Ophthalmology Flashcards
risk factors for cataracts
ageing, smoking, diabetes, alcohol, trauma, steroid use
presentation of cataracts
reduced acuity and colour vision
glare and halos of light
absent red reflex
investigations in cataracts
ophthalmoscopy - normal
slit lamp - can see cataracts
HbA1C / BMs / OGTT
risk factors for macular degeneration
age, female, smoking, FHx, CVD risk factors
presentation of macular degeneration
reduced acuity and night vision, fluctuating
most common form of macular degeneration
dry - atrophy and drusen
describe wet macular degeneration
neovascular degeneration and exudate cause drusen to detach and scar retina irreversibly
less common than dry
management of magular degenration
anti VEGF injections and AREDS2 supplementation
risk factors for chronic glaucoma
age, FHx, diabetes, black, myopia, HTN, steroids
presentation of chronic glaucoma
progressive field loss
tunnel vision
what does fundoscopy show in chronic glaucoma
disc cupping
optic disc pallor
bayonetting of the vessels
RAPD
management of chronic glaucoma
topical prostaglandins (latanoprost) and beta blockers (timolol) laser
causes of acute angle closure glaucoma
tumours, marfans, trauma, retinopathy, ischaemia
presentation of acute angle closure glaucoma
mydriasis (fixed dilated pupil) nausea and vomiting headache pain redness
what would you see on slit lamp experiment in AACG
shallow anterior chamber; and signs of glaucoma: large optic cup, narrowing of the neuroretinal rim, splinter haemorrhage, nerve fibre loss
hazy cornea - oedema
iris atrophy
management of AACG
carbonic anhydrase i - topical acetazolamide topical beta blockers - timolol topical pilocarpine - pupil constriction IV mannitol surgery
when do you do diabetic retinopathy screening?
every 2 years, or annual if +ve
what are the 4 stages of diabetic retinopathy
- mild nonproliferative : microaneurysms
- moderate nonproliferative : microaneurysms, dot and blot hemorrhages, cotton wool spots, venous bleeding
- severe non proliferative: many hemorrhages and
cotton wool spots - proliferative: new vessels on the disc
what are the 4 stages of hypertensive retinopathy
- narrow and tortuous arterioles
- elschnig’s spots - choroidal capillary infarction, AV nipping
- cotton wool spots, flame and blot hemorrhages
- papilloedema
a patients pupils constrict when looking at your finger near their nose (accommodation reflex normal)
when you shine a light in the pupils they fail to constrict (absent pupillary reflex)
what is this?
argyll robertson pupil
neurosyphilis, diabetes
explain the Relative afferent pupillary defect
when light is swung from one eye to another the opposite pupil should constrict
in RAPD:
both pupils equal in room light
affected eye constricts when light shone in (normal)
when light shone to other eye both constrict (normal)
when light again shone on affected eye the pupil appears to dilate
what causes RAPD
optic nerve damage
severe retinal disease
what may cause mydriasis
(dilated pupil)
congenital, 3rd nerve palsy, trauma, AACG, anticholinergics, amphetamines
what may cause miosis
(constricted pupil) horners syndrome cholinergics opiods anterior uveitis argyll - robertson pupil
how does horner’s syndrome present and what are the causes
miosis, ptosis, anhidrosis
stroke, MS, tumour (lung - pancoast’s), encephalitis, trauma, carotid dissection/aneurysm
what do you see in a third nerve palsy
eye is down and out (abducted and infraducted)
diplopia
how does 4th nerve palsy present + what muscle
superior oblique muscle
vertical diplopia
difficulty going down stairs
how does a 6th nerve palsy present and what mucle
lateral rectus
horizontal diplopia
convergent squint (adduction)
investigations in HSV keratitis
fluorescein stain - dendritic ulcer
reduced corneal sensation
what do you see on slit lamp examination in anterior uveitis
hypopyon, keratotic precipitates, miosed irregular pupil, rubeosis of sclera, non reactive pupil
what may cause anterior uveitis
ank spond, SLE infection IBD sarcoid MS
causes, investigations and presentation of retinal detachment
trauma, macular degen, diabetes, myopia, vitreous haemorrhage
grey area on retina
central scotoma/loss of vision, flashes of light, floaters
what do you see on fundoscopy in central retinal artery occlusion
cherry red spot and white retina
causes and treatment of periorbital cellulitis
staph aureus / strep pyogenes from sinuses
oral co-amox
causes and treatment of orbital cellulitis
strep and HIB spread from ethmoid sinus
IV Abx
how do you tell the differenece between scleritis and episcleritis?
in scleritis phenylephrine wont reduce the redness
what causes scleritis
RA, SLE
ophthalmoscopy findings in central retinal vein occlusion and diagnosis
flame hemorrhages, optic disc swelling, cotton wool spots, tortuous veins
fluorescein angiography
what is retinitis pigmentosa and what do you see on opthalmoscopy
genetic - degeneration of the retina
bony spicules, optic atrophy, attenuated vessels
what eye problem do people with HIV get
CMV retinitis
