Ophthalmology Flashcards
1
Q
What is amblyopia ?
A
This is when you have acuity up corrected by lenses. No anatomical defect
2
Q
What is ambler grid used for?
A
Test is a series of intersecting lines used in macular disease.
If macular disease is present the patient will have wavy lines and squares will be distorted.
3
Q
What is a canthus?
A
A medial or lateral angle of the eye. Visible on eye opening
4
Q
What is cyclopegia?
A
Ciliary muscle paralysis
5
Q
What is the fornix?
A
This is when the sclera meets the palpabrae aka the lid
6
Q
What is a medication that causes pupil constriction?
A
Miotic agent such as pilocarpine
7
Q
What medication is used for pupil dilation?
A
Mydriatic such as tropicamide
8
Q
What is xerophthalmia?
A
This is a tropical eye condition that is caused by a lack of vitamin A.
Presents with poor visual acuity, tunnel vision and night blindness
9
Q
How does xerophthalmia present?
A
Tunnel vision
Reduced visual acuity
Night Blindness
10
Q
What will you see on examining the conjunctiva of a patient with xerophthalmia?
A
Foamy plaques called Bilot spots
11
Q
How do you treat xerophthalmia?
A
Vitamin A supplements
12
Q
What is the eye disease trachoma caused by?
Do symptoms happen suddenly or gradually?
A
Trachoma is caused by chlamydia trachomatis. It is transported via fly vector.
Only causes symptoms if you get recurrent infections. As such generally presents in older children/adults
13
Q
What are some of the symptoms of trachoma?
A
- Entropian
- Corneal scaring leading to reduced visual acuity
- Trichiasis
14
Q
What is the 4 step management of trachoma?
A
Surgery for trichiasis
Antibiotic
Facial Cleaning
Environmental changes
15
Q
What is the cause of river blindness?
A
Parasitic worm Onchocerca Volvulus
16
Q
How does river blindness present? From start to finish?
A
Start: parasite enters skin through skin. Severe itching and disfigured skin.
17
Q
How do you treat river blindness?
A
Ivermectin
18
Q
How many eyelids does blepharitis normally affect?
A
All 4 eyelids
19
Q
What time of day is blepharitis worse?
A
Start of the day
20
Q
What is the pathogenesis behind blepharitis?
A
Commonly anterior: staph infection
Posterior: seborrheic dermatitis
With meibomian gland dysfunction
21
Q
What are some of the symptoms of blepharitis?
A
Conjunctival redness
Recurrent lid lumps (chalazion and styes)
Worse first thing in the morning
22
Q
What should you think of when there is unilateral blepharitis?
A
TUMOUR
23
Q
What is the common viral cause of conjunctivitis?
A
Adenovirus
24
Q
What symptoms do you normally get with viral conjunctivitis?
A
Lymphadenopathy
Sore throat
Clear Eye discharge
25
What conjunctivitis are follicles seen in?
Viral conjunctivitis
26
What conjunctivitis are papules seen in?
Vernal and Allergic conjunctivitis
27
What 3 things do tears contain ?
Antibiotics
Lysosomes
Mucin + Oils
28
What are 2 functions of dry eyes?
1. Lubricate
| 2. Oxygenate the ocular surface
29
What are the 3 layers that make up a tear?
1. Lipid Layer (Meibomian Gland)
2. Aqueous Layer (lacrimal gland)
3. Mucous Layer (goblet cells)
30
If you have dry eyes when are your symptoms the worse?
Gets worse as the day goes on.
Eye generally feels heavy, blurred vision and tears
31
What is the diagnostic method used for dry eyes?
Fluroscein eye drops and a slit lamp
32
What symptoms do you get in a HSV infection?
1. Eye pain + discomfort
2. Photophobia + light sensitivity
3. Lid oedema and oral lesions
33
What is the lesion that you get in HSV infections?
Dendritic Ulcer on the Cornea seen with fluorescein drops
34
How would a conjunctival haemorrhage present?
You just get a suddenly red sclera . Normally Assymptomatic and unilateral.
Generally affect the inferior conjunctiva
35
What medication should you avoid in sub conjunctival haemorrhage ?
1. NSAIDs
| 2. Aspirin
36
What is dacryostenosis?
This is when you get an obstructed nasolacrimal duct obstruction
37
How does dacryostenosis present?
1. Warm, red swelling inner canthal region.
| 2. Normally presents in 6w of birth.
38
What is the two step management plan for nasolacrimal duct obstruction?
1. Abx
| 2. Surgery (dacryocystorhinostomy)
39
Who is episcleritis common in?
Young people
40
How does episcleritis typically present?
General un comfortable
No changes to visual acuity
Very acute + superficial red eye.
41
What are some common causes of scleritis?
Autoimmune conditions: SLE, RA, PMR and Wegner’s
42
What is the presentation of someone who has scleritis?
Severe Pain worse with eye movement
Reduced visual acuity
Photophobia and eye watering
43
How do you treat scleritis?
NSAIDs
Immunosuppressant
44
What is Hutchinson’s sign?
This is when you get involvement of the nasociliary branch in ocular shingles
45
What nerve is affected in ophthalmic shingles?
Trigeminal Nerve
46
What is Ramsey Hunt Syndrome?
VZV involvement of the facial nerve
Painful fluid filled rash around one ear, one sided facial pain and weakness. Hearing loss + vertigo.
47
After what condition does a cortical cavernous fistula occur?
Carotid aneurysm rupture
Other causes are: trauma, post nasal surgery or spontaneous
48
How does a cortical cavernous fistula present?
Engorgement of the eye vessels
Lid and conjunctival oedema
Proptosis
Dipolopia and Vision Loss
Headaches
Loud pulsatile bruitus over the eye
49
What are two investigations you need to do in cortical cavernous fistula ?
1. MRI
| 2. Cerebral arteriography
50
What two organisms are associated with bacterial keratitis?
1. pseudomonas
| 2. Staph aureus
51
What are 5 RF for bacterial keratitis?
Contact Lens wearing
Smoking
Poor hygiene
Immune suppression
Ocular Trauma
52
What is the presentation of bacterial keratitis?
Eye pain (severe and rapid)
Loss of visual acuity , red eye, discharge and photophobia
Corneal white and yellow spots
53
What investigation would you like to do in a patient with corneal disease?
Corneal scrape for culture and sensitivity.
54
What is the presentation of marginal keratitis?
Severe eye pain- red- photophobia.
But with no associated visual disturbance.
Management is with steroids and abx
55
What is the Uvea made up of?
Ciliary Body
Lens
Choroid
56
What is a common cause of anterior uveitis?
Autoimmune conditions such as seronegative conditions and sarcoidosis
57
How does anterior uveitis present?
Unilateral acute red painful eye.
Small and irregular pupil.
Reduced vision and photophobia.
58
What will you see on a slit with in someone who has anterior uveitis?
1. Kerratic precipitates on anterior chamber of the cornea
| 2. Flare: caused by a plasma leak
59
What is the management of acute uveitis?
1. Prednisolone Drops
| 2. Eye dilation with cyclopentolate)
60
What are 3 RF of retinal artery occlusion?
Atherosclerosis
Diabetes
AF
Smoking
HTN
61
Can GCA cause a retinal artery occlusion?
YES
62
In a retinal artery occlusion what symptoms would you expect to see?
You would expect to have sudden loss of vision
In a branch artery occlusion expect either superior or inferior loss of vision.
63
In a patient with a central artery or venous occlusion would you expect a RAPD?
YES
64
What two investigations would you like to do in someone with suspected retinal artery occlusion?
1. Fundoscopy: Cherry Spot Occlusion
| 2. Carotid Doppler
65
What is the management of someone with retinal artery occlusion?
Reduce CVS RF with meds start on aspirin and statins and anti-HTN
If they present with retinal oedema- you need to do an ocular massage
66
What is the 2nd most common cause of blindness?
Retinal Vein occlusion
67
What will you see on imaging of a branch vein occlusion?
Flame haemorrhages
Visual field loss
68
What will you see in a patient with a central vein occlusion?
You would see a RAPD
Visual Loss + Visual Field Loss
Widespread flame haemorrhages
Optic Disc swelling
69
What is the management of Retinal Vein Occlusion?
You want to use Anti-VEGF
Photocoagulation
Steroid injections
70
What would be your investigation of choice for retinal vein occlusion?
Fundus Fluroscein Angiogram
71
What is the management of CRVO with ischaemia?
Laser therapy
72
What appearance would you see on a patient with CRVO with ischaemia on fundus fluroscein angiography?
Cotton Wool spots and Optic Disc Swelling
73
What are two RF for CRVO with ischaemia?
Protein C deficiency
Leukaemia
74
How do you treat CRVO with ischaemia?
Laser therapy =
75
What are vitreous haemorrhages secondary to?
Central Retinal Vein occlusion
Branch Retinal Vein occlusion
76
How do vitreous haemorrhages present ? (2 ways)
Full visual field loss
Floaters
77
What are two ways to manage vitreous haemorrhage?
1. Watch and Wait
| 2. Vitrectomy
78
What is a stye?
Anterior eyelash infection
79
What is the management?
Self limiting
Hot towel compress
If recurrent may need to puncture and drain
80
What is a chalazian ?
Inflammation of the meibomian glands
81
What is the aetiology of a non ischaemic anterior ischaemic optic neuropathy (AION)?
Idiopathic
RF: diabetes, HTN etc
82
What is the aetiology of artery anterior ischaemic optic neuropathy?
Giant Cell arteritis
83
What are the symptoms of toxoplasmosis optic neuritis?
Loss of colour vision
Loss of vision.
Management is steroids and antibiotics
84
Where is the macula found?
Lateral to the optic disc
Site of the highest visual acuity is the fovea
85
What 3 things determine good visual acuity?
1. Functional photoreceptors
2. Healthy retinal pigment epithelium
3. Healthy perfusion of blood through capillaries
86
What are drusen?
They are waste from photoreceptors they accumulate in the RPE
87
What is Dry AMD and what is Wet AMD?
Dry AMD is atrophy of the retina
Wet AMD is vessel growth underneath the retina.
88
What are the visual changes in dry AMD wet AMD?
Dry AMD you get a central scotoma with good peripheral vision
Wet AMD you get rapid changes in vision. Lines don’t appear straight and you get the appearance of objects becoming smaller.
89
How do you treat Dry AMD?
Vit A Vit E and Zinc
90
How do you treat Wet AMD?
Anti TNF , photodynamic lasers
91
What are the two investigations to use on a patient with suspected macular degeneration?
Slit Lamp
Ocular Coherence Tomography OCT
Colour Fundus Photography
92
What does the ‘angle’ in glaucoma refer to?
This is the space between the posterior cornea and the anterior surface of the iris
This is where aqeous leaves the eye
93
What is the pathophysiology behind open angle glaucoma?
You get trabecular mesh work not draining properly
94
What is the pathophysiology behind closed angle glaucoma?
Build up of pressure between the cornea and iris
Preventing drainage through the trabecular mesh work.
95
What is the intraocular pressure classed as in IOP?
> 21 mmHg
96
How would chronic open angle glaucoma present?
Progressive loss of visual field and causes tunnel vision
97
What are 3 RF of chronic open angle glaucoma?
Steroids
High Myopia
BME
98
What are two medications that can be used to treat chronic open angle glaucoma?
1. BB Timolol
2. Alpha Agonist: Brimonidine
3. Prostaglandin Analogue: Latanoprost
99
What are two non medical treatments for chronic open angle glaucoma?
1. Laser Iridotomy
| 2. Surgery (trabeculectomy)
100
What are two RF for acute closed angle glaucoma?
1. Age (increasing)
| 2. Long sightedness
101
What are three symptoms of acute closed angle glaucoma?
Red painful eye (acute) unilateral
Headache
Nausea and Vomiting
Reduced vision
Corneal oedema and mid dilated pupil
102
What sign may you see in acute angle closure glaucoma?
+ve eclipse sign
103
What is the management of acute angle closure glaucoma?
1. Reduce IOP with oral acetazolamide and IV mannitol
Give pilocarpine drops to constrict the eye and BB drips (timolol)
After acute management. Surgery can be done to prevent recurrence via iridotomy
104
What embryological layer is the lens made up of?
Ectoderm
It continues to enlarge with life
105
What are the 4 types of cataracts?
1. Posterior subcapular: good vision when the pupil is dilated i.e. dim light. But in bright light when the pupil constricts you get really profound vision loss.
2. Cortical cataract: good visual acuity as the centre of the lens is clear. May complain of seeing a halo of light.
3. Trauma related will appear in a sunflower appearance.
4. Congenital: this is zonular and can normally be delayed for a number of years.
106
What will happen to the pupil in cataracts ?
Leucocoria (white pupil)
107
How does cataract surgery occur?
You get:
| 1. Pharcoemulsification and an intraocular lens put inside
108
What are 3 risks of cataract surgery?
1. Lens capsule rupture or an intraocular haemorrhage
2. Postoperative problems: intraocular lens dislocation, infection, inflammation or capsule pacification
3. Endopthalmitis
4. retinal detachment
109
What are the two types of diabetic eye disease you can get?
1. Non proliferative
| 2. Proliferative
110
What are two management plans for a diabetic retinopathy?
Laser Therapy
Or anti- vEGF
111
Will you get cotton wool spots in proliferative or non proliferative diabetic retinopathy?
Non proliferative
112
What are the 4 stages of diabetic retinopathy?
1. Mild: its Non proliferative and you have 1 or less micro aneurysms
2. Moderate: non proliferative but have some cotton wool spots, hard exudates and blot haemorrhages
3. Severe: non proliferative but blot haemorrhage and micro aneurysms basically take up the whole of the orbit
4. Proliferative Retinopathy: retinal haemorrhages may lead to vitreous haemorrhages
113
If a patient had diabetic retinopathy and they came in with sudden loss of site. What would you be thinking the cause is?
Vitreous Haemorrhage
114
What is a hyphema?
This is when you get a blood pool in the anterior chamber
115
After removing a foreign object from the eye.. what do you always give?
Antibiotics
116
How can retinal detachments happen?
There is a potential space between the retinal pigment epithelium and the photoreceptors. When fluid enters this space you can get retinal detachments.
117
What are 4 causes of detached retinas?
1. High Myopia
2. Eye Surgery
3. Diabetic Retinopathy
118
What is the most common type of retinal haemorrhage?
Rhegmatogenous
119
How would you manage a retinal detachment?
Lasers are used for small tears.
Bigger tears require: gas/laser therapy or surgery
120
What is a Holmes Adie Pupil ?
This is when you have one tonic pupil and an absent knee/ankle jerk
121
What is an Argyll Robertson pupil?
This is secondary to syphilis and when you have bilateral miosis that does not respond to light.
However will dilate and change in accommodation.
122
What are 3 causes of dilated equal pupils?
Cocaine
Topical mydriatrics
Anticholinergic drugs
123
What condition is Humphrey’s visual field test typically used in ?
Management of glaucoma
124
What is the Keith Wagenar classification used for?
To stage hypertensive retinopathy stage 1 to 4
125
What are the 4 stages of hypertensive retinopathy?
1. Arterial narrowing and Tortuous arteries
2. Arterovenous nipping
3. Cotton wool exudates, flame and blot haemorrhages
4. Papilloedema
