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Neuro and SS > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What are the 3 layers of the eye?

A 
Outer protective (sclera + cornea)
Middle coat (choroid, ciliary body and iris)
Inner layer (retina)
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2
Q

What is the anterior chamber of the eye?

A

Space between cornea and iris

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3
Q

What is the posterior chamber of the eye?

A

Space between iris and ciliary body/lens

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4
Q

What is a stye (hordeolum externum)?

A

Inflammatory lid swelling

Abscess or infection (usually Staph) in a lash follicle or gland of Moll/Zeiss, ‘point’ outwards

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5
Q

How should styes be treated?

A

Warm compress for 5-10mins several times each day

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6
Q

What is a chalazion/Meibomiam cyst?

A

Abscess of Meibomian glands which ‘point’ inwards,

opening on conjunctiva and leaving residual swelling

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7
Q

How should Meibomiam cysts be treated?

A

Incision and curettage under LA if not resolving

spontaneously

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8
Q

What is blepharitis and what are some causes?

A

Lid inflammation e.g. staph, seborrheic dermatitis, rosacea, meibomian gland dysfunction

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9
Q

How should blepharitis be treated?

A

Good eyelid hygiene (cotton bud + baby shampoo),
warm compress, artificial tears
If not resolving, oral doxy

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10
Q

What is entropion?

A

Lid inturning so eyelids irritate cornea

Typically due to degen of lower lid fascial attachments and their muscles

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11
Q

How can entropion be managed?

A

Tape eyelids to cheek or use botox to lower lid

Surgery for long lasting refief

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12
Q

What is ectropion?

A

Lower lid eversion causing eye irritation, watering and exposure keratitis

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13
Q

What is blepharospasm?

A

Involuntary contraction of orbicularis oculi, commonly in response to pain

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14
Q

How can blepharospasm be managed?

A

Botox 3-monthly to cause flaccid paralysis

Anticholinergic, dopamine agonists (levodopa, bromocriptine)

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15
Q

What is a blow out fracture?

A

Partial herniation of the orbital contents through one

of its walls (medial + inferior weakest)

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16
Q

How can blow out fracture present?

A

Enophthalmos (posterior displacement of eye), diplopia, infraorbital numbness, retrobulbar haemorrhage

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17
Q

How can retrobulbar haemorrhage present?

A

Tight, swollen eyelid, fixed dilated pupil, loss of vision

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18
Q

What is the management for retrobulbar haemorrhage?

A

Urgent canthotomy + cantholysis

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19
Q

What can cause dry eyes (keratoconjunctivitis sicca)?

A

Old age

Sjogren’s, mumps, sarcoid, drugs

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20
Q

How can dry eyes be managed?

A

Artificial tears and lubricating drops

Reducing size of punctum by plugs, cautery or laser

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21
Q

What can cause watery eyes?

A

Punctal stenosis, canaliculitis
Dust, irritant, corneal injury, FB
Entropion, ectropion, MG, FN palsy

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22
Q

What is dacryocystitis and how does it present?

A

Infection of lacrimal drainage sac

Red, tender swelling at medial canthus

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23
Q

What is the treatment for dacryocystitis?

A

High dose oral Abx and referral to secondary care

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24
Q

What are some presenting features of retinoblastoma?

A

Strabismus, leukocoria (white pupil), absent red reflex

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25
Q

What are some management options for retinoblastoma?

A

Enucleation: eye removal, may be needed if large, retinal detachment, optic nerve invasion
Chemo (bilateral), RT/cryo

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26
Q

What are some risk factors for ophthalmic shingles?

A

Age, trauma to area, immunocompromised (HIV, transplant, Hodgkin’s)

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27
Q

How does ophthalmic shingles present?

A

Pain and neuralgia in CN V1 dermatome preceding blistering inflammed rash
Ocular involvement: conjunctivitis, visual loss, episcleritis/scleritis, iritis

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28
Q

What is Hutchinson’s sign in reference to ophthalmic shingles?

A

Nose-tip involvement makes it likely eye will be affected

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29
Q

How should ophthalmic shingles be managed?

A

Oral acyclovir/famciclovir for 7-10d if within 72h of rash onset
Steroid eye drops if ocular involvement

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30
Q

What is orbital cellulitis?

A

Infection of soft tissues posterior to orbital septum

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31
Q

What are some signs of orbital cellulitis?

A

Fever, lid swelling, ↓eye mobility, painful eye movements, diplopia, proptosis, chemosis

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32
Q

What are some complications of orbital cellulitis?

A

Visual loss due to optic neuritis, CRVO/CRAO

Meningitis, brain abscess, dural/cavernous sinus thrombosis

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33
Q

How should orbital cellulitis be investigated?

A

CT, ENT, ophthalmic opinion, blood cultures/swab

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34
Q

How should orbital cellulitis be managed?

A

Cefotaxime and metro IV

If abscess, surgical drainage

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35
Q

What are the differences between orbital and periorbital cellulitis?

A

Periorbital cellulitis is infection of soft tissues anterior to orbital septum
Also NO pain on eye movement or diplopia or visual impairment in periorbital

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36
Q

How should periorbital cellulitis be managed?

A

Amoxicillin/co-amoxiclav 7-10d

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37
Q

How can squints be diagnosed?

A

Corneal reflection

Cover test

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38
Q

How can squints be managed?

A

Spectacles to correct error
Patching good eye to encourage use of one which squints
Resection of rectus muscles, Botox

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39
Q

What are the features of an oculomotor nerve palsy?

A

Ptosis, proptosis, fixed pupil dilatation, eye down and

out

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40
Q

What are the features of a trochlear nerve palsy?

A

Diplopia, pt may tilt head, cannot look down and in

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41
Q

What are the features of an abducens nerve palsy?

A

Diplopia in horizontal plane

Eye is medially deviated and cannot move laterally from midline

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42
Q

What can cause an afferent pupillary defect?

A

Optic neuritis, optic atrophy, retinal disease

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43
Q

What can cause an efferent pupillary defect?

A

3rd nerve palsy

Cavernous sinus lesions, superior orbital fissure syndrome, diabetes, PosCom artery aneurysm

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44
Q

What can cause a fixed, dilated pupil?

A

3rd nerve palsy, mydriatics, trauma, acute glaucoma, coning

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45
Q

What is a tonic (Adie) pupil?

A

Lack of parasympathetic innervation results in poor

constriction to light and slow response to accommodation

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46
Q

What are the features of Horner’s syndrome?

A 
Miosis, partial ptosis, unilateral facial anhidrosis (sweating intact in distal lesions)
Iris heterochromia (if congenital Horner’s)
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47
Q

What can cause Horner’s syndrome?

A

PICA/basilar occlusion, syringomyelia, MS, cavernous sinus thrombosis, Pancoast, aortic aneurysm, carotid dissection

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48
Q

What are the features of Argyll-Robertson pupil?

A

Bilateral miosis, poor pupillary dilation, pupil irregularity, light-near dissociation (-ve to light, +ve
to accommodation)

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49
Q

What is myopia?

A

Eyeball is too long, only close objects focus on retina (short-sightedness)

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50
Q

What is the management for myopia?

A

Concave lenses

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51
Q

What is astigmatism?

A

Cornea has greater degree of curvature in one place compared to another and is an irregular surface (rugby ball shape)

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52
Q

What is hypermetropia?

A

Eye is too short, light focused behind retina, close

object blurry and far objects may be normal

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53
Q

How can hypermetropia be corrected?

A

Convex lenses

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54
Q

What is presbyopia?

A

Age-related reduced near-acuity from failing accommodation (lens stiffens)

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55
Q

Lesions at the optic chiasm cause what visual field defect?

A

Bitemporal hemianopia

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56
Q

Lesions at the optic tracts cause what visual field defect?

A

Contralateral homonymous hemianopia

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57
Q

Lesions at the optic radiations in the temporal lobe cause what visual field defect?

A

Superior quadrantanopia

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58
Q

Lesions at the optic radiations in the parietal lobe cause what visual field defect?

A

Inferior quadrantanopia

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59
Q

Lesions at the visual cortex cause what visual field defect?

A

Contralateral homonymous hemianopia often with macula sparing

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60
Q

How can visual fields be examined?

A

Finger mapping of fields
Hat-pin confrontation: red (central vision) and white hat-pins are used to define size of blind spot, boundaries of scotoma
Amsler grids

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61
Q

What are some causes of red eye that require immediate referral?

A

Acute glaucoma, acute iritis, corneal ulcers, scleritis

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62
Q

What is a subconjunctival haemorrhage?

A

Harmless, pool of blood behind conjunctiva

from small bleed

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63
Q

How can episcleral vessels be differentiated from scleral vessels?

A

Episcleral vessels lie superficially, will move when
probed with cotton bud and blanch with application of 10% phenylephrine
Deeper scleral vessels will not move or blanch

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64
Q

How should episcleritis be managed?

A

Symptomatic relief, artificial tears and topical/systemic NSAIDs

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65
Q

What are some features of scleritis?

A

Constant, severe dull ache which bores into eye
Ocular movements are painful, headache, photophobia
White patches within the red eye

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66
Q

What condition is scleritis associated with?

A

Systemic disease e.g. RA

67
Q

How should scleritis be managed?

A

Urgent referral
Oral NSAIDs ± oral pred
Systemic immunosuppression
Surgery if imminent globe perforation

68
Q

What is the uvea?

A

Pigmented part of eye (iris, ciliary body, choroid)

69
Q

What is the anterior uvea?

A

Iris and ciliary body

70
Q

What is the posterior uvea?

A

Choroid

71
Q

What are some causes of anterior uveitis (iritis)?

A

Ank spond, JIA, sarcoid, IBD, reactive arthritis, herpes, TB, HIV, syphilis, Behcet’s

72
Q

What are some causes of posterior uveitis (choroiditis)?

A

MS, lymphoma, sarcoid

73
Q

What are some cause of intermediate uveitis?

A

Herpes, toxo, TB, CMV, endophthalmitis, lymphoma, sarcoid, Behcet’s

74
Q

What are some presenting features of anterior uveitis?

A

Onset is over hours/days
Ocular pain, blurred vision, photophobia, red eye, ↑lacrimation, small irregular pupil (adhesions between lens and iris, synechiae)

75
Q

What can be used to help diagnose anterior uveitis?

A

Slit lamp with dilated pupil to visualise location of inflammatory cells (leucocytes in anterior chamber)

76
Q

How should anterior uveitis be managed?

A

Urgent eye clinic
Control underlying disease
0.5-1% pred drops to decrease inflamm and cyclopentolate to prevent adhesions.

77
Q

What is acute closed angle glaucoma?

A

Form of glaucoma where angle of anterior

chamber narrows acutely causing sudden rise in intraocular pressure to >30mmHg

78
Q

What are the features of acute closed angle glaucoma?

A

Onset over hours-days
N+V, headache, painful red eye, blurred vision, halos
around lights, hazy cornea
Pupil becomes fixed and dilated, hard eye

79
Q

How should acute closed angle glaucoma be managed?

A

Urgent referral for gonioscopy
Beta blockers, topical pilocarpine, IV acetazolamide
Peripheral iridectomy/laser iridotomy once IOP
controlled to remove piece of iris allowing aqueous flow

80
Q

What are the complications of acute closed angle glaucoma?

A

Visual loss, CRAO, CRVO, repeated episodes

81
Q

What are some features of conjunctivitis?

A

Conjunctiva red and inflamed, movable hyperaemic vessels, eyes itch, burn and lacrimate
Often bilateral and discharge may cause lids to stick
together

82
Q

What are some non-infective causes of conjunctivitis?

A

Allergic, toxic, autoimmune, neoplastic, contact lens

83
Q

What are some infective causes of conjunctivitis?

A

Non-herpetic viral (serous discharge) is most common, 80% adenovirus
Bacterial (purulent discharge), can be chlamydial or gonococcal

84
Q

How should alkali burns to the eye be managed?

A

Irrigation for prolonged period until pH returns to

normal and give topical Abx

85
Q

What is the treatment for viral conjunctivitis?

A

Artificial tears and topical antihistamines

86
Q

What is the treatment for bacterial conjunctivitis?

A 
Topical Abx (chloramphenicol) or wait for 1-2w
If sexual disease, contact lens, immunocompromised: immediate topical/oral Abx
87
Q

What is the treatment for allergic conjunctivitis?

A

Antihistamine drops

88
Q

What is keratitis?

A

Corneal inflammation due to bacterial (S. aureus), fungal, ameobic

89
Q

What are some features of keratitis?

A

White deposit in cornea, photophobia, gritty sensation, hypopyon

90
Q

How is keratitis treated?

A

Topical Abx and cycloplegics

91
Q

How should corneal abrasion be investigated?

A

Use fluorescein drops and blue light on slit lamp to stain lesions green and invert eye lid to look for FBs

92
Q

What are some causes of corneal ulcers?

A

Bacterial, herpetic, fungal (candida, aspergillus), protozoal or from vasculitis (e.g. RA)

93
Q

How can corneal ulcers present?

A

Eye pain, photophobia, watering of eye

94
Q

How should bacterial corneal ulcers be managed?

A

Until cultures are known, alternate chloramphenicol drops with ofloxacin drop

95
Q

How should herpes simplex (dendritic) corneal ulcers be managed?

A

Acyclovir eye ointment

96
Q

What are some causes of sudden painless loss of vision?

A 
GCA
CRAO
CRVO
Optic neuropathies
Vitreous haemorrhage
97
Q

What are the features of optic neuropathies?

A

Mononuclear vision loss with central scotoma
RAPD
Colour blindness
Papillitis on fundoscopy progressing to optic atrophy

98
Q

What are some features of visual loss in giant cell arteritis?

A

Typically mononuclear and may be transient (amaurosis fugax)

99
Q

What investigations should be done if giant cell arteritis is susecpted?

A

CRP, plasma viscosity, TAB after 1w of starting pred

100
Q

What are the features of optic neuritis?

A

Subacute loss of vison, colour vision affected (red desaturation), eye movements hurt, RAPD

101
Q

What is the treatment for optic neuritis?

A

High dose methypred IV then pred oral

102
Q

What are some features of central retinal artery occlusion?

A

Dramatic loss of vision within seconds of occlusion,

RAPD, retina white with cherry red spot at macula

103
Q

How should central retinal artery occlusion be managed?

A

Reduce IOP by ocular massage, surgical removal of aqueous or intraocular hypotensive treatment

104
Q

What conditions are associated with central retinal vein occlusion?

A

Age, arteriosclerosis, HTN, DM, polycythaemia,

glaucoma

105
Q

What are some features of central retinal vein occlusion (esp. ischemic)?

A

Cotton-wool spots, swollen optic nerve, macular

oedema and risk of neo-vascularisation

106
Q

How should central retinal vein occlusion be managed?

A

Panretinal photocoagulation
If visual loss, intravitreal anti-VEGF
Laser or dex implants to treat macular oedema

107
Q

How can vitreous haemorrhage arise?

A 
Retinal neovascularisation (DM, BRVO, CRVO),
retinal tears, retinal detachment or trauma
108
Q

How can vitreous haemorrhage present?

A

Small extravasation of blood produce vitreous floaters (black dots or tiny ring like forms)

109
Q

How should vitreous haemorrhage be managed?

A

Normally undergoes spontaneous absorption

If dense VH, vitrectomy

110
Q

What are some causes of gradual loss of vision?

A

Cataract, macular degen, glaucoma, diabetic retinopathy, HTN, optic atrophy, slow retinal detachment

111
Q

What are some risk factors for age-related macular degeneration?

A

Age (>70y), smoking, CVD, FH, cataract surgery

112
Q

What are some features of age-related macular degeneration?

A

Difficulty reading, making out faces, night vision, visual fluctuation, metamorphopsia (distortion of images)

113
Q

How should age-related macular degeneration be investigated?

A

Slit lamp, fundus photography, fluorescein angiography, OCT, Amsler grid

114
Q

What is drusen?

A

Optic nerve-head axonal degen
Abnormal axonal metabolism leads to intracellular mitochondrial calcification which can be deposited when axons rupture causing drusen formation

115
Q

Describe wet ARMD:

A

Pathologic choroidal neovascular membranes
develop under retina
Can leak fluid and blood and cause central disciform
scar

116
Q

What is the management for wet ARMD?

A

Stop smoking, diet rich in green veg, antioxidants
Intravitreal VEGF inhibitors (Lucentis)
Laser photocoagulation, photodynamic therapy and intravitreal steroids

117
Q

Describe dry ARMD:

A

Slower (decades), progressive visual loss relative to wet (months)
Shows mainly drusen and changes at macula

118
Q

What can cause optic atrophy?

A

RIOP (glaucoma), retinal damage (choroiditis), ischemic (RAO)
MS, syphilis, external pressure on nerve (SOL)

119
Q

What are the most common cause of blindness in UK?

A

Cataract, ARMD, glaucoma, diabetic retinopathy

120
Q

What are some risk factors for chronic glaucoma?

A

RIOP, black, FH, age

HTN + diabetes, myopia

121
Q

How is chronic (open angle) glaucoma diagnosed?

A

3+ locations outside of normal limits on VF testing and cup-to-disc ratio >0.7 (normal 0.4-0.7)

122
Q

What are some medications that can be used in the management of open angle glaucoma?

A 
Prostaglandin analogues (latanoprost)
Beta-blockers (timolol)
Alpha agonist (brimonidine)
Carbonic anhydrase inhibitors (dorzolamide)
Miotics (pilocarpine)
Sympathomimetic (dipivefrine)
123
Q

What are some non-pharmaceutical management options for open angle glaucoma?

A 
Laser therapy (trabeculoplasty)
Trabeculectomy
124
Q

What causes optic disc cupping?

A

Loss of disc substance which makes cup look larger

As damage progresses, disc atrophies, cup widens and deepens

125
Q

What visual loss occurs in optic disc cupping?

A

Vessels displaced nasally

Nasal and superior fields lost first, temporal last and central vision tends to be maintained

126
Q

What is a cataract?

A

Any opacity in lens

127
Q

What are some risk factors for cataract formation?

A

Age, genetics, DM, steroids, myopia, smoking, alcohol, trauma

128
Q

How can cataracts be classified?

A

Dense
Nuclear
Cortical
Posterior subcapsular

129
Q

How can cataracts present?

A

Blurred vision, distance judgement affected, gradual loss of vision, difficulty driving at night

130
Q

When might surgery be considered for cataracts?

A

Usually at 6/12 or worse

131
Q

Describe the surgery for cataracts:

A

Day case using LA, remove lens by phacoemulsion (US and aspirate) and insert artificial lens

132
Q

What are some post-op complications of cataract surgery?

A

Posterior capsule thickening leading to opacification Eye irritation, gritty sensation, anterior uveitis Endophthalmitis, vitreous haemorrhage, retinal
detachment, posterior capsule rupture

133
Q

What is retinal detachment?

A

Holes/tears in retina allow fluid to separate the sensory retina from pigmented epithelium

134
Q

What are some risk factors for retinal detachment?

A

Myopia, age, previous cataract, eye trauma

135
Q

What are the types of retinal detachment?

A

Rhegamatogenous – tear allowing fluid to collect (myopia, trauma)
Exudative – no tear (HTN, vasculitis, ARMD)
Tractional (proliferative retinopathy)

136
Q

How can retinal detachment present?

A

Floaters, flashes, field loss and fall in acuity

137
Q

How can retinal detachment be managed?

A

Vitrectomy and gas tamponade (or silicon oil), scleral silicone implants
Cryo or laser coag to secure retina

138
Q

What are the features of retinitis pigmentosa?

A

Inherited degen of retina

Primarily males presenting with night blindness and peripheral and central daytime visual loss

139
Q

What are some causes of floaters?

A

Trauma/retinal detachment, vitreous haemorrhage, diabetic retinopathy, CRVO, posterior vitreous detachment

140
Q

What is posterior vitreous detachment?

A

Degen changes in vitreous lead to eventual separation from retina

141
Q

How can posterior vitreous detachment present?

A

Monochromatic photopsia in peripheral temporal field, with increase in floaters

142
Q

What is a macula hole?

A

Small break in macular region of retinal tissue, usually involves fovea

143
Q

What are some risk factors for development of a macula hole?

A

Elderly, myopic, injury to eye and retinal detachment

144
Q

How can macula hole present?

A

Distorted vision and visual loss

145
Q

How can macula hole be investigated?

A

Amsler grid, OCT

146
Q

How should macula hole be managed?

A

Vitrectomy with gas tamponade

147
Q

What are the features to look out for when examining the optic disc?

A

Borders (well defined?), colour (pink-yellow with pale centre?) and the cup

148
Q

What can cause swelling of the optic disc?

A

Papilloedema, malignant HTN, cavernous sinus

thrombosis, optic neuritis, SOL, optic neuropathy, central vein occlusion

149
Q

What features can be seen on fundoscopy in papilloedema?

A

Venous engorgement, blurred margins of disc, loss of disc cup

150
Q

How are the eyes of diabetics monitored?

A

Screen at diagnosis then yearly with dilated fundus photography

151
Q

What are the features of non-proliferative diabetic retinopathy?

A

Microaneurysms (dots), haemorrhages (blots), hard exudates (yellow patches), engorged tortuous veins, cotton wool spots, blot haemorrhages
(severe if latter 3)

152
Q

What is proliferative diabetic retinopathy?

A

Fine new vessels appear on optic disc, retina and can cause vitreous haemorrhage

153
Q

What is maculopathy in terms of diabetic retinopathy?

A

Vascular leakage causes macula oedema which can threaten vision

154
Q

How should diabetic retinopathy be managed?

A

Control blood sugar and BP
Laser photocoagulation to treat maculopathy and proliferative retinopathy
Intravitreal anti-VEGF

155
Q

What are some examples of topical mydriatic/cycloplegic eye drops?

A

Tropicamide is used to dilate eye before examination

Also: atropine, cyclopentolate, phenylephrine

156
Q

What are the 4 classes of hypertensive retinopathy?

A

I – arteriolar narrowing and tortuosity, silver wiring
II – AV nipping
III – cotton wool spots, flame haemorrhages, hard exudates
IV – papilloedema

157
Q

What are some features of thyroid eye disease?

A

Eye discomfort, grittiness, ↑tears, photophobia, diplopia, ↓acuity, exophthalmos, proptosis, ophthalmoplegia due to muscle swelling and fibrosis

158
Q

What is the management for thyroid eye disease?

A

Treat thyroid, stop smoking, artificial tears, elevation of bed
If severe, high dose steroids and may need surgical decompression

159
Q

How can rheumatoid arthritis affect the eyes?

A

Dry eyes, episcleritis, scleritis, corneal ulceration, keratitis

160
Q

What are the features of allergic conjunctivitis?

A

Mild, small papillae on tarsal conjunctiva

Bilateral conjunctival erythema and swelling (chemosis), itch prominent, swollen eyelids

161
Q

How should allergic conjunctivitis be managed?

A

Antihistamine drops/systemic antihistamines, mast cell stabilisers

162
Q

What are some complications associated with contact lens use?

A

Red eye, giant papillary conjunctivitis, infection e.g. pseudomonas

163
Q

How should wet ARMD be monitored?

A

Fluorescein angiogram and 4-6w reviews with OCT, screening with Amsler grid

164
Q

What are some investigations for open angle glaucoma?

A

IOP measurement using tonometry, central corneal thickness, gonioscopy (peripheral ant chamber configuration and depth), VF measurement,
optic nerve assessment

Neuro and SS (5 decks)

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