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Finals Bible: Surgery > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What nerve causes a RAPD?

A

CN2, the optic nerve

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2
Q

What will you see in RAPD?

A

Affected eye = no direct response to light, consensual response intact.

Swinging light test gives apparent dilation when moving to the pathological eye

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3
Q

What nerve causes an efferent defect?

A

CN3, occulomotor

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4
Q

What are the types of 3rd nerve palsy?

A

Surgical = Compresses the outer fibres where the parasympathetic fibres run = dilated pupil

Medical = damages vast forum = pupil sparing

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5
Q

Examples of medical and surgical 3rd nerve palsy?

A

Medical = MS and diabetes

Surgical = Posterior communicating artery aneurysm

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6
Q

Signs of a 3rd nerve palsy?

A

Down and out pupil

Affected eye will elicit a consensual response, but will not constrict itself to direct or consensual reflex

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7
Q

What causes Holmes-Adie pupil?

A

Damage to the post-ganglionic parasympathetic fibres

These fibres allow pupillary constriction and near vision

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8
Q

Clinical features of Holmes-Adie pupil?

A

Young woman with sudden blurring vision
Dilated pupil with no response to light
Sluggish response to accommodation

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9
Q

What is Holmes-Adie Syndrome?

A

The pupil + absent knee/ankle reflexes + hypotensive

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10
Q

What causes Argyll-Robertson pupil?

A

Focal lesion in pretectal nucleus.

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11
Q

Clinical features of AR pupil?

A

Small irregular pupil

Accommodates but doesn’t react to light.

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12
Q

What are the different causes of Horners Syndrome?

A

1st order = Central lesion = MS / stroke

2nd order = pre-ganglionic = Pancoasts, apical TB, cervical rib

3rd order = post-ganglionic = Herpes zoster, carotid dissection / aneurysm

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13
Q

What is the cause of INO?

A

Lesion to the medial longitudinal fasciculus, which runs between the pons and the midbrain

Connects CN3/4/6

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14
Q

Clinical features of INO?

A

Dissociated eye movements
Impaired adduction ipsilaterally
Nystagmus contra laterally on abduction

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15
Q

Clinical features of CN4 lesion?

A

Paralysis of superior oblique = when lateral eye is up and out. When medial eye is slightly elevated

Diplopia when looking down and in e.g. going down stairs

May see abnormal head tilt

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16
Q

Causes of CN4 lesion?

A

Diabetes

Cavernous sinus thrombosis

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17
Q

Clinical features of CN6 lesion?

A

Usually abducts the eye via lateral rectus

So get esotropia and diplopia

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18
Q

Causes of CN6 lesion?

A

Long course
Tumours, trauma, CVA e.g. Millard Gubler
Wernickes
mononeuritis multiplex

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19
Q

What is glaucoma?

A

Group of disorders characterised by optic neuropathy, usually due to raised IOP

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20
Q

RF’s for acute glaucoma?

A

Hypermetropia (long sighted)
Pupillary dilation
Lens growth associated with increasing age

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21
Q

Clinical features of acute glaucoma?

A

Severe pain ± headache, N&V
Decreased acuity peripherally
Haloes around lights

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22
Q

Fundoscopy findings in glaucoma?

A

Dull hazy cornea
Optic disc cupping (cup:disc ratio >0.7)
Optic disc pallor
Bayonetting of vessels

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23
Q

Management of acute glaucoma?

A

Urgent ophthalmology referral
Pilocarpine drops = miosis to open blockage
Timolol = reduce aqueous formation
Acetazolamide 500mg IV stat = reduce aqueous formation

Follow up = laser peripheral iridotomy = hole in outer edge = fluid bypasses pupil

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24
Q

What is anterior uveitis?

A

Inflammation of the iris and ciliary body

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25
Q

Clinical features of anterior uveitis?

A

Pain and photophobia

Reduced acuity

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26
Q

Exam findings of anterior uveitis?

A

Small fixed pupil, ciliary flush
Hypopynon
White precipitates on back of cornea

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27
Q

Anterior uveitis associated conditions?

A

Crohns, UC
Ankylosing Spondylitis
Bechets

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28
Q

Management of anterior uveitis?

A

Referral
Steroid eye drops
Atropine = dilate pupil = relieve pain and photophobia

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29
Q

What is keratitis?

A

Inflammation of the cornea

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30
Q

Causes of keratitis?

A 
Infective = HSV, S. aureus and pseudomonas in contact lens wearers
Environmental = Photokeratitis in welders
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31
Q

Clinical features of keratitis?

A

Red eye + photophobia
Foreign body / gritty sensation
Hypopynon

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32
Q

Management of keratitis?

A

Antibiotic eye drops = Gentamicin and cefazolin

Atropine for symptom relief

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33
Q

What is corneal abrasion

A

Epithelial breech without keratitis

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34
Q

Investigation of abrasion?

A

Slit lamp with fluroscein stain

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35
Q

Management of abrasion?

A

Chloramphenicol for prophylaxis

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36
Q

Management of scleritis?

A

Referral
NSAIDs
Corticosteroids

37
Q

What is conjunctivitis?

A

Inflammation of the lining of eyeball and eyelids

38
Q

Clinical features of bacterial vs Viral vs allergic conjunctivitis ?

A

Bacterial = purulent discharge, eyes stuck in morning

Viral = Serous discharge, recurrent URTI, LN’s

Allergic = Bilateral, itch, atopy Hx

39
Q

Management of conjunctivitis

A

Conservative = No towel sharing, no lenses, can go to school

Medical = Topical chloramphenicol
Topical fusidic acid if pregnant

Allergic = Topical / systemic anti-histamines

40
Q

Clinical features of optic neuritis?

A

Only painful cause of sudden visual loss

Red desaturation
Pain worse on eye movement
Central visual loss

41
Q

Causes of optic neuritis?

A

MS
Diabetes
Syphilis

42
Q

Management of optic neuritis?

A

High dose methylpred. IV then oral.

43
Q

Clinical features of vitreous haemorrhage?

Management?

A

Painless sudden visual loss
Floaters and dark spots
Big bleed = No red reflex and cannot visualise retina

Often spontaneous reabsorption
Vitrectomy if dense

44
Q

Central retinal artery occlusion causes?

A

Due to thromboembolism from atherosclerosis or temporal arteritis

45
Q

Clinical features of CRAO?

Management?

A

Painless sudden visual loss
Afferent pupillary defect
PALE RETINA = cherry red spot

If within 6 hours = reduce IOP:
Surgical removal of aqueous
Local/systemic anti-HTN

46
Q

Retinal vein occlusion causes?

A

Atherosclerosis
HTN
DM
Polycythaemia

47
Q

Clinical features of RVO?

A 
Painless vision loss
RAPD
Stormy sunset appearance
Tortuous dilated vessels
Haemorrhage
48
Q

Retinal detachment types?

A

Rhematogenous = tear/break in retina lets vitreous fluid leak in = separates

Tractional = tissue grows on retina pulling it away e.g. diabetic proliferative retinopathy

Exudative = fluid under retina but no tear. rare

49
Q

Clinical features?

Management?

A 
Four F's:
Floaters
Flashes
Field loss = curtains falling
Fall in acuity = straight lines appear curved

Urgent surgery = Vitrectomy and laser coagulation to secure the retina

50
Q

RF’s for age related macular degeneration?

A

Smoking
Female
FHx

51
Q

Types of ARMD?

A

Dry = Drusen around Bruch’s membrane. Slow visual decline over 2 years

Wet = Aberrant vessel growth from choroid into retina = haemorrhage
Visual decline over weeks

52
Q

Investigations and management for AMRD?

A

Optical coherence topography (OCT)
If neovascularisation = fluorescein hagiography

Conservative = stop smoking and high dose beta carotene/Vitc/Zinc (unless smoker as cancer risk)

Dry = no management

Wet = Anti VEGF intravitreal

53
Q

RF’s for COAG?

A

FHx
Black
HTN, DM
Myopia

54
Q

If FHx of glaucoma when do you screen from?

A

Annually at 35

55
Q

COAG investigations

A

Tonometry = IOP > 21

Fundoscopy

56
Q

Management of COAG?

A

Lifelong follow up
1st line = Latanoprost
2nd line or if IOP still >24 = Timolol
3rd line = Brimonidine / Acetazolamide / Pilocarpine

Still refractory = laser trabeculoplasty

57
Q

Which COAG drugs reduce aqueous formation and their class?

A 
Timolol = BB
Brimodine = alpha agonist
Acetazolamide = Carbonic anhydrase inhibitor
58
Q

Which COAG drugs increase uveoscleral outflow and class?

A 
Latanprost = Prostaglandin analogue
Miotics = Pilocarpine
59
Q

What is the leading cause of blindness <60?

A

Diabetes

60
Q

Pathology of diabetic eye?

A

Blood is hyperviscous = Inner endothelial cels thicken, but outer pericytes atrophy
This atrophy = thin walls and leaky walls = micro-aneurysms and dot haemorrhages
These then cause oedema
Once the oedema clears it leaves fatty deposits = hard exudate.

61
Q

Classification of pre-proliferative diabetic retinopathy?

A

mild = >1 microaneurysm

Moderate = Microaneurysm, dot haemorrhages and hard exudate

Severe = Dot haemorrhages and microaneurysm in 4 quadrants
Venous bleeding
Intra-retinal microvascular abnormalities = IRMA

62
Q

Signs of proliferative diabetic retinopathy?

A

Neoangiogenesis = Can be disk or outside disc
Vitreous haemorrhage
Retinal detachment

63
Q

Eye screening for diabetics?

A

Annually
Photographs
Refer if Maculopathy, PDR, NPDR

64
Q

Management of diabetic retinopathy?

A

Good control
Laser photocoagulation:
Maculopathy = focal / grid
Proliferative disease = pan-retinal

65
Q

Hypertensive retinopathy classification?

A

Keith-Wagner classification:
1 = Arteriolar narrowing and silver wiring
2= AV nipping
3 = Cotton wool exudates and flame haemorrhages
4 = Papilloedema

66
Q

What is cataracts?

A

Opacification of the crystalline lens

67
Q

Causes of cataracts?

A

Age
DM
Steroids
Congential e.g. Rubella

68
Q

4 types of cataracts?

A

Nuclear = change lens refractive index

Polar = localised, in the visual axis

Subcapsular = due to steroid use, deep in the lens capsule, in visual axis

Dot opacities = common in normal lens, also seen in DM

69
Q

Clinical features of cataracts?

A

Increasing short sightedness
Gradual vision loss, not corrected by glasses
Dazzling in light

70
Q

management of cataracts?

A

Conservative = sunglasses and regular follow up

Surgical:
Phaecoemulsification ± intra-ocular lens implant

71
Q

What is phaecoemulsification?

Complications?

A

Under local
Incision in eye and circular incision in membrane around cataracts
US wave used to break up and suctioned out
New folded intra-ocular lens use to replace

1% of serious e.g. retinal detachment
infection
Lens displacement

72
Q

Clinical features of retinitis pigmentosa?

A

Night blindness
Tunnel vision
Blind by mid-30’s

73
Q

What is retinitis pigmentosa?

A

Genetic disorder with breakdown of retinal cells

74
Q

Conditions associated with RP?

A

Ushers
Friedrichs ataxia = Absent ankle jerk, cerebella ataxia and optic atrophy
Refsums disease = Cerebellar damage due to phytanic acid storage
Keams-Sayre

75
Q

Clinical features of retinoblastoma and management?

A

Absent red reflex, strabismus

No vitreous seeding = chemo + laser ablation

Vitreous seeding post chemo = External beam radiation

Vitreous seeding = enucleation and prosthesis

76
Q

What is blepharitis?

Cause?

A

Inflammation of eyelid margins

Meibomian gland dysfunction = posterior

Anterior = seborrheic dermatitis

77
Q

Clinical features of blephairits and management?

A

Bilateral red eyes
Gritty and itchy
Scales on lashes

Clean crust with warm soaks

78
Q

types of stye?

A

Hordeolum external = infection of the glands of Zeis

Hordeolum internal = Infection of Meibomian gland

79
Q

What is a chalazion?

A

Retention cyst of Meibomian gland = firm painless lump

80
Q

Entropion vs Ectropion

A 
Entropion = inversion
Ectropion = eversion
81
Q

Orbital vs peri-orbital cellulitis?

A

Orbital = infectious process in muscles / fat of orbit = due to bacterial sinusitis

Peri-orbital = Infectious process in eyelid tissue superficial to orbital septum = Superficial injury e.g. bug bite

82
Q

Clinical features and management of cellulitis?

A

Child, swelling and exophthalmos

Empirical antibitoics e.g. Cefazolin

83
Q

What is myopia?

A

Short sighted = Eye is too long, distant object are focused to far forwards

Concave lens

84
Q

Hypermetropia?

A

Long-sighted = eye is too short, cannot accommodate objects close up
Can cause convergent squint in children as contraction of ciliary muscles to focus images

Convex lens

85
Q

Astigmatism

A

Cornea or lens doesn’t have same degree of curvature in horizontal and vertical planes

Images distorted vertically / horizontally

Convex lens

86
Q

What is strabismus?

A

Misalignment of eyes

Esotropia = Convergent squint

Exotropia = Divergent squint

87
Q

Non paralytic vs paralytic quint?

A

Diagnosis?

Corneal reflection test = if not symmetrical = squint

Cover test = Movement of uncovered eye to take up fixation demonstrates quint
If eye goes out = esotropia
If eye moves medially = exotropia

If paralytic = Eye won’t fixate on covering. Cover each eye in turn, which ever eye see the outer image is dysfunctioning

88
Q

Management of strabismus?

A

3 O’s

Optical = correct refractive errors
Orthoptic = patch over good eye
Operations = Resection of rectus muscles

Finals Bible: Surgery (3 decks)

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