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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
What is scleritis?
More severe inflammation | May be associated with other collagen vascular diseases e.g. RA or SLE
26
What are the features of scleritis?
Intense ocular pain | Inflammation and ischaemia of the sclera, swollen
27
How is scleritis treated?
High doses of systemic steroids
28
What conditions affect the eyelids?
``` Blepharitis Marginal keratitis Trichiasis Chalazion Stye ```
29
What is blepharitis?
Inflammation of the lid margin
30
What are the features of blepharitis?
``` Lid crusting Redness Telangiectasia Misdirected lashes Gritty / FB sensation Itching and mild pain Assoc with styles and conjunctivitis ```
31
How do you manage blepharitis?
Lid hygiene Topical antibiotics Lubricants
32
What causes blepharitis?
Staph infections | Or other skin flora
33
What is marginal keratitis?
Associated with chronic staphylococcal blepharitis | Foreign body sensation
34
What is trichiasis?
Inward turning lashes | May be secondary to chronic blepharitis or herpes zoster
35
What is chalazion?
Internal hordeolum | Staph infection of Meibomian gland
36
What is a stye?
External hordeolum | Staph abscess of lash follicle & its associated gland of Zeiss or Moll
37
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
38
What is uveitis?
Inflammation of uveal tract | I.e. Iris, ciliary body and choroid
39
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
40
What are the majority of cases of uveitis?
75% are anterior uveitis (iritis) | Half of patients with uveitis have an associated systemic disease
41
What are the symptoms of uveitis?
Ocular pain Photophobia Blurring of vision Redness of eye
42
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
43
What are the signs of uveitis?
Reduced visual acuity | Inflamed eye mostly around limbus
44
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
45
What are the features of intermediate or posterior uveitis?
Cells in the vitreous Retinal or choroidal foci of inflammation Macular oedema
46
What investigations should you do in uveitis?
Anterior: ankylosing spondylitis (HLA) Sarcoidosis: CXR, serum ACE levels Posterior uveitis: infections or systemic inflammatory cause
47
What are the specific signs in uveitis related to sarcoidosis?
Presence of large KPs | Nodules on the iris
48
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
49
Define cataract
Congenital or acquired opacity in the capsule or lens substance
50
What are the causes of cataract?
Congenital Senile Diabetes, inflammation, trauma, steroids
51
What factors contribute to senile cataracts?
Smoking UV radiation Elevated blood sugar levels
52
What are the symptoms of cataract?
Painless loss of vision Glare Change in refraction
53
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
54
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
55
How is the correct lens implant selected for cataract surgery?
Measure length of eye and curvature of cornea to select correct strength
56
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
57
What are the complications of cataract surgery?
``` Vitreous loss - risk of glaucoma Iris prolapse Endophthalmitis Cystoid macular oedema Retinal detachment Opacification of posterior capsule ```
58
What are the features of endophthalmitis?
Painful red eye Reduced visual acuity Collection of white cells in anterior chamber
59
How do you manage endophthalmitis?
Sample aqueous and vitreous | Intra-vitreal broad-spectrum antibiotics
60
What is the most common type of retinal detachment?
Rhegmatogenous - tear in retina allows vitreous into subretinal space
61
What are the risk factors for rhegmatogenous retinal detachment?
High myope Cataract surgery Previous detached retina in fellow eye Recent severe eye trauma
62
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
63
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
64
How is retinal detachment treated?
Surgery - internal or retinal | Close causative break and increase strength of attachment
65
What is the prognosis for retinal detachment?
Excellent if surgery successful | Poor if macula detached for more than 24hrs before surgical repair
66
What type of retinal detachment are diabetics predisposed to?
Traction retinal detachment

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