Ophthalmology Flashcards
Pathology of Uveitis
Inflammation of uvea
- Types
- Anterior uveitis - iris with or without ciliary body inflamed
- Intermediate uveitis - ciliary body inflamed
- Posterior uveitis - choroid inflamed
Symptoms and signs of anterior uveitis
Symptoms
- acute red eye
- photophobia
- blurred vision
- deep aching pain
Signs
- non-reactive small pupil
- slit lamp exam: cloudy aqueous humor
- cells in the AC may settle inferiorly - hypopyon
Management of anterior uveitis
- Topical steroids
- Antimuscarinic cytoplegics
Explain the symptoms of intermediate uveitis
Symptoms
- Patient complains of floaters or hazy vision
- Usually painless
Ciliary body is inflammed and leaks cells and proteins which leads to hazy vitreous humour
Explain the symptoms of posterior uveitis
Blurred vision
Choroid is inflammed, as the choroid sits under the retina, the inflammation frequently spreads to the retina causing blurred vision.
Pathology of a Stye / hordeolum
Acute eyelid swelling due to infection of eyelash follicle (stye; typically staph aureus) or meibomian gland blockage (meibomian cyst)
Presentation of Stye
- red lump on eyelid
- stye is typically painful and found on eyelid margin or inner eyelid
- meibomian cyst typically painless, though may be painful initially and / or if it grows significantly
Management of Stye
- warm compress three times daily
- typically self resolves but refractory cases may require incision
Signs and symptoms of corneal abraison
- pain
- watering
- blurred vision
- epithelial defect
Treatment of corneal abraision
- Topical antibiotics
- Analgesia
- Do not give topical anaesthesia as this slows healing
Causes of premature cataracts
- steroids, including topical therapy near eyes
- congenital
- occular disease: glaucoma, severe myopia, retinal detachment
- diabetes
- UV or infrared radiation
Symptoms of cataracts
Signs
- blurred vision and gradual decrease in acuity
- glare from bright lights
- monocular diplopia
- loss of stereopsis if unilateral
Symptoms
- reduced red reflex
- clouded lens
Treatment of cataracts
Non surgical
- conservative treatment often appropriate initially
Surgical
- phacoemulsification: lens broken up with ultrasound and aspirated from eye - extracapsular extraction
- intraocular lens implant inserted into remaining capsule
- done under local anaesthetic in around 20 minutes
Signs and symptoms of age related macular degeneration
Symptoms
- progressive loss of central vision
- distortion
Signs
- distortion of amsler chart
- drusen
- pigment epithelial changes
Investigation for age related macular degeneration
- Amsler grid
- optical coherence tomography (OCT)
- fluorescein angiography
How are dry and wet age related macular degeneration connected?
Most AMD starts as the dry type and in 10-20% of individuals it progresses to the wet type.
AMD is always bilateral but does not necessarily progress at the same pace in both eyes.
Pathology of dry AMD
Small white deposits, called drusen, form on the retina, behind the macula causing it to degenerate.
Pathology of wet AMD
Abnormal blood vessels grow towards the macula, they tend to break and bleed, damaging the macula and causing it to lift up and pull away from its base.
Signs of dry age related macular degeneration
- Drusen
- Atrophy
Management of dry age related macular degeneration
- low vision aids
- registration
Management of wet age related macular degeneration
- intravitreal antiVegf
- low vision aids
- registration
Signs and symptoms of central retinal artery occlusion
- sudden painless loss of vision in one eye
- fundoscopic exam will show a red lesion with surrounding pale retina
- afferent pupil defect, periorbital eyelid oedema, proptosis, ptosis
- at times a hazy/cloudy cornea
Management of central retinal artery occlusion
Identify and treat risk factors (to minimise risk of secondary ischaemic events such as stroke or MI)
Signs and symptoms of central retinal vein occlusion
- Sudden painless loss of vision in one eye
- Fundoscopy shows torturosity and dilation of all branches of the central retinal vein
