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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
What surgical intervention may be appropriate in ACAG?
Peripheral iridotomy
26
What are 2 important complications of ACAG?
Central retinal artery occlusion | Central retinal vein occlusion
27
What may you see on fundoscopy with central retinal artery occlusion?
Cherry red spots
28
Other than ACAG, what else is central retinal artery occlusion associated with?
Giant cell arteritis
29
What is the management of central retinal artery occlusion?
``` <4hrs = massage to move embolism >4hrs = unlikely to regain vision ```
30
What is the hallmark feature of central retinal vein occlusion?
Sudden painless vision loss
31
What is primary open angle glaucoma?
Trabecular meshwork has reduced outflow | Iris is not obstructing meshwork
32
How common is POAG?
Present in 2% >40yrs Symptomatic in 0.5% >40yrs Present in 10% >80yrs
33
What are some risk factors for POAG? (5)
``` Genetics - 16% in 1st-degree relatives Black people HTN DM Steroid use ```
34
When is POAG most often diagnosed?
Opticians | Insidious onset
35
What is the definition of raised IOP?
>24mmHg
36
What is the 1st line management for POAG?
Latanoprost eyedrops (prostaglandin analogue)
37
What are the 2nd line management options for POAG?
Beta-blockers Carbonic anhydrase inhibitor Sympathomimetic eye drops
38
What is the surgical option for POAG?
Iridotomy
39
How does latanoprost work?
Increases uveoscleral outflow
40
What are some side effects of latanoprost?
Brown pigmentation of iris | Increased eyelash length
41
How do beta-blockers work in glaucoma?
Reduce aqueous production
42
How do sympathomimetics work in glaucoma? (eg. brimonidine)
Reduce aqueous production and increases outflow
43
How do carbonic anhydrase inhibitors work in glaucoma? (eg. acetazolamide)
Reduce aqueous production
44
How do miotics work in glaucoma? (eg. pilocarpine)
Increase uveoscleral outflow
45
What is the diagnosis? | Gradual painless vision loss with halos around lights
Cataracts
46
What is a cataract?
Deposition of aggregated proteins in lens -> disruption of crystalline fibres -> cloudy
47
What causes acquired cataracts? (6)
``` Ageing Trauma Diabetes Long-term steroids Alcohol Smoking ```
48
What causes congenital cataracts?
TORCH infections | Down's syndrome
49
What sign may indicate a cataract?
Loss of red reflex
50
What happens to the rest of the eye?
Fundus, retina and pupil all remain normal and functional
51
What are the 3 types of cataracts?
Cortical cataracts Nuclear cataracts Posterior capsule cataracts (Polar cataracts)
52
What are cortical cataracts?
Cataract of lens cortex | Starts in periphery and develops inwards = spoke-like
53
What are nuclear cataracts?
Cataract in the centre part of the lens | Most common in elderly patients
54
What is a posterior capsule cataract?
Cataract at the back of the lens | Associated with diabetes and steroids
55
Which cataract is most associated with ageing?
Nuclear cataract
56
What cataract is most associated with diabetes and steroid use?
Posterior capsule cataract
57
Which cataract is is the most likely to give the halo effect?
Posterior capsule cataract
58
What is the non-surgical management of cataracts?
Stronger glasses | Brighter lights
59
What is the surgical management of cataracts?
Phacoemulsification and replacement of lens
60
Does someone with cataracts need to stop driving?
No - need to be cleared by doctor though | Do NOT need to tell DVLA
61
What are the complications of phacoemulsification? (4)
Posterior capsule opacification = thickening of lens capsule Retinal detachment Posterior capsule rupture Endophthalmitis = inflammation of aqueous and/or vitreous
62
What is Marcus Gunn pupil?
Relative Afferent Pupillary Defect (RAPD)
63
How do you test for RAPD?
Swinging light test
64
What does the swinging light test test?
Afferent fibres of optic nerve (CN2)
65
What happens in a positive swinging light test?
Pupil constricts less when light is swung from unaffected eye to affected eye Affected pupil appears to dilate when light shone into it
66
What is the diagnosis? Diffusely red and mydriatic eye Reduced vision Discharge
Corneal ulcer (keratitis)
67
What is the most common bacterial cause of corneal ulcers?
Staph aureus
68
What is the hallmark feature of herpetic corneal ulcers?
Dendritic appearance on fluorescein staining
69
What are the fungal causes of corneal ulcers?
Candida | Aspergillus
70
What is a protozoal cause of corneal ulcers?
Acanthamoeba
71
What is a specific risk factor for acanthamoeba corneal ulcers?
Contact lenses Specifically showering in them as acanthamoeba lives in water
72
What are the parasitic causes of corneal ulcers?
Onchocercal keratitis = 'river blindness' | Found mainly in central/sub-saharan Africa and Yemen
73
What is a non-infective cause of corneal ulcers?
Rheumatoid A
74
What is the biggest risk factor for corneal ulcers?
Contact lenses
75
What are 4 other risk factors for corneal ulcers?
Trauma Steroid use Sjogren's syndrome Ectropion
76
What is the management of corneal ulcers?
Same-day ophthalmology referral For slit lamp with 1% fluorescein Stop wearing make-up and contact lenses Treat cause
77
What are some topical antibacterial drops?
Chloramphenicol (Gram +ve) | Ofloxacin (Gram -ve)
78
Which topical Abx drop has Gram +ve cover?
Chloramphenicol
79
Which topical Abx drop has Gram -ve cover?
Ofloxacin
80
Which other topical eye drop can be used in the management of corneal ulcers?
Steroids Reduce swelling and scarring
81
What is cornea verticillata?
Corneal deposits on basal epithelium -> faint golden-brown whorl
82
What causes cornea verticillata?
Amiodarone (prolonged use) Also Fabry disease (lysosomal storage disease, X-linked)
83
What is the correct name for a stye?
Hordeolum
84
What typically causes a hordeolum?
Obstruction and infection of eyelash follicle Generally staph infection
85
How does a hordeolum present?
Tender lid margin swelling
86
What is the management of a hordeolum?
Lash removal and drainage | Warm compress and gentle massage
87
When might you use topical Abx with a hordeolum?
Only if associated conjunctivitis
88
What should you refer to ophthalmology regarding a hordeolum?
Visual changes | Cellulitis
89
What is a chalazion?
Blocked Meibomian gland = Meibomian cyst
90
What is the difference in location between a hordeolum and a chalazion?
``` Hordeolum = on eyelash follicle Chalazion = above eyelashes on upper lid, generally ```
91
What is the difference in symptoms between a hordeolum and a chalazion?
``` Hordeolum = tender swelling Chalazion = firm, painless lump ```
92
What is the difference in management between a hordeolum and a chalazion?
Not much difference | Chalazions may require surgical
93
What is the difference between internal and external hordeolums?
``` Internal = infection of Meibomian gland External = infection of glands of Zeis or glands of Moll ```
94
What is Purtscher retinopathy?
Ischaemic retinopathy as a side effect of acute pancreatitis
95
What is conjunctivitis?
Inflammation of conjunctiva
96
How might conjunctivitis present?
Sore, red eye associated with discharge No change in vision Not intense pain
97
What are the 3 types of conjunctivitis?
Bacterial Viral Allergic
98
What might suggest a bacterial conjunctivitis?
Mucopurulent discharge
99
What are the main causes of bacterial conjunctivitis?
S aureus Gonococcal Chlamydia - neonates
100
What might suggest a viral conjunctivitis?
Watery discharge URTI Preauricular LN involvement
101
What are the main causes of viral conjunctivitis?
Adenovirus HSV Molluscum contagiosum
102
What might suggest an allergic conjunctivitis?
``` Bilateral redness Itching Swollen eyelids Cobblestoning chemosis May have trigger May get white stringy discharge ```
103
What is the management of bacterial conjunctivitis?
Swab if sticky Chloramphenicol drops Resolves in 2 weeks
104
What eye drops are an alternative to chloramphenicol for pregnant women?
Fusidic acid
105
What is the management of allergic conjunctivitis?
1st line = antihistamines | 2nd line = topical mast cell stabilisers
106
What is deposited in Dry Age-Related Macular Degeneration?
Drusen
107
What are the 4 stage of diabetic retinopathy?
Background Pre-proliferative Proliferative Maculopathy
108
What are the features of background diabetic retinopathy?
Dot and blot haemorrhages = microaneurysms | Hard exudates
109
What are the features of pre-proliferative diabetic retinopathy?
Cotton wool spots
110
What are the features of proliferative diabetic retinopathy?
Neovascularisation
111
What are the features of maculopathy in diabetic retinopathy?
Hard exudates and other background changes WITHIN 1 DISC OF MACULA
112
How many stages are there to hypertensive retinopathy?
4 | Must have features of previous stage to continue
113
What are the features of Stage 1 HTN retinopathy?
Tortuose vessels Silver-copper wiring Arterial narrowing
114
What are the features of Stage 2 HTN retinopathy?
AV-nipping
115
What are the features of Stage 3 HTN retinopathy?
Flame and splinter haemorrhages Cotton wool spots Hard exudate
116
What is the feature of Stage 4 HTN retinopathy?
Papilloedema
117
What are some causes of papilloedema? (5)
``` Raised ICP Hypercapnia Hypoglycaemia Hypoparathyroid Vitamin A toxicity ```
118
What is the management of a foreign body in the eye?
If loose = irrigate with saline/remove with cotton bud | Refer if fail
119
What must you also do when removing a foreign body from the eye?
Check pupil response and visual acuity before and after
120
What should you do if a patient develops hyphema?
Urgent ophthalmology review
121
What is hyphema?
Blood in the anterior chamber of the eye
122
Why is hyphema an emergency?
Can increase IOP -> ACAG
123
What are Kayser fletcher rings associated with?
Wilson's disease
124
What is the diagnosis? Sudden onset pain, photophobia and blurred vision Red eye Irregular pupil
Acute anterior uveitis
125
What is uveitis?
Inflammation of iris, ciliary body and choroid (uvea)
126
What is uveitis associated with? (4)
Ankylosing spondylitis Reactive arthritis UC Sarcoidosis - may have bilateral disease HLA-B27
127
What are the features of anterior uveitis? (7)
``` Acute painful, red eye Blurred vision Photophobia Reduced visual acuity Irregular pupil Lacrimation Hypopyon ```
128
What is hypopyon?
Pus in anterior chamber | Can see visible fluid level
129
What is the management of anterior uveitis? (4)
Urgent ophthalmology review Check pressure to ensure no ACAG Steroid eye drops Cycloplegics
130
What are cycloplegics?
Dilates the pupil which relieves pain and photophobia
131
Give an example of a cycloplegic
Atropine | Cyclopentolate
132
What is an entropion?
Lid margins roll inwards | Lashes against eye
133
What happens with an entropion?
Lashes act as foreign body -> irritation -> mimics conjunctivitis
134
What is a complication of an entropion?
Corneal abrasion
135
What is the cause of an entropion?
Ageing
136
What is the treatment of entropion?
Surgery
137
What is an ectropion?
Lid margins roll outward | Lacrimal punta in wrong position to drain tears
138
What happens with an ectropion?
Tears don't drain so patients complain of watery eye | BUT dry eye is the condition
139
What are the causes of ectropion?
Ageing | CN7 palsy
140
What is the treatment of an ectropion?
Artificial tears and surgery
141
What is blepharitis?
'Dandruff of the eye'
142
What causes blepharitis? (3)
Meibomian gland dysfunction Seborrhoeic dermatitis Staph infection
143
What is the most common cause of blepharitis?
Meibomian gland dysfunction
144
What kind of blepharitis does Meibomian gland dysfunction cause?
Posterior blepharitis
145
What kind of blepharitis do seborrhoeic dermatitis and Staph infection cause?
Anterior blepharitis
146
What is blepharitis associated with? (2)
Rosacea | Styes and chalazions are more common in patients with blepharitis
147
What are the features of blepharitis? (4)
Bilateral sore 'gritty' eyes Red lid margins Eyes may stick Possibly secondary conjunctivitis
148
What is the management of blepharitis?
Avoid make-up/contact lenses Hot compresses BD Lid hygeine
149
What is the function of Meibomian glands?
Secrete oil onto eye to retain tear film | Dysfunction causes dry eyes
150
What is the triad of dry eyes?
Watery eyes Blurred vision Pain (due to dry eyes)
151
What is the 'tear drop' sign on a head XR indicative of?
Orbital blow out fracture
152
What is the difference between episcleritis and scleritis?
``` Episcleritis = idiopathic superficial inflammation Scleritis = more severe autoimmune dysregulation ```
153
What is scleritis associated with?
Rheumatoid A and similar
154
What are the symptoms of episcleritis?
Acute mild pain Redness Irritation
155
What are the symptoms of scleritis?
``` Severe, 'boring' pain Pain with eye movement Blurred vision/reduced acuity Photophobia Often have systemic features eg. rash ```
156
What test may differentiate between scleritis and episcleritis?
Scleritis does NOT blanch with phenylephrine drops
157
What is the management of episcleritis?
Self-limiting | Consider topical steroids if refractory
158
What is the management of scleritis?
Ophthalmology review Systemic steroids Consider topical ABx
159
What percentage of RA patients suffer from eye problems?
25%
160
What are the 5 eye problems that RA patients may get?
``` Keratoconjunctivitis sicca Episcleritis Scleritis Corneal ulceration Keratitis ```
161
What is the most common eye condition that RA patients get?
Keratoconjunctivitis sicca
162
What are the symptoms of keratoconjuctivitis sicca?
Dry red eyes bilaterally Gritty irritation Worse as day goes on
163
What is a melting ulcer?
Pseudomonas corneal ulcers which break down stroma | Can lose all stoma within 24hrs
164
What is the management of melting ulcers?
Emergency Topical Abx Acetylcysteine Often require corneal transplant to save eye
165
How do you distinguish between periorbital and orbital cellulitis?
Orbital cellulitis has reduced acuity, proptosis and ophthalmoplegia
166
What are 3 causes of sudden vision loss?
Posterior vitreous detachment Retinal detachment Vitreous haemorrhage
167
What are the features of posterior vitreous detachment?
``` Flashing light (photopsia) in peripheral vision Floaters - often temporal ```
168
What are the features of retinal detachment?
Loss of vision peripherally to centrally 'Curtains drawing' Straight lines appear curved Central vision loss
169
What are the features of vitreous haemorrhage?
Large bleeds = sudden vision loss Medium bleeds = numerous dark spots Small bleeds = floaters
170
What 4 things should you describe relating to squints?
Left or Right Manifest or Latent Concomitant or Paralytic Esotropia/Convergent or Extropia/Divergent
171
What is a manifest squint?
Squint present when eyes are open and being used
172
What is a latent squint?
Eye tune only when it is covered or shut
173
What is a concomitant squint?
Deviation does NOT vary with direction of gaze | Due to imbalance of extraocular muscles
174
What is a paralytic squint?
Deviation/presence of squint affected by direction of gaze | Due to paralysis of extraocular muscles
175
What is the management of a squint?
Eye patch of GOOD eye | Surgery
176
What may result from not managing a squint in childhood?
Amblyopia (lazy eye)
177
What age should children have their squint managed by?
7yrs
178
Name the 13 causes of sudden vision loss
``` 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
Name the 7 ocular causes of sudden vision loss
``` ACAG Posterior vitreous detachment Retinal detachment Vitreous haemorrhage Central retinal artery occlusion Central retinal vein occlusion ```
180
Name the 6 non-ocular causes of sudden vision loss
``` Migraine TIA/stroke Space-occupying lesion Optic neuritis Temporal arteritis Drugs (quinine, methanol) Pituitary apoplexy ```
181
What is pituitary apoplexy?
Bleeding into or reduced blood flow to the pituitary | Dx = MRI head
182
How does pituitary apoplexy cause vision loss?
Compression of nerve surrounding it
183
What are the features of pituitary apoplexy?
Sudden headache Rapid worsening vision loss/diplopia Followed by acute endocrine insufficiency effects eg. Addison's
184
What is the management of pituitary apoplexy?
``` Surgical decompression Hormone replacement (often long-term) ```
185
What are 5 causes of gradual vision loss?
``` Optic atrophy Open-angle glaucoma Cataracts Macular degeneration Tobacco amblyopia ```

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