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3b specialties > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is age-related macular degeneration?

A

Degeneration of the macula

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2
Q

Name some RFs for ARMD

A

Age, smoking, hypertension, dyslipidaemia, DM

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3
Q

S+S of ARMD?

A 
Subacute onset of visual loss
Decrease in visual acuity
Decrease in night-time vision
photopsia
Fluctuating visual disturbance
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4
Q

What is DRY ARMD?

A

Presence of drusen

90% of cases

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5
Q

What is WET ARMD?

A

Worse prognosis

Choroidal neovascularisation

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6
Q

Ix of ARMD?

A

Slit lamp microscopy

Fluorescein angiography- looking for neovascularisation

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7
Q

Tx of ARMD?

A

Wet- Anti-VEGF (ranibizumab)

Dry- vitamins ACE and zinc

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8
Q

What are cataracts?

A

Cloudy lens

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9
Q

RFs for cataracts?

A

Age, smoking, alcohol, trauma, DM, radiation, steroids, TORCH infections

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10
Q

Types of cataracts?

A

Nuclear- old age
Polar- inherited
Subcapsular- steroid use
Dot opacities- DM, myotonic dystrophy

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11
Q

S+S of cataracts?

A 
Gradual onset decrease in vision
faded colour vision
glare
haloes around lights
Loss of red reflex
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12
Q

How to diagnose cataracts?

A

Visible of slit lamp examination

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13
Q

Tx of cataracts?

A

Stronger glasses

Surgery

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14
Q

What are RFs for vitreous haemorrhage??

A

DM, bleeding disorders, retinal tear, trauma, wet ARMD

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15
Q

S+S of vitreous haemorrhage?

A

Small bleed= floaters, dark spots
Large bleed= sudden painless LOV
Absent red reflex
retina not visible

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16
Q

Tx of vitreous haemorrhage?

A

Usually spontaneously resorbs

If severe -> vitrectomy

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17
Q

What is CRAO?

A

Central retinal artery occlusion

considered a form of stroke from thromboembolism or temporal arteritis

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18
Q

RFs for CRAO?

A

same a stroke- CV RFs

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19
Q

s+s of CRAO?

A

Sudden painless loss of vision
Marcus-GUNN pupil- relative afferent pupillary defect

Fundoscopy- cherry red spot on a white retina

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20
Q

Tx for CRAO?

A 
CT head
Exclude GSA (DO ESR)
intraocular hypotensives (acetazolamide)
Decreaes intraocular pressure by intraocular massage

Secondary prevention- CV risk factors

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21
Q

What is more common- CRAO or CRVO?

A

Vein

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22
Q

What are the 4 features of fundoscopy of CRVO?

A

cheese and tomato pizza

  1. Cotton wool spots
  2. Swollen optic nerve
  3. Macular oedema
  4. Severe retinal haemorrhage
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23
Q

What is Tx of CRVO?

A

Call ophthalmology immediately
Intra-vitreal anti-VEGF therapy
dexamethasome

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24
Q

What is optic neuritis?

A

Inflammation of the optic nerve

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25
Q

Rfs for optic neuritis?

A

MS, syphilis, SM, leber’s optic atrophy, vitamin deficiency

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26
Q

S+S of optic neuritis?

A 
unilateral, subacute LOV
pain of eye movement
dyschromatopsia (poor colour discrimination- red seems washed out)
Marcus gunn pupil
central scotoma
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27
Q

Tx of optic neuritis?

A

IV methylprednisolone for 72 hours
then oral pred for 11 days
MRI if ?MS

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28
Q

What is retinitis pigmentosa?

A

Inherited degeneration of the retina- >300 different mutations
more common in males
associated with Usker syndrome and Alport syndrome

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29
Q

What are feature of retinitis pigmentosa?

A

night blindness= first sign

tunnel vision- due to loss of peripheral retina

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30
Q

Tx of retinitis pigmentosa?

A

Visual aids and blind registration
electrical stimulation of retinal ganglion cells
neuralprosthetics

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31
Q

What is diabetic retinopathy assocated with?

A

vitreous haemorrhage

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32
Q

What is the pathophysiology of diabetic retinopathy?

A

hyperglycaemia increases retinal blood flow which damages endothelial cells -> increased vascular permeability -> exudates seen on fundoscopy

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33
Q

Classification of diabetic retinopathy?

A

Non- proliferative
mild- 1 or more microaneurysm
moderate- microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading looping
severe- blots and micros in 4 quadrants, venous beading in >2 quadrants

Proliferative
retinal neovascularisation, fibrous tissue forming anterior to retinal disc, high risk of blindness

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34
Q

Ix of diabetic retinopathy?

A

dilated retinal photography with accompanying ophthalmoscopy

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35
Q

Tx of diabetic retinopathy?

A

good glycaemic control
laser therapy
intra-vitreal steroids
anti- VEGF

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36
Q

How is diabetic retinopathy different to maculopathy?

A

changes on macula

more common in T2DM

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37
Q

Causes of hypertensive retinopathy?

A 
exacerbation of essential HTN
intrinsic renal disease
renal artery stenosis
pheochromocytoma
cushings and conns
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38
Q

Features of HT retinopathy?

A 
micro-infarcts
silver wiring of the artery (increased light reflex)
AV nipping
flame haemorrhages
exudates
papilloedema
neovascularisation
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39
Q

Classification of HT retinopathy?

A 
Kieth- Wagner classification
1- arteriolar narrowing and tortuosity, increased light reflex (silver wiring)
2- AV nipping
3- Spots, dots (exudates) and blots
4- papilloedema
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40
Q

tx of HT retinopathy?

A

Control hypertension
manage stroke risk
regular eye checks- yearly

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41
Q

Causes of corneal ulceration/abrasion?

A

Contact lens wearers
infection
mechanical trauma or nutritional deficiencies
steroid eye drops -> fungal infections

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42
Q

S+S of corneal ulcers>

A

Eye pain
Photophobia
watery eye

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43
Q

Ix of corneal ulcers?

A

Focal fluorescein staining of the cornea and slit lamp exam

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44
Q

Tx of corneal ulcers?

A

Stop contact lenses for 1 week
cool compress
good hygiene
topical abx- chloramphenicol;

45
Q

Common causes of red eye? (non urgent)

A

Conjunctivitis, foreign bodies, corneal ulceration, subconjunctival haemorrhages

46
Q

Urgent causes of red eye?

A 
Acute angle closure glaucoma
Anterior uveitis
Scleritis
Conjunctivitis
Subconjunctival haemorrhage
Endophthalmitis
following intraocular surgery
47
Q

Features of acute angle closure glaucoma?

A 
severe pain (may be ocular or headache)
decreased visual acuity, patient sees haloes
semi-dilated pupil
N&V
peripheral visual field loss
hazy cornea
48
Q

Features of anterior uveitis?

A 
acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush (red or purple ring spreading outwards from the cornea)
red eye
decreased visual acuity
49
Q

Features of scleritis?

A 
severe pain (may be worse on movement) and tenderness
red eye
may be underlying autoimmune disease e.g. rheumatoid arthritis, CTD, vasculitis
50
Q

Features of conjunctivitis?

A

purulent discharge if bacterial, clear discharge if viral

red eye

51
Q

Feautures of subconjunctival haemorrhage?

A

history of trauma or coughing bouts, bleeding disorders etc
bleeding of small vessels into conjunctiva
Sudden onset, bright red blood, distinct border

52
Q

Features of endophthalmitis?

A

typically red eye, pain and visual loss

53
Q

Features of episcleritis?

A

Common, benign, no systemic associations, 50% bilateral

causes mild irritation, localised redness, watery, no discharge, no LOV

54
Q

tx of episcleritis?

A

NSAIDs for pain

eyedrops e.g. phenylephrine to ease irrigation

55
Q

tx of scleritis?

A

NSAIDS
oral prednisolone
cyclophosphamide or other immune suppressants to tackle vasculitis or CTD

56
Q

tx of subconjunctival haemorrhage?

A

no official tx unless other injuries present

57
Q

tx of anterior uveitis?

A

dilate eye to relieve pain- atropine or cyclophenolate
steroid eye drops (prednisolone acetate)
review by ophthalmology

58
Q

what is keratitis?

A

infection/inflammation of the cornea

59
Q

What is a viral cause of keratitis?

60
Q

Features of keratitis?

A 
dendritic shape corneal ulcer
red, painful eye
photophobia
watering
decreased visual acuity
foreign body sensation
61
Q

Ix of keratitis?

A

fluorescein staining to look for ulcer

62
Q

tx of keratitis?

A

urgent referral
if viral cause- topical acyclovir
if bacterial cause- abx

63
Q

What are bacterial causes of conjunctivitis?

A

staphylococcus. streptococcus, haemophilus, Neisseria, chlamydia

reactive conjunctivitis= chlamydia or campylobacter

64
Q

Viral cause of conjunctivitis?

A

adenovirus

65
Q

general advice for conjunctivitis?

A

no contact lenses, don’t share towels, no need for school exclusion

66
Q

tx for bacterial conjunctivitis?

A

self-limiting
topical abx- chloramphenicol
if pregnant- topical fusidic acid

67
Q

pointers towards viral conjunctivitis?

A

recent URTI
serous discharge
re-auricular lymphadenopathy

68
Q

tx of viral conjunctivitis?

A

oral analgesia and artificial eye drops

self-limiting

69
Q

features of allergic conjunctivitis?

A

hay-fever symptoms
itchy,swollen conjunctiva, erythema
sticky mucous discharge
large papillae if caused by pollen

70
Q

tx of allergic conjunctivitis?

A

topical or systemic anti-histamines

topical mast cell stabilisers (sodium cromoglicate, nedocromil)

71
Q

what is acute angle closure glaucoma?

A

raised IOP that causes damage to optic nerve

IOP >21mmHg

72
Q

RFs of acute angle closure glaucoma?

A

hypermetropia (long-sightedness), pupillary dilatation

73
Q

Ix of acute angle closure glaucoma?

A 
slit lamp examination- showing large cup and nerve fibre loss
Gonioscopy
visual field examination
automated perimetry
measure IOP- tonometry
74
Q

tx of acute angle closure glaucoma?

A
  1. lower the pressure
    - prostaglandin analogues e.g. lantoprost (increase uveoscleral outflow)
    - beta blockers e.g. timolol (decrease aqueous secretion)
    - sympathomimetics (alpha-2 adrenoceptor agonists)- e.g. brimonidine (decrease secretion and increase outflow)
    - carbonic anhydrase inhibitors e.g. dorzolamide (decrease aqueous secretion)
  2. constrict the pupil
    - e.g. pilocarpine drops (increase uveloscleral outflow)
  3. prevent recurrence- laser iridotomy (hole in iris) and surgery
75
Q

AEs of lantoprost?

A

brown pigmentation of iris

increase eyelash length

76
Q

CIs of timolol?

A

asthmatics and heart block

77
Q

CIs of brimonidine?

A

avoid if taking TCAs or MAOI

78
Q

AEs of pilocarpine

A

headache, blurred vision, prolonged constricted pupil

79
Q

RFs of chronic glaucoma?

A

age, FH, short-sightedness, HTN, DM, afro-caribbean

80
Q

Diagnosis of chronic glaucoma?

A

> 21mmHg, abnormal disc (cupping, pallor, notching, disc haemorrhage), visual field defect
Can be routine finding in opticians or symptoms of tunnel vision or decrease visual acuity

81
Q

tx of chroic glaucoma?

A

1st line- lantoprost (eye drops)
2nd line- timolol, carbonic anhydrase inhibitor, alpha 2 agonist
3rd line- trabeculectomy

82
Q

When to screen for chronic glaucoma if +ve FH?

A

annually from the age of 40

83
Q

what is retinal detachment and what can precede it?

A

holes/tears in the retina allow fluid to separate the sensory retina from the retinal pigmented epithelium
vitreous detachment can precede it (flashers and floaters)

84
Q

RFs of retinal detachment?

A 
myopia (short-sightedness)
cataract surgery
DM
HTN
trauma
vasculitis
85
Q

features of retinal detachment?

A

4Fs and no Pain

  1. flashers
  2. floaters
  3. fall in acuity
  4. field loss- usually central

straight lines appear curved
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision

86
Q

ix of retinal detachment?

A

B-scan USS
ophthalmoscopy
slit lamp exam- peeling away of retina

87
Q

tx of retinal detachment?

A 
urgent referral 
if superior detachment- lie flat
if inferior detachment- sit at 30 degrees with head up
laser therapy
urgent surgery
88
Q

Causes of CRVO?

A

causes: glaucoma, polycythaemia, hypertension

89
Q

Causes of sudden painless LOV?

A
  • ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
  • vitreous haemorrhage
  • retinal detachment
  • retinal migraine
90
Q

What is temporal arteritis?

A

occlusion of the ciliary arteries which supply the optic nerves

91
Q

features of temporal arteritis?

A

sudden loss of vision with pain
central scotoma
unilateral then bilateral
associated temporal headache and/or tenderness over the temporal arteries

92
Q

Dx of temporal arteritis?

A

ESR >40
Biopsy of temporal artery
ophthalmoscopy- swollen optic disc
test both eyes

93
Q

mx of temporal arteritis?

A

prednisolone 60-100mg STAT and continue for a week before tapering

94
Q

differentials of tunnel vision?

A 
papilloedema
glaucoma
retinitis pigmentosa
chorioretinitis
optic atrophy secondary to tabes dorsalis
95
Q

what is papilloedema?

A

optic disc swelling

96
Q

causes of papilloedema?

A 
SOL
malignant hypertension
IIH
hydrocephalus
hypercapnia
hypoparathyroidism, hypocalcaemia, vit A toxicity
97
Q

signs of raised ICP?

A

headache worse on morning
blurred vision
tunnel vision
vomiting

98
Q

features on fundoscopy of papilloedema?

A 
venous engorgement
loss of venous pulsation
blurring of optic disc margin
elevation of optic disc
loss of optic cup
paton's lines
99
Q

What is a chalazion?

A

granuloma of Meibomian glands (reactions to accumulation of lipid following duct blockage)
hard and inflamed lump on eyelid

100
Q

tx of chalazion?

A

warm compress, chloramphenicol ointment

incision and curette under anaesthesia

101
Q

What is a stye?

A

infection of lash follicle
red,tender swelling
head of pus

102
Q

tx of stye?

A

warm compress and analgesia

103
Q

what is blepharitis?

A

chronic condition with sore, gritty eyes and sore eyelids
blocked Meibomian glands
inflamed lid margins
conjunctiva may be inflamed

104
Q

tx of blepharitis?

A 
keep lids open
treat infection
hot compress
mechanical removal of lid debris
artificial teats
acute ulcerative form- staph or herpes virus
105
Q

what is the classic appearance of BCC?

A

pearly smooth edge with necrotic centre

106
Q

What is ectropion vs entropion?

A

ectropion- out-turning of eyelids

entropion- in-turning of eyelids

107
Q

how to tell the difference between 3rd nerve palsy and horner’s syndrome?

A

3rd nerve palsy= ptosis and dilated pupil

horner’s syndrome= ptosis and constricted pupil

108
Q

causes of keratitis?

A

Viral infection with herpes simplex
Bacterial infection with pseudomonas or staphylococcus
Fungal infection with candida or aspergillus
Contact lens acute red eye (CLARE)
Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropion)

3b specialties (7 decks)

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