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Phase 3B > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are some common colour changes that may be seen in the eyes due to pathology?

A
  • Red: bleeding or inflammation
  • Blue: indicates thinning of the sclera (RA and osteogenesis imperfecta)
  • Yellow: jaundice
  • Brown/black: pigmentation
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2
Q

What are the main ‘red flag’ features or a red eye?

A
  • Impaired vision
  • Pain/photophobia
  • Lack of ocular discharge (if discharge present, more likely to be infection ie conjunctivitis)
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3
Q

What kind of ocular pathology causes rapid onset visual loss?

A
  • Vascular eg Central retinal vein occlusion

- Inflammatory ie GCA

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4
Q

What kind of ocular pathologies cause slow onset loss of vision?

A

-Degenerative causes ie age related macular degeneration

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5
Q

What is acute angle closure glaucoma?

A
  • Rare but serious cause of red eye
  • Associated with raised intra-ocular pressure
  • Normal: 10-21mmHG
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6
Q

What are the risk factors for acute angle closure glaucoma?

A

-Hypermetropia (long sightedness)
-Increase in age
-Pupillary dilatation
>is sat in a dark room watching a movie when the pain starts

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7
Q

What are the symptoms of acute angle closure glaucoma?

A
  • Severe pain (eye pain or headache)
  • Decrease in visual acuity
  • Worse with dilated pupil
  • Red eye
  • Haloes around lights
  • Systemic upset ie nausea and vomiting
  • Photophobia
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8
Q

What are the signs of acute angle closure glaucoma?

A
  • Red eye
  • Semi-dilated, non reacting pupil
  • Corneal oedema: dull/hazy cornea
  • Poor visual acuity
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9
Q

What type of visual loss dose acute glaucoma cause?

A

-Primarily causes visual loss by peripheral visual field deficit

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10
Q

How is acute angle closure glaucoma investigated?

A 
-Slit lamp examination.
>Shows large cup and nerve fibre loss
-Gonioscopy
-Automated perimetry (allows assessment of visual field)
-Meaure intraocular pressure
-Visual field loss on assessment
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11
Q

How is acute glaucoma managed?

A

-Urgent referral to ophthalmology
1. Lower the pressure
>topical carbonic anhydrase inhibitors (dorzolamide) or topical beta blockers
>+oral/iv acetazolamide
2. Constrict the pupil
>Pilocaprine drops (topical cholinergic agonist)
3. Prevent recurrence
>laser +/- surgery

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12
Q

What is chronic glaucoma/primary open angle glaucoma?

A
  • Optic neuropathy associated with raised intra-ocular pressure
  • Prevalence increases with age
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13
Q

What are the risk factors for chronic open angle glaucoma?

A
  • Increasing age
  • Family history
  • Myopia (short sightedness)
  • Hypertension
  • DM
  • Afro-caribbean origin
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14
Q

What are the features of chronic glaucoma?

A

-Triad of:
>raised IOP
>Abnormal disc
>visual field defect

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15
Q

What are the symptoms of chronic glaucoma?

A

-Insidious onset
-Often asymptomatic
-Routine finding
-Peripheral visual field loss
>nasal scotoma leading to tunnel vision
-Decreased visual acuity

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16
Q

How is chronic glaucoma investigated?

A
  • Fundoscopy
  • Automated perimetry (assess visual fields)
  • Slit lamp examination
  • Applanation tonometry
  • Central corneal thickness measurement
  • Gonioscopy
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17
Q

What are the signs of chronic glaucoma on fundoscopy?

A
  • Optic disc cupping
  • Optic disc pallor: optic atrophy
  • Bayonetting of vessels
  • Cup notching
  • Disc haemorrhage
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18
Q

How is chronic glaucoma treated?

A

-Eye drops
>prostaglandin analogue eyedrops ie lantoprost
-2nd line:
>beta blocker or carbonic anhydrase inhibitor or sympthomimetic eyedrops
-If more advanced: surgery or laser treatment
-Regular reassessment to exclude progression and VF loss

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19
Q

What is age related macular degeneration?

A
  • Most common cause of blindness in the UK
  • Degeneration of the central retina (macula)
  • Bilateral changes
  • Females>males
  • Disease of age >70
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20
Q

What are risk factors for ARMD?

A
  • Increasing age
  • Smoking
  • Family history
  • Hypertension
  • Dyslipidaemia
  • DM
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21
Q

What are the symptoms of ARMD?

A
  • Visual loss (subacute onset)
  • Decrease in visual acuity (near field )
  • Decrease in night time/dark vision
  • Fluctuating visual disturbance (varies from day to day)
  • Photopsia (flickering/flashing lights, glare around objects)
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22
Q

What is dry ARMD?

A
  • Earlier disease
  • most cases are dry
  • General atrophy
  • Presence of drusen
  • Alterations to the reintal pigment epitherlium
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23
Q

What are drusen in regards to ARMD?

A
  • Yellow round spons in the Bruch’s membrane

- Sign of dry ARMD

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24
Q

What is wet ARMD?

A
  • Worse prognosis
  • Later disease
  • Exudative with neovascularisation
  • Characterised by choroidal neovascularisation
  • Leakage of serous fluid and blood can result in rapid loss of vision
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25
Q

What are the signs of macular degeneration?

A

-Distortion of line perception
-Drusen on fundoscopy (dry) and may later form a macular scar
-Wet: well demarcated red patches
(intra/subretinal leakage or haemorrhage)

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26
Q

What investigations need to be done for ARMD?

A
  • Slit lamp microscopy with colour fundus photography
  • Fluorescein angiography (to look for neovascularisation)
  • Optical coherence tomography
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27
Q

How is ARMD treated?

A

-Vitamins ‘ACE to Z’ (a,c,e and zinc)
-Antivascular endothelial growth factor for wet ARMD
>ranibizumab (slows progression of neovascularisation)
-Blind registration and visual aids

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28
Q

What are cataracts?

A
  • Common condition = lens gradually opacifies and becomes cloudy)
  • Decreased visual acuity and blurred vision
  • Leading cause of blindness worldwide
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29
Q

What are the causes of cataracts?

A
  • Most common cause: normal ageing
  • Smoking
  • Alcohol
  • DM
  • Trauma
  • Steroids
  • Radiation
  • Metbolic disorders
  • Congenital ie TORCH infections
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30
Q

How does the type/classification of cataract relate to its cause?

A
  • Nuclear: old age
  • Polar: inherited
  • Subscapular: steroid use
  • Dot opacities: common in normal lenses, seen in diabetics and myotonic dystrophy
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31
Q

What are the symptoms of cataracts?

A
  • Gradual onset
  • Decrease in vision
  • Faded colour vision
  • Glare
  • Haloes around lights
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32
Q

What is the hallmark sign of cataracts which can be elicited on examination?

A

-Defect in/loss of red reflex

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33
Q

What investigations need to be done for cataracts?

A

-Ophthalmoscopy on dilated pupil
>need to see normal fundus and normal optic nerve
-Slit lamp examination

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34
Q

How are cataracts managed?

A

-Conservative management initially
>stronger glasses
>encourage use of brighter lights
-Surgery
>definitive treatment - removes cloudy lens and replaces with artificial one
>referral for: visual impairment, impact on QoL, pt choice

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35
Q

What are some possible complications of cataract surgery?

A
  • Posterior capsule opacification (thickening of lens capsule)
  • Retinal detachment
  • Posterior capsule rutpture
  • Endophthalmitis (inflammation of the aqueous and or vitreous humour)
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36
Q

What is vitreous detachment?

A
  • Precedes retinal detachment.
  • Vitreous shrinks with age and can sometimes pull away causing bleeds or retinal detachment
  • Causes flashes and floaters
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37
Q

What is retinal detachment?

A
  • Acute sudden painless loss of vision
  • Holes/tears in the retina allow fluid to separate the sensory retina from the retinal pigmented epithelium
  • Visual defect location depends on which part of the retina has detached
  • A retinal tear needs fixing before detachment occurs
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38
Q

What are some risk factors/causes of retinal detachment?

A
  • Myopia (short-sightedness)
  • Cataract surgery
  • Diabetes
  • Hypertension
  • Trauma
  • Vasculitis
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39
Q

How does retinal detachment present? Think about the 4Fs..

A
  1. Flashes
  2. Floaters
  3. Fall in acuity
  4. Field loss
    - Painless loss of acuity - like a curtain falling down
    - Complain of seeing ‘spider webs’
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40
Q

What investigations are done for retinal detachment?

A
  • B-scan USS
  • Ophthalmoscopy
  • Slit lamp examination
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41
Q

What would the investigations for retinal detachment show?

A
  • Grey, opalescent retina which balloons forwards

- ‘Peeling away’ of retina, tears may be visible

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42
Q

How is retinal detachment managed?

A

-Urgent ophthalmology referral
-Rest
-Positioned according to location of detachment
>superior detachment: lie flat
>inferior detachment: sit at 30* with head up
-Laser therapy
-Urgent surgery

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43
Q

What is a vitreous haemorrhage?

A
  • Bleeding into areas around the vitreous humour

- Causes sudden painless loss of vision

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44
Q

What are the risk factors/causes of vitreous haemorrhage?

A

-Anything which can cause neovascularisation or bleeding risk
>Diabetes
>Bleeding disorders
>Retinal tear/detachment
>Trauma
>Central retinal vein occlusion which has neovascularised
>Wet ARMD

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45
Q

What are the symptoms of vitreous haemorrhages?

A
  • Small bleed: floaters, dark spots

- Large bleed: obscured, complete loss of vision

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46
Q

What are the signs of vitreous haemorrhage on examination?

A
  • Absent red reflex

- Retina not visible

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47
Q

What investigations should be done for vitreous haemorrhage?

A
  • Fundoscopy
  • B scan USS
  • Eye examination > decreased visual acuity
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48
Q

How is a vitreous haemorrhage managed?

A
  • Usually spontaneously resorbs

- If dense/severe: vitrectomy to remove the blood

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49
Q

What is a central retinal artery occlusion?

A
  • Considered a form of stroke
  • Dramatic visual loss within seconds of occlusion
  • acuity limited to finger counting or worse
  • Less common than CRVO
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50
Q

What are the causes/risk factors of CRAO?

A
  • Thromboembolic/vascular disease
  • Arteritis
  • AF
  • Heart valve disease
  • Diabetes
  • Smoking
  • Hyperlipidaemia
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51
Q

What are the features of CRAO?

A

-Sudden painless loss of vision

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52
Q

What are the signs of CRAO?

A
  • Relative afferent pupillary defect: MARCUS-GUNN pupil

- Fundoscopic signs: white retina, cheery red spot at macular

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53
Q

How is CRAO managed?

A
  • Treat as stroke
  • Immediate CT head
  • Exclude GCA (using ESR)
  • Intraocular hypotensives (acetazolamide)
  • Decrease IOP by ocular massage
  • Address cv risk factors to reduce recurrence
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54
Q

What is central retinal vein occlusion?

A

-Sudden painless LOV

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55
Q

What are the risk factors/causes of CRVO?

A
  • Glaucoma
  • Polycythaemia
  • Hypertension
  • DM
  • Increasing age
  • Vascular disease
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56
Q

What are the symptoms of CRVO?

A
  • Sudden painless loss of vision

- Severe drop in acuity

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57
Q

What are the signs of CRVO on fundoscopy?

A
  • Cotton wool spots
  • Swollen optic nerve
  • Macular oedema
  • Severe retinal haemorrhage
  • cheese and tomato pizza appearance
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58
Q

How is CRVO managed?

A
  • Ophthalmology
  • Intra-vitreal anti-vgef therapy
  • Dexamethasone implants
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59
Q

What are some complications of CRVO?

A
  • Neovascularisation

- Chronic macular oedema

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60
Q

What is optic neuritis?

A

-Inflammation of the optic nerve

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61
Q

What are the causes of optic neuritis?

A
  • MS
  • Syphillis
  • Diabetes
  • Leber’s optic atrophy (hereditary form of visual loss)
  • Vitamin deficiency
62
Q

What are the symptoms of optic neuritis?

A
  • Unilateral subacute loss of vision
  • Pain on eye movement
  • Dyschromatopsia (poor colour vision discrimination)
63
Q

What are the signs of optic neuritis?

A
  • Marcuss-Gunn pupil (RAPD - seen on swinging light test)
  • Central scotoma (areas of depressed vision)
  • Decrease in visual acuity on eye examination
64
Q

How is optic neuritis managed?

A

-High dose steroids
>Iv methylprednisiolone for 72 hours
-MRI if ?MS

65
Q

What is retinitis pigmentosa?

A
  • Inherited degeneration of the retina
  • Usually affects males
  • Inherited AD, AR, X linked
66
Q

Which gene is mutated in retinitis pigmentosa?

A

-Retinitis pigmentosa GTPase regulator gene (RPGR)

67
Q

What are the feautres of retinitis pigmentosa?

A
  • Night blindness (usually one of the first symptoms)
  • Tunnel vision (due to loss of peripheral retina)
  • Central daytime visual loss follows
  • Eventual blindness
  • Family hx
68
Q

Which diseases are assocated with retinitis pigmentosa?

A
  • Usher syndrome (affects hearing and vision)

- Alport syndrome (kidney disease, hearing loss, eye abnormalities)

69
Q

What are the signs of retinitis pigmentosa on fundoscopy?

A
  • Black bone spicule shaped pigmentation in peripheral retina
  • Mottling of retinal pigment epitherlium
  • Decrease acuity on examination
70
Q

How can retinitis pigmentosa be treated?

A
  • Visual aids and blind registration
  • Electrical stimulation of retinal ganglion cells
  • Neural prosthetics
71
Q

What is diabetic retinopathy?

A
  • Painless, gradual decrease in central vision

- Associated with vitreous haemorrhage

72
Q

Why does diabetes cause retinopathy?

A
  • Hyperglycaemia causes increase in retinal blood flow which damages the endothelial cells
  • Endothelial dysfunction = increased vascular permeability (visual exudates on fundoscopy)
  • Microaneurysms and neovascularisation occurs later
73
Q

How can diabetic retinopathy be classified?

A
  • Background (non-sight threatening)
  • Pre-proliferative
  • Proliferative
74
Q

What are the features of ‘background’ diabetic retinopathy?

A
  • Dots, blots and spots
    1. Microaneurysms (dots)
    2. Blot haemorrhages (<3)
    3. Hard exudates
75
Q

Features of pre-proliferative Diabetic retinopathy?

A
  • Cotton wool spots
  • > 3 blot haemorrhages
  • Venous beading/looping
  • Deep/dark cluster haemorrhages
  • More common in T1DM
76
Q

What are the features of proliferative diabetic retinopathy?

A
  • Retinal neovascularisation
  • Fibrous tissue forming anterior to the retinal disc
  • More common in T1DM
  • 50% blind in 5 years
77
Q

What are the risk factors for diabetic retinopathy?

A
  • Early/long term diagnosis
  • Hypertension
  • Renal disease with proteinuria
  • Pregnancy
  • Minority ethnic groups
78
Q

How is diabetic retinopathy diagnosed?

A

-Dilated retinal photography with accompanying ophthalmoscopy

79
Q

How is diabetic retinopathy treated?

A
  • Good glycaemic control
  • Laser treatment
  • Intravitreal steroids
  • Anti-VEGF (vascular endothelial growth factor)
80
Q

What are the complications of diabetic retinopathy?

A 
-Visual loss due to:
>macular oedema
>macular ischaemia
>vitreous haemorrhage
>retinal detachment
81
Q

What is diabetic maculopathy?

A
  • Hard exudates and other background changes on the macula

- More common in T2Dm

82
Q

What is the management for diabetic maculopathy?

A
  • Check visual acuity

- Treat with laser therapy

83
Q

What is hypertensive retinopathy?

A

-Eye disease/damage from hypertension

>occurs from chronic, poorly controlled hypertension or malignant hypertension

84
Q

What may cause accelerated hypertensive retinopathy?

A
  • Exacerbation of essential HTN
  • Intrinsic renal disease
  • Renal artery stenosis
  • Pheochromocytoma
  • Cushing’s and Conn’s
85
Q

What are the features of hypertensive retinopathy?

A
  • Microinfarcts
  • Heightened light reflex on the artery (silver wiring)
  • arteriovenous nipping
  • Flame haemorrhages
  • Exudates
  • Papilloedema
  • Neovascularisation
86
Q

What are the Keith-Wagener classification stages of hypertensive retinopathy?

A
  • Stage 1: arteriolar narrowing + tortuosity and increased light reflex
  • Stage 2: arteriovenous nipping
  • Stage 3: spots, dots, blots (cotton wool spots, exudates, flame and blot haemorrhages)
  • Stage 4: papilloedema
87
Q

What are some other causes of poor vision in hypertension?

A
  • Acute optic nerve damage
  • Macular oedema
  • Retinal artery closure/occlusion
  • Choroidal ischaemia
88
Q

How is hypertensive retinopathy managed?

A
  • Control hypertension
  • Manage stroke risk
  • Regular eye checks for hypertensive pts
89
Q

What are the features of subconjunctival haemorrhage?

A
  • Sudden onset
  • Bright red blood (stays bright red as Hb gets oxygenated from the atmosphere)
  • Distinct border
  • Blood spreads freely around the whole globe
90
Q

What are the causes of subconjunctival haemorrhage?

A
  • Trauma to the eye
  • Heavy bouts of coughing
  • Contact lenses
  • Hypertension
  • Bleeding disorders
  • DM
  • CHD/vascular disease
  • medications: warfarin, aspiring, NSAIDs, steroids
  • Spontaneously in the elderly
91
Q

How is subconjunctival haemorrhage managed?

A

-Conservative management

>unless episode of trauma: look for oribital/ocular injury

92
Q

What is anterior uveitis?

A
  • AKA Irisitis
  • Important differential of red eye
  • Painful red eye with decreased visual acuity
93
Q

Which conditions is anterior uveitis associated wtih?

A

-Seronegative arthropathies (HLA B27)
>ank spond. psoriatic arthirits, enteropathic arthritis, IBD
-Granulomatous disease
>Sarcoidosis, syphillis
-Bechet’s disease
>mouth and genital ulcers, skin rashes etc

94
Q

What are the symptoms of anterior uveitis?

A
  • Acute painful red eye
  • Unilateral
  • Photophobia
  • Blurred vision (acuity can be impaired)
  • Lacrimation
95
Q

What are the signs of anterior uveitis?

A
  • Intense redness of the globe
  • Normal/decreased acuity
  • Irregular smal pupil
  • Hypopyon
  • Ciliary flush
96
Q

What is a hypopyon?

A

-Pus and inflammatory cells in the outer chamber of the eye (looks like white dots) and a visible fluid level

97
Q

What is ciliary flush?

A

-A ring of red and pruple spreading outwards from the cornea

98
Q

How is anterior uveitis managed?

A

-Dilate the eye to relieve the pain and photophobia with atropine
-Urgent ophthalmology
>steroid drops

99
Q

What is episcleritis?

A

-Common benign unilateral or bilateral inflammation of the episclera (layer between the conjunctiva and the connective tissue layer that forms the white of the eye)

100
Q

What are the features of episcleritis?

A
  • Mild irritation of the eye
  • Localised redness
  • watery, mild photophobia
  • No loss of vision or discharge
101
Q

How is episcleritis managed?

A

-Conservative
>NSAIDs if painful
-Eyedrops/artificial tears ease irritation

102
Q

How do you clinically differentiate between scleritis and episcleritis as a cause of red eye

A

-Scleritis is PAINFUL
-Use of phenylephrine drops
>blanches the conjunctival and episcleral vessels but not the scleral vessel
>episcleritis eye redness improves with phenylephrine

103
Q

What is scleritis?

A
  • Rare and serious condition

- Associated with systemic vasculitis and connective tissue disease

104
Q

Which conditions is sceritis associated with?

A

-RA
>may have blue sclera
-Vasculitis

105
Q

What are the features of scleritis?

A
  • Very painful red eye
  • Loss of vision
  • watering
  • Photophobia
106
Q

How is scleritis managed?

A
  • Oral NSAIDs
  • Oral prednisolone
  • Cyclophosphamide or other immune suppressants to tackle the cause
107
Q

Complications of scleritis?

A
  • Scleral thinning
  • Ischaemia of the anterior segment of the globe
  • Raised intraocular pressure
  • Retinal detachment
  • Uveitis
  • Cataract
  • Phthisis (globe atrophy)
108
Q

What is keratitis?

A

-Infection/inflammation of the conrea

109
Q

What is the most common cause of viral keratitis?

A

-Herpes simplex virus

110
Q

How does HSV keratitis tend to present?

A
  • ‘Dendritic shape’ corneal ulcer

* buzzword

111
Q

What are the symptoms of HSV keratitis?

A
  • Red, painful eye
  • Photophobia
  • Epiphora (excessive watering of the eye)
  • Decreased visual acuity
  • Foreign body sensation
112
Q

Investigations for HSV keratitis?

A

-Flourescin staining to look for a dendritic ulcer

113
Q

How is HSV keratitis managed?

A

-Urgent referral to ophthalmology
-Topical acyclovir
-AVOID steroids
>causes enlargement of the dendritic ulcer

114
Q

What is bacterial keratitis?

A
  • Bacterial infection of the cornea

- Rare and serious

115
Q

What are the features of bacterial keratitis?

A 
-Symptoms:
>Painful red eye
>loss of vision
-Signs:
>hazy cornea with central abscess
116
Q

How is bacterial keratitis managed?

A
  • Urgent referral

- intense abx

117
Q

What is a corneal abrasion?

A

-Any defect of the corneal epithelium
-Commonly caused by trauma
>finger nail
>branches
>dust

118
Q

What are the features of conreal abrasion?

A
  • Pain
  • Photophobia
  • Foreign body sensation
  • Decreased acuity
  • Conjunctival injection
119
Q

How is corneal abrasion investigated for?

A
  • Flourescin staining and slit lamp examination

- Yellow stained abrasion will show up

120
Q

How is corneal abrasion managed?

A

-Topical antibiotics to prevent bacterial superinfection

eg chloramphenicol

121
Q

What is a corneal ulcer?

A

-Epithelial defect in the cornea with underlying inflammation/infection

122
Q

What are the causes/risk factors of corneal ulcers?

A
  • Most common in contact lens wearers
  • Infection with bacteria, fungi, viruses, acanthamoeba
  • Can be initiated by mechanical trauma or nutritional deficiencies
123
Q

What are the features of a corneal ulcer?

A
  • Eye pain
  • Photophobia
  • Watery eye
124
Q

Investigations for corneal ulcer?

A

-Focal fluorescin staining

125
Q

How do you manage a corneal ulcer?

A
  • Stop contact lenses for 1 week
  • Cool compress
  • good hygiene
  • Topical abx: chloramphenicol
126
Q

What is conjunctivitis?

A

-Inflammation of the conjunctiva

127
Q

What are the 3 main causes of conjunctivitis?

A
  1. viral
  2. bacterial
  3. allergic

-reactive arthritis and history of chlamydia or campylobacter also need to be discussed

128
Q

What are the general features of conjunctivitis?

A
  • Sore red eyes

- Sticky discharge

129
Q

What are the features of bacterial conjunctivitis?

A
  • Purulent discharge
  • Eyes can be stuck together in the morning
  • Starts in one eye and then spreads to the other
130
Q

What are the common causative organisms for bacterial conjunctivitis?

A
  • Staph
  • Strep
  • Haemophillus
  • Neisseria
  • Chlamydia
131
Q

How is bacterial conjunctivitis treated?

A
  • Self limiting in 1-2 weeks
  • Hygiene advice about lenses, towel sharing etc
  • Topical abx: chloramphenicol
132
Q

What abx should be used for conjunctivitis if pt is pregnant?

A

-Topical fusidic acid

133
Q

What are the features of viral conjunctivitis?

A
  • Serous discharge
  • Recent URTI
  • Re-auricular lymphadenopathy
134
Q

What is the most common cause of viral conjunctiviits?

A

-Adenovirus

135
Q

How is viral conjunctivitis managed?

A
  • Conservative management

- Oral analgesia and artificial eye drops for symptomatic relief

136
Q

What ar ethe features of allergic conjunctivitis?

A
  • Often seen in the context of hayfever
  • Bilateral symptoms
  • Conjunctival erythema and swelling (chemosis)
  • History of atopy
  • Swollen eye lids
  • may be seasonal
  • Sticky mucous discharge
  • large papillae
137
Q

How is allergic conjunctivitis treated?

A
  • Topical/systmic antihistamines

- 2nd line: topical mast cell stabilisers (sodium cromoglicate, nedocromil)

138
Q

What is non-arteritis ischaemic neuropathy?

A
  • Ageing process associated with poor blood supply to the optic nerve
  • Swollen optic disc
  • Painless loss of vision
  • Needs to be excluded from GCA
  • No raised inflammatory markers
139
Q

What are the complications of non-arteritis ischaemic neuropathy?

A
  • Diplopia

- Emboli can lodge in the retinal artery and cause CRAO

140
Q

How is non-arteritic ischaemic neuropathy managed?

A

-High dose steroids to protect the eye

>IV methylpred for 3/7 then oral

141
Q

What are the features of Horner’s syndrome?

A
  1. Miosis (constricted pupil)
  2. Ptosis
  3. Anhidrosis
  4. Enophthalmos (eye retracts backwards into the head)
142
Q

What are the causes of Horner’s syndrome?

A
  • Pancoast lung tumour
  • Carotid artery dissection
  • Stroke
  • MS
  • Brain tumour
  • Encephalitis
143
Q

How is horner’s syndrome managed?

A

-Treat underlying cause

144
Q

What are they types of eye disease associated with RA?

A
  • Scleritis
  • Episcleritis
  • Secondary Sjogren’s with sicca complex (dry eyes)
145
Q

What is papilloedema?

A

-Optic disc swelling

146
Q

What are the causes of papilloedema?

A
  • SOL (Neoplastic, vascular, abscess)
  • Malignant hypertension
  • IIH
  • Hydrocephalus
  • Hydrocephalus
  • Hypercapnia
147
Q

What are the features of papilloedema on fundoscopy?

A
  • Venous enlargement
  • Loss of venous pulsation
  • Blurring of optic disc margin
  • Elevation of optic disc
  • Loss of optic cup
  • Paton’s lines (concentric/radial retinal lines cascading from the optic disc)
148
Q

What are the causes of tunnel vision?

A
  • Papilloedema
  • Glaucoma
  • Retinitis pigmentosa
  • Choridoretinitis
  • Optic atrophy
149
Q

What is optic atrophy?

A
  • Pale optic disc on fundoscopy
  • Well demarcated
  • Usually bilateral
  • Causes gradual vision loss
150
Q

What are some acquired causes of optic atrophy?

A

-MS
-Papilloedema
-Raised ICP
-Retinal damage ie retinitis pigmentosa
-Ischaemia
-Vit deficiencies:
B1, B2, B6, B12

151
Q

What are some congenital causes of optic atrophy?

A
  • Fredrich’s ataxia

- Leber’s optic atrophy

Phase 3B (14 decks)

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