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Specialities > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the different types of glaucoma?

A

Primary Open Angle

Primary Closed Acute Angle
Secondary Closed Acute Angle (due to trauma, bleeding etc)

Normal tension

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2
Q

What are the symptoms and clinical features of Acute primary angle closure?

A

Eye pain
Headache
Visual Halo’s
Nausea and Vomiting

Clinically:

  • red eye
  • mid-dilated fixed pupil
  • Clouding of the cornea
  • reduced visual acuity
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3
Q

What type of visual field defect is typically seen in glaucoma?

A

Arcuate scotoma

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4
Q

List some differentials to sudden vision loss:

A

Retinal detachment

Wet ARMD

Retinal vein/ artery occlusion

Optic neuritis

Optic neuropathy

Stroke

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5
Q

Give some differentials for gradual vision loss:

A

Cataract

Glaucoma

Diabetic retinopathy

Dry ARMD

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6
Q

What are the medical terms for long and short sighted?

A

Myopia

Hypermetropia

Astigmatism
- the cornea is not a smooth shape but is irregular. As such causes blurring off the image

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7
Q

In sudden painless loss of vision there are a set of questions/ investgiations which can be useful to ask to help establish cause - what are these?

A

HELLP

  • Headache - Giant cell arteritis
  • ESR level?
  • Lights/ flashing - retinal detachment
  • Like a curtain - amaurosis fugax
  • Poorly controlled DM - Vitreous haemorrhage
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8
Q

What is the term for when fluid accumulates behind the retina causing it to detach? and what are the two most common types?

A

Rhegmatogenous
- Posterior vitreous detachment

  • traumatic retinal detachment
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9
Q

What are the symptoms of retinal detachment? how can you localie the area detached?

A

the Four F’s:

  • Flashes
  • Floaters
  • Field loss
  • Fall in visual acuity

Usually painless

The area detached will reflect in the area of vision lost.
i.e. upper detachment results in lower vision loss

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10
Q

What is the management of retinal detachment?

A

Rest and body position

  • if superior tear lie flat
  • if inferior tear sit at 30 degrees

Surgery

  • vitrectomy
  • laser
  • Tamponade
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11
Q

List some differentials for a traumatic and non traumatic red eye:

A

Traumatic:

  • Corneal abrasion
  • Subconjunctival Haemorrhage
  • Chemical injury
  • Penetrating ocular injury

Non-traumatic:

  • COnjunctivitis
  • Subconjunctival Haemorrhage
  • Keratitis (corneal ulcer)
  • Iritis
  • Episcleritis
  • Acute glaucoma
  • Cellulitis
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12
Q

Outline some of the findings you would expect to see with bacterial conjunctivitis and what is a serious cause of bacterial conjunctivitis and how does it present?

A

Unilateral
Sticky purulent discharge
Papillae formation
Chemosis

Gonococcus conjunctivitis 
- Masked lid swelling 
- Chemosis 
- Papillae 
- Peri-auricular lymphadenopathy 
\+/- 
- Keratitis 
*needs referal to GUM + systemic treatment
**most common in neonates <30 days old
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13
Q

How can you differentiate between Gonocal and chlamydial conjunctivitis?

A

Subacute for Gonocoal

Chlamydia takes about 2-3 weeks to cause infection

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14
Q

What is the most common cause of infective blindness and what is it?

A

Trachoma
- due to repeated chlamydia infections.

Causes large scarring and inflammation of the conjunctiva

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15
Q

How does a corneal ulcer and abrasion differ?

A

Abrasion:

  • only the surface epithelium is involved/ Stroma
  • corneal contour is unchanged

Ulcer

  • Entirely through the epithelium squamous and to the Bowman’s layer
  • Contour is changed
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16
Q

List some complications for corneal ulceration:

A

Vision loss

Perforation

Corneal scarring

Endophthalmitis

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17
Q

What is the immediate management of acute closed angle glucoma?

A
  • Immediate referral
  • Avoid darkness or anything that dilates the pupil

Timolol
- beta blocker to stop production of aquaous humour

Pilocarpine drops

Acetazolamide IV

Surgery
- peripheral iridectomy (laser or surgical)

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18
Q

What is the gold standard diagnostic test for glaucoma? and list other investigations you would want to do:

A

Goldman Applanation Tonometry

  • visual field testing *peripheral vision loss in accurate scotoma
  • Slit lamp investigation
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19
Q

What are the symptoms of optic neuritis?

A

Decreased vision
- usually a centralised blind spot

Pain on eye movement

Reduced colour vision
- red desaturation

RAPD

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20
Q

What screening must be done to all children <32 weeks and what is the other time this is done?

A

Retinopahty of prematurity

Screening carried out when:
- <32 weeks
or
- <1.5kg

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21
Q

What are the red flags in the history for ophthalmology?

A

Floaters / Flashing lights
- retinal detachment

Hoales
- acute angular glaucoma

Headaches

  • jaw claudication
  • worse when leaning over

Repeated bouts of transient vision loss

  • impeting stroke
  • vascular pathology
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22
Q

When taking a history for eye complaints, what additional piece of information do you want in the social history? And what is standard for visual acuity?

A

DVLA history

  • are they driver?
  • Work for lorries etc

6/12 is the standard

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23
Q

When testing colour desaturation, what first sign indicates there is disease to the optic nerve?

A

When there is red desaturation

- this appears with the red becoming paler and more pink

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24
Q

What instruments are used to test peripheral field defects?

A

Golmann Perimetry

Automated perimetry
- gluacoma

*automated is when the machine moves

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25
Q

What is the characteristic sign seen on fundoscopy of the retina in a patient with dry macular degeneration?

A

Drusen - yellow round spots

26
Q

What are the grades of hypertensive retinopathy?

A

Grade 1: Chronic
- Narrowing, sclerosis of vessels

Grade 2: Chronic

  • Exaggerated retinal light reflex
  • Definite narrowing

Grade 3: Acute

  • cotton wool spots
  • flamed shaped haemorrohages
  • exudates

Grade 4: Acute
- Papilloedema

SAFE

  • silver wiring
  • AV nipping
  • flame haemorrhages
  • Edema (papilledema)
27
Q

The snellen chart can’t always be used for patients, for example they may be illiterate, or a child and unable to speak. What are some alternatives?

A

E chart - If illiterate

Kay pictures - >2 years

Toys or movements - <2 years

28
Q

What are some of the opthalmic findings of shaken baby syndrome?

A

Retinal detachment in all 4 quadrants

Retinoschisis
- separation of retinal layers

29
Q

Give 3 causes of a leukorocic pupil in a new born:

A

Retinoblastoma

Congenital cataracts

Retinopathy of prematurity

30
Q

What is the name of the condition which causes hallucinations in people who are blind or losing sight?

A

Charles Bonnet Syndrome

  • visual hallucinations of usually small people
  • due to brain interrupting signals despite no input
  • not associatted with delirium, patients are aware the hallucinations are not real
31
Q

List some complications of contact lenses, and what bacterial is commonly involved in infection?

A

Contact lens induced red eye reaction:
- inflammatory response to anterior segment of the eye due to contacts

Sensitivities
- mixing of washing material

The most common organism in contact wearers is:
- pseudomonas

*if contact wearers develop keratitis they need same day referral to eye unit due to more severe keratitis developing.

32
Q

What are some signs of anterior uveitis?

A

Anterior chamber cells

Posterior Synechiae

Keratic Precipitates
- inflammatory cells within the cornea

Hypopyon

Redness across the sclera

33
Q

What is the treatment of anterior uveitis?

A

Topical steroids

Cycloplegics
- paralysis of the iris to prevent it moving anf causing pain.

34
Q

What are the 5 top things you want to establish from the past medical opthalmic history?

A

Refractive Status

  • myopia
  • hypermyopia

Previous episodes

  • previous vision loss
  • previous uveitis

Previous surgery

Previous laser

Previous amblyopia

35
Q

List 6 causes of rapid changes in refractive error:

A

Senile cataract

Diabetes - rapid changes in cataracts

Eye drops

Eye lid bumps
- Astigmatism - by compressing on cornea

Keratoconus
- progressive thinning of the cornea

Lens subluxation

36
Q

List 6 causes of gradual painless loss of vision:

A

Refractive error

Cataracts

Macular degeneration

Advance glaucoma

Retinal degeneration

Chronic Optic nerve ischemia

37
Q

List 5 causes of acute painful loss of vision:

A

Acute closed angle glaucoma

Optic neuritis

Corneal ulcer

Uveitis

Orbital cellulitis

38
Q

List 5 features of chronic glaucoma:

A

Optic disc cupping >0.8

Increased intra ocular pressure

Accurate scotoma peripheral vision loss

Neovascularization

Complete vision loss

39
Q

List the various medications which can be used in Glaucoma:

A

Latanoprost - Prostaglandin analogue (1st line)
- increases outflow

Timolol - Beta blocker

Acetazolamide - Carbonic Anhydrase Inhibitor

Brimonidine - Alpha -2 agonist

Pilocarpine - Parasympathetic drops

40
Q

What are the pupils called that are associated with neurosyphilus? how do they react?
what other condition is it also associated with?

A

Argyll - Robertson Pupils

  • small pupils and
  • accommodation reflex is present, light reflex is not

Also associatedwith diabetic retinopathy

41
Q

Give 5 features of Horner’s syndrome:

A 
Miosis 
Ptosis 
Anhidrosis 
Enophthalmos
Iris Heterochromia
42
Q

What are the diagnostic investigations into glaucoma?

A

Goldmann Tanometry

Visual field testing

Central corneal thickness measurement

Slitlamp
- assess the optic nerve

Gonioscopy

43
Q

What signs may be present in macular degeneration - age related and what investigations should be carried out:

A

Distortion of line perception
- via Amsler grid testing

Drusen/ yellow areas on the macula
- seen via fundoscopy

Investigations:

  • slit lamp
  • Fluorescein Angiography if Wet ARMD is suspected
  • OCT

**OCT is definitive test for diagnosis

44
Q

List some risk factors for ARMD:

A 
Advancing age 
Female 
Smoking 
Caucasian 
Hypermetropia 
Cardiovascular disease
45
Q

Refractive erros can be associatted with glaucoma, what are they?

A

Primary open angle glaucoma:
- Myopia

Acute closed angle glaucoma
- Hypermyopia

46
Q

Other than raised ICP, what else may cause papilledema?

A

Hypercapnia

*in the emergency room you can induce hyperventilation to reduce the papiloedma

Malignant hypertension

Idiopathic hypertension

47
Q

Which type of cataracts is most associated with steroid use?

A

Subcapsular cataracts

48
Q

Give 5 causes of homologous hemianopia:

A 
Stroke 
Migraine 
Tumour 
Trauma
Demyelinating disease
49
Q

List 3 major causes of a RAPD:

A

Neuritis / MS

Extensive retinal damage - vein occlusion/ advance diabetic retinopathy

Dense macular lesion

50
Q

The ocular nerve as well carrying parasympathetic fibres, also carries sympathetic fibres, what do these innervate?

A

Levator Palpebrae Superioris

51
Q

What are the characteristic findings in a 4th nerve palsy?

A

diplopia on upwards gaze

Failure to look at nose

Head tilt

*job is look inwards and look downwards

52
Q

What are the characteristics of a 6th nerve palsy?

A

Failure to converge

Diplopia horizontal when abducting

53
Q

What are the features of acute closed angle glaucoma?

A

Blurred vision halos

Severe pain with headache and vomiting

Cloudy cornea

Dilated fixed pupil

Hard feeling eye - as the pressure is fixed

54
Q

What are the causes of exophthalmos?

A

Thyroid eye disease

Carotid Cavernous sinus fistula

Cavernous sinus thrombosis

Orbital tumour

Orbital cellulitis

55
Q

List some common causes of ptosis:

A

Horner’s syndrome

3rd nerve palsy

Senile

Myasthenia gravis

Congenital

56
Q

What are clinical features of orbital cellulitis?

A

Lid erythema

Exophthalmoses

Conjunctival injection/ chemosis

Visual disturbance

Diplopia/ reduced eye movement

57
Q

Describe the stages of diabetic retinopathy:

A
  1. Background Diabetic retinopathy
    - flame haemorrhages
  2. Pre-proliferative
    - blots
    - dots
    - hard exudates
    - cotton wool spots
  3. Proliferative
    - angiogenesis
    - neovascularization
  4. Retinal detachment
  5. Macula oedema
    * macula oedema can occur at any stage
58
Q

What are the risk factors for diabetic retinopathy to progress?

A

Poor glycaemic control

Hypertension

Hyperlipidemia

Pregnancy

Long standing diabetes

59
Q

List some causes for optic disc swelling:

A

Raised ICP

Neuritis

Ophthalmic vein occlusion

Vasculitis

Orbital cellulitis

60
Q

What are the most common causes of leukocoria

A

Cataracts

Retinoblastoma

retinopathy of prematurity

61
Q

Which patient group are at risk of vitreous haemorrhage?

A

Diabetics

62
Q

What are the signs of retinitis pigmentosa?

A

Night blindness

Tunnel vision formation
- peripheral vision is lost

Mottling of the retinal pigmental epithelium

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