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Year 3 ICSM Sofia > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is cataracts?

A

Opacification of the lens of the eye

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2
Q

What is the aetiology of cataracts?

A

Majority of cases are idiopathic age-related (senile cataracts). Numerous secondary causes including:

  • Local: Previous eye trauma, uveitis, intraocular tumours
  • Systemic: DM, metabolic disorders (hypocalcaemia, Wilsons disease), skin disease (atopic dermatitis, scleroderma), drugs (steroids), X-ray and UV radiation, myotonic dystrophy, genetic syndromes (Down’s)
  • Congenital: Congenital rubella syndrome
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3
Q

What is the aetiology of cataracts?

A

Major cause of treatable blindness worldwise

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4
Q

What are the presenting symptoms of cataracts?

A
  • Gradual onset painless loss of vision
  • Glare from bright light, vision may worsen in bright light (especially with central lens opacity)
  • May experience monocular diplopia and see haloes around lights
  • May notice that they can read without glasses (nuclear sclerotic cataract may increase lens-converging power)
  • In infants, may be amblyopia or nystagmus
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5
Q

What are the signs of cataracts on examination?

A
  • Loss of reflex and hazy lens appearance

- Reduced visual acuity

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6
Q

What are the investigations for cataracts?

A

Unnecessary unless occurring at an early age or in background of systemic disease

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7
Q

What is conjunctivitis?

A

Inflammation of the lining of the eyelids and eyeball caused by bacteria, viruses, allergic or immunological reactions, mechanical irritation or medicines

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8
Q

What is the aetiology of conjunctivitis?

A
  • Most common bacterial pathogens in infective include Pneumococcus, Staphylococcus aureus, M. catarrhalis and H. influenzae
  • Viral: adenovirus, herpes simplex, Epstein-Barr, varicella zoster and enteroviruses
  • Contact lens wear may lead to a keratoconjunctivitis
  • Mechanical caused by chronic conjunctival irritation especially while sleeping.
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9
Q

What is the epidemiology of conjunctivitis?

A

Commonly affects males and females of all ages

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10
Q

What are the presenting symptoms of conjunctivitis?

A
  • Watery discharge
  • Itchy predominant symptom
  • Eyelids stuck together
  • Eyelids stuck together in mornings
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11
Q

What are the signs of conjunctivitis on examination?

A
  • Ropy, mucoid discharge
  • Prululent discharge
  • Tender, pre-auricular lymphadenopathy
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12
Q

What are the risk factors for conjunctivitis?

A
  • Exposure to infected person
  • Infection in one eye
  • Environmental irritants
  • Allergen exposure
  • Camps, swimming pools, military bases
  • Asian or Mediterranean young male
  • Atopy
  • Contact lens use
  • Ocular prosthesis
  • Mechanical irritation
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13
Q

What are the investigations for conjunctivits?

A
  • Rapid adenovirus immunoassay: 2 visual lines equal positive
  • Cell culture
  • Gram stain
  • PCR
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14
Q

What is glaucoma?

A

Optic neuropathy with typical field defect usually associated with ocular hypertension (intraocular pressure more than 21mmHg)

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15
Q

What is the aetiology of glaucoma?

A
  • Primary causes: Acute close angle glaucoma (ACAG), primary open-angled glaucoma (POAG), chronic closed-angle glaucoma
  • Secondary causes: Trauma, uveitis, steroids, rubeosis iridis (diabetes, central retinal vein occlusion)
  • Congenital: Buphthalmos, other inherited ocular disorders
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16
Q

What is the epidemiology of glaucoma?

A
  • Prevalence 1% in over 40 years
  • 10% over 80 yrs (POAG)
  • 3rd most common cause of blindness worldwide
17
Q

What are the presenting symptoms of glaucoma?

A
  • ACAG: Painful red eye, vomiting, impaired vision, haloes around lights
  • POAG: Usually asymptomatic, peripheral visual field loss may be noticed
  • Congenital: Bupthalmos (ox eye), watering, cloudy cornea
18
Q

What are the signs of glaucoma on examination?

A

By slit-lamp

  • ACAG: Red eye, hazy cornea, loss of red reflex, fixed and dilated pupil, eye tender and hard on palpation, cupped optic disc, visual field defect (arcuate scotoma), moderately raised IOP
  • POAG: Optic disc may be cupped. Usually no signs
19
Q

What are the investigations for glaucoma?

A
  • Goldman Applanation Tonometry: standard exam to measure ocular pressure
  • Pachymetry: Detect pathologically cupped disc
  • Gonioscopy: Assess to iridocorneal angle
  • Perimetry (visual field testing): For arcuate scotoma (early), tunnel vision (late)
20
Q

What is uveitis?

A

Inflammation of the iris and ciliary body (iritis or iridocyclitis)

21
Q

What is the aetiology of uveitis?

A
  • Anterior uveitis may be caused by infection (e.g. herpes simplex, herpes zoster)
  • Can occur as manifestation of systemic inflammatory conditions e.g. juvenile chronic arthritis, HLA B27-related spondyloarthritides, sarcoidosis, Behcet’s disease
22
Q

What is sympathetic ophthalmia?

A

Inflammation of the contralateral eye weeks/months after penetrating injury (rare)

23
Q

What is the epidemiology of uveitis?

A
  • Associated with sponduloarthritis

- 2x more common in males

24
Q

What are the presenting symptoms of uveitis?

A
  • Pain (ciliary spasm and inflammation, pain increases on accommodation)
  • Photophobia
  • Red eyes
  • Blurred vision
  • Lacrimation
  • May rarely be associated with tubulointerstitial nephritis (flank pain, haematuria, proteinuria, sterile pyuria and acute renal failure)
25
Q

What are the signs of uveitis on examination?

A
  • Reduced visual acuity
  • Ciliary flush (redness may be confined to the corneoscleral junction
  • Hyponyon (proteinaceous exudate and inflammatory cells in the inferior angle of the anterior chamber)
  • Small irregular due to posterior synechiae (adhesions of the iris to the lens)
26
Q

What are the signs of uveitis with a slit lamp?

A

Keratic precipitates (deposits of leucocytes of the corneal endothelium)

27
Q

What are the signs of uveitis with fundoscopy?

A

Excludes retinal detachment

Posterior inflammation or a tumour that may give rise to anterior uveitis

28
Q

What are the signs of the complications of uveitis?

A
  • Raised intraocular pressure

- Cataract

29
Q

What are the investigations for uveitis?

A

Investigate for associated systemic conditions depending on associated symptoms:

  • U&E’s
  • Spondyloarthritides (sacroiliac joints X-ray, HLA typing)
  • Sarcoidosis (CXR, serum calcium, serum ACE)
  • Syphilis serology

Year 3 ICSM Sofia (16 decks)

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