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Phase 2 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the signs of bacterial conjunctivitis?

A

Redness of eye
Purulent discharge
Ocular irritation

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2
Q

What bacteria commonly cause conjunctivitis?

A

Staph
Strep
Pneumococcus
Haemophilus

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3
Q

What are the features of viral conjunctivitis?

A

Watery discharge
Conjunctival follicles
Lid oedema and excessive lacrimation

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4
Q

How do you manage conjunctivitis?

A

Usually self-limiting
Viral highly contagious
Bacterial: chloramphenicol if troublesome

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5
Q

How can chlamydia affect the eye?

A

Inclusion keratoconjunctivitis

Trachoma (uncommon in developed world)

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6
Q

How does chlamydia inclusion keratoconjunctivitis present?

A

Mucopurulent follicular conjunctivitis and micropannus

Urethritis / cervicitis common

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7
Q

How do you treat chlamydia?

A

Refer to GUM for azithromycin 1g PO stat

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8
Q

What is allergic conjunctivitis?

A

IgE mediated reaction to airborne allergens (hay fever)

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9
Q

How is allergic conjunctivitis treated?

A

Mast cell stabilisers eg sodium cromoglycate
Antihistamines
Topical steroids in severe cases

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10
Q

What is the risk of topical steroids in the eye?

A

Glaucoma and cataract

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11
Q

What are the symptoms of allergic conjunctivitis?

A

Itchiness
Conjunctival injection and swelling
Lacrimation

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12
Q

Name 4 conjunctival signs

A

Papillae
Follicles
Injection
Subconjunctival haemorrhage

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13
Q

Name 4 corneal signs

A

Epithelial and stromal oedema
Focal, granular white spots
Chronic keratitis - can lead to pannus (new blood vessels under epithelium)
Keratin precipitates

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14
Q

What conditions affect the cornea?

A

Bacterial keratitis

Viral keratitis

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15
Q

What are the types of viral keratitis?

A

Herpes simplex keratitis

Herpes zoster ophthalmicus

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16
Q

What is herpes zoster ophthalmicus?

A

Ophthalmic shingles

Affecting ophthalmic division of trigeminal nerve

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17
Q

What are the features of herpes zoster ophthalmicus?

A

Prodrome of being unwell
Pain and vesicles in ophthalmic distribution of CNV
Corneal symptoms: redness, clouding, discharge, photophobia

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18
Q

How do you treat herpes zoster ophthalmicus?

A

Oral aciclovir for skin

Topical steroids and antibacterials for ocular infection

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19
Q

What bacteria commonly cause keratitis?

A 
Staph.epidermidis
Staph.aureus
Strep.pneumoniae
Pseudomonas
Haemophilus
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20
Q

What normally protects the conjunctiva and cornea from infection?

A 
Blinking
Flow of tears washes away debris
Mucus - entraps foreign particles
Tears: antibacterial properties
Corneal epithelium - barrier function
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21
Q

What are the features of bacterial keratitis?

A 
Pain
Purulent discharge
Ciliary injection
Visual loss
Hypopyon
White corneal opacity
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22
Q

How do you manage bacterial keratitis?

A

Scrape the base for gram stain and culture

Topical ABx - often dual - drops hourly for 1st 2days then reduce in frequency according to clinical picture

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23
Q

What is a serious complication of bacterial keratitis?

A

Corneal perforation

Requires tissue adhesives then corneal graft

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24
Q

What is episcleritis?

A

Inflammation of superficial layer of sclera
Mild discomfort
Self-limiting

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25
Q

What is scleritis?

A

More severe inflammation

May be associated with other collagen vascular diseases e.g. RA or SLE

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26
Q

What are the features of scleritis?

A

Intense ocular pain

Inflammation and ischaemia of the sclera, swollen

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27
Q

How is scleritis treated?

A

High doses of systemic steroids

28
Q

What conditions affect the eyelids?

A 
Blepharitis
Marginal keratitis
Trichiasis
Chalazion
Stye
29
Q

What is blepharitis?

A

Inflammation of the lid margin

30
Q

What are the features of blepharitis?

A 
Lid crusting
Redness
Telangiectasia
Misdirected lashes
Gritty / FB sensation
Itching and mild pain
Assoc with styles and conjunctivitis
31
Q

How do you manage blepharitis?

A

Lid hygiene
Topical antibiotics
Lubricants

32
Q

What causes blepharitis?

A

Staph infections

Or other skin flora

33
Q

What is marginal keratitis?

A

Associated with chronic staphylococcal blepharitis

Foreign body sensation

34
Q

What is trichiasis?

A

Inward turning lashes

May be secondary to chronic blepharitis or herpes zoster

35
Q

What is chalazion?

A

Internal hordeolum

Staph infection of Meibomian gland

36
Q

What is a stye?

A

External hordeolum

Staph abscess of lash follicle & its associated gland of Zeiss or Moll

37
Q

What are the differentials for acute red eye?

A

Lids: blepharitis, chalazion, stye, marginal keratitis
Conjunctivitis
Epi-/ scleritis
Cornea: bacterial or herpetic keratitis
Anterior chamber: anterior uveitis, iritis, acute angle closure, orbital cellulitis

38
Q

What is uveitis?

A

Inflammation of uveal tract

I.e. Iris, ciliary body and choroid

39
Q

How is uveitis classified?

A

Iritis = anterior uveitis
Intermediate uveitis = cyclitis (CB) and vitritis (vitreous)
Posterior uveitis - may involve choroid, retina or both
Panuveitis is anterior chamber, vitreous and retina

40
Q

What are the majority of cases of uveitis?

A

75% are anterior uveitis (iritis)

Half of patients with uveitis have an associated systemic disease

41
Q

What are the symptoms of uveitis?

A

Ocular pain
Photophobia
Blurring of vision
Redness of eye

42
Q

What do you want to ascertain in the history of a patient with suspected uveitis?

A

Whether they have any features of systemic disease
Resp, GI, joint, skin, etc
Think ank spond, SLE, UC etc

43
Q

What are the signs of uveitis?

A

Reduced visual acuity

Inflamed eye mostly around limbus

44
Q

What do you see in anterior uveitis?

A

Inflammatory cells visible clumped together on endothelium of cornea
Aqueous cells and flare on slit lamp ( exuded protein )
Dilated vessels on iris
Increased intraocular pressure

45
Q

What are the features of intermediate or posterior uveitis?

A

Cells in the vitreous
Retinal or choroidal foci of inflammation
Macular oedema

46
Q

What investigations should you do in uveitis?

A

Anterior: ankylosing spondylitis (HLA)
Sarcoidosis: CXR, serum ACE levels
Posterior uveitis: infections or systemic inflammatory cause

47
Q

What are the specific signs in uveitis related to sarcoidosis?

A

Presence of large KPs

Nodules on the iris

48
Q

How do you manage uveitis?

A

Steroids - drops in anterior, systemic in posterior
Specific antiviral or antibiotic medication may be required
Dilation of pupil to ease pain from ciliary spasm - mydriatics eg cyclopentolate or atropine drops

49
Q

Define cataract

A

Congenital or acquired opacity in the capsule or lens substance

50
Q

What are the causes of cataract?

A

Congenital
Senile
Diabetes, inflammation, trauma, steroids

51
Q

What factors contribute to senile cataracts?

A

Smoking
UV radiation
Elevated blood sugar levels

52
Q

What are the symptoms of cataract?

A

Painless loss of vision
Glare
Change in refraction

53
Q

What are the signs of cataract?

A

Reduced visual acuity
Appears black against the red reflex
Slit lamp: exact site of opacity of lens can be identified

54
Q

How is cataract managed?

A

Surgery: phacoemulsification…
Opening made in anterior capsule, lens removed and plastic lens implant inserted
Implant held in place by capsular bag

55
Q

How is the correct lens implant selected for cataract surgery?

A

Measure length of eye and curvature of cornea to select correct strength

56
Q

What is the post-op management from cataract surgery?

A

Short course of antibiotics and steroid drops

New glasses prescribed after a few weeks once incision has healed

57
Q

What are the complications of cataract surgery?

A 
Vitreous loss - risk of glaucoma
Iris prolapse
Endophthalmitis
Cystoid macular oedema
Retinal detachment
Opacification of posterior capsule
58
Q

What are the features of endophthalmitis?

A

Painful red eye
Reduced visual acuity
Collection of white cells in anterior chamber

59
Q

How do you manage endophthalmitis?

A

Sample aqueous and vitreous

Intra-vitreal broad-spectrum antibiotics

60
Q

What is the most common type of retinal detachment?

A

Rhegmatogenous - tear in retina allows vitreous into subretinal space

61
Q

What are the risk factors for rhegmatogenous retinal detachment?

A

High myope
Cataract surgery
Previous detached retina in fellow eye
Recent severe eye trauma

62
Q

What are the symptoms of retinal detachment?

A

Floaters and flashing lights (=posterior vitreous detachment)
Progressive field defect: shadow/curtain
Rapid progression - superior detachment
Fall in visual acuity - if macula affected

63
Q

What are the signs of retinal detachment?

A

Retina appears as a floating, diaphanous membrane
Movements of retina may be visible as eye moves
Retinal tear appears pink-red due to underlying choroidal vessels

64
Q

How is retinal detachment treated?

A

Surgery - internal or retinal

Close causative break and increase strength of attachment

65
Q

What is the prognosis for retinal detachment?

A

Excellent if surgery successful

Poor if macula detached for more than 24hrs before surgical repair

66
Q

What type of retinal detachment are diabetics predisposed to?

A

Traction retinal detachment

Phase 2 (21 decks)

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