Ophthalmology Flashcards
What are the different types of conjunctivitis? What is the discharge like for each?
Bacterial - mucopurulent
Viral - watery
Chlamydial - watery
Allergic - stringy
What is the main treatment for bacterial conjunctivitis?
- Chloramphenicol - risk of aplastic anaemia
2. Fusidic acid
How does blepharitis present?
Burning feeling Crusting = staph infection Gunking = secretions from Meibomian glands Loss of eyelashes Frothy tears
Differentiate between entropion and ectropion?
Entropion = inversion of eyelids caused by lower lid laxity so orbicularis muscle overrides tarsal plate
- Red, itchy, sore, gritty, uncomfortable eyes
- Irritation from eyelashes can cause corneal ulcer
Ectropion = eversion of eyelids due to laxity causing exposure of tarsal conjunctiva
- Dryness, redness
- Frequently discharging
What is a chalazion?
Meibomian cyst
Blockage of gland within tarsal plate traps sebaceous secretions, leading to chronic granulomatous inflammation
How can you treat a chalazion?
Hot compresses
Massage
Incision + curettage to drain
What can cause ptosis?
Age-related degeneration of levator muscle aponeurosis
CNIII palsy/Horner’s syndrome
Myasthenia gravis/muscular dystrophy
What most commonly causes a corneal ulcer?
Contact lenses
Bacteria
Viruses
Acanthamoeba (live in water)
Fungi (immunocompromised)
How does anterior uveitis present?
Pain worse in bright lights (spasm of iris muscles)
Headache
Blurred vision
What would you see on examination of uveitis?
Hypopyon = leukocyte exudate in the anterior chamber
Red eye
What conditions is uveitis associated with?
HLA-B27
- Ankylosing spondylitis
- Psoriasis
- IBD
- Sarcoidosis
- Behcet’s
How do you treat uveitis?
Prednisolone 1% eye drops
How would scleritis present?
Deep boring pain Wakes patient up from sleep Radiates to forehead Red eye Vision may decrease
What conditions is scleritis associated with?
Rheumatoid arthritis
SLE
How is episcleritis different from scleritis?
There is no pain
Vision is normal
It is associated with IBD
Define glaucoma
Optic neuropathy usually with high intraocular pressure (>21mmHg), optic disc cupping and progressive visual loss
What type of glaucoma is most common? How does it present?
Open angle glaucoma
Bilateral peripheral visual loss (can be asymptomatic)
What are the risk factors for open angle glaucoma?
Family history
Hypertension
Diabetes
Myopia = short sighted
How does closed angle glaucoma present?
Acute eye pain Associated nausea + vomiting Decreased visual acuity Haloes when look at lights Abdominal pain
What causes angle closure glaucoma?
Long sightedness (small eyes) - when the pupil is mid-dilated the iris blocks the drainage of fluid so pressure increases
What is the treatment for open angle glaucoma?
Latanoprost (prostaglandin analogue) - increases outflow
Timolol (beta-blocker) - reduces aqueous
What are the side effects of latanoprost?
Thicker, darker, longer lashes
Darker iris + skin around eyes
What is the treatment of acute angle closure glaucoma?
IV acetazolamide (carbonic anhydrase inhibitor) - reduces aqueous production
What are the red flags in a red eye?
Severe pain Reduced vision Photophobia Proptosis (protrusion of eye) Miosis in affected eye
What are the 5 stages of cellulitis?
I = preseptal II = orbital III = subperiosteal abscess IV = orbital abscess V = cavernous sinus thrombosis
What organisms most commonly cause preseptal and orbital cellulitis? How do you treat each?
Preseptal
- Staph aureus
- Abx: co-amoxiclav 10 days
Orbital
- Strep pneumoniae
- Abx: flucloxacillin/ceftriaxone IV
How can you differentiate between preseptal and orbital cellulitis?
Preseptal
- Normal eye
- Normal vision
- No proptosis
Orbital
- Red eye
- Blurred vision
- Proptosis
What are the main complications of orbital cellulitis?
Blindness
Meningitis
Cavernous sinus thrombosis
What can cause a painful loss of vision?
Acute angle closure glaucoma Giant cell arteritis Optic neuritis Uveitis, slceritis, keratitis Shingles Orbital cellulitis
What can cause a painless loss of vision?
Cataracts Retinal detachment Retinal vessel occlusion Diabetic retinopathy Age-related macular degeneration Optic nerve compression (Berry aneurysm)
What are the symptoms of retinal detachment?
4 Fs
Flashes = photopsia
Floaters
Fall in visual acuity
Field loss - ‘curtain coming down’
NO pain
What is amaurosis fugax?
TIA of a retinal artery
Causes transient monocular blindess due to transient retinal ischaemia
What does fundoscopy of a retinal artery occlusion look like?
Pale retina with oedema
Cherry-red macula
Arteriolar narrowing
What causes retinal vein occlusion?
Arteries go over veins so if the artery is hardened due to longstanding hypertension, the vein is nipped
What would fundoscopy of retinal vein occlusion show?
Cotton-wool spots = nerves dying due to ischaemia Tortuous dilated vessels Flame haemorrhages (sudden hypertension) Disc oedema Macular oedema
How do you manage retinal vein occlusion?
anti-VEGF
Vascular endothelial growth factor is released to recruit new blood vessels
What is the triad for presentation of optic neuritis?
Unilateral reduced vision
Reduced colour vision (especially red)
Eye pain
What can cause optic neuritis?
Acute demyelination - MS
Ischaemic optic neuropathy - GCA, diabetes
Other - steroids, TB, syphilis, orbital cellulitis, B12 deficiency, amiodarone
What are the macula and fovea?
Macula = 3mm temporal from optic disc Fovea = centre of macula
Differentiate between dry and wet age-related macular degeneration
Dry
- Atrophic
- Drusen in macula (yellow spots)
Wet
- Exudative
- Neovascularisation
- Subretinal haemorrhages in/around macula
What are the risk factors for age-related macular degeneration?
Smoking Cardiovascular disease Malnutrition Obesity UV light
How does ARMD present?
Progressive central visual deterioration
How do you treat wet ARMD?
Anti-VEGF - prevents neovascularisation
Laser phocoagulation
What are cataracts?
Lens opacities
What are congenital cataracts associated with?
TORCH
- Toxoplasmosis
- Rubella
- CMV
- Herpes
EBV
Chickenpox
How does herpes simplex present in the eye?
Dendritic ulcer
Red eye
Extremely painful
No discharge
What are the stages of diabetic retinopathy?
Background - Microaneurysms (dots) - Haemorrhages (blots) - Hard exudates (yellow clouds) Pre-proliferative - Cotton-wool spots (nerve infarcts) - Haemorrhages Proliferative - Neovascularisation Maculopathy - Oedema around fovea
How do you treat diabetic retinopathy?
Laser phocoagulation
What does retinal detachment look like on fundoscopy?
Grey retina ballooning fowards
How does giant cell arteritis present?
Vision goes dark
What signs would vitreous haemorrhage give with fundoscopy?
No red reflex
Can’t see retina
(if you can’t see in and patient can’t see out, it is likely vitreous haemorrhage and retinal detachment is the differential)
What causes optic atrophy (big cup)?
Optic neuritis
End stage glaucoma
Tumour compressing optic nerve
How does papilloedema look in fundoscopy?
Bilateral swollen discs
How do you treat giant cell arteritis?
High dose IV steroids
