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MK SR INDEX CASES SPECIAL SENSES > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

OD vs OS

A

OD (oculus dexter) right eye
OS (oculus sinister) left eye
OU (oculus uterque) both eyes

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2
Q

Explain how to interpret snellen chart results

A

In this notation, the first number
represents the distance between the patient and the eye
chart (usually the Snellen eye chart); the second number
represents the distance at which the letters can be read by
a person with normal acuity. Visual acuity of 20 / 80 thus
indicates that the patient can recognize at 20 feet a symbol
that can be recognized by a person with normal acuity at
80 feet.

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3
Q

How should visual acuity be measured if visual acuity is 20/40 or less in one or both eyes?

A

repeat the test with the subject viewing the test chart
through a pinhole occluder and record these results. The
pinhole occluder may be used over the subject’s glasses.
If a patient cannot see the largest Snellen letters, proceed to reduce the distance

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4
Q

How is visual acuity tested if they are unable to see snellen chart from 3 or 1.5 m?

A
  • Reduce distance to chart
  • Count fingers
  • Hand movement
  • Light perception
  • No light perception (NLP)
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5
Q

Marcus Gunn pupil

A

afferent pupillary defect that can be detected with swinging torch test

affected eye has less response to light

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6
Q

What are normal vs abnormal response on swinging-torch pupil examination?

A

A normal response is initial
pupillary constriction followed by variable amounts of
redilation.

An abnormal response is slow dilation without
initial constriction. The relative afferent pupillary defect
almost always indicates a lesion in the optic nerve on the
affected side.

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7
Q

What is a normal optic cup size?

A

The size of the physiologic cup varies
among individuals. Normal cup:disc diameter ratio is .3 to .6

Larger C/D ratios may be a sign of glaucoma.

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8
Q

Steps in Eye Examination

A

· Measure the visual acuity for each eye.
· Test the pupils for direct and consensual responses.
· Test the extraocular movements.
· Inspect the lids and the surrounding tissues.
· Inspect in order : conjunctiva, sclera, cornea and iris.
· Assess the anterior chamber for depth and clarity.
· Assess the lens for clarity through direct
ophthalmoscopy
· Use the ophthalmoscope to study the fundus,
including the disc, vessels, and macula.
· Perform a confrontation field test for each eye.
· Perform tonometry when indicated.

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9
Q

Presentations where eye examination is essential

A
  • Headache
  • Signs of raised ICP
  • Malignant hypertension
  • Sudden visual loss
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10
Q

Important Nerves for eye examination

A
  • II- Optic
  • III- Oculomotor
  • IV- Trochlear
  • VI- Abducens
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11
Q

Assessing the OPTIC (CN II) function

A 
AFRO
• Acuity
• Fields
• Reaction
• ophthalmoscopy
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12
Q

Causes of Relative Afferent Pupillary Defect

A

optic neuritis

advanced glaucoma

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13
Q

Where is the lesion in a lower homonymous quadrantanopia?

A

lesion at left parental radiation

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14
Q

Where is the lesion in a upper homonymous quadrantanopia?

A

lesion at left temporal radiation

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15
Q

Causes of Eye movement disorders

A
  • Brainstem disorders
  • Cranial nerve palsies
  • Hypertension, diabetes
  • Intracranial aneurysm or cavernous sinus lesion
  • Myasthenia gravis
  • Muscle disease
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16
Q

Symptoms of eye movement disorders

A
  • Diplopia (III= complicated, IV= vertical, VI= horizontal)
  • Others
  • droopy eyelid, dilated pupil, neurological etc.
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17
Q

What is binocular vs monocular diplopia?

A

Binocular Diplopia: Goes when one eye closed. Caused by misalignment between two eyes

Monocular Diplopia: Often more than 2 images, Present when one eye open, Caused by disturbances in optical media.

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18
Q

Signs of third cranial nerve palsy

A
  • Signs- “Down and out”
  • Ptosis
  • Pupil- may be dilated/ “blown out”
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19
Q

Why would patient have dilated pupil in third nerve palsy?

A

parasympathetic fibres run along CN3

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20
Q

Why would patient have ptosis in third nerve palsy?

A

CN III supplies levator palpebrae

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21
Q

Causes of 4th CN nerve palsy

A

Very hard to pick up - Superior oblique isn’t working

  • Trauma - susceptible due to long passage through cranial vault
  • Congenital
  • Ischemic (diabetic)
  • SOL
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22
Q

presentation of 6th CN nerve palsy

A

Eye can’t abduct past the midline

23
Q

Causes of 6th CN nerve palsy

A 
Associated with:
• Cardiovascular
• Raised ICP
• Demyelination
• Vasculitis

Note: Abducens nerve runs up the floor of the skull to get to the cavernous sinus and into the orbit. When enters cavernous sinus, it makes an abrupt 90-degree bend. It is susceptible to high intracranial pressure

24
Q

How can you differentiations between myasthenia graves eye features and CN palsy?

A

Myasthenia gravis can mimic any nerve palsy

But NEVER effects pupil

25
Q

Hutchinson’s sign

A

Vesicles on the tip of the nose, or vesicles on the side of the nose, precedes the development of ophthalmic herpes zoster.[This occurs because the nasociliary branch of the trigeminal nerve innervates both the cornea and the lateral dorsum of the nose as well as the tip of the nose

26
Q

Holmes-Adie pupil

A
  • large and irregular
  • constriction to light is slow and incomplete
  • accomodation is relatively normal
  • once the pupil has constricted it remains small for an abnormally long time (tonic pupil)
27
Q

What is Holmes-Adie syndrome?

A

The Holmes-Adie syndrome is the association of a Holmes- Adie pupil with absent deep tendon jerks.
• Clinical features include:
• unilateral in 80% of cases
• dilated pupil in early stages
• decreased consensual and direct light reflex
• tonic pupil: pupil slowly constricts in bright light
• decreased accommodation reflex
• decreased tendon reflexes
• hypersensitivity to G pilocarpine solution (0.12%)
• patients are often young women

28
Q

Argyll Robertson Pupil

A

Signs of tertiary syphilis

Small, irregular, reacts to near stimulus only

  • The Argyll Robertson pupil is usually bilateral and characterised by:
  • small, irregular pupils
  • the size of the pupils may be unequal
  • absence of the light reflex
  • a prompt accomodation reflex
  • pupils slowly dilate with mydriatics
29
Q

Can patients have eye features of Graves’ disease but normal thyroid function tests?

A

• Eye and orbital changes usually in association with
hyperthroidism - Graves’ disease
• Patient may be clinically and biochemically euthyroid -
ophthalmic Graves’ disease

30
Q

Eye features of thyroid disease

A 
• Exophthalmos (proptosis)
• Grossly swollen extraocular muscles, esp. medial and inferior recti
• Lid retraction and lid lag
• May cause blindness
- Optic nerve damage
-  Corneal perforation
31
Q

Rheumatological conditions associated with dry eyes

A

Rheumatoid arthritis

Sjogren’s

32
Q

Rheumatological conditions associated with (epi)scleritis

A

Mainly RA

33
Q

Rheumatological conditions associated with Uveitis

A
  • Behçet
  • Sarcoidosis
  • JIA
34
Q

Rheumatological conditions associated with ophthalmic vascular occlusion

A

SLE

35
Q

Rheumatological conditions associated with Orbital disease

A

Granulomatosis with

polyangiitis

36
Q

What is Behçet’s Disease?

A
  • Idiopathic multisystem disorder
  • Occlusive vasculitis - eyes involved in 75%
  • Presents in the 3rd and 4th decades
Diagnosis: Oral ulceration with two of
• Recurrent genital ulceration
• Skin lesions - folliculitis, erythema nodosum
• Positive pathergy test
• Eye involvement
• Acute anterior uveitis
• Vitritis, vasculitis, retinitis
37
Q

Treatment for Behçet’s Disease?

A

systemic immunosuppression

38
Q

What is Hypopyon?

A

Hypopyon is a medical condition involving inflammatory cells in the anterior chamber of the eye. It is a leukocytic exudate, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera.

39
Q

Ophthalmic risks associated with Giant Cell Arteritis

A 
• Risk of blindness from
ischaemic optic neuropathy
• Risk of systemic involvement
including CVA
• Often preceding history of
amaurosis
40
Q

What is Blepharitis?

A 
• Ubiquitous seborroheic disorder
of the meibomian glands
• Causes mild ‘gritty’ sensation
• Treated with lid hygeine ± oral
tetracyclines
41
Q

Ophthalmic risks associated with Stevens Johnson Syndrome

A

pseudomembranous conjunctivitis, cicatrisation of the

conjunctiva and lids

42
Q

What is Herpes Zoster Ophthalmicus?

A

Shingles affecting CN V1

Multiple possible ocular
complications: 
• Keratitis
• Uveitis
• Glaucoma

Require ophthalmic examination

43
Q

What is Mucous Membrane Pemphigoid?

A
  • Rare, idiopathic, chronic progressive, females>males
  • Inflammation followed by scarring
Eye: 50-70% have eye involvement 
• Dry eye, symblepharon,
ankyloblepharon, keratopathy
• Treatment with topical and systemic steroids, immunosuppressants, contact
lenses, lid surgery
44
Q

Sturge-Weber Syndrome

A
  • Rare congenital disorder
  • Port-Wine Stain
  • Seizures
  • Mental Retardation
  • 50% have glaucoma
45
Q

Features that should raise suspicion of Chlamydial Conjunctivitis

A

• Conjunctivitis not improving
with treatment
• Pre-auricular lymphadenpathy

46
Q

Treatment for Chlamydial Conjunctivitis

A
  • Single dose azithromycin 1g

* Refer to GU

47
Q

Ophthalmic complication of corticosteroids

A

• Posterior subcapsular
cataract
• Secondary glaucoma

48
Q

Ophthalmic complication of (Hydroxy)Chloroquine

A

Maculopathy

49
Q

Ophthalmic complication of Desferrioxamine

A

Maculopathy

50
Q

Ophthalmic complication of tamoxifen

A

Maculopathy

51
Q

Ophthalmic complication of Quinine

A

Optic atrophy, arteriolar

narrowing

52
Q

Ophthalmic complication of Amiodarone

A

Corneal change

“Amiodarone Keratopathy”

53
Q

Ophthalmic complication of Vigabatrin

A

Visual field loss

MK SR INDEX CASES SPECIAL SENSES (17 decks)

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