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Year 5 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is a cataract?

A

Opacification of the proteins in the lens of the eye leading to loss of visual acuity

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2
Q

Give 3 causes of cataracts

A 
Old age 
UV light 
Trauma
Smoking
Alcohol
Diabetes 
Metabolic disorders
Uveitis
Steroids 
Congenital
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3
Q

What are the symptoms of cataract?

A

Painless loss of vision
Misting/blurring
Change in refractive error

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4
Q

Give 2 examples of common complaints a patient with cataract may express

A

Difficulty reading
Difficulty recognising faces
Difficulty driving at night
Halos around lights

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5
Q

What 2 conditions may cause halos around lights?

A

Cataract

Glaucoma

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6
Q

What features may be seen on examination of a patient with cataract

A

Reduced visual acuity

Reduced red reflex

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7
Q

How are cataracts managed?

A

Surgery (vision worse than 6/12) - phaecoemulsification with synthetic lens replacement

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8
Q

What should a patient be informed about regarding the recovery period for cataract surgery?

A

Eye patch for 24 hours
Avoid driving, swimming and heavy lifting for 5 days
Steroids, antibiotics and dilating drops may be prescribed

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9
Q

What are the contraindications to cataract surgery?

A

Diabetic retinopathy

Intraocular inflammation

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10
Q

What are the complications of cataract surgery?

A 
Posterior capsule opacification 
Choroidal haemorrhage (bleeding)
Endophthalmitis (infection)
Glaucoma 
Vitreous loss 
Visual disturbance 
Retinal detachment
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11
Q

What is posterior capsule opacification and how is it managed?

A

Cloudy layer of scar tissue (residual lens epithelial cells) at the back of the lens capsule after replacement
YAG laser capsulotomy

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12
Q

What is the most common complication of cataract surgery?

A

Posterior capsule opacification

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13
Q

What do phakic, pseudophakic and aphakic mean?

A

Phakic - natural lens
Pseudophakic - natural lens removed and artificial lens inserted
Aphakic - natural lens removed but not replaced

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14
Q

Other than treatment of cataract, what other reasons may a patient undergo cataract surgery?

A

Treatment of angle closure glaucoma

Improve visualisation of retina to manage co-morbidity (e.g. diabetic retinopathy)

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15
Q

What is biometry?

A

Measurement of corneal curvature and length of the eye prior to cataract surgery to allow selection of the most appropriate intraocular lens implant

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16
Q

Name 3 types of cataract and their cause

A

Nuclear sclerotic - age, yellow/white
Posterior subcapsular - steroids and diabetes, inflammation
Congenital - inherited or idiopathic, amblyopia
Traumatic - blunt/penetrating trauma

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17
Q

What is glaucoma?

A

Gradual death of the optic nerve due to high intraocular pressure, usually due to an imbalance in the production and drainage of aqueous humour

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18
Q

Where is aqueous humour produced and drained?

A

Produced - ciliary body

Drained - irido-corneal angle -> trabecular meshwork -> canal of Schlemm

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19
Q

What is open angle (chronic) glaucoma?

A

Defect of the trabecular meshwork slows down the flow of aqueous humour which increases ocular pressure leading to optic nerve damage and gradual vision loss

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20
Q

What is closed angle (acute) glaucoma?

A

Narrowing of the irido-corneal angle which prevents aqueous fluid drainage, leading to rapid rise in ocular pressure and damage to the retina via stretching and decreased blood supply

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21
Q

Which type of glaucoma is most common?

A

Open angle

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22
Q

What are the risk factors for open angle glaucoma?

A 
Family history 
Age
Black ethnicity 
Thin cornea
Large vertical nerve cupping 
High ocular pressure
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23
Q

How is open angle glaucoma screened for?

A

Strong family history - screening every 2 years from age 30

Otherwise - every 5 years from age 40 and 2 years from age 60

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24
Q

What are the symptoms of open angle glaucoma?

A

Gradual peripheral visual loss - patient may not be aware of this

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25
Q

Give 2 features of open angle glaucoma seen on examination

A

Elevated pressure
Optic disc changes - increased cupping, haemorrhage, thinning and notching of rim, optic atrophy
Peripheral visual loss - central spared

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26
Q

What is a normal ocular pressure? When is it at its highest normally?

A

10-22 mmHg

Morning

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27
Q

How is ocular pressure measured and how is it affected by corneal thickness?

A

Tonometer
Thin cornea = lower reading than actual value
Thick cornea = higher reading than actual value

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28
Q

How is open angle glaucoma managed medically?

A

Topical beta-blocker (timolol) - decrease aqueous production
Prostaglandin analogues (latanoprost)- increase aqueous outflow
Carbonic anhydrase inhibitor (brinzolamide) - decreased production
Alpha 1 agonist (brimonidine) - both

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29
Q

How is open angle glaucoma managed surgically?

A

Trabeculectomy - with mitomycin C
Laser trabeculoplasty - burn meshwork/ciliary body to increase aqueous outflow/decrease aqueous production
Shunt - Molteno tube, Ahmed valve

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30
Q

What are the symptoms of acute angle closure glaucoma?

A

Extremely red and painful eye
Associated nausea and vomiting
Halos around light

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31
Q

What features may be seen on examination of acute angle closure glaucoma?

A

Sluggish dilated pupil
Elevated pressure (>60mmHg)
Rock hard eye on palpation

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32
Q

How is acute angle closure glaucoma managed medically?

A

Topical - pilocarpine (reduces pressure)

Systemic - IV acetazolamide

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33
Q

How is acute angle closure glaucoma managed surgically?

A

YAG laser iridotomy - create communication between anterior and posterior chambers to relieve pressure gradient
Both eyes, even if only 1 was affected

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34
Q

What is the ISNT rule?

A

Pattern of neural rim width

(thickest)
I - inferior rim 
S - superior rim
N - nasal rim
T - temporal rim
(thinnest)

This rule is lost in glaucoma

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35
Q

What investigations can be done for glaucoma?

A 
Tonometer 
Slit lamp 
Visual fields (scotoma)
OCT optic disc
Gonioscopy
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36
Q

What are the complications of trabeculectomy for open angle glaucoma?

A

Hypotony
Infection
Cataract
Bleb leakage

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37
Q

What populations are at higher risk of acute angle closure glaucoma?

A

Elderly
Hypermetropic (abnormal ability to focus of distant objects; far-sightedness)
Chinese ethnicity

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38
Q

Give 3 features of congenital glaucoma

A 
Large, watering photophobic eyes 
Increased corneal diameter 
Cloudy cornea
Reduced vision 
Raised pressure 
Treatment - goniotomy, trabeculotomy
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39
Q

How does neovascular glaucoma occur?

A

Diabetic retinopathy or retinal vein occlusion
VEGF produced from ischaemic retina which leads to neovascularisation of iris
Fibrous membrane forms over trabecular meshwork which closes drainage angle
Needs surgery

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40
Q

What is pigment dispersion syndrome?

A

Occurs in young caucasian myopic (near-sighted) males
Pigmented iris rubs against zonules -> pigment sheds and clogs meshwork
Can be caused/worsened by exercise

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41
Q

What is pseudoexfoliation syndrome?

A

Systemic disorder in which a fibrillar, proteinaceous substance is produced in abnormally high concentrations within ocular tissues

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42
Q

What are the 2 types of macular degeneration?

A

Dry/atrophic (slow decline)

Wet/exudative (rapid decline)

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43
Q

What are the risk factors for macular degeneration?

A 
Age >55
Smoking 
Family history 
Diabetes
Previous history of macular degeneration in other eye
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44
Q

What type of macular degeneration is more common?

A

Dry

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45
Q

What are the symptoms of macular degeneration?

A

Decline in visual acuity - central vision, distortion (e.g. of lines)

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46
Q

What may be seen on examination of macular degeneration?

A

Normal visual fields
Reduced visual acuity
No pupillary defect

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47
Q

What investigation can be done for macular degeneration and what features will be seen in dry and wet types?

A

Fundoscopy/retinal imaging
Dry - drusen, atrophy of retina, darker macula
Wet - scarring and haemorrhages, neovascularisation

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48
Q

How is dry macular degeneration managed?

A

No treatment
High dose vitamins
Smoking cessation
Annual eye examination

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49
Q

How is wet macular degeneration managed?

A

Anti-VEGF injections into the eye

Laser therapy to target new blood vessels

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50
Q

What are the main features of central retinal vein occlusion?

A 
Sudden painless loss of vision (central)
Unilateral 
Vision not improved with pinhole
May have RAPD if severe 
Elderly
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51
Q

What signs may be seen on examination of CRVO?

A 
Hyperaemic retina with engorged veins 
Swollen optic disc 
Multiple haemorrhages 
Cotton wool spots 
'Stormy sunset' appearance
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52
Q

What are the causes of CRVO?

A

Raised ocular pressure (glaucoma, HTN)
Hyperviscosity (polycythaemia)
Vessel wall disease (diabetes, sarcoidosis, hyperlipidaemia)

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53
Q

How is CRVO managed?

A

No treatment needed - address cause and CV RFs

Fibrinolysin/laser therapy may be useful

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54
Q

What is central retinal artery occlusion?

A

‘Stroke of the retina’

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55
Q

How does CRAO present?

A

Sudden painless loss of vision
Unilateral
Curtain across vision

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56
Q

What features may be seen on examination of CRAO?

A

RAPD
Reduced visual acuity (no perception of light)
Ophthalmoscopy - retinal emboli, may be normal, pale retina with cherry red spot (macular sparing due to supply from posterior ciliary artery)

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57
Q

What should be ruled out in CRAO and how?

A

Temporal arteritis - ESR

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58
Q

What are the causes of CRAO?

A

Arterial embolus from carotid/valvular heart disease/AF
Temporal arteritis
Vasculitis (polyarteritis nodosa)
Atherosclerosis (diabetes, HTN)

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59
Q

How is CRAO managed?

A

<30 minutes from onset - globe massage to dislodge embolus
Rebreath CO2 (paper bag)
IV acetazolamide - reduce pressure
Bloods - ESR

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60
Q

What is amaurosis fugax?

A

‘TIA of the retina’

Transient loss of vision due to temporary occlusion of retinal artery

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61
Q

Give 4 causes of sudden painless loss of vision

A 
Retinal detachment  
Vitreous haemorrhage
CRVO
Amaurosis fugax
CRAO
Wet AMD
Posterior vitreous detachment
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62
Q

How does retinal detachment present?

A

Sudden painless loss of vision
Flashing lights, floaters, visual field defects
Classic curtain over vision
Macular involvement = central vision affected

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63
Q

What features may be seen on examination of retinal detachment?

A

RAPD
Abnormal red reflex
May be able to visualise fold in eye
May be normal

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64
Q

In what patients are retinal detachments more common?

A

Myopic (near-sighted)
Diabetic retinopathy
Previous surgery (e.g. cataracts)

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65
Q

What is the main differential for retinal detachment?

A

Posterior vitreous detachment

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66
Q

How is retinal detachment managed?

A

Minor - laser to encourage inflammation and healing

Major - retinal surgery +/- vitrectomy

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67
Q

Give 4 causes of a red eye

A 
Conjunctivitis 
Corneal abrasion 
Corneal ulceration 
Anterior uveitis 
Episcleritis
Scleritis
Subconjunctival haemorrhage
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68
Q

What are the symptoms of conjuncivitis?

A 
Gritty irritation
Itchiness
Discharge 
Injection 
Normal vision (improved on pinhole if mildly reduced)
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69
Q

What are the causes of conjuncitivis and their defining features?

A

Bacterial - purulent sticky discharge
Viral (e.g. adenovirus, HSV) - watery discharge, lymphoid follicles on conjunctiva, pre-auricular lymphadenopathy
Allergy - itchy, watery

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70
Q

How are bacterial, viral and allergic conjunctivitis managed?

A

Bacterial - antibiotics
Allergic - self-resolving, anti-histamines
Viral - lubricating eye drops, frequent cleaning, hygiene measures

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71
Q

What symptoms should be asked about in a patient presenting with a red eye?

A 
Blurred vision 
Sticky/gritty/discharge 
Photophobia
Pain/halo/headache/vomiting
Discomfort/dryness
Foreign body sensation 
Redness/swelling 
Itch 
Watering 
Hearing loss/jaw claudication
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72
Q

How should a red eye be examined?

A 
Visual acuity (plus pinhole)
External examination 
Slit lamp - fluoroscein, topical anaesthetic, eversion of eyelids 
Pupils 
Eye movements
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73
Q

What is chemosis?

A

Swelling/oedema of the conjunctiva

74
Q

What features can be seen on eversion of the eyelids? What types of conjunctivitis do they correspond to?

A

Papillae - cobblestoned nodules; bacterial, allergic

Follicles - lymphoid hyperplasia; viral

75
Q

What is trachoma?

A

Most common infectious cause of blindness
Repeated episodes of infection with chlamydia trachomatis in childhood lead to severe conjunctival inflammation, scarring, and potentially blinding in-turned eyelashes (trichiasis or entropion) in later life

76
Q

What is the difference between a corneal ulcer and abrasion?

A

Ulcers involve the stroma and are opaque and uneven

77
Q

Give 3 features of bacterial keratitis

A 
Rapid onset 
Contact lens user, dry eyes, abrasion 
Pain, foreign body sensation, reduced vision, photophobia
Round/oval white lesion
Lasts 7-14 days
78
Q

Give 3 features of viral keratitis

A 
Insidious onset 
History of cold sores/feeling run down 
Pain, irritation, reduced vision
Dendritic appearance (HSV), raised IOP 
Lasts <7 days
79
Q

Give 3 features of fungal keratitis

A

Onset over several days
Outdoors, vegetative trauma
Pain, photophobia, red eye, reduced vision
Feathery edges, satellite lesions, necrotic slough
Lasts 1-2 months

80
Q

What are the risk factors for corneal ulcers?

A 
Trauma 
Contact lens use 
Ocular surface disease (e.g. dry eyes, blepharitis, corneal anaesthesia)
Lid disease (e.g. entropion)
Systemic condition (e.g. RA, DM)
81
Q

What are the symptoms of corneal ulcers?

A 
Pain 
Foreign body sensation
Redness
Photophobia
Tearing 
Discharge
Reduced vision 
Injection 
Single/multiple white  foci 
Hypopyon
82
Q

What are the complications of corneal ulcers?

A

Scleral extension
Corneal perforation
Endophthalmitis
Corneal scarring

83
Q

What investigations can be carried out for a corneal ulcer?

A 
Corneal scrape (>1mm)
Contact lenses - send lenses, solution and case for culture 
Swabs - viral PCR
84
Q

How is HSV keratitis/dendritic ulcer managed?

A

Aciclovir ointment

85
Q

How are corneal ulcers managed before a cause is know?

A

Empirical antibiotic therapy (e.g. cefuroxine and gentamicin)
Cyclopentolate (dilate pupil to reduce photophobia)

86
Q

What are the symptoms of scleritis?

A

Acute red eye
Pain on eye movement
Globe tenderness
Severe pain - keeping patient up at night

87
Q

How is scleritis managed?

A

Oral steroids

Investigation of cause/vasculitis

88
Q

What are the symptoms of episcleritis?

A

Diffuse or sectoral red eye
Mild pain
Self-limiting

89
Q

How is episcleritis managed?

A

Topical NSAIDs

Topical steroids

90
Q

What is uveitis?

A

Inflammation of the uveal tract (iris, ciliary body, choroid) and neighbouring structures

91
Q

How is uveitis classified?

A

Based on anatomical location

Anterior, intermediate, posterior, panuveitis

92
Q

What causes uveitis?

A 
Idiopathic (50%)
Trauma 
Infection 
Autoimmune (e.g. RA)
Neoplastic
93
Q

What are the symptoms of uveitis?

A

Anterior - photophobia, redness, watering, pain, reduced vision
Intermediate - reduced vision, floaters, photopsia
Posterior - reduced vision, floaters, photopsia, scotoma

94
Q

What features may be seen on examination of uveitis?

A 
Limbal injection (circumcorneal)
Anterior chamber (AC) cells
AC flare
Posterior synechiae
Keratic precipitates (KP’s) (mainly inferiorly)
\+/- fibrin and hypopyon
95
Q

What are the complications of uveitis?

A

Raised IOP
Cataract
Cystoid macular oedema
Optic neuropathy

96
Q

Why is a systemic review important in uveitis?

A 
May give clues to underlying cause 
Joint pain/swelling/back pain - ank spond, RA, JIA
Cough - TB, sarcoid
Rash - sarcoid, Behcets
Diarrhoea - IBD (crohns/UC)
Dysuria - Reiters
IV Drug use, sexual history - HIV
Immunocompromised - CMV
Recent Travel - TB
97
Q

How is uveitis managed?

A

Treat cause if known
Anterior - topical steroids and cyclopentolate
Intermediate - as above
Posterior - systemic steroids (if infectious cause ruled out)

98
Q

What ocular issues may result from trauma?

A 
Foreign body
Abrasions
Lacerations
Hyphaema
Penetrating trauma
Retrobulbar haemorrhage
Orbital wall fracture
99
Q

What is a corneal abrasion?

A

‘Scratch on eye’

Defect in epithelium

100
Q

How is corneal abrasion managed?

A

Chloramphenicol ointment 4x day for 3 days

101
Q

How is a foreign body managed?

A

Topical anaesthetic and use a green needle to remove

Chloramphenicol ointment 4x day for 3 days

102
Q

How should chemical injuries be managed?

A

Irrigate immediately with at least 2L of water and evert eyelids
Check pH after irrigation and then at 5 and 20 mins

103
Q

What is the difference between acidic and alkaline chemical injuries?

A

Acidic (e.g. sulfuric acid) - coagulative necrosis

Alkaline (e.g. lime) - worse than acid, causes liquefactive necrosis which can penetrate further

104
Q

What signs may be seen on anterior segment blunt trauma?

A

Cornea - abrasion, oedema
Hyphaema (blood)
Iris - miosis or mydriasis, sphincter rupture
Lens - cataract, subluxation

105
Q

What signs may be seen on posterior segment blunt trauma?

A

Vitreous - detachment, haemorrhage
Retina - bruising, bleeding, tears, detachment
Choroid - rupture
Optic nerve - traumatic neuropathy

106
Q

What are the symptoms of globe rupture?

A 
Extreme pain 
Obvious penetrating trauma or suspicious mechanism of injury 
Irregular pupil 
360 degree subconjunctival haemorrhage 
Flat anterior compartment
107
Q

How is suspected globe rupture managed?

A 
Do not press on the globe 
Measure visual acuity
Slit lamp and pupils if able 
CT (thin slice)
Refer to ophthalmology
108
Q

How should lid lacerations be assessed?

A

Clean
Assess for associated injuries
Check if - full thickness, involves lid margin, puncta involvement
Suture

109
Q

How does retrobulbar haemorrhage present?

A 
Reduced vision 
RAPD
Raised pressure 
Pain 
Proptosis 
Reduced motility
110
Q

What type of orbital fracture is most common and how is it managed?

A

Floor

Most suitable for OP review

111
Q

What are the symptoms of orbital cellulitis and how does this differ from preseptal?

A 
Proptosis 
Painful/restricted movemement 
Reduced visual acuity 
Reduced colour vision 
RAPD 
(None of these features occur in preseptal)
112
Q

How is orbital cellulitis managed?

A

Ophthalmic emergency
IV antibiotics
CT

113
Q

What bacteria are commonly implicated in orbital cellulitis?

A

Strep pneumoniae
Staph aureus
Strep pyogenes
Haemophilus influenzae

114
Q

What is Hutchinson’s sign?

A

Relates to involvement of the tip of the nose from facial herpes zoster
It implies involvement of the external nasal branch of the nasociliary nerve (branch of the ophthalmic division of the trigeminal nerve) and thus raises the spectre of involvement of the eye

115
Q

What is amblyopia?

A

A reduction in visual acuity due to a problem with focusing in early childhood

116
Q

What causes amblyopia?

A

Stabismus (lazy eye)
Refractive defects
Congenital cataracts

117
Q

What is strabismus?

A

A condition in which the eyes do not properly align with each other when looking at an object
AKA lazy eye/squint

118
Q

How is amblyopia diagnosed?

A

Visual acuity

Eye movements

119
Q

How is strabismus managed?

A

Eye patches or drops (atropine) to obscure the good eye and force the brain to process information from the affected eye for 4-6 hours/day

120
Q

How is amblyopia caused by refractive error managed?

A

Glasses

121
Q

Give 3 differentials of dry eye

A 
Allergy 
Conjunctivitis 
Glaucoma
HSV
VZV
Thyroid disease 
Sjogren's syndrome
122
Q

Give 3 causes of dry eyes

A 
Elderly - reduced tear secretion 
Contact lenses
Staring at screens - reduced blinking 
Diabetes 
Cataract surgery
123
Q

How do dry eyes present?

A 
Watery eyes 
Dry, gritty sensation 
Worse towards end of day 
Eyelids may be red and sticky
Usually bilateral
124
Q

What are the red flags for dry eyes?

A 
Eye pain
Altered visual acuity
Photophobia 
Significant redness
Diplopia
Acute onset
125
Q

What investigation can be done for dry eyes?

A

Schirmer’s test - strip of filter paper in fornix to measure advancing edge of tears

126
Q

How are dry eyes managed?

A 
Artificial tears/ointment 3-4 times/day 
Acetylcysteine drops (disperse mucus)
Medication review 
Smoking cessation 
Minimise contact lens wear 
Blink more frequently, break from screens 
Temporary punctal plug
127
Q

What are the complications of dry eyes?

A

Conjunctivitis
Keratitis
Ulceration
Infection

128
Q

What is blepharitis?

A

A condition where the edges of the eyelids become red and swollen

129
Q

What is a chalazion, how does it present and how is it managed?

A

Granuloma of meibomian glands
Hard, inflamed lump visible on lid eversion
Warm compress, chloramphenicol, incise

130
Q

What is a stye, how does it present and how is it managed?

A

Infection of the lash follicle
Red, tender swelling of lid margin which may have a head of pus
Warm compress and chloramphenicol

131
Q

What is a marginal cyst, how does it present and how is it managed?

A

Cysts of sweat (Moll) or lipid (Zeiss) glands
Dome shaped, no inflammation
Removal for cosmetic reasons only

132
Q

What is the most common eyelid malignancy, how does it present and how is it managed?

A

Basal cell carcinoma
Mainly lower lid, does not metastasise, local infiltration
Pearly smooth edge with necrotic core or diffuse indurated lesion
Excision or radiotherapy

133
Q

How does blepharitis present and how is it managed?

A

Inflamed lid margin, blocked meibomian glands, margin crusting
Keep lids clean, treat infection, artificial tears

134
Q

What eye movement/s are controlled by the superior rectus muscles?

A

Abduction

Elevation

135
Q

What eye movement/s are controlled by the lateral rectus muscles?

A

Abduction

136
Q

What eye movement/s are controlled by the inferior rectus muscles?

A

Abduction and depression

137
Q

What eye movement/s are controlled by the inferior oblique muscles?

A

Adduction

Elevation

138
Q

What eye movement/s are controlled by the medial rectus muscles?

A

Adduction

139
Q

What eye movement/s are controlled by the superior oblique muscles?

A

Adduction

Depression

140
Q

How do you describe a squint?

A

Persistence - manifest squint (present all the time), latent squint (present on dissociation)
Direction of deviation - exotropia (divergent), esotropia (inwards), hypertropia (upwards), hypotropia (downwards)

141
Q

Give 3 causes of a squint?

A 
Blowout fracture 
Diabetes
Hypertension 
Aneurysm (posterior communicating artery)
Cavernous sinus thrombosis 
Acoustic neuroma 
Glioma 
Sarcoidosis
Vasculitis
Raised ICP
Cataracts
Retinoblastoma
High refractive error
142
Q

What is ischaemic optic neuropathy and what are the 2 different types?

A

Damage of the optic nerve caused by a blockage of its blood supply
Arteritic (e.g. GCA) and non-arteritic

143
Q

What are the symptoms of giant cell arteritis?

A 
Headache
Jaw claudication
Malaise
Myalgia
Depression
144
Q

How is GCA diagnosed?

A

Clinical features and suspicion
Elevated ESR and CRP
Temporal artery biopsy

145
Q

How is GCA managed?

A

High dose systemic steroids - 1-2 mg/kg/day with daily ESR monitoring
Prophylaxis - bisphosphonate, PPI

146
Q

What is Charles Bonnet syndrome?

A

A disease in which visual hallucinations occur as a result of vision loss

147
Q

What are the symptoms of Charles Bonnet syndrome?

A

Hallucinations - simple (lines, light flashes) or complex (people, animals), not disturbing, patient aware they are not real, often on wakening, last several minutes

148
Q

How is Charles Bonnet syndrome managed?

A 
Optimal eye care 
Low vision aids 
Avoidance of - stress, anxiety, social isolation, sensory deprivation
Reassurance 
Medication - olanzapine, clonazepam
Rapid eye movements/blinking 
Repetitive TMS
149
Q

What is endophthalmitis?

A

Inflammation of the interior cavity of the eye, usually caused by infection. It is a possible complication of all intraocular surgeries, particularly cataract surgery, and can result in loss of vision or loss of the eye itself.

150
Q

What organisms can cause endophthalmitis?

A

Staphylococcus
Streptococcus
Gram negatives
Fungi

151
Q

What are the risk factors for endophthalmitis?

A

Surgical - increased operative time, posterior capsule rupture, wound leakage
Contamination - patient’s bacterial flora, instruments, corneal transplant donor
Patient - diabetes, immunosuppression, HIV

152
Q

What are the symptoms of endophthalmitis?

A

Visual loss
Pain
Redness
Photophobia

153
Q

What are the signs of endophthalmitis?

A 
Lid oedema 
Conjunctival chemosis and hyperaemia
Corneal haze
Cells and flare in anterior compartment (exudate/hypopyon)
Absent/sluggish pupillary light reflex
Absent red reflex
154
Q

What are the differentials for endophthalmitis?

A

Post-operative inflammation without infection
Acute red eye - anterior uveitis
Vitreous haemorrhage

155
Q

How is endophthalmitis managed?

A

Anterior chamber/vitreous tap or vitrectomy followed by microbiology of specimen
Antibiotics
Steroids

156
Q

What is retinoblastoma?

A

Most common intraocular malignancy in children

157
Q

How does retinoblastoma present?

A 
Age <3 years 
Leukocoria (white pupillary reflex)
Strabismus 
Pseudo-orbital cellulitis 
Visual disturbance 
Ocular pain
158
Q

What are the risk factors for retinoblastoma?

A

RB1 gene mutation
HPV exposure
Advanced parental age
Family history

159
Q

How is retinoblastoma investigated?

A 
Examination under anaesthesia 
USS 
MRI 
LP
Bone marrow aspirate
Bone scan 
Genetic testing
160
Q

How is retinoblastoma managed?

A

Small - cryotherapy, laser therapy, radioactive plaque, thermotherapy
Large - chemotherapy, enucleation (removal of eye), radiotherapy

161
Q

How might the normal function of the eye be affected by drugs used in ITU?

A

Muscle relaxants - reduce tonic contraction of orbicularis muscle which normally keeps lids closed
Sedation - reduced blink rate and reflex

162
Q

What type of ITU patients are at higher risk of eye damage?

A

Mechanically ventilated
Greater length of stay
Use of sedatives/paralytics
Those on positive pressure ventilaton

163
Q

What conditions can affect the eye in ITU?

A 
Corneal abrasion
Exposure keratopathy 
Chemosis
Conjunctivitis
Keratitis
164
Q

What is lagophthalmos?

A

Incomplete closure of the eyelid

165
Q

What measures can be taken to protect the eyes in ITU?

A

Manual closure/taping of eyes shut

Lubricating ointment

166
Q

How is exposure of the eyes graded in ITU?

A

Grade 0 - no exposure
Grade 1 - any conjunctival exposure
Grade 2 - any corneal exposure

167
Q

Give 4 complications of contact lens wear

A 
Microbial keratitis
Allergies
Papillary conjunctivitis
Corneal abrasion 
CL induced acute red eye (CLARE) 
Corneal infiltrates
Dry eyes
Neovascularisation
168
Q

What can be used to predict diabetic eye disease?

A

Measures of renal microvasculature damage - proteinuria, blood urea nitrogen, creatinine

169
Q

What is the most accurate predictor of diabetic retinopathy? What are the additional risk factors?

A

Duration of diabetes

Smoking, hypertension, pregnancy

170
Q

What are the 2 different types of diabetic retinopathy and which is most common?

A

Non-proliferative (most common, 95%)

Proliferative

171
Q

What features of non-proliferative diabetic retinopathy may be seen on fundus exam?

A 
Vessel microaneurysms
Dot and blot haemorrhages
Flame haemorrhages  
Cotton wool spots 
Beading of retinal veins
172
Q

What is the defining feature of proliferative diabetic retinopathy seen on fundus exam?

A

Neovascularisation

173
Q

What are the complications of neovascularisation in proliferative diabetic retinopathy?

A

Blindness
Detachment
Haemorrhage

174
Q

What is the most common cause of blindness in diabetic patients and how does this occur?

A

Macular oedema

Leakage of capillaries and aneurysms at the macular retina which causes fluid swelling

175
Q

What features of macular oedema can be seen on fundus exam?

A

Macula appears cloudy and elevated

Hard yellow exudates

176
Q

How is diabetic retinopathy managed?

A

Tight diabetic control

Surgical treatment - laser or vitrectomy

177
Q

How is macular oedema treated with laser?

A

Laser seals off leaking vessels and microaneurysms by burning them - selective for small areas or grid photocoagulation for larger areas

178
Q

How are advanced retinopathy and neovascularisation treated with laser?

A

Pan-retinal photocoagulation (PRP) - thousands of spots are burned around the peripheral retina to destroy the ischaemic part and reduce angiogenic signals

179
Q

What are the complications of PRP?

A

Peripheral vision loss

Decreased night vision

180
Q

How is a vitrectomy carried out?

A

Removal of vitreous humour from the eye and replacement with saline - removes haemorrhaged blood, inflammatory cells and other debris

Year 5 (10 decks)

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