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Year 4 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Name the structures light travels through to make an image on the retina

A

Tear film-> conjuntiva->cornea-> aqueous humour-> lens-> vitreous-> retina

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2
Q

Name the layers of the retina

A

Nerve fibre layer
Photoreceptors
Retinal pigment epithelium

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3
Q

Difference between two types of photoreceptor cells

A

Rods: diffuse, black and white and dim settings
Cones: colour vision, mainly in macula

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4
Q

Name the 7 bones that make up the orbit

A

Frontal, zygomatic, maxillary, lacrimal, ethmoid, palatine, sphenoid

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5
Q

Name the extraocular muscles supplied by the oculomotor nerve

A

Superior rectus, Inferior rectus, medial rectus, inferior oblique and levator palpebrae superioris

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6
Q

Name the extraocular muscles supplied by CNIV

A

Superior oblique

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7
Q

Name the extraocular muscles supplied by CNVI

A

Lateral rectus

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8
Q

What happens in 3rd nerve palsy?

A

‘Blown pupils’
Fixed down and out position of eyes
ptosis on affected side

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9
Q

Name the layers of the eyelid from anterior to posterior

A 
Skin
Orbicularis oculi muscle
Tarsal plate and Muller's muscle
Meibonian glands
Conjunctiva
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10
Q

What nerve supplies sensation to the eyelids?

A

CN V1 (ophthalmic)

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11
Q

Describe the drainage route for tears

A 
Puncta
Canaliculi
Lacrimal sac
Nasolacrimal duct
Nasopharyngeal canal
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12
Q

What does the tear film consist of?

A

Ant->post
Lipid (from meibonium gland)
->aqueous (from lacrimal gland)
->mucin (from conjunctiva)

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13
Q

What is the average thickness of the cornea?

A

550µm

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14
Q

Name the layers of the cornea (ant->post)

A 
Epithelium
Bowman's
Stroma
Decemet's
Endothelium
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15
Q

What does parasympathetic innervation do to the pupil and lens?

A

Contracts sphincter pupillae to constrict pupil

Relaxes zonules of ciliary body, lens becomes more rounded (accommodation)

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16
Q

Describe the passage of aqueous humour

A

From ciliary body
Through pupil into anterior chamber and angle
Through trabecular meshwork to canal of Schlemm
Into veins

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17
Q

Where do the optic nerves synapse?

A

Lateral Geniculate Bodies in the occiptal lobe

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18
Q

Which fibres do not cross at the optic chiasm?

A

The temporal retinal branches

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19
Q

What is emmetropia?

A

No refractive error

Light is focussed on the retina

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20
Q

What is myopia?

A

Short sightedness, light focusses in front of retina

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21
Q

How do you correct myopia?

A

Concave lens

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22
Q

What is hyperopia?

A

Long sightedness

Light is focussed behind the retina

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23
Q

How do you correct hyperopia?

A

Convex lens

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24
Q

What is presbyopia?

A

The lens hardens with age, less able to accommodate

Need reading glasses for near vision

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25
Q

Name 5 classes of ocular antihypertensives

A 
Beta blockers
Carbonic anhydrase inhibitors
a2-agonists
Muscarinic agonists
Prostaglandin analogues
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26
Q

Name a beta blocker eye drop and SEs

A

Timolol

Bronchospasm, bradycardia

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27
Q

Name a carbonic anhydrase inhibitor used in ophthalmology and SEs

A

Acetazolamide

Deranged renal function

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28
Q

Name an a2-agonist and SEs

A

Brimonidine

Dry mouth, hypotension

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29
Q

Name a muscarinic agonist and SEs

A

Pilocarpine

Sweating, bradycardia

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30
Q

Name a prostaglandin analogue and SEs

A

Latanoprost

Asthma, lash growth

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31
Q

Which ocular antihypertensives reduce aqueous production?

A

Beta blockers, carbonic anhydrase inhibitors, a2-agonists

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32
Q

Which ocular antihypertensives increase aqueous outflow

A

a2-agonists, muscarinic agonists, prostaglandin analogues

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33
Q

Name 2 lubricants

A

Hypromellose, viscotears

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34
Q

What are the classes of drugs used for pupil dilation

A

Myadratics (a1-agonists- phenylephrine)

Cycloplegics (muscarinic antagonists- tropicamide)

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35
Q

Name 4 anti-inflammatory eye drugs

A

Steroids (prednisolone)
Mast cell stabilisers (sodium cromoglycate)
Antihistamines (Antazoline)
NSAIDs (diclofenac)

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36
Q

Name the main antibiotics used in ophthalmology

A

Chloramphenicol (grey baby, used for conjunctivitis)

Ofloxacin (used for corneal ulcers)

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37
Q

Name the most common antivirals

A

Aciclovir, valciclovir

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38
Q

What drugs can be given as an intravitreal injection?

A

Steroids (dexamethasone)
Anti-microbial (vancomycin)
Anti-VEGF (ranibizumab)

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39
Q

What are anti-VEGF injections used to treat?

A

Neovascularisation in wet macular degeneration and proliferative diabetic retinopathy

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40
Q

How do you go about an eye examination?

A 
IMAFRO
Inspection
Movement
visual Acuity
visual Fields
pupillary Reflexes
Ophthalmoscopy
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41
Q

What does inspection in the ophthalmic examination include?

A

Facial asymmetry
Skin
Eyelids (evert upper eyelid, crusting, droopiness)
Conjunctiva (colour, foreign bodies)
Cornea (ulcers, abrasions, foreign bodies)

42
Q

What does 6/60 vision mean?

A

What a normal person can see at 60m, the patient can see at 6m

43
Q

What is the pinhole used for?

A

To limit refractive error

To assess underlying vision issues

44
Q

What is LogMAR?

A

Like Snellen, 6/6 is 0.0, 6/60 is 1

45
Q

Colour vision is measured with?

A

Ishihara plates

46
Q

What is the screening visual field test?

A

Ask pt to look at your nose, is any of my face missing?

47
Q

What do you test in a more advanced visual field test?

A

Colour desaturation and blind spot mapping

48
Q

What do you test in pupillary reflexes?

A

Look at both pupils (size and shape)
Direct and consensual reflexes
Swinging light test for relative afferent pupillary defect

49
Q

Describe steps of ophthalmoscopy

A

Wash hands, introduce, explain, gain consent
Low brightness, middle size light, check on palm forst
Gain idea of patients refractive error (green for long-sighted)
Darken room, ask pt to fixate on wall
Right hand, right eye
Red reflex from arm’s distance away
Place free hand behind patient
Find optic disc (colour, contour, cupping)
Main vessels, haemorrhages, exudate
Macula (look directly at light)

50
Q

Additional eye examination tests?

A

Lid lag for Grave’s disease

Cover-uncover test for Strabismus

51
Q

What is acute angle closure glaucoma?

A

Iris adheres to lens, obstructs outflow of aqueous, raised intraocular pressure

52
Q

Symptoms of acute angle closure glaucoma

A

Red severely painful eye, nausea and vomiting, halos around light, blurring of vision

53
Q

Signs of acute angle closure glaucoma

A

Eyeball hard on palpation
Unreactive semi-dilated pupil
Redness around hazy cornea
Cornea cloudy (oedematous)

54
Q

Management of acute angle closure glaucoma

A 
Constrict pupil: pilocarpine
Reduce aqueous production: IV acetazolamide
Reduce inflammation: Prednisolone drops
Laser iridotomy?
Lie pt supine
55
Q

2 causes of CNIII palsy

Differences

A

Posterior communicating artery aneurysm: blown pupil, thunderclap headache
Ischaemia secondary to diabetic neuropathy: pupil sparing

56
Q

What is orbital cellulitis?

A

Painful swollen eyelid, fever
Staph or strep infection
Life threatening as can move to brain, can cause 2º glaucoma
Reduced eye movements, proptosis

57
Q

How do you treat orbital cellulitis?

A

IV broad spectrum antibiotics

58
Q

What is temporal arteritis?

A

Inflammation of the arteries supplying the optic nerve

Necrosis and visual loss

59
Q

Symptoms of temporal arteritis

A

Sudden unilateral blurred vision. headache, tender scalp

Jaw claudication, malaise, weight loss, night sweats

60
Q

Diagnosis: thunderclap headache, fixed dilated down and out pupil, ptosis

A

Posterior communicating artery aneurysm

61
Q

Diagnosis: sudden blurred vision, headache, tender scalp

A

Temporal arteritis

62
Q

Management of temporal arteritis

A

IV steroids and bone protection

63
Q

Blood results for temporal arteritis

A

Raised ESR/CRP/low Hb/raised platelets

64
Q

What could cause an absent red reflex in children?

A

Retinoblastoma or congenital catarcts

65
Q

What can cause congenital cataracts?

A 
TORCH infection intrauterine exposure
Toxoplasmosis
Other (syphilis, varicella-zoster, parvovirus B19)
Rubella
Cytomegalovirus (CMV)
Herpes infections
Intrauterine steroid exposure
66
Q

What is endophthalmitis?

A

Infection in the vitreous or aqueous of the eye
Usually post-operative and sight threatening
Onset minutes to hours
May see hypopyon as well as red eye and discharge
Worst case scenario loss of eye

67
Q

What does distortion hint at?

A

Macula issues

68
Q

Symptoms of retinal detachment

A 
Floaters
Flashes
Curtain being drawn across vision
Distortion if macula is involved
If due to traction in diabetes it is gradual vision loss
69
Q

What is a central retinal artery occlusion and what does it look like under a fundoscope?

A

Thromboembolic blockage causing retinal infarction
Painless sudden visual loss
RAPD
Retina pale with cherry red spot of macula

70
Q

Treatment central retinal artery occlusion?

A

Rule out temporal arteritis
Screen for cardiovascular risk factors
Fluorescein angiography
Aim to reduce intra-ocular pressure (acetazolamide, aspirin, hyperventilate)

71
Q

What is a retinal vein occlusion and symptoms?

A

Thrombosis of retinal veins, branch is more common than central
Causes painless visual loss unilaterally, retinal flame haemorrhages and cotton wool spots. Vitreous haemorrhage, swollen optic disc, tortuous vessels

72
Q

Treatment of retinal vein occlusion

A

Investigate for cardiovascular risk factors
Autoimmune disease/clotting disorders/glaucoma screening
Monitor regularly
Low dose aspirin
Treat risk factors

73
Q

Which is worse in the eye: acid or alkali?

How do you manage?

A

Alkali is more destructive

Wash eye until tear pH is back to normal

74
Q

What must you do in penetrating ocular trauma?

A

Xray for foreign bodies in eye

75
Q

What would hypertensive retinopathy look like?

A

Retinal damage due to chronic hypertension
Cotton wool spots, flame haemorrhages, papilloedma is advanced/malignant hypertension
• Acute ischaemia in choroid
• Optic disc swelling
Chronic hypertension
• Arteriosclerosis (copper wiring)
• AV nipping

76
Q

How can you tell the difference between hypertensive retinopathy, vein occlusion and diabetic retinopathy?

A

Diabetic retinopathy has hard yellow exudates

77
Q

Definition and symptoms of thyroid eye disease

A 
Autoimmune
Anti-TSH receptor antibodies target extraocular muscles
Irritable red eyes
Aching
Pain on eye-movement
Double vision
78
Q

Examination and investigations for thyroid eye disease

A 
Eye movements
Proptosis
Lid retraction
Lid lag on downward gaze
Systemic signs
Thyroid function tests, anti TSH antibodies, CT scan for extraocular swelling
79
Q

How does Sjögren’s syndrome manifest in the eye?

A

Autoimmune destruction of lacrimal and salivary glands
Associated with rheumatoid and SLE
Burning gritty eyes, dry mouth, difficulty swallowing
Treat with eye lubricants and underlying autoimmune condition

80
Q

What is uveitis associated with?

A 
Ankylosing spondylitis
Psoriatic arthritis
IBD
Sarcoidosis
Syphilis
81
Q

Treatment of uveitis

A

Steroids

Dilate pupil

82
Q

Whats more common, scleritis and episcleritis?

A

Episcelritis

83
Q

What can scleritis lead to?

A

Globe perforation

84
Q

Differences between scleritis and episcleritis

A

Scleritis: subacute severe pain, immobile hyperaemic vessels, associated with rhematoid/SLE
Episcleritis: common, acute mild pain, mobile hyperaemic vessels, self limiting

85
Q

Name 5 non emergency diagnoses for red eye

A 
Subconjunctival haemorrhage
Dry eyes
Conjunctivitis
Corneal abrasion
Keratitis
86
Q

Name 6 causes for acute visual loss

A

Central retinal artery occlusion
Acute angle closure glaucoma
Optic neuritis
Vitreous haemorrhage (retinal vein occlusion/diabetic retinopathy)
Anterior ischaemic optic neuropathy (after temporal arteritis)

87
Q

4 causes of gradual vision loss

A

Refractive errors
Cataracts
Age related macular degeneration
Primary open angle glaucoma

88
Q

3 causes of flashes/floaters

A

Posterior vitreous detachment
Migraine with aura
Retinal detachment

89
Q

4 subacute causes of abnormal eyelids

A

Blepharitis and chalazion
BCC
Herpes zoster
Entropion and ectropion

90
Q

2 causes of irregular pupils

A

Horner’s

Adie’s

91
Q

What can be found on an everted eyelid that differentiates between 2 diagnoses?

A

Follicles: viral
Papillae: allergic, pink

92
Q

Treatment of chlamydial conjunctivits

A

Oral azithromycin, swabs and refer to GUM

93
Q

Corneal abrasion treatment

A

Chloramphenicol drops

94
Q

What is optic neuritis?

A

Demyelination of the optic nerve
1st presentation of MS
Blurred optic disc, RAPD, reduced visual acuity

95
Q

What is age related macula degeneration?

A

Dry: retinal atrophy with drusen
Wet: neovascularisationm haemorrhages distorting macula. Can be treated with anti-VEGF

96
Q

What does a cupped disc mean?

A

Primary open angle glaucoma

Progressive optic neuropathy

97
Q

Treatment of chalazion

A

Massage, eyelid hygeine
Topical antibiotics if infected
Surgical excision

98
Q

What is the most common eyelid neoplasm?

A

BCC

99
Q

What is amblyopia?

A

Squint causing double vision
Brain ignores one side-> abnormal development if not corrected by age 7
Corrected with temporary patching of good eye

100
Q

What visual loss can you have and still drive a car?

A

6/12 in at least 1 eye (read reg plate at 20m)

Have visual field of 120º horizontally

Year 4 (9 decks)

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