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Year 5 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Causes of blepharitis

A
  • Idiopathic
  • Bacterial infection
  • Viral infection e.g. HSV dermatitis, ZVZ
  • Allergies
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2
Q

Symptoms of blepharitis

A
  • Symptoms generally worse in the morning
  • Scaly eyelid
  • Red eyelid
  • Burning/itching/gritty sensation in the eye
  • Increased lacrimation
  • Crusting/sticking of the eyelids
  • Photophobia
  • Blurred vision
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3
Q

Investigations to consider in a patient with suspected blepharitis

A
  • Slit lamp examination

- Tear break-up time

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4
Q

Management of blepharitis

A
  • Eyelid hygiene - heat compress, eyelid massage, eyelid scrubs
  • Topical antibiotics
  • Topical steroids
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5
Q

Conjunctivitis is inflammation of the … layer in the sclera

A

Conjunctival vessels

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6
Q

Causes of conjunctivitis

A

Bacterial:

  • Staphylococcus
  • Streptococcus
  • Haemophilus

Viral:

  • Adenovirus
  • HSV
  • Enterovirus

Allergic:

  • Pollen
  • Perfumes, cosmetics
  • Smoke
  • Dust mites
  • Eye drops
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7
Q

Symptoms of bacterial conjunctivitis

A
  • Unilateral but may quickly spread to other eye
  • Rapid onset of symptoms
  • Conjunctival redness
  • Eyelid swelling
  • Sticky discharge and crusting of eye
  • Gritty/scratchy feeling
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8
Q

Symptoms of viral conjunctivitis

A
  • Associated URTI
  • Usually begins in one eye then spreads to the other
  • Fine, diffuse redness in eye
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9
Q

Symptoms of allergic conjunctivitis

A
  • Usually bilateral
  • Increased itching
  • Redness
  • Swelling of conjunctiva
  • Increased lacrimation
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10
Q

Investigations required for a patient with suspected conjunctivitis

A
  • Usually none
  • Swab for bacterial culture if bacterial cause suspected and no response to topical antibiotics
  • Viral cultures in epidemic cases
  • Patch test in allergic
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11
Q

Management of conjunctivitis

A

Usually none required

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12
Q

Episcleritis is inflammation of the … layer of the sclera

A

Superficial episcleral plexus

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13
Q

Symptoms/signs of episcleritis

A
  • Symptoms are usually bilateral
  • Redness (may be sectoral)
  • Discomfort (mild-moderate)
  • Grittiness
  • Photophobia
  • Normal visual acuity
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14
Q

Investigations required in suspected episcleritis

A

None

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15
Q

Management of episcleritis

A

Usually none required

Can consider topical/oral NSAID +/- weak topical steroid

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16
Q

Causes of keratitis

A

Non-infectious:

  • Exposure
  • Photo-keratitis
  • Allergic
  • Autoimmune
  • Post-LASIK surgery

Bacterial:
- Pseudomonas

Viral:

  • HSV
  • VZV

Fungal:

  • Candida
  • Aspergillus

Protozoal:
- Acanthomoeba

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17
Q

Management of non-infectious keratitis

A

Analgesia and treatment of cause

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18
Q

Infectious keratitis is an ocular emergency (T/F)

A

True - it is a major cause of blindness worldwide

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19
Q

Complications of keratitis

A
  • Corneal scarring
  • Corneal perforation
  • Endopthalmitis (vitreal humour infection)
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20
Q

Risk factors for bacterial keratitis

A
  • Trauma
  • Contact lenses
  • Severe dry eyes
  • Immunocompromise
  • History of autoimmune disease
  • Previous eye surgery
  • Poor lid function
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21
Q

Risk factors for viral keratitis

A
  • Trauma
  • Contact lenses
  • Severe dry eyes
  • Immunocompromise
  • History of autoimmune disease
  • Topical steroids
  • Previous HSV/VZV infection
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22
Q

Risk factors for fungal keratitis

A
  • Trauma
  • Contact lenses
  • Severe dry eyes
  • Immunocompromise
  • History of autoimmune disease
  • Topical steroids
  • Ocular trauma with plant matter
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23
Q

Risk factors for protozoal keratitis

A
  • Trauma
  • Contact lenses
  • Severe dry eyes
  • Immunocompromise
  • History of autoimmune disease
  • Contaminated water exposure
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24
Q

Symptoms/signs of bacterial keratitis

A
  • Pain
  • Photophobia
  • Blurred vision
  • Lid oedema
  • Red eye
  • Increased lacrimation
  • Decreased visual acuity
  • Corneal ulcers
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25
Q

Symptoms/signs of viral keratitis

A
  • Pain
  • Photophobia
  • Blurred vision
  • Lid oedema
  • Red eye
  • Increased lacrimation
  • Decreased visual acuity
  • Dendritic corneal ulcer, raised IOP (HSV)
  • Dermatomal rash (VZV)
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26
Q

Symptoms/signs of fungal keratitis

A
  • Pain
  • Photophobia
  • Blurred vision
  • Lid oedema
  • Red eye
  • Increased lacrimation
  • Decreased visual acuity
  • Satellite lesions
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27
Q

Symptoms/signs of protozoal keratitis

A
  • Pain
  • Photophobia
  • Blurred vision
  • Lid oedema
  • Red eye
  • Increased lacrimation
  • Decreased visual acuity
  • Prominent nerves
  • Ring abscess
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28
Q

Investigations to consider in a patient with suspected keratitis

A
  • Corneal scraping for microscopy and culture
  • Bloods: FBC (?infection), HIV screen (?immunosuppression)
  • Visual acuity
  • Slit lamp examination
  • Intra-ocular pressure measure
  • Fundoscopy
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29
Q

Management of a patient with bacterial keratitis

A
  • URGENT referral

- Topical levofloxacin (+/- topical gentamicin if high risk)

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30
Q

Management of a patient with viral keratitis

A
  • URGENT referral

- Oral and topical aciclovir (high dose if VZV)

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31
Q

Management of a patient with fungal keratitis

A
  • URGENT referral

- Topical anti-fungals

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32
Q

Management of a patient with protozoal keratitis

A
  • URGENT referral

- 6 months topical chlorhexidine, polyhexidine + propamidine

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33
Q

Ocular emergencies

A
  • Acute angle closure glaucoma
  • Scleritis
  • Infectious keratitis
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34
Q

Scleritis describes inflammation in the … layer of the sclera

A

Deep vascular plexus

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35
Q

Complications of scleritis

A
  • Keratitis
  • Scleromalacia perforans
  • Posterior scleritis
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36
Q

Causes of scleritis

A
  • Rheumatoid arthritis

- Granulomatosis with polyangitis

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37
Q

Symptoms/signs of scleritis

A
  • Redness (diffuse, nodular or necrotising)
  • Deep severe ocular pain
  • Decreased visual acuity
  • Photophobia
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38
Q

Investigations to consider in a patient with suspected scleritis

A
  • Bloods: FBC, CRP, rheumatology antibodies
39
Q

Management of a patient with scleritis

A
  • URGENT referral
  • Oral/IV steroids
  • Oral NSAIDs
  • Cytotoxic therapy
  • Scleral graft
40
Q

Structures affected in anterior uveitis/iritis

A
  • Iris

- Ciliary body

41
Q

Causes of anterior uveitis/iritis

A
  • Idiopathic (50%)
  • Infection e.g. HSV, VZV, TB, syphilis
  • Inflammatory conditions e.g. ankylosing spondylitis, IBD< sarcoidosis
  • MS
  • Trauma
42
Q

Structure involved in intermediate uveitis

A

Vitreous humour

43
Q

Causes of intermediate uveitis

A
  • MS
  • Sarcoidosis
  • IBD
44
Q

Structures involved in posterior uveitis

A
  • Choroid

- Retina

45
Q

Causes of posterior uveitis

A
  • CMV

- Toxoplasmosis

46
Q

Structures involved in panuveitis

A

All uveal structures

  • iris
  • ciliary body
  • vitreous humour
  • choroid
  • retina
47
Q

Causes of panuveitis

A
  • Sarcoidosis

- Behcet’s disease

48
Q

Risk factors for uveitis

A
  • Inflammatory disease
  • HLA-B27+
  • Ocular trauma
  • Age 30-40
49
Q

Symptoms/signs of uveitis

A
  • Ocular pain (posterior uveitis may not be painful)
  • Photophobia
  • Blurred vision
  • Red eye
  • Systemic symptoms of inflammation/infection
50
Q

Investigations to consider in a patient with ?uveitis

A
  • Bloods: FBC, U&Es, LFTs, CRP, serum ACE, ANA, ANCA, RF
  • VDLR
  • Lyme disease screen
  • Bartonella screen
  • Toxoplasma titre
  • CXR
51
Q

Management of uveitis

A
  • Referral
  • Topical corticosteroids + cyclopentolate
  • Treatment of underlying cause
52
Q

Complications of uveitis

A
  • Ciliary injection (inflammation around the iris)
  • Keratin precipitates (inflammatory deposits on the corneal epithelium)
  • Hypopon (inflammatory exudate in the anterior chamber)
  • Posterior syechiae (adhesions between the pupil margin and the lens capsule)
53
Q

Causes of cataracts

A

Ocular causes:

  • Uveitis
  • Trauma
  • High myopia
  • Steroid eye drops
  • Intraocular tumour
  • UV radiation

Systemic causes:

  • Diabetes
  • Wilson’s disease
  • Systemic steroids
  • Chlorpromazine
  • X-rays
  • Congenital rubella
  • Atopic dermatitis
  • Myotonic dystrophy
  • Down syndrome
54
Q

Risk factors for cataracts

A
  • Age >65
  • Smoking
  • Long-term UV exposure
  • Family history
55
Q

Symptoms/signs of cataracts

A
  • Progressive painless loss of vision
  • Glare
  • Change in refraction
  • Altered colour perception
  • Decreased visual acuity (especially in bright light)
  • Difficulty driving at night
  • Dark silhouette against red reflex
56
Q

Management of cataracts

A

Surgical ultrasonic phacoemulsification with intra-ocular lens implant

57
Q

Indication for surgical management of cataracts

A

Cataracts are having a significant impact on quality of life

58
Q

Complications of cataract surgery

A
  • Iris prolapse
  • Posterior capsule opacification
  • Endopthalmitis
  • Cystoid macular oedema
  • Vitreous loss and retinal detachment
59
Q

A lesion in the left optic nerve would present with …?

A

Total loss of vision in the left eye

60
Q

A lesion in the optic chiasm would present with …?

A

Bitemporal hemianopia

61
Q

A lesion in the left optic tract would result in …?

A

Right homonymous hemianopia

62
Q

A lesion in the right optic radiation in the temporal lobe would result in …?

A

Left superior quadrantanopia

63
Q

A lesion in the left optic radiation of the parietal lobe would result in …?

A

Right inferior quadrantanopia

64
Q

A lesion in the right posterior tip of the occipital lobe would result in …?

A

Left central homonymous hemianopia with peripheral sparing

65
Q

A lesion in the left optic radiation in the anterior occipital lobe would result in …?

A

Right homonymous hemianopia with macular sparing

66
Q

Leading cause of visual impairment and irreversible blindness in the industrialised world

A

Age-related macular degeneration

67
Q

Risk factors for AMD

A
  • Age
  • Smoking
  • Family history e.g. complement factor H mutation
  • Obesity
68
Q

Symptoms of AMD

A
  • Progressive blurring/distortion of vision

- Progressive central vision loss

69
Q

Clinical signs of AMD on imaging

A
  • Early: ‘Drusen’ (lipo-proteinaceous deposits under the retinal pigment epithelium)
  • Focal areas of macular hypo- and hyper-pigmentation
  • Dry AMD: atrophy of the RPE and destruction of the rods and cones
  • Wet AMD: neovascularisation of the retinal pigment epithelium
70
Q

Management of patients with any stage of AMD

A
  • Specialist referral
  • High-dose antioxidant and mineral supplementation
  • Monitoring with fluorescein angiography and OCT
71
Q

Additional management of a patient with WET AMD

A
  • Intra-vitreal anti-VEGF

- Photodynamic therapy

72
Q

Which type of photoreceptors are more likely to be affected in retinitis pigmentosa?

A

Rods

73
Q

Clinical features of retinitis pigmentosa

A
  • Progressive night blindness (nyctalopia)
  • Decreased peripheral vision
  • Decreased central vision
  • Glare
74
Q

Typical appearance of retinitis pigmentosa on imaging

A
  • ‘Bone-spicule’ pigment clumping in the mid-periphery of the retina
75
Q

Investigations to consider in a patient with suspected retinitis pigmentosa

A
  • Fundoscopy
  • Electroretinography
  • Electro-oculography
  • Family history
76
Q

Causes of retinal detachment

A
  • Retinal tears/holes
  • Tractional detachment e.g. diabetic retinopathy
  • Exudative/serous detachment e.g. choroidal tumour, uveitis (posterior), intraocular tumours, central serous retinopathy
  • Vitreous humour detachment e.g. old age
77
Q

Risk factors for retinal detachment

A
  • High myopia
  • Ocular trauma
  • Family history
  • Cataract surgery
78
Q

Clinical features of retinal detachment

A
  • Floaters and flashing lights
  • Peripheral visual field loss which progresses to central visual loss
  • Loss of red reflex
  • Grey retina which ‘balloons’ forward and retinal blood vessels seen on examination
  • Features of any underlying causative diseases
79
Q

Management of retinal tear/hole and retinal detachment

A
  • Immediate ophthalmology referral

- Surgical repair - indentation of eye wall, vitrectomy, laser or cryotherapy

80
Q

Clinical features of retinoblastoma

A

Children with:

  • Leukocoria
  • Strabismus
  • Secondary glaucoma
  • White fleshy mass on fundoscopy
81
Q

Investigations to consider in a child with suspected retinoblastoma

A
  • Fundoscopy
  • US, CT and MRI of globe
  • Tumour marker blood tests
  • Staging scans, LP and bone marrow aspiration
82
Q

Management of retinoblastoma

A

Enucleation

83
Q

Most common primary intra-ocular tumour in adults

A

Choroidal melanoma

84
Q

Clinical features of choroidal melanoma

A
  • Age >50
  • Flashing lights in vision
  • Substantial retinal elevation
  • Adjacent exudative retinal detachment
  • Orange pigment deposits
  • Increasing size
85
Q

Management options in choroidal melanoma

A
  • Enucleation
  • Proton beam radiotherapy, radioactive plaque application, local resection
  • Palliative chemotherapy
86
Q

Common sites of origin for choroid metastasis

A
  • Breast
  • Lung
  • GI tract
87
Q

Appearance of choroidal metastasis on fundoscopy

A
  • Pale, shallowly elevated masses

- Often at the posterior pol and often multiple and bilateral

88
Q

Causes of optic neuropathy

A
  • Ischaemia
  • Glaucoma
  • Meningioma
  • Optic neuritis
  • Uveitis
  • Retinal vein occlusion
  • Optic nerve compression
  • Transmission of raised intra-cranial pressure
  • Pituitary gland compression
89
Q

Clinical features of optic nerve disease

A
  • Loss of visual acuity/blurred vision
  • Enlargement of the blind spot
  • Central scotomata or other visual field defects
  • Loss of colour vision
  • Relative afferent pupillary defect
90
Q

Two types of Anterior Ischaemic Optic Neuropathy

A

1) Arteritic (GCA)

2) Non-arteritic - associated with atherosclerosis, hypertension, smoking and diabetes

91
Q

Symptoms of anterior ischaemic optic neuropathy

A
  • Sudden onset unilateral sight loss
  • May be preceded by transient episodes of visual loss
  • Relative afferent pupillary defects
  • Altitudinal visual field defects
92
Q

Fundoscopy results in anterior ischaemic optic neuropathy

A
  • Swollen optic disc
  • Haemorrhage
  • Cotton wool spots
93
Q

Clinical features of optic neuritis

A
  • Typically in young women
  • Rapidly progressive loss of visual acuity
  • Rapidly progressive loss of colour vision
  • Pain exacerbated by eye movements
  • Central scotomata
  • Relative afferent pupillary defect

Year 5 (9 decks)

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