Ophthalmology Flashcards
Uveitis S+S + management
Unilateral burning, red eye
Blurred vision + photophobia
Treat with prednisolone + ciclosporin
Cyclopentolate to paralyse ciliary body
Scleritis S+S + management
Pain worse with movement
Watering + photophobia
Treat with NSAIDs and prednisolone
Optic neuritis S+S + management
Swollen optic nerve
Periocular pain, gradual vision loss
Treat with methylprednisolone
Corneal ulcer S+S + management
White hazy mark on cornea
Pain + redness
Treat with acyclovir
Open angle glaucoma S+S, fundoscopy + management
Cupping and pallor of optic disc
Slow onset painless peripheral visual field loss
Raised IOP
Treat with prostaglandin analogs (pilocarpine)
Angle closure glaucoma S+S + management
Sudden severe eye pain, blurred vision, haloes, fixed mid-dilated pupil
Redness + N+V
Treat with timolol, prednisolone, pilocarpine + acetazolamide (IV)
Conjunctivitis S+S + management
Pain, burning, redness
Itching + discharge
Treat with chloramphenicol
Horners S+S + pathology
Sympathetic nerve interruption from hypothalamus to orbit
Ptosis
Miosis
Bloodshot conjunctiva
Retinitis pigmentosa S+S + management
Reduced night vision
Loss of mid peripheral visual field
Photophobia
Myopia
Fundoscopy = peripheral pigment deposits
Treat with Vit A and acetazolamide
Detached retina S+S
Floaters, flashes of light
Painless visual field loss
Risk: myopia
Macula degeneration S+S + how to diagnose
Central vision loss
Use Amsler grid to diagnose
Wet = haemorrhages + scarring
Diabetic retinopathy pathology
Blurred vision, darkened images
Dot blot haemorrhages, cotton wool spots + hard exudates + neovascularisation
Cataracts S+S
Gradual onset blurred vision Glares/ haloes Nystagmus Sensitivity to light Loss of red reflex Opacity within lens
Orbital cellulitis S+S + management
Redness, swollen eye
Pain
Cefotaxime + flucloxacillin + metronidazole (IV)
What is ocular hypertension?
Raised IOP without glaucoma
RF for acute angle closure
Females
Asian
Long sighted
Older age
RF for cataracts
Family hx
Corticosteroids
Smoking
Prolonged exposure to UVB
Cataracts management
Surgery
Types of stye
Internal = occurs on conjunctival surface of eyelid caused by infection of meobomian gland External = appears along edge of eyelid caused by infection of eyelash follicle
Complications of styes
Periorbital cellulitis
Meibomian cyst
Stye management
Self-limiting
Warm compresses
Epilate eyelash or incision + drainage
Causes of infective conjunctivitis (viral + bacterial)?
Adenovirus
Staph aureas
H influenza
Strep pneumoniae
What is hyperacute conjunctivitis?
Rapidly developing severe conjunctivitis caused by Neisseria gonorrhoea
What is ophthalmia neonatorum?
Conjunctivitis in first 4 weeks
Who is at greatest risk of complications from conjunctivitis?
Contact lens wearers + immunosuppressed pts
What are the complications of conjunctivitis?
Keratitis
Keratoconjunctivitis (usually viral) - vision loss + light sensitivity
Pathology + types of allergic conjunctivitis
IgE hypersensitivity reaction Seasonal Perennial Vernal (hot arid environments) Atopic Giant papillary (due to chronic micro-trauma)
S+S of allergic conjunctivitis
Itching
Watery discharge
Redness
Management of allergic conjunctivitis
Topical anti-histamines or mast cell stabilisers
Types of detached retina
Rhegmatogenous detachment - occurs as vitreous shrinks
Exudative detachment - due to leakage of fluid into subretinal space due to inflammation or malignancy
Tractional - due to diabetes where abnormal vasculature causes contraction of vitreous
Types of uveitis
Anterior = iritis, iridocyclitis Intermediate = ciliary body, pars plana + anterior vitreous Posterior = choroiditis, retinitis, optic nerve head (papillitis)
Causes of uveitis
Autoimmune disorder, infection, trauma, neoplasia
Complications of uveitis
Cystoid macular oedema
Secondary cataracts
Secondary glaucoma
Types of blepharitis
Anterior = inflammation of eyelash base (bacterial or seborrhoeic dermatitis) Posterior = inflammation of meobomian glands
S+S blepharitis
Worse in AM
Burning, itching, erythema + crusting
What conditions are associated with blepharitis?
Dry eye syndrome
Seborrhoeic dermatitis
Rosacea
Management of blepharitis
Warm compresses
Cloramphenicol 2nd line
S+S of corneal FB
Irritation, redness + watering
Pain
Repeated blink reflex
What is Seidel’s test?
Perform if penetrating injury is a possiblity
Apply 10% fluorescein
Observe using slit lamp with cobalt blue (or Woods light)
If penetrative injury is present, stream of clear fluid will be seen in the pool of orange dye
Signs of corneal FB
Visible FB
Rust ring
Management of corneal FB
Use topical anaesthetic
Irrigate eye with water or remove FB with cotton wool bud
What eye conditions are associated with diabetes?
Diabetic retinopathy
Cataracts
Rubeosis iridis + glaucoma
Ocular motor nerve palsies
What characteristic features indicate diabetic retinopathy?
Microaneurysms Hard exudates Hemorrhages Cotton wool spots Neovascularisation
How is diabetic retinopathy classified?
Background = 1 microaneurysm Non-proliferative = hemorrhages, cotton wool spots Proliferative = neovascularisation on disc
What is diabetic maculopathy?
Macular oedema
Ischemic maculopathy
RF for diabetic retinopathy
Prolonged hyperglycaemia
HTN + CV RF
Pregnancy
Renal disease
S+S of diabetic retinopathy
Painless gradual reduction in central vision
Dark, painless floaters
Diagnosis of diabetic retinopathy
Dilated retinal photography w/ ophthalmoscopy
Management of diabetic retinopathy
Glycaemic control (HbA1c <7%) BP control Lipid control Laser treatment Intravitreal steroids Anti-vascular endothelial growth factor treatments Surgery
Complications of diabetic retinopathy
Macular oedema
Macular ischemia
Vitreous hemorrhage
Tractional retinal detachment
Pathology of hypertensive retinopathy
Arterial narrowing (copper wiring)
Followed by vascular leakage + arteriosclerosis (arteriovenous nipping)
Hemorrhages + exudates
Choroidal changes may occur
S+S of hypertensive retinopathy
Usually asymptomatic
Slightly decreased vision
Malignant HTN = headaches + decreased vision
Fundoscopy findings in malignant HTN
Macular star (thin white streaks radiating around macular) Disc swelling Cotton wool spots Flame hemorrhages Arterial/ venous occlusions
What is an ectropion?
Lower eyelid turns outwards away from eye
Causes of ectropion
Old age
Burn/ infection/ eyelid trauma
Facial paralysis
S+S of entropion
Irritation + pain, watering
Management of entropion
Taping eyelid to cheek
Injecting muscle with botox
Surgery
Difference between episcleritis + scleritis in pathology
Epi = inflammation of superficial, episcleral layer. Common + self-limiting Scleritis = inflammation of sclera, severe + can cause complications
Types of episcleritis
Simple = vascular congestion Nodular = characterised by discrete elevated area of inflamed episclera
Difference between epi + scleritis in S+S
Epi = acute onset of redness + discomfort, grittiness Scleritis = gradual onset of boring eye pain radiating to forehead + jaw, worse with eye movement + at night, associated symptoms (fever, vomiting)
DDx for acute light sensitivity
Iritis, keratitis, abrasion, ulcer
DDx for acute unilateral pain
Iritis, keratitis, abrasion, ulcer
Herpes, acute angle closure glaucoma, scleritis
DDx for acute white spot on cornea
Ulcer
DDx for acute non-reactive pupil
Acute glaucoma, iritis
DDx for acute blurred vision
Iritis, keratitis, abrasion, ulcer
Herpes, acute angle closure glaucoma, scleritis
S+S of retinal artery occlusion
Sudden, painless monocular vision loss
Cherry red spot + retinal pallor on fundoscopy
Management of retinal artery occlusion
Restore blood flow
Massage globe
Decrease IOP (BB, IV mannitol)
CI to dilating pupils
shallow anteriorchamber
iris supported lens implant
Potentially neuro abnormality requiring pupillary evaluation
caution with CV disease - can cause tachycardia
