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ophthalmology Flashcards

1
Q

RED eye/Conjunctiva (unlike what?!?!?!?!?!?)
Sore EYELIDS
Gritty-Foreign Body / Sticky / Burning

O/E: Conjunctiva =

  • diffusely injected -> transient blurring
  • crusted eyelids
  • SWOLLEN conjunctivae #chemosis=oedema
1a. Dx?
Muco-PURULENT discharge
Stuckkkk @MORNING
--Noooooot itchy
--usually no Pre-Auric LNopathy
  • Tx?
  • Tx @preg?
  • Re-attender mx?

-Refer when?

1b -Muco-PURULENT d/c +
Pre-Auric LNopathy +
?STD Hx =
Dx?

_____________

2. Dx?
SEROUS discharge
Recent URTI
Pre-AURICULAR lymph NODES
PRURITIS
-Chemosis=Conjunc-Oedema/erythema
  • what organism? -> Epidemic KeratoConjunctivitis -> -pseudo?
  • severe PAIN
  • Subconjunctival Haemorrhage
  • visual changes/photophobia.

-Ax? Bact Pre-auric LNs Ax?!
-Tx?
-Re-attender mx?
___________

  1. Dx?
    sticky RED @neonate
    5–14 days after birth

2 presentations:

  • Copious purulent dischargeand eyelid swelling - Ax?
  • petechial/subconjunctival haemorrhages, lymphadenopathy - Ax?

Tx?
-Mild = presentation?
-Severe = Ix?
___________

  1. Summer time, itchy eyes - Dx? Tx?

_____________

  1. Non-resolving i.e. chronic conjunctivitis despite top chloramphenicol - Dx?
A

RED eye (unlike blepharitis/dry eye synd)

Conjunctivitis: CFR-HOOMP-sCDT-AAA

1a. Bacterial conjunctivitis: CFR-HOOMP

  • Chloramphenicol-Top
  • FUSIDIC @pregggg-Top
  • Re-attends = SWAB:
  • -viral PCR #adeno/HSV
  • -bacteria #top ABx
  • Refer: HOOMP
  • HSV #ulcer/keratitis
  • Ophthalmia neonatorum #STD:CT/GC NAAT
  • Ocular surgery
  • Molluscum-contagiosum #pox-virus
  • Periorbital OR orbital #cellulitis

1b. Muco-PURULENT d/c + Pre-Auric LNopathy + STD Hx =
GONORRHOEA
_____________

  1. Viral - sCDT
    - ADENO -> Epidemic KeratoConjunctivitis -> -pseudoMEMBRANES
    - severe pain
    - subconjunctival haemorrhage
    - visual changes / photophobia

Ax:

  • Adeno
  • Chlam/Gon present w/ Pre-AURIC NODES!!!!!
Tx:
self-limit (towel/handwash) 1-2w
COOL comp
Debris removal 
Tears/lube @dry-eyes = Hypromellose
-Re-attends = SWAB: 
---viral PCR #adeno/HSV 
---bacteria #top ABx
\_\_\_\_\_\_\_\_\_\_\_
  1. Neonatorum-Ophthalmicus
    - Copious purulent discharge + eyelid swelling #Gonococcal
    - petechial/subconjunctival haemorrhages, lymphadenopathy #Viral - adeno/HSV

Tx = REFER
-Mild = Encrusted Eyelid
-Severe = Bloods, CT/GC NAAT
___________

  1. Allergic = AAA
    Avoid allergens
    AHist/Mast-cell stab Cromoglic
    -Artifical tears/lube @dry-eyes = Hypromellose

______________

  1. Orbital Lymphoma
    ________

Refer for bottom causes suspected:

  • Ddx:
    1. Corneal abrasion - Yellow/green focal uptake Top ABx
    2. Corneal ulcer - discrete/focal area of upake - Top ABx
    3. Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
  1. HSV Keratitis- Feathery Dendritic Top Aciclovir
  2. HZO urgent admit PO aciclovir - U+E
red eye ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
Intra-occ surg / pre/orbital cellulitis / Molluscum
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2
Q

NOOOOOO red eye unlike WHAT?!

-EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS EyeLIDDDDS

Burn / Itchy @eyeLIDS
Sore eyeLIDDDD - #CRUST
Gritty / Sticky
-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING-WORSE @MORNING

-Recurrent STYE !!!!!!!!!!!

O/E: EyeLIDDDD margins = RED
-NOT swollen

Assoc w/

  • Meibomian dx
  • A. Rosacea
  • Parkinsons
  • Seborrh Derm / Staph infection
  • EyeLID margins Red + Swollen @?infection?!?!
  • Dx? Tx?

-Posterior blepharitis w/ meibomian gland dx + rosacea
-> Tx??
___________

Pathphys of posterior blepharitis -> dry eye synd

? glands = secrete what? ->
which forms what? ->
-stop what?
-improve what?

@Meibomian blepharitis – ? reduced -> ?

A

NOOOOOO red eye unlike CONJUNCTIVITIS
_____________

BLEPHARITIS = EyeLID dx - WMDA ALI

O/E:
-Eyelid margins red AND swollen
@S.Aureus Blepharitis

  • Warm compression
  • Massage @post-bleph
  • Debris removal*
  • Ax tx / ?ABx: Chloramphen
  • Artifical tears/lube @dry-eyes = Hypromellose
  • Lens-wear = reduce/change
  • Incr humidity / Lower comp screens = lower lid aperture
  • Posterior blepharitis w/ meibomian gland dx + rosacea
  • > DOXY

*cooled boiled water w/cotton buds /
Na HCO3-
___________

-POSTERIOR blepharitis -> dry eye synd
Meibomian tarsal glands = oily secretion -> 
form outer part of tear-film -> 
-stop tear EVAP 
-improve tear stability/spreading

@Meibomian blepharitis – oily secretion reduced -> tear EVAP

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3
Q

NOOOOOO red eye unlike WHAT?!

Usually B/L

-Fluoroscein Exam: PUNCTATE stain
PHOTOsensitive
Mucous d/c
Occular FATIGUE
-WORSEN/Tearing @WIND
-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day-WORSEN @THROUGHOUT day

Burn / Itchy @EYE
?Bluuuuurring = ?INTERMITTENT
Gritty / Sticky

  • Meibomian orifices on bilateral lids = plugged with OILY material
  • EyeLids/Conjuntiva = crusted/Red
  • Margins = irregular.

NORMAL acuity/pupils/sclera
NORMAL ant slit: cornea/chambers

PMH: Bell’s palsy - not compliant w/ taping eyelid b4 sleep

  1. Dx? Tx?

2.
If pt use > ? drops/day –>
consider ?-free drops
-cos preservatives= ???

@mod-severe ?? potential = is higher due to
? dosing and
? tear secretion.

@severe - use what?
?what @tear ducts –>
dos what???

3.
Pathphys of posterior blepharitis -> dry-eye synd:
-Meibomian tarsal glands = secrete what? ->
which forms what? ->
-stop what?
-improve what?

A

NOOOOOO red eye unlike CONJUNCTIVITIS
_____________

  1. DRY eye - WMD ALI
    - Warm compression
    - Massage @post-bleph
    - Debris removal*
    - Ax tx / ?ABx-Chloramphen
  • Artifical tears/lube @dry-eyes = Hypromellose
  • Lens-wear = reduce/change
  • Incr humidity / Lower comp screens = lower lid aperture

*cooled boiled water w/
-cotton buds
-Na HCO3-
_____________

  1. Dry Eye WMD ALI
    If pt use > 6 drops/day –>
    consider PRESERVATIVE-free drops
    -cos preservatives = FURTHER damage cornea/conjunctiva-epith

@mod-severe, PRESERVATIVE TOXICITYpotential = is higher due to
MORE frequent dosing and
REDUCED tear secretion.

-@severe:
PUNCTAL plugs @tear ducts –>
increase tear film
_____________

3. POSTERIOR blepharitis -> Dry Eye Synd
Meibomian tarsal glands = OILY secretion -> 
form OUTER part of tear-film -> 
-stop tear EVAP 
-improve Stability/Spreading of tear

@Meibomian blepharitis – oily secretion reduced -> tear EVAP

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4
Q

Fluorescein:

  • Punctate stain
  • YELLOW/green stained abrasion #?surface
  • discrete/FOCAL area of yellow/green

-FEATHERY Dendritic ULCER
_______________

ACUTE Local TRAUMA

PAIN, Photophobia
FOREIGN BODY sensation

LOCAL TRAUMA
After removing contact lens -
?nail scratch-self

Fluorescein exam =
YELLOW/green stained abrasion
Corneal UPTAKE

A

Fluorescein:

  • Punctate stain – Dry eye
  • YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
  • discrete/FOCAL area of yellow/green – C. Ulcer

-FEATHERY Dendritic ULCER – HSKeratitis
________________

Corneal abrasion
-Top chloramphenicol
_____________________

Ddx:

  1. Corneal abrasion - Yellow/green focal uptake Top ABx
  2. Corneal ulcer - discrete/focal area of upake - Top ABx
  3. Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
  4. HSV Keratitis- Feathery Dendritic Top Aciclovir
  5. HZO urgent admit PO aciclovir
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5
Q

Fluorescein:

  • Punctate stain
  • YELLOW/green stained abrasion #?surface
  • discrete/FOCAL area of yellow/green

-FEATHERY Dendritic ULCER
_______________

Contact lens users (CLARE)

-Red eye
Pain, Photophobia
Tearing

Pupils normal

Fluorescein exam =
discrete/FOCAL area
of yellow/green fluorescence
under a blue light

  • Tx?
  • Can present as?
  • Avoid what?
A

Fluorescein:

  • Punctate stain – Dry eye
  • YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
  • discrete/FOCAL area of yellow/green – C. Ulcer

-FEATHERY Dendritic ULCER – HSKeratitis
________________

Corneal Ulcer
-Top chloramphenicol 
-CAN Presents as Dendritic Feathery Herpes Simlex Keratitis
-AVOID top anaesthetic drops
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Ddx:

  1. Corneal abrasion - Yellow/green focal uptake Top ABx
  2. Corneal ulcer - discrete/focal area of upake - Top ABx
  3. Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
  4. HSV Keratitis- Feathery Dendritic Top Aciclovir
  5. HZO urgent admit PO aciclovir = U+E
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
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6
Q

Fluorescein:

  • Punctate stain
  • YELLOW/green stained abrasion #?surface
  • discrete/FOCAL area of yellow/green

-FEATHERY Dendritic ULCER
_______________

CLARE: Contact Lens Acute Red Eye
-Climber/skiers
-Welders (arc eye)
-Sunbed users
NOT USED PROTECTIVE goggles
\+
FOREIGN BODY sensation #GRITTY
BLEPHARO-SPASM #eyelid-spasm
PAIN, PHOTOphobia
RED eye - hyperaemia
O/E:
?Hypopyon
Cornea = HAZY ant slit lamp
NORMAL pupils
Punctate lesions

Dx?
Which Bacteria @contact-use ?
Still bact most common?
Tx?

A

Fluorescein:

  • Punctate stain – Dry eye
  • YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
  • discrete/FOCAL area of yellow/green – C. Ulcer

-FEATHERY Dendritic ULCER – HSKeratitis
________________

Keratitis - corneal inflamm - ACTS

  • Contacts - P. Aerug #CLARE
  • but still S.Aureus > P.Aerug
  • Admit ASAP for Ant slit lamp to r/o Microbial Keratitis
  • CycloPlegicPentolate = Analgesia #mydriasis
  • Top ABx - quinolone
  • Stop contact lens

Ax:

-HSV / Staph > P.Aerug #ContactsLARE)
-Fungal/ AmoebaSoil/ ParasiteRiverBlindness
_____________________

Ddx:

  1. Corneal abrasion - Yellow/green focal uptake Top ABx
  2. Corneal ulcer - discrete/focal area of upake - Top ABx
  3. Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
  4. HSV Keratitis- Feathery Dendritic Top Aciclovir
  5. HZO urgent admit PO aciclovir - U+E
    _____________________
    ddx:
    ACAG
    A.Uveitis
    Scleritis/EPainlesScleritis
    Conjunctivitis
    Subconjunc haemorrhage
    Chorioretinitis-CMV/Toxo
    HZO
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7
Q

Fluorescein:

  • Punctate stain
  • YELLOW/green stained abrasion #?surface
  • discrete/FOCAL area of yellow/green

-FEATHERY Dendritic ULCER
_______________

RED eye
PAIN, Photophobia
Tearing

?decreased acuity

Fluorescein exam =
small, area of abnormal uptake @epithelium
-FEATHERY Dendritic ULCER

Tx? Avoid? Can presents with?

A

Fluorescein:

  • Punctate stain – Dry eye
  • YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
  • discrete/FOCAL area of yellow/green – C. Ulcer

-FEATHERY Dendritic ULCER – HSKeratitis
________________

Herpes Simples KERATITIS

  • Urgent OPHTHAL
  • Top ACICLOVIR
  • AVOID top steds
  • Can present w/ Dend Corneal Ulcer

_____________________

Ddx:

  1. Corneal abrasion - Yellow/green focal uptake Top ABx
  2. Corneal ulcer - discrete/focal area of upake - Top ABx
  3. Keratitis: Top ABx and CycloPlegicPentate-MYDRIASIS
  4. HSV Keratitis- Feathery Dendritic Top Aciclovir
  5. HZO urgent admit PO aciclovir - U+E
    ddx:
    ACAG
    A.Uveitis
    Scleritis/EPainlesScleritis
    Conjunctivitis
    Subconjunc haemorrhage
    Chorioretinitis-CMV/Toxo
    HZO
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8
Q

Marco Tropical Scam in Pak:

Marcus-Gunn RAPD CN2 Ax
-M.ARCO

Tunnel vision Ax
-T.ROPIC

Scotoma Ax
-S.CAM
___________

Hypopyon Ax
-PAK

Squint strabismus:

  • Up till when is it normal?
  • When to start worrying?
  • Types? Which one more common in concomitant?
  • Ix?

Tx: Refer - eye patch @ > age ?
________

Aciclovir: when Top/PO?

A

Marco Tropical Scam in Pak:

Marcus-Gunn RAPD

  • AION
  • RVO/RAO-central
  • CRVO/CRAO
  • Optic Neuritis: MS/DM/Syph

TTTunnel Vision:

  • Ret pigmentosa
  • Optic Atrophy @TTTabesDorsalisSyph
  • POAG-ACAG
  • ICP high i.e. pappilooedema
  • ChorioRet-CMV/Toxo
Scotoma:
-CRVO
-ARMD 
-Migraine - scintillating
\_\_\_\_\_\_\_\_\_\_\_\_\_
Hypopyon:
-Post-op endophthalmitis,
-Ant uveitis, 
-Keratitis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  • Intermittent squint in NEWborn <3 months = NORMAL - underdeveloped eye muscles
  • > 3m ?start worrying #refer

Concomitant: Convergent In > Divergent Out
Paralytic: muscle paralysis

Ix:
Corneal light reflection
Cover test

Tx: Refer - eye patch @ >3months
________

Aciclovir:
Top @HSV Keratitis
PO @HZO

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9
Q

SUDDEN ocular irritation;
-ABERRANT lash OR
-CLUSTER of lashes seen;
_____________

Eyelid turned out

Eyelid turned in

What does 6/12 vision mean?
__________

Fluorescein:

  • Punctate stain
  • YELLOW/green stained abrasion #?surface
  • discrete/FOCAL area of yellow/green
  • FEATHERY Dendritic ULCER

______________

Marfan’s - SuddenUnilatPainless vision loss

Blue sclera @paed condition
__________

Valsalva manoeuvre, coughing, sneezing, or heavy lifting;
- asymptomatic;
PMH: HTN or Anticoagulants
O/E: well-circumscribed area of confluent haemorrhage underneath conjunctiva

A

Trichiasis
_____________

Ectropion

Entropion

6/12 vision = METRES!!!!!! = Pt V Normal
-PT can see X at 6m
-That a NORM person would see at 12m
________

Fluorescein:

  • Punctate stain – Dry eye
  • YELLOW/green stained abrasion #de-epithelialized surface – C. Abrasion
  • discrete/FOCAL area of yellow/green – C. Ulcer

-FEATHERY Dendritic ULCER - HSKeratitis
____________

Lens dislocation - Marfan
Scoliosis SCLERA blue 
Lens UPWARD dislocation 
ARm:Height >1.05
AOrtic sinus dilation 
ADom 
PCavus / Excavatum

Blue sclera = Osteogen IMPERFECTA
__________

Non-traumatic subconjunctival haemorrhage

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10
Q

Keith Wagener HTN retinopathy classification:

SABP
________

Non-Proliferative BACKGROUND Diabetic Retinopathy:
-mild
-mod
-severe
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Proliferative retinopathy DM ? > ?
-Pathphys?
-Tx?
_______________

Blurrrrrring vision, DM2,
HARD exudates @fovea
‘BG’ changes on macula
-vessels @macula = leaky / blocked

A

Keith Wagener HTN retinopathy classification:
-SABP

1
Silver wiring - INCR light reflex
Tortuous/narrow arteries

  1. AV nipping

3.
Blot Flame hamorrhages
Cotton-wool exudates

4.
Papilloedema
___________

Non-Proliferative Diabetic Retinopathy: 1/+ MBChB BMI

Mild - 1 or more microaneurysm

Mod - MBChB:

  • Microaneurysms
  • Blot hemorrhages
  • Cotton wool spots
  • hard exudates / IRMA
  • BEADING/LOOOOP=venous
Severe: BMI
-BEADING=venous 2 quadrants
-Blot haemorrhages 4 quadrants
-Microaneurysms 4 quadrants
-1RMA 1 quadrant
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Proliferative retinopathy DM 1 > 2

  • Ret NEOvasc –> Vit Haemorrh (veil-like periph->central)
  • Fibrous tissue ANT to retinal disc

-LASER Tx
_______________

Maculopathy:
Hard exudates
‘BG’ changes on macula

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11
Q

ACUTE

RED eye
Photophobia
Blurrrrrrrrrrrrring vision
Tearing - Lacrimation
--PainLESSSSS

Apply gentle pressure:
-vessels = MOBILE
PainLESSSSS

PhenylEphrine --> 
redness IMPROVE
-Why??
PainLESSSSS
\_\_\_\_\_\_\_\_\_\_\_
*Dx Related:
PauciArth / Asymm / OP
E.Nodosum
Episcleritis 
C>UC
Dx UNrelated:
PolyArth / P - Symm / Clubbing = PSCholang
P.gangrenosum
Uveitis
Smoking
UC>C
A

Episcleritis PainLESSSSSSSSSS motherfuckrr!!!

PhenylEphrine –>
blanches the SUPERFICIAL conjunctival and episcleral vessels –>
redness IMPROVE
_____________________

ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
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12
Q

ACUTE

RED eye
Photophobia
Blurrrrrrrrrrrrring vision
Tearing - Lacrimation
--PAIN

Apply gentle pressure:
-vessels = DEEPER so NOT mobile
PAIN

PhenylEphrine –>
redness NOT IMPROVE
PAIN

Rhem arthiritis assoc more with what?

A

Scleritis PainFULLLLLL motherfuckrr!!!

RhemArth = assoc MORE with
KeratoConjuncitivitis Sicca > Scleritis!! #passmedQ

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13
Q

ACUTE

RED eye
PAIN and Photophobia
Blurrrrrrrrrrrrring vision
Tearing - Lacrimation / Ciliary flush

Pupil = FIXED OVAL (as opposed to DILATED)

  • misshapen OVAL
  • irregular OVAL
  • small OVAL
  • HYPOPYON in the Anterior Chamber

PMH:

  • HLA-B27 BACK pain
  • Can’t see, can’t pee, can’t climb tree
  • Painless Genital ulcers/VTE/Uveitis
  • black man, HyperCalc, high ACE, SOB, BHL
  • LUQ pain, blood @stool

Tx?

Dx Related:
PauciArth / Asymm #OP
E.Nodosum
Episcleritis
-C > UC
Dx Unrelated:
PolyArth-Symm-Clubbing #PSC
P.Ganrenosum
Uveitis 
-Smoking 
--UC > C
A

Anterior uveitis

  • ank spond / reactive arth
  • behcets
  • sarcoid/ UC > C

C.steds TOP
Mydriatics - CycloPlegPent/ Atrop/ PhenylEph TOP
_____________________

ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
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14
Q

PAIN
Reduced acuity - HALOES
Semi-FIXED-DILATED pupil (as opposed to OVAL)
Hazy cornea

-watching TV @dark-room
-LONG-sighted #HyperMetropia
Mydriatic use CAP
-AntiMuscs = CycloPlegicPentate / Atropine
-Adr = PhenylEphrine

Those with a 
POS FHx of 
glaucoma should be 
screened ?HOW OFTEN 
from aged ? years
  • LONG-sighted # ?opia = ?GLAUCOMA
  • Short-sighted # ?opia = ?GLAUCOMA

_____________

  • Myopia-Near-Sightedness
  • black/HTN/DM/c.steds

Features:

  • ? vessels
  • Cup:Disc >0.? #?
  • Disc issues?
  • Visual dx?

What’s normal pressure?
____________

Tx?

A

ACAG
-halo in Cataract + ACAGA

ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
\_\_\_\_\_\_\_\_\_\_\_\_
Those with a 
POS FHx of 
glaucoma should be 
screened ANNUALLY 
from aged 40 years
  • LONG-sighted #HyperMetropia = ACAG
  • Short-sighted #Myopia = POAG

POAG

  • Bayonetting vessels
  • Cup:Disc >0.7 #notching
  • Disc Haemorrhages/ Pallor #Atrophy
  • FOVL -> tunnel vision

-normal pressure 10-21
____________

Tx:

Surg: Laser Iridotomy / Trabeculo -plasty -ectomy -shunt
Meds: ALBAMA

AIM = Inc UveoScleralFlow + Lower Aqueous Production

-Lantoprost = Inc USF #BrownPigmentation #Blepharitis #LashLengthen
-Beta-Timolol - Lower AP - Asthma/HB CI
_________
Alpha AGONIST - Brimonidine = FOVL / Inflamm - itch/Red / TCA-MAOi CI
-inc USF + lower AP

Musc AGONIST - Pilocarpine = HA / Blurry / Ciliary Constriction Spasm
-inc USF
_________________
-Acetazmol - lower AP = sulfa-like rxns

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15
Q

50M SAM the THIN GORA SMOKER

Scotoma - central LOV
Acuity fucked
Metamorphopsia #PulfrichPhenomenon #AmslerGrid

  • age >50 years;
  • smoker; thin; white

a) Yellow-Drusen @Brusch-Membrane -> Gradual
Tx?

b) Choroidal Neo-Vascularisation + Haemorrhage -> Acute
Tx?
-Why avoid smoking in Beta-Carotene?

c) Mac-Degen + Hallucinations

A

a) DRY age-related macular degeneration
PT/OT/Education #NO-cure
-SVN: Smoking-cessation, Visual rehab, Nutrition

b) WET age-related macular degeneration
PT/OT/Education #NO-cure
-BV: Beta-carotene/ VEGF ointment/ Vit C+E
-Photo -coag -dynamic

  • Why avoid smoking in Beta-Carotene? LUNG CANCER
    c) Mac-Degen + Hallucinations = Charles-Bonnet Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Gradual
    vision = deteriorated + BLURRED

SHADOW in the red reflex
HALOS surrounding light source

PMH: DM2 / steroids / LOW Ca
_________________

  1. RED eye
    PAIN
    Sudden Vision LOSS

RECENT hx of /glaucoma INTRAOCCULAR Surgery

Inflammation =
hyperaemia / hypopyon
-Chemosis=Conjunc-Oedema
________________

  1. DAYS/WEEEEEEKS after Cataract SURGery Inflammation –> blurring
    _________________
  2. A/W painLESS, BLURRING
    Prev B/L cataract surgery
    YEEEEARS agoooooo
A
  1. Cataract
    -halos in cataract + ACAG ffs
    ____
  2. Post-op Endophthalmitis - urgent ophthal referral
    ________
  3. CMO: Cystoid Macular Oedema - days-weeks after
    _______
  4. Post Capsule Opacification YEEEARS later
17
Q

DISTANCE vision WORSEN
-I.e. Now short-sighted

blurred vision
-improve with use of a PINHOLE

NEAR vision > DISTance vision

-LONG-sighted #HyperMetropia = ?Glaucoma
-Short-sighted #Myopia = ?Glaucoma
______________

-poor glycaemic control HbA1c 48/+

DISTANCE vision WORSEN

blurred vision
-improve with use of a PINHOLE

NEAR vision > DISTance vision

A

Myopic lens shift #Myopia

  • NEAR vision best
  • pinhole helps
  • LONG-sighted #HyperMetropia = ACAG
  • Short-sighted #Myopia = POAG
Those with a 
POS FHx of 
glaucoma should be 
screened ANNUALLY 
from aged 40 years
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Diabetic Myopic lens shift
-NEAR vision best

18
Q

Flashes @periph #photopsia
Floaters @temporal side
-? ring @fundoscopy
____________

** PMH: DM, Bleeding dx, APlts/ACoags **
?Von Hippel Lindau

SUP-VL

  • ? - small bleed
  • ? - mod bleed
  • ? - large bleed
  • —red hueeee in the vision
@Fundoscope = ?GONE
-Ix = B-USS

Tx?
____________

-Periph --> central 
#VEIL-LIKE-Dense SHADOW

** PMH: Features of
Post-Vit-Detach PRECEDE:
-Spider-‘Spindley’-Flashers/Floaters **

O/E

  • grey-opalescent @fundoscopy
  • ?RAPD

?Straight lines = CURVY!!

Tx? Types?

A

Post Vit Detachment
–Weiss ring @fundoscopy
____________

Vitreous haemorrhage

  • Floaters - small bleed
  • Dark spots - mod bleed
  • SUP VL - large bleed
  • @Fundoscope = Red Reflex GONE
Tx: 
Bedrest
30 to 45° head
Lazer –> Vitrectomy
\_\_\_\_\_\_\_\_\_\_\_\_

RETinal Detachment = HOLE-BB-Pull

  • Buckling retinopexy vitrectomy
  • similar to Mac Degen

-Rhegmatogenous = HOLE
retina hole @degen -> fluid accum

-Exudative = B-B-B
Blood-Retina-Barrier Breakdown -> fluid accum

-Tractional = Pull
Pull retina off

19
Q

SUP-VL

O/E:
1. FLAME-shaped Blot HAEMORRHAGES - #PIZZAAAAAAA

  1. RAPD
  2. Optic disc = ?
  3. Anterior slit lamp NORMAL

Ax:
Polycythemia
Inc Age / AF
Glaucoma / HTN

  • BRVO – SUP-VL @?
  • CRVO - SUP + ?

-Surg? Prev? Rubeoid glaucoma?

A

CRVO

  • BRVO – SUP-VL @ OCCLUSION area
  • CRVO - SUP + SCOTOMA

Optic disc = SWOLLEN

  • Surgery = Vitrectomy
  • Prevention = decrease cardiac RFs
  • Rubeoid glaucoma - Photocoag/Lucentis/Dexa implant

_________

SUP-VL:
-BRVO - @ OCCLUSION area
-CRVO - SCOTOMA
Tx = Vitrectomy Prev cardiac RFs
Photocoag, Lucentis @Rubeoid

SUP-VL:
-BRAO= altitudinal
-CRAO= central
Tx = MATH

20
Q

SUP-VL

  • Pale retina /
  • Cherry red spot
  • RAPD
Pupil = POORly constrict 2 light 
Consensual = FINE

Ax: VTE / Atheroscl / GCA

  • Tx?????????????
  • BRAO= ? SUP-VL
  • CRAO= ? SUP-VL
A

Central Retinal Arterial Occlusion

  • Tx = MATH
  • BRAO= altitudinal
  • CRAO= central
Tx
RAO: AIM=dec IOP
Massage– >paracentesis
Mannitol
Acetazolamide 
Thrombolytics
Hyperbaric chamber
\_\_\_\_\_\_\_
SUP-VL:
-BRVO - @ OCCLUSION area
-CRVO - SCOTOMA
Tx = Vitrectomy Prev cardiac RFs
Photocoag, Lucentis @Rubeoid

SUP-VL:
-BRAO= altitudinal
-CRAO= central
Tx = MATH

21
Q
  • Redness and swelling around eye
  • Eyelid oedema and ptosis

Normal acuity, no proptosis, no eye pain, no eye-movement pain i.e. no ophthalmoplegia
________________

Recent cold......................
-Redness and swelling around eye
-Eyelid oedema and Ptosis
\+
PAIN @ eye
Ophthalmoplegia/Pain @ eye-movement
Reduced ACUITY
Proptosis
  • COMMONEST cause of orbital cellulitis in kids?
  • Which sinus?
  • Why
  • Cx and how to Ix?
A

Pre-Septal Cellulitis
_____________

Orbital cellulitis
-SINUSITIS of the ETHMOIDAL sinus

-THIN MEDIAL wall of the ORBIT =
COMMONEST cause of orbital cellulitis in kids

  • CT-sinuses for SUB-periosteal abscess
  • meningitis
22
Q

Old person, circular ring @eye
AKA annular……?
___________

UNILAT decrease in acuity
over HOURS/DAYS - graaaadual

Poor discrim of colours, ‘red desat’

pain WORSE on eye MOVEment
RAPD

central SCOTOMA - missing area of the visual field

Dx? Ax? Tx?

A

Corneal Arcus = Annnular Senilis
________

Optic neuritis
-MS/DM/Syph

HIGH dose steroids @MS

23
Q 
HA @valsava - cough/early Morning 
DOUBLE vision 
Vision LOSS 
-FOVL
-COLOUR vision

Optic disc:
-Swell / Blurrr / Elevation
-Concentric/Radial ? lines =
? from optic disc

-Optic cup ?

What used in emergency to reduce ICP?!

A

Papilloedema
- SLOW PROG vision loss
-Concentric/Radial RET lines =
CASCADE from optic disc

–Optic cup LOSS

HyperVentilation –> HYPOcapnia –>
vasoCONSTRICTION
Reduce ICP @emergency

24
Q

6m neonate/infant

Recurrent STICKY left eye.

  • Constant TEARING
  • Chloramphenicol = FAIL
  • Visual development Fine
  • NOTT muco-purulent yellow/green,
  • no Pre-Auric LNopathy
  • Eye swab = negative
  • (hence r/o NOphthalmicus #STD)

Dx?
- self-resolves by ? year of age

A

Congenital
tear (lacrimal) duct
obstruction
- self-resolves by 1 y/o

25
Q

Sudden Unilat Painless
Vision loss

Elderly females.

Unilateral headache/scalp tenderness, possible temporal artery tenderness,

jaw claudication.

?shoulder/pelvic girdle pain

Focal granulomatous inflammation, high ESR

Dx? 
Which vessel (short post....?!) -> damage what?

What rheum dx? Large/med/small?
Tx?

A 
Anterior Isch Optic Neuropathy
-Short posterior 
ciliary artery 
OCCLUSION  -->
Optic NERVE damage

GCA Temp Arteritis
-LARGE vessel disease

Bisphosphonate

26
Q
  1. diabetic / prostitue

BILAT small pupils
-ARP-PRA
________________

2. Light is SWUNG from 
Normal --> Affected eye
-Normal eye: Constrict to light 
-Affected eye: Dilates w/ light #NotConstrict
\_\_\_\_\_\_\_\_\_\_\_
3. 
Mass/Tumour/Hematoma -> 
CN3 compression IPSI-lat - >
Unilat DILATED pupil = 
UNresponsive 2 light 
\_\_\_\_\_\_\_\_\_
4. 
Tonically dilated pupil UNILAT
-Absent knee/ankle jerk
VIRAL/BACT infection
\_\_\_
  1. Ptosis, Anhydrosis, Miosis-constricted
    ______

Pupil dilated:

  • Unilateral = iCUMP, H/H
  • Bilateral = ?

Constricted:

  • Unilateral = ?
  • Bilateral = ?OPA
A
  1. Argyll-Robertson pupil ARP-PRA
    -Accommodation Reflex Present
    -Pupil Reflex Absent
    ____
  2. Marcus-Gunn RAPD
    -SUP-VL: AION/CRVO/CRAO
    -Pain: Optic Neuritis = MS/DM/Syph
    ___
  3. Hutchinson Pupil
    _______
  4. Holmes-Adie Pupil
    ___
  5. Horner occulosympathetic above T1
    ______
Pupil dilated:
-Unilateral = 
Isch, 
cav sinus thrombosis, 
uncal/TT herniation->Hutchinson Pupil, 
midbrain weber, 
pcomm art
--iCUMP, Holmes/Hutchinson 
?RAPDMarcusGunn

-Bilateral = CN3 dx bilat

Constricted:
-Unilateral = OcculoSymp dx @T1 above dx

-Bilateral = OPA
Opiates
Pontine dx =PAMP... *
Argyll-Robertson ARP-PRA
-DM/Syph #prostitues-pupil

*pontine=absent horizontal eye, miosis, paraplegia

27
Q

Worsening of watering eyes
Reduced ACUITY B/L
ABSENT red Reflex

B/L ptosis since childhood
FRONTAL BALDing

long-standing problem with
-writing /gripping / letting go after handshake

All family members on one side of family have

  • droopy eyelids and
  • frontal balding

In light of the neuro condition, what EYE issue is there????!!!
-inheritance

A

CATARACT - Myotonic dystrophy
-Autosomal Dominant

___

Duchenne is XLr!!!!

28
Q

ACUTE

Red eye
PAIN and Photophobia
Blurrrrrrrrrrrrring vision
?Floaters

O/E:
1-
White + RED retinal lesions
PIZZA PIE

2-
White FOCAL retinitis
OVERlying VITREOUS inflammation.

  • ALL forms of ??
  • Check what???
    3. Ear, Eye, Heart dx

a-EYE: Smaaaaall-Eyes ,
CATARACT/ ACAG
——‘SALT-pepp’ CHORIOret

b-EAR: SENSORIneural DEAF

c-HEART: CongenHeartDx - ?

HSM+-Blueberry muffin rash
_________________

Nyclatopia
Tunnel-vision

Black Bone-Spicule Shaped Pigmentation

Grandad has same issue…

_________________

Children with an absent red reflex.

A

Chorioretinitis:

1-
WHITE + RED retinal lesions
PIZZA PIE
-CMV retinitis

2-
WHITE focal retinitis
OVERLYING vitreous inflammation.
-TOXO retinitis

  • ALL forms of POST uveitis
  • CHECK HIV STATUS
  1. Rubella
    - Ear, Eye, Heart dx - PDA
ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
\_\_\_\_\_\_\_\_\_\_\_\_\_

Retinitis pigmentosa
____________

RetinoBLASToma - 2WW Ophthal

29
Q

d

A

d

30
Q

d

A

d

31
Q

?? = in-turning of the eyelids
?? = out-turning of the eyelids
____________

STYE - HORDELUM: PAINful lump - ?pus-filled
@ 1. Outer eye-LID: Hord ?
? infection @
-?? - sebum gland
-?? glands - sweat gland
  1. INNER eye-LID Hord ? =
    ?? infection –> ??

Tx? SWAT
IF conjunctiva RED, add what else??
___________

PainLESS lump @ eyeLIDDD - firm
_____________

In summary:
Stye tx?
Stye + conjunctivitis?

A

ENTropion: IN-turning of the eyelids

ECTropion: OUT-turning of the eyelids
________

STYE - HORDELUM: PAINful lump - ?pus-filled
@1. OUTER eye-LID Hord EXT:
staph infection @
-Zeis - sebum gland ZEEEEBUM
-Moll glands - sweat gland
  1. INNER eye-LID Hord INT =
    Meibomian infection –> Chalazion = painLESS lump
Stye - SWAT
WARM COMP+
Analgesia
TOP ABx if conjunctivitis: 
\_\_\_\_\_\_\_\_\_\_

Chalazion Meibomian Cyst
___________

In summary:
-Stye tx? warm comp, analgesia

-Stye + conjunctivitis?
Warm comp, Analgesia, Top abx

EXT(Zies-ZEEBUM SWEATY Moll lol ) ;
INT (Meibomian->Chalazion)

32
Q

VESICULAR rash around eye.

Red Eye
Photophobia
______________

  • Nose-tip rash = sign??
  • Suggestive of involvement of what?!

-Which branch of trigeminal?
______________

Tx?

What else given to tx 2ndary inflammation?

A

HZO
______________

  • Hutchinson sign
  • Suggests CORNEAL Occular dx

-Naso-Ciliary branch of V1
Trigem Ophthalmic Branch
______________

  1. URGENT ophthal r/v
  2. Oral Aciclovir <72hr onset = 10 days
  3. IV Aciclovir @severe/IC

?Top c-sted for inflammation

ddx:
ACAG
A.Uveitis
Scleritis/EPainlesScleritis
Conjunctivitis
Subconjunc haemorrhage
Chorioretinitis-CMV/Toxo
HZO
33
Q

Fundoscopy:

  • Venous engorgement
  • Venous pulsation loss
  • bilateral optic disc swelling;
  • Loss of optic cup
  • Blurred+Elevation of optic disc
  • Concentric/radial RET lines cascading from optic disc

Causes?

WHAT may be used in the emergency setting to reduce intracranial pressure?

A

Papilloedema
-Raised ICP / CO2

HyperVentilation –> HYPOcapnia –>
reduce ICP @emergency

34
Q

d

A

d

35
Q
  1. Blepharoplasty op for droopy eyelids –>
    can’t close eye lid
  2. Tropical climate (ex-pat moved to nice country) –>
    a: YELLOW-GREY nodule
    b. fleshy tissue that GROWS OVER cornea
  3. Smoker + visual dx
A
  1. Lag-ophthalmos
  2. a. Pingu-ecla @sclera
    b. Pterygium
  3. Tobacco-alcohol ambylopia
    - toxins v malnutrition
36
Q

cerebellar haemangiomas: –> SAH
retinal haemangiomas –> vitreous haemorrhage
renal cysts (premalignant) –> clear-cell RCC

phaeochromocytoma
extra-renal CYSTS: epididymal, panc/liver
endolymphatic sac tumours

A

Von Hippel-Lindau

37
Q

RIGHT EYE–LEFT EYE
? ?
?—–?
?-? ?-?

4- ?CN
3- ?CN
6- ?CN
____________

Diplopia Double Vision 
Direction #H
^                ^
|  < - - - - > |
v                v

?* ?* ?*

CranioPharyngioma = ?
Pituitary tumour = ?

____________

CN formula..?

NTR:

  1. RON ?
    - chiasm-> (right chiasm = ?)
  2. ROT ?
    - LGN->
  3. SIñOR Pi-Ts:
    - RsOR @which lobe -> ?
    - RiOR @which lobe -> ?
    - Rs+iOR = PiTs = ?
SIñOR Pi-Ts:
S OR @?-qa 
I  OR  @?-qa 
Post Cerebal Art Occluded = ?
\_\_\_\_\_\_\_

Med #?dx
INO - InterNuclear Ophthalmoplegia
Long
Fasciculus:

So.. normally when you trying to look left for example…
what muscle ABDucts @left eye
+
what muscle ADDucts @right eye

but in INO..
what muscle ABDucts @left eye
\+
what muscle ADDucts=? @right eye
-->

contra LR6 works ? to stim ? –>
? nystagmus

A 
RIGHT EYE\_\_LEFT EYE
4                                  4
                6-------6
3-dilated                     3-dilated
    ptosis                         ptosis

4-Trochlear
3-Occulumotor
6-Abducens
____________

Diplopia Double Vision 
DIRECTION: #H
^                ^
|  < - - - - > |
v                v

4 6 4

  • 4 vertical
  • 6 horizontal
  • 4 vertical

CranioPharyngioma =
-Inf Bitemp HAnopia

Pituitary tumour =
-Sup Bitemp HAnopia
____________

LR6 SO4 R3 =
-Lr - SO - 3R
6 4

Nerve Tract Radiation:

  1. RON - right MonoOccularVisionLoss
    - chiasm-> (right chiasm = right NasalHAnopia)
  2. ROT #LeftHomoHAnopia
    - LGN->
  3. SIñOR Pi-Ts:
    - RsOR @Pi = LiQA
    - RiOR @Ts #Meyer = LsQA
    - Rs+iOR = PiTs = #LeftHomoHAnopia
SIñOR Pi-Ts:
S OR @PI-qa - Parietal-InfQA
I  OR  @TS-qa - Temp-SupQA
Post Cerebal Art Occluded = Macular SPARING
\_\_\_\_\_\_\_

Med #MS #Stroke
INO - InterNuclear Ophthalmoplegia
Long
Fasciculus:

So.. normally when you trying to look LEFT for example…
contralat LR6 ABDucts @left eye
+
ipsilat MR ADDucts @right eye

but in INO..
contralat LR6 ABDucts @left eye
\+
ipsilat MR3 ADDucts=FAILS @right eye
-->

contra LR6 works overtime to stim ipsi MR3 –>
contra LR6 nystagmus

38
Q

Monoplegia -?
Hemiplegia -?
Quadriplegic -?
-Paraplegia -?

ACA–MCA–PCA*

*PCA - midbrain Weber
________________

Amaurosis fugax - which vessel?
Locked in syndrome - which vessel?
__________

  • Absent < – > horizontal eye-move
  • Miosis
  • Paralysis=Quadriplegia
  • Same FACE: PD/PT (paralysis/deaf // pain/temp)
  • Opp limb
  • Nystagmus
  • Ataxia

-Same FACE: PD/PT (pain/temp)
-Opp limb
-Nystagmus
-Ataxia
__________

  • Unilat sensory/motor FAL
  • Cog dx - VisuoSpatial/Dysphasia
  • HomoHNopia
1 of:
-Sensory
-AtaxicHemiParesis
-Motor
PURELY + HTN

4-6-4 H:
CN4 present?
CN3 present?
CN6 present?

________

Nystagmus: central v peripheral?
______

Brainstem death
______

Delirium > Dementia

A

Monoplegia - 1 limb
Hemiplegia - Unilat 2 limbs
Quadriplegic - 4 limbs
-Paraplegia - Bilat LOWER limbs

ACA MCA PCA*
L>UL ; UL>L

< – HemiParesis
……..Aphasia – > Agnosia
……..Sensory
….HomoHAnopia – > Mac-Sparing

*PCA - Weber Midbrain
-Same CN3, opp HemiParesis
-Agnosia
-Macular sparing HomoHNopia
________________

Amaurosis fugax - Retinal/Ophthalmic Artery
Locked in syndrome - Basilar Artery
____________

Pontine bleed

  • Absent < – > horizontal eye-move
  • Miosis
  • Paralysis=Quadriplegia

AICA: Lat Pont

  • Same FACE: PD/PT (paralysis/deaf // pain/temp)
  • Opp limb
  • Nystagmus
  • Ataxia

PICA: Lat Med Wallenburg

  • same as above EXCEPT
  • paralysis and deafness

______________

Anterior Circulation Stroke:

3=TotalACS
2=PartialACS

  • Unilat sensory/motor FAL
  • Cog dx - VisuoSpatial/Dysphasia
  • HomoHNopia
LacACS Assoc w/ HTN 
1 of:
-Sensory
-AtaxicHemiParesis
-Motor
PURELY
\_\_\_\_\_\_\_\_\_

4-6-4 H:
CN4 vertical nystagmus
CN3 Ptosis, Dilated, Vertical nystagmus
CN6 horizontal nystagmus

Nystagmus: Central v Periph:
central is:

  • B/L
  • Assoc sens/motor dx
  • Direction = multi / purely uni or rotatory
Brainstem Death:
Coma unknown Ax
Reversible ax excluded
Sedation X
Electrolytes fine
Bronchial stim -> no cough
Response to sound/Supra-Orb Pressure
Occ-Vestib Reflex absent
Corneal Reflex absent
Disconnect ventilator 5-mins -> no resp support
\_\_\_\_\_\_\_\_\_
  • Emotions = fear, agitation
  • Fluct Syx = worse @night, normal periods
  • GCS impaired
  • Hallucinations/Illusions/Delusions #perception
39
Q

Blood in ant chamber
-Mono ocular vision blur

Blunt ocular trauma + hyphema –>
high-risk of raised ?pressure and therefore WHAT disease????????

Diagnosed on inspection apparently.. looool
_________

Difficulty opening mouth

NO visual changes
________

Blowout fracture of the orbit
________

Binocular vision + facial trauma

Step deformity @orbital margin
Depressed CHEEEEK contour

A

Hyphaema = Red

-Blunt ocular trauma + Hyphema -->
high-risk of raised IOP
#intraocular pressure-Glaucoma

Hypopyon = pus
_______

Ramus MAXILLARY fracture
______

Comminuted MAXillary fracture
—Blowout
______

Depressed zygomatic fracture

  • –CHEEK
  • –BINOCULAR vision

GI (22 decks)

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