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4MB Medicine (My version) > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What makes up the uvea?

A

Iris
Ciliary body
Choroid

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2
Q

What does a miotic agent do? Give an example of one

A

Miotics constrict the pupil

Pilocarpine

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3
Q

What does a mydriatic agent do? Give an example of one

A

Mydriatics dilate the pupil

Tropicamide

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4
Q

What is a stye?

A

Inflammatory lid swelling

Non-specific term - may be transient or infectious

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5
Q

What is hordeolum externum?

A

Abscess/infection present in lash follicle

May involve sweat/sebum glands, usually points outwards

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6
Q

What is a chalazion?

A

Residual non-infectious lid swelling that occurs due to blockage of Meibomian gland

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7
Q

Outline management of stye and other lid swellings

A

Warm compresses
Topical antibiotics (fusidic acid)
Incision and curettage

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8
Q

What is blepharitis?

A

Inflammation of the eyelid

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9
Q

List aetiology/risk factors for blepharitis

A

Anterior: seborrhoeic, Staph aureus
Posterior: Meibomian gland dysfunction

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10
Q

List clinical features of anterior blepharitis

A 
Red lid margin
Scale, dandruff
Dermatitis
Style, ulcer
Distorted lashes
Keratitis
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11
Q

List clinical features of posterior blepharitis

A 
Deep red lid
Dried secretions
Gritty eyes
Chalazion
Rosacea
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12
Q

Outline management of blepharitis

A 
Lid hygiene - cotton wool swab, bathing
Warm compresses
Topical fusidic acid/chloramphenicol
Topical steroid
Incision and curettage for chalazion
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13
Q

What is entropion?

A

Lid turns inwards, causing lashes to rub against globe

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14
Q

List aetiology/risk factors for entropion

A

Ageing

Degeneration of lid fascial elements and muscles

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15
Q

List clinical features of entropion

A

Red eye

Irritation

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16
Q

Outline management of entropion

A

Surgical taping of eyelid

Botox for lower eyelid

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17
Q

What is ectropion?

A

Lid turns outwards

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18
Q

List aetiology/risk factors for ectropion

A

Ageing

Facial nerve palsy

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19
Q

Outline management of ectropion

A

Surgical weight implant

Plastic surgery

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20
Q

What is keratoconjunctivitis sicca?

A

“dry eye syndrome” due to reduced tear production or excess tear evaporation

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21
Q

List aetiology/risk factors for keratoconjunctivitis sicca

A 
Lacrimal gland destruction (Sjogren's)
Mucin deficiency (low vitamin A, SJ syndrome)
Ageing
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22
Q

What is a normal Schirmer test?

A

Test strip should soak more than 15mm in 5 mins

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23
Q

Outline management of keratoconjunctivitis sicca

A

Artificial tears if symptomatic

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24
Q

List aetiology/risk factors for orbital cellulitis

A

Spread from paranasal sinus infection
Dental injury
Staphylococci
Streptococci

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25
Q

List clinical features of orbital cellulitis

A

Fever
Lid swelling
Reduced eye mobility
Blindness if optic nerve involvement

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26
Q

What scan would you want to do promptly for orbital cellulitis?

A

CT scan

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27
Q

Outline management of orbital cellulitis

A

IV cefuroxime

Surgery to prevent meningitis

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28
Q

List clinical features of ophthalmic shingles

A

Pain and neuralgia in dermatomal distribution of CN V1
Blistering rash
Globe may be affected (iritis, corneal signs, scleritis)
Nose tip involvement (Hutchinson sign) implies nasociliary nerve branch involvement, increasing likelihood of globe affected

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29
Q

Outline management of ophthalmic shingles

A

Oral aciclovir

Refer to specialist

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30
Q

Who typically gets retinoblastoma?

A

Most common primary intraocular tumour in children

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31
Q

List aetiology/risk factors for retinoblastoma

A

Hereditary: RB gene 13q14, autosomal dominant, mutated tumour suppressor gene
Pineal gland tumour
Osteosarcoma
Rhabdosarcoma

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32
Q

List clinical features of retinoblastoma

A

Strabismus
Leukoconia (white pupil)
Absent red reflex

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33
Q

Outline management of retinoblastoma

A

Chemotherapy for bilateral
Enucleation (eye removal) if large/long-standing retinal detachment
Radiotherapy

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34
Q

What is strabismus/squint?

A

Abnormality in coordinated movement of both eyes

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35
Q

Describe esotropia

A

Eye sits inwards

Outward movement on cover test

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36
Q

Describe exotropia

A

Eye sits outwards

Inward movement on cover test

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37
Q

Describe hypertropia

A

Eye sits upwards

Downward movement on cover test

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38
Q

Describe hypotropia

A

Eye sits downwards

Upward movement on cover test

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39
Q

Outline management of strabismus

A

Optical: correct refractive error
Orthoptic: patch good eye
Operation: resection and recession of rectus, botox

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40
Q

List aetiology/risk factors for oculomotor nerve palsy

A

Cavernous sinus lesions
Superior orbital fissure syndrome
Diabetes

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41
Q

List clinical features of oculomotor nerve palsy

A 
Posterior communicating artery aneurysm
Ptosis
Proptosis
Pupil dilation
"down and out" pupil
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42
Q

List aetiology/risk factors for trochlear nerve palsy

A

Trauma
Diabetes
Tumour

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43
Q

List clinical features of trochlear nerve palsy

A

Diplopia
Head-tilting (ocular torticollis)
“up and in” pupil
Cannot look down and out

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44
Q

List aetiology/risk factors for abducens nerve palsy

A

Increased ICP
Base of skull trauma
Vascular disease
Multiple sclerosis

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45
Q

List clinical features of abducens nerve palsy

A

Diplopia in horizontal plane
Adducted eye
Botox may help

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46
Q

Which nerve is responsible for normal light detection (afferent pathway)?

A

Optic nerve

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47
Q

Which nerve is responsible for pupil constriction (efferent pathway)?

A

Oculomotor nerve

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48
Q

Which nerve is responsible for pupil dilation?

A

Ciliary nerve (sympathetic chain)

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49
Q

What is an afferent pupillary defect?

A

Absent direct response - pupil does not respond (constrict) to light due to optic nerve damage
Contralateral pupil constricts to indicate intact consensual response (intact oculomotor nerve)

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50
Q

List aetiology/risk factors for afferent pupillary defect

A

Optic neuritis
Optic atrophy
Retinal disease

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51
Q

On swinging light test, both pupils constrict in an afferent pupillary defect. True/False?

A

True

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52
Q

What is an efferent pupillary defect?

A

Fixed dilated pupil

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53
Q

What is a Holmes-Adie pupil?

A

Initially monolateral, then bilateral pupil dilation
Tonic pupil
Delayed response to near vision effort, causes sudden blurring of vision

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54
Q

List clinical features of Horner’s syndrome

A

Miosis
Ptosis
Constricted pupil
Unilateral sweating

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55
Q

What is a Argyll Robertson pupil?

A

Bilateral miosis
Irregular pupils
No direct response

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56
Q

What is myopia?

A

Short sightedness due to large eyeball - light focuses in front of retina

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57
Q

List clinical features of myopia

A

Children change spectacles frequently
Able to see close objects
Retinal detachment
Macular bleeding

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58
Q

Outline management of myopia

A

Concave lens correction

LASIK

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59
Q

What is hypermetropia?

A

Long sightedness due to small eyeball

Light focuses beyond retina

60
Q

List clinical features of hypermetropia

A 
Tiredness of gaze
Convergent squint (try to accommodate)
61
Q

Outline management of hypermetropia

A

Convex lens correction

62
Q

A lesion affecting the right optic nerve would cause what visual field defect?

A

No vision out of right eye

63
Q

A lesion affecting the optic chiasma would cause what visual field defect?

A

Bitemporal hemianopia

64
Q

A lesion affecting the right optic tract would cause what visual field defect?

A

Left homonymous hemianopia

65
Q

A lesion affecting the left parietal optic radiation would cause what visual field defect?

A

Right inferior homonymous quadrantonopia

66
Q

A lesion affecting the left temporal optic radiation would cause what visual field defect?

A

Right superior homonymous quadrantonopia

67
Q

A lesion affecting the occipital lobe would cause what visual field defect?

A

Homonymous hemianopia with macular sparing

68
Q

List the main causes of a red eye

A 
Acute closed-angle glaucoma
Anterior uveitis
Scleritis
Episcleritis
Conjunctivitis
69
Q

What is acute closed-angle glaucoma?

A

Blocked drainage of aqueous from anterior chamber via canal of Schlemm, causing increased intraocular pressure

70
Q

List clinical features of closed-angle glaucoma

A 
Blurred vision
Painful red eye
Headache
Haloes around lights
Worse at night
Nausea, vomiting
Corneal haze
Dilated pupil
"hard" eye
71
Q

Outline management of closed-angle glaucoma

A 
Pilocarpine + IV acetazolamide
Analgesia
Anti-emetic
Admit to hospital
Peripheral iridectomy once intraocular pressure reduces
72
Q

What is anterior uveitis?

A

Inflammation affecting iris and ciliary body (anterior uvea)

73
Q

List aetiology/risk factors for anterior uveitis

A

Ankylosing spondylitis
Sarcoidosis
Reactive arthritis
Inflammatory bowel disease

74
Q

List clinical features of anterior uveitis

A 
Red, painful eye
Photophobia
Normal/blurred vision
Lacrimation
Circumcorneal redness
Small pupil
Talbot +ve test: pain increases on convergence as finger approaches nose
75
Q

What would slit lamp examination show in anterior uveitis?

A

Cells in anterior chamber
White precipitates on back of cornea
Hypopyon may be seen

76
Q

Outline management of anterior uveitis

A

Topical NSAID
Systemic steroid
Treat underlying condition

77
Q

What is the commonest cause of a red eye?

A

Conjunctivitis

78
Q

Which type of bacterial conjunctivitis is associated with neonates/sexually active?

A

Chlamydial

79
Q

List typical viruses that cause viral conjunctivitis

A

Adenovirus
Herpes simplex
Molluscum contagiosum

80
Q

List clinical features of bacterial conjunctivitis

A 
Red, inflamed conjunctiva
Hyperaemic vessels
Purulent discharge
Chemosis
Oedema
Papillae
Slow-onset red eye in chlamydial
81
Q

List clinical features of viral conjunctivitis

A 
Red, inflamed conjunctiva
Preceding URTI
Watery discharge
Pseudomembrane
Follicles
82
Q

Outline management of bacterial conjunctivitis

A

Bacterial usually self-limiting within 14 days
Chloramphenicol
Penicillin if gonococcal
Erythromycin if chlamydial

83
Q

Outline management of viral conjunctivitis

A

Usually self-limiting
Topical aciclovir
Topical steroid

84
Q

What is episcleritis?

A

Inflammation below the sclera

85
Q

List clinical features of episcleritis

A

Nodule
Blue sclerae
Achey, tender eye
Normal acuity

86
Q

Phenylephrine drops constrict vessels more in episcleritis than in scleritis. True/False?

87
Q

List clinical features of scleritis

A 
Severe eye pain
Pain in forehead/brow/jaw
Localised/diffuse red eye
Violaceous hue - purple sclera
Tender globe
88
Q

Outline management of scleritis and episcleritis

A

Topical steroid
Topical NSAID
Systemic NSAID

89
Q

What is a corneal abrasion?

A

Break in epithelium of cornea in the absence of keratitis

Usually caused by trauma

90
Q

List clinical features of corneal abrasion

A 
Needle-like pain
Photophobia
Blurred vision
Lacrimation
Circumcorneal redness
Hypopyon
91
Q

How does corneal abrasion appear under slit lamp?

A

Fluorescein drops under blue light: orange dye stains abrasion green

92
Q

List aetiology/risk factors for corneal ulcer

A 
Bacterial (Pseudomonas)
Viral (herpes zoster, herpes simplex)
Fungal (candida, aspergillus)
Protozoal (acanthamoeba)
Vasculitis (rheumatoid)
93
Q

List clinical features of corneal ulcer

A

Reduced visual acuity
Pain
Lacrimation
Hypopyon

94
Q

What urgent investigation would you do for corneal ulcer?

A

Diagnostic smear + gram stain

95
Q

Outline management of corneal ulcer

A

Chloramphenicol/aciclovir drops

96
Q

List aetiology/risk factors for keratitis

A

Herpes simplex
Contact lens use
Blepharitis
Foreign body

97
Q

List clinical features of keratitis

A

Conjunctival injections
Gritty eyes
Photophobia
Reduced visual acuity

98
Q

What investigation would you do for keratitis?

A

Corneal scrape under anaesthetic

Gram stain

99
Q

Outline management of keratitis

A

Ofloxacin/aciclovir

100
Q

What are 5 important questions to ask when someone comes in with vision loss?

A

Associated headache? (GCA)
Pain on eye movement? (optic neuritis)
Lights or flashes? (retinal detachment)
Like a curtain descending? (amaurosis fugax)
Poorly controlled diabetes? (haemorrhage)

101
Q

What is ischaemic optic neuropathy?

A

Damage to optic nerve caused by ischaemia to the posterior ciliary artery

102
Q

List aetiology/risk factors for ischaemic optic neuropathy

A

Artertic (GCA)

Non-arteritic (atherosclerosis, diabetes, smoking)

103
Q

List clinical features of ischaemic optic neuropathy

A

Arteritic: pain, headache, neck pain, GCA-like symptoms
Non-arteritic: typically painless
Vision loss

104
Q

What investigations would you do for ischaemic optic neuropathy?

A

ESR
CRP
Temporal biopsy

105
Q

Outline management of ischaemic optic neuropathy

A

Treat underlying cause

e.g. high dose prednisolone for GCA

106
Q

List aetiology/risk factors for optic neuritis

A

Multiple sclerosis
Diabetes
Syphilis
Vitamin deficiency

107
Q

List clinical features of optic neuritis

A 
Unilateral vision loss over hours/days
Relative afferent pupillary defect
Dyschromatopsia (cannot discriminate colour)
Red desaturation
Painful eye movements
108
Q

Outline management of optic neuritis

A

IV methylprednisolone

Reduce to oral prednisolone

109
Q

List aetiology/risk factors for vitreous haemorrhage

A 
Angiogenesis
Central retinal vein occlusion
Retinal tear
Trauma
Diabetes
110
Q

List clinical features of vitreous haemorrhage

A

Floaters in vision
No red reflex
Difficulty seeing retina under funduscopy

111
Q

Outline management of vitreous haemorrhage

A

Photocoagulation
Anti-VEGF
Vitrectomy

112
Q

List aetiology for central retinal artery occlusion (CRAO)

A 
Atherosclerosis
Virchow's triad
Tumour
Clots
Infection
113
Q

List clinical features of CRAO

A

Sudden painful vision loss
Acuity usually CF or worse
Relative afferent pupillary defect
GCA-like symptoms

114
Q

How would CRAO look under slit lamp?

A

White retina

Cherry red spot on macula

115
Q

Outline management of CRAO

A 
Exclude/treat GCA
Ocular massage
Bag breathing
IV acetazolamide
Surgical removal of aqueous
116
Q

List aetiology/risk factors for central retinal vein occlusion (CRVO)

A 
Ageing
Arteriosclerosis
Hypertension
Diabetes
Polycythaemia
Open-angle glaucoma
117
Q

List clinical features of CRVO

A

Sudden painless vision loss

Acuity usually CF

118
Q

How would CRVO look under slit lamp?

A

Retinal haemorrhages
Cotton wool spots
Disc swelling

119
Q

Outline management of CRVO

A

Photocoagulation

Anti-VEGF

120
Q

What is retinal detachment?

A

Tear in the retina that allows fluid to collect in space between sensory retina and pigment epithelium

121
Q

List aetiology/risk factors for retinal detachment

A

Melanoma
Surgery (cataract)
Trauma
Myopia

122
Q

List clinical features of retinal detachment

A 
Floaters
Flashes
Field loss
Fall in acuity
Progressive painless visual loss, like a curtain coming down
123
Q

What would you see on slit lamp examination in retinal detachment?

A

Grey retina

Loss of central vision if macula is affected

124
Q

Outline management of retinal detachment

A

Vitrectomy
Gas tamponade
Coagulation

125
Q

List aetiology/risk factors of choroiditis

A 
Granulomatous reactions
Toxoplasmosis
Toxocara
TB
Sarcoidosis
126
Q

Blurred vision occurs in choroiditis. True/False?

127
Q

What investigations would you do for choroiditis?

A

CXR
Mantoux test
Slit lamp: grey-white raised patch on retina, cells, vitreous opacities

128
Q

What is open-angle glaucoma?

A

Raised intraocular pressure due to reduced outflow of aqueous humour

129
Q

List aetiology/risk factors of open-angle glaucoma

A 
Family history
Afrocarribbeans
Myopia
Diabetes
Thyroid eye disease
130
Q

List clinical features of open-angle glaucoma

A 
Gradual painless peripheral vision loss
Present late (central vision is preserved)
131
Q

What would you see on slit lamp/funduscopy in open-angle glaucoma?

A

Optic disc cupping, atrophy
Haemorrhages
IOP greater than 21 mm Hg

132
Q

Outline management of open-angle glaucoma, listing drugs used and their basic action

A

Prostaglandin analogue increases outflow (latanoprost)
B blocker blocks ciliary body to decrease aqueous production (timolol)
Alpha agonist reduces aqueous production (brimonidine)
Carbonic anhydrase inhibitor reduces aqueous production (acetazolamide)
Miotics reduce resistance to outflow (pilocarpine)
Surgery (trabeculectomy)

133
Q

What is the commonest cause of vision loss in patients over the age of 65?

A

Age-related macular degeneration (ARMD)

134
Q

What is dry ARMD?

A

Degenerative change at macula, slow progression

Causes deposits of lipofuscin (drusen)

135
Q

What is wet ARMD?

A

Angiogenesis from choroid into neurosensory retina, rapid progression
Causes leaking

136
Q

List aetiology/risk factors for ARMD

A 
Mutations (fibulin 5, complement H)
Ageing
Smoking
Hypertension
Hypercholesterol
UV exposure
137
Q

List clinical features of ARMD

A

Dry: painless gradual vision loss, drusen deposits
Wet: sudden central vision loss, blind spots, distorted lines

138
Q

Outline management of ARMD

A

PDT
Laser therapy
Intravitreal anti-VEGF in wet ARMD
Lifestyle and diet improvement

139
Q

What is cataract?

A

Clouding of the lens

140
Q

List aetiology/risk factors for cataract

A 
Ageing
Diabetes
Hypocalcaemia
Maternal infection can cause congenital cataracts
Corticosteroid use
Amiodarone
Myopia
Down's syndrome
141
Q

List clinical features of cataract

A 
Blurred vision
Frequent glassess changes
Dazzled in light
Squint
Loss of red reflex indicates dense cataract
142
Q

Outline management of cataract

A

Mydriatics
Sunshades
Sunglasses for symptomatic relief
Phacoemulsification cataract extraction and intraocular lens implant

143
Q

What is the leading cause of blindness in 20-65 yo people?

A

Diabetic retinopathy

144
Q

Outline the basic pathophysiology of diabetic retinopathy

A

Microangiopathy in capillaries and vessels leads to occlusion and leakage, causing ischaemia and ultimately angiogenesis

145
Q

State the classifications (R0-R3) of diabetic retinopathy

A

R0: normal
R1: moderate, non-proliferative changes (microaneurysms)
R2: severe non-proliferative changes (dot blot haemorrhages, venous beading, cotton wool spots)
R3: proliferative changes (neovascularisation, vitrous haemorrhage)

146
Q

Outline management of diabetic retinopathy

A

Control diabetes
Treat comorbidities
Photocoagulation by laser therapy
Vitrectomy

147
Q

State the classifications of (I-IV) of hypertensive retinopathy

A

I: mild retinal arteriolar narrowing and sclerosis
II: AV nipping, focal narrowing, sclerosis
III: retinal haemorrhages, hard exudates, cotton wool spots
IV: grade III + papilloedema

4MB Medicine (My version) (19 decks)

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