

A

With eyelid involvement:

  • Blepharitis (Can also be painful)
  • Ectropion
  • Trichiasis
  • Eyelid lesion

Without - conjunctivitis (also painful)

47
Q

PainLESS LOCALISED red eye conditions

A

Localised:

  • pterygium
  • corneal foreign body (can also be painful)
  • ocular trauma (can also be painful)
  • subconjunctival haemmhorage
48
Q

What is blepharitis?

A

Noninfectious lid margin inflammation with chronic redness +/- crusting

(like chalazion but no cyst formation)

+/- bacterial superinfection

49
Q

What is ectropion?

A

Lid turns outwards with exposure of conjunctival sacs

50
Q

What do you call the condition when the eyelashes are turned inwards?

What commonly causes this?

A

Trichiasis

Caused by trachoma (infectious disease caused by bacterium Chlamydia trachoma’s, common in children with poor sanitation)

51
Q

What is pterygium?

A

Flesh grows over the sclera. Benign. May become inflamed and painful.

Needs lubrication and sunglasses w non-urgent referral.

52
Q

What is the cause of a painless, unilateral, well circumscribed bloody red patch on eyeball

With no other visual abnormalities

A

Subconjunctival haemorrhage

53
Q

what is the difference between episcleritis and scleritis?

A

Episcleritis blanches when injected w 10% phenylephrine ophthalmic drops, but NOT in scleritis

Scleritis generally more red and painful with tenderness to palpation.
Episcleritis generally NOT painful and is self-resolving.

Both red but have no photophobia and normal vision and pupil.

54
Q

What is episcleritis usually caused by?

A

Autoimmune conditions

  • RA
  • SLE
  • graves
  • ankylosing spondylitis
  • IBD
  • psoriatic arthritis
55
Q

Treatment of episcleritis

A

Self limiting
Hydration
Topical prednisilone if prolonged steroids +/- systemic NSAID/CS

Workup for autoimmune diseases

56
Q

What usually causes bacterial/acanthamoebal ulcer? (epithelial keratitis)

A

from unclean contacts

57
Q

What is the common cause of keratitis that needs urgent opthal referral?

TX?

A

HSV-1

TX: trifluoridine eye drops with antiviral therapy
AVOID topical steroids! makes it worse!

58
Q

Signs of hypertensive retinopathy

A

Grade 1: copper wiring

Grade 2
As grade 1 + Irregularly located, tight constrictions - Known as AV nicking or AV nipping - Salu’s Sign

Grade 3
As grade 2 + cotton wool spots and flame-hemorrhages

Grade 4
As grade 3 + optic disc swelling + macular star

MD2 (16 decks)

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