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Year 3 Special Senses > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Open angle glaucoma definition

A

Damage of optic nerve head with progressive loss of ganglion cells. Progressive of visual field.

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2
Q

Open angle glaucoma aetiology

A
  • Loss of retinal ganglions and their axons
  • Accompanied by raised IOP
  • Reduced flow through trabecular meshwork (absorbs aqueous humour) = painless, chronic degeneration
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3
Q

Open angle glaucoma risk factors

A
  • Raised IOP, >26mmHg or systemic HTN
  • Myopia
  • Diabetes
  • FHx
  • Afro-Caribbean ethnicity
  • Prolonged steroid use
  • Restricted ocular blood flow: diabetic retinopathy, central retinal vein occlusion.
  • Eye trauma
  • Uveitis
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4
Q

Open angle glaucoma presentation

A
  • Majority asymptomatic
  • Early disease: peripheral vision loss which is covered by other eye
  • Late disease: central vision loss and decreased visual acuity
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5
Q

Open angle glaucoma investigation

A
  • Gonioscopy: measures angle between cornea and iris
  • Corneal thickness: influences IOP reading
  • Tonometry: measures IOP
  • Optic disc exam
  • Visual field assessment
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6
Q

Open angle glaucoma management

A
  • Set target IOP depending on degree of damage
  • Drugs that reduce IOP = beta-blocker, prostaglandin analogue
  • Laser treatment tried after 2 unsuccessful attempts with pharmacological treatment
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7
Q

Acute angle closure glaucoma definition

A
  • Emergency
  • Acutely raised IOP
  • Causes anterior chamber angle to be obstructed
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8
Q

Acute angle closure glaucoma risk factors

A
  • Female gender (4:1)
  • Asian
  • Age
  • Fhx
  • Narrow eyes, thin iris, thick lens, shorter axial length of eyeball
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9
Q

Acute angle closure glaucoma aetiology

A
  • Anterior angle = junction of iris and cornea at periphery of anterior chamber.
  • Iris opposed to trabecular meshwork (lies around circumference of angle) and block off aqueous drainage.
  • Causes IOP to rise

Primary causes:

  • naturally narrow angle
  • iris pushed forwards as lens grows
  • pupillary dilation

Secondary causes:

  • forces exerted on iris
  • trabecular meshwork blocked by a) blood b) blood vessels (diabetes) c) proteins
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10
Q

Acute angle closure glaucoma presentation

A
  • Pain: severe, rapid. Orbital and associated frontal / generalised headache.
  • Blurred vision progressing to visual loss
  • Coloured halos around lights: mild
  • General malaise inc. N+V
  • Eye: red - more marked around cornea periphery.. Non-reactive mid-dilated pupil.
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11
Q

Acute angle closure glaucoma investigation

A

Clinical diagnosis based on at least two of:

  • ocular pain
  • N+V
  • intermittent blurred vision with halos and 3 of
  • raised IOP
  • conjunctival infection
  • mid-dilated non-reactive pupil
  • corneal epithelial oedema
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12
Q

Acute angle closure glaucoma management

A

Immediate referral to save sight

  • Medical: topical beta-blockers / steroids / phenylephrine, plus UV acetazolamide.
  • Surgical: to re-open angle
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13
Q

Orbital cellulitis definition

A
  • Ophthalmic emergency

- Infection of soft tissues behind the orbital septum

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14
Q

Orbital cellulitis aetiology

A

-Local or haematogenous spread

Infection sources:

  • peri-orbital structures
  • pre-septal cellulitis
  • direct from trauma
  • post-surgery
  • bacteraemia

Pathogens:

  • S. pneumoniae
  • S. aureus
  • S. pyogenes
  • H. influenzae
  • MRSA
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15
Q

Orbital cellulitis presentation

A
  • Anterior: acute onset unilateral of conjunctiva + lids, oedema, erythema, pain, chemosis (oedema)
  • Orbital: proptosis, pain with eye movement, blurred vision, decreased acuity, diplopia, RAPD
  • Systemic: fever, malaise
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16
Q

Orbital cellulitis investigation

A

Clinical diagnosis, investigations to identify source

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17
Q

Orbital cellulitis management

A

Emergency to secondary care

  • IV Abx for 7-10 days
  • Optic nerve monitored every 4 hours
  • Surgery if CT evidence of orbital collection and no response to Abx
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18
Q

Giant cell arteritis definition

A

Immune-mediated vasculitis which can cause sudden and potentially bilateral vision loss

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19
Q

Giant cell arteritis risk factors

A
  • Women (3:1)
  • European
  • FHx, or of PMR
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20
Q

Giant cell arteritis presentation

A
  • Temporal headache
  • Scalp tenderness
  • Myalgia
  • Fever, malaise
  • Jaw claudication, comes on gradually during chewing
  • Diplopia
  • Abnormality of temporal artery = absent pulse, beaded, tender, enlarged
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21
Q

Giant cell arteritis investigation

A
  • Temporal biopsy

- ESR, CRP, LFTs, ferritin

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22
Q

Giant cell arteritis management

A

Steroids: immediate high dose corticosteroid
Aspirin: low dose, decreases rate of visual loss and stroke

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23
Q

Conjunctivitis definition

A

Inflammation of conjunctiva

24
Q

Conjunctivitis aetiology

A

Viral:

  • adenovirus
  • HSV / VZV
  • Molluscum contagiosum
  • Feature of systemic viral condition

Bacterial:

  • staph
  • S. pneumoniae
  • H. influenzae
  • M. catarrhalis

Allergenic:

  • seasonal allergy
  • perennial (daily)
  • giant papillary conjunctivitis
25
Q

Conjunctivitis presentation

A

Symptoms:

  • red eye (bilateral)
  • irritation / grittiness
  • discharge: watery, mucoid, sticky or purulent

Signs:

  • conjunctival injection
  • chemosis
  • follicles and papillae
26
Q

Conjunctivitis investigation

A

History:

  • recurrent URTI / infectious contact
  • morning discharge and stickiness
  • glasses / contacts
  • eye trauma

Exam:

  • general malaise
  • Pre-auricular lymphadenopathy
  • Orbital cellulitis,blepharitis, herpetic rash, nasolacrimal blockage
  • Fundoscopy if unsure
27
Q

Conjunctivitis management

A

Bacterial: slef-limiting so supportive.

Viral: supportive - cool compress, artificial tears, lubricant eye drops, cleansing

Allergic: prevent release of allergic mediators.

  • Avoid eye rubbing and contacts, cool compresses to sooth.
  • Pharmacological: topical mast cell stabilisers / antihistamines, topical / oral corticosteroids
28
Q

Uveitis definition

A

Inflammation of uveal tract (= iris + ciliary body + choroid plexus)

  • Anterior: iris
  • Intermediate: vitreous + posterior ciliary body
  • Posterior: choroid
  • Panuveitis: throughout
29
Q

Uveitis aetiology

A

Inflammatory cells and sustained production of cytotoxic cytokines

  • Inflammatory: autoimmune
  • Infectious
  • Infiltrative secondary to neoplastic
  • Trauma: commonly anterior
  • Iatrogenic: surgery, medication
  • Ischaemic: impaired circulation
30
Q

Uveitis presentation

A

Anterior: unilateral. pain, redness, photophobia, progressive over hours / days, blurred vision, excess tear production, associated headache

Posterior: gradual visual loss, bilateral, occasional photophobia

Intermediate: painless floaters, decreased vision, minimal external signs

31
Q

Uveitis investigation

A
  • Slit lamp exam

- SSx normal but uveitis granulomatous, further investigations e.g. FBC, ESR, ANA, HLA to investigate cause

32
Q

Uveitis management

A

Control inflammation, prevent visual loss and minimise long term complications.

  • steroids
  • cycloplegic mydriatic drugs to paralyse ciliary body
  • immunosuppressants
  • surgery considered if severe or intractable
33
Q

Diabetic retinopathy definition

A

Chronic progressive and potentially sight-threatening disease of retinal microvasculature associated with prolonged hyperglycaemia of DM.

34
Q

Diabetic retinopathy epidemiology

A

Most common cause of sight loss in working age group

35
Q

Diabetic retinopathy aetiology

A
  • Macrovascular occlusion causes retinal ischaemia
  • This leads to AV shunts and neovascularisation
  • Leakage causes intraretinal haemorrhage and oedema
36
Q

Diabetic retinopathy risk factors

A
  • Increased severity / length of time of hyperglycaemia
  • HTN / CVD risk factors
  • Renal disease: proteinuria and elevated urea / creatinine
  • Pregnancy
37
Q

Diabetic retinopathy presentation

A

Symptoms:

  • Painless gradual reduction of central vision
  • Sudden onset dark painless floaters (due to haemorrhage)

Signs:

  • Microaneurysms
  • Hard exudates: precipitates of lipoproteins leaking from retinal blood vessels
  • Haemorrhages: ‘flame’ haemorrhages seen tracking along nerve fibres
  • Cotton wool spots: axonal debris due to poor metabolism at ischaemic infarcts
  • Neovascularisation: attempt by healthy retina to re-vascularise hypoxic tissue
38
Q

Diabetic retinopathy management

A

Primary: glycaemic / lipid / BP control, weight loss, smoking cessation

Ophthalmic intervention: most do not need treatment. Laser treatment to induce regression of neovascularisation and reduce central macular thickening. Anti-vascular endothelial growth factor. Intravitreal steroids.

39
Q

Diabetic retinopathy complications

A

Visual loss secondary to:

  • macular oedema / ischaemia
  • haemorrhage
  • tractional retinal detachment
40
Q

Age-related Macular Degeneration definition

A

Ageing changes without other precipitating factor that occur in the macula in individuals aged 55+.

41
Q

Age-related Macular Degeneration aetiology

A

Appearance of drusen (yellow lipid deposits) in macula, accompanied by:

wet: choroidal neovascularisation
dry: geographic atrophy

Dry:

  • Soft drusen
  • Atrophy of RPE progresses over time
  • Can advance and cause vision loss without progressing into wet
  • Progression to visual loss is gradual
  • End stage: whole macula affected

Wet:

  • New blood vessels grow under retina
  • Spread under / over RPE, are fragile and leak easily
  • Causes haemorrhage and scar formation
  • End stage = disciform macular degeneration
42
Q

Age-related Macular Degeneration risk factors

A
  • Smoking
  • FHx - several gene associations
  • CVD risk factors
  • Caucasian
  • Sunlight
43
Q

Age-related Macular Degeneration presentation

A

General Symptoms:

  • Painless deterioration of cental vision
  • Reduction in visual acuity
  • Loss of contrast sensitivity
  • Size / colour of objects appearing differently in each eye
  • Abnormal dark adaptation
  • Photopsia
  • Light glare
  • Visual hallucinations

Dry symptoms:

  • Gradual visual loss
  • Scotoma: black patch affecting central visual field

Wet symptoms:

  • Central visual blurring and distortion - straight lines appear wavy
  • Rapid visual deterioration
  • If bleed: sudden deterioration to profound central visual loss

Signs:

  • Decreased acuity
  • Drusen in macula
  • Macular scar (late)
44
Q

Age-related Macular Degeneration management

A

Dry: no treatment, lifestyle adjustments slow progression

Wet: intravitreal injection of anti-VEGF - prevents neovascularisation

45
Q

Cataracts definition

A

Lens opacities that become large enough to block light / obstruct vision

46
Q

Cataracts aetiology

A
  • New lens fibres generate from lens epithelium, old fibres not removed
  • transparency maintained by lens protein alignment
  • Disruption of fibres affects structure leading to protein aggregation
  • Cataracts result from deposition of aggregated proteins in lens causing clouding, scattering, and vision obstruction
  • Accumulation of yellow brown pigment in lens which affects colour vision and contrast
47
Q

Cataracts presentation

A

Symptoms:

  • Gradual painless visual loss
  • Diplopia
  • Haloes

Signs:

  • Deflects in red reflex
  • Visual acuity not improved by pin hole
  • Normal pupillary reactions
48
Q

Cataracts management

A

Phacoemulsification surgery

49
Q

Amaurosis Fugax definition

A

Unilateral, painless, transient vision loss

50
Q

Amaurosis Fugax aetiology

A

Transient ischaemia of retina from various pathologies:

  • Occlusive artery disease: atherosclerosis, cardiac thrombo-emboli, arteritis
  • Reduced perfusion pressure: postural hypotension, multiple occlusions of extracranial cerebral arteries, AV fistula, IC HTN, glaucoma
  • Increases resistance to retinal perfusion: malignant hypertension, migraine, increase in blood viscosity, vasospasm
51
Q

Amaurosis Fugax presentation

A
  • Rapid onset blindness (within 15secs) lasting up to minutes
  • Curtain drawn up / down over eye
  • Clears slowly and uniformly from reverse direction
52
Q

Amaurosis Fugax investigation

A
  • Non-invasive tests for carotid blood flow and lumen diameter
  • Angiography considered
53
Q

Amaurosis Fugax management

A

Depends on test results

If as a result of atherosclerosis, give anti-platelet e.g. aspirin

54
Q

Optic neuritis definition

A

Inflammation of the optic nerve

55
Q

Optic neuritis aetiology

A

Various causes:

  • Acute demyelinating: associated with MS
  • Ischaemic: GCA, diabetic papillopathy
  • Inflammatory: AI disease = sarcoidosis, SLE
  • Infection: TB, syphillis
  • Nutrition: B12 deficiency
  • Drugs: amiodarone, isoniazid
  • Children: viral infection
56
Q

Optic neuritis presentation

A

Symptoms: triad of;

  • visual impairment developing over hours to days and made worse by hot bath
  • eye pain worse on movement
  • disturbance of colour vision

Signs:

  • Decreased pupillary light reaction in affected eye: RAPD
  • Varying degrees of visual loss
  • Abnormal contrast sensitivity and colour vision
  • Scotoma
57
Q

Optic neuritis management

A

-Acute demyelinating: corticosteroids during acute phase

Year 3 Special Senses (3 decks)

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