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Phase 3b > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the differential diagnosis for a painless red eye?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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2
Q

What are the differential diagnosis for a painful red eye?

A 
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical body
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3
Q

What are the red flags for a red eye?

A

Impaired vision
Pain/photophobia
Lack of ocular discharge

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4
Q

Define conjunctivitis

A

Inflammation and redness of the conjunctiva

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5
Q

Symptoms of conjunctivitis

A 
Red eyes
Unilateral or bilateral 
Vision unaffected
Bloodshot
Itchy or gritty sensation
Discharge from the eye
Does not cause pain, photophobia or reduced visual acuity
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6
Q

Symptoms of bacterial conjunctivitis

A 
Purulent discharge -> pus
Eye may be stuck together in the morning
Highly contagious
Starts in one eye and spreads to other
Papillae
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7
Q

What are the causative organisms for bacterial conjunctivitis?

A

Staphylococcus
Streptococcus
Haemophilus
Neisseria

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8
Q

Symptoms for viral conjunctivitis

A

Clear discharge (serous)
Dry cough, sore throat, blocked nose
Preauricular lymph nodes (in front of ears)
Recent URTI

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9
Q

Commonest cause of viral conjunctivitis?

A

Adenovirus -> causes follicles

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10
Q

What type of hypersensitivity is allergic conjunctivis?

A

Type 1 hypersensitivity

Caused by contact with allergens

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11
Q

Symptoms of allergic conjunctivitis

A

Most frequent type of conjunctivitis
Watery discharge - serous
Itch
Caused by contact with allergens

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12
Q

Treatment for allergic conjunctivitis

A

Antihistamines (oral or topical) used to reduce symptoms

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13
Q

Treatment for bacterial conjunctivitis

A

Chloramphenicol

Fuscidic acid

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14
Q

General treatment for conjunctivitis

A

Reassurance (resolves after 1-2 weeks)

Good hygiene

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15
Q

Define ophthalmia neonatorum

A

Conjunctivitis in the first 3 weeks of life

Purulent discharge

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16
Q

Causes of ophthalmia neonatorum

A

Chlamydia
Herpes simplex
Gonorrhoea
Staphylococcus/streptococcus

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17
Q

Treatment for chlamydia

A

Erythromycin

Azithromycin

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18
Q

Treatment for gonorrohoea

A

Cefotaxime and chloramphenicol

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19
Q

Define episcleritis

A

Thin vascular layer between sclera and conjunctiva

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20
Q

Symptoms of episcleritis

A 
Common, benign
Acute onset
Unilateral (bilateral in 30%)
Typically not painful
Segmental redness
Dilated episcleral vessels
Watering of eye
No discharge
Visual acuity is normal
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21
Q

Treatment for episcleritis

A

Self-limiting and will recover in 1-4 weeks
Artificial tears
Topical or systemic NSAIDs (e.g. naproxen)

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22
Q

Define subconjunctival haemorrhage

A

Small blood vessel within the conjunctiva ruptures and releases blood into the space between the sclera and the conjunctiva

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23
Q

When is a subconjunctival haemorrhage likely to occur?

A

After episodes of strenous activity such as heavy coughing, weight lifting or straining when constipated

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24
Q

Causes of subconjunctival haemorrhage

A

Hypertension
Whooping cough
Trauma
Medications (Warfarin, NOAC’s antiplatelets)
Bleeding disorders (e.g. thrombocytopenia)

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25
Q

Symptoms of subconjunctival haemorrhage

A

Sudden onset
Painless - does not affect vision
Bright red covering white section

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26
Q

Management of subconjunctival haemorrhage

A

Resolves spontaneously roughly two weeks

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27
Q

Define scleritis

A

Inflammation of the full thickness of the sclera
More serious than episcleritis
Rare

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28
Q

What is the most serious type of scleritis?

A

Necrotising scleritis

Can cause visual impairment and perforation of the sclera

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29
Q

What conditions are associated with scleritis?

A 
Rheumatoid arthritis
SLE
Inflammatory bowel disease
Sarcoidosis
Wegener's granulomatosis
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30
Q

Symptoms of scleritis

A 
Constant, severe dull ache
Severe pain
Pain with eye movement
Eye watering -> no discharge
Photophobia
Reduced visual acuity
Headache
Abnormal pupil reaction to light
Tenderness to palpation of the eye
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31
Q

Management of scleritis

A

Urgent referral within 24 hours
Oral NSAIDs
Oral high-dose prednisolone
Treat underlying condition - Methotrexate for rheumatoid arthritis

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32
Q

Define anterior uveitis (iritis)

A

Inflammation in the anterior uvea (comprises the iris and ciliary body)

Posterior uvea contains the choroid (inflammation here is termed choroiditis)

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33
Q

Causes of anterior uveitis

A 
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
Sarcoidosis
Syphilis
Lyme disease
TB
Herpes simplex
Behcet's disease
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34
Q

Symptoms of anterior uveitis

A 
Unilateral
Dull, aching painful red eye
Ciliary flush (ring of red spreading from the cornea outwards)
Reduced visual acuity - blurred vision
Photophobia
Pain on movement
Lacrimation (excessive tear production)
Floaters and flashes
Miosis (constricted pupil)
Abnormally shaped pupil due to posterior synechiae (adhesions)
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35
Q

Questions to ask when suspecting anterior uveitis?

A 
Headaches
Mouth ulcers (Behcet's disease)
Joint problems
Chest and skin disease
GU symptoms
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36
Q

Investigations for anterior uveitis

A

Slit lamp with dilated pupil to visualise inflammatory cells (leucocytes), measure IOP too
Fundus fluorescein and indocyanide green-angiography

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37
Q

Treatment for anterior uveitis

A

Urgent same day referral to ophthalmologist
Topical prednisolone
Cyclopentolate or atropine -> to dilate the pupil
DMARDs or TNF inhibitors for immunosuppression
Laser therapy/surgery (vitrectomy) in severe cases

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38
Q

Define keratitis

A

Inflammation of the cornea

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39
Q

Causes of keratitis

A 
Viral = herpes simplex
Bacterial = psuedomonas or staphylococcus
Fungal = candida or aspergillus
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40
Q

Symptoms of herpes simplex keratitis

A 
Painful red eye
Photophobia
Vesicles around the eye
Watery discharge
Foreign body sensation
Reduced visual acuity
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41
Q

Investigations for viral keratitis

A

Staining with fluorescein - shows dendritic corneal ulcer
Slit lamp examination
Corneal swabs or scrapings

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42
Q

Management for viral keratitis

A

Same day urgent referral to ophthalmologist
Aciclovir (topical or oral)
Don’t use steroids without expert opinion

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43
Q

Symptoms of bacterial keratitis

A

Painful red eye
Loss of vision

Signs: Hazy cornea with central abscess

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44
Q

Management of bacterial keratitis

A

Requires specialist

Intense antibiotics

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45
Q

Define corneal abrasions

A

Scratches or damage to the cornea

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46
Q

Causes of corneal abrasions

A 
Contact lenses - may have psuedomonas infection
Foreign bodies
Finger nails
Eyelashes
Entropian (inward turning eyelid)
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47
Q

Symptoms of corneal abrasions

A 
History of contact lenses/foreign body
Painful red eye
Foreign body sensation
Watering eye
Blurring vision
Photophobia
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48
Q

Investigations for corneal abrasions

A

Staining with fluorescein -> yellow/orange colour

Slit lamp examination

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49
Q

Management for corneal abrasions

A 
Same day referral to ophthalmologist
Analgesia - paracetamol
Lubricating eye drops
Antibiotic eye drops - chloramphenicol
Cyclopentolate eye drops - dilate pupil and improves photophobia

Usually heal over 2-3 days

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50
Q

Define keratoconjunctivitis sicca

A

Dry eyes

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51
Q

What are the components of tears?

A 
Watery layer (main, middle) - lacrimal glands
Oily layer (thin outer) - meibomian glands
Mucus layer (inner) - conjunctiva
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52
Q

Causes of dry eyes

A

Old age
Medications (beta blockers, antihistamines, antidep, diuretics)
Systemic illness (RA, sarcoidosis, Sjogren’s)
Blepharitis (decreased tear production)
Allergic conjunctivitis
Increased evapouration

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53
Q

Symptoms of dry eyes

A

Irritation
Sight blurring
Photophobia - discomfort when looking at bright lights

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54
Q

Investigations for dry eyes

A

Schirmer’s test - strip of filter paper
Slit lamp
Assessment of corneal damage - fluorescein stain

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55
Q

Treatment for dry eyes

A

Artificial tears
Drops
Gels

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56
Q

Define blepharitis

A

Inflammation of the eyelids

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57
Q

Symptoms of blepharitis

A 
Gritty, irritable eyes
Itching
Dry sensation
Loss of eyelashes
Thick, red, inflamed eyelids
Watery discharge
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58
Q

What can blepharitis lead to?

A

Styes and chalazions

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59
Q

Treatment for blepharitis

A

Eyelid hygiene - baby shampoo
Oral antibiotics - erythromycin
Hot spoon bathing
Lubricants

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60
Q

What are the two types of styes?

A

Hordeolum externum - Staphylococcus infection of the glands of Zeis or gland of Moll.
Can cause tender red lump along the eyelid that may contain pus

Hordeolum internum - Infection of Meibomian glands. They are deeper, tend to be more painful and may point inwards

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61
Q

Management of styes

A

Hot compression

Analgesia

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62
Q

Define Chalazion

A

Occurs when a Meibomian gland (may develop from hordeolum internum) becomes blocked and swells
It is typically not tender and hard

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63
Q

Management of Chalazion

A

Hot compression

Consider topic antibiotics (Chloramphenicol) if inflamed

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64
Q

Define entropian

A

The eyelid (usually lower lid) turns inwards with the lashes against the eyeball

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65
Q

Management for an entropian

A

Tape the eyelid down

Definitive treatment is with surgical intervention

66
Q

Define ectropian

A

Outward turning of the eyelid, with the inner aspect of the eyelid exposed
It usually affects the bottom eyelid

67
Q

Symptoms of an ectropian

A

Watering
Exposure keratitis
Eye irritation

68
Q

Associations with an ectropian

A

Old age

Facial palsy

69
Q

Management of an ectropian

A

Lubricating eye drops

Surgical correction

70
Q

Define trichiasis

A

Inward growth of the eyelashes

71
Q

Symptoms of trichiasis

A

Pain, corneal damage and ulceration

72
Q

Management of trichiasis

A

Remove eyelash - epilation

Recurrent cases - electrolysis, cryotherapy, laser treatment

73
Q

Define acute closed-angle glaucoma

A

Optic nerve damage as a result of a raised intraocular pressure. This raised IOP is caused by a blockage in aqueous humour trying to escape the eye.
Aqueous has to escape through the lens and the cornea, when the iris comes into contact with the lens the humour cannot pass through.
Fluid and pressure then builds up the in the posterior chamber

Acute closed-angle glaucoma is an ophthalmology emergency

74
Q

What is a raised intraocular pressure?

A

> 30 mmHg

Normal = 10-21 mmHg

75
Q

Risk factors for acute closed-angle glaucoma

A 
Increasing age (40-60 years old)
Female 4x more likely
Family history
Chinese and Asian
Medications (Adrenergic - noradrenalin, anticholinergic - oxybutynin, tricyclic antidepressants - amitryptyline)
76
Q

Symptoms of acute closed-angle glaucoma

A 
Headache
Nausea and vomiting
Painful red eye
Halos around lights
Blurred vision
Decreased visual acuity
Dilated pupil
Photophobia
77
Q

Investigations for acute closed-angle glaucoma

A

Slit lamp - large cup and nerve fibre loss
Static perimetry - visual field loss
Gonioscopy - trabecular meshwork not visible

78
Q

Treatment for acute closed-angle glaucoma

A

Pilocarpine drops - constrict the pupil
Acetazolamide (carbonic anhydrase inhibitor) - reduces the production of aqueous humour
Timolol (beta blocker) - suppress aqueous humour production
Mannitol
Laser iridotomy - piece of iris removed - definitive, prevents recurrence

79
Q

Define open angle glaucoma

A

A gradual increase in resistance through the trabecular meshwork - difficult for aqueous humour to flow through. Pressure slowly builds.
Slow and chronic onset.
Increased pressure causes a cupping of the optic disc. A small indent in the optic disc. An optic cup greater than 0.5 the size of the optic disc is abnormal.

80
Q

Risk factors for open angle glaucoma

A 
Increasing age
Family history
Black ethnicity
Nearsightedness
Hypertension
Diabetes
81
Q

Symptoms of open angle glaucoma

A 
Often asymptomatic
Peripheral vision lost first -> tunnel vision then lost
Fluctuating pain
Headaches
Blurred vision
Halos appearing around lights
82
Q

Triad for open angle glaucoma

A 
Raised IOP (>21 mmHg)
Abnormal disc - cup:disc ratio asymmetry - severe cupping
Visual field defect
83
Q

Investigations for open angle glaucoma

A

Goldmann applanation tonometry - measures IOP
Fundoscopy - checks optic disc cupping and optic nerve health
Visual field assessment

84
Q

Management for open angle glaucoma

A

Prostaglandin analogues e.g. Latanoprost - 1st line
Beta blockers e.g. Timolol
Carbonic anhydrase inhibitors e.g. Dorzolamide
Alpha agonists e.g. Brimonidine
Laser therapy - trabeculoplasty

85
Q

What prostaglandin analogues do? and their side effects?

A

Increase uveoscleral outflow

SE: eyelash growth, iris pigmentation, bronchospasm

86
Q

What do beta blockers do, side effects and contraindications?

A

Block production of aqueous humour
SE: dry eyes, bronchospasm, bradycardia, heart block, hyptension
CI: Asthma/COPD, Heart failure

87
Q

What do carbonic anhydrase inhibitors do, side effects and contraindications?

A

Reduce production of aqueous humour
SE: Burning/tearing, blepharoconjunctivitis
CI: Renal/liver failure

88
Q

What do alpha agonists do?

A

Reduce production of aqeuous humour and increase uveoscleral outflow

89
Q

Define cataract

A

When the lens in the eye becomes cloudy and opaque

90
Q

Risk factors for a cataract

A 
Increasing age
Smoking
Alcohol
Diabetes
Steroid use
Hypocalcaemia
91
Q

What are different types of cataracts?

A

Nuclear
Cortical
Posterior subcapsular

92
Q

Symptoms of a cataract

A 
Asymmetrical
Blurred vision - diplopia
Reduction in vision - reduced acuity
Colours become more yellow/brown
'Starbursts' can appear around lights
Loss of red reflex
White colour of pupil (leucocoria)
93
Q

Management for a cataract

A

Cataract surgery - day case, under local anaesthetic

Process of phacoemulsification, an intraocular lens implant and removal of the current lens

94
Q

Complications for cataracts

A

Endophthalmitis - red, painful, loss of vision/eye itself

Treat with intravitreal antibiotics

95
Q

Define age related macular degeneration (ARMD)

A

Degeneration in the macular
Drusen and sometimes blood is found at the macula during fundoscopy
Chief cause of registrable blindness

96
Q

Risk factors for age related macular degeneration

A 
Increasing age
Smoking
Cardiovascular disease
Family history
White or chinese ethnicity
97
Q

What are the four layers of the macula?

A

Photoreceptors
Retinal pigment epithelium
Bruch’s membrane
Choroid layer

98
Q

What degeneration occurs to the macula in both wet and dry ARMD?

A

Drusen - between retinal pigment epithelium and Bruch’s membrane
Atrophy of retinal pigment epithelium
Degeneration of the photoreceptors

99
Q

Symptoms of ARMD

A

Reduced visual acuity
Gradual worsening central visual field loss
Visual fluctuation
Metamorphopsia (distortion of visual images)
Wavy appearance to straight lines

100
Q

Symptoms of wet ARMD

A 
Presents more acutely
Development of new vessels
Loss of vision over days -> progresses to full vision loss over 2/3 years
Progress to bilateral disease
Distortion
Linked with VEGF
101
Q

Define dry ARMD

A

Much slower (over decades)

102
Q

Investigations for ARMD

A

Snellen chart - reduced acuity
Scotoma
Fundoscopy - drusen
Slit lamp

103
Q

Investigations for a wet ARMD

A

Optical coherence tomography - diagnoses wet ARMD

Fluorescien angiography

104
Q

Management for wet ARMD

A

VEGF inhibitors - decrease formation of new blood vessels, increase acuity. E.g. bevacizumab, ranibizumab
Stop smoking
Diet rich in green vegetables
PHotodynamic laser therapy

105
Q

Management for dry ARMD

A 
Vitamin supplementation (Vit A/E/zinc)
Stop smoking
106
Q

Define myopia

A 
Short sight
The eyeball is too long, only close objects focus the retina
Genetic causes (chromosome 18p and 12q)
Treatment = concave contact lenses
107
Q

Define hypermetropia

A

Long sight
The eye is too short
Corrected with convex lens

108
Q

Define retinal vein occlusion

A

Less sudden visual loss than retinal artery occlusion
Much more common than retinal artery occlusion
Occlusion occurs when a blood clot forms in the retinal veins and blocks off the drainage of blood
Causes macular oedema and retinal haemorrhage
Also the release of VEGF - formation of new blood vessels

109
Q

Risk factors for retinal vein occlusion

A 
Incidence increases with age
Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
SLE
110
Q

Central retinal vein occlusion symptoms

A

Sudden onset
Painless blurred vision in one eye
Never asymptomatic

Blood spread out and not as dark

111
Q

Branch retinal vein occlusion symptoms

A

Can be asymptomatic
Blurring of vision

Blood concentrated in one area (that branch vein)

112
Q

Investigations for retinal vein occlusions

A

Fundoscopy - flame and blot haemorrhages, macular oedema, optic disc oedema
Fluoresein angiography
BP - for hypertension

113
Q

Treatment for retinal vein occlusions

A

Immediate referral to ophthalmologist
VEGF inhibitors - ranibizumab, bevacizumab
Laser photocoagulation
Intravitreal steroids - dexamethasone implants

114
Q

Define central retinal artery occlusion

A

Visual loss within seconds
Occurs when something blocks the flow of blood through the central retinal artery
Less common than retinal vein occlusion

115
Q

Risk factors for central retinal artery occlusion

A 
Atherosclerosis
Old age
Family history
Smoking
Alcohol
Hypertension
Diabetes
Poor diet - cholesterol
Obesity/inactivity
116
Q

Symptoms of central retinal artery occlusion

A

Sudden painless loss of vision
Total loss of vision = central retinal artery
Top half or bottom half visual loss = branch retinal artery
Afferent pupillary defect

117
Q

Investigations for central retinal artery occlusion

A

Fundoscopy - pale, white retina. Cherry red spot at the macula, thin retinal arteries

118
Q

Treatment for central retinal artery occlusion

A 
Immediate referral to ophthalmologist
Ocular massage
Removal of fluid to reduce IOP
Inhaling carbogen - to dilate the artery
Sublingual isosorbide dinitrate - to dilate the artery
119
Q

Long term management for central retinal artery occlusion

A

Treat risk factors: stop smoking
cholesterol
Hypertension

120
Q

Define giant cell arteritis

A

Medium to large vessel systemic vasculitis (rupture or stenosis of blood vessels)
Typically seen in patients >70 years old
Rapid onset e.g. <1 month

121
Q

Symptoms of giant cell arteritis

A

Headache
Jaw claudication (chewing pain)
Scalp and temporal artery tenderness (when combing hair)
Neck pain
Sudden blindness, typically in one eye -> amaurosis fugax
Hip and shoulder morning stiffness (polymyalgia rheumatica)

122
Q

Investigations for giant cell arteritis

A

ESR >50 mm/hr
CRP raised
Temporal artery biopsy - shows skip lesions - do within one week of starting prednisolone

123
Q

Treatment for giant cell arteritis

A

Prednisolone (60mg) - high dose for two years

124
Q

Define optic neuritis

A

Unilateral loss of acuity occurs over hours or days
Colour vision is affected (dyschromatopsia): red appears less red
Eye movements hurt
Afferent defect
Associated with multiple sclerosis

125
Q

Treatment for optic neuritis

A

High-dose methylprednisolone (then prednisolone)

Full recovery over 2-8 weeks

126
Q

Define retinal detachment

A

Where the retina separates from the choroid underneath, this is usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid

Sight threatening emergency
The outer retina relies on the blood vessels of the choroid for its blood supply

127
Q

Risk factors for retinal detachment

A 
Trauma to the eye
Posterior vitreous detachment
Diabetic retinopathy
Retinal malignancy
Older age
Family history
128
Q

Symptoms of retinal detachment

A

4 F’s: Flashes and floaters (vitreous haemorrhage), Field loss (blurred or distorted vision), fall in acuity (peripheral vision loss) - like a shadow coming across

129
Q

Management of retinal detachment

A

Virectomy (removal of vitreous fluid)
Scleral buckling
Pneumatic retinopathy

Management of retinal tears: Laser therapy, cyrotherapy

130
Q

Define vitreous haemorrhage

A

Arises from: retinal neovascularization (diabetes & retinal vein occlusions), retinal tears, retinal detachment, trauma

131
Q

Symptoms of vitreous haemorrhage

A 
Vitreous floaters (small bleeds) - small black dots
Sudden vision loss in large bleeds
132
Q

Investigations for vitreous haemorrhage

A

B-scan US

Ophthalmoscopy

133
Q

Treatment for vitreous haemorrhage

A

Virectomy - removes blood

134
Q

Define posterior vitreous detachment

A

The vitreous body is the gel which keeps the retina pressed on the choroid. With age it becomes less firm and less able to maintain its shape.

Posterior vitreous detachment is where the gel comes away from the retina

Common in the elderly

135
Q

Symptoms of posterior vitreous detachment

A

Painless
Flashing lights (photopsia) in peripheral vision
Floaters - in temporal side of vision
Spots of vision loss

136
Q

Management for posterior vitreous detachment

A

Over time symptoms improve

Can cause retinal tears and detachment

137
Q

Define retinal pigmentosa

A

Congenital inherited condition where there is degeneration of the rods and cones in the retina

Rods degenerate more than cones, leading to night blindness

Onset 10-30 years old

138
Q

What time of inheritance is retinal pigmentosa?

A

It can be autosomal dominant, recessive or x-linked

139
Q

Symptoms of retinal pigmentosa

A

Night blindness - 1st symptom

Peripheral vision loss -> followed by central vision loss

140
Q

Investigations for retinal pigmentosa?

A

Fundoscopy - shows pigmentation, narrowing of arterioles, waxy or pale optic disc

141
Q

Associated diseases with retinal pigmentosa

A

Usher’s syndrome
Bassen-Kornzweig syndrome
Refsum’s disease

142
Q

Management for retinal pigmentosa

A

Refer to ophthalmologist + genetic counselling
Inform DVLA + wear sunglasses
Vitamin A/Beta carotene supplements
Oral Acetazolamide

143
Q

Define hypertensive retinopathy

A

Damage to the small blood vessels in the retina.

Can be as a result of years of chronic hypertension or can develop quickly in response to malignant hypertension

144
Q

Signs of hypertensive retinopathy

A 
Silver or copper wiring - arteriole walls become thickened
Arteriovenous nipping
Cotton wool spots
Flame haemorrhage
Hard exudate
Papilloedema
145
Q

What are the stages in the Keith-Wagener classification for hypertensive retinopathy?

A

Stage 1 = mild narrowing of arterioles
Stage 2 = focal constriction of blood vessels & AV nicking
Stage 3 = Cotton-wool patches, exudates & haemorrhages
Stage 4 = Papilloedema

146
Q

Management for hypertensive retinopathy

A

Control BP- stop smoking, diet, exercise

147
Q

Define diabetic retinopathy

A

The blood vessels in the retina are damaged by prolonged exposure to high blood sugar levels (hyperglycaemia) causing retinal damage
Increased vascular permeability leads to leakage from the blood vessels, blot haemorrhages and the formation of hard exudates
Damage to the blood vessel wall leads to microaneurysms and venous bleeding
Damage to nerve fibres in the retina causes cotton wool spots
Neovascularization can occur

148
Q

What categories can diabetic retinopathy be split into?

A

Non-proliferative
Proliferative
Diabetic maculopathy

149
Q

What are the symptoms of non-proliferative diabetic retinopathy?

A

Mild: Microaneurysms -> dots
Moderate: Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding
Severe: Microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous bleeding + intraretinal microvascular abnormality

Can progress to sight-threatening proliferative

150
Q

Symptoms of proliferative diabetic retinopathy?

A

Neovascularization

Vitreous haemorrhage

151
Q

Symptoms of diabetic maculopathy

A

Leakage from vessels close to macula
Macular oedema
Ischaemic maculopathy
Retinal thickening and hard exudates

152
Q

Investigations for diabetic retinopathy

A

Dilated fundus photography

25% of type 2 diabetes mellitus have retinopathy at diagnosis

153
Q

Management for diabetic retinopathy

A

Laser photocoagulation - treats proliferative and maculopathy
Anti VEGF medications e.g. ranibizumab,bevacizumab. SE: endopthalmitis
Vitreoretinal surgery - keyhole surgery on the eye. SE: cataract/haemorrhage

154
Q

Complications of diabetic retinopathy

A 
Retinal detachment
Vitreous haemorrhage
Rebeosis iridis (new blood vessel formation in iris)
Optic neuropathy
Cataracts
155
Q

Risk factors for diabetic retinopathy

A 
Pregnancy
Dyslipidaemia
Hypertension
Smoking
Anaemia
Renal disease
156
Q

Define Horner’s syndrome

A

Ptosis (drooping of upper eyelid)
Miosis (constriction of the pupil)
Anhydrosis (loss of sweating)

May also have enopthalmos
Caused by damage to sympathetic nervous system
Does not dilate to cocaine eyedrops

157
Q

Causes of Horner’s syndrome

A

Stroke
Multiple sclerosis
Swelling (tumours) - Pancoast’s tumour
Syringomyelia (cyst in the spinal cord)

158
Q

What is Holmes Adie pupil?

A

Unilateral dilated pupil
Slow responses to light and accommodation
Young female, impaired sweating

Holmes Adie syndrome = absent ankle and knee reflexes

159
Q

What is Argyll Robertson pupil?

A 
Bilateral
Occurs in neurosyphilis
Does not react to light
Accommodates
Bilaterally small
160
Q

What is third nerve palsy?

A

Ptosis (eyelid droops)
Divergent strabismus (down and out pupil)
Dilated non-reactive pupil

161
Q

Causes of third nerve palsy

A 
Idiopathic
Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised ICP
162
Q

What is a retinoblastoma

A

Most common ocular tumour found in children
The average age of diagnosis is 18 months

Signs: Strabismus, absence of red reflex, white pupil (leukocornia), visual problems

Treatment: Enucleation, chemotherapy, radiotherapy, photocoagulation

Phase 3b (18 decks)

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