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phase 3b > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

4 types of change in appearance of the eyelid

A

Ptosis
Swelling
Entropion (turning in)
Ectropion (turning out)

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2
Q

Which muscles are innervated by CN3?

A

Medial rectus
Superior rectus
Inferior rectus
Inferior oblique

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3
Q

What is the appearance of the eye due to 3rd nerve palsy?

A

Down and out
Ptosis
Fixed dilated pupil

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4
Q

What is strabismus

A

Misalignment of the eyes (squint)

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5
Q

What vasculitis is important to exclude in transient loss of vision?

A

Giant cell arteritis

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6
Q

What is the management of giant cell arteritis?

A

Steroids
Temporal artery biopsy
Very high inflammatory markers

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7
Q

What common eye condition causes loss of peripheral vision?

A

Glaucoma

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8
Q

5 causes of gradual vision loss?

A 
Glaucoma
Cataracts
Macular degeneration 
Diabetic retinopathy
Increased intracranial pressure
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9
Q

What is phacoemulsification?

A

Fragmentation of lens fibres using ultrasound.

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10
Q

What is the most common type of glaucoma?

A

Chronic open angle glaucoma

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11
Q

What does the ‘angle’ refer to in glaucoma?

A

The angle between the posterior surface of the cornea and the anterior surface of the iris (iridocorneal angle)

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12
Q

What produces the aqueous in the eye?

A

Ciliary body

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13
Q

Where does aqueous leave the eye?

A
  • Trabecular meshwork in the angle

- Enters the episcleral veins

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14
Q

What is normal intraocular pressure?

A

<21mmHg

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15
Q

What is chronic open angle glaucoma?

A

Optic neuropathy where by there is an increase in IOP >21 mmHg, enlargement of the optic disc cup (loss of neurones) and progressive loss of visual field

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16
Q

What sort of vision is characteristic of open-angle glaucoma?

A

Tunnel vision (peripheral visual loss)

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17
Q

Which visual fields do arcuate scotomas begin in?

A

Superior or inferior

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18
Q

What is the 1st line treatment of glaucoma?

A

Topical ophthalmic prostaglandins eg lantanoprost

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19
Q

What classes of medications are used to treat glaucoma other than prostaglandins?

A

Beta-blockers eg timolol
Carbonic anhydrase inhibitors eg dorzolamide
Alpha-2 adrenergic agonists eg brimonidine

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20
Q

What surgical treatment is there for glaucoma?

A

Laser trabeculoplasty

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21
Q

At what part of the retina is visual acuity highest?

A

Macula

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22
Q

Where is the macula located?

A

3mm temporal to the optic disc

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23
Q

What are the 2 types of photoreceptors? Where are they located? What are they responsible for?

A

Rods - Peripheral vision, vision at low light levels (scotopic), not present in fovea centralis of macula
Cones - Central vision, high spatial acuity, vision at higher light levels (photopic vision). Found in the fovea centralis of macula

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24
Q

What 3 things does good visual acuity depend upon?

A
  • Functioning photoreceptors
  • Healthy retinal pigment epithelium
  • Perfusion of the capillary layer of the choroid (the choriocapillaris)
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25
Q

What are drusen?

A

Yellow fatty lipid deposits (waste material from photoreceptors) which accumulates below the retinal pigment epithelium

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26
Q

What is the most common type of age related macular degeneration?

A

Dry AMD

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27
Q

What is the visual loss seen in dry AMD?

A

Central scotoma with good peripheral vision

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28
Q

What is the pathology of dry AMD?

A

Atrophy of the retinal pigment epithelium, choroid and photoreceptors in retina

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29
Q

What can be seen with opthalmoscope in patient with dry AMD?

A

Drusen and retinal pigment clumping /atrophy

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30
Q

What can be seen with opthalmoscope in a patient with wet AMD?

A

Macular drusen
Choroidal neovascular membrane - loads of vessels
Subrential or intraretinal haemorrhage

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31
Q

What percentage of AMD cases are wet AMD?

A

10%

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32
Q

What is the pathology of wet AMD?

A

New vessels in choroid are formed (choroidal neovascularisation)
New vessels leak fluids, lipids and blood into layers behind retina
Localised retinal detachment
Retinal scarring

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33
Q

Visual loss in wet AMD?

A

Blurred vision
Metamorphopsia - straight lines appear wavy
Poor night vision
Central visual loss

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34
Q

What does myopia mean? What type of lens is required to correct it?

A

Short sighted

Concave

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35
Q

What does hyperopia mean? What type of lens is required to correct it?

A

Long sighted

Convex

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36
Q

3 features of glaucoma

A

loss of visual fields
cupping of optic disc
intra ocular hypertension

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37
Q

Side effect of carbonic anhydrase?

A

Fatigue, dyspepsia

Pins and needles

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38
Q

What can make the intraocular pressure appear higher than it is?

A

Thick central cornea - some people are born with this

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39
Q

Treatment options for wet AMD?

A

Laser photocoagulation

Intravitreal anti-VEGF

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40
Q

What is the treatment of early dry AMD?

A

Nutritional therapy - high in antioxidants, carotenoids and omega 3 fatty acids.

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41
Q

What can be seen with opthalmoscope in a patient with diabetic retinopathy?

A

Microaneurysms cause weak cap walls which leak (hard exudates) and bleed (haemorrhages) causing ichaemic infarcts (Cotton wool spots) and neovascularisation

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42
Q

Differential diagnoses for causes of microaneurysms?

A

Diabetes
Retinal vein occlusion
Ocular ischaemia

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43
Q

What are the classifications of diabetic retinopathy in the UK?

A

Background
Background/preproliferative
Preproliferative
Proliferative

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44
Q

What is the management of background diabetic retinopathy?

A

No treatment as not currently sight threatening
Annual review
Investigation of other organs that are affected by diabetes.

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45
Q

What area does the macular cover?

A

A circle whose radius is the distance from the foveola to the temporal edge of the optic disc.

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46
Q

What is diabetic maculopathy and are the causes of visual loss of diabetic maculopathy?

A

Leaky or blocked vessels in macula

Macular oedema
Foveal ischaemia
Foveal haemorrhage

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47
Q

What are the treatment options for diabetic maculopathy?

A

Macular grid laser

Anti VEGF injections - ranibizumab

48
Q

How do you determine the sites of leakage in diabetic maculopathy?

A

Flourescein angiography

49
Q

What are the symptoms of diabetic retinopathy?

A

painless central visual loss

floaters

50
Q

Symptoms of diabetic maculopathy

A

central visual loss - blurring of faces and words

51
Q

Treatment options for proliferative retinopathy?

A

Laser photocoagulation
Anti-VEGF injections
Virectomy surgery

52
Q

What muscle and nerve is responsible for pupillary constriction?

A

Pupillary constrictor muscle

Parasympathetic fibres on CN III

53
Q

What neurotransmitter is involved in pupillary constriction? And which receptors does it bind to?

A

Acetylcholine

M3 muscarinic receptors

54
Q

What muscle is responsible for pupillary dilation and what is it innervated by?

A

Dilator pupillae muscle

Sympathetic fibres carries to the eye via blood vessels

55
Q

What neurotransmitter is involved in pupillary dilation and what receptors does it bind to?

A

Noradrenaline

Alpha 1 adrenergic receptors

56
Q

What nucleus supplies the preganglionic parasympathetic fibres to the eye?

A

Edinger Westphal nucleus (CN III nucleus)

57
Q

What are the 3 pupillary reflexes?

A

Reaction to light - constriction
Reaction to dark - dilation
Reaction to near target - convergence

58
Q

What is anisocoria?

A

Pupils of different sizes

59
Q

What does an afferent pupillary defect indicate there is a problem with?

A

Pupil or optic nerve

60
Q

What does an efferent pupillary defect indicate there is a problem with?

A

CN III or sphincter muscle

61
Q

What are the causes of rapid afferent pupillary defect (RAPD)?

A

Sudden: Retinal vein/artery occlusion, Retinal detachment, GCA
Gradual: Glaucoma, Macular degeneration
Other:
Optic nerve damage eg trauma, radiation, tumour (anterior ischaemic optic neuropathy)
Retinal disease
Optic neuritis
Retinal infection

62
Q

If there was a problem with the retina in the right eye and RAPD was present, what would you expect to see?

A

Pupils equal before illumination
Neither pupil constricts in response to illumination of right eye
Both pupils constrict in response to illumination of left eye
Appearance of right pupil dilating in response to light when illumination changes from left to right, when in actual fact the eyes are returning to normal state after left eye being illuminated.

63
Q

If there was an efferent defect associated with a problem with the right eye, what would you expect to see?

A

Right pupil > left pupil
Right eye will not response to illumination
Left eye constricts in response to illumination from either eye.

64
Q

Causes of anisocoria?

A 
Horner's syndrome
Adie's pupil (efferent defect)
3rd nerve palsy
Drugs eg atropine/pilocarpine
Iris damage eg glaucoma, iritis, surgery
65
Q

Features of horner’s syndrome?

A

Miosis
Ptosis
Anhidrosis
Enophthalmos

66
Q

Features of 3rd nerve palsy

A

Fixed dilated pupil
Ptosis
Eye deviated downwards and out (divergent eye)

67
Q

What is miosis?

A

Constriction of pupil

68
Q

Causes of horner’s syndrome

A

Apical lung tumour eg pancoast tumour
Thyroid surgery
Internal carotid artery dissecting aneurysm
Cavernous sinus and orbital disease

69
Q

Test to confirm horner’s syndrome

A

Cocaine test
Cocaine prevents the reuptake of noradrenaline. It dilates the pupil in the normal eye, but eye affected by horner’s syndrome fails to dilate.

70
Q

Features of Adie’s pupil?

A

Caused by parasympathetic denervation.
Mydriasis (dilated pupil)
Reduced accommodation (blurred vision when reading)
Light near dissociation

71
Q

What is important to exclude with 3rd nerve palsy?

A

Posterior communicating artery aneurysm

72
Q

How is RAPD detected?

A

Swinging torch test

73
Q

What are the 3 layers of the eyeball?

A

Sclera, Choroid, Retina

74
Q

Which muscles are responsible for the focussing of the lens?

A

Ciliary muscles

75
Q

Which muscles are responsible for the dilation and constriction of the iris?

A

Pupillary dilator and pupillary constrictor muscles

76
Q

Which eye conditions are associated with rheumatoid arthritis?

A

Sjogren’s
Episcleritis/sceritis
Anterior uveitis

77
Q

What are the 4 symptoms of Horner’s syndrome?

A

Ptosis
Miosis
Anhydrosis
Enophthalmos

78
Q

What tumour causes a bitemporal hemianopia?

A

Pituitary adenoma - pressing on the optic chiasm

79
Q

What are the causes of Horner’s syndrome?

A

Central: Stroke, MS
Pre-ganglionic: Pancoast tumour
Post-ganglionic: Carotid artery dissection

80
Q

What are the most common cause of bacterial conjunctivitis?

A

Staph aureus
Haeophilus influenza
Staph pneumoniae

81
Q

What antibiotics are used to treat conjunctivitis?

A

1st line: Chloramphenicol

2nd line: Fusidic acid

82
Q

Most common cause of keratitis (corneal ulceration)?

A

Non infectious eg dryness, contact lens injury

83
Q

Most common infectious cause of keratitis?

A

HSV1

84
Q

What are my 7 differentials for red eye?

A 
Conjuntivitis
Keratitis
Episcleritis
Scleritis
Subconjunctival haemorrhage
Anterior uveitis
Acute closed-angle glaucoma
85
Q

What is reiter’s syndrome?

A

Conjunctivitis
Urethritis
Arthritis (reactive)

86
Q

How does keratitis present?

A

Painful red eye
Photophobia
Watery eye
Blurred vision

87
Q

What investigation is specific for keratitis caused by HSV1?

A

Branching dendrite is seen on cornea when using Fluorescein and cobalt blue light

88
Q

Presentation of episcleritis?

A

Can be asymptomatic

Mild pain, redness and irritation

89
Q

How can you tell between episcleritis and scleritis?

A

Episcleritis - mild pain, vessels are mobile and blanch with phenylephrine drops
Scleritis - Severe pain (patient will not let you touch eye) , vessel are not mobile, aderhent to globe and do NOT blanch with phenylephrine drops

90
Q

How do you treat scleritis?

A

Oral NSAIDs
Topical steroid drops
Systemic immunosuppression (corticosteroids/cyclophosphamide)

91
Q

How does subconjunctival haemorrhage present?

A

Harmless collection of blood under conjunctiva, looks a lot worse than it is

92
Q

How does scleritis present?

A

Severe pain
Blurred vision
Photophobia
Headache

93
Q

What conditions is scleritis associated with?

A

Rheumatological disease eg RA, SLE, ank spond, GPA

94
Q

What is a complication of scleritis?

A

Globe perforation

95
Q

Which causes of red eye cause photophobia?

A

Keratitis
Scleritis
Anterior uveitis

96
Q

How do you differentiate between keratitis and anterior uveitis?

A

The redness in anterior uveitis starts at the circumcorneal injection. The pupil may also appear irregular due to the iris sticking to the lens (posterior synechiae).
Branching dendrite might be seen in keratitis when due to HSV1
Talbot’s test is positive in anterior uveitis

97
Q

What is Talbot’s test?

A

Pain increases as the eyes converge and pupils constrict (ask the patient to watch their finger approach their nose)

98
Q

How do you treat anterior uveitis?

A

Steroid eye drops (decreases inflammation)

Cyclopentolate (dilates pupil and prevents iris sticking to lens)

99
Q

What is the pathology behind acute closed-angle glaucoma?

A

Sudden rise in intra-ocular pressure due to lens pushing up against iris and preventing flow of aqueous humour (pupillary block)
Closure of iridocorneal angle preventing drainage
Raised intra-ocular pressure leads to fixed dilated pupil and axonal death

100
Q

What is the presentation of acute closed-angle closure?

A

Extremely red and painful eye
Nausea and vomiting
Glare, halos around lights
Blurred vision

101
Q

What is the management of acute closed-angle glaucoma?

A

IV Carbonic anhydrase inhibitors eg acetazolamide
Topical:
B blockers eg timolol
Steroids
Mitotic eg pilocarpine (constricts pupil to open angle)

102
Q

What investigations are used to diagnose acute closed-angle closure?

A

Fundoscopy
Slit-lamp examination
Tonometry
Gonioscopy (measures angle)

103
Q

What is seen in fundoscopy for acute closed-angle glaucoma?

A

Pale cupped optic disc

104
Q

What are the 5 differentials for sudden loss of vision?

A 
Central retinal artery occlusion
Central retinal vein occlusion
Retinal detachment
Giant cell arteritis
Amourosis Fugax
105
Q

How do you differentiate between ischaumic and non-ischaemic retinal vein occlusion?

A

Fluorescein angiography

106
Q

Complications of ischaemic central retinal vein occlusion

A

Neovascular glaucoma

Retinal detachment

107
Q

Visual acuity is improved with pinhole when it is due to what cause?

A

Refractive error

108
Q

What is seen on fundoscopy for central retinal artery occlusion?

A

Cherry red spot

109
Q

What is the management of central retinal artery occlusion?

A 
Occular massage (<100 mins)
IV Acetazolamide
110
Q

What is seen on funcodscopy for central retinal vein occlusion?

A

Widespread haemorrhages
Swollen optic disc
Stormy sunset appearance

111
Q

What is the treatment of central retinal vein occlusion?

A

No treatment if non-ischaemic

Laser treatment if ischaemic

112
Q

What are the complications of ischaemic central retinal vein occlusion?

A

Neovascular glaucoma

Retinal detachment

113
Q

What is the presentation of retinal detachment?

A

Sudden loss of vision preceded by flashing lights, floaters and visual field defects

114
Q

What are the risk factors for retinal detachment?

A

Trauma
Diabetic retinopathy
Myopic individuals
Previous eye surgery

115
Q

Which artery supplies the optic nerve?

A

Central retinal artery

phase 3b (15 decks)

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