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OPHTHALMOLOGY Flashcards

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1
Q

what are the bones of the bony orbit

A 
frontal 
maxilla 
zygomatic
sphenoid 
lacrimal 
ethmoid
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2
Q

what is the base of the bony orbit called

A

the orbital rim

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3
Q

which bone makes up the majority of the roof of the bony orbit

A

frontal bone

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4
Q

what bone makes up the majority of the floor of the bony orbit

A

maxilla

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5
Q

what is the purpose of the orbital rim

A

protect the eye from direct trauma

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6
Q

what are the thinnest parts of the bony orbit

A

medial wall and orbital floor

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7
Q

what is a blowout fracture and its complications

A

medial wall/orbital floor fractured due to impact on the orbital rim
orbital contents can become trapped, damage to infraorbital NVB leading to general sensory deficit of facial skin

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8
Q

complication of fractured zygoma

A

diplopia

suspensory ligament of the eye attaches to the zygoma and droops in zygomatic fracture, causing one eye to lower

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9
Q

common cause of diplopia in young men

A

zygomatic fracture

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10
Q

the two parts of the orbicularis oculi

A

orbital part

palpebral part

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11
Q

what is the orbital septum and what is its function

A

a sheet of fascia deep to the ocularis oculi

prevents spread of infection from superficial to deep

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12
Q

where are the tarsal glands located and what is their purpose

A

embedded in tarsi

lipid secretion

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13
Q

what is the function of the conjunctiva

A

a defensive barrier to foreign bodies penetrating deep to it into the orbit

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14
Q

what I the conjunctival fornix

A

where the conjunctiva covering the eye meets the conjunctiva covering the lower eyelid

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15
Q

what is the limbus

A

corneoscleral junction

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16
Q

what is the function of the lacrimal gland

A

produces lacrimal fluid (tears)

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17
Q

innervation of the lacrimal gland

A

parasympathetic (CNVII)

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18
Q

where does lacrimal fluid drain out of the eye

A

lacrimal puncta to the nasolacrimal duct

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19
Q

what makes up the outer (fibrous) layer of the eye

A

sclera and cornea

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20
Q

what makes up the urea (vascular) layer of the eye

A

iris, ciliary body and choroid

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21
Q

what is the inner layer of the eye called

A

the retina

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22
Q

what is the anterior chamber of the eye

A

part of the anterior segment
between the cornea and iris
contains aqueous humour

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23
Q

what is the posterior chamber of the eye

A

part of the anterior segment
between the iris and suspensory ligaments
contains aqueous humour

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24
Q

what is the posterior segment of the eye

A

behind the eye

contain vitreous humour

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25
Q

where is aqueous humour produced in the eye

A

ciliary processes in the ciliary body

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26
Q

what is the purpose of aqueous humour

A

nourishes the anterior lens and cornea

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27
Q

where is aqueous humour reabsorbed

A

the scleral venous sinus (canal of scheme) at the iridocorneal angle

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28
Q

the ophthalmic artery is a branch of which main artery

A

internal carotid

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29
Q

what type of artery is the central artery of the retina

A

end artery

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30
Q

what are the main branches of the ophthalmic artery

A

nasal cavity branches

forehead (scalp) branches

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31
Q

what veins drain the orbit

A 
posteriorly 
superior/inferior  ophthalmic vein
forehead (scalp) vein
anteriorly 
facial vein
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32
Q

what is the danger triangle of the face

A

an area of the face which is drained by the facial nerve
this superficial venous system connects with the deep system draining the eye and is a possible route for infection to enter the brain

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33
Q

what are the four main parts of the retina

A

fundus
optic disc
macula
fovea

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34
Q

from anterior to posterior, what are the layers of the retina

A

axons of the ganglions cells
ganglion cells
photoreceptors

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35
Q

which axons cross at the optic chiasm

A

nasal axons

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36
Q

what are the extra ocular muscles

A

lateral, medial, superior and inferior rectus
inferior and superior oblique
levator palpeerde superioris

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37
Q

origin of the EO muscles

A

common tendinous ring

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38
Q

innervation of the EO muscles

A

LR6 SO4 AO3

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39
Q

which muscles work together to achieve pure elevation

A

superior rectus and inferior oblique

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40
Q

which muscles work together to achieve pure depression

A

superior oblique and inferior rectus

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41
Q

CNV1 supplies sensory innervation to

A

upper eyelid
cornea
conjunctiva
skin of the root/bridge/tip of nose

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42
Q

CNV2 supplies sensory innervation to

A

skin of the lower eyelid, over the maxilla, ala of nose, skin/mucosa of the upper lip

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43
Q

CNV3 supplies sensory innervation to

A

skin over temporomandibular joint apart from the angle of the mandible (C2,3)

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44
Q

which nerve passes through the supraorbital foramen

A

CNV1

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45
Q

which nerve passes through the infraorbital foramen

A

CNV2

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46
Q

sensory afferent limb of the blink (corneal) reflex

A

CNV1

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47
Q

motor (efferent) limb of blink (corneal) reflex

A

CNVII

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48
Q

where does CNIII connect to the CNS

A

between midline and pons

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49
Q

route of CNIII

A

leaves brain at junction between midline and pons
passes through superior orbital fissure
somatic motor to eye muscles
presynaptic parasympathetic axons to the ciliary ganglion
superior and inferior divisions

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50
Q

what types of nerves are long ciliary nerves

A

sympathetic

somatic sensory

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51
Q

what types of nerves are short ciliary nerves

A

sympathetic

parasympathetic

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52
Q

what type of ciliary nerve forms the first part of the blink reflex

A

long ciliary nerves

somatic sensory

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53
Q

eyes open wider

sympathetic/parasympathetic

A

sympathetic

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54
Q

pupils get wider

sympathetic/parasympathetic

A

sympathetic

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55
Q

pupils constrict

sympathetic/parasympathetic

A

parasympathetic

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56
Q

focus on near objects

sympathetic/parasympathetic

A

parasympathetic

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57
Q

reflex lacrimation

sympathetic/parasympathetic

A

parasympathetic

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58
Q

what type of muscle fibres does LPS contain

A

skeletal and smooth muscle

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59
Q

how do postsynaptic sympathetic fibres reach LPS

A 
superior cervical sympathetic ganglion
internal carotid nerve 
internal carotid plexus 
axons carried on the ophthalmic artery 
branches to LPS
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60
Q

what muscle is responsible for the sympathetic widening of the eyes

A

LPS

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61
Q

what type of nerves are responsible for dilating the pupil

A

sympathetics

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62
Q

action of mydriatic drugs

A

dilate the pupil

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63
Q

what muscles are responsible for dilating the pupil

A

dilator pupillae fibres

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64
Q

what type of nerve constrict the pupil

A

parasympathetics

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65
Q

what is a mitotic pupil

A

non-physiologically constricted

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66
Q

a mitotic pupil is a component of which syndrome

A

Horner’s syndrome

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67
Q

a fixed-dilated pupil as a sign of pathology to which nerve

A

CNIII

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68
Q

what muscle fibres are responsible for pupillary constriction

A

sphincter pupillae fibres

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69
Q

what is the afferent limb of the pupillary light reflex

A

CNII (ipsilateral)

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70
Q

what is the efferent limb of the pupillary light reflex

A

CNIII (bilateral)

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71
Q

pupillary light reflex only occurs in one eye

true/false

A

false

a consensual light reflex occurs in the contralateral eye

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72
Q

relaxation of the ciliary muscle is caused by which nerve type

A

relaxation of the ciliary body is caused by the absence of parasympathetic firing

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73
Q

relaxation of the ciliary muscle occurs in which type of vision

A

far vision

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74
Q

in far vision, what shape is the lens

A

flat

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75
Q

contraction of the ciliary muscle is caused by which type of nerve

A

parasympathetic

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76
Q

contraction of the ciliary muscle occurs in what type of vision

A

near vision

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77
Q

what shape is the lens in near vision

A

spherical

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78
Q

the accommodation reflex is in response to what type of vision

A

near

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79
Q

what are the three aspects of the accommodation reflex

A

pupillary constriction
bilateral convergence
bilateral relaxation of the lens (contraction of ciliary muscles)

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80
Q

what nerve is responsible for the accommodation reflex

A

CNIII

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81
Q

what enzyme do tears contain

A

lysozyme

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82
Q

afferent limb of reflex tears

A

CNVI

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83
Q

efferent limb of reflex lacrimation

A

CNVII (parasympathetic)

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84
Q

symptoms of Horner’s syndrome

A

miosis (constricted pupil)
ptosis (drooping eyelid)
reduced sweating
increased warmth and redness

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85
Q

what causes Horner’s syndrome

A

impaired sympathetic innervation to the head and neck

root of neck trauma, carotid dissection, internal jugular vein engorgement, deep cervical node mets, pancoast tumour

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86
Q

causative pathogens of bacterial conjunctivitis in neonates

A

staph aureus
neisseria gonorrhoeae
chlamydia trachomatis

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87
Q

causative pathogens of bacterial conjunctivitis in children/adults

A

staph aureus
strep pneumoniae
h influenzae (esp in children)

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88
Q

treatment of bacterial conjunctivitis

A

topical antibiotic

chloramphenicol

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89
Q

causative pathogens of viral conjunctivitis

A

adenovirus
herpes simplex
Herpes zoster

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90
Q

signs of chlamydial conjunctivitis

A

chronic history
unresponsive to treatments
bilateral involvement in young adults
may have symptoms of urethritis/vaginitis

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91
Q

causes of microbial keratitis

A

bacteria
viruses
fungi

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92
Q

what is a hypopyon

A

inflammatory cells in the anterior chamber of the eye

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93
Q

herpetic keratitis may be associated with

A

dendrites ulcer

94
Q

why should steroids be avoided in herpetic keratitis

A

can cause corneal melt and perforation of the cornea

95
Q

why would you give antibiotics in adenovirus keratitis

A

to prevent secondary infection

96
Q

fungal causes of keratitis include

A

acanthomoeba

pseudomonas aeruginosa

97
Q

signs orbital cellulitis

A

pain - esp on eye movements
often associated with paranasal sinusitis
pyrexia
erythema/oedema

98
Q

what may a CT show in orbital cellulitis

A

orbital abscess

99
Q

causative pathogens of orbital cellulitis

A

staph, strep, colifroms, H influenzae, anaerobes

100
Q

signs of endophthalmitis

A

very painful
decreasing vision
very red eye

101
Q

what is endopthalmitis

A

inflammation of the interior eye

102
Q

most common cause of endophthalmitis

A

staph epidermis

103
Q

pathogens associated with chorioretinitis

A

CMV in AIDS
toxoplasma gondii
toxocara canis (worm)

104
Q

treatment of dendrites ulcers

A

antivirals (aciclovir)

105
Q

treatment of chlamydial conjunctivitis

A

topical oxytetracycline

106
Q

where is CSF produced

A

secretory epithelium of the choroid plexus

107
Q

where is the choroid plexus found

A

in the ventricles of the brain

108
Q

what is the function of CSF

A 
mechanical protection (shock absorption)
homeostatic function 
circulation (minor exchange of nutrients and waste products between blood and brain)
109
Q

how is CSF analysed

A

lumbar puncture

110
Q

normal appearance of CSF

A

colourless

111
Q

which ventricles is choroid plexus found in

A

lateral, 3rd and 4th

112
Q

what is the name of the foramen the connects the lateral ventricles to the 3rd ventricle

A

foramen of munroe

113
Q

what is the name of the foramen that connects the 3rd ventricle to the 4th ventricle

A

aqueduct of sylvius

114
Q

what are the names of the foramina that release CSF into the subarachnoid space

A

foramina of luschka (laterally)

foramen of megendie (median)

115
Q

describe the circulation of CSF

A

lateral ventricles > foramen of Monroe > 3rd ventricle > aqueduct of sylvius > 4th ventricle > foramina of Luschka/foramen of magendie > subarachnoid space > arachnoid granulations > superior sagittal sinus

116
Q

what does the BBB consist of

A

capillary endothelium
basal membrane
perivascular astrocytes

117
Q

what is the function of the BBB

A

protect the brain from infection and toxins

118
Q

what is hydrocephalus

A

accumulation of CSF in the ventricular system or around the brain leading to enlargement of one or more ventricles and increase in CSF pressure

119
Q

cause of papilloedema

A

raised ICP transmitted to the subarachnoid space surrounding the optic nerve

120
Q

visual symptoms of papilloedema

A

enlarged blind spot
blurring of vision
visual obscurations
loss of vision

121
Q

what is the function of bicarbonate in the aqueous humour

A

buffers H+ produced in the cornea and lens by anaerobic glycolysis

122
Q

what are the four main regions of a photoreceptor

A

outer segment
inner segment
cell body
synaptic terminal

123
Q

type of photoreceptors

A

rods and cones

124
Q

what is the name of the visual pigment molecule present in rods

A

rhodopsin

125
Q

what happens to rhodopsin in the presence of light

A

it is converted to all-trans-retinal

126
Q

what effect does all-trans-retinal have of cGMP

A

causes it to decrease

127
Q

what is the effect of a decrease in cGMP

A

hyperpolarisation of the membrane

128
Q

how does spacing of photoreceptors affect visual acuity

A

decreased spacing (closer together) increases VA

129
Q

what are rods and cones used for

A

cones - colour

rods - dim light

130
Q

how are rods and cones distributed

A

cones - central

rods - peripheral

131
Q

what does high/low convergence mean

A

high convergence = more photoreceptors per ganglion cell

low convergence = fewer photoreceptors per ganglion cell

132
Q

do rods/cones have high or low convergence

A

cones - low convergence

rods - high convergence

133
Q

what effect does convergence have on vision

A

more convergence = increased sensitivity (low light), decreased acuity

134
Q

how do we see colour

A

there are different opsin for different wavelengths (colours) of light

135
Q

visual symptoms associated with raised ICP

A 
transient blurred vision 
double vision
loss of vision
papilloedema 
pupillary changes
136
Q

what are the three layers of the meninges

A

dura
arachnoid
pia

137
Q

where is the sub-arachnoid space

A

between the arachnoid and Pia layers of the meninges

138
Q

where does the dura mater get its nerve supply from

A

CNV

139
Q

how does damage to CNIII manifest

A 
paralysis of MR, IR, SR, IO
paralysis of parasympathetic innervation of sphincter of pupil 
loss of pupillary light reflex
ptosis
eye turned inferolaterally
140
Q

presentation of CNIV palsy

A

affected eye cannot move inferomedially

diplopia when looking down

141
Q

presentation of CNVI palsy

A

medial deviation of the affected eye

142
Q

assessment of eye trauma should include

A

history of the incident
visual acuities
examination of eye (lids, conjunctiva, cornea, anterior segment, pupils, fundus)
use of fluorescein drops

143
Q

what do fluorescein drops identify

A

areas of epithelial loss

144
Q

what is hyphaema

A

blood in the anterior chamber

145
Q

what is commotion retinae

A

bruised retina

146
Q

what is sympathetic ophthalmia

A

trauma to one eye resulting in auto-immune reaction in both eyes
may lead to bilateral blindness

147
Q

signs of penetrating foreign body

A

irregular pupil
shallow anterior chamber
localised cataract
gross inflammation

148
Q

investigation of intra-ocular foreign body

A

x-ray

149
Q

treatment of chemical burns

A

irrigation with at least 2 L of saline

investigation

150
Q

why does chloramphenicol easily penetrate the cornea

A

it is both lipophilic and hydrophilic

151
Q

when is prednisolone acetate used

A

uninflamed cornea, post-operatively

152
Q

when is prednisolone phosphate used

A

inflamed cornea, corneal disease

when low dose steroids are required (limited permeability in uninflamed cornea)

153
Q

what is the function of benzalkonium

A

preservative that enhances corneal penetration and disrupts lipid layer of tear film

154
Q

how to prevent systemic absorption of topical steroids

A

punctual occlusion

155
Q

anti-inflammatory agents used in the eye

A

steroids NSAIDs
anti-histamines
mast cell stabilisers

156
Q

indications for steroids

A

post op cataracts
uveitis
prevention of corneal graft rejection
temporal arteritis

157
Q

local side effects of steroids

A

cataract
glaucoma
exacerbation of viral infection

158
Q

drugs used to treat glaucoma

A 
prostanoids 
beta blockers 
carbonic anhydrase inhibitors 
a2 adrenergic agonist 
parasympathomimetic
159
Q

example of intravitreal drugs

A

anti-VEGF
antibiotics in endophthalmitis
IO steroids

160
Q

how do mydriatic drugs work

A

block parasympathetic supply to iris

161
Q

side effect of ethambutol

A

optic neuropathy

162
Q

pathogenesis of diabetic retinopathy

A

chronic hyperglycaemia > glycosylation of protein/basement membrane > loss of perocytes > microaneurysms > leakage/ischaemia

163
Q

signs of non-proliferative diabetic retinopathy

A

micro aneurysms (dot and blot haemorrhages)
hard exudate
cotton wool patches
abnormalities of venous calibre
intra-retinal microvascular abnormalities

164
Q

new retinal vessel growth in a diabetic patient is a sign of

A

proliferative diabetic retinopathy

165
Q

why do diabetic patients lose vision

A

retinal oedema affecting the fovea
vitreous haemorrhage
scarring/traction retinal detachment

166
Q

management of diabetic retinopathy

A

laser (PRP/macular grid)

vitrectomy

167
Q

features of hypertensive retinopathy

A 
attenuated blood vessels - copper or silver wiring 
cotton wool spots 
hard exudates 
retinal haemorrhage 
optic disc oedema
168
Q

cherry red spot is a sign of

A

central retinal artery occlusion

169
Q

presentation of central retinal artery occlusion

A

sudden painless, profound loss of vision

170
Q

presentation of central vein occlusion

A

sudden painless visual loss, range of visual loss

171
Q

patient presents with headache, jaw claudication, malaise, raised PV and loss of vision

A

GCA (temporal arteritis)

172
Q

extra ocular signs of thyroid eye disease

A

proptosis
lid retraction/lag/oedema/pigmentation
restrictive myopathy

173
Q

ocular signs of thyroid eye disease

A 
chemosis 
injection 
glaucoma 
choroidal folds 
optic nerve swelling
174
Q

RA eye signs

A

dry eyes
scleritis
corneal melt

175
Q

sjorgen’s eye signs

A

dry eyes

176
Q

Marfan’s eye signs

A

conjunctivitis

retinal detachment

177
Q

stevens-johnson syndrome

A

symplepharon

corneal ulcers

178
Q

causes of sudden visual loss

A 
vascular aetiology 
vitreous haemorrhage 
retinal detachment 
ARMD wet type 
closed angle glaucoma
179
Q

vascular causes of sudden visual loss

A

occlusion of retinal circulation (artery/vein)
occlusion of optic nerve head circulation
haemorrhage from abnormal vessels (diabetes, wet ARMD)
retinal tear

180
Q

signs of CRAO

A

relative afferent pupil defect

pale, oedematous retina, thread-like vessels

181
Q

causes of CRAO

A

carotid artery disease

emboli from the heart (unusual)

182
Q

management of CRAO

A

ocular massage id early presentation
establish source of embolus
assess and manage risk factors

183
Q

variants of CRAO

A

branch retinal artery occlusion

amaurosis fugax

184
Q

what is amaurosis fugax

A

transient CRAO

185
Q

symptoms of amaurosis fugax

A

transient painless visual loss
‘like a curtain coming down’
lasts <5 mins with full recovery

186
Q

treatment of amaurosis fugax

A

aspirin

187
Q

causes of CRVO

A

atherosclerosis
hypertension
hyperviscosity
raised IOP

188
Q

signs of CRVO

A

retinal haemorrhages
dilated tortuous veins
disc and macular swelling

189
Q

treatment of CRVO

A

laser treatment of new vessels
anti-VEGF
address risk factors

190
Q

occlusion of optic nerve head circulation is also known as

A

ischaemic optic neuropathy

191
Q

which arteries become occluded in ischaemic optic neuritis

A

posterior ciliary arteries

192
Q

presentation of ischaemic optic neuropathy

A

sudden profound visual loss

193
Q

what are the two types of ischaemic optic neuropathy

A

arteritic (GCA)

non-arteritic (athersclerotic)

194
Q

arteritic ischaemic optic neuritis causes reversible blindness
true/false

A

false

vision loss associated with GCA is irreversible

195
Q

treatment of GCA

A

high dose steroids

196
Q

signs and symptoms of vitreous haemorrhage

A

loss of vision
floaters
loss of red reflex
may see haemorrhage on fundoscopy

197
Q

management of vitreous cause

A

management of cause

vitrectomy if not resolving

198
Q

signs and symptoms of retinal detachment

A

painless loss of vision
sudden onset flashes/floaters
may have RAPD
may see tear on ophthalmoscopy

199
Q

management of retinal detachment

A

surgical

200
Q

2 types of ARMD

A

wet

dry

201
Q

pathogenesis of wet ARMD

A

new blood vessels grow under the retina

leakage causes build up of fluid/blood and eventually scarring

202
Q

signs and symptoms of wet ARMD

A

rapid central visual loss
distorsion (metamorphopsia)
haemorrhage and exudate

203
Q

treatment of wet ARMD

A

anti-VEGF

204
Q

symptoms of closed angle glaucoma

A

painful, red eye
visual loss
nausea and vomiting
headache

205
Q

treatment of closed angle glaucoma

A

medication to lower IOP

laser iridotomy

206
Q

causes of gradual visual loss

A 
cataract
ARMD dry type 
refractive error 
glaucoma 
diabetic retinopathy
207
Q

symptoms of cataract

A

gradual decline in vision (hazy/blurred) that cannot be corrected with glasses
may get glare

208
Q

management of cataract

A

surgical removal with intra-ocular lens implant

209
Q

signs of symptoms of dry ARMD

A

gradual decline in vision
central vision missing (scotoma)
drusen (build up of waste products below RPE)
atrophic patches of retina

210
Q

myopia

A

shortsighted

211
Q

hypermetropia

A

longsighted

212
Q

astigmatism

A

irregular corneal curvature

213
Q

presbyopia

A

loss of accommodation with ageing

214
Q

in myopia, light diverges before/after the retina

A

before

215
Q

in hypermetropia light diverges before/after the retina

A

after

216
Q

pathogenesis of open angel glaucoma

A

resistance to outflow of aqueous humour in trabecular network leading to build up of aqueous humour and raised IOP

217
Q

symptoms of glaucoma

A

often asymptomatic

may have visual loss

218
Q

signs of glaucoma

A

cupped disc
visual field defect
may/may not have high IOP

219
Q

papilloedema vs swollen optic disc

A

swollen optic disc = swelling due to any cause

papilloedema = swollen disc due to raised ICP

220
Q

bilateral optic disc swelling and suspected ICP may be due to

A

a space occupying lesion

221
Q

CNII examination includes

A 
ophthalmoscopy 
VA
pupil exam
visual field assessment 
colour vision
222
Q

what is blepharitis

A

inflamed eyelids

223
Q

what causes posterior blepharitis

A

meibomian gland disease

224
Q

treatment of blepharitis

A

lid hygiene
tear drops
oral doxy 2-3 months

225
Q

non-infective causes of conjunctivitis

A

allergic
chemical/drugs
skin disease) eczema

226
Q

signs of conjunctivitis

A 
red eye 
discharge 
papillae or follicles 
sub conjunctival haemorrhage 
chemosis (oedema)
pre-auricular glands (if viral)
227
Q

papillae are associated with which type of conjunctivitis

A

bacterial

228
Q

follicles are associated with which types of conjunctivitis

A

viral
chlamydial
drugs

229
Q

keratitis affect which part of the eye

A

cornea

230
Q

what are the three layers of the cornea

A

epithelium
strome
endothelium

231
Q

symptoms of corneal ulcers

A 
pain
photophobia 
profuse lacrimation 
vision may be reduced 
red eye (around cornea)
232
Q

treatment of scleritis

A

oral NSAIDs
oral steroids
steroid sparing agents

DERM (5 decks)

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