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Finals Bible: Surgery > Ophthalmology > Flashcards

Ophthalmology Flashcards

(88 cards)

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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
Clinical features of anterior uveitis?
Pain and photophobia | Reduced acuity
26
Exam findings of anterior uveitis?
Small fixed pupil, ciliary flush Hypopynon White precipitates on back of cornea
27
Anterior uveitis associated conditions?
Crohns, UC Ankylosing Spondylitis Bechets
28
Management of anterior uveitis?
Referral Steroid eye drops Atropine = dilate pupil = relieve pain and photophobia
29
What is keratitis?
Inflammation of the cornea
30
Causes of keratitis?
``` Infective = HSV, S. aureus and pseudomonas in contact lens wearers Environmental = Photokeratitis in welders ```
31
Clinical features of keratitis?
Red eye + photophobia Foreign body / gritty sensation Hypopynon
32
Management of keratitis?
Antibiotic eye drops = Gentamicin and cefazolin | Atropine for symptom relief
33
What is corneal abrasion
Epithelial breech without keratitis
34
Investigation of abrasion?
Slit lamp with fluroscein stain
35
Management of abrasion?
Chloramphenicol for prophylaxis
36
Management of scleritis?
Referral NSAIDs Corticosteroids
37
What is conjunctivitis?
Inflammation of the lining of eyeball and eyelids
38
Clinical features of bacterial vs Viral vs allergic conjunctivitis ?
Bacterial = purulent discharge, eyes stuck in morning Viral = Serous discharge, recurrent URTI, LN's Allergic = Bilateral, itch, atopy Hx
39
Management of conjunctivitis
Conservative = No towel sharing, no lenses, can go to school Medical = Topical chloramphenicol Topical fusidic acid if pregnant Allergic = Topical / systemic anti-histamines
40
Clinical features of optic neuritis?
Only painful cause of sudden visual loss Red desaturation Pain worse on eye movement Central visual loss
41
Causes of optic neuritis?
MS Diabetes Syphilis
42
Management of optic neuritis?
High dose methylpred. IV then oral.
43
Clinical features of vitreous haemorrhage? Management?
Painless sudden visual loss Floaters and dark spots Big bleed = No red reflex and cannot visualise retina Often spontaneous reabsorption Vitrectomy if dense
44
Central retinal artery occlusion causes?
Due to thromboembolism from atherosclerosis or temporal arteritis
45
Clinical features of CRAO? Management?
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
Retinal vein occlusion causes?
Atherosclerosis HTN DM Polycythaemia
47
Clinical features of RVO?
``` Painless vision loss RAPD Stormy sunset appearance Tortuous dilated vessels Haemorrhage ```
48
Retinal detachment types?
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
Clinical features? Management?
``` 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
RF's for age related macular degeneration?
Smoking Female FHx
51
Types of ARMD?
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
Investigations and management for AMRD?
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
RF's for COAG?
FHx Black HTN, DM Myopia
54
If FHx of glaucoma when do you screen from?
Annually at 35
55
COAG investigations
Tonometry = IOP > 21 | Fundoscopy
56
Management of COAG?
Lifelong follow up 1st line = Latanoprost 2nd line or if IOP still >24 = Timolol 3rd line = Brimonidine / Acetazolamide / Pilocarpine Still refractory = laser trabeculoplasty
57
Which COAG drugs reduce aqueous formation and their class?
``` Timolol = BB Brimodine = alpha agonist Acetazolamide = Carbonic anhydrase inhibitor ```
58
Which COAG drugs increase uveoscleral outflow and class?
``` Latanprost = Prostaglandin analogue Miotics = Pilocarpine ```
59
What is the leading cause of blindness <60?
Diabetes
60
Pathology of diabetic eye?
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
Classification of pre-proliferative diabetic retinopathy?
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
Signs of proliferative diabetic retinopathy?
Neoangiogenesis = Can be disk or outside disc Vitreous haemorrhage Retinal detachment
63
Eye screening for diabetics?
Annually Photographs Refer if Maculopathy, PDR, NPDR
64
Management of diabetic retinopathy?
Good control Laser photocoagulation: Maculopathy = focal / grid Proliferative disease = pan-retinal
65
Hypertensive retinopathy classification?
Keith-Wagner classification: 1 = Arteriolar narrowing and silver wiring 2= AV nipping 3 = Cotton wool exudates and flame haemorrhages 4 = Papilloedema
66
What is cataracts?
Opacification of the crystalline lens
67
Causes of cataracts?
Age DM Steroids Congential e.g. Rubella
68
4 types of cataracts?
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
Clinical features of cataracts?
Increasing short sightedness Gradual vision loss, not corrected by glasses Dazzling in light
70
management of cataracts?
Conservative = sunglasses and regular follow up Surgical: Phaecoemulsification ± intra-ocular lens implant
71
What is phaecoemulsification? Complications?
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
Clinical features of retinitis pigmentosa?
Night blindness Tunnel vision Blind by mid-30's
73
What is retinitis pigmentosa?
Genetic disorder with breakdown of retinal cells
74
Conditions associated with RP?
Ushers Friedrichs ataxia = Absent ankle jerk, cerebella ataxia and optic atrophy Refsums disease = Cerebellar damage due to phytanic acid storage Keams-Sayre
75
Clinical features of retinoblastoma and management?
Absent red reflex, strabismus No vitreous seeding = chemo + laser ablation Vitreous seeding post chemo = External beam radiation Vitreous seeding = enucleation and prosthesis
76
What is blepharitis? Cause?
Inflammation of eyelid margins Meibomian gland dysfunction = posterior Anterior = seborrheic dermatitis
77
Clinical features of blephairits and management?
Bilateral red eyes Gritty and itchy Scales on lashes Clean crust with warm soaks
78
types of stye?
Hordeolum external = infection of the glands of Zeis Hordeolum internal = Infection of Meibomian gland
79
What is a chalazion?
Retention cyst of Meibomian gland = firm painless lump
80
Entropion vs Ectropion
``` Entropion = inversion Ectropion = eversion ```
81
Orbital vs peri-orbital cellulitis?
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
Clinical features and management of cellulitis?
Child, swelling and exophthalmos Empirical antibitoics e.g. Cefazolin
83
What is myopia?
Short sighted = Eye is too long, distant object are focused to far forwards Concave lens
84
Hypermetropia?
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
Astigmatism
Cornea or lens doesn't have same degree of curvature in horizontal and vertical planes Images distorted vertically / horizontally Convex lens
86
What is strabismus?
Misalignment of eyes Esotropia = Convergent squint Exotropia = Divergent squint
87
Non paralytic vs paralytic quint?
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
Management of strabismus?
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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