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3B Specialties > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

accomodation

A

changing of lens shape to focus on near objects

uses the ciliary muscle

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2
Q

acuity

A

a measure of how well the eye sees a small or distant object

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3
Q

Amblyopia

A

decreased acuity uncorrectable by lenses, with no anatomic defect

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4
Q

amsler grid

A

test chart of intersecting lines used for screening for macular disease
- lines appear wavy, squares distorted

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5
Q

anisocoria

A

unequal pupil size

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6
Q

ansiometropia

A

different refractive errors in each eye

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7
Q

aphakia

A

the state of having no lens- e.g. removed because of cataracts

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8
Q

blepharitis

A

inflamed lids
e.g. staphs, seborrhoeic dermatitis or rosacea
burning itching red margins, scales on the lashes

Treatment- good hygiene- cotton bud and baby shampoo. children- consider oral erythromycin (blepharokeratitis)

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9
Q

canthus

A

the medial or lateral angle made by the open lids

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10
Q

chemosis

A

oedema of the conjunctiva

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11
Q

choroid

A

vascular coat between the retina and the outer scleral coat

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12
Q

ciliary body

A

portion of uvea (uveal tract) between iris and choroid

contains the ciliary procresses and ciliary muscle (for accomodation)

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13
Q

conjunctiva

A

mucous membrane on anterior sclera and posterior lid aspect

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14
Q

cycloplegia

A

ciliary muscle paralysis preventing accomodation

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15
Q

dacrycocystitis

A

inflammation of lacrimal sac

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16
Q

dioptre

A

units for measuring refractive power of lenses

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17
Q

ectropion

A

lids evert (esp. lower lid) causes eye irrititation, watering ± keratitis

associated with old age and facial palsy
plastic surgery to correct deformity

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18
Q

entropion

A 
lids invert (lashes may irritate eyeball)
typically due to degeneration of lower lid fascial attachements

treat with botulinum toxin and then surgery

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19
Q

epiphora

A

passive overflow of teas onto the cheek

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20
Q

fornix

A

where bulbar (scleral) and palpebral (lid) conjunctiva meet

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21
Q

fovea

A

cone rich area of macula, capable of 6/6 vision

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22
Q

fundus

A

part of the retina normally visible through the ophthalmoscope

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23
Q

keratoconus

A

cornea shaped like a cone

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24
Q

keratomalacia

A

the cornea is softened

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25
Q

limbus

A

annular border between clear cornea and opaque sclera

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26
Q

macula

A

retinal area ~5mm across, lateral to optic disc

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27
Q

miotic

A

agent causing pupil constriction (e.g. pilocarpine)

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28
Q

mydriatic

A

an agent causing pupil dilatation (e.g. tropicamide)

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29
Q

near point

A

where the eye is looking when maximally accommodated

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30
Q

optic cup

A

cup like depression in the centre of the optic disc

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31
Q

optic disc

A

part of the optic nerve seen ophthalmoscopically in the fundus

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32
Q

papillitis

A

inflammation of the optic nerve head

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33
Q

presbyopia

A

age-related reduced near-acuity from failing accommodation

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34
Q

pterygium

A

wing shaped degenerative conjunctival condition

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35
Q

ptosis

A

drooping lids

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36
Q

refraction

A

ray deviation on passing through media of different density, or determining refractive errors and correcting them with lenses

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37
Q

retinal detachment

A

sensory retina separates from the pigmented epithelial layer of retina

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38
Q

sclera

A

the whites of the eyes starting from the corneal perimeter

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39
Q

scotoma

A

a defect causing a part of the field of view to go missing

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40
Q

slit lamp

A

a device that illuminates and magnifies structures in the eye

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41
Q

stabismus

A

squint

eyes deviate

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42
Q

tarsorrhaphy

A

surgical procedure to unit upper and lower lids

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43
Q

tonometer

A

device for measuring intraocular pressure

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44
Q

uvea

A

iris, ciliary body, choroid

45
Q

vitrectomy

A

surgical removal of the vitreous

46
Q

vitreous

A

jelly like substance filling the globe behind the lens

47
Q

Stye

Hordeolum externum

A

abscess or infection - usually staphylococcus in a lash follicle (also glands of Moll (sweat) or Zeis (sebum))
point outwards
apply warm compress 5-10 mins, several times a day until resolution

Residual swelling called a chalazion

48
Q

Pinguecula

A

degenerative vascular yellow-grey on conjunctiva either side of the iris
- associated with increases in hair and skin pigment, sun-related skin damage

49
Q

lagophthalmos

A

difficulty in lid closure
- causes exophthalmos, mechaincal impairment of lid movement, leprosy, paralysis of obicularis oculi
lubricate eyes with liquid parafin ointment

50
Q

Retinoblastoma signs

A

stabismus and leukocoria (white pupil)

always suspect when red reflex is absent

51
Q

retinoblastoma inheritance

A

autosomal dominance - 80% penetrance

RB gene is present in everyone - normally suppressor gene or anti-oncogene

52
Q

Associations with retinoblastoma

A

5% occur with pineal or other tumour (trilateral retinoblastoma)
secondary malignancy- osteosarcoma and rhabdomyosarcoma - main cause of death

53
Q

Treatment of retinoblastoma

A

enucleation (eye removal) - traditional. Large tumours, long standing retinal detachment and optic nerve invasion or extrascleral extension
chemotherapy - useful in bilateral tumours
external beam radiotherapy
ophthalmic plaque brachytherapy - focal and shielded radiation
cryotherapy and transpupillary thermotherapy- control of small selected small tumours

54
Q

ophthalmic shingles

A

pain and neuralgia V1 distribution
blistering inflammed rash
treat with oral antivirals within 72 hours of rash onset

55
Q

orbital cellulitis

A

infection of soft tissues posterior to orbital septum
spread from paranasal sinus infection (eyelid, dental injury/infection or external ocular infection

  • inflammation in orbit, fever, id swelling, decreased eye mobility±diplopia. May have chemosis and proptosis
56
Q

Associated complications of orbital cellulitis

A

subperiosteal and orbital abscess
extra-orbitalextension
visual loss from optic neuritis/ central retinal vein or artery occlusion
intra-cranial involvement –> meningitis, brain abscess, thrombosis in dural or cavernous sinus

57
Q

Treatment of orbital cellulitis

A

CT, ENT & ophthalpic opinion
Antibiotics
rule out underlying rhabdomyosarcoma, grave’s disease or cavernous sinus thrombosis

58
Q

Preseptal (periorbital) cellulitis

A

infection of soft tissues anterior to the orbital septum
commonly caused by sinusitis or facial skin lesions - insect bites, trauma

characterised by acute erythematous swelling of the eyelid.

no- painful eye movements, diplopia or visual impairment

Rx- empirical treatment of cellulitis e.g. amoxicillian 1g TDS 7-10days

59
Q

Convergent squint

esotropia

A

commonest in children
may have no cause or due to hypermetropia
strabismic amblyopia the brain supresses the deviated image, visual pathway does not develop normally

60
Q

divergent squint

exotropia

A

occurs in older children

often intermittend

61
Q

Non-paralytic squints

A

usually start in childhood

may be constant or not

62
Q

Diagnosis of squint

A
  1. corneal reflection - reflection from bright light is asymmetrical if squint present
  2. cover test - movement of uncovered eye to ttake up fixation as the other eye is covered= manifest squint
    latent squint = movement of the covered eye as cover is removed
63
Q

Management of squint

A

3 O’s
O - optical - assessment, spectacles
O - orthoptic - patch the good eye
O - operation - resection and recession of rectus muscles

64
Q

Paralytic squints

A

diplopia most on looking in the direction of pull of the paralysed muscle
separation of two images is greatest when the image from the paralysed eye is furthest from the midline and faintest

65
Q

third nerve palsy

occulomotor

A

ptosis, proptosis (reduced recti tone), fixed pupil dilatation
eye looks out and down

Causes- cavernous sinus lesions, superior orbital fissure syndrome, DM, posterior communicating artery aneurysm

66
Q

fourth nerve palsy

trochlear

A

diplopia
ocular torticollis - patient holds head tilted
eye looks upward, in adduction and can’t look down and in (superior oblique paralysed)

causes - trauma, tumour, idiopathic

67
Q

Sixth nerve palsy

abducens

A

diplopia in horizontal plane
medial deviation. cannot move laterally from the mid line
lateral rectus is paralysed

Causes- tumour causing increasing ICP, basal skull trauma, MS

68
Q

Horner’s syndrome

A

disruption in sympathetic fibres
pupil is miotic (smaller)
no dilatation in the dark and partial ptosis
unilateral facial anhydrosis = lesion proximal to carotid plexus

69
Q

Causes of Horners syndrome

A
  • posterior inferior cerebellar artery or basilar artery occlusion
  • multiple sclerosis
  • cavernous sinus thrombosis
  • pancoast tumous
  • hypothalamic lesions
  • cervical adenopathy
  • mediastinal masses
  • pontine syringomyelia
  • Klumpke’s palsy
  • aortic anuerysm
70
Q

Subconjunctival haemorrhage

A

harmless but alarming
pool of blood behind the conjunctiva
- check BP

71
Q

episcleritis

A

inflammation below conjunctiva
often seen with an inflammatory nodule
sclera look blue below a focal, cone shaped wedge of engorged vessels
eye aches duly
Rx- symptomatic relief - artificial tears , topical or systemic NSAIDs

72
Q

scleritis

A

generalised inflammation of sclera with oedema of conjunctiva , scleral thinning and vasculitic changes
associated with systemic disease
constnat severe dull ache boring into eye
may present with headache and photophobia

may be necrotising

73
Q

Uveitis

A

pigmented part of the eye- iris, ciliiary body, choroid

anterior - iris & ciliary body
posterior - choroid
intermediate - vitreous

74
Q

Anterior uveitis

A

ank spon, sarcoid, behçets, IBD, reactive arthritis, herpes, TB

Presentation - red eye, pain, blurred vision and photophobia
increased lacrimation

treat cause

75
Q

acute closed angle glaucoma

A

angle of anterior chamber narrows acutely causing sudden rise in intraocular pressure >30mmHg
pupil becomes fixed and dilated- axonal death occurs
raised intraocular pressure makes the eye feel hard

76
Q

Presentation of acute closed angle glaucoma

A

generally unwell with N&V

headache and painful eye- blurred vision, haloes around lights at night

77
Q

Treatment of acute closed angle glaucoma

A 
b-blockers  tried
pilocarpine
IV acetazolamide
analgesia and antiemetics
peripheral iridectomy once IOP is controlled
78
Q

Complications of acute closed angle glaucoma

A

visual loss
central retinal artery or vein occlusions
repeated episodes

79
Q

Conjunctivitis

A

red and inflammed conjunctiva
hyperaemic vessels may move over sclera

eyes itch, burn and lacrimate
often bilateral with discharge sticking lids together

80
Q

non-infective causes of conjunctivitis

A 
allergic conjunctivitis
toxic
autoimmune 
neoplastic 
contact lenses - reaction to foreign substance
81
Q

infective causes of conjunctivitis

A

non-herpetic viral - serous discharge

bacterial

82
Q

Treatment of bacterial conjunctivitis

A

if sexual disease, contact lens wearer or immunocompromised

chloramphenicol or fusidic acid drops

83
Q

Anterior ischaemic optic neuropathy

A

most common cause of optic neuropathy in older patients

optic nerve is damaged if vascular supply to optic nerve is blocked by inflammation or atheroma

84
Q

Retinal vein occlusion

A

incidence increases with age
2nd most common cause of blindness from retinal vascular disease

Accosicaed with aterioscleroisis, high BP, DM and polycythemia

Rx- intravitreal anti-VEGF therapy, dexamethosone implants

85
Q

Vitreous heamorrhage

A

arise from retinal neovascularisation, retinal tears, retinal detachment or trauma

small extravasation of blood produce vitreous floaters
Check - acuity, pupil reaction, fundi
normally spontaneously resolves
may need vitrectomy in dense haemorrhage

86
Q

Optic neuritis

A

subacute loss of vision
unilateral loss of acuity occurs over hours or days
colour vision is affected- red desaturation
painful eye movements
full recovery over 2-6 weeks
45-80% develop MS in the next 15 years

other causes- syphilis, leber’s optic atrophy, DM, vitamin deficiency

Rx- methylprednisolone IV 72hrs then prednisolone PO for 11 days

87
Q

Wet age related macular degeneration

exudative

A

pathologic choroidal neovascular membranes develop under the retina
- leak fluid and blood causing a central disciform scar
vision deteriorates rapidly - distortion is key
fluid exudation, localised detachment of pigment

Treatment- smoking cessation, diet rich in green leafy veg, VEGF inhibitors- bevacizumab, laser photocoagulopathy, photodyamic therapy, intravitreal steroids

88
Q

Dry age related macular degeneration

non-exudative

A

much slower - over decades, progressive visual loss

aetiology not well known
dursen –> optic nerve head axonal degeneration (leads to intracellular mitochondrial calcification- some axons then rupture –> calcium deposition in the extracellular space)
optic disc is made irregular and lumpy by these deposits
optic cup is absent
abnormal branching vessel patterns

89
Q

Chronic simple open-angle glaucoma

A

optic nueropathy with death of many retinal ganglion cells and their optic nerve axons
IOP may be raised but this isn’t part of the definition
asymptomatic until visual fields are badly impaired

90
Q

Diagnosis of chronic simple open-angle glaucoma

A 
IOP measurement using tonometry
Central corneal thickness measurement 
Peripheral anterior chamber configuration and depth assessments using gonioscopy 
visual field measurement 
optic nerve assessment
91
Q

High risk for chronic simple open-angle glaucoma

need screening

A 
>35 
\+ve family history esp. siblings 
African-Carribean 
myopia
diabetic/thyroid eye disease
92
Q

Drug treatment for chronic simple open-angle glaucoma

aim to reduce production of aqueous or increase uveoscleral outflow

A
  • prostaglandin analogues- latanoprost
  • B-Blockers - timolol or betaxol
  • a-adrenergic agonists - brimonidine, apraclondine
  • carbonic anydrase inhibitors - dorzolamide& brinzolamide
  • miotics - pilocarpine
    sympathomimetic dipiverfrine
    -fixed dose combination drops
    laser therapy or surgery
93
Q

Risk factors for cataracts

A

age related
genetic
occur early in DM
associated wtih smoking, alcohol excess, sunlight exposure, trauma, radiotherapy, HIV+ve

94
Q

Nuclear cataracts

A

change the lens refractive index and dulls colours

95
Q

Cortical cataracts

A

spoke like wedge shaped opacities

milder effects on vision

96
Q

Posterior subcapsular cataracts

A

typically progress faster and cause glare from sunlight and lights when driing at night

97
Q

Presentation of cataracts

A

blurred vision
unilateral cataracts often unnoticed
loss of stereopsis - affects distance judgement
bilateral cataracts cause painless loss of vision ± mononuclear diplopia

98
Q

Post-op complications of cataract surgery

A

posterior capsule thickening

astigmatism becomes more noticeable

99
Q

Retinal detachment

types

A
  1. Rhegmatogenous retinal detachment - fluid passes into vitreous space- caused by trauma
  2. Exudative retinal detachment - no trauma
  3. Tractional retinal detachments - pulling on retina. more common in myopic eyes
100
Q

Presentation of retinal detachment

A

4 F’s

  1. Floaters
  2. Flashes
  3. Field Loss
  4. Fall in acuity- painless, curtain falling over the vision
101
Q

Management of retinal detachment

A

nurse -flat or 30 degree up head tilt (inferior)
laser photocoagulation therapy
vitrectomy and gas tamponade with scleral silicone implants
cryotherapy or laser coagulation to secure the retina

102
Q

Structural eye changes in DM

A

ocular ischaemia causes new blood vessels forming on the iris (rubeosis) - may block the drainage of aqueous fluid
- acceleration of age-related cataract formation

103
Q

Pathogenesis

Eye in DM

A

microangiopathy in capillaries causes:

  1. vascular occlusion causes ischaemia ± new vessel formation - potential to bleed
  2. vascular leakage- pericytes lost, capillaries bulge- oedema and hard exudates–> flame shaped haemorrhages
104
Q

Classification of eye disease in DM

A

Non-proliferative diabetic retinoapthy - mild, moderate or severe depending on degree of ischaemia

proliferative diabetic retinopathy- fine new vessles appear on the optic disc, retina and can cause vitreous haemorrhage

Maculopathy - leakage of vessels close to the macula causing oedema can can significantly threaten vision

105
Q

Papilloedema

A

swelling of the optic disc caused by raised ICP
always bilateral, but not necessarily symmetrical

presentation- symptoms of raised ICP

106
Q

Ramsay Hunt Syndrome

herpes zoster oticus

A

herpes zoster infection of the facial nerve
often in the elderly, severe otalgia precedes VII CN palsy
zoster vesicles appear around the ear, in the deep meatus ± soft palate and tongue
Vertigo, tinnitus or deafness
Rx- aciclovir + prednisolone

107
Q

Corneal abrasion

A

intense pain
local anaesthetic, stain with fluroescein
should start healing within 48hrs- re-examine after 24hrs

108
Q

Eye burns

A

treat chemical burns promptly
instil anaesthetic drops every 2 mins until pt comfortable
bathe eye in copious clean water
late sequelae - corneal scarring, opacification and lid damage

109
Q

Foreign bodies in the eye

A

cause- chemosis, subconjunctival bleeding, irregular pupils, iris prolapse, hypaema, vitreous haemorrhage, retinal tears

X-ray orbit, orbital USS
removal of superficial FBs may be remove dwtih a triangle of clean card- chloramphenicol drops after

3B Specialties (7 decks)

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