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4th Year SB > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

what causes dendritic ulcers

A

HSV

- causes a corneal ulcer

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2
Q

Sx and Ix for dendritic ulcer

A

Sx
- photophobia and eye watering

Ix
- Fluorscein drops stain

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3
Q

Tx for dendritic ulcer

A

Acyclovir

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4
Q

how does orbital cellulitis present

A

Often children with painful inflammation of the orbit, fever, lid swelling and decreased eye movements

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5
Q

what are the common causative organisms of orbital cellulitis and how does it spread

A

Common bugs : Staphs, Strep pyogenes/pneumonia

Spread by paranasal sinus infection, eyelid infection

Risk of extension to meninges and cavernous sinus

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6
Q

Ix and Mx of orbital cellulitis

A

Ix = CT

Mx = IV antibiotics

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7
Q

what is ophthalmic shingles and how does it present

A

Ophthalmic branch of the trigeminal nerve

Sx

  • Pain and neuralgia in V1 dermatome
  • purulent conjunctivitis
  • visual loss
  • episcleritis/scleritis
  • CN palsy
  • optic atrophy
  • blistering rash
  • Corneal signs and iritis
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8
Q

what is Hutchinson’s sign

A

Involvement of nose tip
- means involvement of nasociliary branch of trigeminal nerve which supplies the globe therefore eye is likely to be affected.

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9
Q

Mx of ophthalmic shingles

A

Oral Acyclovir

- start within 4 days of onset

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10
Q

DDx for acute red eye

A

conjunctivitis
keratitis
anterior uveitis
acute glaucoma

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11
Q

how does conjunctivitis present

A

diffuse injection
gritty pain
often bilateral
normal vision, pupil size and iOP

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12
Q

how does keratitis present

A 
diffuse injection
gritty pain
photophobia
reduced vision
normal pupil and IOP
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13
Q

how does AU present

A 
circumcorneal injection (red eye)
pain 
photophobia
reduced vision
constricted pupil in affected eye
normal or raised IOP
proptosis
ciliary flush

HLA B27 associations – Psoriatic Arthritis, ank spon, IBD, sarcoidosis, TB

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14
Q

how does acute glaucoma present

A 
diffuse injection
unilateral
severe pain and nausea etc
mild photophobia
reduced vision
fixed mid dilated pupil
raised IOP
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15
Q

what is classic triad of anterior uveitis

A

redness
pain
photophobia

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16
Q

Tx of AU

A

topical steroid e.g. dexamethasone

dilating the pupil e.g. cyclopentolate

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17
Q

what is used to treat raised IOP

A

Beta blockers
Lantoprost
Acetazolamide

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18
Q

what is a hypopyon

A

pus in the anterior chamber

19
Q

summary of episcleritis

A

Relatively common / no serious associations

Association with gout

Recurrent

Nodules may occur

Self limiting

20
Q

what is scleritis associated with

A

systemic vasculitis

  • Rheumatoid arthritis
  • Wegner’s
21
Q

Sx of scleritis

A

painful
“violet-blue” hue

Phenylephrine test – redness improves in episcleritis

22
Q

Tx of scleritis

A

Oral NSAIDs
Oral Steroids
Steroid Sparing Agents

23
Q

Sx of angle closure glaucoma

A

Sudden onset of red painful eye with blurred vision.

Associated nausea, vomiting, headache.

Circumcorneal injection

Cornea cloudy (oedematous)

FIXED AND MID DILATED IS KEY TERM

24
Q

Tx of angle closure glaucoma

A

IV acetazolamide to reduce IOP

Pilocarpine to constrict pupil and improve aqueous outflow.

Beta blockers and prostaglandin analogues

25
Q

how does CRVO present

A

Sudden painless loss of vision

Can have afferent papillary defect-suggesting ischemia.

26
Q

what are risk factors CRVO

A 
increasing age
hypertension and CVS disease
diabetes
glaucoma
vasculitis
27
Q

how does CRVO look on fundoscopy

A

retinal haemorrhage
cotton wool spots
dilated veins
leakage of fluid from vessels giving retinval oedema.

28
Q

Tx for CRVO

A

Tx for underlying cause

Pan retinal photocoagulation if neovascularisation occurs.

anti VEGF and intravitreal steroids can be also used

29
Q

how does CRAO present

A

Sudden painless severe loss of vision or amaurosis fugax.

An afferent papillary defect is usually present

30
Q

how does CRAO look on fundoscopy

A

cherry red spot is seen at the fovea

31
Q

Tx for CRAO

A

Ocular massage and iv azetaolamide to reduce ocular pressure needed.

Breathing into paper bag builds up CO2 which acts as a vasodilator to help dislodge emboli.

Start on oral aspirin if not contraindicated

Corneal paracenthesis to drain off aqueous humour and decrease pressure

32
Q

how does retinal detachment present

A

Painless, progressive visual field loss. Shadow corresponds to area of detached retina.

Floaters
Sudden flashes of light

33
Q

how does a 3rd nerve palsy present

A

Ptosis
proptosis
fixed pupil dilation
eye is “down and out”

34
Q

how does a 4th nerve palsy present

A

diplopia
patient may hold head tilted (ocular torticollis)

Eye looks upwards, and cannot look down and inwards (superior oblique paralysed)

35
Q

how does a 6th nerve palsy present

A

diplopia in the horizontal plane

36
Q

A 35-year-old man presents with right eye pain which is worse on movement. Examination reveals a relative afferent pupillary defect. Which one of the following is the most likely cause of his problems?

  • MG
  • MND
  • GBS
  • MS
A

MS

37
Q

eye features of MS

A

unilateral decrease in visual acuity over hours or days

poor discrimination of colours, ‘red desaturation’

pain worse on eye movement

relative afferent pupillary defect

central scotoma

38
Q

mx of optic neuritis

A

high-dose steroids

recovery usually takes 4-6 weeks

39
Q

A 75-year-old woman presents to surgery complaining of ‘blurry’ vision in her right eye for the past few months. She also notes that straight lines appear crooked or wavy. This only seem to affect the centre of her right visual field and no problems are noted with the left eye. She has never worn glasses or contact lens. On examination a central scotoma is noted in the right eye.

Which is the SINGLE most likely diagnosis?

A

Age related macular degeneration
- Macular degeneration is associated with central field loss

[Primary open-angle glaucoma is associated with peripheral field loss]

40
Q

A 72-year-old woman presents with a vesicular rash around her left eye. The left eye is red and there is a degree of photophobia. A presumptive diagnosis of herpes zoster ophthalmicus is made and an urgent referral to ophthalmology is made. What treatment is she most likely to be given?

A

Oral Aciclovir

- for 7-10 days, ideally started within 72 hours

41
Q

A 50-year-old man presents with red-eye associated with slight watering and mild photophobia. He reports no pain or tenderness and vision is not affected. Diagnosis?

A

Episcleritis

- red eye classically not painful

42
Q

A 71-year-old man presents with severe pain around his right eye and vomiting. On examination the right eye is red and decreased visual acuity is noted. Which one of the following options is the most appropriate initial management?

A

Refer to hospital

Admit immediately

43
Q

A 6-year-old boy presents to his GP with a swollen right eye. It started when he was playing outside in the garden. His mother is worried because he is struggling to read the writing in his books. He has no past medical history, and this has never happened before. On examination, the right eye lid is erythematous and warm, and the eye appears to be protruding. Eye movements are restricted in all planes. The left eye appears normal. His temperature is 37.9ºC and his heart rate 120 beats/minute. What is the most likely diagnosis?

A

Orbital cellulitis

- differentiated from preorbital cellulitis by presence of: reduced visual acuity, proptosis and pain with eye movements

4th Year SB (22 decks)

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