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Ophthalmology Flashcards

1
Q

What do you need to do before fundoscopy?

A

dilate pupil

-eg atropine

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2
Q

Describe optic disk

A

Colour
Contour
Cup
Circulation

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3
Q

3 causes of retinal haemorrhage

A
  • Diabetic retinopathy
  • SAH
  • Valsalva
  • Hypertensive retinopathy
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4
Q

What are cotton wool spots?

A

Micro infarcts

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5
Q

What are drusen?

A

Pale, round and grey –> sign of age-related macula degeneration

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6
Q

Black pigmentation in peripheral retina?

A

Retinitis pigmentosa (inherited retinal degeneration)

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7
Q

What is a scotoma?

Causes?

A

Blind spot

Lesion in the optic nerve, before the chiasm.
eg ON

Macular degeneration –> central scotoma

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8
Q

What is slit lamp for?

A

Examining anterior segment of the eye (in front of the vitreous body)

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9
Q

Where in the retina has the highest concentration of cones?

A

Macula

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10
Q

What do cones do?

A

Colour vision and acuity

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11
Q

What do rods do?

A

Outer retina, night vision

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12
Q

What provides O2 for outer retina?

A

Choroid

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13
Q

Test for visual acuity?

A

Snellens at 6m

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14
Q

What is a cataract?

A

Opacity/clouding of the lens.
Progressive over years.
Usuall b/l

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15
Q

RFs of cataracts?

A

Sunlight, age, smoking, alcohol, steroids, DM

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16
Q

‘The angle’ in open angle glaucoma is what?

A

Space between posterior cornea and anterior iris.

The space where aqueous humour leaves the eye.

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17
Q

Where is aqueous humour produced? What does it do?

A

Ciliary body

Circulates and nourishes the lens

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18
Q

What is chronic open angle glaucoma?

o/e?

A

Chronic, progressive optic neuropathy with characteristic changes in optic nerve head and corresponding visual field loss.

Enlarged optic disc cup. Progressive visual field loss –> tunnel vision.
Raised IOP >21.

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19
Q

Triad of glaucoma

A
  1. raised IOP (not always present)
  2. Abnormal cup:disc ratio
  3. VF defect (tunnel vision)
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20
Q

Screening for chronic open angle glaucoma

A

IOP
VF
Fundoscopy

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21
Q

Drops used in open angle glaucoma

A
  • Timolol (reduces aq production)
  • Latanoprost (increases outflow)
  • Dorzolamide (reduces aq production)
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22
Q

Non-medical mx for glaucoma?

A
  • Laser therapy (trabeculoplasty)

- Surgery (trabeculotomy)

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23
Q

Dry macular degeneration

  1. fundoscopy
  2. VF loss
A
  1. Atrophy of RPE, drusen

2. Central scotoma

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24
Q

Wet macular degeneration

  1. fundoscopy
  2. VF loss
A
  1. Choroidal neovascular membrane, leaking vessels, exudate, haemorrhage, scarring
  2. Distorted central vision
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25
Q

Mx of wet MD

A

Anti-VEGF injection

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26
Q

DDx of sudden visual loss

A
  • Vascular [CRVO, CRAO]
  • Inflammatory [ON]
  • Retinal detachment
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27
Q

CRAO

  1. pres
  2. o/e
A
  1. Sudden, total (or altitudinal) painless loss of vision
  2. RAPD )
    Cherry red spot at fovea
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28
Q

3 ix in retinal artery

A
  • Carotid artery doppler
  • Fasting serum lipid
  • ECG, FBC, CT head, Clotting screen
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29
Q

What is amaurosis fugax?

A

Loss of vision for 30 mins (ocular TIA)

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30
Q

CRVO

  1. pres
  2. o/e
A
  1. sudden painless u/l loss of vision

2. flame haemorrhages, leaking veins, intact arteries, swollen optic disc

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31
Q

mx of CRVO

A
  1. Anti-VEGF injection e.g. Ranibizimab

2. pan retinal photocoagulation

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32
Q

How to identify retinal non perfusion?

A

RAPD

Blots + microinfarcts

Fluorescein angiography

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33
Q

What is anterior ischaemic optic neuropathy?

Assos?

A
  • Sudden visual loss due to disruption of bloody supply to the head of the optic nerve
  • GCA
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34
Q

Optic neuritis assos?

35
Q

Retinal detachment

  1. Cause?
  2. What happens?
  3. Pres?
A
  1. Retinal tear
  2. Potential space between photoreceptors and RPE fills with fluid
  3. Flashes, floaters, field loss
36
Q

Mx of retinal detachment?

37
Q

Hypertensive retinopathy

  1. what
  2. features
  3. mx
A
  1. HTN causes damage to retinal blood vessels
  2. arteriolar changes, microinfarcts, flame haemorrhages
  3. manage BP!
38
Q

What is the complication of dropping BP too fast in accelerated hypertension?

A

Can cause ischaemic optic neuropathy and blindness

39
Q

Diabetic retinopathy pathophysiology?

A
  • Microvascular leakage

- Occlusion

40
Q

Visual loss in diabetic retinopathy?

A

Patchy visual loss (like cow spots)

41
Q

2 signs on fundoscopy of diabetic macular oedema?

A
  • Retinal thickening
  • Exudates approaching fovea
  • Microaneurysms
42
Q

Mx of diabetic retinopathy?

A
  • Optimise glycaemic control + BP
  • Consider pan-retinal photocoagulation
  • When proliferative, vitrectomy
43
Q

How often to monitor diabetic retinopathy?

In pregnancy?

A
  • 12 months

- Every trimester

44
Q

Red flags of red eye

A
  • Impaired vision
  • Pain/photophobia
  • Lack of ocular discharge
45
Q

Blepharitis

  1. what is it?
  2. how does it present?
  3. mx
A
  1. Inflam of eye lid
  2. Gritty, irritable eyes, watery discharge, foreign body sensation
  3. lubricants, hygeine + topical abx, hot spoon bathing
46
Q

Sx of herpes zoster in eye

A
  • Severe keratitis (corneal inflammation)
  • Vascularisation
  • Corneal clouding + thinning
47
Q

Sub-conjunctival haemorrhage

  1. presentation?
  2. mx
A
  1. Sudden onset, bright red (stays bright red)

2. No treatment required. If post-trauma check for orbital/ocular injury..

48
Q

Sx of conjunctivitis? Visual change?

A

Red eye, discharge, swollen eyelid.

No visual disturbance

49
Q

Usual cause of viral conjunctivitis?

mx?

A
  • Adenovirus

- Self limiting

50
Q

Cause of bacterial conjunctivitis?

Mx?

A
  • Staph, Strep, Neisseria, Haemophillus

- Chloramphenicol / fusidic acid eye drops

51
Q

Recurrent conjunctivitis?

A

?nasolacrimal duct obstruction

52
Q

Conjunctivitis in neonate?

A

?chlamydial –> starts in one eye and spreads to the other

Risk of conjunctival scarring, pneumonitis

53
Q

Hypersensitivity types

A 
ABCD
1 - Allergic, Anaphylaxis, Atopy
2 - antiBody
3 - immune Complex
4 - Delayed
54
Q

Mx of allergic conjunctivitis?

A

Topical steroids

55
Q

Pres of allergic conjunctivitis?

A

V swollen conjunctiva, itchy eyes, usuall u/l

56
Q

Check for corneal abrasion?

A

Fluorescein dye

57
Q

Keratitis

  1. what is it?
  2. usual viral cause?
  3. Ix
  4. sx
  5. mx
A
  1. inflammation of the cornea
  2. Herpes simplex
  3. Characetristic shape with fluorescein stain
  4. foreign body sensation, photophobia, watery discharge
  5. topical aciclovir

!!Topical steroid is CONTRAINDICATED!!

58
Q

Steroids for a red eye?

A

NO!!

Seek specialist opinion

Risk of enlarging dendritic ulcer –> amoeboid ulcer

59
Q

Bacterial keratitis?

  1. Sx
  2. Sign
  3. Ix
  4. Mx
A

RARE

  1. painful red eye + loss of vision
  2. hazy cornea w/ central abscess
  3. Scrapes + gram-stain and culture
  4. SPECIALIST (intense abx cef +gent)
60
Q

Anterior uveitis associations?

A

HLA-B27

  • IBD
  • Psoriatic arthritis
  • Ankylosing spondylitis

Granulomatous disease

  • Sarcoid
  • Syphillis

Behcet’s disease (multisystem, mouth ulcers)

61
Q

Mx of anterior uveitis?

A
  • Atropine
  • Steroid eye drops
  • Refer to ophthalmology
62
Q

Acute angle closure glaucoma

  1. pres
  2. o/e
A
  1. Unilateral, painful red eye with profound loss of vision + nausea + vomiting + photophobia
  2. Very high IOP
63
Q

Mx of acute angle closure glaucoma (medical)

A
  • Lower the pressure [timolol, latanoprost, acetazolamide]
  • Constrict the pupil [Pilocarpine]
  • Treat the other eye prophylactically
64
Q

Non-medical mx of acute angle closure glaucoma

A
  • Laser +/- surgery
  • Laser iridotomy
  • Treat the other eye prophylactically
65
Q

What is more worrying? u/l or b/l red eye

A

u/l is more worrying!

66
Q

Which eye conditions are asymptomatic in early disease?

A
  • Chronic glaucoma
  • Diabetic retinopathy
  • HTN
  • Papilloedema
67
Q

Sx of retinitis pigmentosa?

Pathophysiology?

A

Ring scotoma and night vision problems at 10-30yo

Hereditary, progressive dystrophy of photoreceptors in retina and RPE

68
Q

Mx of retinitis pigmentosa

A
  • Refer to ophthalmology + genetic counselling
  • Screen for complications (cataracts, glaucoma, macular oedema)
  • Inform DVLA + wear sunglasses
69
Q

Ix in dry eyes

A

Schirmer’s test (look for Sjogrens)

70
Q

Scleritis sx

A

Intense pain, blurred vision, swollen sclera, choroidal effusions

71
Q

Mx of scleritis

A

Refer to ophthalmo
Steroids –> indomethacin
Cytotoxic therapy in severe disease

72
Q

Pres of uveitis

A

PPPR

  • Pain
  • Photophobia
  • Poor vision
  • Red eye
73
Q

Pres of closed angle glaucoma

A
  • Raised IOP
  • Red eye
  • Rainbow halos around lights
  • Photophobia
  • Pain (+headache)
  • Blurred vision
  • N+V
  • Abdo pain
74
Q

DDx of red, painful eye.

Which are emergencies?

A

Keratitis, conjunctivitis, uveitis, scleritis, episcleritis, close angle glaucoma

EMERGENCIES
Closed angle glaucoma
Keratitis
Uveitis

75
Q

Clinical findings of acute angle closure glaucoma?

A

Semi-dilated non-reacting pupil
Corneal oedema –> hazy
Raised IOP

76
Q

Treatment for acute angle closure glaucoma?

Give 2 and their route

A

Acetazolomide PO

Pilocarpine eye drops

77
Q

Laser treatment for acute angle closure glaucoma?

What is the mechanism?

A

Peripheral iridotomy - allows aqueous humour to drain - decreasing IOP

78
Q

RFs for acute angle closure glaucoma

A

Hypermetropia (long-sightedness)

79
Q

Clinical findings of anterior uveitis?

A

Pupil abnormally shaped
Cells in aqueous humour –> becomes cloudy with ‘FLARE’
Hypopyon
Keratic precipitates - inflammatory cells clumped
Ciliary flush - violaceous ring around cornea

80
Q

Treatments for anterior uveitis?

Give 2 and their route

A

Steroid eye drops

Cycloplegics (atropine, cyclopentolate) –> to dilate pupil

81
Q

Causes of floaters?

A

Diabetic retinopathy
Retinal detachment
Posterior vitreous detachment
Aging

82
Q

Causes of retinal detachment?

A

Rhegmatogenous - due to PVD
Exudative
Tractional

83
Q

Pres of retinal detachment?

A

Floaters
Flashes
Sudden onset, painless, progressive visual field loss

84
Q

Investigations in retinal detachment?

What would you see?

A

Fundal examination - Schaffer’s sign
Ophthalmoscopy
USS - flying angels sign

Finals (20 decks)

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