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5th Year > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is myopia?

A

Short-sightedness

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2
Q

Are eyes longer or shorter in myopia?

A

Longer

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3
Q

What is hypermetropia?

A

Long-sightedness

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4
Q

Are eyes longer or shorter in hypermetropia?

A

Shorter

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5
Q

Where does light focus in myopia?

A

In front of retina

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6
Q

Where does light focus in hypermetropia?

A

Behind the retina

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7
Q

What is an astigmatism?

A

Imperfect curvature of cornea so can’t focus on retina properly

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8
Q 
What is the diagnosis?
Unilateral worsening eye pain
Decreased visual acuity
Red eye
Nausea and headache
A

Acute Closed Angle Glaucoma

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9
Q

What is a glaucoma?

A

Optic neuropathy associated with raised intraocular pressure

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10
Q

Where is aqueous humour normally produced?

A

Ciliary bodies (behind iris)

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11
Q

Where does aqueous humour normally drain?

A

Trabecular meshwork

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12
Q

Where is the trabecular meshwork?

A

Angle between the iris and cornea

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13
Q

What happens to in glaucoma to cause the raised intraocular pressure?

A

Iris pushes against the cornea and blocks the trabecular meshwork -> humour can’t drain

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14
Q

What happens in open-angle glaucoma?

A

Drainage through trabecular meshwork is reduced/obstructed over -> gradual build up of humour

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15
Q

What happens in closed-angle glaucoma?

A

Iris is compressed against the cornea -> blocks trabecular meshwork -> humour can’t drain -> acute rise in pressure

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16
Q

What are some symptoms of ACAG? (5)

A 
Unilateral worsening eye pain with worsening vision
Halos around light
Red eye
Severe headache
Nausea
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17
Q

What are some signs of ACAG? (4)

A

Fixed semi-dilated pupil
Hazy cornea
Shallow anterior chamber on slit lamp
Hard to palpate (increased IOP)

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18
Q

What happens to the optic disc in glaucoma?

A

Increased cup:disc ratio

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19
Q

What is a normal cup:disc ratio?

A

<0.5

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20
Q

What are some causes of ACAG? (5)

A 
Hypermetropia
Pupil dilation
Family Hx
Medications
Trauma
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21
Q

Give 3 examples of pupil dilation?

A

Dim lights
Exercise
Eye drops

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22
Q

Which 3 drugs are associated with ACAG?

A

SSRIs
TCAs
Ipratropium

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23
Q

What is the general management of ACAG?

A

Urgent ophthalmology referral
Avoid dark rooms
Medical Mx
?Surgery

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24
Q

What the medical management of ACAG? (3)

A

Reduce aqueous production = IV acetazolamide
Induce pupillary constriction = topical pilocarpinene
Beta-blocker = topical timolol

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25
Q

What surgical intervention may be appropriate in ACAG?

A

Peripheral iridotomy

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26
Q

What are 2 important complications of ACAG?

A

Central retinal artery occlusion

Central retinal vein occlusion

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27
Q

What may you see on fundoscopy with central retinal artery occlusion?

A

Cherry red spots

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28
Q

Other than ACAG, what else is central retinal artery occlusion associated with?

A

Giant cell arteritis

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29
Q

What is the management of central retinal artery occlusion?

A 
<4hrs = massage to move embolism
>4hrs = unlikely to regain vision
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30
Q

What is the hallmark feature of central retinal vein occlusion?

A

Sudden painless vision loss

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31
Q

What is primary open angle glaucoma?

A

Trabecular meshwork has reduced outflow

Iris is not obstructing meshwork

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32
Q

How common is POAG?

A

Present in 2% >40yrs
Symptomatic in 0.5% >40yrs
Present in 10% >80yrs

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33
Q

What are some risk factors for POAG? (5)

A 
Genetics - 16% in 1st-degree relatives
Black people
HTN
DM
Steroid use
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34
Q

When is POAG most often diagnosed?

A

Opticians

Insidious onset

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35
Q

What is the definition of raised IOP?

A

> 24mmHg

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36
Q

What is the 1st line management for POAG?

A

Latanoprost eyedrops (prostaglandin analogue)

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37
Q

What are the 2nd line management options for POAG?

A

Beta-blockers
Carbonic anhydrase inhibitor
Sympathomimetic eye drops

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38
Q

What is the surgical option for POAG?

A

Iridotomy

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39
Q

How does latanoprost work?

A

Increases uveoscleral outflow

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40
Q

What are some side effects of latanoprost?

A

Brown pigmentation of iris

Increased eyelash length

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41
Q

How do beta-blockers work in glaucoma?

A

Reduce aqueous production

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42
Q

How do sympathomimetics work in glaucoma? (eg. brimonidine)

A

Reduce aqueous production and increases outflow

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43
Q

How do carbonic anhydrase inhibitors work in glaucoma? (eg. acetazolamide)

A

Reduce aqueous production

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44
Q

How do miotics work in glaucoma? (eg. pilocarpine)

A

Increase uveoscleral outflow

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45
Q

What is the diagnosis?

Gradual painless vision loss with halos around lights

A

Cataracts

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46
Q

What is a cataract?

A

Deposition of aggregated proteins in lens -> disruption of crystalline fibres -> cloudy

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47
Q

What causes acquired cataracts? (6)

A 
Ageing
Trauma
Diabetes
Long-term steroids
Alcohol
Smoking
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48
Q

What causes congenital cataracts?

A

TORCH infections

Down’s syndrome

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49
Q

What sign may indicate a cataract?

A

Loss of red reflex

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50
Q

What happens to the rest of the eye?

A

Fundus, retina and pupil all remain normal and functional

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51
Q

What are the 3 types of cataracts?

A

Cortical cataracts
Nuclear cataracts
Posterior capsule cataracts
(Polar cataracts)

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52
Q

What are cortical cataracts?

A

Cataract of lens cortex

Starts in periphery and develops inwards = spoke-like

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53
Q

What are nuclear cataracts?

A

Cataract in the centre part of the lens

Most common in elderly patients

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54
Q

What is a posterior capsule cataract?

A

Cataract at the back of the lens

Associated with diabetes and steroids

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55
Q

Which cataract is most associated with ageing?

A

Nuclear cataract

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56
Q

What cataract is most associated with diabetes and steroid use?

A

Posterior capsule cataract

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57
Q

Which cataract is is the most likely to give the halo effect?

A

Posterior capsule cataract

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58
Q

What is the non-surgical management of cataracts?

A

Stronger glasses

Brighter lights

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59
Q

What is the surgical management of cataracts?

A

Phacoemulsification and replacement of lens

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60
Q

Does someone with cataracts need to stop driving?

A

No - need to be cleared by doctor though

Do NOT need to tell DVLA

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61
Q

What are the complications of phacoemulsification? (4)

A

Posterior capsule opacification = thickening of lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis = inflammation of aqueous and/or vitreous

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62
Q

What is Marcus Gunn pupil?

A

Relative Afferent Pupillary Defect (RAPD)

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63
Q

How do you test for RAPD?

A

Swinging light test

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64
Q

What does the swinging light test test?

A

Afferent fibres of optic nerve (CN2)

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65
Q

What happens in a positive swinging light test?

A

Pupil constricts less when light is swung from unaffected eye to affected eye

Affected pupil appears to dilate when light shone into it

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66
Q

What is the diagnosis?
Diffusely red and mydriatic eye
Reduced vision
Discharge

A

Corneal ulcer (keratitis)

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67
Q

What is the most common bacterial cause of corneal ulcers?

A

Staph aureus

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68
Q

What is the hallmark feature of herpetic corneal ulcers?

A

Dendritic appearance on fluorescein staining

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69
Q

What are the fungal causes of corneal ulcers?

A

Candida

Aspergillus

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70
Q

What is a protozoal cause of corneal ulcers?

A

Acanthamoeba

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71
Q

What is a specific risk factor for acanthamoeba corneal ulcers?

A

Contact lenses

Specifically showering in them as acanthamoeba lives in water

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72
Q

What are the parasitic causes of corneal ulcers?

A

Onchocercal keratitis = ‘river blindness’

Found mainly in central/sub-saharan Africa and Yemen

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73
Q

What is a non-infective cause of corneal ulcers?

A

Rheumatoid A

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74
Q

What is the biggest risk factor for corneal ulcers?

A

Contact lenses

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75
Q

What are 4 other risk factors for corneal ulcers?

A

Trauma
Steroid use
Sjogren’s syndrome
Ectropion

76
Q

What is the management of corneal ulcers?

A

Same-day ophthalmology referral
For slit lamp with 1% fluorescein
Stop wearing make-up and contact lenses
Treat cause

77
Q

What are some topical antibacterial drops?

A

Chloramphenicol (Gram +ve)

Ofloxacin (Gram -ve)

78
Q

Which topical Abx drop has Gram +ve cover?

A

Chloramphenicol

79
Q

Which topical Abx drop has Gram -ve cover?

A

Ofloxacin

80
Q

Which other topical eye drop can be used in the management of corneal ulcers?

A

Steroids

Reduce swelling and scarring

81
Q

What is cornea verticillata?

A

Corneal deposits on basal epithelium -> faint golden-brown whorl

82
Q

What causes cornea verticillata?

A

Amiodarone (prolonged use)

Also Fabry disease (lysosomal storage disease, X-linked)

83
Q

What is the correct name for a stye?

A

Hordeolum

84
Q

What typically causes a hordeolum?

A

Obstruction and infection of eyelash follicle

Generally staph infection

85
Q

How does a hordeolum present?

A

Tender lid margin swelling

86
Q

What is the management of a hordeolum?

A

Lash removal and drainage

Warm compress and gentle massage

87
Q

When might you use topical Abx with a hordeolum?

A

Only if associated conjunctivitis

88
Q

What should you refer to ophthalmology regarding a hordeolum?

A

Visual changes

Cellulitis

89
Q

What is a chalazion?

A

Blocked Meibomian gland = Meibomian cyst

90
Q

What is the difference in location between a hordeolum and a chalazion?

A 
Hordeolum = on eyelash follicle
Chalazion = above eyelashes on upper lid, generally
91
Q

What is the difference in symptoms between a hordeolum and a chalazion?

A 
Hordeolum = tender swelling
Chalazion = firm, painless lump
92
Q

What is the difference in management between a hordeolum and a chalazion?

A

Not much difference

Chalazions may require surgical

93
Q

What is the difference between internal and external hordeolums?

A 
Internal = infection of Meibomian gland
External = infection of glands of Zeis or glands of Moll
94
Q

What is Purtscher retinopathy?

A

Ischaemic retinopathy as a side effect of acute pancreatitis

95
Q

What is conjunctivitis?

A

Inflammation of conjunctiva

96
Q

How might conjunctivitis present?

A

Sore, red eye associated with discharge
No change in vision
Not intense pain

97
Q

What are the 3 types of conjunctivitis?

A

Bacterial
Viral
Allergic

98
Q

What might suggest a bacterial conjunctivitis?

A

Mucopurulent discharge

99
Q

What are the main causes of bacterial conjunctivitis?

A

S aureus
Gonococcal
Chlamydia - neonates

100
Q

What might suggest a viral conjunctivitis?

A

Watery discharge
URTI
Preauricular LN involvement

101
Q

What are the main causes of viral conjunctivitis?

A

Adenovirus
HSV
Molluscum contagiosum

102
Q

What might suggest an allergic conjunctivitis?

A 
Bilateral redness
Itching
Swollen eyelids
Cobblestoning chemosis
May have trigger
May get white stringy discharge
103
Q

What is the management of bacterial conjunctivitis?

A

Swab if sticky
Chloramphenicol drops
Resolves in 2 weeks

104
Q

What eye drops are an alternative to chloramphenicol for pregnant women?

A

Fusidic acid

105
Q

What is the management of allergic conjunctivitis?

A

1st line = antihistamines

2nd line = topical mast cell stabilisers

106
Q

What is deposited in Dry Age-Related Macular Degeneration?

A

Drusen

107
Q

What are the 4 stage of diabetic retinopathy?

A

Background
Pre-proliferative
Proliferative
Maculopathy

108
Q

What are the features of background diabetic retinopathy?

A

Dot and blot haemorrhages = microaneurysms

Hard exudates

109
Q

What are the features of pre-proliferative diabetic retinopathy?

A

Cotton wool spots

110
Q

What are the features of proliferative diabetic retinopathy?

A

Neovascularisation

111
Q

What are the features of maculopathy in diabetic retinopathy?

A

Hard exudates and other background changes WITHIN 1 DISC OF MACULA

112
Q

How many stages are there to hypertensive retinopathy?

A

4

Must have features of previous stage to continue

113
Q

What are the features of Stage 1 HTN retinopathy?

A

Tortuose vessels
Silver-copper wiring
Arterial narrowing

114
Q

What are the features of Stage 2 HTN retinopathy?

A

AV-nipping

115
Q

What are the features of Stage 3 HTN retinopathy?

A

Flame and splinter haemorrhages
Cotton wool spots
Hard exudate

116
Q

What is the feature of Stage 4 HTN retinopathy?

A

Papilloedema

117
Q

What are some causes of papilloedema? (5)

A 
Raised ICP
Hypercapnia
Hypoglycaemia
Hypoparathyroid
Vitamin A toxicity
118
Q

What is the management of a foreign body in the eye?

A

If loose = irrigate with saline/remove with cotton bud

Refer if fail

119
Q

What must you also do when removing a foreign body from the eye?

A

Check pupil response and visual acuity before and after

120
Q

What should you do if a patient develops hyphema?

A

Urgent ophthalmology review

121
Q

What is hyphema?

A

Blood in the anterior chamber of the eye

122
Q

Why is hyphema an emergency?

A

Can increase IOP -> ACAG

123
Q

What are Kayser fletcher rings associated with?

A

Wilson’s disease

124
Q

What is the diagnosis?
Sudden onset pain, photophobia and blurred vision
Red eye
Irregular pupil

A

Acute anterior uveitis

125
Q

What is uveitis?

A

Inflammation of iris, ciliary body and choroid (uvea)

126
Q

What is uveitis associated with? (4)

A

Ankylosing spondylitis
Reactive arthritis
UC
Sarcoidosis - may have bilateral disease

HLA-B27

127
Q

What are the features of anterior uveitis? (7)

A 
Acute painful, red eye
Blurred vision
Photophobia
Reduced visual acuity
Irregular pupil
Lacrimation
Hypopyon
128
Q

What is hypopyon?

A

Pus in anterior chamber

Can see visible fluid level

129
Q

What is the management of anterior uveitis? (4)

A

Urgent ophthalmology review
Check pressure to ensure no ACAG
Steroid eye drops
Cycloplegics

130
Q

What are cycloplegics?

A

Dilates the pupil which relieves pain and photophobia

131
Q

Give an example of a cycloplegic

A

Atropine

Cyclopentolate

132
Q

What is an entropion?

A

Lid margins roll inwards

Lashes against eye

133
Q

What happens with an entropion?

A

Lashes act as foreign body -> irritation -> mimics conjunctivitis

134
Q

What is a complication of an entropion?

A

Corneal abrasion

135
Q

What is the cause of an entropion?

A

Ageing

136
Q

What is the treatment of entropion?

A

Surgery

137
Q

What is an ectropion?

A

Lid margins roll outward

Lacrimal punta in wrong position to drain tears

138
Q

What happens with an ectropion?

A

Tears don’t drain so patients complain of watery eye

BUT dry eye is the condition

139
Q

What are the causes of ectropion?

A

Ageing

CN7 palsy

140
Q

What is the treatment of an ectropion?

A

Artificial tears and surgery

141
Q

What is blepharitis?

A

‘Dandruff of the eye’

142
Q

What causes blepharitis? (3)

A

Meibomian gland dysfunction
Seborrhoeic dermatitis
Staph infection

143
Q

What is the most common cause of blepharitis?

A

Meibomian gland dysfunction

144
Q

What kind of blepharitis does Meibomian gland dysfunction cause?

A

Posterior blepharitis

145
Q

What kind of blepharitis do seborrhoeic dermatitis and Staph infection cause?

A

Anterior blepharitis

146
Q

What is blepharitis associated with? (2)

A

Rosacea

Styes and chalazions are more common in patients with blepharitis

147
Q

What are the features of blepharitis? (4)

A

Bilateral sore ‘gritty’ eyes
Red lid margins
Eyes may stick
Possibly secondary conjunctivitis

148
Q

What is the management of blepharitis?

A

Avoid make-up/contact lenses
Hot compresses BD
Lid hygeine

149
Q

What is the function of Meibomian glands?

A

Secrete oil onto eye to retain tear film

Dysfunction causes dry eyes

150
Q

What is the triad of dry eyes?

A

Watery eyes
Blurred vision
Pain (due to dry eyes)

151
Q

What is the ‘tear drop’ sign on a head XR indicative of?

A

Orbital blow out fracture

152
Q

What is the difference between episcleritis and scleritis?

A 
Episcleritis = idiopathic superficial inflammation
Scleritis = more severe autoimmune dysregulation
153
Q

What is scleritis associated with?

A

Rheumatoid A and similar

154
Q

What are the symptoms of episcleritis?

A

Acute mild pain
Redness
Irritation

155
Q

What are the symptoms of scleritis?

A 
Severe, 'boring' pain
Pain with eye movement
Blurred vision/reduced acuity
Photophobia
Often have systemic features eg. rash
156
Q

What test may differentiate between scleritis and episcleritis?

A

Scleritis does NOT blanch with phenylephrine drops

157
Q

What is the management of episcleritis?

A

Self-limiting

Consider topical steroids if refractory

158
Q

What is the management of scleritis?

A

Ophthalmology review
Systemic steroids
Consider topical ABx

159
Q

What percentage of RA patients suffer from eye problems?

A

25%

160
Q

What are the 5 eye problems that RA patients may get?

A 
Keratoconjunctivitis sicca
Episcleritis
Scleritis
Corneal ulceration
Keratitis
161
Q

What is the most common eye condition that RA patients get?

A

Keratoconjunctivitis sicca

162
Q

What are the symptoms of keratoconjuctivitis sicca?

A

Dry red eyes bilaterally
Gritty irritation
Worse as day goes on

163
Q

What is a melting ulcer?

A

Pseudomonas corneal ulcers which break down stroma

Can lose all stoma within 24hrs

164
Q

What is the management of melting ulcers?

A

Emergency
Topical Abx
Acetylcysteine
Often require corneal transplant to save eye

165
Q

How do you distinguish between periorbital and orbital cellulitis?

A

Orbital cellulitis has reduced acuity, proptosis and ophthalmoplegia

166
Q

What are 3 causes of sudden vision loss?

A

Posterior vitreous detachment
Retinal detachment
Vitreous haemorrhage

167
Q

What are the features of posterior vitreous detachment?

A 
Flashing light (photopsia) in peripheral vision
Floaters - often temporal
168
Q

What are the features of retinal detachment?

A

Loss of vision peripherally to centrally
‘Curtains drawing’
Straight lines appear curved
Central vision loss

169
Q

What are the features of vitreous haemorrhage?

A

Large bleeds = sudden vision loss
Medium bleeds = numerous dark spots
Small bleeds = floaters

170
Q

What 4 things should you describe relating to squints?

A

Left or Right
Manifest or Latent
Concomitant or Paralytic
Esotropia/Convergent or Extropia/Divergent

171
Q

What is a manifest squint?

A

Squint present when eyes are open and being used

172
Q

What is a latent squint?

A

Eye tune only when it is covered or shut

173
Q

What is a concomitant squint?

A

Deviation does NOT vary with direction of gaze

Due to imbalance of extraocular muscles

174
Q

What is a paralytic squint?

A

Deviation/presence of squint affected by direction of gaze

Due to paralysis of extraocular muscles

175
Q

What is the management of a squint?

A

Eye patch of GOOD eye

Surgery

176
Q

What may result from not managing a squint in childhood?

A

Amblyopia (lazy eye)

177
Q

What age should children have their squint managed by?

A

7yrs

178
Q

Name the 13 causes of sudden vision loss

A 
ACAG
Posterior vitreous detachment
Retinal detachment
Vitreous haemorrhage
Central retinal artery occlusion
Central retinal vein occlusion
Migraine
TIA (amaurosis fugax)/stroke
Space-occupying lesion
Optic neuritis
Temporal arteritis
Drugs (quinine, methanol)
Pituitary apoplexy
179
Q

Name the 7 ocular causes of sudden vision loss

A 
ACAG
Posterior vitreous detachment
Retinal detachment
Vitreous haemorrhage
Central retinal artery occlusion
Central retinal vein occlusion
180
Q

Name the 6 non-ocular causes of sudden vision loss

A 
Migraine
TIA/stroke
Space-occupying lesion
Optic neuritis
Temporal arteritis
Drugs (quinine, methanol)
Pituitary apoplexy
181
Q

What is pituitary apoplexy?

A

Bleeding into or reduced blood flow to the pituitary

Dx = MRI head

182
Q

How does pituitary apoplexy cause vision loss?

A

Compression of nerve surrounding it

183
Q

What are the features of pituitary apoplexy?

A

Sudden headache
Rapid worsening vision loss/diplopia
Followed by acute endocrine insufficiency effects eg. Addison’s

184
Q

What is the management of pituitary apoplexy?

A 
Surgical decompression
Hormone replacement (often long-term)
185
Q

What are 5 causes of gradual vision loss?

A 
Optic atrophy
Open-angle glaucoma
Cataracts
Macular degeneration
Tobacco amblyopia

5th Year (8 decks)

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