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4MB Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What makes up the uvea?

A

Iris
Ciliary body
Choroid

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2
Q

What does a miotic agent do? Give an example of one

A

Miotics constrict the pupil

Pilocarpine

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3
Q

What does a mydriatic agent do? Give an example of one

A

Mydriatics dilate the pupil

Tropicamide

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4
Q

What is a stye?

A

Inflammatory lid swelling

Non-specific term - may be transient or infectious

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5
Q

What is hordeolum externum?

A

Abscess/infection present in lash follicle

May involve sweat/sebum glands, usually points outwards

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6
Q

What is a chalazion?

A

Residual non-infectious lid swelling that occurs due to blockage of Meibomian gland

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7
Q

Outline management of stye and other lid swellings

A

Warm compresses
Topical antibiotics (fusidic acid)
Incision and curettage

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8
Q

What is blepharitis?

A

Inflammation of the eyelid

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9
Q

List aetiology/risk factors for blepharitis

A

Anterior: seborrhoeic, Staph aureus
Posterior: Meibomian gland dysfunction

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10
Q

List clinical features of anterior blepharitis

A 
Red lid margin
Scale, dandruff
Dermatitis
Style, ulcer
Distorted lashes
Keratitis
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11
Q

List clinical features of posterior blepharitis

A 
Deep red lid
Dried secretions
Gritty eyes
Chalazion
Rosacea
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12
Q

Outline management of blepharitis

A 
Lid hygiene - cotton wool swab, bathing
Warm compresses
Topical fusidic acid/chloramphenicol
Topical steroid
Incision and curettage for chalazion
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13
Q

What is entropion?

A

Lid turns inwards, causing lashes to rub against globe

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14
Q

List aetiology/risk factors for entropion

A

Ageing

Degeneration of lid fascial elements and muscles

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15
Q

List clinical features of entropion

A

Red eye

Irritation

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16
Q

Outline management of entropion

A

Surgical taping of eyelid

Botox for lower eyelid

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17
Q

What is ectropion?

A

Lid turns outwards

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18
Q

List aetiology/risk factors for ectropion

A

Ageing

Facial nerve palsy

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19
Q

Outline management of ectropion

A

Surgical weight implant

Plastic surgery

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20
Q

What is keratoconjunctivitis sicca?

A

“dry eye syndrome” due to reduced tear production or excess tear evaporation

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21
Q

List aetiology/risk factors for keratoconjunctivitis sicca

A 
Lacrimal gland destruction (Sjogren's)
Mucin deficiency (low vitamin A, SJ syndrome)
Ageing
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22
Q

What is a normal Schirmer test?

A

Test strip should soak more than 15mm in 5 mins

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23
Q

Outline management of keratoconjunctivitis sicca

A

Artificial tears if symptomatic

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24
Q

List aetiology/risk factors for orbital cellulitis

A

Spread from paranasal sinus infection
Dental injury
Staphylococci
Streptococci

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25
List clinical features of orbital cellulitis
Fever Lid swelling Reduced eye mobility Blindness if optic nerve involvement
26
What scan would you want to do promptly for orbital cellulitis?
CT scan
27
Outline management of orbital cellulitis
IV cefuroxime | Surgery to prevent meningitis
28
List clinical features of ophthalmic shingles
Pain and neuralgia in dermatomal distribution of CN V1 Blistering rash Globe may be affected (iritis, corneal signs, scleritis) Nose tip involvement (Hutchinson sign) implies nasociliary nerve branch involvement, increasing likelihood of globe affected
29
Outline management of ophthalmic shingles
Oral aciclovir | Refer to specialist
30
Who typically gets retinoblastoma?
Most common primary intraocular tumour in children
31
List aetiology/risk factors for retinoblastoma
Hereditary: RB gene 13q14, autosomal dominant, mutated tumour suppressor gene Pineal gland tumour Osteosarcoma Rhabdosarcoma
32
List clinical features of retinoblastoma
Strabismus Leukoconia (white pupil) Absent red reflex
33
Outline management of retinoblastoma
Chemotherapy for bilateral Enucleation (eye removal) if large/long-standing retinal detachment Radiotherapy
34
What is strabismus/squint?
Abnormality in coordinated movement of both eyes
35
Describe esotropia
Eye sits inwards | Outward movement on cover test
36
Describe exotropia
Eye sits outwards | Inward movement on cover test
37
Describe hypertropia
Eye sits upwards | Downward movement on cover test
38
Describe hypotropia
Eye sits downwards | Upward movement on cover test
39
Outline management of strabismus
Optical: correct refractive error Orthoptic: patch good eye Operation: resection and recession of rectus, botox
40
List aetiology/risk factors for oculomotor nerve palsy
Cavernous sinus lesions Superior orbital fissure syndrome Diabetes
41
List clinical features of oculomotor nerve palsy
``` Posterior communicating artery aneurysm Ptosis Proptosis Pupil dilation "down and out" pupil ```
42
List aetiology/risk factors for trochlear nerve palsy
Trauma Diabetes Tumour
43
List clinical features of trochlear nerve palsy
Diplopia Head-tilting (ocular torticollis) "up and in" pupil Cannot look down and out
44
List aetiology/risk factors for abducens nerve palsy
Increased ICP Base of skull trauma Vascular disease Multiple sclerosis
45
List clinical features of abducens nerve palsy
Diplopia in horizontal plane Adducted eye Botox may help
46
Which nerve is responsible for normal light detection (afferent pathway)?
Optic nerve
47
Which nerve is responsible for pupil constriction (efferent pathway)?
Oculomotor nerve
48
Which nerve is responsible for pupil dilation?
Ciliary nerve (sympathetic chain)
49
What is an afferent pupillary defect?
Absent direct response - pupil does not respond (constrict) to light due to optic nerve damage Contralateral pupil constricts to indicate intact consensual response (intact oculomotor nerve)
50
List aetiology/risk factors for afferent pupillary defect
Optic neuritis Optic atrophy Retinal disease
51
On swinging light test, both pupils constrict in an afferent pupillary defect. True/False?
True
52
What is an efferent pupillary defect?
Fixed dilated pupil
53
What is a Holmes-Adie pupil?
Initially monolateral, then bilateral pupil dilation Tonic pupil Delayed response to near vision effort, causes sudden blurring of vision
54
List clinical features of Horner's syndrome
Miosis Ptosis Constricted pupil Unilateral sweating
55
What is a Argyll Robertson pupil?
Bilateral miosis Irregular pupils No direct response
56
What is myopia?
Short sightedness due to large eyeball - light focuses in front of retina
57
List clinical features of myopia
Children change spectacles frequently Able to see close objects Retinal detachment Macular bleeding
58
Outline management of myopia
Concave lens correction | LASIK
59
What is hypermetropia?
Long sightedness due to small eyeball | Light focuses beyond retina
60
List clinical features of hypermetropia
``` Tiredness of gaze Convergent squint (try to accommodate) ```
61
Outline management of hypermetropia
Convex lens correction
62
A lesion affecting the right optic nerve would cause what visual field defect?
No vision out of right eye
63
A lesion affecting the optic chiasma would cause what visual field defect?
Bitemporal hemianopia
64
A lesion affecting the right optic tract would cause what visual field defect?
Left homonymous hemianopia
65
A lesion affecting the left parietal optic radiation would cause what visual field defect?
Right inferior homonymous quadrantonopia
66
A lesion affecting the left temporal optic radiation would cause what visual field defect?
Right superior homonymous quadrantonopia
67
A lesion affecting the occipital lobe would cause what visual field defect?
Homonymous hemianopia with macular sparing
68
List the main causes of a red eye
``` Acute closed-angle glaucoma Anterior uveitis Scleritis Episcleritis Conjunctivitis ```
69
What is acute closed-angle glaucoma?
Blocked drainage of aqueous from anterior chamber via canal of Schlemm, causing increased intraocular pressure
70
List clinical features of closed-angle glaucoma
``` Blurred vision Painful red eye Headache Haloes around lights Worse at night Nausea, vomiting Corneal haze Dilated pupil "hard" eye ```
71
Outline management of closed-angle glaucoma
``` Pilocarpine + IV acetazolamide Analgesia Anti-emetic Admit to hospital Peripheral iridectomy once intraocular pressure reduces ```
72
What is anterior uveitis?
Inflammation affecting iris and ciliary body (anterior uvea)
73
List aetiology/risk factors for anterior uveitis
Ankylosing spondylitis Sarcoidosis Reactive arthritis Inflammatory bowel disease
74
List clinical features of anterior uveitis
``` Red, painful eye Photophobia Normal/blurred vision Lacrimation Circumcorneal redness Small pupil Talbot +ve test: pain increases on convergence as finger approaches nose ```
75
What would slit lamp examination show in anterior uveitis?
Cells in anterior chamber White precipitates on back of cornea Hypopyon may be seen
76
Outline management of anterior uveitis
Topical NSAID Systemic steroid Treat underlying condition
77
What is the commonest cause of a red eye?
Conjunctivitis
78
Which type of bacterial conjunctivitis is associated with neonates/sexually active?
Chlamydial
79
List typical viruses that cause viral conjunctivitis
Adenovirus Herpes simplex Molluscum contagiosum
80
List clinical features of bacterial conjunctivitis
``` Red, inflamed conjunctiva Hyperaemic vessels Purulent discharge Chemosis Oedema Papillae Slow-onset red eye in chlamydial ```
81
List clinical features of viral conjunctivitis
``` Red, inflamed conjunctiva Preceding URTI Watery discharge Pseudomembrane Follicles ```
82
Outline management of bacterial conjunctivitis
Bacterial usually self-limiting within 14 days Chloramphenicol Penicillin if gonococcal Erythromycin if chlamydial
83
Outline management of viral conjunctivitis
Usually self-limiting Topical aciclovir Topical steroid
84
What is episcleritis?
Inflammation below the sclera
85
List clinical features of episcleritis
Nodule Blue sclerae Achey, tender eye Normal acuity
86
Phenylephrine drops constrict vessels more in episcleritis than in scleritis. True/False?
True
87
List clinical features of scleritis
``` Severe eye pain Pain in forehead/brow/jaw Localised/diffuse red eye Violaceous hue - purple sclera Tender globe ```
88
Outline management of scleritis and episcleritis
Topical steroid Topical NSAID Systemic NSAID
89
What is a corneal abrasion?
Break in epithelium of cornea in the absence of keratitis | Usually caused by trauma
90
List clinical features of corneal abrasion
``` Needle-like pain Photophobia Blurred vision Lacrimation Circumcorneal redness Hypopyon ```
91
How does corneal abrasion appear under slit lamp?
Fluorescein drops under blue light: orange dye stains abrasion green
92
List aetiology/risk factors for corneal ulcer
``` Bacterial (Pseudomonas) Viral (herpes zoster, herpes simplex) Fungal (candida, aspergillus) Protozoal (acanthamoeba) Vasculitis (rheumatoid) ```
93
List clinical features of corneal ulcer
Reduced visual acuity Pain Lacrimation Hypopyon
94
What urgent investigation would you do for corneal ulcer?
Diagnostic smear + gram stain
95
Outline management of corneal ulcer
Chloramphenicol/aciclovir drops
96
List aetiology/risk factors for keratitis
Herpes simplex Contact lens use Blepharitis Foreign body
97
List clinical features of keratitis
Conjunctival injections Gritty eyes Photophobia Reduced visual acuity
98
What investigation would you do for keratitis?
Corneal scrape under anaesthetic | Gram stain
99
Outline management of keratitis
Ofloxacin/aciclovir
100
What are 5 important questions to ask when someone comes in with vision loss?
Associated headache? (GCA) Pain on eye movement? (optic neuritis) Lights or flashes? (retinal detachment) Like a curtain descending? (amaurosis fugax) Poorly controlled diabetes? (haemorrhage)
101
What is ischaemic optic neuropathy?
Damage to optic nerve caused by ischaemia to the posterior ciliary artery
102
List aetiology/risk factors for ischaemic optic neuropathy
Artertic (GCA) | Non-arteritic (atherosclerosis, diabetes, smoking)
103
List clinical features of ischaemic optic neuropathy
Arteritic: pain, headache, neck pain, GCA-like symptoms Non-arteritic: typically painless Vision loss
104
What investigations would you do for ischaemic optic neuropathy?
ESR CRP Temporal biopsy
105
Outline management of ischaemic optic neuropathy
Treat underlying cause | e.g. high dose prednisolone for GCA
106
List aetiology/risk factors for optic neuritis
Multiple sclerosis Diabetes Syphilis Vitamin deficiency
107
List clinical features of optic neuritis
``` Unilateral vision loss over hours/days Relative afferent pupillary defect Dyschromatopsia (cannot discriminate colour) Red desaturation Painful eye movements ```
108
Outline management of optic neuritis
IV methylprednisolone | Reduce to oral prednisolone
109
List aetiology/risk factors for vitreous haemorrhage
``` Angiogenesis Central retinal vein occlusion Retinal tear Trauma Diabetes ```
110
List clinical features of vitreous haemorrhage
Floaters in vision No red reflex Difficulty seeing retina under funduscopy
111
Outline management of vitreous haemorrhage
Photocoagulation Anti-VEGF Vitrectomy
112
List aetiology for central retinal artery occlusion (CRAO)
``` Atherosclerosis Virchow's triad Tumour Clots Infection ```
113
List clinical features of CRAO
Sudden painful vision loss Acuity usually CF or worse Relative afferent pupillary defect GCA-like symptoms
114
How would CRAO look under slit lamp?
White retina | Cherry red spot on macula
115
Outline management of CRAO
``` Exclude/treat GCA Ocular massage Bag breathing IV acetazolamide Surgical removal of aqueous ```
116
List aetiology/risk factors for central retinal vein occlusion (CRVO)
``` Ageing Arteriosclerosis Hypertension Diabetes Polycythaemia Open-angle glaucoma ```
117
List clinical features of CRVO
Sudden painless vision loss | Acuity usually CF
118
How would CRVO look under slit lamp?
Retinal haemorrhages Cotton wool spots Disc swelling
119
Outline management of CRVO
Photocoagulation | Anti-VEGF
120
What is retinal detachment?
Tear in the retina that allows fluid to collect in space between sensory retina and pigment epithelium
121
List aetiology/risk factors for retinal detachment
Melanoma Surgery (cataract) Trauma Myopia
122
List clinical features of retinal detachment
``` Floaters Flashes Field loss Fall in acuity Progressive painless visual loss, like a curtain coming down ```
123
What would you see on slit lamp examination in retinal detachment?
Grey retina | Loss of central vision if macula is affected
124
Outline management of retinal detachment
Vitrectomy Gas tamponade Coagulation
125
List aetiology/risk factors of choroiditis
``` Granulomatous reactions Toxoplasmosis Toxocara TB Sarcoidosis ```
126
Blurred vision occurs in choroiditis. True/False?
True
127
What investigations would you do for choroiditis?
CXR Mantoux test Slit lamp: grey-white raised patch on retina, cells, vitreous opacities
128
What is open-angle glaucoma?
Raised intraocular pressure due to reduced outflow of aqueous humour
129
List aetiology/risk factors of open-angle glaucoma
``` Family history Afrocarribbeans Myopia Diabetes Thyroid eye disease ```
130
List clinical features of open-angle glaucoma
``` Gradual painless peripheral vision loss Present late (central vision is preserved) ```
131
What would you see on slit lamp/funduscopy in open-angle glaucoma?
Optic disc cupping, atrophy Haemorrhages IOP greater than 21 mm Hg
132
Outline management of open-angle glaucoma, listing drugs used and their basic action
Prostaglandin analogue increases outflow (latanoprost) B blocker blocks ciliary body to decrease aqueous production (timolol) Alpha agonist reduces aqueous production (brimonidine) Carbonic anhydrase inhibitor reduces aqueous production (acetazolamide) Miotics reduce resistance to outflow (pilocarpine) Surgery (trabeculectomy)
133
What is the commonest cause of vision loss in patients over the age of 65?
Age-related macular degeneration (ARMD)
134
What is dry ARMD?
Degenerative change at macula, slow progression | Causes deposits of lipofuscin (drusen)
135
What is wet ARMD?
Angiogenesis from choroid into neurosensory retina, rapid progression Causes leaking
136
List aetiology/risk factors for ARMD
``` Mutations (fibulin 5, complement H) Ageing Smoking Hypertension Hypercholesterol UV exposure ```
137
List clinical features of ARMD
Dry: painless gradual vision loss, drusen deposits Wet: sudden central vision loss, blind spots, distorted lines
138
Outline management of ARMD
PDT Laser therapy Intravitreal anti-VEGF in wet ARMD Lifestyle and diet improvement
139
What is cataract?
Clouding of the lens
140
List aetiology/risk factors for cataract
``` Ageing Diabetes Hypocalcaemia Maternal infection can cause congenital cataracts Corticosteroid use Amiodarone Myopia Down's syndrome ```
141
List clinical features of cataract
``` Blurred vision Frequent glassess changes Dazzled in light Squint Loss of red reflex indicates dense cataract ```
142
Outline management of cataract
Mydriatics Sunshades Sunglasses for symptomatic relief Phacoemulsification cataract extraction and intraocular lens implant
143
What is the leading cause of blindness in 20-65 yo people?
Diabetic retinopathy
144
Outline the basic pathophysiology of diabetic retinopathy
Microangiopathy in capillaries and vessels leads to occlusion and leakage, causing ischaemia and ultimately angiogenesis
145
State the classifications (R0-R3) of diabetic retinopathy
R0: normal R1: moderate, non-proliferative changes (microaneurysms) R2: severe non-proliferative changes (dot blot haemorrhages, venous beading, cotton wool spots) R3: proliferative changes (neovascularisation, vitrous haemorrhage)
146
Outline management of diabetic retinopathy
Control diabetes Treat comorbidities Photocoagulation by laser therapy Vitrectomy
147
State the classifications of (I-IV) of hypertensive retinopathy
I: mild retinal arteriolar narrowing and sclerosis II: AV nipping, focal narrowing, sclerosis III: retinal haemorrhages, hard exudates, cotton wool spots IV: grade III + papilloedema

4MB Medicine (19 decks)

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