Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

cardinal features of Horner’s Syndrome?

A

PEAS

Ptosis: partial (superior tarsal muscle)

Enophthalmos

Anhydrosis

Small pupil (miosis) - due to loss of sympathetic dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

causes of horner’s syndrome?

A

Central:

MS, Wallenberg’s Lateral medullary syndrome

Pre-ganglionic (Neck):

Pancoast tumour

trauma: carotid artery aneurysm/ ICA dissection

Post-ganglionic:

cavernous sinus thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

features of an argyll robertson pupil?

A

small, irregular pupils

accommodate but dont react to light

atrophied and depigmented iris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cause of argyll robertson pupil?

A

highly specific sign of neurosyphilis

can also be a sign of diabetic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

features of an afferent defect of the pupil?

A

no direct response but intact consensual response

cannot initiate consensual response in contralateral eye

dilatation on moving light from normal to abnormal eye

causes: total CN II lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a relative afferent pupillary defect?

A

minor constriction to direct light

dilatation on moving light from normal to abnormal eye

RAPD = Marcus Gunn pupil

The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

causes of marcus gunn pupil / Relative afferent pupillary defect?

A

optic neuritis

optic atrophy

retinal disease

lesion of optic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

features of an efferent defect of the pupil?

A

dilated pupil does not react to light (no constriction)

initiates consensual response in contralateral pupil

opthalmoplegia + ptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cause of efferent defect of pupil

A

CN III nerve palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

differential of a fixed dilated pupil?

A

mydriatics: e.g. tropicamide

iris trauma

acute glaucoma

CN3 compression: tumour, coning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

features of Holmes-Adie pupil?

A

Dilated pupil has no response to light but sluggish response to accommodation

Initially unilateral and then bilateral pupil dilatation

Young woman w sudden blurring of near vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ix of holmes adie pupil?

A

Iris shows spontaneous wormy movements on slit-lamp examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is holmes -adie syndrome?

A

tonically dilated pupil + absent knee/ ankle jerks + low BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cause of holmes adie pupil?

A

damage to postganglionic parasympathetic fibres

idiopathic: may have viral origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

features of optic neuropathy/ atrophy?

A

decreased acuity

decreased colour vision (esp red)

central scotoma

pale optic disc

RAPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of optic atrophy/ neuropathy?

A

congenital:

alcohol/ toxins

Compression: Glaucoma, pituitary adenoma

vascular: DM, GCA, thromboembolic
inflammatory: optic neuritis -MS, DM, Devic’s

Sarcoid

infection: herpes zoster, TB, syphilis
oedema: papilloedema

Neoplastic: lymphoma, leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

visual history?

A

vision:

blurred, distorted, diplopia, visual defect/ scotoma, floaters

sensation:

pain, irritation, itching, photophobia

appearance:

red, puffy lids

discharge:

watery, sticky, stringy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

symptoms of acute glaucoma?

A

severe pain

decreased visual acuity

hazy/ cloudy cornea

large pupil

increased IOP

prodrome: rainbow haloes around lights at night time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

features of anterior uveitis?

A

pain

photophobia

decreased visual acuity

small pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

conjunctivitis features?

A

pain

photophobia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

acute closed angle glaucoma

pathophysiology?

A

blocked drainage of aqueous humour from anterior chamber via the canal of Schlemm

pupil dilatation (esp at night) worsens the blockage

IOP rises from 15-20 -> 60 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

risk factors for acute closed glaucoma?

A

hypermetropia

shallow ant chamber

female

FH

increased age

drugs: anticholinergics, sympathomimetics, TCAs, anti-histamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

examination findings of acute closed angle glaucoma?

A

cloudy cornea with circumcorneal injection

fixed, dilated, irregular pupil

Increased IOP makes eye feel hard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ix of acute closed angle glaucoma?

A

tonometry: raised IOP

(usually > 40 mmHg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

acute mx of acute closed angle glaucoma?

A

refer to ophthalmologist

pilocarpine 2-4% drops stat: miosis opens blockage

topical BB (e.g. timolol): decrease aqueous formation

Acetazolamide 500mg IV stat: decrease aqueous formation

analgesia and antiemetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

long term mx of acute closed angle glaucoma?

A

bilateral YAG laser peripheral iridotomy once IOP decreased medically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the uvea?

A

pigmented part of eye and includes: iris, ciliary body and choroid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is anterior uveitis?

A

Uvea is pigmented part of eye and included: iris, ciliary body and choroid.

Iris + ciliary body = anterior uvea
Iris inflammation involves ciliary body too.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

symptoms of acute uveitis?

A

acute pain and photophobia

blurred vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

examination findings of anterior uveitis?

A

Small pupil initially, irregular later
Circumcorneal injection
Hypopyon: pus in anterior chamber

White (keratic) precipitates on back of cornea

Talbots test: ↑pain on convergence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

mx of anterior uveitis?

A

Refer to ophthalmologist

Prednisolone drops

Cyclopentolate drops: dilates pupil and prevents

adhesions between iris and lens (synechiae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is episcleritis?

A

characterized by the abrupt onset of painless eye redness.

The episclera is a thin layer of tissue that lies between the conjunctiva and sclera

benign, self-limiting inflammatory disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

presentation of episcleritis?

A

Localised reddening: can be moved over sclera

Painless / mild discomfort

Acuity preserved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

mx of episcleritis?

A

topical or systemic NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is scleritis?

A

vasculitis of the sclera

associated with Wegener’s, rheumatoid arthritis, lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

presentation of scleritis?

A

severe pain: worse on eye movement

Generalised scleral inflammation (vessels wont move over sclera)

Conjunctival oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

mx of scleritis?

A

refer to specialist

most need corticosteroids / immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

complications of scleritis?

A

thinning of sclera (scleromalacia) -> globe perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

causes of conjunctivitis?

A

viral: adenovirus
bacterial: staph, chlamydia, gonococcus

allergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

presentation of conjunctivitis?

A

often bilateral with purulent discharge

(bacterial: sticky/ viral: watery)

discomfort

conjunctival injection (vessels may move over the sclera)

acuity, pupil responses and cornea are unaffected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

tx of bacterial conjunctivitis?

A

chloramphenicol 0.5% ointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

mx of allergic conjunctivitis?

A

antihistamine drops e.g. emedastine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

symptoms of corneal abrasion?

A

pain

red eyes

photophobia

blurred vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ix of corneal abrasion?

A

slit lamp: fluorescein stains defect green

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

mx of corneal abrasion?

A

chloramphenicol ointment for infection prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Mx of corneal ulcer + keratitis?

A

refer immediately to specialist who will

  • take smears and cultures
  • abx drops, oral/topical aciclovir
  • cycloplegics/ mydriatics ease photophobia
  • steroids may worsen symptoms: professionals only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

risk factors of corneal ulcer + /- keratitis?

A

contact lens wearers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

ix of corneal ulcer +/- keratitis?

A

slit lamp: fluorescein stains green

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

complications of corneal ulcer +/- keratitis?

A

scarring and visual loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

presentation of corneal ulcer +/- keratitis?

A

pain, photophobia

conjunctival hyperaemia (excess of blood)

decreased acuity

white corneal opacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is opthalmic shingles?

A

variceller zoster reactivation of CN V1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

presentation of opthlamic shingles?

A

pain in CNV1 dermatome precedes blistering rash

40% -> keratitis, iritis

Hutchinson’s sign: nose-tip zoster due to involvement of nasociliary branch (increased chance of globe involvement as nasociliary nerve also supplies globe)

opthalmic involvement: keratitis + corneal ulceration (fluoresceins stain)

+/- iritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Sudden loss of vision

key questions?

A

Headache associated: GCA?

Eye movements hurt: optic neuritis

Lights/ flashes preceding visual loss: detached retina

like curtain descending: TIA, GCA

Poorly controlled DM: vitreous bleed from new vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is anterior ischaemic optic neuropathy (AION)?

A

optic nerve damaged if posterior ciliary arteries blocked by inflammation or atheroma

pale/ swollen optic disc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

causes of Anterior ischaemic optic neuropathy?

A

Giant cell arteritis

HTN, DM, high lipids, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

symptoms of optic neuritis?

A

unilateral loss of acuity over hours- days

decreased colour discrimination

eye movements may hurt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

signs of optic neuritis

A

decreased acuity

decreased colour vision

enlarged blind spot

optic disc may be: normal, swollen, blurred

afferent defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

mx of optic neuritis?

A

high dose methylprednisolone IV for 72 h

then oral pred for 11 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what is a vitreous haemorrhage?

A

extravasation of blood into or around the areas of the vitreous humour of the eye

e.g. new vessels - DM

retinal tears/ detachment/ trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

presentation of vitreous haemorrhage?

A

small bleeds -> small black dots/ ring floaters

large bleed can obscure vision-> no red reflex, retina cant be visualized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

mx of vitreous haemorrhage?

A

undergoes spontaneous absorption

vitrectomy may be performed in dense VH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

presentation of central retinal artery occlusion?

A

dramatic unilateral visual loss in seconds

afferent pupil defect (may recede retinal changes)

pale retina w cherry red macula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

causes of central retinal artery occlusion?

A

GCA

thromboembolism: clot, infection, tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Mx of central retinal artery occlusion?

A

if seen within 6 h aim is to increase retinal blood flow by decreasing IOP

  • ocular massage
  • surgical removal of aqueous humour
  • anti-hypertensives (local and systemic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

causes of transient visual loss?

A

vascular: TIA, migraine

MS

subacute glaucoma

papilloedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what is retinal detachment?

A

Holes/tears in retina allow fluid to separate sensory retina from retinal pigmented epithelium

May be 2O to cataract surgery, trauma, DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

presentation of retinal detachment?

A

4Fs

floaters: numerous, acute onset, ‘spiders web’

flashes

field loss

faill in acuity

painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

appearance of fundus in retinal detachment?

A

grey, opalescent retina, ballooning forwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

mx of retinal detachment?

A

urgent surgery

vitrectomy + gas tamponade with laser coagulation to secure the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

presentation of occlusion of branch of retinal vein?

A

unilateral visual loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

causes of central retinal vein occlusion?

A

atherosclerosis, HTN, DM, polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

presentation of central retinal vein occlusion?

A

sudden unilateral visual loss with RAPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

fundus appearance with central retinal vein occlusion?

A

stormy sunset appearance

tortuous dilated vessels

haemorrhages

cotton wool spots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

complications of central retinal vein occlusion?

A

glaucoma

neovascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

complications of occlusion of a branch of retinal vein?

A

retinal ischaemia -> VEGF release and neovascularisation

(tx: laser photocoagulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

common causes of gradual vision loss?

A

diabetic retinopathy

age related macular degeneration

cataracts

open angle glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

commonest cause of blindness in the elderly?

A

age related macular degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

risk factors of age related macular degeneration?

A

smoking

increasing age

genetic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

presentation of age related macular degeneration?

A

elderly pt

with central visual loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what is dry age related macular degeneration?

A

small white or yellowish deposits, called drusen, form on the retina, beneath the macula, causing it to deteriorate or degenerate over time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is wet age related macular degeneration?

A

Wet age-related macular degeneration (AMD) develops when abnormal blood vessels grow into the macula.

-> Leak blood or fluid which leads to scarring of the macula and rapid loss of central vision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

ix of wet age related macular degeneration?

A

Fundoscopy shows macular haemorrhage -> scarring

  1. Slit lamp: identify any pigmentary, exudative or haemorrhagic changes affecting the retina

amsler gird detects distortion

fluorescein angiography -> can guide intervention with anti-VEGF therapy

OCT: optical coherence tomography gives high resolution images of the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Mx of wet age related macular degeneration?

A

photodynamic therapy

intravitreal VEGF inhibitors

  • bevacizumab, ranibizumab

antioxidant vitamins (C, E) + zinc may help early ARMD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what is tobacco-alcohol amblyopia?

A

Due to toxic effects of cyanide radicals when combined with thiamine deficiency.

Optic atrophy, loss of red/green discrimination, scotomata

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

pathogenesis of chronic simple (open angle) glaucoma?

A

trabecular meshwork dysfunction

IOP > 21 mmHg -> decreased blood flow and damage to optic nerve -> optic disc atrophy (pale) + cupping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

presentation of chronic open angle glaucoma?

A

Peripheral visual field defect: superior nasal first

Central field is intact. acuity maintained until late

Presentation delayed until optic N. damage is irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Ix of chronic open angle glaucoma?

A

Tonometry: IOP >21 mmHg

Fundoscopy: cupping of optic disc

Visual field assessment: peripheral loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

mx of chronic open angle glaucoma?

A

eye drops to decrease IOP to baseline

1st line: BB

e.g. timolol, betaxolol to decrease aqueous production

(caution in asthma, HF)

prostaglandin analogues: to increase uveoscleral outflow

e.g. latanoprost, travoprost

a-agonists:

to decrease aqueous production and increase uveoscleral outflow

e.g. brimonidine, apraclonidine

carbonic anhydrase inhibitors:

dorzolamide drops, acetazolamide PO

miotics: pilocarpine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

surgical mx of chronic open angle glaucoma?

A

laser trabeculoplasty

surgery (trabeculectomy) is used if drugs fail

  • new channel allows aqueous to flow into conjunctival bleb
90
Q

how does DM increase risk of cataracts?

A

DM accelerates cataract formation

lens absorbs glucose which is converted to sorbitol by aldose reductase

-> sorbitol forms deposits within lens

91
Q

What is diabetic retinopathy?

A

too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don’t develop properly and can leak easily.

microangiopathy -> occlusion

new vessel formation bleed -> vitreous haemorrhage

-> retinal detachment

Occlusion also -> cotton wool spots (ischaemia)

vascular leakage -> oedema and lipid exudates

Rupture of microaneurysms -> blot haemorrhage

92
Q

eye screening for diabetics?

A

all diabetics should be screened annually

fundus photography

refer those w maculopathy etc to ophthalmologist

93
Q

ix of diabetic retinopathy

A

fluorescein angiography

94
Q

mx of diabetic retinopathy?

A

good BP and glycaemic control

tx concurrent disease: HTN, dyslipidaemia, renal disease, smoking, anaemia

Laser photocoagulation:

maculopathy- focal or grid

Proliferative disease: pan retinal (macula spared)

95
Q

Cranial nerve palsies due to diabetes?

A

CNIII and CNVI palsies

due to damage to the small blood vessels that feed the nerve

In diabetic CN III palsy the pupil may be spared as its nerve fibres run peripherally and receive blood from pial vessels.

96
Q

presentation of cataracts?

A

increasing myopia

blurred vision -> gradual visual loss

esp difficult in bright lights/ sunshine

monocular diplopia

97
Q

ix of cataracts?

A

visual acuity

dilated fundoscopy

Slit lamp: to visualize cataract

tonometry

blood glucose to exclude DM

98
Q

conservative mx of cataracts?

A

glasses

encouraging the use of brighter lighting to improve vision

99
Q

surgical mx of cataracts?

A

consider if symptoms affect lifestyle or driving

day case surgery under LA

  • phacoemulsification + lens implant

post op capsule thickening is common: easily tx w laser capsultomy

post op eye irritation is common and requires drops

100
Q

What is Retinitis Pigmentosa?

A

most prevalent inherited degeneration of the macula

involve a breakdown and loss of cells in the retina—which is the light sensitive tissue that lines the back of the eye.

101
Q

presentation of retinitis pigmentosa?

A

night blindness

loss of peripheral vision -> tunnel vision

most are registrable blund by mid 30s

102
Q

Fundoscopy findings of retinitis pigmentosa?

A

pale optic disc: optic atrophy

peripheral retina pigmentation: spares the macula

103
Q

signs of retinoblastoma?

A

strabismus

leukocoria (white pupil) -> no red reflex

104
Q

mx of retinoblastoma

A

depends on size

chemo/ radio/ enucleation

105
Q

what is a stye?

A

aka hordeolum externum

a bacterial infection of an oil gland in the eyelid

(usually staph aureus)

106
Q

mx of stye?

A

hot compresses and analgesia

local abx e.g. fusidic acid if there is an associated conjunctivitis

107
Q

what is hordeolum internum/ chalazion?

A

infection / abscess of the meibomian gland (oil gland of the eyelid) which points inwards onto conjunctiva

resolve spontaneously but some require surgical drainage

May leave a residual chalazion (Meibomian cyst): firm painless lump

108
Q

what is blepharitis?

A

inflammation of eyelid margins

e.g. due tomeibomian gland dysfunction or staph, seborrhoeic dermatitis

meibomian glands secrete oil on to the eye surface to prevent rapid evaporation of the tear film. Any problem affecting the meibomian glands (as in blepharitis) can hence cause drying of the eyes which in turns leads to irritation

109
Q

features of blepharitis?

A

red eyes

gritty/ itchy sensation

eyes may be sticky in the morning

scales on lashes

often assoc w rosacea

symptoms are usually bilateral

eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis

110
Q

mx of blepharitis?

A

clean crusts of lashes with warm soaks

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*

artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film

111
Q

what is entropion?

A

lid inversion -> corneal irritation

typically caused by muscle spasm or by inflammation or scarring of the conjunctiva (as in diseases such as trachoma)

112
Q

what is an ectropion?

A

low lid eversion -> watering and exposure keratitis

assoc w ageing and facial n palsy

113
Q

what is lagophthalmos?

A

Difficulty in lid closure over the globe which may →exposure keratitis

Causes: exophthalmos, facial palsy, injury

114
Q

mx of lagophthalmos?

A

Lubricate eyes w liquid paraffin ointment

Temporary tarsorrhaphy may be needed if corneal ulcers develop.

115
Q

what is pinguecula?

A

yellowish, slightly raised thickening of the conjunctiva on the white part of the eye (sclera), close to the edge of the cornea.

116
Q

what is a pterygium?

A

benign growth of the conjunctiva or mucous membrane that covers the white part of your eye over the cornea

-> decreased vision

assoc w dusty, windblown life styles, sun exposure

117
Q

mx of orbital cellulitis?

A

IV abx

e.g. cefuroxime

118
Q

presentation of orbital cellulitis?

A

inflammation of orbit + lid swelling

pain and decreased range of eye movement

exophthalmos

systemic signs e.g. fever

+/- tenderness over the sinuses

119
Q

complications of orbital cellulitis?

A

local extension -> meningitis and cavernous sinus thrombosis

blindness due to optic n pressure

120
Q

myopia

pathophysiology?

A

eye is too long (AP diameter)

distant objects are focused in front of the back of the eye

121
Q

mx of myopia?

A

concave lenses

122
Q

astigmatism

pathophysiology?

A

Cornea or lens doesn’t have same degree of curvature in horizontal and vertical planes.

Image of object is distorted longitudinally or vertically

solution: correcting lenses

123
Q

hypermetropia

pathophysiology?

A

eye is too short

when eye is relaxed and not accommodating, objects are focussed behind the retina

contraction of ciliary muscles to focus image -> tiredness of gaze and possibly a convergent squint in children

124
Q

mx of hypermetropia?

A

convex lenses

125
Q

presbyopia pathophysiology?

A

long-sightedness caused by loss of elasticity of the lens of the eye

(around 40->60)

use convex lenses

126
Q

what is esotropia?

A

convergent squint

commonest type in children

may be idiopathic or due to hypermetropia

127
Q

what is exotropia?

A

divergent squint

128
Q

diagnosis of non-paralytic squint?

A

corneal reflection test

(Hirschberg test): to see if light reflects off corneas symmetrically

cover test: covering unaffected eye causes movement of affected eye

129
Q

mx of non paralytic squint

A

optical: correct refractive errors

Operations - of eye muscles to help alignment

Patching good eye encourages use of squinting eye

130
Q

paralytic squint

features?

A

diplopia greatest on looking in direction of pull of paralysed muscle

eye wont move to centre on covering

cover each eye in turn: whichever eye sees the outer image is malfunctioning

131
Q

CNIII palsy squint presentation?

A

ptosis (LPS weakness)

Fixed dilated pupil (no parasympathetic)

eye down and out

132
Q

CN IV paralytic squint features?

A

diplopia especially on going down stairs

test: cant depress eyes in adduction

head tilt

133
Q

CNVI paralytic squint features?

A

diplopia in horizontal plane

eye medially deviated and cannot abduct

134
Q

Eye trauma

what to do??

A

Record acuity of both eyes

Take detailed Hx of event

If unable to open injured eye, instil LA (e.g. tetracaine

1%)

if foreign body suspected: xray orbit

if corneal abrasions? -> fluorescein dye

135
Q

mx of eye trauma

A

chloramphenicol drops as infection prophylaxis

eye patch

cycloplegic drugs to decrease pain: tropicamide

136
Q

what is an orbital blowout fracture?

A

traumatic deformity of the orbital floor or medial wall,

-> herniation of orbital contents into maxillary sinus

137
Q

presentation of orbital blowout fracture?

A

ophthalmoplegia + diplopia

(tethering of inferior rectus and inferior oblique)

loss of sensation to lower lid skin (infraorbital n injury)

ipsilateral epistaxis (damage to anterior ethmoidal artery)

decreased acuity

irregular pupil that reacts slowly to light

138
Q

Mx of orbital blowout fracture?

A

fracture reduction and muscle release if necessary

139
Q

initial investigation of choice for age related macular degeneration?

A

slit-lamp microscopy

to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD

usually + colour fundus photography

140
Q

what is grade 1 of the Keith Wagener Barker classification of hypertensive retinopathy?

A

mild generalized retinal arteriolar narrowing

141
Q

what is grade 2 of the keith wagener barker classification of hypertensive retinopathy?

A

definite focal narrowing and arteriovenous nipping

142
Q

what is grade 3 of the keith wagener barker classficiation of hypertensive retinopathy?

A

grade 2 + Cotton-wool exudates
Flame and blot haemorrhages

143
Q

what is grade 4 of the keith wagener barker classification of hypertensive retinopathy?

A

severe grade 3 + papilloedema

144
Q

what is trachoma?

A

caused by chlamydia trachomatis (A, B, C)

spread by flies

Inflammatory reaction under lids → scarring → lid distortion → entropion → eyelashes scratch cornea →ulceration → blindness

145
Q

mx of trachoma?

A

tetracycline 1% ointment +/- PO

146
Q

mx of ophthalmic shingles?

A

oral aciclovir for 7-10 days, ideally started within 72 hours.

oral corticosteroids may reduce the duration of pain but do not reduce the incidence of post-herpetic neuralgia

ocular involvement requires urgent ophthalmology review

147
Q

what is Hutchinson’s sign?

A

rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

148
Q

Anhidrosis in Horner’s syndrome

Anhydrosis of the face, arm and trunk suggests lesion is in?

A

Central lesion

e.g.

Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis

149
Q

Anhidrosis in Horner’s syndrome

Anhidrosis of the face alone suggests lesion is in?

A

Pre-ganglionic lesions

e.g.

Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib

150
Q

Anhidrosis in Horner’s syndrome

no anhidrosis suggests lesion is in?

A

post-ganglionic lesion

e.g.

Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

151
Q

distinguishing features between acute closed angle glaucoma and anterior uveitis?

A

anterior uveitis:

acute onset

pain

blurred vision and photophobia

small, fixed oval pupil, ciliary flush

Acute angle closure glaucoma:

severe pain (may be ocular or headache)

decreased visual acuity, patient sees haloes

semi-dilated pupil

hazy cornea

152
Q

features of papilloedema on fundoscopy?

A

venous engorgement: usually the first sign

loss of venous pulsation: although many normal patients do not have normal pulsation

blurring of the optic disc margin

elevation of optic disc

loss of the optic cup

Paton’s lines: concentric/radial retinal lines cascading from the optic disc

153
Q

what type of visual field defect may arise from glaucoma?

A

peripheral visual field

154
Q

in age related macular degeneration, straight lines may be seen as?

A

curvy

155
Q

1st line mx of chronic open angle glaucoma?

A

Topical prostaglandin analogues

e. g. latanoprost
- increases uveoscleral outflow of aqueous humour.

or

Topical BB

e. g. timolol, betaxolol
- decreases aqueour humour production

156
Q

adverse effects of miotics e.g. pilocarpine?

A

Adverse effects included a constricted pupil, headache and blurred vision

157
Q

adverse effect of prostaglandin analogue e.g. latanoprost for glaucoma?

A

brown pigmentation of iris

158
Q

features of severe non proliferative diabetic retinopathy?

A

blot haemorrhages and microaneurysms in 4 quadrants

venous beading in at least 2 quadrants

intraretinal microvascular abnormalities (IRMA) in at least 1 quadrant

159
Q

features of moderate non proliferative diabetic retinopathy?

A

microaneurysms

blot haemorrhages

hard exudates

cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

160
Q

example of miotic?

A

Pilocarpine

161
Q

surgical mx of different types of glaucoma?

A

Trabeculoplasty: to open trabecular meshwork

for open angle glaucoma

Iridotomy: for closed angle

162
Q

example of carbonic anhydrase inhibitor?

A

dorzolamide, acetazolamide

Reduces aqueous production

in open angle glaucoma

163
Q

e.g. of alpha agonists

for glaucoma? + mode of action?

A

e.g. brimonidine, apraclonidine

decreases aqueous humour production +

increases uveoscleral outflow

164
Q

e.g. of topical antihistamines for eye?

A

emedastine

antazoline

165
Q

e.g. lubricants for eyes

A

hypromellose eye drops - artificial tears

carbomer - viscotears

166
Q

anaesthetic used to permit examination of painful eye?

A

tetracaine

167
Q

mydriatics e.g.s?

A

tropicamide: half life 3h
cyclopentolate: half life 24h (preferred for paediatric use)

168
Q

side effects of mydriatics?

A

ciliary paralysis -> blurred vision due to loss of accommodation

loss of light reflex

caution: may cause acute glaucoma if shallow anterior chamber

169
Q

indications for mydriatics?

A

eye exam

prevention of synechiae in anterior uveitis

170
Q

what is keratoconjunctivitis sicca?

A

dry eyes due to decreased tear production

+ dry mouth

in sjogrens!

schirmer’s test +ve

171
Q

mx of keratoconjunctivitis sicca?

A

artificial tears/ saliva

172
Q

what are Roth spots?

A

seen in infective endocarditis

boat shaped haemorrhages w pale centres

173
Q

kayser-fleischer rings?

A

wilson’s disease

174
Q

corneal calcification

what metabolic disease?

A

hyperparathyroidism

175
Q

features of CMV retinitis on fundoscopy?

A

pizza pie fundus + flames

176
Q

features of HIV retinopathy on fundoscopy?

A

cotton wool spots

177
Q

red eye

classically not painful (in comparison to scleritis), but mild pain may be present

watering and mild photophobia may be present

dx?

A

episcleritis

178
Q

painless transient loss of vision in one or both eyes

‘black curtain coming down’

A

amaurosis fugax

179
Q

red, painful eye

photophobia

dendritic ulcer seen on the slit lamp examination with fluorescein stain

dx?

A

Herpes simplex keratitis

tx:

immediate referral to an ophthalmologist

topical aciclovir

180
Q

causes of sudden painless loss in vision?

A

ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)

occlusion of central retinal vein

occlusion of central retinal artery

vitreous haemorrhage

retinal detachment

181
Q

tx of dry age related macular degeneration?

A

no treatment available, but vision aids can help reduce the effect on your life.

182
Q

lifestyle changes that can help to slow down progression of dry age related macular degeneration?

A

stop smoking

183
Q

mx of seasonal allergic conjunctivis?

A

1st line: topical antihistamines

Oral antihistamines may be used if there are other symptoms such as rhinosinusitis.

Topical mast cell stabilisers (e.g. sodium cromoglycate) may be used

184
Q

features of allergic conjunctivitis?

A

Bilateral symptoms conjunctival erythema, conjunctival swelling (chemosis)

Itch is prominent

the eyelids may also be swollen

May be history of atopy

May be seasonal (due to pollen) or perennial (due to dust mite, washing powder or other allergens)

185
Q

how often should someone get screened if +ve history for glaucoma?

A

People older than 40 years of age who have a first-degree relative (parent, sibling, or child) with open angle glaucoma should be examined annually

186
Q

xerophthalmia

what is it?

A

caused by vitamin A deficiency

pathologic dryness of the conjunctiva and cornea

can lead to corneal ulceration and ultimately to blindness as a result of corneal damage

tx w vit A

187
Q

keratomalacia

what is it?

A

results from vitamin A deficiency

ack of vitamin A leads to atrophic changes in the normal mucosal surface, with loss of goblet cells, and replacement of the normal epithelium by an inappropriate keratinized stratified squamous epithelium

  • > cornea becomes opaque
  • > blindness
188
Q

what is onchocerciasis?

A

infection with the parasitic worm Onchocerca volvulus

severe itching, bumps under the skin, and blindness.

Fly bites → microfilariae infection → invade the eye →

inflammation → fibrosis → corneal opacities and synechiae

189
Q

tx of onchocerciasis?

A

Ivermectin

190
Q
A

Retinitis Pigmentosa

characterised by triad of arteriolar attenuation, bone specule pigmentation and waxy optic disc pallor

191
Q

what type of eye drops are a risk factor for development of corneal ulcer?

A

steroid eye drops

reducing inflammation and thus the immune reaction to an infection, this leads the cornea at risk of infection from a bacteria, fungi or protists.

192
Q

risk factors for vitreous haemorrhage?

A

Diabetes

Trauma

Anticoagulants

Coagulation disorders

Severe short sightedness

193
Q

what alternative tx is used for pregnant women w infective conjunctivitis?

A

topical fusidic acid is an alternative and should be used for pregnant women. Treatment is twice daily

194
Q

most common causes of a sudden painless loss of vision?

A

ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)

occlusion of central retinal vein

occlusion of central retinal artery

vitreous haemorrhage

retinal detachment

195
Q

causes of papilloedema?

A

space-occupying lesion: neoplastic, vascular

malignant hypertension

idiopathic intracranial hypertension

hydrocephalus

hypercapnia

196
Q

features of papilloedema on fundoscopy?

A

venous engorgement: usually the first sign

loss of venous pulsation: although many normal patients do not have normal pulsation

blurring of the optic disc margin

elevation of optic disc

loss of the optic cup

Paton’s lines: concentric/radial retinal lines cascading from the optic disc

197
Q

what is Hutchinson’s sign?

A

rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement in herpes zoster ophthalmicus

198
Q

ix of age related macular degeneration?

A

slit-lamp microscopy: initial investigation of choice, to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD. Usually accompanied by colour fundus photography to provide a baseline against which changes can be identified over time.

fluorescein angiography: if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy. This may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation.

ocular coherence tomography: to visualise the retina in three dimensions, because it can reveal areas of disease which aren’t visible using microscopy alone.

199
Q
A

branched retinal vein occlusion

200
Q
A

central retinal vein occlusion

201
Q
A

central retinal artery occlusion

‘cherry red’ spot on a pale retina

202
Q

Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

A

retinal detachment

203
Q

mx of anterior uveitis?

A

urgent review by ophthalmology

cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate

steroid eye drops

204
Q
A

optic disc atrophy (pale) + increased cupping

Chronic glaucoma

205
Q

visual field defect of chronic glaucoma?

A

superior arcuate defect

206
Q

mx of central retinal artery occlusion?

A

rapid reduction in IOP by ocular massage, or surgical drainage of fluid from the eye by paracentesis, may dislodge an embolus from the central retinal artery into a smaller vessel -> restoration of vision

207
Q

Causes of central retinal artery occlusion?

A

GCA (Check ESR)

Thromboembolism: clot, infective, tumour

(check ECG, carotid doppler, echo for IE)

208
Q
A

Hyphaema

A hyphema is a pooling or collection of blood inside the anterior chamber of the eye

usually painful

usually caused by trauma to eye

at risk of precipitating secondary glaucoma (due to raised IOP)

209
Q

features of retinitis pigmentosa?

A

night blindness

peripheral blindness

family history +veee

210
Q
A

dendritic ulcer

HSV keratitis

211
Q
A

Hypopyon

  • pus deposition from leucocytes in the anterior chamber

tx with topical corticosteroids may reduce inflammation and prevent adhesion formation and visual loss

212
Q

what organism most commonly causes infection following ocular foreign bodies?

A

Staphylococcus

213
Q

What organism is most commonly the cause of infection in contact lens wearers?

A

pseudomonas

214
Q

what pH is most damaging to the eye?

A

alkali - high pH

can penetrate the surface of the eye and cause severe injury to both external structures such as the cornea and internal structures such as the lens

215
Q
A
216
Q

signs of cataracts?

A

A Defect in the red reflex

Slit lamp examination. Findings: visible cataract

217
Q

mx of infective conjunctivitis in pregnant woman?

A

topical fusidic acid

218
Q

what eye medication causes eyelashes to grow in length?

A

prostaglandin analogues

e.g latanoprost

219
Q

signs of chronic open angle glaucoma?

A

increased intraocular pressure

visual field defect

pathological cupping of the optic disc

220
Q

mx of primary open angle glaucoma?

A

1st line: prostaglandin analogue (latanoprost) eyedrop

2nd line: beta-blocker (e.g. timolol), carbonic anhydrase inhibitor (Dorzolamide), or sympathomimetic (e.g. brimonidine) eyedrop

if more advanced: surgery (trabeculectomy) or laser treatment can be tried

Surgery (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions