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Ophthalmology Flashcards

1
Q

What is the function of the orbicularis oculi? and where does it sit anatomically?

A

Sits just under the skin and connective tissue in eyelid

Function is the close the eyelids and allow drainage of tears

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2
Q

What is the function of the tarsal plates (that sit directly behind the orbicularis oculi) and what do they contain?

A

Dense connective tissue - maintains structure of eye

Contain Meibomian glands- secretes oily substance to lubricate eye

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3
Q

What are the two main eyelid muscles that act to open the eye?

A

Levator palpabrae superioris
Muller’s muscle
both act on upper eyelid to open

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4
Q

What are the type types of conjuctiva in the eye and which one is more superficial?

A

Tarsal is more superficial to bulbar (continuous with sclera)

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5
Q

Where does the lacrimal fluid from eye drain eventually?

A

From nasolacrimal duct –> inferior meatus of nasal cavity

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6
Q

The sclera and cornea are continuous with each other creating the fibrous layer of the eyeball. Why is the cornea transparent and why is the sclera white?

A

Cornea is transparent- kept dehydrated- water is pumped out

Sclera is white- kept hydrated- no pumps to pump water out

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7
Q

What makes up the anterior uveal tract ?

A

Iris, ciliary body, choroid

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8
Q

What is the function of the ciliary body?

A

Produces aqueous humour to nourish the eye and maintain intra-ocular pressure. Fills the anterior and posterior chamber. Drains via trabecular meshwork.

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9
Q

What is the function of the choroid?

A

Vascular layer- continuous with choroid, lies behind retina. Supplies eye with oxygen and nutrients.

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10
Q

What gives vascular supply to the retina?

A

Retinal artery

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11
Q

What gives vascular supply to the macula and fovea?

A

Choroid

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12
Q

What is the function of the vitreous humour?

A

Fills the space between the lens and the retina. Keeps eye shape and protects eye.

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13
Q

What is the function and innervation of levator palpabrae superioris?

A

Elevates the upper eyelid. Innervation: CN3 (oculomotor)

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14
Q

What is the function and innervation of superior rectus?

A

Elevates the eye (and adducts & intorts). Innervation: CN3 (oculomotor)

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15
Q

What is the function and innervation of inferior rectus?

A

Depresses the eye (and abducts & extorts). Innervation: CN3 (oculomotor)

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16
Q

What is the function and innervation of medial rectus?

A

Adducts the eye (moves towards the midline). Innervation: CN3 (oculomotor)

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17
Q

What is the function and innervation of lateral rectus?

A

Abducts the eye (moves away). Innervation: CN6 (abducens)

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18
Q

What is the function and innervation of superior oblique?

A

Depresses, abducts and intorts. Innervation: CN 4 (trochlear)

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19
Q

What is the function and innervation of inferior oblique?

A

Elevates, abducts and extorts. Innervation: CN3 (oculomotor)

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20
Q

What is an entropian? what is the most common cause?

A

When the eyelid turns inwards. eyelashes abrade the cornea. Cause = lid laxity in elderly

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21
Q

What is an ectropian? What are the most common causes?

A

Eyelid turns outwards. Causes a watery eye. Cause= lid laxity/facial nerve palsy

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22
Q

What is the most common cause of blephairits?

A

Bacterial infection

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23
Q

What symptoms do you get with blepharitis?

A

Gritty, irritable eyes- worse at the START of the day

Foreign body sensation

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24
Q

What signs do you get with blepharitis?

A

Red, thickened eyelids
In growing eyelashes
Plaques/crusts of epithelium (bacteria) on eyelid

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25
How do you treat blepharitis?
Lid hygiene - baby shampoo to clean Chloramphenicol ointment, may need oral Abx massage of lids, tear substitute
26
Are the symptoms of blepharitis unilateral or bilateral?
Bilateral- usually all 4 lids affected
27
A patient presents to GP with some clear sticky discharge of his eyes, he descibres it worse in the morning and needs to blink a few times to clear it. His vision is not affected. On examination- you notice some redness white spots on the tarsal conjuctiva. He says he has had a bit of a cold recently. What is the likely diagnosis and the likely cause?
Conjuctivitis- likely viral cause (adenovirus) due to the watery clear discharge. Recent illness. White spots on tarsal conjuctiva.
28
How do you differentiate between bacteria, viral and allergic causes of conjuctivitis?
Viral- usually adenovirus. clear, watery, sticky discharge. Associated with systemic illness, lymphadenopathy, sore throat. Allergic- itching, acute allergic reaction , history of atopy Bacterial - purulent, thick green discharge. usually staphylcoccal.
29
What are the symptoms and signs of conjuctivitis?
Discharge- either watery/sticky or purulent/green Lids sticking together Redness of tarsal conjuctiva Papillae- allergic or white follicles - viral on conjuctiva
30
How do you treat bacterial, viral and allergic conjuctivitis?
Viral- reassure, explain highly infectious. Lubricant drops for comfort. Bacterial- chloramphenicol ointment Allergic- antihistamines, lubricant eye drops
31
Are the symptoms of conjuctivitis usually unilateral or bilateral?
Bilateral
32
Name some causes of dry eye (4)
Drugs- anticholingerics Eye disease = blepharitis, post conjuctivitis AI diseae= Sjogren's syndrome Mechanical: Facial nerve palsy, contact lenses, lid lumps eg. BCC on lid
33
What are the symptoms and signs of dry eye?
Gritty, foreign body sensation- worse at END OF DAY May get some watering (epiphora- as reflex tears kick in) Blurred vision- need to blink a few times Recurrent infections only a MILDLY red eye
34
How do you treat dry eyes?
Check medication , stop contact lens wearing for period of time Frequent topical lubricants Blinking periodically
35
What are the signs/symptoms of episcleritis? Does it affect 1 or both eyes?
Usually 1 eye affected Mild irritation, no discharge or change in vision Localised area of intense redness
36
How do you treat episcleritis?
Self - limiting/benign Reassure that it will resolve in 1-2 weeks. Give NSAIDs if pain
37
What are the signs/symptoms of scleritis? Does it affect 1 or both eyes?
Usually 1 eye affected. Painful- can radiate to forehead and cheeks and affects sleeping Change/loss of vision Dark redness on examination
38
In which condition- scleritis or episcleritis is there an autoimmune association?
Scleritis- RA, SLE, G with polyangitis
39
How do you treat scleritis?
Referral urgently. Steroid drops/oral
40
What are the symptoms and signs of anterior uveitis (iritis)? Does it usually affect 1 or both eyes?
1 eye Sx: acute pain, decreased vision, photophobia Sig: redness, irregular pupil shape
41
What are the three most common systemically associated diseases with anterior uveitis/iritis
IBD - ask about abdo pain, diarrhoea, mouth ulcers | HLA-B27 ank spond and psoriatic arthritis - ask about back pain, arthritis, rashes
42
What can be seen on slit lamp in anterior uveitis/iritis?
Flare- turbid material leaks out
43
What is the cause of acute angle closure glaucoma?
The area between the iris and lens closes off so the aequous humour cannot drain- builds up causing increased pressure in the eye
44
What are the symptoms and signs of acute angle closure glaucoma? Is it typically unilateral or bilateral?
``` Unilateral Sx: Severe pain Loss of vision Headache N&V Haloes- around lights Sig: red eye, pupils different sizes ```
45
What demographic is likely affected by acute angle closure glaucoma?
Elderly, long sighted individuals
46
What demographic is likely affected by corneal ulcer/bacterial keratitis? And what is the reason behind this?
Contact lens wearers. The cornea doesnt have its own blood supply so those who wear contact lenses all the time - dont allow the air in.
47
What are the symptoms and signs of corneal ulcer/bacterial keratitis? is it usually unilateral/bilateral?
unilateral painful red eye, loss of vision Signs: central abscess
48
What are the symptoms and signs of herpes simplex ulcer/keratitis? (HSV 1/2)
painful red eye. Sensitivity to light. Dendritic branching ulcer History of cold sore
49
Patient presents with acutely red eye and describes it being painful to blink. On further questioning she says she was in her garden, repotting plants when it happened. What is the likely diagnosis?
Subtarsal foreign body - painful to blink. Remove the FB.
50
Corneal foreign body is worse than a subtarsal foreign body. What symptoms would you expect with a corneal FB?
Redness, pain, watery. Can get blurring of vision and infections.
51
What is a stye?
Lid lump- infection at the base of the eyelid
52
How do you treat a stye?
Self limiting, heat to lid, may need topical Abx
53
What is a chalazion?
Lid lump- Inflammation of the Meibomian gland - blocked gland which ruptures.
54
How do you treat a chalazion?
Self limiting. Heat, lid massage to empty glands. If chronic= refer
55
How does a choroidal naevus differ from a choroidal melanoma?
Choroidal naevus- flat lesions, retinal vessels running over it Choroidal melanoma- increases/changes size, overlying retinal detachment
56
A patient presents with sudden loss of vision in his right eye. On swinging test- both pupils dilate. He has a PMH of ischaemic heart disease and a previous stroke. He currently takes a statin. What is the likely diagnosis and likely cause?
Central retinal artery occlusion. | Cause - emboli. Others= atherosclerosis
57
What would you see on swinging light torch test if a patient had a relative afferent pupillary defect?
On swinging to affected eye with RAPD - both pupils will dilate, swing to unaffected eye= constrict and back to RAPD eye= both dilate. (because the diseased eye causing visual pathway to believe the decrease in stimulation is due to decreased light stimulation (instead of retinal/optic tract disease) --> so both eyes dilate.
58
What do you classically see on opthalmoscopy in retinal artery occlusion?
Cherry red spot (macular is supplied by choroid- when retinal artery is occluded, retina becomes pale and see macula shining through) Retinal oedema- pallor
59
How do you investigate and treat a retinal artery occlsuion?
Look for cause- carotid doppler | Secondary management: Aspirin
60
How would a retinal vein occlusion present?
Total/partial loss of vision + RAPD on examination
61
What are the causes of a central vein occlusion?
Atherosclerosis, HTN
62
What do you see on opthalmoscopy in retinal vein occlusion?
Haemorrhages + optic disc swelling
63
If ischaemia is present from retinal vein occlusion- what will you now see on opthalmoscopy?
Cotton wool spots and pallor
64
What symptoms & signs would you get in a patient with ischaemic optic neuropathy?
Loss of vision + RAPD on examination Commonly associated with GCA/PMR (but not always)- jaw claudication, headache, scalp tenderness, muscular stiffness and pain
65
What do you see on opthalmoscopy in ischaemic optic neuropathy?
Swollen and pale optic disc, cotton wool spots if ischaemia, haemorrhage of optic disc
66
How would you investigate and treat ischaemic optic neuropathy secondary to GCA?
ESR & CRP, temporal artery biopsy | Prednisolone high dose
67
A patient with numbness and weakness of arms of legs presents with sudden loss of vision over a few days and pain on eye movements. On swinging torch test- both pupils dilate on swinging to right eye and constrict on swinging to left eye. There is also loss of colour vision. What is the likely diagnosis?
Optic neuritis- secondary to multiple sclerosis
68
What are the symptoms & signs of optic neuritis?
``` Painful eye movements Loss of vision over a couple of days RAPD Loss of colour vision Central scotoma - dark spot in centre of vision ```
69
What do you see on opthalmoscopy in optic neuritis?
Optic disc is swollen with hyperaemia- excess blood vessels running over it
70
How do you treat optic neuritis?
Usually resolves spotaenously. Steroids can help. Look for MS if associated symptoms- MRI spinal cord and brain
71
What are the risk factors for retinal detachment?
Trauma (usually preceded by retinal tear), FMH, inflammation, myopia
72
What are the 3 classic symptoms of retinal detachment and why do they occur?
Floaters- blood/proteins from tear spill out Flashes of light- retina is stimulated by the tear Field loss- dark curtain over vision because retina is detached
73
What is the most common cause of benign flashes and floaters? no other symptoms
benign posterior vitreous detachment - settles over 6 months
74
What can you see on opthalmoscopy in retinal detachment?
Pale, retina detachment --> rippled appearance, may see the tear
75
How do you treat retinal detachment?
Urgent surgery to preserve vision.
76
What are the causes of vitreous haemorrhage?
Trauma, retinal detachment, diabetic vascular proliferation (commonest in diabetics)
77
What symptoms and signs would a patient with vitreous haemorrhage present with?
Painless, abrupt loss of vision | Floaters +/- flashes
78
Would there be a RAPD present in vitreous haemorrhage and why or why not?
No - the retina is still intact for light to get through and constrict the pupil
79
What are some causes of gradual loss of vision?
Refractive error Cataracts Macular degeneration Chronic open angle glaucoma
80
What is a cataract?
Opacity/clouding of the lens
81
What are some risk factors for cataracts?
``` Age Long term steroids Diabetes Down's syndrome Myopia Retinitis pigmentosa ```
82
What are some symptoms/signs of cataracts? What signs/symptoms are specific to the different types of cataracts?
Blurring/double of vision , decreased visual acuity Nuclear: blurring Cortical: glares, haloes, fractured vision Sub-scapular: poor vision in bright light (usually in diabetics, steroid use)
83
What are the features (sx and signs) of chronic open angle glaucoma?
Raised intraocular pressure causing headache, N&V Enlargement of optic disc cup Loss of vision eventually leading to tunnel vision
84
How do you treat chronic open angle glaucoma?
Drops - helps to drain aqueous humour | Laser/ surgery - drain aqueous humour
85
What is drusen?
Waste material from a poorly functioning RPE- first sign of macular degeneration.
86
What are the features of dry AMD?
Atrophy of the retina and RPE Deterioration in vision Central scotoma.
87
What are the features of wet AMD?
Blood vessels that are abnormal leak --> exudates and haemorrhages and get new vascular proliferation Central scotoma & DISTORTION in vision
88
What is an Adie's pupil? is it an efferent or afferent defect?
Efferent. Affected pupil doesnt respond to light at all- direct or consensual. Does have a sustained (tonic) response to accomodation though. Associated with Holmes Adie syndrome- young girls with absent deep tendon reflexes + Adie's pupil
89
What is Horner's syndrome?
Miosis (small pupil) + ptosis (lid collapse) + anhydrosis
90
What are some causes of Horner's syndrome?
``` Due to interruption of sympathetic chain eg Pancoast tumour Carotid artery dissection Nasopharyngeal tumours Brachial plexus injury ```
91
What are some causes of RAPD? (or Marcus Gunn pupil)
``` Retinal artery/vein occlusion Anterior ischaemic neuropathy Optic neuritis Retinal detachment Direct damage to optic nerve- trauma, tumour, radiation ```

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