Ophthalmology Flashcards
Papilloedema
Optic disc swelling due to raised ICP
Treat underlying cause
Myopia (short sighted)
Concave lenses
Hyperopia (long sighted)
Convex lenses
Optic neuritis
High-dose steroids
Bacterial conjunctivitis
Purulent discharge
Eyes may be ‘stuck together’ in the morning)
Self-limiting
Chloramphenicol drops 2-3 hours, ointment qds
Topical fusidic acid for pregnant women
Chlamydial conjunctivitis
Topical oxytetracycline
Azithromycin- for genitals
Viral conjunctivitis
Serous discharge
Recent URTI
Preauricular lymph nodes
Aciclovir
Allergic conjunctivitis
1st line: topical or systemic antihistamines
2nd line: topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil
Bacterial keratitis
1st: Ofloxacin
2nd: Gentamycin and cefuroxime
Herpetic keratitis
Herpes simplex keratitis most commonly presents with a dendritic corneal ulcer
Immediate referral to an ophthalmologist
Topical aciclovir
Orbital Cellulitis
Inflammation of the tissues behind the eye
Antibiotics and drainage
Endophthalmitis
Inflammation of the inner eye
Associated with cataract surgery
Amikacin
Ceftazidine
Vancomycin
Cytomegalovirus retinitis
Common in AIDs patients
Ganciclovir
Chorioretinitis
Often caused by Toxoplasmosis/ Toxocara
Corticosteroids
Antibiotics
Uveitis
- Cycloplegics/Mydriatic eye drops (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
- Steroid eye drops
- Steroid injection
- Steroid oral tablets
Wet ARMD
Wet (exudative, neovascular) macular degeneration: characterised by choroidal neovascularisation. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. Carries worst prognosis
Photocoagulation
Photodynamic therapy
Anti-vascular endothelial growth factor (anti-VEGF): intravitreal ranibizumab
Dry ARMD
Dry (geographic atrophy) macular degeneration: characterised by drusen - yellow round spots in Bruch’s membrane
Not much tbh
Vision aids- magnifiers etc
Stop smoking
High dose of beta-carotene, vitamins C and E, and zinc may help to slow down visual loss for patients with established macular degeneration. Supplements should be avoided in smokers due to an increased risk of lung cancer
Primary Open Angle Glaucoma
Peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
Decreased visual acuity
Optic disc cupping
1st line:
- Prostaglandin analogues (e.g. Latanoprost)
- Beta-blockers (e.g. Timolol)
2nd line:
- Combining a topical prostaglandin analogue or prostamide with a topical beta-blocker
3rd line:
- Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist)
- Carbonic anhydrase inhibitors (e.g. Dorzolamide, a topical. Acetazolamide, systemic)
- Miotics (e.g. pilocarpine, a muscarinic receptor agonist)
Acute angle Glaucoma
In acute angle closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow.
Reducing aqueous secretions with acetazolamide
Inducing pupillary constriction with topical pilocarpine
CRAO
due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
features include afferent pupillary defect, ‘cherry red’ spot on a pale retina.
No treatment
Can often try with:
Eye massages
Nitrates
Acetazolamide
Inhaled carbogen
CRVO
Incidence increases with age, more common than arterial occlusion
causes: glaucoma, polycythaemia, hypertension
severe retinal haemorrhages are usually seen on fundoscopy
Laser treatment
Anti-VEGF
Vitreous haemorrhage
causes: diabetes, bleeding disorders
features may include sudden visual loss, dark spots
Self-resolving
Vitrectomy (removal of vitreous fluid)
Retinal Detachment
Urgent surgery
Cataract
Cloudiness of lens
Surgery
Blepharitis
Blepharitis is inflammation of the eyelid margins. It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis). Blepharitis is also more common in patients with rosacea
Softening of the lid margin using hot compresses twice a day
Mechanical removal of the debris from lid margins - cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used/ sodium bicarbonate
Artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film
If bacterial: oral doxycycline for 2-3 months
Corneal ulcers
Corneal ulcers are more common in contact lens users
Bacterial: Ofloxacin
Viral: Aciclovir
Autoimmune: oral steroids
Scleritis
a serious inflammatory disease that affects the white outer coating of the eye
Oral NSAID
Oral Steroid
Episcleritis
a benign, self-limiting inflammatory disease affecting part of the eye called the episclera. The episclera is a thin layer of tissue that lies between the conjunctiva and the connective tissue layer that forms the white of the eye (sclera).
Association with gout
Self limiting
Lubricant
NSAID/ steroids
Diabetic Retinopathy
Treat systemic diabetes
Laser therapy
Anti-VEGF
Thyroid Eye Disease
Control thyroid dysfunction Lubricants to help prevent corneal inflammation caused by exposure Surgical decompression steroids radiotherapy
Retinoblastoma
Enucleation- removal of the eye External beam radiotherapy Brachytherapy- radioactive implant Thermotherapy Laser photocoagulation Cryotherapy Chemotherapy
