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Phase 4 > Ophthalmology > Flashcards

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
Q

How do you treat blepharitis?

A

Lid hygiene - baby shampoo to clean
Chloramphenicol ointment, may need oral Abx
massage of lids, tear substitute

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26
Q

Are the symptoms of blepharitis unilateral or bilateral?

A

Bilateral- usually all 4 lids affected

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27
Q

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?

A

Conjuctivitis- likely viral cause (adenovirus) due to the watery clear discharge. Recent illness. White spots on tarsal conjuctiva.

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28
Q

How do you differentiate between bacteria, viral and allergic causes of conjuctivitis?

A

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.

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29
Q

What are the symptoms and signs of conjuctivitis?

A

Discharge- either watery/sticky or purulent/green
Lids sticking together
Redness of tarsal conjuctiva
Papillae- allergic or white follicles - viral on conjuctiva

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30
Q

How do you treat bacterial, viral and allergic conjuctivitis?

A

Viral- reassure, explain highly infectious. Lubricant drops for comfort.
Bacterial- chloramphenicol ointment
Allergic- antihistamines, lubricant eye drops

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31
Q

Are the symptoms of conjuctivitis usually unilateral or bilateral?

A

Bilateral

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32
Q

Name some causes of dry eye (4)

A

Drugs- anticholingerics
Eye disease = blepharitis, post conjuctivitis
AI diseae= Sjogren’s syndrome
Mechanical: Facial nerve palsy, contact lenses, lid lumps eg. BCC on lid

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33
Q

What are the symptoms and signs of dry eye?

A

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

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34
Q

How do you treat dry eyes?

A

Check medication , stop contact lens wearing for period of time
Frequent topical lubricants
Blinking periodically

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35
Q

What are the signs/symptoms of episcleritis? Does it affect 1 or both eyes?

A

Usually 1 eye affected
Mild irritation, no discharge or change in vision
Localised area of intense redness

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36
Q

How do you treat episcleritis?

A

Self - limiting/benign
Reassure that it will resolve in 1-2 weeks.
Give NSAIDs if pain

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37
Q

What are the signs/symptoms of scleritis? Does it affect 1 or both eyes?

A

Usually 1 eye affected.
Painful- can radiate to forehead and cheeks and affects sleeping
Change/loss of vision
Dark redness on examination

38
Q

In which condition- scleritis or episcleritis is there an autoimmune association?

A

Scleritis- RA, SLE, G with polyangitis

39
Q

How do you treat scleritis?

A

Referral urgently. Steroid drops/oral

40
Q

What are the symptoms and signs of anterior uveitis (iritis)? Does it usually affect 1 or both eyes?

A

1 eye
Sx: acute pain, decreased vision, photophobia
Sig: redness, irregular pupil shape

41
Q

What are the three most common systemically associated diseases with anterior uveitis/iritis

A

IBD - ask about abdo pain, diarrhoea, mouth ulcers

HLA-B27 ank spond and psoriatic arthritis - ask about back pain, arthritis, rashes

42
Q

What can be seen on slit lamp in anterior uveitis/iritis?

A

Flare- turbid material leaks out

43
Q

What is the cause of acute angle closure glaucoma?

A

The area between the iris and lens closes off so the aequous humour cannot drain- builds up causing increased pressure in the eye

44
Q

What are the symptoms and signs of acute angle closure glaucoma? Is it typically unilateral or bilateral?

A 
Unilateral
Sx: Severe pain
Loss of vision 
Headache 
N&V 
Haloes- around lights
Sig: red eye, pupils different sizes
45
Q

What demographic is likely affected by acute angle closure glaucoma?

A

Elderly, long sighted individuals

46
Q

What demographic is likely affected by corneal ulcer/bacterial keratitis? And what is the reason behind this?

A

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
Q

What are the symptoms and signs of corneal ulcer/bacterial keratitis? is it usually unilateral/bilateral?

A

unilateral
painful red eye, loss of vision
Signs: central abscess

48
Q

What are the symptoms and signs of herpes simplex ulcer/keratitis? (HSV 1/2)

A

painful red eye. Sensitivity to light.
Dendritic branching ulcer
History of cold sore

49
Q

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?

A

Subtarsal foreign body - painful to blink. Remove the FB.

50
Q

Corneal foreign body is worse than a subtarsal foreign body. What symptoms would you expect with a corneal FB?

A

Redness, pain, watery. Can get blurring of vision and infections.

51
Q

What is a stye?

A

Lid lump- infection at the base of the eyelid

52
Q

How do you treat a stye?

A

Self limiting, heat to lid, may need topical Abx

53
Q

What is a chalazion?

A

Lid lump- Inflammation of the Meibomian gland - blocked gland which ruptures.

54
Q

How do you treat a chalazion?

A

Self limiting. Heat, lid massage to empty glands. If chronic= refer

55
Q

How does a choroidal naevus differ from a choroidal melanoma?

A

Choroidal naevus- flat lesions, retinal vessels running over it
Choroidal melanoma- increases/changes size, overlying retinal detachment

56
Q

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?

A

Central retinal artery occlusion.

Cause - emboli. Others= atherosclerosis

57
Q

What would you see on swinging light torch test if a patient had a relative afferent pupillary defect?

A

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
Q

What do you classically see on opthalmoscopy in retinal artery occlusion?

A

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
Q

How do you investigate and treat a retinal artery occlsuion?

A

Look for cause- carotid doppler

Secondary management: Aspirin

60
Q

How would a retinal vein occlusion present?

A

Total/partial loss of vision + RAPD on examination

61
Q

What are the causes of a central vein occlusion?

A

Atherosclerosis, HTN

62
Q

What do you see on opthalmoscopy in retinal vein occlusion?

A

Haemorrhages + optic disc swelling

63
Q

If ischaemia is present from retinal vein occlusion- what will you now see on opthalmoscopy?

A

Cotton wool spots and pallor

64
Q

What symptoms & signs would you get in a patient with ischaemic optic neuropathy?

A

Loss of vision + RAPD on examination
Commonly associated with GCA/PMR (but not always)- jaw claudication, headache, scalp tenderness, muscular stiffness and pain

65
Q

What do you see on opthalmoscopy in ischaemic optic neuropathy?

A

Swollen and pale optic disc, cotton wool spots if ischaemia, haemorrhage of optic disc

66
Q

How would you investigate and treat ischaemic optic neuropathy secondary to GCA?

A

ESR & CRP, temporal artery biopsy

Prednisolone high dose

67
Q

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?

A

Optic neuritis- secondary to multiple sclerosis

68
Q

What are the symptoms & signs of optic neuritis?

A 
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
Q

What do you see on opthalmoscopy in optic neuritis?

A

Optic disc is swollen with hyperaemia- excess blood vessels running over it

70
Q

How do you treat optic neuritis?

A

Usually resolves spotaenously.
Steroids can help.
Look for MS if associated symptoms- MRI spinal cord and brain

71
Q

What are the risk factors for retinal detachment?

A

Trauma (usually preceded by retinal tear), FMH, inflammation, myopia

72
Q

What are the 3 classic symptoms of retinal detachment and why do they occur?

A

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
Q

What is the most common cause of benign flashes and floaters? no other symptoms

A

benign posterior vitreous detachment - settles over 6 months

74
Q

What can you see on opthalmoscopy in retinal detachment?

A

Pale, retina detachment –> rippled appearance, may see the tear

75
Q

How do you treat retinal detachment?

A

Urgent surgery to preserve vision.

76
Q

What are the causes of vitreous haemorrhage?

A

Trauma, retinal detachment, diabetic vascular proliferation (commonest in diabetics)

77
Q

What symptoms and signs would a patient with vitreous haemorrhage present with?

A

Painless, abrupt loss of vision

Floaters +/- flashes

78
Q

Would there be a RAPD present in vitreous haemorrhage and why or why not?

A

No - the retina is still intact for light to get through and constrict the pupil

79
Q

What are some causes of gradual loss of vision?

A

Refractive error
Cataracts
Macular degeneration
Chronic open angle glaucoma

80
Q

What is a cataract?

A

Opacity/clouding of the lens

81
Q

What are some risk factors for cataracts?

A 
Age
Long term steroids
Diabetes
Down's syndrome
Myopia 
Retinitis pigmentosa
82
Q

What are some symptoms/signs of cataracts? What signs/symptoms are specific to the different types of cataracts?

A

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
Q

What are the features (sx and signs) of chronic open angle glaucoma?

A

Raised intraocular pressure causing headache, N&V
Enlargement of optic disc cup
Loss of vision eventually leading to tunnel vision

84
Q

How do you treat chronic open angle glaucoma?

A

Drops - helps to drain aqueous humour

Laser/ surgery - drain aqueous humour

85
Q

What is drusen?

A

Waste material from a poorly functioning RPE- first sign of macular degeneration.

86
Q

What are the features of dry AMD?

A

Atrophy of the retina and RPE
Deterioration in vision
Central scotoma.

87
Q

What are the features of wet AMD?

A

Blood vessels that are abnormal leak –> exudates and haemorrhages and get new vascular proliferation
Central scotoma & DISTORTION in vision

88
Q

What is an Adie’s pupil? is it an efferent or afferent defect?

A

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
Q

What is Horner’s syndrome?

A

Miosis (small pupil) + ptosis (lid collapse) + anhydrosis

90
Q

What are some causes of Horner’s syndrome?

A 
Due to interruption of sympathetic chain eg 
Pancoast tumour
Carotid artery dissection
Nasopharyngeal tumours 
Brachial plexus injury
91
Q

What are some causes of RAPD? (or Marcus Gunn pupil)

A 
Retinal artery/vein occlusion
Anterior ischaemic neuropathy
Optic neuritis
Retinal detachment
Direct damage to optic nerve- trauma, tumour, radiation

Phase 4 (15 decks)

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