Ophthalmology Flashcards
(164 cards)
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)
2
Q
What is the anterior chamber of the eye?
A
Space between cornea and iris
3
Q
What is the posterior chamber of the eye?
A
Space between iris and ciliary body/lens
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
5
Q
How should styes be treated?
A
Warm compress for 5-10mins several times each day
6
Q
What is a chalazion/Meibomiam cyst?
A
Abscess of Meibomian glands which ‘point’ inwards,
opening on conjunctiva and leaving residual swelling
7
Q
How should Meibomiam cysts be treated?
A
Incision and curettage under LA if not resolving
spontaneously
8
Q
What is blepharitis and what are some causes?
A
Lid inflammation e.g. staph, seborrheic dermatitis, rosacea, meibomian gland dysfunction
9
Q
How should blepharitis be treated?
A
Good eyelid hygiene (cotton bud + baby shampoo),
warm compress, artificial tears
If not resolving, oral doxy
10
Q
What is entropion?
A
Lid inturning so eyelids irritate cornea
Typically due to degen of lower lid fascial attachments and their muscles
11
Q
How can entropion be managed?
A
Tape eyelids to cheek or use botox to lower lid
Surgery for long lasting refief
12
Q
What is ectropion?
A
Lower lid eversion causing eye irritation, watering and exposure keratitis
13
Q
What is blepharospasm?
A
Involuntary contraction of orbicularis oculi, commonly in response to pain
14
Q
How can blepharospasm be managed?
A
Botox 3-monthly to cause flaccid paralysis
Anticholinergic, dopamine agonists (levodopa, bromocriptine)
15
Q
What is a blow out fracture?
A
Partial herniation of the orbital contents through one
of its walls (medial + inferior weakest)
16
Q
How can blow out fracture present?
A
Enophthalmos (posterior displacement of eye), diplopia, infraorbital numbness, retrobulbar haemorrhage
17
Q
How can retrobulbar haemorrhage present?
A
Tight, swollen eyelid, fixed dilated pupil, loss of vision
18
Q
What is the management for retrobulbar haemorrhage?
A
Urgent canthotomy + cantholysis
19
Q
What can cause dry eyes (keratoconjunctivitis sicca)?
A
Old age
Sjogren’s, mumps, sarcoid, drugs
20
Q
How can dry eyes be managed?
A
Artificial tears and lubricating drops
Reducing size of punctum by plugs, cautery or laser
21
Q
What can cause watery eyes?
A
Punctal stenosis, canaliculitis
Dust, irritant, corneal injury, FB
Entropion, ectropion, MG, FN palsy
22
Q
What is dacryocystitis and how does it present?
A
Infection of lacrimal drainage sac
Red, tender swelling at medial canthus
23
Q
What is the treatment for dacryocystitis?
A
High dose oral Abx and referral to secondary care
24
Q
What are some presenting features of retinoblastoma?
A
Strabismus, leukocoria (white pupil), absent red reflex
25
What are some management options for retinoblastoma?
Enucleation: eye removal, may be needed if large, retinal detachment, optic nerve invasion
Chemo (bilateral), RT/cryo
26
What are some risk factors for ophthalmic shingles?
Age, trauma to area, immunocompromised (HIV, transplant, Hodgkin’s)
27
How does ophthalmic shingles present?
Pain and neuralgia in CN V1 dermatome preceding blistering inflammed rash
Ocular involvement: conjunctivitis, visual loss, episcleritis/scleritis, iritis
28
What is Hutchinson's sign in reference to ophthalmic shingles?
Nose-tip involvement makes it likely eye will be affected
29
How should ophthalmic shingles be managed?
Oral acyclovir/famciclovir for 7-10d if within 72h of rash onset
Steroid eye drops if ocular involvement
30
What is orbital cellulitis?
Infection of soft tissues posterior to orbital septum
31
What are some signs of orbital cellulitis?
Fever, lid swelling, ↓eye mobility, painful eye movements, diplopia, proptosis, chemosis
32
What are some complications of orbital cellulitis?
Visual loss due to optic neuritis, CRVO/CRAO
| Meningitis, brain abscess, dural/cavernous sinus thrombosis
33
How should orbital cellulitis be investigated?
CT, ENT, ophthalmic opinion, blood cultures/swab
34
How should orbital cellulitis be managed?
Cefotaxime and metro IV
| If abscess, surgical drainage
35
What are the differences between orbital and periorbital cellulitis?
Periorbital cellulitis is infection of soft tissues anterior to orbital septum
Also NO pain on eye movement or diplopia or visual impairment in periorbital
36
How should periorbital cellulitis be managed?
Amoxicillin/co-amoxiclav 7-10d
37
How can squints be diagnosed?
Corneal reflection
| Cover test
38
How can squints be managed?
Spectacles to correct error
Patching good eye to encourage use of one which squints
Resection of rectus muscles, Botox
39
What are the features of an oculomotor nerve palsy?
Ptosis, proptosis, fixed pupil dilatation, eye down and
| out
40
What are the features of a trochlear nerve palsy?
Diplopia, pt may tilt head, cannot look down and in
41
What are the features of an abducens nerve palsy?
Diplopia in horizontal plane
| Eye is medially deviated and cannot move laterally from midline
42
What can cause an afferent pupillary defect?
Optic neuritis, optic atrophy, retinal disease
43
What can cause an efferent pupillary defect?
3rd nerve palsy
| Cavernous sinus lesions, superior orbital fissure syndrome, diabetes, PosCom artery aneurysm
44
What can cause a fixed, dilated pupil?
3rd nerve palsy, mydriatics, trauma, acute glaucoma, coning
45
What is a tonic (Adie) pupil?
Lack of parasympathetic innervation results in poor
| constriction to light and slow response to accommodation
46
What are the features of Horner's syndrome?
```
Miosis, partial ptosis, unilateral facial anhidrosis (sweating intact in distal lesions)
Iris heterochromia (if congenital Horner’s)
```
47
What can cause Horner's syndrome?
PICA/basilar occlusion, syringomyelia, MS, cavernous sinus thrombosis, Pancoast, aortic aneurysm, carotid dissection
48
What are the features of Argyll-Robertson pupil?
Bilateral miosis, poor pupillary dilation, pupil irregularity, light-near dissociation (-ve to light, +ve
to accommodation)
49
What is myopia?
Eyeball is too long, only close objects focus on retina (short-sightedness)
50
What is the management for myopia?
Concave lenses
51
What is astigmatism?
Cornea has greater degree of curvature in one place compared to another and is an irregular surface (rugby ball shape)
52
What is hypermetropia?
Eye is too short, light focused behind retina, close
| object blurry and far objects may be normal
53
How can hypermetropia be corrected?
Convex lenses
54
What is presbyopia?
Age-related reduced near-acuity from failing accommodation (lens stiffens)
55
Lesions at the optic chiasm cause what visual field defect?
Bitemporal hemianopia
56
Lesions at the optic tracts cause what visual field defect?
Contralateral homonymous hemianopia
57
Lesions at the optic radiations in the temporal lobe cause what visual field defect?
Superior quadrantanopia
58
Lesions at the optic radiations in the parietal lobe cause what visual field defect?
Inferior quadrantanopia
59
Lesions at the visual cortex cause what visual field defect?
Contralateral homonymous hemianopia often with macula sparing
60
How can visual fields be examined?
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
61
What are some causes of red eye that require immediate referral?
Acute glaucoma, acute iritis, corneal ulcers, scleritis
62
What is a subconjunctival haemorrhage?
Harmless, pool of blood behind conjunctiva
| from small bleed
63
How can episcleral vessels be differentiated from scleral vessels?
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
64
How should episcleritis be managed?
Symptomatic relief, artificial tears and topical/systemic NSAIDs
65
What are some features of scleritis?
Constant, severe dull ache which bores into eye
Ocular movements are painful, headache, photophobia
White patches within the red eye
66
What condition is scleritis associated with?
Systemic disease e.g. RA
67
How should scleritis be managed?
Urgent referral
Oral NSAIDs ± oral pred
Systemic immunosuppression
Surgery if imminent globe perforation
68
What is the uvea?
Pigmented part of eye (iris, ciliary body, choroid)
69
What is the anterior uvea?
Iris and ciliary body
70
What is the posterior uvea?
Choroid
71
What are some causes of anterior uveitis (iritis)?
Ank spond, JIA, sarcoid, IBD, reactive arthritis, herpes, TB, HIV, syphilis, Behcet’s
72
What are some causes of posterior uveitis (choroiditis)?
MS, lymphoma, sarcoid
73
What are some cause of intermediate uveitis?
Herpes, toxo, TB, CMV, endophthalmitis, lymphoma, sarcoid, Behcet’s
74
What are some presenting features of anterior uveitis?
Onset is over hours/days
Ocular pain, blurred vision, photophobia, red eye, ↑lacrimation, small irregular pupil (adhesions between lens and iris, synechiae)
75
What can be used to help diagnose anterior uveitis?
Slit lamp with dilated pupil to visualise location of inflammatory cells (leucocytes in anterior chamber)
76
How should anterior uveitis be managed?
Urgent eye clinic
Control underlying disease
0.5-1% pred drops to decrease inflamm and cyclopentolate to prevent adhesions.
77
What is acute closed angle glaucoma?
Form of glaucoma where angle of anterior
| chamber narrows acutely causing sudden rise in intraocular pressure to >30mmHg
78
What are the features of acute closed angle glaucoma?
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
How should acute closed angle glaucoma be managed?
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
What are the complications of acute closed angle glaucoma?
Visual loss, CRAO, CRVO, repeated episodes
81
What are some features of conjunctivitis?
Conjunctiva red and inflamed, movable hyperaemic vessels, eyes itch, burn and lacrimate
Often bilateral and discharge may cause lids to stick
together
82
What are some non-infective causes of conjunctivitis?
Allergic, toxic, autoimmune, neoplastic, contact lens
83
What are some infective causes of conjunctivitis?
Non-herpetic viral (serous discharge) is most common, 80% adenovirus
Bacterial (purulent discharge), can be chlamydial or gonococcal
84
How should alkali burns to the eye be managed?
Irrigation for prolonged period until pH returns to
| normal and give topical Abx
85
What is the treatment for viral conjunctivitis?
Artificial tears and topical antihistamines
86
What is the treatment for bacterial conjunctivitis?
```
Topical Abx (chloramphenicol) or wait for 1-2w
If sexual disease, contact lens, immunocompromised: immediate topical/oral Abx
```
87
What is the treatment for allergic conjunctivitis?
Antihistamine drops
88
What is keratitis?
Corneal inflammation due to bacterial (S. aureus), fungal, ameobic
89
What are some features of keratitis?
White deposit in cornea, photophobia, gritty sensation, hypopyon
90
How is keratitis treated?
Topical Abx and cycloplegics
91
How should corneal abrasion be investigated?
Use fluorescein drops and blue light on slit lamp to stain lesions green and invert eye lid to look for FBs
92
What are some causes of corneal ulcers?
Bacterial, herpetic, fungal (candida, aspergillus), protozoal or from vasculitis (e.g. RA)
93
How can corneal ulcers present?
Eye pain, photophobia, watering of eye
94
How should bacterial corneal ulcers be managed?
Until cultures are known, alternate chloramphenicol drops with ofloxacin drop
95
How should herpes simplex (dendritic) corneal ulcers be managed?
Acyclovir eye ointment
96
What are some causes of sudden painless loss of vision?
```
GCA
CRAO
CRVO
Optic neuropathies
Vitreous haemorrhage
```
97
What are the features of optic neuropathies?
Mononuclear vision loss with central scotoma
RAPD
Colour blindness
Papillitis on fundoscopy progressing to optic atrophy
98
What are some features of visual loss in giant cell arteritis?
Typically mononuclear and may be transient (amaurosis fugax)
99
What investigations should be done if giant cell arteritis is susecpted?
CRP, plasma viscosity, TAB after 1w of starting pred
100
What are the features of optic neuritis?
Subacute loss of vison, colour vision affected (red desaturation), eye movements hurt, RAPD
101
What is the treatment for optic neuritis?
High dose methypred IV then pred oral
102
What are some features of central retinal artery occlusion?
Dramatic loss of vision within seconds of occlusion,
| RAPD, retina white with cherry red spot at macula
103
How should central retinal artery occlusion be managed?
Reduce IOP by ocular massage, surgical removal of aqueous or intraocular hypotensive treatment
104
What conditions are associated with central retinal vein occlusion?
Age, arteriosclerosis, HTN, DM, polycythaemia,
| glaucoma
105
What are some features of central retinal vein occlusion (esp. ischemic)?
Cotton-wool spots, swollen optic nerve, macular
| oedema and risk of neo-vascularisation
106
How should central retinal vein occlusion be managed?
Panretinal photocoagulation
If visual loss, intravitreal anti-VEGF
Laser or dex implants to treat macular oedema
107
How can vitreous haemorrhage arise?
```
Retinal neovascularisation (DM, BRVO, CRVO),
retinal tears, retinal detachment or trauma
```
108
How can vitreous haemorrhage present?
Small extravasation of blood produce vitreous floaters (black dots or tiny ring like forms)
109
How should vitreous haemorrhage be managed?
Normally undergoes spontaneous absorption
| If dense VH, vitrectomy
110
What are some causes of gradual loss of vision?
Cataract, macular degen, glaucoma, diabetic retinopathy, HTN, optic atrophy, slow retinal detachment
111
What are some risk factors for age-related macular degeneration?
Age (>70y), smoking, CVD, FH, cataract surgery
112
What are some features of age-related macular degeneration?
Difficulty reading, making out faces, night vision, visual fluctuation, metamorphopsia (distortion of images)
113
How should age-related macular degeneration be investigated?
Slit lamp, fundus photography, fluorescein angiography, OCT, Amsler grid
114
What is drusen?
Optic nerve-head axonal degen
Abnormal axonal metabolism leads to intracellular mitochondrial calcification which can be deposited when axons rupture causing drusen formation
115
Describe wet ARMD:
Pathologic choroidal neovascular membranes
develop under retina
Can leak fluid and blood and cause central disciform
scar
116
What is the management for wet ARMD?
Stop smoking, diet rich in green veg, antioxidants
Intravitreal VEGF inhibitors (Lucentis)
Laser photocoagulation, photodynamic therapy and intravitreal steroids
117
Describe dry ARMD:
Slower (decades), progressive visual loss relative to wet (months)
Shows mainly drusen and changes at macula
118
What can cause optic atrophy?
RIOP (glaucoma), retinal damage (choroiditis), ischemic (RAO)
MS, syphilis, external pressure on nerve (SOL)
119
What are the most common cause of blindness in UK?
Cataract, ARMD, glaucoma, diabetic retinopathy
120
What are some risk factors for chronic glaucoma?
RIOP, black, FH, age
| HTN + diabetes, myopia
121
How is chronic (open angle) glaucoma diagnosed?
3+ locations outside of normal limits on VF testing and cup-to-disc ratio >0.7 (normal 0.4-0.7)
122
What are some medications that can be used in the management of open angle glaucoma?
```
Prostaglandin analogues (latanoprost)
Beta-blockers (timolol)
Alpha agonist (brimonidine)
Carbonic anhydrase inhibitors (dorzolamide)
Miotics (pilocarpine)
Sympathomimetic (dipivefrine)
```
123
What are some non-pharmaceutical management options for open angle glaucoma?
```
Laser therapy (trabeculoplasty)
Trabeculectomy
```
124
What causes optic disc cupping?
Loss of disc substance which makes cup look larger
| As damage progresses, disc atrophies, cup widens and deepens
125
What visual loss occurs in optic disc cupping?
Vessels displaced nasally
| Nasal and superior fields lost first, temporal last and central vision tends to be maintained
126
What is a cataract?
Any opacity in lens
127
What are some risk factors for cataract formation?
Age, genetics, DM, steroids, myopia, smoking, alcohol, trauma
128
How can cataracts be classified?
Dense
Nuclear
Cortical
Posterior subcapsular
129
How can cataracts present?
Blurred vision, distance judgement affected, gradual loss of vision, difficulty driving at night
130
When might surgery be considered for cataracts?
Usually at 6/12 or worse
131
Describe the surgery for cataracts:
Day case using LA, remove lens by phacoemulsion (US and aspirate) and insert artificial lens
132
What are some post-op complications of cataract surgery?
Posterior capsule thickening leading to opacification Eye irritation, gritty sensation, anterior uveitis Endophthalmitis, vitreous haemorrhage, retinal
detachment, posterior capsule rupture
133
What is retinal detachment?
Holes/tears in retina allow fluid to separate the sensory retina from pigmented epithelium
134
What are some risk factors for retinal detachment?
Myopia, age, previous cataract, eye trauma
135
What are the types of retinal detachment?
Rhegamatogenous – tear allowing fluid to collect (myopia, trauma)
Exudative – no tear (HTN, vasculitis, ARMD)
Tractional (proliferative retinopathy)
136
How can retinal detachment present?
Floaters, flashes, field loss and fall in acuity
137
How can retinal detachment be managed?
Vitrectomy and gas tamponade (or silicon oil), scleral silicone implants
Cryo or laser coag to secure retina
138
What are the features of retinitis pigmentosa?
Inherited degen of retina
| Primarily males presenting with night blindness and peripheral and central daytime visual loss
139
What are some causes of floaters?
Trauma/retinal detachment, vitreous haemorrhage, diabetic retinopathy, CRVO, posterior vitreous detachment
140
What is posterior vitreous detachment?
Degen changes in vitreous lead to eventual separation from retina
141
How can posterior vitreous detachment present?
Monochromatic photopsia in peripheral temporal field, with increase in floaters
142
What is a macula hole?
Small break in macular region of retinal tissue, usually involves fovea
143
What are some risk factors for development of a macula hole?
Elderly, myopic, injury to eye and retinal detachment
144
How can macula hole present?
Distorted vision and visual loss
145
How can macula hole be investigated?
Amsler grid, OCT
146
How should macula hole be managed?
Vitrectomy with gas tamponade
147
What are the features to look out for when examining the optic disc?
Borders (well defined?), colour (pink-yellow with pale centre?) and the cup
148
What can cause swelling of the optic disc?
Papilloedema, malignant HTN, cavernous sinus
| thrombosis, optic neuritis, SOL, optic neuropathy, central vein occlusion
149
What features can be seen on fundoscopy in papilloedema?
Venous engorgement, blurred margins of disc, loss of disc cup
150
How are the eyes of diabetics monitored?
Screen at diagnosis then yearly with dilated fundus photography
151
What are the features of non-proliferative diabetic retinopathy?
Microaneurysms (dots), haemorrhages (blots), hard exudates (yellow patches), engorged tortuous veins, cotton wool spots, blot haemorrhages
(severe if latter 3)
152
What is proliferative diabetic retinopathy?
Fine new vessels appear on optic disc, retina and can cause vitreous haemorrhage
153
What is maculopathy in terms of diabetic retinopathy?
Vascular leakage causes macula oedema which can threaten vision
154
How should diabetic retinopathy be managed?
Control blood sugar and BP
Laser photocoagulation to treat maculopathy and proliferative retinopathy
Intravitreal anti-VEGF
155
What are some examples of topical mydriatic/cycloplegic eye drops?
Tropicamide is used to dilate eye before examination
| Also: atropine, cyclopentolate, phenylephrine
156
What are the 4 classes of hypertensive retinopathy?
I – arteriolar narrowing and tortuosity, silver wiring
II – AV nipping
III – cotton wool spots, flame haemorrhages, hard exudates
IV – papilloedema
157
What are some features of thyroid eye disease?
Eye discomfort, grittiness, ↑tears, photophobia, diplopia, ↓acuity, exophthalmos, proptosis, ophthalmoplegia due to muscle swelling and fibrosis
158
What is the management for thyroid eye disease?
Treat thyroid, stop smoking, artificial tears, elevation of bed
If severe, high dose steroids and may need surgical decompression
159
How can rheumatoid arthritis affect the eyes?
Dry eyes, episcleritis, scleritis, corneal ulceration, keratitis
160
What are the features of allergic conjunctivitis?
Mild, small papillae on tarsal conjunctiva
| Bilateral conjunctival erythema and swelling (chemosis), itch prominent, swollen eyelids
161
How should allergic conjunctivitis be managed?
Antihistamine drops/systemic antihistamines, mast cell stabilisers
162
What are some complications associated with contact lens use?
Red eye, giant papillary conjunctivitis, infection e.g. pseudomonas
163
How should wet ARMD be monitored?
Fluorescein angiogram and 4-6w reviews with OCT, screening with Amsler grid
164
What are some investigations for open angle glaucoma?
IOP measurement using tonometry, central corneal thickness, gonioscopy (peripheral ant chamber configuration and depth), VF measurement,
optic nerve assessment
