Ophthalmology Flashcards
Retinal features of retina pigmentosa
- Bone-spicule pigmentation - peripheral, follows veins, spares the macula
- Pale optic disc - optic atrophy secondary to neuronal loss
- Thin arterioles
Associated syndromes of retina pigmentosa
- Refsum’s disease - autosomal recessive inborn error of lipid metabolism: ataxia, deafness, nystagmus
- Usher’s disease - blindness + deafness
- Kearns-Sayre syndrome - mitochondrial disease: blindness, ophthalmolplegia, heart block (may have PPM)
Name 4 stages of diabetic retinopathy and findings of fundoscopy
- Background retinopathy: microaneurysms + hard exudates
- Pre-proliferative: cotton wool spots + haemorrhage
- Proliferative: new vessel formation
- Post laser photo coagulation
Indications for laser photocoagulation in diabetic retinopathy
- Maculopathy
2. Pre-proliferative + proliferative diabetic retinopathy
Hypertensive retinopathy - 4 stages with retinal features
- Stage 1: silver wiring
- Stage 2: AV nipping
- Stage 3: cotton wool spots + flame haemorrhage
- Stage 4: papillodema, macular star
Complications of proliferative diabetic retinopathy
- Vitreous haemorrhage
- Retinal detachment
- Neovascular glaucoma
4 causes of tunnel vision
- Papilloedema
- Glaucoma
- Choroidoretinitis
- Migraine
Optic atrophy - causes
Pressure - tumour, glaucoma, Pagets
Ataxia - Friedrich’s Ataxia
Leber’s - hereditary optic neuropathy
Dietary - B12 deficiency. Degernative - retinitis pigmentosa
Ischaemia - central retinal artery occulusion
Syphilis + other infections (CMV, Toxo)
Cynaide + other toxins (alcohol, lead, tobacco)
Sclerosis - MS
Optic atrophy - findings on fundoscopy
- Disc pallor
2. Relative afferent pupil defect
Retinal findings for Branch Retinal Vein Occlusion
- Engorged retinal veins
- Flame haemorrhages in only one quadrant
- Ghost vessel - white vessel - obliterated vein
Causes of flame haemorrhages in all 4 quadrants
- Central retinal vein occlusion
2. Grade 4 hypertensive retinopathy
Causes of loss of red reflex
- Cataracts
- Retinal detachment
- Retinoblastoma
Clinical features of age related macular degeneration
- Drusen - extracellular material
- Geographic atrophy
- Fibrosis
- Neovascularisation
Cataracts - associated diseases
- Congenital Rubella
- Turners syndrome
- Old age
- Chronic steroid use
- Diabetes
- Myotonic dystrophy (bilateral ptosis)
Cause of small pupil
- Loss of sympathetic innervation
- Horner’s Syndrome - Argyll Robertson pupil
Features of Horner’s Syndrome
P - Ptosis - levator palpebrae is partially supplied by sympathetic fibres
E - enophthalmos
A - anhydrosis
S - small pupil (miosis)
Causes of Horner’s Syndrome
- Central cause
- MS - Wallenberg’s syndrome (lateral medullary syndrome) - SOL - synringomyelia - Pre-ganglionic
- Thyroid cancer - Pancoast’s tumour - Trauma to neck - Thoracic aortic aneurysm - Post ganglionic
- cluster headache - carotid artery dissection/aneurysm - cavernous sinus thrombosis - middle ear infection
3rd nerve palsy - occulomotor
- clinical features
- Ptosis
- Dilated pupil (if surgical 3rd nerve palsy)
- Ophthalmoplegia - “down and out”
3rd nerve palsy - causes
- medical
- surgical
Medical M - mononeuritis multiplex e.g. diabetes M - midbrain infarction e.g. Weber's M - midbrain demyelination e.g. MS M - migraine
Surgical
C - communicating artery aneursym
C - carvernous sinus pathology - thrombosis/tumour/fistula
C - cerebral uncus herniation
Causes of loss of visual accommodation
- Congenital - rare
- Isolated accommodation insufficiency - Presbyopia
- Associated with primary ocular disease - uveitis (viral induced), metastases to suprachoroidal space damaged ciliary plexus, trauma to globe,
- Associated with Neuromuscular Disorders - myasthenia gravis, botulism, myotonic dystrophy
- Associated with neurological disorders - midbrain lesions, encephalitis, hydrocephalus, Wilson’s disease.
- Associated with systemic disorders - diabetes, diphtheria,
Causes of central scotoma
- Damage to optic nerve (PALEDISCS)
- Demyelination - MS (retrobulbar neuritis) - Damage to retina
- HTN
- toxins: ethambutol, quinine, methyl alcohol
- Abx: streptomycin - Bilateral scotoma - bitemporal heminaopia due to pituitary tumour
- Pre-eclampsia
