Ophthalmology Flashcards
Eyelid problems
Blepharitis
- Inflammation of eyelid margins
- Red eye
Stye - Infection of eyelid glands
Chalazion
- Meibomian cyst
- Firm painless lump in eyelid
- Resolves spontaneously
Entropion - In-turning of eyelids
Ectropion - Out-turning of eyelids
Blepharitis aetiology
Inflammation of eyelid margins
Meibomian gland dysfunction
Seborrhoeic dermatitis - Staph infection
More common in patients with rosacea
Meibomian glands
- Secrete oil onto eye surface
- Prevent rapid evaporation of tear film
- Meibomian gland disorders cause dry eyes
Blepharitis clinical features
Bilateral - RED EYE
Grittiness and discomfort - Around eyelid margins Sticky eyes in morning Swollen if Staph Styes and chalazions Secondary conjunctivitis
Blepharitis management
Hot compress - Soften lid margin
Lid hygiene - Mechanical removal of debris - Cotton wool buds
- Baby shampoo in cooled boiled water
- Sodium bicarb in cooled boiled water
Artificial tears
Stye
Infection of eyelid glands
External
- Glands of Zeis - Sebum producing
- Glands of Moll - Sweat producing
Internal
- Meibomian glands
- May leave residual chalazion
Management
- Hot compress
- Analgesia
Conjunctivitis aetiology and management
Bacterial
- Purulent discharge
- Sticky eyes in morning
Viral
- Serous discharge
- Recent URTI
- Periauricular lymph nodes
Management - Self-limiting - 1-2 weeks
- Topical abx - Chloramphenicol
- Pregnant women - Topical fusidic acid
- Avoid contact lenses
- Prophylaxis - Don’t share towels
Anterior uveitis aetiology
Iritis
Inflammation of uvea - Iris and ciliary body
Associated conditions - HLA-B27 CRABS - Crohn's/UC - Reactive arthritis - Ankylosing spondylitis - Bechet's disease - Sarcoidosis - BL
Anterior uveitis management
Urgent ophthalmology review
Steroid eye drops - Prednisolone acetate
Cycloplegics Dilate the pupil Relieve pain and photophobia - Atropine - Cyclopentolate
Episcleritis
Red eye
- Bilateral 50%
- Not painful
- Watering
- Photophobia
- Injected vessels mobile when gentle pressure applied to sclera
Diagnosis - Phenylephrine drops
- Blanches conjunctival and episcleral vessels
NOT scleral vessels
- If redness improves after phenylephrine - Diagnosis is episcleritis
Management - Conservative
- Artificial tears
Corneal ulcer
More common in contact lens users
Eye pain
Photophobia
Eye watering
Focal fluoruescein staining of cornea
Acute angle closure glaucoma aetiology
Impaired aqueous outflow due to mispositioned iris
Predisposing factors
- Hypermetropia - Long-sightedness
- Pupillary dilatation
- Lens growth associated with age
AACG clinical features
Severe pain - Ocular or headache
Systemic upset - N/V + Abdo pain
Symptoms worsen with mydriasis - E.g. watching TV in a dark room
Decreased visual acuity Hard red eye Haloes around lights Semi-dilated non-reactive pupil Corneal oedema - Dull/hazy cornea
AACG management
Emergency - Urgent ophthalmology referral
Combination of eye drops
Direct parasympathetic - Pilocarpine
- Contraction of ciliary muscle
- Opening of trabecular meshwork
- Increased outflow of aqueous humour
BB - Timolol - Decreases aqueous humour production
A2 agonist - Apraclonidine
- Decreased aqueous humour production
- Increases uveoscleral outflow
Acetazolamide IV - Reduces aqueous secretions
Definitive management - Laser peripheral iridotomy
- Hole in peripheral iris
- Increased aqueous outflow
Primary open-angle glaucoma aetiology and clinical features
Trabecular meshwork not draining properly
Family history
Black
Myopia
HTN
DM
Corticosteroids
Clinical features - Insidious onset…
- Peripheral visual field loss - Nasal scotomas > Tunnel vision
- Decreased visual acuity
Primary open-angle glaucoma investigations
Fundoscopy
- Optic disc cupping
- Optic disc pallor
- Bayonetting of vessels
- Cup notching
- Disc haemorrhages
Automated perimetry - Assess visual field
Slit lamp examination with pupil dilatation - Assess optic nerve and fundus
Applanation tonometry - Measure IOP
Central corneal thickness measurement
Gonioscopy - Assess peripheral anterior chamber configuration and depth
Primary open-angle glaucoma management and prognosis
- Prostaglandin analogue eyedrop
- BB, carbonic anhydrase inhibitor, sympathomimetic eyedrop
Advanced disease - Surgery or laser treatment
Reassessment - Exclude progression and visual field loss
Risk factors for future visual impairment
- IOP
- Central corneal thickness
- Family history
- Life expectancy
Latanoprost
Prostaglandin analogue
Increases uveoscleral outflow
Adverse effects
- Brown iris pigmentation
- Increased eyelash length
Timolol / Betaxolol
BB
Reduces aqueous production
CI in asthma
Brimonidine
Sympathomimetic
Reduces aqueous production
Increases outflow
Dorzolamide
Carbonic anhydrase inhibitor
Reduces aqueous production
Pilocarpine
Miotic
Increases uveoscleral outflow
Adverse effects
- Constricted pupil
- Headache
- Blurred vision
Cataracts aetiology
Lens gradually opacifies
Blocks light from reaching retina
Reduced / blurred vision
Leading cause of curable blindness
Normal ageing process
Smoking / Alcohol
Trauma
DM
Long-term corticosteroids
Radiation exposure
Myotonic dystrophy
Metabolic disorders - Hypocalcaemia
Cataracts clinical features and investigations
Insidious onset
- Reduced vision
- Faded colour vision
- Glare - Lights appear brighter than usual
- Halos around lights
- Red reflex defects
Ophthalmoscopy - After pupil dilatation
- Normal fundus
- Normal optic nerve
Slit-lamp examination - Visible cataract
Cataracts classification and management
Nuclear - Change in lens refractive index
Polar - Localised, inherited, lie in visual axis
Subcapsular - Steroid use, deep to lens capsule, lie in visual axis
Dot opacities - Common in normal lenses, DM and myotonic dystrophy
Non-surgical management
- Stronger glasses / contacts
- Encourage use of brighter lighting
Surgical management - Artificial lens replacement
Complications following cataract surgery
Posterior capsule opacification - Thickening of lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis - Inflammation of aqueous and/or vitreous humour
Central retinal vein occlusion
Sudden painless loss of vision
Risk factors
- Increasing age
- Glaucoma
- Polycythaemia
Clinical features
- Sudden painless loss of vision/acuity - Unilateral
- Fundoscopy - Several retinal haemorrhages
Central retinal artery occlusion
Sudden painless loss of vision
Aetiology
- Thromboembolism - Atherosclerosis
- Arteritis - Temporal arteritis
Clinical features
- Afferent pupillary defect
- Cherry red spot on pale retina
Retinal detachment aetiology and clinical features
Preceded by retinal tear
Holes/tears in retina
Fluid separates sensory retina from retinal pigment epithelium
4 Fs
- Floaters
- Flashes
- Fall in acuity
- Field loss
Retinal detachment investigations and management
Ophthalmoscopy
Superior - Lie flat
Inferior - Lie 30 degrees head up
Urgent referral for surgery
Vitreous haemorrhage aetiology and presentation
Retinal neovascularisation
- DM
- CRVO
Retinal tears
Retinal detachment
Trauma
Sudden onset - Vitreous floaters
- Small black dots
- Tiny rings with clear centres
Vitreous haemorrhage diagnosis and ?management
Ophthalmoscopy
Refer to ophthalmology
Should resolve spontaneously
May require surgery if severe
(This card is a complete waste of time)
