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phase 4 > ophthalmology > Flashcards

ophthalmology Flashcards

1
Q

Describe afferent defect in the pupils

A
  • No direct response, therefore no consensual response in contralateral eye
  • Consensual response intact
  • Dilation on moving light from normal eye to abnormal eye
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2
Q

Cause of afferent defect in pupil

A

CN II lesion

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3
Q

What is a relative afferent pupillary defect

A
  • marcus gunn pupil
  • minor constriction to direct light
  • dilation on moving light from normal eye to abnormal eye
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4
Q

causes of RAPD?

A 
optic neuritis (maybe MS)
optic atrophy
retinal disease (detachment)
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5
Q

symptoms of efferent defect

A
  • dilated pupil does not react to light
  • initiates consensual response in contralateral pupil
  • ophthalmoplegia (paralysis of the muscles) and ptosis
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6
Q

causes of efferent defect

A

3rd nerve palsy

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7
Q

symptoms of a 3rd nerve palsy

A 
ptosis
down and out
dilated pupil (often spared in a vascular lesion e.g. DM) as pupillary fibres run in the periphery
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8
Q

causes of 3rd nerve palsy

A

vascular
DM
compression (tumour, coning)

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9
Q

differential of a fixed dilated pupil

A

mydriatics e.g. atropine
iris trauma
acute glaucoma
CN3 compression (tumour, coning)

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10
Q

symptoms of Holmes Adie pupil

A
  • young woman with sudden blurring of near vision
  • dilated pupil has no or sluggish constriction response to light (accommodation)
  • starts unilaterally then is bilateral
  • then constricted pupils stays constricted for a long time
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11
Q

investigation of holmes adie tonic pupil

A

slit lamp

iris shows spontaneous wormy movements and iris streaming

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12
Q

cause of holmes adie tonic pupil

A
  • damage to post ganglionic parasympathetic fibres

- viral

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13
Q

what is holmes adie syndrome

A

holmes adie pupil (tonic) + absent knee/ankle jerks + decreased BP

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14
Q

symptoms of Horners syndrome

A 
PEAS
ptosis
enophthalmos 
anhydrosis
small pupil (miosis)
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15
Q

causes of horners syndrome

A
  • central - MS, Wallenbergs lateral medullary syndrome
  • pre ganglionic (neck) - pancoasts tumour (T1 nerve root lesion), trauma (from CVA insertion of CEA)
  • post ganglionic - cavernous sinus thrombosis (usually 2ary to spreading facial infection via the ophthalmic veins, CN 3,4,5,6, palsies), carotid artery dissection
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16
Q

investigations in horners

A

CT/MRI head for stroke

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17
Q

symptoms of argyll robertson pupil

A
  • small, irregular pupils
  • accommodate but don’t react to light
  • atrophied and depigmented iris
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18
Q

cause of argyll robertson pupil

A

DM

quaternary syphillis

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19
Q

function of the parasympathetic and sympathetic nervous system in the pupils

A

SNS - causes dilation (therefore issue is horners causes miosis)

PNS - causes constriction (therefore issue is adies tonic pupil causing dilation)

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20
Q

what is miosis and mydriasis

A 
miosis = small
mydriasis = big
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21
Q

causes of bilateral miosis pupils

A

opiates and central pontine haemorrhage

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22
Q

causes of bilateral mydriasis pupils

A

sympathetics (cocaine), antihcolinergics, topical mydriatics (atropine and tropicamide)

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23
Q

symptoms of optic neuritis / neuropathy

A
  • reduced acuity
  • reduced colour vision (esp red) [dyschromotopia]
  • central scotoma (sudden LOV over hours to days)
  • pale optic disc
  • RAPD
  • pain on eye movement
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24
Q

causes of optic neuropathy

A

CCAC VISION

C - common - MS, glaucoma
C - congenital - Leber’s, Friedrichs ataxia, DIDMOAD, retinitis pigmentosa
A - alcohol [and other toxins], lead, ethambutol, B12 def
C - compression - neoplasia, glaucoma, pagets
V - vascular - DM, GCA, thromboembolic
I - inflammatory - MS
S - sarcoid
I - infectious - herpes zoster, TB, syphilis
O - papilloedema
N - neoplastic - lymphoma, leukaemia

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25
Q

investigations in optic neuritis

A

fundoscopy - pale optic disc, optic atrophy
if MS - MRI shows plaques, CSF shows oligoclonal bands, visual evoked potentials shows increased time between visual stimulus and brain response

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26
Q

treatment of optic neuritis

A

high dose methyl-pred IV for 72hrs

then oral pred for 11 days

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27
Q

symptoms of MS

A

optic neuritis - sudden LOV, pain on eye movement, dyschromotopia, RAPD, swollen pale optic disc
UMN signs - spasticity, weakness, brisk reflexes, increased tone
Uthoffs phenomenon - symptoms worse on heat
Lerhmittes sign - voluntary flexing of the head leads to shock sensation down limb
fatigue

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28
Q

treatment of MS

A

acute - steroids
prevent relapse - B-IFN
symptoms - baclofen

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29
Q

pathophysiology of optic neuritis in MS

A

inflammatory demyelination of the optic nerve and oedema in the myelinated nerve sheaths

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30
Q

pathophysiology of acute close angle glaucoma

A

blocked drainage in trabecular meshwork of aqueous humour from anterior chamber via canal of Schlemm

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31
Q

risk factors of acute close angle glaucoma

A
  • hypermetropia (longsighted)
  • shallow anterior chamber
  • female
  • FH
  • age
  • drugs that cause dilation = sympathetics (cocaine), anticholinergics, topical mydriatics (atropine and tropicamide), antihistamines
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32
Q

symptoms of acute closed angle glaucoma

A
  • hazy/dull cornea
  • red and painful eye
  • reduced acuity and blurred vision (peripheral vision loss)
  • N + V
  • prodrome of rainbow haloes around lights (due to swelling of cornea)
  • dilated pupil
  • photophobia
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33
Q

investigations in acute closed angle glaucoma

A
  • fundoscopy = cloudy cornea with circumcorneal injection, fixed/dilated/irregular pupil
  • tonometry = increase IOP >40mmHG
  • gonioscopy = examines anterior angle and trabecular meshwork is not visible
  • slit lamp = large cup, pale optic disc, optic disc atrophy, vertical thinning and notching of neural rim, disc haemorrhage
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34
Q

treatment of acute closed angle glaucoma

A
  • carbonic anhydrase inhibitor = IV acetazolamide to decrease aqueous formation
  • topical BB = timolol to decrease aqueous formation
  • topical cholinergic = pilocarpine to constrict pupil
  • bilateral laser iridotomy = puts hole in iris to bypass pupil and allow aqueous humour flow once IOP has decreased
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35
Q

complications of acute closed angle glaucoma

A

blindness

reoccurrence

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36
Q

pathophysiology of chronic open angle glaucoma

A

increase IOP >21mmHg leads to decreased blood flow and increases pressure on retina and optic nerve to cause damage and optic disc changes

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37
Q

symptoms of chronic open angle glaucoma

A

peripheral vision loss with temporal crescent (tunnel vision), presentation is delayed until optic nerve damage is irreversible

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38
Q

risk factors of chronic open angle glaucoma

A

> 40years, Afro Caribbean, FH, steroids, DM, HTN, migraines, myopia

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39
Q

optic disc changes in chronic open angle glaucoma

A

pale optic disc
optic disc atrophy
vertical thinning and notching of neural rim
disc haemorrhage

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40
Q

investigations of chronic open angle glaucoma

A

tonometry = IOP >21mmHg
fundoscopy = optic disc changes
visual field assessment = peripheral loss

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41
Q

treatment of chronic open angle glaucoma

A 
1 = BB - timolol to reduce aqueous production
2 = prostaglandin analogues - latanoprost to increase uveoscleral outflow 
3 = alpha agonist - brimonidine/apraclonidine to increase outflow and reduce production 
4 = carbonic anhydrase inhibitor - azetazolamide 
5 = mitotics - pilocarpine 
6 = laser trabeculoplasty 
7 = surgical trabeculotomy
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42
Q

function of aqueous humour

A

produced by ciliary bodies to maintain eye shape and nourish the avascular lens and cornea

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43
Q

what is anterior uveitis

A

uvea = pigmented part of the eye, made up of the iris, ciliary body and choroid

iris + ciliary body = anterior uvea

iritis inflammation involves ciliary body too

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44
Q

symptoms of anterior uveitis

A
  • acute painful red eye
  • blurred vision due to precipitates in the aqueous
  • small pupil then irregular oval shape
  • circumcorneal injection
  • hypopyon (pus in anterior chamber)
  • white keratic precipitates on back of cornea due to lymphocytes
  • talbots test +ve (pain on convergence and constriction)
  • unilateral photophobia
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45
Q

causes of anterior uveitis

A
  • HLA B27 seronegative arthropathies e.g. anky spon, IBD, psoriatic arthritis, Reiters
  • autoimmune - sarcoidosis, Behcets
  • malignancy - NH lymphoma, leukaemia
  • infection - TB, syphilis, HSV, CMV, toxoplasmosis
  • stills/JIA
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46
Q

investigations in anterior uveitis

A

slit lamp shows cloudy anterior chamber and hypopyon and keratic precipitate at back of cornea

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47
Q

treatment of anterior uveitis

A
  • ensure not keratitis then give steroids (prednisone drops)

- cyclopentolate (or tropicomide?) to dilate pupil and prevent adhesions between iris and lens (synechiae)

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48
Q

complication of anterior uveitis

A

reoccurrence

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49
Q

differentials of red eye

A

glaucoma, uveitis, scleritis, episcleritis, keratitis, conjunctivitis, orbital cellulitis, allergies, endopathalmitis, foreign body, subconjunctival haemorrhage, blepharitis, chalazion

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50
Q

what is episcleritis and scleritis

A 
e = inflammation below conjunctiva in the episclera
s = vasculitis of the sclera
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51
Q

symptoms of episcleritis

A

local reddening, painless, mild discomfort, acuity preserved

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52
Q

causes of episcleritis

A

idiopathic, RA, SLE

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53
Q

treatment of episcleritis

A

topical or systemic NSAIDs or artificial tears

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54
Q

symptoms of scleritis

A
  • red eye
  • severe pain
  • pain on eye movement
  • conjunctival oedema (chemosis)
  • lacrimation
  • photophobia
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55
Q

causes of scleritis

A

RA, SLE, Wegener’s, SLE, vasculitis

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56
Q

treatment of scleritis

A

specialist input, NSAIDs, oral or topical corticosteroids/immunosuppressants

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57
Q

complications of episcleritis and scleritis

A 
e = can become s
s = scleromalacia (thinning) which leads to globe perforation
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58
Q

how to differentiate between episcleritis and scleritis

A

give phenylephrine drops, blanches in e, stays red in s

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59
Q

symptoms of each type of conjunctivitis

A

bacterial - sticky and purulent
viral - watery and sticky
allergic - watery
chlamydia (ophthalmia neonatorium)

sore, itchy, red eye with no acuity change

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60
Q

causes of each type of conjunctivitis

A

bacterial = staph aureus, chlamydia, gonococcus
viral = adenovirus
allergic

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61
Q

treatment of each type of conjunctivitis

A 
bacterial = chloramphenicol (fusidic acid if pregnant)
viral = self limiting, cold compress, analgesic
allergic = antihistamine e.g. emedastine
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62
Q

complications of conjunctivitis

A

can become bilateral

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63
Q

pathophysiology of a corneal abrasion

A

trauma causes an epithelial breech (no keratitis)

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64
Q

symptoms of corneal abrasion

A

pain, photophobia, blurred vision

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65
Q

investigations in corneal abrasion

A

slit lamp with fluorescein to stain defect green

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66
Q

treatment of corneal abrasion

A

chloramphenicol ointment for infection prophylaxis

analgesia

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67
Q

causes of a corneal ulcer/keratitis

A

bacterial, herpetic, fungal, protozoa, vasculitic (RA), trauma from contact lens

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68
Q

symptoms of corneal ulcer/keratitis

A

pain, photophobia, conjunctival hyperaemia, reduced acuity, white corneal opacity

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69
Q

investigation of corneal ulcer/keratitis

A

slit lamp with fluorescein green

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70
Q

treatment of corneal ulcer/keratitis

A
  • refer to specialist
  • take smears and cultures
  • Abx eye drops/acyclovir
  • mydriatics to ease photophobia
    NO STEROIDS
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71
Q

complications of corneal ulcer/keratitis

A

scarring
blind
amoebic ulcer if given steroids

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72
Q

what causes a dendritic ulcer

A

HSV

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73
Q

causes of a subconjunctival haemorrhage

A

trauma, contact lens, warfarin, spontaneously in the elderly

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74
Q

presentation of subconjunctival haemorrhage

A

sudden, bright red blood with distinct border which resolves spontaneously

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75
Q

investigations in foreign body in eye

A
  • xray orbit if metal

- fluorescein may show corneal abrasion

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76
Q

management of foreign body in eye

A
  • chloramphenicol to prevent infection
  • eye patch
  • cycloplegia drops to decrease pain (tropicamide/cyclopentolate)
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77
Q

what is ophthalmic shingles

A

herpes zoster virus in the ophthalmic division of the trigeminal nerve (CNV1)

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78
Q

symptoms of ophthalmic shingles

A
  • pain in dermatome precedes a blistering rash
  • Hutchinson’s sign (nose to tip zoster due to involvement of nasociliary branch, can mean an increase change of globe involvement as nasociliary nerve also supplies globe)
  • ophthalmic involvement - keratitis and corneal ulceration
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79
Q

treatment of ophthalmic shingles

A

oral/IV antivirals, topical corticosteroids or ophthalmology review if ocular involved

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80
Q

causes of sudden LOV

A

AION, optic neuritis, vitreous haemorrhage, CRAO, CRVO, retinal detachment

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81
Q

key questions in sudden LOV

A

HELLP
headache = GCA
eye movements hurt = optic neuritis
lights/flashes preceding = detached retina
like curtain descending = TIA, GCA
poorly controlled DM = vitreous bleed from new vessels

82
Q

what is anterior ischaemic optic neuropathy (AION)

A

optic nerve damaged if posterior ciliary arteries blocked by inflammation or atheroma

83
Q

causes of AION

A 
arteritic = GCA
non arteritic (atherosclerotic) = HTN, DM, increased lipids, cholesterol
84
Q

causes of a vitreous haemorrhage

A

new vessels from DM, retinal tears/ detachment, trauma, bleeding disorder, myopia (short sighted)

85
Q

symptoms of vitreous haemorrhage

A

small bleeds = small black dots/ring floaters

large bleeds = total vision loss, no red reflex and retina can’t be visualised

86
Q

investigations of vitreous haemorrhage

A
  • B scan US to identify cause
  • fundoscopy
  • slit lamp (shows peeling away from retina)
87
Q

treatment of vitreous haemorrhage

A
  • spontaneous absorption
  • positional (lie flat if superior, sit at 30 degrees if inferior)
  • vitrectomy if dense
  • laser for small tears
88
Q

what causes a posterior viteous haemorrhage

A

age causes the posterior vitreous to shrink and detach from retina leading to flashers/photopsia in peripheral and floaters in temporal

89
Q

symptoms of AION

A

altitudinal field defects

90
Q

treatment of AION

A

treat the cause

91
Q

investigation of AION

A

fundoscopy - pale and swollen optic disc

92
Q

causes of retinal detachment

A

holes in retina, cataracts surgery, trauma, DM

93
Q

symptoms of retinal detachment

A

4Fs

floaters, (spider web)
flashes
field loss (central loss if macula involved, peripheral loss if macula not involved)
fall in acuity (curtain)
painless

RAPD

94
Q

investigations of retinal detachment

A

fundoscopy - grey, opalescent retina, ballooning forward (Schaffer’s sign)

95
Q

treatment of retinal detachment

A

urgent surgery for fixation (vitrectomy and gas tamponade with laser coagulation to secure the retina)
need visual acuity of 6/12 combined to drive

96
Q

causes of transient visual loss

A

TIA, migraine, MS, subacute glaucoma, papilloedema

97
Q

causes of papilloedema

A

overweight, female, young, idiopathic inter cranial HTN, SOL, hypercapnia, hydrocephalus - all lead to increases inter cranial pressure

98
Q

symptoms of papilloedema

A

headache

visual disturbance

99
Q

investigation in papilloedema

A

CT head

fundoscopy - pale and swollen optic disc, loss of optic cup, patrons line, blurred optic disc margin

100
Q

treatment of papilloedema

A

lose weight, treat cause, mannitol, ventricle shunt

101
Q

pathophysiology of CRAO

A

GCA, thromboembolism, DM, HTN, AF causes blockage of retinal artery (basically stroke of retinal artery, TIA is amaurosis fugax)

102
Q

symptoms of CRAO

A

sudden painless LOV in seconds, RAPD, pale retina and cherry red spot macula (as you can see through retina onto choroid)

103
Q

treatment of CRAO

A
  • if <6 hr aim to increase retinal blood flow by decreasing IOP with ocular massage, surgical removal of aqueous and antihypertensive
  • check FBC for ESR in case of GCA
  • IV acetazolamide
  • CT head for stroke
  • prevention = aspirin
  • CO2 rebreathe mask to increase Co2 and vasodilate
104
Q

risk factors of amaurosis fugax

A

male, smoking, alcohol, DM, strokes, GCA

105
Q

symptoms of GCA

A

amaurosis fugax, scalp tenderness, jaw claudication , polymyalgia rheumatica, fever, pale optic disc on fundoscopy due to ischaemia

106
Q

treatment of amaurosis fugax

A

if GCA - ESR and prednisone and PPI and temporal artery biopsy
if stroke - do CT head then aspirin if ichaemic (antiplatelet) and ABCD2 score, may need carotid endarterectomy

107
Q

pathophysiology of CRVO

A
  • raised IOP - due to glaucoma or HTN
  • hyper viscosity - due to polycythaemia
  • vessel wall disease - due to DM or sarcoidosis
108
Q

symptoms of CRVO

A 
sudden painless LOV + RAPD
fundoscopy 
- stormy sunset
- tortuous dilated vessels
- cotton wool spots
- swollen optic disc
- retinal flame haemorrhages
109
Q

investigations in CRVO

A

RAPD

fundoscopy angiography to establish retinal non perfusion and foveal circled integrity

110
Q

complications of CRVO

A

glaucoma and neovascularisation (treat this with laser photocoagulation)

111
Q

treatment of CRVO

A

treat cause, TRIAMANTRISOLVE, anti vegf therapy, dexamethasone implant

112
Q

causes of gradual vision loss

A

diabetic retinopathy, ARMD, cataracts, open angle glaucoma (rare = retinitis pigmentosa, hypertension, optic atrophy)

113
Q

risk factors of ARMD

A

smoking, age, genetic, cardiovascular, female

114
Q

symptoms

A 
central vision loss
decreased night vision
photopsia (flick and flash)
glare
distortion in line perception
115
Q

investigations in ARMD

A

fundoscopy
OCT (optical coherence tomography)
fluorescein angiography
Amsler grid

116
Q

pathophysiology of dry ARMD

A

degeneration of macula leading to drusen deposition

117
Q

pathophysiology of wet ARMD

A

choroidal neovascularisation into retina, has quicker decline than dry

118
Q

fundoscopy in ARMD

A

drusen or neovascularisation
macular haemorrhage leading to scarring
macular oedema
sub retinal haemorrhage

119
Q

treatment of ARMD

A

dry = zinc and antioxidant vitamins A/C/E in early
wet = laser photodynamic therapy,, intravitreal VEGF inhibitors e.g. ranibizumab
smoking cessation

120
Q

what is retinitis pigmentosa

A

inherited degeneration of the macula (AR, AD (best), X linked (worst)

121
Q

symptoms of retinitis pigmentosa

A

night blindness
tunnel vision (due to loss in peripheral retina)
blind by mid 30s
(night -> peripheral -> colour -> tunnel)

122
Q

fundsocopy on retinitis pigmentosa

A

pale optic disc due to optic atrophy
black bone spicule in peripheral macula
peripheral retina pigmentation spares the macula

123
Q

what is retinitis pigmentosa associated with

A

friedrichs ataxia
refuses disease
kearns sayre syndrome
ushers syndrome

124
Q

treatment of retinitis pigmentosa

A

refer to opthalmology
genetic counselling
DVLA
vit A

125
Q

what is tobacco-alcohol amblyopia

A

caused by the toxic effects of cyanide radicals when combined with thiamine deficiency, leads to optic atrophy, loss of red/green discrimination and scotomata (vitamins may help)

126
Q

types of eye disease in diabetes

A

cataracts
retinopathy
cranial nerve palsies may occur

127
Q

pathophysiology of cataracts in diabetes

A

lens absorbs glucose which is converted to sorbitol by aldose reductase, accelerating cataracts formation

128
Q

pathophysiology of retinopathy in diabetes

A

leads to microangiopathy, which causes occlusion
occlusion leads to ischaemia with new vessel formation in retina, bleeds and vitreous haemorrhage, retinal detachment, cotton wool spots, oedema and lipid exudates vascular leakage, blot haemorrhage due to rupture of micro aneurysms

129
Q

what is involved in diabetic eye screening

A

annual screening with fundus photography, and refer those with maculopathy, non proliferative and proliferative to ophthalmology

130
Q

what does background retinopathy show on fundoscopy

A

LEAKAGE
dots - micro aneurysm
blot haemorrhage
hard yellow lipid exudates

131
Q

what does pre proliferative retinopathy show on fundoscopy

A 
ISCHAEMIA
cotton wool spots (infarcts)
venous bleeding 
dark haemorrhages 
intra retinal microvascular abnormalities
132
Q

what does proliferative retinopathy show on fundoscopy

A

new vessels
pre retinal or vitreous haemorrhage
retinal detachment

133
Q

what does maculopathy show on fundoscopy

A

MACULAR OEDEMA

decreased acuity with hard exudates within one disc width of macula

134
Q

investigations in diabetic retinopathy

A 
fundoscopy
fluorescein angiography to assess damage 
B scan 
snellens test for acuity 
optical coherence tomography
135
Q

treatment of diabetic retinopathy

A

good BP, glycemic control, treat co-morbidities
laser photocoagulation (maculopathy =focal/grid and proliferative = pan retinal as macula spared)
antivegf

136
Q

what is vegf

A

expressed in hypoxia and promotes vascular endothelial cell mitosis and increases retinal capillary permeability

137
Q

6th cranial nerve palsy symptom and pathophysiology

A

abducent nerve - controls lateral rectus and unable to abduct the eye so medially deviated and diplopia in horizontal plane

138
Q

3rd cranial nerve palsy symptom and pathophysiology

A

oculomotor nerve - controls lateral rectus and superior oculomotor so appears down and out and fixed dilated pupil

139
Q

causes of cataracts

A

diabetes, age, steroids, congenital, uv light

140
Q

congenital causes of cataracts

A

rubella, wilsons, myotonic dystrophy

141
Q

symptoms of cataracts

A

blurred vision, increasing myopia, cloudy lens, faded colours, dazzling in bright lights, monocular diplopia

142
Q

pathophysiology of cataracts

A

opacification of the lens

143
Q

investigations in cataracts

A 
DILATED fundoscopy
snellens for visual acuity 
tonometry 
blood glucose to exclude DM
slit lamp shows defected red reflex and visible cataracts
144
Q

treatment of cataracts

A

glasses, sunglasses, mydriatic drops

surgery - phaecoemulsion and lens implant

145
Q

complications of cataracts surgery

A

anterior uveitis, vitreous haemorrhage, retinal detachment, secondary glaucoma, endopthalmitis, post op capsule thickening, post op eye irritation

146
Q

things to look at when looking at optic disc

A

colour, contour, cup

147
Q

pathophysiology of retinoblastoma

A

intraocular tumour in tumour, AD

148
Q

symptoms of retinoblastoma

A

stabismus
leukocoria (white pupil)
no red reflex
can leads to osteosarcoma and rhabdomyosarcoma

149
Q

treatment of retinoblastoma

A

depends on size, chemo/radio/enucleation

150
Q

what is a stye

A

an abscess/infection in a lash follicle which points outward

151
Q

treatment of stye

A

fusidic acid or regular warm swelling

152
Q

what is a chalazion

A

abscess of the meibomian glands which points inwards onto conjunctiva (sebaceous gland of eyelid)

153
Q

what is blepharitis

A

chronic inflammation of eyelid leading to red eyes, gritty/itchy, scales on lashes

154
Q

causes of blepharitis

A

seoborrhoeic dermatitis, staphs, rosacea

155
Q

treatment of blepharitis

A

fusidic acid drops, regular warming, lubricants, lid hygiene

156
Q

what is an entropion

A

lid INversion leading to corneal irritation and degeneration of lower lid fascia

157
Q

what is an ectropion

A

low lid Eversion leading to watering and exposure keratitis

158
Q

treatment of entropion

A

surgical correction

159
Q

causes of exophthalmos

A

graves, orbital cellulitis, trauma, wegeners, neoplasm

160
Q

pathophysiology of orbital cellulitis

A

infection from local spread (paranasal sinuses, eyelid, external eye) - staphs, pneumococcus

161
Q

symptoms of orbital cellulitis

A 
child with inflammation of orbit and lid swelling
painful eye movements
exophthalmos 
systemic signs
tender sinuses
162
Q

treatment of orbital cellulitis

A

IV antibiotics

163
Q

complications of orbital cellulitis

A 
local extension (meningitis and cavernous sinus thrombosis)
blindness due to optic nerve pressure
164
Q

symptoms of cavernous sinus thrombosis

A

fever and orbital cellulitis, loss of eye movements

165
Q

what is lagophthalmos, pinguecula, pterygium, carotico caervnous fistula

A

?

166
Q

treatment / cause of myopia (short sight)

A

concave lenses as distant objects are focussed too far fowards (caused by genetics or excessive close work in early decades)

167
Q

whats astigmatism

A

cornea or lens does not have the same degree of curvature in horizontal and vertical planes causing image of object to be distorted - need correcting lenses

168
Q

treatment / cause of hypermetropia (long sight)

A

eye is too short so when eye is relaxed and not accommodating, objects are focussed behind the retina - need convex lens

169
Q

what is presbyopia

A

with age, lens becomes stiff and less easy to deform, need convex lens

170
Q

what is an esotropia

A

a convergent squint (towards nose) - idiopathic or hypermetropia

171
Q

what is an exotropia

A

a divergent squint (towards temporals)

172
Q

2 types of squint

A

paralytic - paralysis of extraocular muscles

concomitant - imbalance in extra ocular muscles

173
Q

diagnosis of non paralytic squint

A

corneal reflection and cover test

174
Q

management of non paralytic squint

A

3 O’s

optical - correct refractive errors
orthoptic - patching good eye encourages use of squinting eye
operations - resection and recession of rectus muscles

175
Q

causes of cranial nerve palsies

A

diabetes, MS, infarction, increased ICP, compression, vascular, SOL, cavernous sinus thrombosis

176
Q

symptoms of cranial nerve 4 palsy

A

diplopia on going down stairs, head tilt and can’t depress in adduction

177
Q

causes of floaters

A

retinal detachment
vitreous haemorrhage
diabetic retinopathy
old retinal branch vein occlusion

178
Q

causes of flashes

A

migraine

retinal detachment

179
Q

causes of haloes

A

acute glaucoma
cataracts
corneal oedema
migraines

180
Q

treatment of allergic eye disorders

A 
remove allergen
cold compress
artificial teats
oral antihistamines 
topical antihistamines (eye drops)
mast cell stabilizers
steroids 
saids (diclofenac)
181
Q 
allergic eye disease
trachoma
onchocerciasis (river blindness)
xerophthalmia 
keratomalacia
A

?

182
Q

symptoms of Miller fisher

A

ophthalmoplegia, ataxia an areflexia

183
Q

symptoms of intranuclear ophthalmoplegia

A

nystagmus as can’t abduct affected eye

184
Q

causing on hypertensive retinopathy

A 
uncontrolled HTN
phaechromocytoma
renal artery stenosis
cushings
conns
185
Q

symptoms of hypertensive retinopathy

A

poor acuity

eye floaters

186
Q

fundoscopy in hypertensive retinopathy

A

1) tortuosity and silver wiring
2) av nipping
3) flame haemorrhages
soft/cotton wool spots
4) papilloedema

187
Q

eye defects depending on lesion location

A 
scotoma - tunnel vision
optic nerve - unilateral vision loss
optic chasm - bitemporal hemianopia 
optic tract - homonymous hemianopia 
optic radiation - homonymous quadrantopia
188
Q

what are photoreceptors

A

in the retina rods and cones
rods = outer retina for night vision
cones = central retina for colour vision and acuity

189
Q

treatment of hypertensive retinopathy

A

control HTN
manage stroke risk
regular eye check
don’t drop BP too quick

190
Q

eye disease in granulomatous disorders

A

TB, sarcoid, toxo, leprosy all can cause uveitis and choroidoretinitis

191
Q

systemic inflammatory disease causing conjunctivitis

A

SLE, reactive arthritis, IBD

192
Q

systemic inflammatory disease causing scleritis

A

RA, vasculitis, SLE, IBD

193
Q

systemic inflammatory disease causing iritis

A

anky spon, IBD, sarcoid

194
Q

systemic inflammatory disease causing retinopathy

A

dermatomyositis

195
Q

symptoms of CMV retinitis

A

pizza pie fundus and flames

196
Q

symptoms of HIV retinopathy

A

cotton wool spots

197
Q

examples of mydriatics

A

tropicamide

198
Q

examples of mitotics

A

pilocarpine

199
Q

orbital blowout fracture
intra ocular haemorrhage
chemical injury

A

?

200
Q

blood supply of the eye

A

ophthalmic artery

central retinal artery

phase 4 (19 decks)

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