Ophthalmology Flashcards
Optic neuritis is the common presenting feature of what condition?
MS
Presenting symptoms of optic neuritis?
Sudden deterioration in visual acuity Desaturation of colour vision Eye pain on movement
What is strabismus? What is amblyopia
Strabismus = Having a squint, this is normally a result of amblyopia which is reduced vision in one eye
What medication is associated with vision becoming yellow?
Digoxin
Dendritic ulcer is associated with what virus?
HSV
Flashes and floaters are associated with what condition?
Vitreous detachment
What conditions are associated with ischaemic optic neuropathy?
Atherosclerosis and temporal arteritis
Medications used in treatment of open angle glaucoma?
Prostaglandin analogues: latanoprost Beta-blockers: timalol Sympathomimetics: Brominidine Carbonic anydrase inhibitors (mast cell & antihistamine) dorzolamide Miotics: constrict pupil
Aidie pupil presentation?
Unilateral (80%) dilated pupil that is slowly reactive to accommodation, but very poorly to light. Associated with absent ankle/knee reflexes
Ptosis and dilated pupil = ? Ptosis and constricted pupil = ?
Ptosis and dilated pupil = third nerve palsy Ptosis and constricted pupil = horners syndrome
retinal vein occlusion and artery occlusion present how?
Sudden painless loss of vision: Vein - lots of haemorrhages on fundoscopy Artery - white with cherry area on fundoscopy
What is ectropion?
When the lower eyelid has come down from the eye. associated with ageing.
Haloes around light sources is indicative of what condition?
Cataracts
Three conditions in which anti-VEGF injections may be used?
Diabetic retinopathy Wet macular degeneration Retinal vein occlusion (to treat macula oedema)
Sclera is ruptured in blunt or penetrating trauma?
penetrating, not in blunt
What does choroidal rupture look like on fundoscopy?
like vertical striae
Most likely cause of intraocular foreign body?
hammer and chisel injury
What hurts more, intraocular foreign body or corneal foreign body?
Corneal
What is latent strabismus (squint)?
When it is only seen when one eye is covered up
What is manifest squint?
Seen when both eyes are open.
If bilateral deficits are seen to the visual field, is this likely to be neurological or ocular?
Neurological
Episcleritis presentation?
Superficial vessels dilated, benign, self-limited, frequently recurrent.
Scleritis presentation?
Episcleral and scleral vessels injected, relatively benign, does not progress to necrosis
What is different about the presentation of conjunctivitis - compared to scleritis?
Cojunctivitis typically spares the limbus.
is ciliary flush seen in conjunctivitis?
NO
What red eye condition is worse in morning and what is worse in the evening?
Conjunctivitis is worse in the morning, dry eye is worse in the evening.
Risks associated with orbital cellulitis?
Within 24 hours could develop septicaemia, cavernous sinus thrombosis
what type of discharge in staphylococcus?
Purulent
what type of discharge in Pneumococcal conjunctivitis?
Mucopurulent
What type of eye infection in watery serous discharge?
Viral (adenovirus?)
Topical ocular anti-inflammatory drugs?
Mast cell stabilisers: - Sodium cromoglycate Mast cell stabilisers & antihistamines: - Olopatadine
Damage to the optic nerve would cause what visual deficit?
Blindness in one eye
Damage to the optic chiasm would cause what visual deficit?
Bitemporal hemianopia
Damage to the right optic tract would cause what visual deficit?
left homonymous hemianopia (but not so distinctive)
Damage to the right occipital lobe would cause what visual deficit?
left homonymous hemianopia (very distinct cut off)
Blind spot is temporal or nasal?
Temporal
What is scotoma?
a field defect surrounded by a normal field - relative: not seen in low luminance, but can in high - absolute: no sensitivity within an area at all
Treatment of giant cell arteritis?
Steroids
Uveitis treatment?
Steroids then methotrexate NSAID in eye.
When would you not use steroids?
Dendritic ulcer
Treatment for allergic eye disease?
steroids (if no dendritic ulcers) sodium cromoglycate olopatadine
Treatment for diabetic retinopathy?
Anti-VEGF Steroid implants Laser
What drug can cause bullseye macula disorder?
chloroquine
Bells palsy presentation?
Facial nerve palsy unilaterally
BCC presentation?
Only found on the skin, pearly white edges, grows slowly.
SCC presentation?
scaly, fast growing (90% of mouth cancers)
Five things to check when reviewing CN II?
- Visual acuity 2. Visual fields 3. Colour - ishihara 4. Fundoscopy 5. Reflexes.
Treatment for chalazion?
- watch and wait - massage and heat 2. removal under LA 3. steroid injection
Common infected agents associated with conjunctivitis?
Staph/strep/pseudomonas (CL) Adenovirus/HSV/Zoster Chlamydia
Symptoms of a blocked nasal lacrimal duct
Excessive tearing and infections
How can diplopia be corrected?
Botox Surgery Fresnel prism Occlusion of one eye
What is keratitis, what is it caused by?
Dryness - in palsy/dry eye UV exposure CL infection
What’s more common anterior or posterior uveitis?
Anterior
Complications with untreated diabetic retinopathy?
Vitreous haemorrhage Retinal detachment Vision loss optic neuropathy
What can a fluourescein angiogram assess for?
Vessel occlusion Macular degen (leaky spot in macula) Other CVD
What can cause straight lines to appear curvy?
AMD Migraine
What can be used to assess whether straight lines are being seen as curvy?
Amsler grid
What is pterygium?
Thickening of the sclera, caused by damage to limbal stem cells or UV exposure, can grow across cornea.
What percentage of people over 85 have some degree of AMD?
60%
Post op care for cataract surgery?
Chloramphenicol for 4 weeks. Steroids for 4 weeks
Whats more common open or closed angle glaucoma?
Open angle
Causes of open angle glaucoma?
Not totally known Raised intraocular pressure Age Genetics Afro-Caribbean race
Cause of a vein occlusion?
Atherosclerotic arteries.
Retinal detachment for likely to happen to hypermetropic or myopic patients?
Myopic (big eyes)
Open angle glaucoma more likely to happen to hypermetropic or myopic patients?
Myopic (big eyes)
Symptoms of retinal detachment/tear?
New onset floaters & flashes, painless visual field loss.
Significance of unilaterally cupped disc?
Optic nerve damage due to raised pressure - glaucoma
Ddx in sudden painless loss of vision?
ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis) occlusion of central retinal vein occlusion of central retinal artery vitreous haemorrhage retinal detachment
Eye anatomy summary from anterior to posterior?
Anterior chamber: - Cornea most anterior over the middle - Conjunctiva over the white, Sclera is under this - Iris under cornea (pupil in middle) Posterior chamber - Lens and ciliary body form the posterior border Vitreous body retina, then choroid then sclera
Red eye differentials, and their features?
Acute angle closure glaucoma: - red eye - severe pain (may be ocular or headache) - decreased visual acuity, patient sees haloes - semi-dilated pupil - hazy cornea Anterior uveitis - Red eye - acute onset - pain - blurred vision and photophobia - small, fixed oval pupil, ciliary flush Scleritis - Severe pain (may be worse on movement) and tenderness - May be underlying autoimmune disease e.g. rheumatoid arthritis Episcleritis - Watery eyes - Mild/no pain - Injected superficial vessels Conjunctivitis - Purulent discharge if bacterial, clear discharge if viral Subconjunctival haemorrhage - History of trauma or coughing bouts Corneal ulcer - foreign body sensation
How would you treat dry eye? What may cause it?
Caused by: - Meibonian gland dysfunction/blepharitis - Diet issues Use eye lubrication drops
What is a chalazion and what is a stye?
Chalazion is a cyst in the eyelid (further inwards), red but not painful A stye or hordeolum is a bacterial infection of eyelid glands can be internal (meibonian) or external (lash gland), normally staph
What is intropium and ectropium?
Intropium = eyelid turned inward Ectropium = eyelid turned outwards
Management of a stye?
Hot compress and analgesia Abx only if associated conjunctivitis
Causes of heterochromia?
Congenital Iron deposits Trauma Congenital horners Use of latanoprost
What is a hypopyon and a hyphaema?
hypopyon is pus in anterior chamber and hyphaema is blood.
When might you see hypoyon?
Keratitis, Endophthalmitis (interior of eye), iritis
How might anterior uveitis (iritis) present?
Usually unilateral. Pain, redness and photophobia are typical. Eye pain is often worse when trying to read. Progressive - occurs over a few hours/days. Blurred vision. There may be excess tear production. Associated headache is common.
Presentation of allergic eye?
intense itch, burning sensation, red watery Papillae on eversion, conjunctival oedema conjunctival infection
What is the difference between follicles and papillae, when are each present?
Papillae
- Allergic
- Bacterial
Follicles
- White spots,
- Associated with viral infections
Presentation of thyroid eye disease?
Exopthalmos: - Proptosis (eye bulging), sclera seen around iris, lid lag, lid retraction, chemosis.
In kids how long do you wait before intervention in a kid diagnosed with sticky/watery eye?
2 y/o, latest 4, this is because it may resolve spontaneously, caused by blocked nasal lacrimal duct
What is leukocoria, risks in kids?
Lack of red light reflex, could be retinoblastoma, congenital cataracts.
Other term for a lazy eye? Up till what age is patching useful?
Amblyopia Up to 7 years, but could try it up to 10/12 years
Difference in a concomitant squint and a paralytic squint?
Paralytic squint - Acquired through damage to muscles and nerves - 6th, 4th or 3rd nerve palsies
Concomitant squint - An acquired squint - is the same on all eye movements - normal muscles and nerves
What is a fresnel prism?
A prism (normally made of plastic) Fitted to glasses to help with double vision or diagnose it
How can you correct double vision?
- botox 2. surgery 3. fresnel prism 4. occlusion of one eye
Types of diplopia and their causes?
Binocular diplopia
- Caused by a mismatch between the eyes, normally nerve palsies
- Disappears when you cover one eye
Monocular
- A lot less common
- Remains with only one eye
- Abnormalities in the cornea, lens or retina
Myopia, presbyopia (and hyperopia) and astigmatism?
Myopia - Short sightedness - Big eyes Presbyopia - Long sightedness associated with lens hardening and old age Hyperopia - Far sightedness not necessarily associated with increasing age Astigmatism - cornea is unevenly curved
phakia and aphakia definition?
Phakia - lens Aphakia - no lens
What actually is a cataract?
An opacity of the lens
Rough process of diabetic retinopathy?
Retinal damage and microvascular changes 1. Damage to blood vessels, leading to oedema 2. Neovascularisation
Retinal detachment presentation?
New onset floaters and flashes, dark curtain descending, from periphery to centre No pain
Presentation of the two types of glaucoma?
Acute closed angle - Sudden onset severe pain - Vomiting and nausea - Hazy cornea - Fixed mid dilated pupil Primary open angle - Peripheral vision loss - >21mmHg - not always noticed until much later
Two types of visual field tests?
Confrontation - Normal one
you can do Goldmans/humphries
What is pappiloedema, optic disc cupping/swelling and their causes?
Papilloedema is optic disc swelling specifically caused by raised ICP
Optic disc cupping is optic disc swelling that can be caused by many things:
- Raised ICP (papilloedema)
- Optic neuritis
- Retinal artery or vein occlusion
- Glaucoma
Image shows normal ratio (small) to large ratio (abnormal)
Standard colour sensitivity test?
Ishihara plates
Blood test abnormalities in temporal arteritis?
ESR, CRP and platelets
Management of chemical injury to eye?
Wash for as long as possible with normal saline, find out what type of chemical, assess pH
Orbital cellulitis complications?
Intracerebral abscess
Raised IOP
Endophalamitis
Optic nerve damage
Cavernous sinus thrombosis
Signs of a direct carotid-cavernous fistula?
Pulsatile proptosis
Bruit over eye
Visual pathway general? (picture)
