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FINALS revision - @medicbotanist > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

What is amblyopia ?

A

This is when you have acuity up corrected by lenses. No anatomical defect

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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.

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3
Q

What is a canthus?

A

A medial or lateral angle of the eye. Visible on eye opening

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4
Q

What is cyclopegia?

A

Ciliary muscle paralysis

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5
Q

What is the fornix?

A

This is when the sclera meets the palpabrae aka the lid

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6
Q

What is a medication that causes pupil constriction?

A

Miotic agent such as pilocarpine

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7
Q

What medication is used for pupil dilation?

A

Mydriatic such as tropicamide

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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

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9
Q

How does xerophthalmia present?

A

Tunnel vision
Reduced visual acuity
Night Blindness

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10
Q

What will you see on examining the conjunctiva of a patient with xerophthalmia?

A

Foamy plaques called Bilot spots

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11
Q

How do you treat xerophthalmia?

A

Vitamin A supplements

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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

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13
Q

What are some of the symptoms of trachoma?

A
  1. Entropian
  2. Corneal scaring leading to reduced visual acuity
  3. Trichiasis
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14
Q

What is the 4 step management of trachoma?

A

Surgery for trichiasis
Antibiotic
Facial Cleaning
Environmental changes

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15
Q

What is the cause of river blindness?

A

Parasitic worm Onchocerca Volvulus

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16
Q

How does river blindness present? From start to finish?

A

Start: parasite enters skin through skin. Severe itching and disfigured skin.

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17
Q

How do you treat river blindness?

A

Ivermectin

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18
Q

How many eyelids does blepharitis normally affect?

A

All 4 eyelids

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19
Q

What time of day is blepharitis worse?

A

Start of the day

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20
Q

What is the pathogenesis behind blepharitis?

A

Commonly anterior: staph infection

Posterior: seborrheic dermatitis

With meibomian gland dysfunction

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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

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22
Q

What should you think of when there is unilateral blepharitis?

A

TUMOUR

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23
Q

What is the common viral cause of conjunctivitis?

A

Adenovirus

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24
Q

What symptoms do you normally get with viral conjunctivitis?

A

Lymphadenopathy

Sore throat

Clear Eye discharge

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25
Q

What conjunctivitis are follicles seen in?

A

Viral conjunctivitis

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26
Q

What conjunctivitis are papules seen in?

A

Vernal and Allergic conjunctivitis

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27
Q

What 3 things do tears contain ?

A

Antibiotics
Lysosomes
Mucin + Oils

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28
Q

What are 2 functions of dry eyes?

A
  1. Lubricate

2. Oxygenate the ocular surface

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29
Q

What are the 3 layers that make up a tear?

A
  1. Lipid Layer (Meibomian Gland)
  2. Aqueous Layer (lacrimal gland)
  3. Mucous Layer (goblet cells)
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30
Q

If you have dry eyes when are your symptoms the worse?

A

Gets worse as the day goes on.

Eye generally feels heavy, blurred vision and tears

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31
Q

What is the diagnostic method used for dry eyes?

A

Fluroscein eye drops and a slit lamp

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32
Q

What symptoms do you get in a HSV infection?

A
  1. Eye pain + discomfort
  2. Photophobia + light sensitivity
  3. Lid oedema and oral lesions
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33
Q

What is the lesion that you get in HSV infections?

A

Dendritic Ulcer on the Cornea seen with fluorescein drops

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34
Q

How would a conjunctival haemorrhage present?

A

You just get a suddenly red sclera . Normally Assymptomatic and unilateral.

Generally affect the inferior conjunctiva

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35
Q

What medication should you avoid in sub conjunctival haemorrhage ?

A
  1. NSAIDs

2. Aspirin

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36
Q

What is dacryostenosis?

A

This is when you get an obstructed nasolacrimal duct obstruction

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37
Q

How does dacryostenosis present?

A
  1. Warm, red swelling inner canthal region.

2. Normally presents in 6w of birth.

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38
Q

What is the two step management plan for nasolacrimal duct obstruction?

A
  1. Abx

2. Surgery (dacryocystorhinostomy)

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39
Q

Who is episcleritis common in?

A

Young people

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40
Q

How does episcleritis typically present?

A

General un comfortable

No changes to visual acuity

Very acute + superficial red eye.

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41
Q

What are some common causes of scleritis?

A

Autoimmune conditions: SLE, RA, PMR and Wegner’s

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42
Q

What is the presentation of someone who has scleritis?

A

Severe Pain worse with eye movement

Reduced visual acuity

Photophobia and eye watering

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43
Q

How do you treat scleritis?

A

NSAIDs

Immunosuppressant

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44
Q

What is Hutchinson’s sign?

A

This is when you get involvement of the nasociliary branch in ocular shingles

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45
Q

What nerve is affected in ophthalmic shingles?

A

Trigeminal Nerve

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46
Q

What is Ramsey Hunt Syndrome?

A

VZV involvement of the facial nerve

Painful fluid filled rash around one ear, one sided facial pain and weakness. Hearing loss + vertigo.

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47
Q

After what condition does a cortical cavernous fistula occur?

A

Carotid aneurysm rupture

Other causes are: trauma, post nasal surgery or spontaneous

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48
Q

How does a cortical cavernous fistula present?

A

Engorgement of the eye vessels

Lid and conjunctival oedema

Proptosis

Dipolopia and Vision Loss

Headaches

Loud pulsatile bruitus over the eye

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49
Q

What are two investigations you need to do in cortical cavernous fistula ?

A
  1. MRI

2. Cerebral arteriography

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50
Q

What two organisms are associated with bacterial keratitis?

A
  1. pseudomonas

2. Staph aureus

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51
Q

What are 5 RF for bacterial keratitis?

A

Contact Lens wearing

Smoking

Poor hygiene

Immune suppression

Ocular Trauma

52
Q

What is the presentation of bacterial keratitis?

A

Eye pain (severe and rapid)

Loss of visual acuity , red eye, discharge and photophobia

Corneal white and yellow spots

53
Q

What investigation would you like to do in a patient with corneal disease?

A

Corneal scrape for culture and sensitivity.

54
Q

What is the presentation of marginal keratitis?

A

Severe eye pain- red- photophobia.

But with no associated visual disturbance.

Management is with steroids and abx

55
Q

What is the Uvea made up of?

A

Ciliary Body

Lens

Choroid

56
Q

What is a common cause of anterior uveitis?

A

Autoimmune conditions such as seronegative conditions and sarcoidosis

57
Q

How does anterior uveitis present?

A

Unilateral acute red painful eye.

Small and irregular pupil.

Reduced vision and photophobia.

58
Q

What will you see on a slit with in someone who has anterior uveitis?

A
  1. Kerratic precipitates on anterior chamber of the cornea

2. Flare: caused by a plasma leak

59
Q

What is the management of acute uveitis?

A
  1. Prednisolone Drops

2. Eye dilation with cyclopentolate)

60
Q

What are 3 RF of retinal artery occlusion?

A

Atherosclerosis

Diabetes

AF

Smoking

HTN

61
Q

Can GCA cause a retinal artery occlusion?

62
Q

In a retinal artery occlusion what symptoms would you expect to see?

A

You would expect to have sudden loss of vision

In a branch artery occlusion expect either superior or inferior loss of vision.

63
Q

In a patient with a central artery or venous occlusion would you expect a RAPD?

64
Q

What two investigations would you like to do in someone with suspected retinal artery occlusion?

A
  1. Fundoscopy: Cherry Spot Occlusion

2. Carotid Doppler

65
Q

What is the management of someone with retinal artery occlusion?

A

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
Q

What is the 2nd most common cause of blindness?

A

Retinal Vein occlusion

67
Q

What will you see on imaging of a branch vein occlusion?

A

Flame haemorrhages

Visual field loss

68
Q

What will you see in a patient with a central vein occlusion?

A

You would see a RAPD

Visual Loss + Visual Field Loss

Widespread flame haemorrhages

Optic Disc swelling

69
Q

What is the management of Retinal Vein Occlusion?

A

You want to use Anti-VEGF

Photocoagulation

Steroid injections

70
Q

What would be your investigation of choice for retinal vein occlusion?

A

Fundus Fluroscein Angiogram

71
Q

What is the management of CRVO with ischaemia?

A

Laser therapy

72
Q

What appearance would you see on a patient with CRVO with ischaemia on fundus fluroscein angiography?

A

Cotton Wool spots and Optic Disc Swelling

73
Q

What are two RF for CRVO with ischaemia?

A

Protein C deficiency

Leukaemia

74
Q

How do you treat CRVO with ischaemia?

A

Laser therapy =

75
Q

What are vitreous haemorrhages secondary to?

A

Central Retinal Vein occlusion

Branch Retinal Vein occlusion

76
Q

How do vitreous haemorrhages present ? (2 ways)

A

Full visual field loss

Floaters

77
Q

What are two ways to manage vitreous haemorrhage?

A
  1. Watch and Wait

2. Vitrectomy

78
Q

What is a stye?

A

Anterior eyelash infection

79
Q

What is the management?

A

Self limiting

Hot towel compress

If recurrent may need to puncture and drain

80
Q

What is a chalazian ?

A

Inflammation of the meibomian glands

81
Q

What is the aetiology of a non ischaemic anterior ischaemic optic neuropathy (AION)?

A

Idiopathic

RF: diabetes, HTN etc

82
Q

What is the aetiology of artery anterior ischaemic optic neuropathy?

A

Giant Cell arteritis

83
Q

What are the symptoms of toxoplasmosis optic neuritis?

A

Loss of colour vision

Loss of vision.

Management is steroids and antibiotics

84
Q

Where is the macula found?

A

Lateral to the optic disc

Site of the highest visual acuity is the fovea

85
Q

What 3 things determine good visual acuity?

A
  1. Functional photoreceptors
  2. Healthy retinal pigment epithelium
  3. Healthy perfusion of blood through capillaries
86
Q

What are drusen?

A

They are waste from photoreceptors they accumulate in the RPE

87
Q

What is Dry AMD and what is Wet AMD?

A

Dry AMD is atrophy of the retina

Wet AMD is vessel growth underneath the retina.

88
Q

What are the visual changes in dry AMD wet AMD?

A

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
Q

How do you treat Dry AMD?

A

Vit A Vit E and Zinc

90
Q

How do you treat Wet AMD?

A

Anti TNF , photodynamic lasers

91
Q

What are the two investigations to use on a patient with suspected macular degeneration?

A

Slit Lamp
Ocular Coherence Tomography OCT
Colour Fundus Photography

92
Q

What does the ‘angle’ in glaucoma refer to?

A

This is the space between the posterior cornea and the anterior surface of the iris

This is where aqeous leaves the eye

93
Q

What is the pathophysiology behind open angle glaucoma?

A

You get trabecular mesh work not draining properly

94
Q

What is the pathophysiology behind closed angle glaucoma?

A

Build up of pressure between the cornea and iris

Preventing drainage through the trabecular mesh work.

95
Q

What is the intraocular pressure classed as in IOP?

96
Q

How would chronic open angle glaucoma present?

A

Progressive loss of visual field and causes tunnel vision

97
Q

What are 3 RF of chronic open angle glaucoma?

A

Steroids

High Myopia

BME

98
Q

What are two medications that can be used to treat chronic open angle glaucoma?

A
  1. BB Timolol
  2. Alpha Agonist: Brimonidine
  3. Prostaglandin Analogue: Latanoprost
99
Q

What are two non medical treatments for chronic open angle glaucoma?

A
  1. Laser Iridotomy

2. Surgery (trabeculectomy)

100
Q

What are two RF for acute closed angle glaucoma?

A
  1. Age (increasing)

2. Long sightedness

101
Q

What are three symptoms of acute closed angle glaucoma?

A

Red painful eye (acute) unilateral

Headache

Nausea and Vomiting

Reduced vision

Corneal oedema and mid dilated pupil

102
Q

What sign may you see in acute angle closure glaucoma?

A

+ve eclipse sign

103
Q

What is the management of acute angle closure glaucoma?

A
  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
Q

What embryological layer is the lens made up of?

A

Ectoderm

It continues to enlarge with life

105
Q

What are the 4 types of cataracts?

A
  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
Q

What will happen to the pupil in cataracts ?

A

Leucocoria (white pupil)

107
Q

How does cataract surgery occur?

A

You get:

1. Pharcoemulsification and an intraocular lens put inside

108
Q

What are 3 risks of cataract surgery?

A
  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
Q

What are the two types of diabetic eye disease you can get?

A
  1. Non proliferative

2. Proliferative

110
Q

What are two management plans for a diabetic retinopathy?

A

Laser Therapy

Or anti- vEGF

111
Q

Will you get cotton wool spots in proliferative or non proliferative diabetic retinopathy?

A

Non proliferative

112
Q

What are the 4 stages of diabetic retinopathy?

A
  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
Q

If a patient had diabetic retinopathy and they came in with sudden loss of site. What would you be thinking the cause is?

A

Vitreous Haemorrhage

114
Q

What is a hyphema?

A

This is when you get a blood pool in the anterior chamber

115
Q

After removing a foreign object from the eye.. what do you always give?

A

Antibiotics

116
Q

How can retinal detachments happen?

A

There is a potential space between the retinal pigment epithelium and the photoreceptors. When fluid enters this space you can get retinal detachments.

117
Q

What are 4 causes of detached retinas?

A
  1. High Myopia
  2. Eye Surgery
  3. Diabetic Retinopathy
118
Q

What is the most common type of retinal haemorrhage?

A

Rhegmatogenous

119
Q

How would you manage a retinal detachment?

A

Lasers are used for small tears.

Bigger tears require: gas/laser therapy or surgery

120
Q

What is a Holmes Adie Pupil ?

A

This is when you have one tonic pupil and an absent knee/ankle jerk

121
Q

What is an Argyll Robertson pupil?

A

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
Q

What are 3 causes of dilated equal pupils?

A

Cocaine

Topical mydriatrics

Anticholinergic drugs

123
Q

What condition is Humphrey’s visual field test typically used in ?

A

Management of glaucoma

124
Q

What is the Keith Wagenar classification used for?

A

To stage hypertensive retinopathy stage 1 to 4

125
Q

What are the 4 stages of hypertensive retinopathy?

A
  1. Arterial narrowing and Tortuous arteries
  2. Arterovenous nipping
  3. Cotton wool exudates, flame and blot haemorrhages
  4. Papilloedema

FINALS revision - @medicbotanist (20 decks)

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