Ophthalmology Flashcards
What are the signs of bacterial conjunctivitis?
Redness of eye
Purulent discharge
Ocular irritation
What bacteria commonly cause conjunctivitis?
Staph
Strep
Pneumococcus
Haemophilus
What are the features of viral conjunctivitis?
Watery discharge
Conjunctival follicles
Lid oedema and excessive lacrimation
How do you manage conjunctivitis?
Usually self-limiting
Viral highly contagious
Bacterial: chloramphenicol if troublesome
How can chlamydia affect the eye?
Inclusion keratoconjunctivitis
Trachoma (uncommon in developed world)
How does chlamydia inclusion keratoconjunctivitis present?
Mucopurulent follicular conjunctivitis and micropannus
Urethritis / cervicitis common
How do you treat chlamydia?
Refer to GUM for azithromycin 1g PO stat
What is allergic conjunctivitis?
IgE mediated reaction to airborne allergens (hay fever)
How is allergic conjunctivitis treated?
Mast cell stabilisers eg sodium cromoglycate
Antihistamines
Topical steroids in severe cases
What is the risk of topical steroids in the eye?
Glaucoma and cataract
What are the symptoms of allergic conjunctivitis?
Itchiness
Conjunctival injection and swelling
Lacrimation
Name 4 conjunctival signs
Papillae
Follicles
Injection
Subconjunctival haemorrhage
Name 4 corneal signs
Epithelial and stromal oedema
Focal, granular white spots
Chronic keratitis - can lead to pannus (new blood vessels under epithelium)
Keratin precipitates
What conditions affect the cornea?
Bacterial keratitis
Viral keratitis
What are the types of viral keratitis?
Herpes simplex keratitis
Herpes zoster ophthalmicus
What is herpes zoster ophthalmicus?
Ophthalmic shingles
Affecting ophthalmic division of trigeminal nerve
What are the features of herpes zoster ophthalmicus?
Prodrome of being unwell
Pain and vesicles in ophthalmic distribution of CNV
Corneal symptoms: redness, clouding, discharge, photophobia
How do you treat herpes zoster ophthalmicus?
Oral aciclovir for skin
Topical steroids and antibacterials for ocular infection
What bacteria commonly cause keratitis?
Staph.epidermidis Staph.aureus Strep.pneumoniae Pseudomonas Haemophilus
What normally protects the conjunctiva and cornea from infection?
Blinking Flow of tears washes away debris Mucus - entraps foreign particles Tears: antibacterial properties Corneal epithelium - barrier function
What are the features of bacterial keratitis?
Pain Purulent discharge Ciliary injection Visual loss Hypopyon White corneal opacity
How do you manage bacterial keratitis?
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
What is a serious complication of bacterial keratitis?
Corneal perforation
Requires tissue adhesives then corneal graft
What is episcleritis?
Inflammation of superficial layer of sclera
Mild discomfort
Self-limiting
What is scleritis?
More severe inflammation
May be associated with other collagen vascular diseases e.g. RA or SLE
What are the features of scleritis?
Intense ocular pain
Inflammation and ischaemia of the sclera, swollen
How is scleritis treated?
High doses of systemic steroids
What conditions affect the eyelids?
Blepharitis Marginal keratitis Trichiasis Chalazion Stye
What is blepharitis?
Inflammation of the lid margin
What are the features of blepharitis?
Lid crusting Redness Telangiectasia Misdirected lashes Gritty / FB sensation Itching and mild pain Assoc with styles and conjunctivitis
How do you manage blepharitis?
Lid hygiene
Topical antibiotics
Lubricants
What causes blepharitis?
Staph infections
Or other skin flora
What is marginal keratitis?
Associated with chronic staphylococcal blepharitis
Foreign body sensation
What is trichiasis?
Inward turning lashes
May be secondary to chronic blepharitis or herpes zoster
What is chalazion?
Internal hordeolum
Staph infection of Meibomian gland
What is a stye?
External hordeolum
Staph abscess of lash follicle & its associated gland of Zeiss or Moll
What are the differentials for acute red eye?
Lids: blepharitis, chalazion, stye, marginal keratitis
Conjunctivitis
Epi-/ scleritis
Cornea: bacterial or herpetic keratitis
Anterior chamber: anterior uveitis, iritis, acute angle closure, orbital cellulitis
What is uveitis?
Inflammation of uveal tract
I.e. Iris, ciliary body and choroid
How is uveitis classified?
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
What are the majority of cases of uveitis?
75% are anterior uveitis (iritis)
Half of patients with uveitis have an associated systemic disease
What are the symptoms of uveitis?
Ocular pain
Photophobia
Blurring of vision
Redness of eye
What do you want to ascertain in the history of a patient with suspected uveitis?
Whether they have any features of systemic disease
Resp, GI, joint, skin, etc
Think ank spond, SLE, UC etc
What are the signs of uveitis?
Reduced visual acuity
Inflamed eye mostly around limbus
What do you see in anterior uveitis?
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
What are the features of intermediate or posterior uveitis?
Cells in the vitreous
Retinal or choroidal foci of inflammation
Macular oedema
What investigations should you do in uveitis?
Anterior: ankylosing spondylitis (HLA)
Sarcoidosis: CXR, serum ACE levels
Posterior uveitis: infections or systemic inflammatory cause
What are the specific signs in uveitis related to sarcoidosis?
Presence of large KPs
Nodules on the iris
How do you manage uveitis?
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
Define cataract
Congenital or acquired opacity in the capsule or lens substance
What are the causes of cataract?
Congenital
Senile
Diabetes, inflammation, trauma, steroids
What factors contribute to senile cataracts?
Smoking
UV radiation
Elevated blood sugar levels
What are the symptoms of cataract?
Painless loss of vision
Glare
Change in refraction
What are the signs of cataract?
Reduced visual acuity
Appears black against the red reflex
Slit lamp: exact site of opacity of lens can be identified
How is cataract managed?
Surgery: phacoemulsification…
Opening made in anterior capsule, lens removed and plastic lens implant inserted
Implant held in place by capsular bag
How is the correct lens implant selected for cataract surgery?
Measure length of eye and curvature of cornea to select correct strength
What is the post-op management from cataract surgery?
Short course of antibiotics and steroid drops
New glasses prescribed after a few weeks once incision has healed
What are the complications of cataract surgery?
Vitreous loss - risk of glaucoma Iris prolapse Endophthalmitis Cystoid macular oedema Retinal detachment Opacification of posterior capsule
What are the features of endophthalmitis?
Painful red eye
Reduced visual acuity
Collection of white cells in anterior chamber
How do you manage endophthalmitis?
Sample aqueous and vitreous
Intra-vitreal broad-spectrum antibiotics
What is the most common type of retinal detachment?
Rhegmatogenous - tear in retina allows vitreous into subretinal space
What are the risk factors for rhegmatogenous retinal detachment?
High myope
Cataract surgery
Previous detached retina in fellow eye
Recent severe eye trauma
What are the symptoms of retinal detachment?
Floaters and flashing lights (=posterior vitreous detachment)
Progressive field defect: shadow/curtain
Rapid progression - superior detachment
Fall in visual acuity - if macula affected
What are the signs of retinal detachment?
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
How is retinal detachment treated?
Surgery - internal or retinal
Close causative break and increase strength of attachment
What is the prognosis for retinal detachment?
Excellent if surgery successful
Poor if macula detached for more than 24hrs before surgical repair
What type of retinal detachment are diabetics predisposed to?
Traction retinal detachment
