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ophthalmology Flashcards

1
Q

rash in trigeminal distribution on right

A

herpes zoster opthalmicus. oral antivirals, maybe topical steroid, ocular involvement see ophthalm
Hutchinson’s sign: vesicles extending to the tip of the nose. This is strongly associated with ocular involvement in shingles

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2
Q

horners syndrome

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

can be caused by pancoasts tumour (apical lung- can cause pain)

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3
Q

vitreous haemorrhage risk factors

A 
Diabetes
Trauma
Anticoagulants
Coagulation disorders
Severe short sightedness

presents with sudden vision loss and dark spots

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4
Q

scleritis

A 
features
red eye
painful (episcleritis is not)
watering and photophobia
gradual decrease in vision
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5
Q

types of stye

A

external (hordeolum externum): infection (usually staphylococcal) of the glands of Zeis (sebum producing) or glands of Moll (sweat glands).
internal (hordeolum internum): infection of the Meibomian glands. May leave a residual chalazion (Meibomian cyst)

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6
Q

argyll roberston pupil

A

prostitutes pupil- neurosyphillis

no response to light but constriction on accomodation

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7
Q

herpes simplex keratitis

A 
red, painful eye
photophobia
epiphora
visual acuity may be decreased
fluorescein staining may show a dendritic epithelial ulcer
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8
Q

HLA B27

A

anterior uveitis

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9
Q

cheese and tomato pizza

A

central retinal vein occlusion

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10
Q

Tx for anterior uveitis

A

Anterior uveitis is most likely to be treated with a steroid + cycloplegic (mydriatic) drops

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11
Q

wet vs dry age related macular degeneration

A

dry (90% of cases, geographic atrophy) macular degeneration: characterised by drusen - yellow round spots in Bruch’s membrane
wet (10% of cases, exudative, neovascular) macular degeneration: characterised by choroidal neovascularisation. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. Carries worst prognosis

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12
Q

Holmes-Adie pupil

A

unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light

Holmes-Adie syndrome
association of Holmes-Adie pupil with absent ankle/knee reflexes

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13
Q

central retinal artery occlusion

A

causes sudden unilateral visual loss
due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
features include afferent pupillary defect, ‘cherry red’ spot on a pale retina

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14
Q

Tunnel vision

causes

A 
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
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15
Q

types of glaucoma associate with which vision changes

A

acute angle closure- hypermetropia

primary open angle- myopia

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16
Q

acetazolamide

A

carbonic anhydrase inhibitor

17
Q

screening for glaucoma

A

yearly if family history of primary open angle glaucoma from age 40

18
Q

stages of hypertensive retinopathy

A 
I	Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
II	Arteriovenous nipping
III	Cotton-wool exudates and blot haemorrhages
IV	Papilloedema
19
Q

glaucoma medication

A 
Medication	Mode of action	Notes
Prostaglandin analogues (e.g. latanoprost)	Increases uveoscleral outflow	Once daily administration

Adverse effects include brown pigmentation of the iris, increased eyelash length

Beta-blockers (e.g. timolol, betaxolol) Reduces aqueous production Should be avoided in asthmatics and patients with heart block

Sympathomimetics (e.g. brimonidine, an alpha2-adrenoceptor agonist) Reduces aqueous production and increases outflow Avoid if taking MAOI or tricyclic antidepressants

Adverse effects include hyperaemia

Carbonic anhydrase inhibitors (e.g. Dorzolamide) Reduces aqueous production Systemic absorption may cause sulphonamide-like reactions

Miotics (e.g. pilocarpine, a muscarinic receptor agonist) Increases uveoscleral outflow Adverse effects included a constricted pupil, headache and blurred vision

20
Q

glaucoma guidelines

A

first line: prostaglandin analogue (PGA) eyedrop
second line: beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop
if more advanced: surgery or laser treatment can be tried2

21
Q

Periorbital (preseptal) vs Orbital cellulitis

A

Absence of painful movements, diplopia and visual impairment indicates the former

22
Q

squint features

A

Concomitant
Due to imbalance in extraocular muscles
Convergent is more common than divergent

Paralytic
Due to paralysis of extraocular muscles

23
Q

squint names

A

the nose: esotropia

temporally: exotropia
superiorly: hypertropia
inferiorly: hypotropia

24
Q

management of ARMD

A

fluorescein angiography is utilised if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy. This may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation.
zin +vit acd
laser photocoag

25
Q

types of diabetic retinopathy

A

Mild NPDR
1 or more microaneurysm

Moderate NPDR
microaneurysms
blot haemorrhages
hard exudates
cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR

Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant

26
Q

night blindness and tunnel vision

A

retinitis pigmentosa fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

27
Q

causes of cataracts

A 
Smoking
Increased alcohol consumption
Trauma
Diabetes mellitus
Long-term corticosteroids
Radiation exposure
Myotonic dystrophy
Metabolic disorders: hypocalcaemia
28
Q

causes of papilloedema

A 
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
29
Q

retinal artery occlusion

A

due to thromboembolism or arteritis

features include afferent pupillary defect, ‘cherry red’ spot on a pale retina

revision (24 decks)

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