Ophthalmology Flashcards
Age-related macular degeneration (ARMD)
- Cause
- Initial investigation
Dry
- What percentage is dry, + time frame
- Risk factors
- Cause, + where cause builds up
- Macular dysfunction symptoms (4)
- Management - general
Wet
- What percentage is wet, + time frame
- Pathology
- Investigation is wet ARMD suspected
- Management + how it works
- Juvenile macular degeneration - AKA
- What is the macula
- Cone cell defect so macula cannot function as well
- Slit lamp microscopy
- 85%, gradual
- Female, smoking, HTN, previous cataract surgery
- Drusen deposits between RPE and Bruch’s membrane
- Painless, blurred central vision (peripheries unaffected), metamorphopsia (straight lines look wavy), micropsia / macropsia, decreased reading/colours/facial recognition
- Good diet/exercise, stop smoking, low vision clinic + aids
- 15%, subacute (days-weeks)
- Neovascularisation in attempt to correct vision
- Fluorescein angiography
- Anti-vitreal anti VEGF injections into the eye (monthly initially), laser therapy - stops neovascularisation
- Stargardt’s disease
- Part of retina responsible for central vision
Diabetic retinopathy
- Risk factors (5)
- Manifestations (4)
- Screening - when
- R1 (0 = none)
- R2 - refer
- R3
- M1 (0 = none) - refer
- Examination in maculopathy
- Management - lifestyle
- Management - if proliferative
- End points if not managed properly (2)
- Vitrectomy - indication
- Fundoscopy findings - end stage
- Type 1, HTN, poor control, rapid improvement, macro-micro albuminuria
- Maculopathy, new vessel disease, cataracts, CVA
- Kids 5 years post-diagnosis, increased in pregnancy
- Mild, non-P (microaneurysms, haemorrhages)
- Moderate/severe, non-P (exudate, cotton wool spots, venous bleeding, microvascular abnormalities)
- Proliferative - retinal neovascularisation
- Diabetic maculopathy
- Check acuity; reduction in acuity due either to cataracts or maculopathy
- Reduce BP, blood lipid levels, + HbA1C (slowly)
- Panretinal photocoagulation
- Tractional retinal detachment, rubeotic glaucoma
- Treat retinal detachment / macular oedema
- Scarring (white scar tissue bands) + retinal traction
Central retinal artery occlusion
- Main arteries supplying eye (2)
- Embolic causes (+ origins) (3)
- Causes - other (4)
- Symptoms (3)
- Fundoscopy - typical retinal sign
- What it leads to
- What to exclude
Management
- Drug to reduce intra-ocular pressure
- Drugs to start prophylactically
- Examination on follow-up
- Central retinal artery, posterior ciliary artery
- Fibrin-platelet (carotid arteries), Cholesterol (carotid arteries), Calcific (heart valves)
- Arteritis, migraine, syphilis, HSV
- Acute painless loss of vision, profound drop in visual acuity, RAPD in that pupil
- White (pale retina) but with a cherry red spot
- Ischaemia of the inner retinal layers and therefore oedema of nerve fibre layers
- GCA (potential reversible cause)
- Acetazolamide (arteriole dilatation)
- Aspirin, statin
- Check for carotid bruits and heart murmur
Blunt/sharp injuries to eye
Definitions
- Ecchymosis
- Hyphaema
- Substance used to visualise the corneal surface
- USS for what
Management
- Used to reduce inflammation and prevent rebleeding
- Blackball hyphaema
- Traumatic iritis - what is it
- Symptoms (3)
- Slit lamp finding
- Management
- Retrobulbar haemorrhage - what is it
- Symptoms
- Management
- Orbital floor fracture - presentation
- Urgent repair - indication
- Non-urgent repair - indication
- Skin discolouration due to bleeding
- Collection of blood in the anterior chamber
- Fluorescien
- Supra/subretinal haemorrhage
- Steroid, dilating drops (phenylephrine)
- Surgical washout
- Inflammation of the anterior chamber
- Pain, photophobia, blurred vision
- White cells and flare
- Steroid, mydriatic drops
- Compartment syndrome within the orbit
- Pain, proptosis, decreased vision, poor pupil reactions
- Emergency lateral canthotomy, cantholysis
- Diplopia, limited eye movements
- Painful restriction of upward gaze
- Persistent restricted eye movement / enophthalmos after one week
Retinal detachment
- Causes
- Who more at risk + why
- Common symptoms
- When is visual acuity normal
- Fundoscopy findings
- Rhegmatogenous detachment - definition/management
- Tractional detachment - definition/management
- Exudative detachment - definition/management
- Age-related retinal thinning, trauma
- Myopia - larger eyes, thinner far peripheral retina
- Posterior vitreous detachment symptoms: sudden unilateral floater(s), photopsia (flashes of light)
then retinal detachment: gradual blurred vision, ‘shadow’ spreading across vision - When the macula is spared
- Tobacco dust in the anterior vitreous
- Full thickness tear e.g. myopia; reattachment via laser cryotherapy and surgery with vitrectomy
- Fibrous / vascular membranes growing abnormally in the vitreous e.g patient with diabetic retinopathy; relieve traction
- Inflammatory / neoplastic condition leads to serous exudation from leaking BV beneath the retina; treat cause
Giant cell (temporal) arteritis
- What it is
- Associated disease
- Risk factors
- Ophthalmic features (2)
- Neuro-ophthalmic features (4)
- Systemic features
- Sign (temples)
- Examination finding
- Fundoscopy findings
- Important blood test
- Management
- Vasculitis manifesting in the eye
- Polymyalgia rheumatica
- > 50, female
- Unilateral acute loss of vision (amaurosis fugax), diplopia due to CN palsies
- Headache and scalp tenderness, hair loss, jaw claudication (all features rapid onset)
- Myalgia, anorexia, weight loss
- Tendorness over temporal artery
- RAPD
- White and swollen optic nerve, cotton wool spots and haemorrhages
- ESR (raised)
- Prednisolone 1mg/kg
Cataracts
- Definition
- Risk factors (including refractive error)
- Causes (4)
- Drug causes (3)
- Symptoms (3)
- Fundoscopy finding
- Management - conservative
- Management - definitive, + disadvantage of this
- Congenital cataracts - inheritance
- Other identifiable causes (4)
- Associated conditions (5)
- Opacity of the lens of the eye
- Myopia, DM
- Old age (commonest), trauma, radiation, surgery
- Steroids, phenothiazines, amiodarone
- Reduced colour, halos around lights, worsens in bright light/darkness ‘starbursts’
- Loss of red reflex
- Stronger glasses/ contact lens, brighter lighting
- Lens replacement; accommodation reflex is lost
- Autosomal dominant
- Chromasome abnormaility, Metabolic disorders, Intra-uterine infections
- Rubella, Down/Edward syndrome, varicella, CMV
Orbital cellulitis
- Pathology
- History
- Pre-septal / periorbital - involvement
- Presentation
- Management
- Orbital - causative organisms (3)
- Associated conditions
- Symptoms
- Associated pupillary defect
- Bloods
- Bedside tests
- Imaging
- Complications (4)
- Infection / inflammation of orbital soft tissue with ocular dysfunction
- Recent sinus infection, trauma
- Only eyelids (skin symptoms but no eye symptoms)
- Both eyes are swollen and tender
- IV ABX
- H.influenzae, streptococcus, staphylococcus
- URTI, undiagnosed sinusitis
- Painful, swollen eye, erythema, chemosis, reduced vision, reduced/painful eye movements, systemically unwell
- RAPD - due to CN 2 compression
- FBC, WBC, CRP, consider blood culture
- Swabs
- CT sinus and orbits
- Sepsis, meningitis, optic nerve damage, cavernous sinus thrombosis
Red eye - general
- Chemosis - meaning
- History - important points
- Differentials (5)
- Subconjunctival haemorrhage - causes (2), presentation
- Anterior uveitis/iritis - presentation
- Acute glaucoma - presentation
- Likelier to present in
- Symptoms
- Scleritis - presentation (give NSAIDs)
- Conjunctivitis - presentation
- Endophthalmitis - presentation
- Episcleritis - presentation
- Red, swollen conjunctiva
- Contact lens use, sexual activity, recent URTI, allergies, contact with other people with red eyes
- Conjunctivitis, anterior uveitis (iritis), bacterial keratitis, ACAG, dendritic ulcer, subconjunctival haemorrhage, scleritis, endophthalmitis
- Trauma, HTN (history of trauma/coughing bouts); painless bright red blood patch, vision unaffected
- Pain, photophobia, less/blurred vision, small fixed oval pupil
- Red eye, mild dilated pupil, fixed, hazy cornea
- Dim light (pupils dilate)
- Pain, photophobia, nausea
- Severe pain (worse on movement), autoimmune links
- Discharge - purulent (bacterial) / clear (viral)
- Red eye, pain, visual loss following ocular surgery
- Mostly PAINLESS, watering, mild photophobia, improves after phenylephrine (if not then scleritis)
Strabismus + refraction
- Concomitant strabismus - definition
- Incomitant strabismus - definition
- Strabismus in children - cause
- Emmetropia - definition
- Hypermetropia - definition
- What eyeball shape, + relation between light/retina
- Management
- Myopia - definition
- What eyeball shape, + relation between light/retina
- Management
- Astigmatism - definition
- What eyeball shape, + relation between light/retina
- Presbyopia - definition
- Cause
- Deviations remains the same in all positions of gaze
- Angle of deviated eye changes with gaze position i.e. it’s not constant
- Amblyopic eye
- Normal eye with no refractive error
- Long sightedness (can see in distance but not near)
- Small eyeball, light behind retina (blurry close-up)
- Convex glasses
- Short sightedness (can see near but not far away)
- Stretched eye, light in front of retina (blurry far away)
- Concave glasses
- Unequal refraction
- Imperfectly-shaped lens/cornea; uneven light on retina (blurry at any distance)
- Gradual loss of focusing/accommodation power
- Age-related lens stiffening
Glaucoma
- Classification (3 questions)
- Definition
- Which part of vision lost
- Risk factors - vascular (3)
- Risk factors - non-vascular
- Screening if positive FH
- What is used to measure IOP
- Raised IOP leads to
- Fundoscopy - findings
- Other examination - findings
- Primary/secondary, open/closed angle, acute/chronic
- Multifocal optic neuropathy
- Peripheral
- CVD, vasospasm (migraine, raynaud’s), systemic hypotension
- Age, raised IOP, FH, race, myopia, decreased corneal thickness, DM, tight collar/tie
- Annually from 35yo
- Goldmann applanation tonometer
- Axon loss
- Cupping (thinning of optic disc neuroretinal rim), peripapillary atrophy, vascular/RNFL changes
- Decreased visual fields (+ VA if central VF affected)
Visual field defects - lesion site
- Tests to check (2)
- Optic nerve
- Optic chiasm (pituitary adenoma)
- Optic tract
- Optic radiation
- Sudden painless loss of vision - causes (5)
- Inattention (2 eyes, significant VF loss/stroke), Confrontation (1 eye, numbers/movement)
- Ipsilateral mononuclear visual loss
- Bitemporal hemianopia
- Contralateral homonymous hemianopia
- Contralateral homonymous hemianopia w/ macular sparing
- Amaurosis fugax from ischaemic/vascular (thrombosis, embolism, GCA, ischaemic optic neuropathy), Retinal vein occlusion, Retinal artery occlusion, Vitreous haemorrhage, Retinal detachment
Optic disc pathology
- Unilateral disc swelling - causes
- Vascular (4)
- Inflammatory (5)
- Infiltrative (1)
- Infective (2)
- Bilateral disc swelling - causes (3)
- Retinal dystrophy - types (2)
Optic atrophy - causes
- Main vascular
- Nutritional (3)
- Inflammatory (2)
- Neurological (1)
- Presentation
- Optic pallor - causes (5)
- Central retinal vein occlusion, Diabetic papillopathy
- Ischaemic optic neuropathy, GCA
- Papilitis, SLE, paranasal sinus disease, MS, sarcoidosis
- Lymphoma
- Herpes, Toxoplasmosis
- SOL, Hydrocephalus, Malignant HTN
- Cone dystrophy, Retinitis pigmentosa (night blindness, bone spicule pigmentation in mid-peripheral retina)
- Central retinal artery occlusion
- Vit B12 deficiency, tobacco, alcohol
- Sarcoidosis, polyarteritis nodosa
- Demyelination (+ neuritis)
- Reduced visual acuity, central scotoma, pale disc, RAPD
- SOL, optic neuritis, low B12/folate glaucoma, disc infarct
Hypertensive retinopathy
- Stage 1
- Stage 2
- Stage 3
- Stage 4
- Above classification name
- Arteriolar narrowing and tortuosity (silver/copper wiring), increased light reflex
- Arteriovenous nipping
- Cotton wool exudates, flame and blot haemorrhages
- Papilloedema
- Keith-Wagener Classification
Conjunctivitis
- Causes (4 broad)
- General signs
- Investigations
- Management - lifestyle
- Viral - history
- Commonest virus
- Spread
- Examination
- Discharge
- Management
- Allergic - history
- Examination
- Discharge
- Management
- Chlamydial - history
- Examination
- Discharge
- Management
- Bacterial, viral, allergic, chlamydial
- Red eye (conjunctival injection), mucoid discharge, reactive pupils, normal visual acuity
- Swabs - bacterial / viral / chlamydial
- No contact lenses for 48hrs after symptom resolution, wash hands, avoid sharing towels
- History of cough/cold; weeks duration
- Adenovirus (non-enveloped, double-stranded DNA)
- Respiratory/ocular secretions
- Diffuse redness +/- follicles/lymphadenopathy
- Clear discharge
- Self-limiting; hygiene measures
- Itchy, history of atopy or contact with chemicals/eye drops
- Chemosis, +/- papillae
- Clear stringy discharge
- Topical/oral antihistamines, topical steroids
- Young patient, chronic and bilateral, STI symptoms
- Diffuse, injection +/- follicles, keratitis +/- pannus
- Mucopurulent discharge
- Topical ABX; test partner for STI
Uveitis
- What it is
- Anterior uveitis - definition
- Symptoms
- Signs
- Management
- Associated with
- Inflammation of the uveal tract (iris, ciiary body, retina, choroid
- Inflammation of iris (iritis) or ciliary body
- Pain on looking at bright lights, blurry vision, acute onset, dull ache, lacrimation
- IOP raised (posterior synechiae), unilateral non-blanching red conjunctiva around cornea (ciliary flush), injected iris, small/irregular pupil (iris stuck to lens - PS). No discharge
- Topical steroid drop (can’t drive), cyclopentolate drop (dilating for pain relief)
- HLA-B27 (and associated conditions)
Corneal ulcer
- Keratitis - definition
- Investigation - how to examine
- IOP
- Bacterial keratitis - definition
- Management
- Dendritic ulcer - causative organism
- Presentation
- Management
- What not to use
- Thickened cornea/central opacification - suggests what
- Inflammation of cornea
- Use fluorescin (orange) under cobalt blue filter
- Normal/raised
- Corneal ulcer caused by bacteria
- Topical broad spectrum ABX
- HSV 1
- Pain, red, burning, irritation, photophobia, vesicles around eye, watering, ‘foreign body sensation’
- Aciclovir 3% eye ointment tds for 3 days
- Steroids
- Disciform keratitis
Presentations
- Migraine
- Optic neuritis
- Benign intracranial HTN
- Central retinal vein occlusion
- Unilateral headache, maybe aura/prodromal symptoms, photophobia, nausea, maybe triggers, vision normal
- Unilateral decrease in VA, colour vision loss, PAIN on eye movement, may have RAPD
- Headache (ICP symptoms) blurred vision, N+V
- Sudden PAINLESS loss of vision, retinal haemorrhages (flame and blot), oedema (disc, macula)
Vitreous haemorrhage
- Risk factors
- Presentation
Retinopathy of prematurity
- Why it occurs
- Management
- Result if left untreated
- Screen if
- DM, bleeding disorders/anticoagulants, retinopathy of prematurity
- Sudden painless loss of vision, dark spots
- Exposure to increased concentrations of ambient oxygen
- Transpupillary diode laser therapy
- Vitreous haemorrhage, retinal detachment, blindness
- Born before 32 weeks or under 1.5kg
Pupil - other findings
- Argyll-Robertson Pupil - findings
- Significance
- Holmes-Adie pupil - findings
- Common patient
- Associated findings
- Marcus Gunn pupil (RAPD) - finding
- Pathophysiology
- Causes (2)
- Tadpole pupil
- Acute angle closure glaucoma
- Constricted - causes
- Dilated - causes
- ARP (accomodation reflex present), PRA (pupillary reflex absent) - no response to light, constricts to close object
- Neurosyphilis, diabetic neuropthy
- Unilateral dilated, slow to redilate post- constriction
- Female
- Absent ankle/knee reflexes
- Affected pupil remains dilated when light shone in but dilates when a bright light is swung from the unaffected eye to the affected eye
- Caused by lesion anterior to optic chiasm i.e. optic nerve or retina (optic pathway)
- Retinal detachment, optic neuritis
- Temporary; migraines
- Vertical oval (dilated, fixed)
- Horner’s, cluster, A-R, opiates, nicotine, pilocarpine
- CN 3 palsy, H-A, raised ICP, anticholinergics
Vision loss - important history
- Timing
- Pattern
- PMH
- FH
- SH
- Acute/subacute/chronic
- One (which) or both eyes, pattern (patchy, VF, central)
- Ophthalmic disease/surgery, ocular injury (mechanism important), ambylopia (lazy eye), spectacle/lens use (up to date prescription?)
- Unexplained visual loss
- Smoking/drinking, occupation, whether they drive
Visual acuity - examination
- How it should be tested
- Next steps if patient cannot read top line of Snellen chart at 1.5 metres
- Maximum VA
- LogMAR VA - when to stop
- Best score
- 6m Snellen Chart
Wear corrective lenses
If still wrong, use pin holes (record VA stating PHs used)
If patient cannot see top line at 6m, do 3m, then 1.5m - Check hand movements, perception to light, then ‘NPL’
- 6/4.5 to 6/3.5
- If patient gets 4/5 letters on a line wrong
- Best scores closest to 0
Anatomy
- Retina - number of layers
- Important layers (2)
- Arterial supply (branch of what)
- Cornea - structure composed of what
- Number of layers
- Derives oxygen from where
- Sclera - structure composed of what
- 10 layers
- Retinal pigment epithelium; Photoreceptor layer - rods (night), cones (colour/day)
- Ophthalmic artery (branch of carotid)
- Regular arranged collagen fibres
- 5
- Avascular; so oxygen dervied from tear film and aqueous
- Irregular arranged collagen fibres
Fundoscopy - general
- Stages (5)
- When might red reflex not be present (4)
- White red reflex - aka
- White red reflex - causes (3)
- What to say when looking for peripheral changes
- What to say when want to look at macula
- What to look for in optic disc (3 Cs)
- C1 - normal finding
- What is cupping, found when
- C2 - normal finding
- Abnormal finding
- C3 - normal finding
- Abnormal findings
- Red reflex, retinal imaging (follow to optic disc), four vascular arcades, peripheral changes, macula
- Problem with cornea, anterior chanber, lens, vitreous cavity
- Leukocoria
- Lens (cataract), Vitreous (haemorrhage), Retina (retinoblastoma)
- Look up/down/left/right
- Look directly at light
- Cup, colour, contour
- Rim 0.3 of centre
- Increased rim:centre ratio; glaucomatous change
- Should be pinky/orange
- White is avascular
- Clear borders
- Blurred borders; suggest papilloedema
DVLA regulations
- General
- Diplopia
- Must be able to read number plate at 20m
At least 6/12 in best eye if car driver
At least 6/7.5 in best eye if lorry/bus driver
At least 6/60 in other eye
Glasses acceptable (max 8 prescription strength)
Visual fields: 160 degrees horizontal, 30 degrees vertical - Stop immediately, inform DVLA, can restart if treated/resolves
Retinoblastoma
- Commonest what
- Why it occurs
- Types (2)
- Predisposing gene
- Non-heritable - specific features (3)
- Primary paediatric intra-ocular malignancy
- Malignant transformation of primitive retinal cells before differentiation around 3 years old
- Heritable (40%), Non-Heritable (60%)
- RB1 at 13q14
- Unilateral, non-transmissible, doesn’t pre-dispose to secondary non-ocular cancers
Bacterial conjunctivitis
- History
- Common causative organisms
- Examination
- Discharge
- Management
- Management - H.Influenzae in children
- Less severe + unresponsive to treatment, do what
- Severe in adults - organism
- Management
- Severe in children - organism
- Management
- Unilateral/bilateral
- Strep pneumoniae, Staph aureus ,Haemophillius influenzae (kids), Moraxella catarrhalis
- Diffuse redness
- Mucopurulent discharge
- Chloramphenicol eye drops QDS, hygiene measures
- PO amoxicillin, Clavulanic acid
- Do PCR; rule out chlamydial or viral conjunctivitis
- Neisseria gonorrhoeae
- Ceftriaxone/quinolone/macrolide
- Meningitidis - meningococcal conjunctivitis
- IM benzylpenicillin/ceftriaxone or PO ciprofloxacin
Endophthalmitis
- What it is
- Commonly occurs when
- Commonest causes (3)
- Symptoms
- Management - medical
- Management - surgical
- Vancomycin covers what
- Ceftadizime covers what
- Inflammation of the interior of the eye
- Post-op complication (mainly cataract surgery)
- Infective (bacterial or fungal), trauma, allergic reaction
- Unilateral severe pain, acute loss of vision, conjunctival/episcleral redness (‘injected’), hypopynon in anterior chamber
- Urgent intra-vitreal antibiotics (vancomycin and ceftazidime), steroids
- Pars plana vitrectomy/evisceration
- Gram positive bacteria
- Gram negative bacteria
Herpes simplex virus (HSV)
- Difference between HSV1 and HSV2
- Childhood primary infection - ophthalmic signs (2)
- Other symptoms (3)
- Herpes zoster ophthalmicus - what is it
- Signs
- Management
- HSV 1 - infection above waist (face, lips, eyes)
HSV 2 - genital herpes, neonatal conjunctivitis - Blepharitis, conjunctivitis
- Mild fever, malaise, URT symptoms
- Shingles (varicella zoster virus) affecting ophthalmic branch of facial nerve
- Peri/orbital vesicular rash, huntington’s sign (rash on side/tip of nose)
- PO/IV antivirals, topical steroid if inflamed
Random points to remember
- Fluorescin staining - useful when (3)
- Steroids - do not prescribe in what (3)
- Retinal vessels formed when, from what
- When avascular, retina produces what
- Dendritic ulcers, Corneal abrasion, Microbial keratitis
- Conjunctivitis, bacterial keratitis, dendritic ulcers
- 4th month of gestation; from hyaloid vessels
- VEGF
Aqueous humour
- Secreted from
- Subsequent path
- Leaves eye via (2)
- Conventional pathway - structures involved (3)
- Unconventional pathway
- Drainage angle - structures involved
- Ciliary processes
- CP, posterior chamber, pupil, anterior chamber, leaves eye
- Conventional (84%) or unconventional/uvoscleral (6%) pathway
- Trabecular meshwork (at drainage angle), Schlemm’s canal, Episcleral veins
- Ciliary body, through suprachoroidal space, into venous circulation
- Iris, cornea
Acute closed angle glaucoma
- What this means
- Risk factors
- IOP
- Potential complaint
- Do not prescribe what + why
- Immediate management (+ MOA)
- Maintenance management
- Surgical preventative measures
- Secondary glaucoma - commonest cause
- Other causes (6)
- Normal tension glaucoma - normal IOP
- Commonest race
- Peripheral iris covers the trabecular meshwork
- SE Asian, females, small/hypermetropic eyes (shallow anterior chambers), cataracts
- 60-79mmHg
4. Preceding transient episodes of headache and coloured halos around bright lights on affected side Headache and vomiting (raised IOP) Painful, hard, red eye Dilated and fixed pupil (oval) Decreased VA, cloudy oedematous cornea
- Pupil dilators e.g. tropicamide/phenylephrine; can close off angle completely
- IV acetazolamide (suppress aqueous production), pilocarpine (opens angle)
- PO acetazolamide
- Laser peripheral cridotomy, surgical iridectomy
- Trabecular network obstruction
- Cataracts, hyphaema, uveitis, dispersion syndrome, pseudo-exfoliative, steroid-induced
- 12-22mmHg
- Japanese
Open angle glaucoma
- Commonest type (of all glaucomas)
- What this means
- Who more at risk
Primary open angle (POAG)
- Early symptoms
- Bit of vision lost first
- Management - 1st line + SE
- 2nd line (2) + SEs
- Which are aqueous suppressors
- Prophylactic topical drops
- Chronic open angle (COAG)
- Peripheral iris is clear of the trabecular meshwork
- Black people, myopia
- Asymptomatic
- Peripheral field
- Prostaglandin analogue ‘prost’ (eyelash growth)
- Timolol (cardiac, impotence) OR carbonic anhydrase inhibitors e.g. olamide (bitter)
- Beta blockers, alpha agonists, carbonic anhydrase inhibitors
- Phenylphrine, tropicamide
Blowout fracture
- Signs/symptoms
- Management - non-surgical
- What to avoid + why
- Vertical diplopia (mechanical restriction)
Raised IOP - echymosis, enophthalmous, swelling
Infra-orbital paraesthesia (V2 from CN 5 affected) - Broad-spectrum ABX
- Don’t blow nose (communication with sinuses - bacteria enters orbit)
Diplopia
- History
- Important PMH
- Differentials
- Examination - considerations (3)
- Vertical causes
- Horizontal causes
- Horizontal + vertical causes
- TED - symptoms
- Management - temporary
- Management - permanent
- Speed of onset, sudden pain, where is diplopia
- Trauma, DM, HTN
- CN 4/6 palsy, thyroid eye disease, blowout fracture
- No glasses (frames get in the way), Ask for diplopia/pain in each position, Use light + always look for corneal reflection
- CN 4 palsy (+ torsion), blowout fracture
- CN 6 palsy (worst when looking towards palsy/distance fixation)
- Thyroid eye disease
- Pain, proptosis, lid retraction, chemosis, periorbital oedema, epiphora (but still feels dry)
- Patch/fresnel prism
- Long-term prism/surgical realignment
Uncomfortable eyes - description
- Dry eye
- Ocular surface problems
- Uveitis/scleritis/increased eye pressure
- Gritty/dry/want to close
- Sharp/stabbling/like needles
- Dull ache (like toothache)
Dilating eye drops
- Common examples (3)
- Which to use in children
- Which to visualise corneal surface
- Which to manage uveitis
- When not to use (2)
- Topicomide 1%, Cyclopentalate 1%, Phenylephrine 2.5%
- Cyclopentolate
- Phenylephrine
- Cyclopentolate
- Painful red eye, narrow angle glaucoma
Retinal vascular disease - general
- Causes
- Changes seen in capillary occlusion (3)
- Changes seen in capillary leakage (3)
- DM, HTN, GCA
- Cotton wool spots, irregular retinal veins, new vessel formation
- Lipid exudates, oedema, haemorrhages
Corneal disease - general
- Main types (4)
- Which is age-related
- Which is inflammatory
- Which involves thinning/astigmatism
- Abrasion - examination with what
- Presentation
- Management
- Fuch’s dystrophy, keratitis, HSV/shingles, keratoconus
- Fuch’s dystrophy
- Keratitis - commonest is HSV
- Keratoconus
- Fluorescin dye
- Pain, red, photophobia, foreign body sensation, watering, blurry
- Topical ABX (chloramphenicol drops), analgesia
Eyelid problems
- Blepharitis - eyelid margin inflammation
- Stye (hordoleum) - external, what it infected
- Internal - what is infected
- Management
- Chalazion - aka
- Presentation
- Management
- Entropion - complications
- Ectropion - complication
- Gritty, itchy, dry sensation - hot compress, gentle clean
- Glands of Zeis / glands of Moll
- Meibomian glands
- Hot compress, analgesia, chloramphenicol if persistent or + conjunctivitis
- Meibomian cyst
- Eyelid swelling, most non-tender (can be tender/red)
- Hot compress, analgesia, chloramphenicol if acutely inflamed
- Corneal damage / ulceration
- Exposure keratopathy