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Core Conditions Year 3 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Conjunctivitis

Presentation

A 
Red eye
Gritty irritation
Injection worse peripherally
Discharge (can be watery or purulent)
Follicles and papillae in fornix of the eye
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2
Q

Does conjunctivitis affect both eyes?

A

It can do as it is easily transmitted but not always

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3
Q

Does conjunctivitis cause altered visual acuity?

A

Tearing and discharge may make vision difficult but there is not a true reduction in visual acuity

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4
Q

Viral causes of acute conjunctivitis

A

Adenovirus
Herpes
Molluscum contagiosum

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5
Q

What associated symptom do you get with conjunctivitis caused by adenovirus?

A

Lymph node enlargement

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6
Q

Bacterial causes of conjunctivitis

What uncommon cause can cause severe infection?

A

Staph.
Strep. pneumoniae
H. influenza
M. catarrhalis

Rare but severe - gonorrhoea (Neisseria gonorrhoeae)

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7
Q

Chronic causes of conjunctivitis

A

Repeated infections:
Molluscum contagiosum
Chlamydia
Trachoma

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8
Q

What symptom will tell you conjunctivitis is caused by bacteria or virus?

A

Bacterial conjunctivitis will usually present with the patient’s eyes being stuck upon waking up

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9
Q

Treatment for conjunctivitis

A

Often self limiting
Cleaning the eyes with water can help
For bacterial cases, Chloramphenicol is the standard antibiotic
Fusidic acid can be given in pregnancy

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10
Q 
Anterior Uveitis (Iritis)
Symptoms
A 
Central redness
Photophobia
Acute pain
Small pupil due to iris spasms
Inflammatory deposits (which can lead to hypopyon)
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11
Q

Common causes of Iritis

A

Infectious: Varicella zoster, Herpes simplex, CMV, toxoplasmosis
Malignancy: Retinoblastoma, leukaemia, Non-Hodgkin’s
Autoimmune: Psoriatic arthritis, sarcoidosis

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12
Q

Management of iritis

A

Steroids
Atropine to paralyse ciliary body
Systemic immunosuppression and antibiotics can be used in severe cases

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13
Q

Episcleritis

Causes and symptoms

A

Non-infectious inflammation of episclera
Associated with collagen disorders or RA
Asymptomatic, or can cause mild pain

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14
Q

Treatment of episcleritis

A

Self limiting

Steroids can be used if symptoms persist

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15
Q

Scleritis

Presentation

A

Patient has deep, boring pain in the eye
Wakes them up at night
Lacrimation
Photophobia

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16
Q

Scleritis

Causes

A

Herpes zoster

Collagen disorders, sarcoidosis, gout, IBD

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17
Q

Scleritis

Treatment

A

Steroids (topical and then oral)

18
Q

Glaucoma

Cause

A

Blockage of trabecular meshwork, so aqueous humour can’t drain away and ocular pressure builds up
Presses on optic nerve and can cause vision loss

19
Q

Open angle glaucoma

Presentation

A

Visual loss
Fundoscopic changes: Increased cupping, optic disc atrophy, haemorrhage, rim changes
Increased ocular pressure

20
Q

What happens to cause angle closure in glaucoma?

A

Iris (pupil) catches on the lens while it is in mid-dilation

This is common in shock, TV in low light (any time when the pupil suddenly changes size)

21
Q

Treatment of Open angle glaucoma

A

Topical Beta blocker (Timolol) and Carbonic Anhydrase inhibitors to reduce aqueous production

Prostaglandin analogues to increase drainage

22
Q

Risk factors for Open angle glaucoma

A

Age
Family history
Nerve pinching
Being African American

23
Q

Risk factors for closed angle glaucoma

A 
Hyperopic eyes (have a smaller anterior chamber)
Pupil dilation (including with antihistamines)
24
Q

Presentation of close angled glaucoma

A

Painful red eye
Nausea and vomiting
Seeing haloes in their vision (from water in the cornea)

25
Q

Treatment of closed angle glaucoma

A

EMERGENCY
Pilocarpine to constrict pupil and open blockage
Timolol and carbonic anhydrase inhibitors to reduce aqueous production
Laser surgery (to make a hole through the iris) can be a definitive treatment

26
Q

Orbital cellulitis

Aetiology

A

Infection behind the orbital septum

Sight threatening emergency

27
Q

Causes of orbital cellulitis

A

Spread of infection from other sites (paranasal sinuses and dental infections)
Direct innoculation in trauma (72hrs post injury)

28
Q

Pathogens in orbital cellulitis

A

Strep pneumonia/ pyogenes
Staph aureus
H. influenza (in kids)
MRSA

29
Q

Orbital cellulitis

Presentation

A 
Unilateral oedema, erythema, chemosis and pain
Proptosis (anterior protrusion of eye)
Ophthalmoplegia (paralysis of the eye)
Reduced visual acuity
RAPD
30
Q

Orbital cellulitis

Treatment

A

Emergency
IV antibiotics (Cefotaxime and Flucloxacillin with metronidazole)
Clindamycin and ciprofloxacin in penicillin allergy

Surgery can be indiciated

31
Q

Giant cell arteritis

Definition

A

Chronic vasculitis, characterised by granulomatosis of blood vessels in the head, particularly branches of the carotid artery

32
Q

Clues to Giant cell arteritis

A 
Unilateral headache
Tenderness or thickening of temporal artery
Scalp tenderness (brushing hair)
Jaw claudication
Vision loss
Fever
Distal swelling and pitting oedema
33
Q

Diagnosis of Giant cell arteritis

A

Temporal artery biopsy

Bloods: ESR, CRP, ALP, FBC (raised platelets)

34
Q

Treating Giant cell arteritis

A

Oral prednisolone

Aspirin and PPI long term

35
Q

Physiological changes in macular degeneration

A

Drusen
Abnormalities in RPE
Neovascularisation within the retina - causes scarring and bleeding

36
Q

Major risk factors for AMD

A

Smoking
Family history
Increasing age

37
Q

Presentation of AMD

A

Loss of central vision or scotoma
Metamorphopsia (waving of lines)
Reduced adaptation to light and dark

38
Q

Treatment of AMD

A

Anti-VEGF treatments

Holistic care, looking at functioning, driving and coping with vision loss

39
Q

Classic symptoms of Optic neuritis

A

Vision loss
Eye pain (particularly on movement)
Loss of colour vision

40
Q

Major risk in someone with vitreous detachment?

A

Progressing to retinal detachment

41
Q

Risk factors for retinal detachment?

A

Age
Short sightedness
FHx
Previous history of detachment

42
Q

Presentation of retinal detachment

A

New onset floaters and flashes

Progressing to painless sudden vision loss

Core Conditions Year 3 (3 decks)

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