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Finals Studying - Condensed > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

sclera

A

white of the eye

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2
Q

conjunctiva

A

covers sclera

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3
Q

cornea

A

covers the iris

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4
Q

where is the lens

A

sits behind the iris

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5
Q

role of the lens

A

helps to refract light and focus it on the retina

changes shape to alter the focus distance (accommodation)

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6
Q

how is lens attached

A

attached to the ciliary body via suspensory ligaments

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7
Q

what composes outer layer of eye

A

sclera

cornea

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8
Q

what composes middle layer of eye (uvea)

A

iris
ciliary body
choroid

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9
Q

what composes inner layer of eye (retina)

A

macula
fovea
optic disc

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10
Q

roles of the ciliary body

A

control iris
shape the lens
secrete aqueous humour

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11
Q

circulation of aqueous humour

A

produced by ciliary body
circulates in posterior chamber (of anterior segment) and nourishes the lens
travels through pupil into anterior chamber (of anterior segment) and nourishes cornea
Absorbed at iridocorneal angle through trabecular meshwork at the canal of schlemm

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12
Q

anterior segment of the eye

A

in front of the lens
split into anterior chamber and posterior chamber

anterior chamber
- between cornea and iris

posterior chamber
- between the iris and suspensory ligaments

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13
Q

posterior segment of the eye

A

behind the lens

- contains the vitreous body (vitreous humour)

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14
Q

where is the blind spot

A

the optic disc

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15
Q

mneumonic to rememeber eye muscle innervation

A

LR6 SO4 AO3

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16
Q

topical Abx

A

chloramphenicol

ofloxacin

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17
Q

s/e of topical steroids for eyes

A

local

  • cataracts
  • glaucoma

systemic

  • weight gain
  • diabetes
  • thinning skin
  • gastric ulceration
  • osteoporosis
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18
Q

List drug classes used in glaucoma Tx

A 
prostaglandins 
beta blockers 
carbonic anhydrase inhibitors 
sympathomimetics 
parasympathomimetics
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19
Q

mechanism of topical prostaglandins

A

increase uveoscleral outflow

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20
Q

examples of prostaglandins

A

latanoprost

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21
Q

s/e of prostaglandins

A

increase eyelash length
segmental iris colour change
dehydrates periorbital fat

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22
Q

mechanism of beta blockers

A

decrease aqueous humour production

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23
Q

examples of beta blockers

A

timolol

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24
Q

s/e of beta blockers

A

systemic absorption

tiredness

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25
Q

mechanism of carbonic anhdrase inhibtors

A

decrease aqueous humour production

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26
Q

examples of carbonic anhydrase inhibitors

A

dorzolamide

acetozolamide

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27
Q

s/e of carbonic anhydrase inhibitors

A

short term use only - kidney damage

acetozolamide is oral and has systemic effects

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28
Q

examples of sympathomimetics

A

adrenaline

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29
Q

s/e of sympathomimetics

A

pupil dilation

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30
Q

mechanism of parasympathomimetics

A

increase uveoscleral outflow

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31
Q

examples of parasympathomimetics

A

pilocarpine

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32
Q

s/e of parasympathomimetics

A

pupil constriction

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33
Q

most common cause of endophthalmitis

A

post-cataract surgery

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34
Q

causative organism endophthalmitis

A

s. epidermidis

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35
Q

risk factors for AACG

A

hypermetropia (long-sightedness)

pupil dilation

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36
Q

presentation AACG

A 
red eye
n+v
pain ++ 
fixed mid dilated pupil
photophobia 
reduced visual acuity 
systemically unwell
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37
Q

characteristic visual field testing in AACG

A

arching

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38
Q

Mx AACG

A 
IV Diamox (Acetozolamide) 
Mannitol 
Pilocarpine when IOP <50mmHg (constricts pupil)
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39
Q

causes of scleritis

A

connective tissue diseases - always investigate further

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40
Q

Mx scleritis

A

topical NSAIDs

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41
Q

violaceous hue

A

scleritis

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42
Q

cause of orbital cellulitis

A

extension from sinuses

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43
Q

preorbital cellulitis

A

little pain on eye movements
no reduced eye movements
no reduced visual acuity

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44
Q

Mx orbital cellulitis

A

IV Abx - ceftriaxone, fluclox + met

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45
Q

associations with episcleritis

A

gout

tiredness

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46
Q

Mx episcleritis

A

self-limiting - can give lubricants

give NSAIDS if not resolving

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47
Q

presentation anterior uveitis

A 
red eye 
pain ++ 
photophobia 
hypoyon 
keratitic precipitates 
posterior synechiae
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48
Q

Mx anterior uveitis

A 
Topical steroids (hrly, reduce gradually) + 
Mydriatics - tropicamide or cyclopentolate (dilates pupil and prevents posterior synechiae)
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49
Q

presentation bacterial keratitis

A 
red eye 
pain ++ 
reduced visual acuity 
photophobia 
purulent discharge 
white corneal opacity seen with naked eye
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50
Q

Ix bacterial keratitis

A

corneal scrape form gram stain and culture

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51
Q

Mx bacterial keratitis

A

Topical Abx - ofloxacin

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52
Q

linear branching dendritic ulcer

A

herpes simplex corneal ulcer/keratitis

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53
Q

presentation adenoviral keratitis

A

bilateral

follows URTI

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54
Q

organism usually causing fungal keratitis

A

aspergillus

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55
Q

who gets fungal keratitis

A

farmers or gardeners

Hx of trauma from vegetation

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56
Q

organism causing protozoal keratitis

A

acanthomoeba

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57
Q

who gets protozoal keratitis

A

contact lens wearers

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58
Q

most common cause of viral conjunctivitis

A

adenovirus

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59
Q

Mx viral conjunctivitis

A

self-limitng +/- aciclovir if needed

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60
Q

Mx bacterial conjunctivitis

A

mild - mod: erythromycin

mod -sev: ofloxacin

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61
Q

Mx gonorrhoeal conjunctivitis

A

ceftriaxone + doxycycline

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62
Q

Mx chlamydial conjunctivitis

A

topical azithromycin and doxycycline

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63
Q

Mx allergic conjunctivitis

A

mild: cold compresses
mod: mast cell stabiliser + antihistamines
severe: + corticosteroid

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64
Q

seborrhoeic anterior blepharitis

A

++ dandruff
teepee sign
lashes themselves are unaffected

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65
Q

squamous anterior blepharitis

A

lashes affected - distorted

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66
Q

posterior blepharitis

A

inflammation of the meibomian glands

tarsal glands swollen and outpouching

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67
Q

risk factors for subconjunctival haemorrhage

A

blood thinners
elderly
truama
HTN

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68
Q

most common cause of vitreous haemorrhage

A

diabetic retinopathy

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69
Q

presentation vitreous haemorrhage

A

sudden painless unilateral loss of vision
red hue to vision
floaters/dark spots in vision

70
Q

Mx vitreous haemorrhage

A

usually spontaneously resorbs

if dense - vitrectomy

71
Q

Ix if retina cant be seen on ophthalmoscope e.g. due to bleed

A

b-scan ultrasound

72
Q

causes of retinal detachment

A

primary - traction (ageing process - vitreous gel becomes more liquid)

secondary - trauma, post-inflammatory, CTDs, myopia

73
Q

presentation retinal detachment

A 
the 4 F's 
floaters
flashes
field loss 
fall in acuity

dense shadow that starts peripherally and progresses towards central vision

central vision lost if macula affected

74
Q

Mx retinal tear

A

laser

75
Q

Mx retinal detachment

A

external approach - scleral buckle

internal approach - vitrectomy

76
Q

presentation CRAO

A

sudden painless loss of vision (counting fingers)
pale oedematous retina with cherry red spot
RAPD

77
Q

Ix CRAO

A

need to rule out GCA - do ESR, CRP
fluorescein angiography
carotid artery imaging

78
Q

Mx CRAO

A

prognosis v poor - aim is to dislodge the clot

ocular massage
IV acetozolamide
paper bag breathing

anterior chamber paracentesis

79
Q

curtain coming down

A

amaurosis fugax

80
Q

what is amaurosis fugax

A

transient CRAO

81
Q

Mx amaurosis fugax

A

immediate referral !

82
Q

presentation CRVO

A

sudden painless loss of vision
dark retina
RAPD
swollen disc

+/- neovascularisation
+/- macular oedema

83
Q

Mx CRVO

A

no ischaemia - observe 3m
ischaemia - observe 4-6w
ischaemia + neovascularisation - panretinal photocoagulation

84
Q

Ix CRVO

A

fluorescein angiography

optical coherance tomography (OCT)

85
Q

risk factors for cataracts

A

down’s syndrome
long term steroid use
hypocalcaemia
diabetes

86
Q

sub types of cataract

A

nuclear sclerotic
posterior subcapsular
cortical
mature

87
Q

Mx cataracts

A

phaecoemulsification with intraocular lens implantation

88
Q

what is given post op cataracts

A

steroids and chloramphenicol 4xday for 4w

89
Q

complications post-op cataracts

A

retinal detachment
endophthalmitis
posterior capsule rupture
posterior capsule opacification

90
Q

what is the characteristic finding of ARMD

A

drusen - calcium deposits due to axonal degeneration

91
Q

major risk factor for ARMD

A

smoking

92
Q

dry type ARMD

A

geographic atrophy of the macula

93
Q

wet type ARMD

A

neovascularisation of the macula - eye grows new vessels to repair the damage from dry type

94
Q

presentation dry type ARMD

A

gradual central vision loss

absent opic cup and abnormal branching patterns

95
Q

Mx dry type ARMD

A

supportive - vision aids
stop smoking
blind registration

96
Q

presentation wet type ARMD

A

sudden central vision loss

97
Q

Mx wet type ARMD

A

anti-VGEF (ranibizumab) - prevents new vessel growth

98
Q

what is open angle glaucoma

A

optic neuropathy and visual field loss due to clogging up of trabecular meshwork which blocks the drainage of aqueous humour

99
Q

presentation open angle glaucoma

A

no symp till late - screened for by optometrists
increase cup to disc ratio (>0.4) - caused by loss of nerve fibres
peripheral vision loss
+/- raised IOP

100
Q

Mx open angle glaucoma

A 
prostaglandins
beta blockers 
carbonic anhydrase inhibitors 
sympathomimetics 
parsympathomimetics

surgery - trabeculectomy

101
Q

optic nerve lesion - visual field defect

A

unilateral field loss

102
Q

causes of an optic nerve lesion

A

ischaemic optic neuropathy (arteritic or non-arteritic)

optic neuritis

103
Q

optic chiasm lesion - visual field defect

A

bitemporal hemianopia

104
Q

optic tract lesion - visual field defect

A

homonymous hemianopia

105
Q

parietal optic radiation lesion - visual field defect

A

contralateral inferior quadrantanopia

106
Q

temporal optic radiation lesion - visual field defect

A

contralateral superior quadrantanopia

107
Q

visual cortex lesion - visual field defect

A

homonymous hemianopia with macular sparing

108
Q

presentation of RAPD

A

when light is shone in eye - it dilates because there is a problem with the optic nerve communicating to the brain

109
Q

what is horners syndrome

A

lesion in the sympathetic pathway

110
Q

causes of horners syndrome

A

pancoast tumour
carotid/aortic aneurysms
congenital

111
Q

presentation of congenital horners syndrome

A

will have diff coloured eyes

112
Q

presentation horners syndrome

A

pupil constriction
ptosis
reduced ipsilateral sweating

113
Q

holmes adie pupil

A

dilated

114
Q

argyll robertson pupil

A

constricted pupil - associated with neurosyphilis

115
Q

internuclear ophthalmoplegia

A

affected eye has impaired adduction

116
Q

cause of internuclear ophthalmoplegia

A

issue with medial longitudinal fascia

117
Q

presentation of internuclear ophthalmoplegia

A

(say R eye is affected)

fine on looking to the right side - eye can abduct fine
when looking to the left - right eye wont be able to, and left eye will have nystagmus

118
Q

presentation CN III palsy

A

dilated pupil

down and out

119
Q

painful third nerve palsy

A

aneurysm

120
Q

presentation CN IV palsy

A

eye floats upwards

excylotorsion (head tils)

121
Q

cause of CN VI palsy

A

increased ICP (pressed against petrous bone)

122
Q

presentation CN VI palsy

A

convergent squint of affected eye

123
Q

tropia

A

= manifest squint

124
Q

phoria

A

= latent squint

125
Q

esotropia/esophoria

A

eye is IN

you see OUTWARD movement at cover test

126
Q

exotropia/exophoria

A

eye is OUT

you see INWARD movement at cover test

127
Q

hypertropia/hyperphoria

A

eye is HIGHER

128
Q

hypotropia/hypophoria

A

eye is LOWER

129
Q

duanes retraction syndrome

A

hypoplastic IVth nerve

limited abduction and global retraction

130
Q

browns syndrome

A

problem with SO, eye is elevated more than it should be

131
Q

MX adult squint

A

non-surgical: temporary prisms, botox injection to temporarily paralse EOM

surgical: EOM surgery

132
Q

amblyopia

A

lazy eye

impairment of vision without any clinically detectable abnormality of the eye or visual pathway

133
Q

classification of amblyopia

A

ametropic
strabismic
anisometropic
stimulus deprivation

134
Q

cause of an ametropic amblyopia

A

bilateral uncorrected refractive error

135
Q

cause of a strabismic amblyopia

A

the squinting eye is being suppressed

136
Q

cause of an anisometropic amblyopia

A

an unequal refractive error

137
Q

cause of a stimulus deprivation amblyopia

A

congenital cataract or ptosis

138
Q

Mx of amblyopia

A

occlusion therapy:
partial - patch for max 6h/d
total - atropine 1% into good eye

139
Q

what is the problem in myopic people

A

short sighted

eye is too big so light focusses in front of the retina

140
Q

type of lens needed for myopia

A

concave - takes power away from the eye so light focusses on the retina

141
Q

what is the problem in hypermetropic people

A

long sighted

eye is too small so light focusses behind the retina

142
Q

type of lens needed for hypermetropia

A

convex - adds power to the eye so light focusses on the retina

143
Q

astigmatism

A

light doesnt focus evenly on the retina

144
Q

presbyopia

A

natural degeneration in the lens that occurs with age

145
Q

type of lens needed for presbyopia

A

convex - add power to eye

146
Q

signs of diabetic retinopathy/maculopathy

A

microaneurysms
dot/blot haemorrhages
cotton wool spots
hard exudates

147
Q

cause of cotton wool spots

A

swelling of nerve axons that appear fluffy and white against the retina

148
Q

cause of hard exudates

A

yellow deposits on the retina due to plasma leakage from capillaries

149
Q

stages of non-proliferative diabetic retinopathy

A

mild, moderate, severe

150
Q

mild non-proliferative diabetic retinopathy

A

only microaneurysms present

at least one dot haemorrhage

151
Q

moderate non-proliferative diabetic retinopathy

A

4 or more haemorrhages, but not in all 4 quadrants

152
Q

severe non-proliferative diabetic retinopathy

A

implies a “busy fundus”

large amounts of haemorrhage and microaneurysm formation in all 4 quadrants

153
Q

what characterises proliferative diabetic retinopathy

A

new vessel formation (VGEF)

154
Q

Mx diabetic retinopathy

A

no retinopathy - screen 12m

mild non-proliferative - screen 12m

mod non-proliferative - screen 6m

severe non-proliferative - refer to ophthal

proliferative - urgent refer to ophthal

155
Q

Mx proliferative diabetic retinopathy

A

retinal laser photocoagulation

156
Q

grading of diabetic maculopathy

A

based on the location of the changes with respect to the fovea

  1. no maculopathy
  2. observable maculopathy - exudates between 1 and 2 disc diameters from the fovea
  3. referrable maculopathy - exudates < 1 disc diameter from the fovea
157
Q

Mx observable maculopathy

A

resecreen 6m

158
Q

Mx referable maculopathy

A

laser photocoagulation

159
Q

stage I hypertensive retinopathy

A

silver or copper wiring

160
Q

stage II hypertensive retinopathy

A

arteriovenous nipping

161
Q

stage III hypertensive retinopathy

A

cotton wool exudates

flame and blot haemorrhages

162
Q

stage IV hypertensive retinopathy

A

papilloedema

163
Q

test to see how far back into eye a penetrating trauma goes

A

siedels test - fluorescein will be diluted as it leaks back through to the front of the eye

164
Q

Mx corneal abrasion

A

chloramphenicol - as preventative to bacteria

usually take 24-48h to heal

165
Q

sympathetic ophthalmia

A

a bilateral granulomatous uveitis due to trauma to one eye, thought to be autoimmune

166
Q

Mx sympathetic ophthalmia

A

steroids and mydriatics

167
Q

causes of alteration in colour of red reflex

A

aymmetrical camera shot

retinoblastoma

168
Q

cause of opactiy of red reflex

A

cataract

169
Q

causes of no/black red reflex

A

retinoblastoma

retinal detachment

170
Q

Mx retinoblastoma

A

enucleation

171
Q

Mx blocked nasolacrimal duct in kids

A

bathe and massage sac

most spontaneously resolve

172
Q

Mx preorbital cellulitis

A

IV co-amoxiclav

Finals Studying - Condensed (22 decks)

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