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Ophthalmology Flashcards

1
Q

What are some bacterial causes of conjunctivitis in neonates?

A

Staph Aureus, Neisseria Gonorrhoea, Chlamydia trachomatosis

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2
Q

What are some bacterial causes of conjunctivitis in other ages?

A

Staph Aureus, Strep pneumoniae, haemophilus influenzae

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3
Q

What are some viral causes of conjunctivitis?

A

Adenovirus, herpes simplex, herpes zoster

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4
Q

Which types of organism would cause a purulent discharge?

A

Bacterial

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5
Q

Which types of organism would cause a watery discharge?

A

Viral

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6
Q

Which type of organism would cause enlarged preauricular lymph nodes?

A

Viral

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7
Q

How is conjunctivitis investigated/diagnosed?

A

Do an eye swab

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8
Q

How is bacterial conjunctivitis treated?

A

Topical chloramphenicol

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9
Q

How is bacterial conjunctivitis treated during pregnancy?

A

Topical fusidic acid

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10
Q

What does chloramphenicol during pregnancy cause?

A

Grey baby syndrome

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11
Q

How is allergic conjunctivitis treated?

A

Antihistamine drops/tablets

2nd line - sodium cromoglycate drops

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12
Q

Who should you suspect chlamydia conjunctivitis in?

A

Young adults where the disease has been unresponsive to treatment

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13
Q

How does chlamydial conjunctivitis present?

A

Follicular appearance with subtarsal scarring

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14
Q

How is chlamydial conjunctivitis treated?

A

Topical oxytetracycline

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15
Q

What is Herpes Zoster Ophthalmicus?

A

Reactivation of varicella zoster in CNV2

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16
Q

What is Hutchinson’s sign?

A

Vesicle on tip of nose suggesting nasociliary involvment

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17
Q

How is herpes zoster ophthalmicus treated?

A

Oral antivirals and steroids

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18
Q

What is keratitis?

A

Inflammation of the cornea

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19
Q

What are the broad causes?

A

Infective (bacterial, viral, fungal), autoimmune, vitamin A deficiency

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20
Q

How does keratitis present?

A

Circumcorneal red eye, photophobia, profuse lacrimation, reduced acuity, stabbing pain

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21
Q

What organism tends to cause a dendritic ulcer?

A

Herpes simplex virus

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22
Q

How is keratitis investigated?

A

Corneal scrape

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23
Q

What happens if you use steroids on a dendritic ulcer?

A

Corneal melt

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24
Q

How is bacterial keratitis treated?

A

Topical ofloxacin +/- gentamicin and cefotuxamine

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25
Q

How is viral keratitis treated?

A

Topical aciclovir

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26
Q

How is autoimmune keratitis treated?

A

Topical steroids

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27
Q

What is orbital cellulitis?

A

Infection that develops BEHIND the orbital septum

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28
Q

What organisms commonly cause orbital cellulitis?

A

Strep pneumoniae, staph aureus

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29
Q

How does orbital cellulitis present?

A

Unilateral red swollen eye lid, difficulty opening the eye, proptosis, reduced vision, reduced eye movements, painful eye movements, ophthalmoplegia

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30
Q

How is orbital cellulitis investigated?

A

CT sinus and orbit (to rule out abscess)

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31
Q

How is orbital cellulitis managed?

A

URGENT ADMISSION

IV ceftriaxone, metronidazole and flucloxicillin +/- drainage

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32
Q

What is peri-orbital cellulitis?

A

Same as orbital cellulitis but NO proptosis, reduction in vision or eye movements

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33
Q

How is peri-orbital cellulitis investigated?

A

CT sinus and orbit (to rule out abscess)

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34
Q

How is peri-orbital cellulitis managed?

A

Co-amoxiclav

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35
Q

What is endophthalmitis?

A

Sight threatening infection of inside the eye

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36
Q

When does endophthalmitis occur?

A

Usually post eye surgery or penetrating injury

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37
Q

What are some causative organisms of endophthalmitis?

A

Propionbacterium, staph epidermidis

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38
Q

How is endophthalmitis investigated?

A

Vitreal/aqueous humour culture

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39
Q

How is endophthalmitis treated?

A

Intravitreal anikacin and vancomycin

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40
Q

What is chorioretinitis?

A

Inflammation of choroid and retina (posterior uveitis)

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41
Q

What are some causes of chorioretinitis?

A

CMV, Toxoplasma, Toxocara

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42
Q

How does chorioretinitis present?

A

Gradual vision loss, pain, red eyes, floaters, photophobia

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43
Q

‘Pizza Fundus’

A

CMV

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44
Q

‘Punched out chorioretinal scars’

A

Toxoplasma

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45
Q

‘Granulomatous damage to retina’

A

Toxocara

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46
Q

How does a CNIII palsy present?

A

Eye is down and out
Pupil is dilated
Ptosis

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47
Q

What are some causes of a CNIII palsy?

A

Diabetes, vasculitis, cavernous sinus thrombosis, amyloidosis, Webers syndrome

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48
Q

What may be the cause in a painful CNIII palsy?

A

Aneurysm

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49
Q

What muscle does a CNIV palsy affect?

A

Superior oblique

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50
Q

What are some features of a CNIV palsy?

A

Intorsion, depression of eye in adduction, abduction weak, vertical diplopia

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51
Q

When may people with CNIV palsy notice diplopia?

A

On reading/walking up and down stairs (vertical)

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52
Q

What are some causes of a CNIV palsy?

A

Trauma, diabetes, tumour, idiopathic

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53
Q

What muscle is affected in a CNVI palsy?

A

Lateral Rectus

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54
Q

What are some features of a CNVI palsy?

A

Medially deviated eye, unable to abduct, horizontal diplopia

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55
Q

What are some causes of a CNVI palsy?

A

Microvascular, raised ICP, tumour, congenital

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56
Q

What is internuclear ophthalmoplegia?

A

Injury/dysfunction of medial longitudinal fasciculatis

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57
Q

What causes internuclear ophthalmoplegia?

A

MS, stroke

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58
Q

How does internuclear ophthalmoplegia present?

A

Affected eye cannot adduct

Unaffected eye abducts with nystagmus

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59
Q

Where is the affected structure - unilateral vision loss

A

Optic nerve (causes - MS, ION)

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60
Q

Where is the affected structure - bitemporal hemianopia

A

Optic chiasm (causes - pituitary tumour)

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61
Q

Where is the affected structure - homonymous hemianopia

A

Optic tract (tumour, MS, stroke)

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62
Q

Where is the affected structure - superior quadrantopia

A

Optic radiation in temporal lobe

63
Q

Where is the affected structure - inferior quadrantopia

A

Optic radiation in parietal lobe

64
Q

Where is the affected structure - homonymous hemianopia with macular sparing

A

Occipital cortex

65
Q

What is a concomitant squint?

A

Imbalance of extra-ocular muscles (can be convergent or divergent)

66
Q

What is a paralytic squint?

A

Due to paralysis of extra-ocular muscles

67
Q

How can a squint be detected?

A

Corneal light test and cover uncover test

68
Q

What is amblyopia?

A

Reduced vision in one eye due to a degraded retinal image, therefore leading to poor binocular vision

69
Q

What are the main causes of amblyopia?

A

Squint, refractive error, obstruction to visual axis

70
Q

How is amblyopia treated?

A

Occlusion of good eye

71
Q

What are the 3 main ways to treat squints?

A

Treat refractive errors, treat amblyopia, surgery

72
Q

What is blepharitis?

A

Inflammation of the eyelid margins

73
Q

What is the cause of posterior blepharitis?

A

Meibomian gland dysfunction

74
Q

What is the cause of anterior blepharitis?

A

Sebhorroeic dermatitis, staph infection

75
Q

What condition is associated with blepharitis?

A

Acne rosacea

76
Q

How does blepharitis present?

A

Bilateral grittiness and discomfort, eyes sticky in morning, red and swollen, styes common

77
Q

How is blepharitis managed?

A

Lid hygiene (compresses), mechanical removal of debris, doxycycline

78
Q

What is anterior uveitis?

A

Inflammation of the uvea (iris, choroid, ciliary body)

79
Q

What are causes of anterior uveitis?

A

Reactive arthritis, UC, crohns, ankylosing spondylitis, sarcoidosis, leukaemia, TB, syphilis, Behcets

80
Q

How does anterior uveitis present?

A

Acute onset red eye, discomfort/pain, irregular and small pupil, photophobia, blurred vision, lacrimation, cells and flare in anterior chamber

81
Q

How is anterior uveitis managed?

A

Urgent review
Cycloplegics (e.g. atropine, cyclopentolate)
Steroid eye drops

82
Q

What is episcleritis?

A

Inflammation below conjunctiva in episclera

83
Q

How does episcleritis present?

A

Mild discomfort, red eye, watering, photophobia, vessels on eye BLANCH and are MOBILE

84
Q

How is episcleritis treated?

A

Self limiting - topical lubricants, NSAIDs

85
Q

What is scleritis?

A

Vasculitis of the sclera

86
Q

How does scleritis present?

A

Moderate/severe pain, diffuse deep redness, decreased acuity, watering, photophobia. Vessels CANNOT be moved and do not blanch with phenylephrine

87
Q

How is scleritis treated?

A

Oral NSAIDs, oral steroids, immunosuppression

88
Q

How should penetrating eye trauma be managed in A&E?

A

Attempt removal with slit lamp

89
Q

Which substance (acid or alkali) penetrates the eye more?

90
Q

How should chemical burns be initially treated?

A

Urgent washout of eye

91
Q

What are some symptoms of an orbital blowout fracture?

A

Double vision, sunken ocular globes, loss of sensation of cheek and upper gums due to infra-orbital nerve injury

92
Q

What signs may be seen with orbital blowout fracture?

A

Peri-orbital bruising, subconjunctival haemorrhage, teardrop sign on x-ray, air-fluid level in maxillary sinuses

93
Q

How is an orbital blowout fracture treated?

A

Prophylactic antibiotics, oral steroids +/- surgery

94
Q

What are the main causes of SUDDEN vision loss?

A

CRAO, CRVO, BRAO, BRVO, Amarosis fugax, AION, vitreous haemorrhage, retinal detachment, Wet ARMD, closed angle glaucoma

95
Q

What are the main presenting symptoms of CRAO?

A

Dramatic visual loss in seconds which is painless

96
Q

What signs may be seen in CRAO?

A

RAPD

Pale retina with cherry red spot on macula

97
Q

How is CRAO managed?

A

Ocular massage, paper bag breathing, IV acetazolamide, establish source of embolus (e.g. carotid doppler). Assess and manage risk factors

98
Q

What is amaurosis fugax?

A

Transient CRAO

99
Q

How does amaurosis fugax present?

A

Transient painless monocular vision loss
‘Like a curtain coming down’
Lasts around 5 minutes then full recovery

100
Q

How is amaurosis fugax managed?

A

Referral to TIA clinic. Aspirin

101
Q

How does CRVO present?

A

Sudden onset blurry vision loss in one eye, painless

102
Q

What signs may be seen with CRVO?

A

RAPD
Retinal haemorrhages
Dilated tortuous veins
Disc and macular swelling

103
Q

How is CRVO managed?

A

Observation unless evidence of neorevascularisation (in which case do laser photocoagulation)

104
Q

What is Anterior Ischaemic Optic Neuropathy (AION)?

A

Occlusion of posterior ciliary arteries leading to infarction of optic nerve head

105
Q

How does AION present?

A

Sudden onset, profound, irreversible vision loss

106
Q

What is AION associated with?

A

Giant Cell arteritis (screen for other symptoms)

107
Q

How is AION managed?

A

High dose steroids (prevent loss of vision in other eye)

Treat underlying causes

108
Q

What are some causes of vitreous haemorrhage?

A

Bleeding from neorevascularisation or retinal tears/trauma

109
Q

What are some symptoms of vitreous haemorrhage?

A

Loss of vision, floaters

110
Q

What are signs of vitreous haemorrhage?

A

Loss of red reflex, unable to visualise retina

111
Q

What investigation should be done if suspect vitreous haemorrhage?

A

B scan ultrasound

112
Q

How is vitreous haemorrhage managed?

A

Identify the cause. Vitrectomy if dense

113
Q

What are some causes of retinal detachment?

A

Trauma, retinal tear, following vitreous haemorrhage (risk increased in myopes)

114
Q

What are the symptoms of retinal detachment?

A

Vision loss, flashing, floaters, dark shadow in peripheral vision

115
Q

What are some signs of retinal detachment?

A

RAPD, tear may be seen

116
Q

How is retinal detachment managed?

A

If you can see retinal tear - do laser to prevent a full detachment
If detached - vitrectomy, laser, gas bubble tamponade

117
Q

What is the underlying cause of wet age related macular degeneration?

A

Choroidal neorevascularisation, leakage of fluid causes build up and eventually scarring

118
Q

What are some symptoms of wet ARMD?

A

Rapid central vision loss and vision distortion (vision seems wavy)

119
Q

What signs of wet ARMD may be seen?

A

Haemorrhage, exudate

120
Q

How is wet ARMD treated?

A

Intravitral anti-VEGF injections

121
Q

What are causes of gradual vision loss?

A

Cataracts, dry ARMD, refractive error, diabetic retinopathy, open angle glaucoma

122
Q

What is a cataract?

A

An opacity of the lens

123
Q

What are some causes of cataracts?

A

Age related, UV light, congenital (IU infection), diabetes, hypoglycaemia, trauma, steroids, Downs syndrome

124
Q

What intra-uterine infections can cause cataracts?

A

Rubella, CMV, toxoplasma

125
Q

What are some types of cataract?

A

Nuclear, subcapsular, polychromatic

126
Q

What predisposes to subcapsular cataracts?

A

Steroid use

127
Q

How are cataracts treated?

A

Phaecoemulsification and IOL

128
Q

What is the commonest cause of vision loss in the elderly?

129
Q

What are some causes of Dry ARMD?

A

Epigenetics, diet, smoking, increased age

130
Q

What are some symptoms of dry ARMD?

A

Gradual decline in vision, central scotoma

131
Q

What are some signs of dry ARMD?

A

Drusen, retinal pigment epithelium atrophy

132
Q

How is dry ARMD treated?

A

Stop smoking, healthy diet, vitamin supplements, visual aids

133
Q

What is myopia and what lens is used to correct it?

A

Short sighted - concave lens

134
Q

What is hypermetropia and what lens is used to correct it?

A

Long sighted - convex lens

135
Q

What is astigmatism?

A

Irregular corneal curvature

136
Q

What is presbyopia?

A

Loss of accommodation with age due to stiffening of the lens

137
Q

What is the pathogenesis of diabetic retinopathy?

A

Hyperglycaemia causes increased retinal blood flow and metabolism, leading to endothelial dysfunction, pericyte dysfunction and an increase in growth factor

138
Q

What are the results of the pathogenesis of diabetic retinopathy?

A

Exudates
Microaneurysms
Neorevascularisation

139
Q

How is diabetic retinopathy classified?

A

Non proliferative (mild, moderate, severe) and proliferative

140
Q

How is diabetic retinopathy treated?

A

Tighter diabetic control, laser photocoagulation, anti-VEGF

141
Q

What is glaucoma?

A

Group of diseases characterised by progressive optic nerve damage and visual field loss

142
Q

What are some signs of glaucoma?

A

Arcuate field defect, optic disc cupping, raised ICP

143
Q

How is glaucoma diagnosed and monitored?

A

Tonometry (IOP), perimetry (visual fields), clinical exam (optic nerve)

144
Q

What is the cause of primary open angle glaucoma?

A

Blocked drainage of aqueous through trabecular meshwork

145
Q

What are some risk factors for POAG?

A

Increased age, family history, myopes, increased IOP, afro-carribean ethnicity

146
Q

What is the first line treatment for POAG?

A

Prostaglandins (e.g. Latanoprost)

147
Q

What are some side effects of prostaglandin drops?

A

Iris colour change, eyelash growth

148
Q

What is second line treatment for POAG?

A

Beta-blocker (e.g. timolol) - CI in asthma/HF

149
Q

What other treatments are available for POAG?

A

Carbonic anhydrase inhibitors
Parasympathomimmetics
Sympathomimmetics

150
Q

What surgery can be done for POAG?

A

Trabeculectomy

151
Q

What is closed angle glaucoma?

A

Pressure in eye rises very quickly leading to visual symptoms

152
Q

How does closed angle glaucoma present?

A

Pain, nausea and vomiting, reduced vision
Hazy cornea
Fixed, mid-dilated pupil
Blurred vision and haloes

153
Q

How is closed angle glaucoma initially managed?

A 
Pilocarpine (constrict pupil and open angle)
IV acetazolamide (to reduce IOP)
\+/- analgesia and antiemetics
154
Q

Once the IOP is stabilised in closed angle glaucoma, how is it treated?

A

Peripheral Laser Iridotomy

- hole at 12 o’clock in both eyes to allow pressure to equilibriate

Finals Revision (22 decks)

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