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4th Year Long term conditions > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Pathology of Uveitis

A

Inflammation of uvea

  • Types
    • Anterior uveitis - iris with or without ciliary body inflamed
    • Intermediate uveitis - ciliary body inflamed
    • Posterior uveitis - choroid inflamed
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2
Q

Symptoms and signs of anterior uveitis

A

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
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3
Q

Management of anterior uveitis

A
  • Topical steroids
  • Antimuscarinic cytoplegics
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4
Q

Explain the symptoms of intermediate uveitis

A

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

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5
Q

Explain the symptoms of posterior uveitis

A

Blurred vision

Choroid is inflammed, as the choroid sits under the retina, the inflammation frequently spreads to the retina causing blurred vision.

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6
Q

Pathology of a Stye / hordeolum

A

Acute eyelid swelling due to infection of eyelash follicle (stye; typically staph aureus) or meibomian gland blockage (meibomian cyst)

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7
Q

Presentation of Stye

A
  • 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
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8
Q

Management of Stye

A
  • warm compress three times daily
  • typically self resolves but refractory cases may require incision
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9
Q

Signs and symptoms of corneal abraison

A
  • pain
  • watering
  • blurred vision
  • epithelial defect
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10
Q

Treatment of corneal abraision

A
  • Topical antibiotics
  • Analgesia
  • Do not give topical anaesthesia as this slows healing
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11
Q

Causes of premature cataracts

A
  • steroids, including topical therapy near eyes
  • congenital
  • occular disease: glaucoma, severe myopia, retinal detachment
  • diabetes
  • UV or infrared radiation
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12
Q

Symptoms of cataracts

A

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
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13
Q

Treatment of cataracts

A

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
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14
Q

Signs and symptoms of age related macular degeneration

A

Symptoms

  • progressive loss of central vision
  • distortion

Signs

  • distortion of amsler chart
  • drusen
  • pigment epithelial changes
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15
Q

Investigation for age related macular degeneration

A
  • Amsler grid
  • optical coherence tomography (OCT)
  • fluorescein angiography
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16
Q

How are dry and wet age related macular degeneration connected?

A

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.

17
Q

Pathology of dry AMD

A

Small white deposits, called drusen, form on the retina, behind the macula causing it to degenerate.

18
Q

Pathology of wet AMD

A

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.

19
Q

Signs of dry age related macular degeneration

A
  • Drusen
  • Atrophy
20
Q

Management of dry age related macular degeneration

A
  • low vision aids
  • registration
21
Q

Management of wet age related macular degeneration

A
  • intravitreal antiVegf
  • low vision aids
  • registration
22
Q

Signs and symptoms of central retinal artery occlusion

A
  • 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
23
Q

Management of central retinal artery occlusion

A

Identify and treat risk factors (to minimise risk of secondary ischaemic events such as stroke or MI)

24
Q

Signs and symptoms of central retinal vein occlusion

A
  • Sudden painless loss of vision in one eye
  • Fundoscopy shows torturosity and dilation of all branches of the central retinal vein
25
Q

Management of central retinal vein occlusion

A
  • intravitreal anti VEGF
  • identify and treat risk factors
26
Q

Signs and symptoms of giant cell arteritis

A

Symptoms

  • loss of vision
  • headache
  • loss of appetite
  • scalp tenderness
  • pain on chewing

Signs

  • tenderness of superficial temporal arteries
  • raised inflammatory markers
27
Q

Management of giant cell arteritis

A

High dose systemic steroids

28
Q

Acute angle closure glaucoma pathology

A

Closure of iridocorneal angle leading to increased intraocular pressure - a sight threatening emergency

29
Q

Risk factors for acute angle closure glaucoma

A
  • female
  • hyperopia
  • age 55-65
30
Q

Signs and symptoms of acute angle closure glaucoma

A
  • Sudden onset, painful, vision lost/blurred, headache (often confused with migraine)
  • Nausea and vomiting
  • Red eye, cornea often opaque as raised IOP drives fluid into cornea
  • AC shallow and angle is closed
  • Pupil mid-dilated and non-reactive
  • IOP severely raised
31
Q

Management of acute angle closure glaucoma

A
  • decrease IOP
    • beta blocker drops if no contraindication
    • constrictor eye drops - pilocarpine
    • steroid eye drops
  • analgesics, antiemetics
  • iridotomy to both eyes to bypass the blockage
32
Q

Pathology of chronic open angle glaucoma

A

Increased resistance to aqueous fluid outflow via trabecular meshwork → increased intraocular pressure → optic nerve damage

33
Q

Signs and symptoms of chronic open angle glaucoma

A
  • often asymptomatic until late stage
  • gradual progression of visual field defects (eventually complete blindness)
  • usually bilateral
  • fundoscopy: optic disc cupping (increased cup:disc ratio) and later optic disc atrophy
34
Q

Chronic open angle glaucoma treatment

A
  • topical treatment is 1st line:
    • prostaglandin analogues increase aqueous outflow
    • beta blockers, alpha 2 agonists and carbonic anhydrase inhibitors reduce aqueous secretions
  • if medically refractory, laser trabeculoplasty (1st line) or surgical trabeculoplasty (2nd line) to increase outflow through trabecular meshwork

4th Year Long term conditions (5 decks)

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