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Phase 3B > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is the main bacterial cause of infective conjunctivitis?

A

Staph aureus
Staph epidermis
Chlamydia

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2
Q

What are the symptoms of conjunctivitis?

A

Red eye
Irritation/grittiness/discomfort
Sticky/purulent discharge

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3
Q

When should you refer a patient for conjunctivitis?

A

Lots of discharge
Neonatal patient
Refractory

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4
Q

What is the usual treatment for infective conjunctivitis?

A

Conservative treatment such as lid hygiene

Topical chloramphenicol

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5
Q

What is the treatment for allergic conjunctivitis?

A 
Topical antihistamine (antazoline)
Topical sodium cromoglycate
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6
Q

What is the difference between anterior and posterior uveitis?

A

Inflammation of the uveal tract, specifically the iris (anterior) or the choroid (posterior)

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7
Q

Which type of uveitis is more likely to be bilateral?

A

Posterior

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8
Q

What are two risk factors for uveitis?

A

Autoimmune disease

HLA-B27 positivity

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9
Q

What are four causes of uveitis?

A 
Intraocular lymphoma
Trauma
Sarcoidosis
Ischaemic
HSV
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10
Q

What are the main symptoms of anterior uveitis?

A

Painful red eye

Photophobia and diplopia

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11
Q

What are the main symptoms of posterior uveitis?

A

Gradual visual loss

Diplopia and floaters

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12
Q

Posterior uveitis is suggested by inflammatory cells where?

A

In the vitreous

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13
Q

Why is the aqueous hazy in anterior uveitis?

A

Inflamed vessels leak protein

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14
Q

If the retina appears yellow-white on examination, what does this suggest?

A

Retinitis, either in isolation or associated with uveitis

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15
Q

In uveitis, what happens to the optic disc, optic nerve, and IOP on examination?

A

Optic disc - oedema, cupping
Optic nerve - oedema
IOP - decreased as decreased production of aqueous

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16
Q

What is seen on slit lamp examination in uveitis?

A

Cornea - Keratic precipitates (KPs) - cluster of inflammatory cells
Ciliary flush
Cell and flare - hazy aqueous
Hypopyon

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17
Q

What is the management of a suspected uveitis patient?

A

Refer within 24h
Cyclopentolate 1%
Corticosteroids (topical/PO/IV depending on severity)

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18
Q

How does cyclopentolate 1% work?

A

It is a cycloplegic-mydriatic drug

Paralyses the ciliary body, relieves pain, and prevents adhesions

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19
Q

What drug is added if uveitis is persisting?

A

Ciclosporin

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20
Q

Name three complications of uveitis.

A

Secondary cataract
Cystoid macular oedema
Retinal detachment

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21
Q

What are the two types of episcleritis?

A

Simple (vascular congestion on an even surface)

Nodular (discrete elevated area of inflamed episclera)

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22
Q

What is the cause of episcleritis?

A

Idiopathic

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23
Q

What are the symptoms of episcleritis?

A

Mild pain/discomfort

Redness, watering, and mild photophobia

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24
Q

Is visual acuity normal in episcleritis?

A

Yes

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25
Q

How long does episcleritis last before spontaneously resolving?

A

7-10 days

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26
Q

What is the most common form of scleritis?

A

Anterior - 90%

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27
Q

Name six risk factors for scleritis.

A 
Rheumatoid arthritis
GPA/CTDs
Female
Ocular surgery
Local infections
Sarcoidosis
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28
Q

Describe the pain of scleritis.

A

Severe, boring
Radiates to forehead/brow/jaw
Worse with movement and at night

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29
Q

What are the other symptoms of scleritis?

A

Red eye
Gradual decrease in vision
Diplopia in posterior disease

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30
Q

What are the signs of scleritis?

A

Reduced visual acuity
Bluish tinge to sclera and tender globe
Scleral, episcleral, and conjunctival vessels all inflamed causing redness

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31
Q

What percentage of scleritis patients have a systemic vasculitis?

A

15%

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32
Q

What are the treatment steps for anterior, nodular, and posterior scleritis?

A

PO NSAIDs
PO prednisolone
Methotrexate/azathioprine

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33
Q

What is the main treatment difference for necrotizing scleritis?

A

Skip the oral NSAIDs and go straight to oral prednisolone

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34
Q

What are the complications of scleritis?

A

Raised IOP
Retinal detachment
Uveitis
Cataracts

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35
Q

What are the three causes of blepharitis?

A

Staphylococcal
Seborrhoeic
Meibomian

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36
Q

What is the cause of seborrheic blepharitis?

A

Reaction to malassezia furfur

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37
Q

What are two risk factors for blepharitis?

A

Keratoconjunctivitis sicca

Skin disease

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38
Q

What is the management of blepharitis?

A

Regular eyelid hygiene including warmth, massage, and cleansing
Artificial tears

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39
Q

What are three complications of blepharitis?

A

Chalazion
Stye
Conjunctivitis

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40
Q

What does the uveal tract consist of?

A

Iris, ciliary body, choroid

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41
Q

What is intermediate uveitis?

A

Inflammation of the vitreous, posterior ciliary body, and peripheral retina

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42
Q

What are some imaging techniques used to qualify eye inflammation?

A

Fundus fluorescein angiography

Optical coherence tomography

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43
Q

What is glaucoma?

A

Damage to the optic nerve head with progressive loss of retinal ganglion cells and their axons

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44
Q

What is glaucoma commonly associated with?

A

Raised intraocular pressure

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45
Q

Define raised IOP.

A

> 21mmHg on two consecutive occasions in the absence of any glaucomatous change

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46
Q

What is the end stage of glaucoma?

A

Absolute glaucoma

No vision, no pupillary reflex, eye has a stony appearance. Very painful

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47
Q

What part of the eye produces aqueous humour?

A

The ciliary body

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48
Q

What is the anterior chamber angle?

A

The junction of the iris and the cornea at the periphery of the anterior chamber

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49
Q

What is primary open angle glaucoma?

A

Chronic degenerative obstruction of aqueous flow through the trabecular meshwork.

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50
Q

What is closed angle glaucoma?

A

Acutely raised IOP with a physically obstructed iridocorneal angle

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51
Q

What causes pressure build up in closed angle glaucoma?

A

Aqueous humour cannot flow from the posterior to the anterior chamber. Rapid build up of fluid is painful

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52
Q

What are the symptoms of the early and late stages of glaucoma?

A

Early - peripheral visual fields affected

Late - foveal vision and acuity affected

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53
Q

What are six risk factors for glaucoma?

A 
Raised IOP particularly >26mmhg
Women - shallow anterior chambers
Eye trauma/uveitis/other eye conditions
Family history
Myopia
Steroids
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54
Q

What are the symptoms of closed angle glaucoma?

A

Suddenly painful red eye

Blurred vision rapidly progressing to visual loss

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55
Q

What are the extra symptoms of acute angle closure glaucoma (10%)?

A

Coloured halos around lights
Nausea and vomiting
Very severe pain

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56
Q

What are the symptoms of open angle glaucoma?

A

Asymptomatic

Peripheral visual loss

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57
Q

What investigation measures the iridocorneal angle to test whether the glaucoma is closed or open angle?

Which investigation measures intraocular pressure?

A

Gonioscopy

Tonometry

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58
Q

Examination of what in glaucoma is a direct marker of disease progression?

A

Optic disc

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59
Q

What suggests glaucoma when examining the optic disc?

A

Increased diameter of cup compared to overall disc size, with time

60
Q

What is seen on examination in CAG?

A

CAG - marked redness, hazy cornea, hard globe, non reactive dilated pupil, shallow anterior chambers, closed iridocorneal angles and corneal epithelial oedema

61
Q

What is the treatment of CAG?

A

Topical IOP lowering drug with IV acetazolamide

62
Q

What are the possible surgical options for CAG?

A

Peripheral iridotomy
Surgical iridectomy
Trabeculoplasty

63
Q

Name some IOP lowering drugs, used for both OAG and CAG.

A 
Topical BB: timolol
Topical PG analogue: Travaprost
Topical parasympathomimetics: pilocarpine
IV acetazolamide
IV mannitol
64
Q

What is the aim of OAG treatment with IOP lowering drugs?

A

Stall progression of glaucoma but not reverse it

65
Q

What are some second line treatment options in glaucoma?

A

Argon/selective laser trabeculoplasty

Trabeculectomy

66
Q

What are some causes of keratoconjunctivitis sicca?

A 
Sjogren's syndrome
Lacrimal gland insufficiency
Meibomian gland dysfunction (blepharitis, isotretinoin)
Reflex hyposecretion
Blink disorders e.g. Parkinsons
Lagophthalmos
67
Q

What are some causes of reflex hyposecretion in keratoconjunctivitis sicca?

A 
Contact lens wear
Diabetes
Corneal surgery
Anticholinergic medication
Antidepressants
68
Q

What are some risk factors for keratoconjunctivitis sicca?

A 
Vitamin A deficiency
Older age
Contact lenses
Preservatives in topical drops
Post menopausal oestrogen therapy
69
Q

What are the symptoms of keratoconjunctivitis sicca?

A

Gritty irritation and burning/mild pain aggravated by air con, prolonged reading, computer work.
Symptoms worse at end of the day

70
Q

What tests can confirm keratoconjunctivitis sicca?

A

Slit lamp examination
Schirmer’s test
Rose Bengal staining

71
Q

What are some complications of keratoconjunctivitis sicca?

A

Conjunctivitis
Keratitis
Corneal ulceration

72
Q

What is macular degeneration?

A

Ageing changes in the macula (centre of the retina) causing visual loss

73
Q

What are the two types of macular degeneration?

A

Wet - choroidal neovascularisation

Dry - atrophy and changes to pigmentation of retinal pigment epithelium (RPE)

74
Q

What are three risk factors for macular degeneration, apart from age?

A

Smoking
Family history
Prior history of AMD

75
Q

How does macular degeneration present?

A

Painless scotoma esp. for near vision
Reduced acuity and contrast sensitivity
Abnormal dark adaptation
Photopsia and light glare

76
Q

What tool is used to test visual acuity in macular degeneration?

A

Amsler grid

77
Q

What is seen on fundoscopy in macular degeneration?

A

Macular drusen and scarring
Dry - Changes in pigmentation to the RPE
Wet - intraretinal, subretinal, or sub RPE haemorrhages

78
Q

What is the cause of wet/neovascular AMD?

A

New blood vessels grow from the choriocapillaris and spread around the RPE. They are fragile and leak easily, causing disciform scarring

79
Q

Name three differentials, apart from AMD, for painless loss of vision.

A

Cataracts
Primary open angle glaucoma
Retinal detachment

80
Q

What drug class is used to prevent progression of wet AMD?

A

Anti-vascular endothelial growth factor (anti-VEGF)

Intraviteal injections

81
Q

How do anti-VEGFs work and give an example.

A

Decreases angiogenesis and vascular permeability

Ranibizumab

82
Q

What is the pathophysiology of strabismus?

A

Misalignment of the eyes resulting in the retinal image not being in corresponding areas of both eyes

83
Q

What does strabismus result in?

A

Adults - diplopia

Children - Amblyopia

84
Q

What prefixes are used in describing strabismus?

A

Eso - inward ocular deviation
Exo - outward ocular deviation
Hypo - downward deviation
Hyper - upward deviation

85
Q

What is the name of an inward-turning squint?

A

Esotropia

86
Q

Hypertropic/hypotropic squints are commonly due to what?

A

Superior oblique paresis

87
Q

What is the leading cause of strabismus in adults?

A

Stroke

88
Q

What are the symptoms of strabismus in adults?

A

Diplopia
Asthenopia
Pulling sensations

89
Q

How is strabismus investigated?

A

Bruckner and cover tests

Hirschburg’s test (corneal reflection test)

90
Q

How is strabismus treated in a patient less than 8 years old

A

Eye patching and cycloplegic drops

91
Q

What is blepharospasm?

A

A focal dystonia of the orbicularis oculi muscle resulting in an increased lid closure frequency

92
Q

What is the first line treatment of blepharospasm?

A

Botulinum toxin A into orbicularis oculi.

93
Q

What is the triad of features in optic neuritis?

A

Visual loss
Eye pain worse on movement
Dyschromatopsia especially red desaturation

94
Q

What is the most common cause of optic neuritis?

A

Multiple sclerosis

95
Q

What are some other causes of optic neuritis?

A

GCA
Sarcoidosis, SLE, Behcet’s
Post infection
Lyme disease

96
Q

What are the signs of optic neuritis?

A

Decreased pupillary light reflex
RAPD
Arcuate defects/scotoma/papillitis

97
Q

How is optic neuritis diagnosed?

A

Clinical diagnosis
Fundoscopy - pale optic disc
MRI - demyelinating plaque

98
Q

What is the treatment of optic neuritis?

A

1g methylprednisolone 3 days

99
Q

What features of optic neuritis suggest a cause other than MS?

A

Patient aged <12 or >50
Bilateral
Absent or extremely severe pain
Lack of RAPD

100
Q

What are risk factors for diabetic retinopathy?

A

Pregnancy
DM diagnosed before 30
HTN and other CV risk factors, renal disease

101
Q

How is diabetic retinopathy classified?

A

Non-proliferative (mild, mod, severe)

Proliferative (non high risk to high risk)

102
Q

What is seen on fundoscopy in diabetic retinopathy?

A

Microaneurysms
Hard exudates and cotton wool spots
Neovascularisation
Intra-retinal haemorrhages

103
Q

How does diabetic retinopathy present?

A

Painless reduction in central vision

Dark painless floaters (from haemorrhage)

104
Q

What is primary prevention of diabetic retinopathy?

A

Optimal glycaemic control (HbA1c<7%)

105
Q

A minority of patients with diabetic retinopathy undergo intervention such as…

A

Laser treatment
Intravitreal steroids
Vitrectomy

106
Q

What is the gold standard investigation for diabetic retinopathy?

A

Dilated retinal photography

107
Q

What is a cataract?

A

Lens opacity

108
Q

What are risk factors for cataracts?

A

Female, age, smoking, DM, systemic corticosteroids

109
Q

What are the symptoms of cataracts?

A

Depends on the size and location of the opacity
Gradual painless loss of
vision.
May have halos surrounding light sources

110
Q

What are the four types of cataract?

A

Nuclear sclerosis
Cortical
Posterior subcapsular
Paediatric

111
Q

What are the signs of cataracts?

A

Defects in the red reflex

Brown or white lens

112
Q

What is the surgical intervention of cataracts?

A

Lens extraction and replacement.

113
Q

What is retinal detachment?

A

The neurosensory layer of the retina separates from the underlying retinal pigment epithelium

114
Q

How are retinal detachments classified?

A

Rhegmatogenous

Non-rhegmatogenous (exudative/tractional)

115
Q

What are most RDs preceded by?

A

Posterior vitreous detachment which causes traction on the retina and a retinal tear

116
Q

What are risk factors for RD?

A 
Age
RD in the contralateral eye
Marfan syndrome
FH
Myopia
Previous eye injury/surgery/infection
117
Q

What is lattice degeneration?

A

The peripheral retina becomes thinned/atrophic in a lattice pattern, and is prone to breaks or tears which may further progress to RD.

118
Q

How does RD present?

A

New onset floaters
New onset photopsia
Painless sudden visual loss

119
Q

Name some things seen on examination in RD.

A

Tobacco dust
Visual field defects
RAPD
Billowing sensory retina, and the tear, on fundoscopy

120
Q

How is RD treated?

A

Cryotherapy/laser photocoagulation

121
Q

What is a hyphaema and how is it treated?

A

Blood in the anterior chamber

Evacuation

122
Q

How is eye trauma/foreign body managed?

A

Tetracaine 1% drops allow examination
Pad the unaffected eye to prevent damage from conjugate movement
X-Ray the orbit, not MRI, as foreign bodies may be magnetic
After removal: chloramphenicol 0.5% drops

123
Q

Apart from papilloedema, what are the causes of optic disc swelling?

A

Optic neuritis
GCA
Retinal vein occlusion

124
Q

What are the causes of papilloedema and raised ICP?

A

Tumour
Cerebral trauma, haemorrhage, infection, or inflammation
Idiopathic intracranial hypertension

125
Q

What is absent on examination if the optic disc is swollen?

A

Spontaneous venous pulsation

126
Q

What is usually an important investigation in a patient with papilloedema?

A

Urgent MRI with gadolinium enhancement

127
Q

Why does papilloedema suggest raised ICP?

A

The optic nerve sheath is continuous with the sub arachnoid space so increased ICP is transmitted to SA space surrounding the optic nerve

128
Q

What is seen on examination in papilloedema?

A

Blurred optic margins
Disc swelling
Venous engorgement
Paton’s lines - radial retinal lines

129
Q

What are the risk factors for primary open angle glaucoma?

A 
FH
Afro-Caribbean
Myopia
Hypertension
DM
Corticosteroids
130
Q

How can the red eye of glaucoma be distinguished from uveitis?

A

Glaucoma: severe pain, haloes, semi-dilated pupil, dull/hazy cornea from oedema

Uveitis: small, fixed oval pupil, ciliary flush, blurred vision and photophobia

131
Q

What is the triad of Horner’s syndrome?

A 
Partial ptosis (eyelid drooping)
Miosis (pupil constriction) leading to anisocoria
Hemifacial anhidrosis
132
Q

What are four causes of Horner’s syndrome?

A

Pancoast’s tumour
Stroke/MS
Herpes Zoster
Cluster headaches/migraine

133
Q

What are the key side effects of prostaglandin analogues used to treat glaucoma?

A

Increased eyelash length
Iris pigmentation
Periocular pigmentation

134
Q

What is the classification system for hypertensive retinopathy?

A

Keith-Wagener

135
Q

Describe the Keith Wagener system for hypertensive retinopathy.

A

1: silver wiring
2: arteriovenous nipping
3: Cotton wool exudates and flame haemorrhages
4: papilloedema

136
Q

Name four causes of tunnel vision.

A

Papilloedema
Glaucoma
Retinitis pigmentosa
Choroidoretinitis

137
Q

Which cranial nerves supply the extraocular muscles?

A

Oculomotor - MR, SR, IR, IO
Trochlear - SO
Abducens - LR

138
Q

What is a Holmes-Adie pupil?

A

Dilated pupil that shows delayed and incomplete constriction to light, but better response to accommodation

139
Q

What is Holmes-Adie syndrome?

A

Young females
Holmes-Adie pupil
Reduced deep tendon reflexes
Pilocarpine test

140
Q

What is retinitis pigmentosa?

A

Inherited condition presenting in young adulthood
Loss of rod photoreceptor cells
First symptoms: loss of night vision, loss of peripheral vision

141
Q

How can you differentiate viral conjunctivitis from other types?

A

Tarsal follicles

142
Q

What are the symptoms of keratitis?

A

Painful red eye
Purulent discharge if bacterial
Hypopyon - pus in anterior chamber
White opacity of corneal ulcer

143
Q

How can you differentiate corneal ulcers from corneal abrasions?

A

Ulcers - corneal oedema, blurred vision

Abrasions - normal vision, no oedema

144
Q

What is the only treatment of dry AMD?

A

Vitamin supplementation - C, E, beta-carotene, and zinc.

145
Q

How is retinal detachment with vitreous haemorrhage diagnosed?

A

USS B scan of the globe

146
Q

What is microbial keratitis and a risk factor?

A

Corneal ulcer

Steroid eye drops/contact lenses

Phase 3B (20 decks)

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