Ophthalmology Flashcards
What makes up the uvea?
Iris
Ciliary body
Choroid
What does a miotic agent do? Give an example of one
Miotics constrict the pupil
Pilocarpine
What does a mydriatic agent do? Give an example of one
Mydriatics dilate the pupil
Tropicamide
What is a stye?
Inflammatory lid swelling
Non-specific term - may be transient or infectious
What is hordeolum externum?
Abscess/infection present in lash follicle
May involve sweat/sebum glands, usually points outwards
What is a chalazion?
Residual non-infectious lid swelling that occurs due to blockage of Meibomian gland
Outline management of stye and other lid swellings
Warm compresses
Topical antibiotics (fusidic acid)
Incision and curettage
What is blepharitis?
Inflammation of the eyelid
List aetiology/risk factors for blepharitis
Anterior: seborrhoeic, Staph aureus
Posterior: Meibomian gland dysfunction
List clinical features of anterior blepharitis
Red lid margin Scale, dandruff Dermatitis Style, ulcer Distorted lashes Keratitis
List clinical features of posterior blepharitis
Deep red lid Dried secretions Gritty eyes Chalazion Rosacea
Outline management of blepharitis
Lid hygiene - cotton wool swab, bathing Warm compresses Topical fusidic acid/chloramphenicol Topical steroid Incision and curettage for chalazion
What is entropion?
Lid turns inwards, causing lashes to rub against globe
List aetiology/risk factors for entropion
Ageing
Degeneration of lid fascial elements and muscles
List clinical features of entropion
Red eye
Irritation
Outline management of entropion
Surgical taping of eyelid
Botox for lower eyelid
What is ectropion?
Lid turns outwards
List aetiology/risk factors for ectropion
Ageing
Facial nerve palsy
Outline management of ectropion
Surgical weight implant
Plastic surgery
What is keratoconjunctivitis sicca?
“dry eye syndrome” due to reduced tear production or excess tear evaporation
List aetiology/risk factors for keratoconjunctivitis sicca
Lacrimal gland destruction (Sjogren's) Mucin deficiency (low vitamin A, SJ syndrome) Ageing
What is a normal Schirmer test?
Test strip should soak more than 15mm in 5 mins
Outline management of keratoconjunctivitis sicca
Artificial tears if symptomatic
List aetiology/risk factors for orbital cellulitis
Spread from paranasal sinus infection
Dental injury
Staphylococci
Streptococci
List clinical features of orbital cellulitis
Fever
Lid swelling
Reduced eye mobility
Blindness if optic nerve involvement
What scan would you want to do promptly for orbital cellulitis?
CT scan
Outline management of orbital cellulitis
IV cefuroxime
Surgery to prevent meningitis
List clinical features of ophthalmic shingles
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
Outline management of ophthalmic shingles
Oral aciclovir
Refer to specialist
Who typically gets retinoblastoma?
Most common primary intraocular tumour in children
List aetiology/risk factors for retinoblastoma
Hereditary: RB gene 13q14, autosomal dominant, mutated tumour suppressor gene
Pineal gland tumour
Osteosarcoma
Rhabdosarcoma
List clinical features of retinoblastoma
Strabismus
Leukoconia (white pupil)
Absent red reflex
Outline management of retinoblastoma
Chemotherapy for bilateral
Enucleation (eye removal) if large/long-standing retinal detachment
Radiotherapy
What is strabismus/squint?
Abnormality in coordinated movement of both eyes
Describe esotropia
Eye sits inwards
Outward movement on cover test
Describe exotropia
Eye sits outwards
Inward movement on cover test
Describe hypertropia
Eye sits upwards
Downward movement on cover test
Describe hypotropia
Eye sits downwards
Upward movement on cover test
Outline management of strabismus
Optical: correct refractive error
Orthoptic: patch good eye
Operation: resection and recession of rectus, botox
List aetiology/risk factors for oculomotor nerve palsy
Cavernous sinus lesions
Superior orbital fissure syndrome
Diabetes
List clinical features of oculomotor nerve palsy
Posterior communicating artery aneurysm Ptosis Proptosis Pupil dilation "down and out" pupil
List aetiology/risk factors for trochlear nerve palsy
Trauma
Diabetes
Tumour
List clinical features of trochlear nerve palsy
Diplopia
Head-tilting (ocular torticollis)
“up and in” pupil
Cannot look down and out
List aetiology/risk factors for abducens nerve palsy
Increased ICP
Base of skull trauma
Vascular disease
Multiple sclerosis
List clinical features of abducens nerve palsy
Diplopia in horizontal plane
Adducted eye
Botox may help
Which nerve is responsible for normal light detection (afferent pathway)?
Optic nerve
Which nerve is responsible for pupil constriction (efferent pathway)?
Oculomotor nerve
Which nerve is responsible for pupil dilation?
Ciliary nerve (sympathetic chain)
What is an afferent pupillary defect?
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)
List aetiology/risk factors for afferent pupillary defect
Optic neuritis
Optic atrophy
Retinal disease
On swinging light test, both pupils constrict in an afferent pupillary defect. True/False?
True
What is an efferent pupillary defect?
Fixed dilated pupil
What is a Holmes-Adie pupil?
Initially monolateral, then bilateral pupil dilation
Tonic pupil
Delayed response to near vision effort, causes sudden blurring of vision
List clinical features of Horner’s syndrome
Miosis
Ptosis
Constricted pupil
Unilateral sweating
What is a Argyll Robertson pupil?
Bilateral miosis
Irregular pupils
No direct response
What is myopia?
Short sightedness due to large eyeball - light focuses in front of retina
List clinical features of myopia
Children change spectacles frequently
Able to see close objects
Retinal detachment
Macular bleeding
Outline management of myopia
Concave lens correction
LASIK