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Year 5 > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Two types of age related macular degeneration

A

Dry (90%) - characterised by drusen, and degeneration of photoreceptors in the macula
Wet (10%) - characterised by neovascularisation, new vessels growing from the choroid layer into the retina. These vessels can leak fluid or blood causing oedema and rapid vision loss

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2
Q

Risk factors for age related macular degeneration

A 
Age 
Smoking 
Female sex 
Family history 
Cardiovascular disease
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3
Q

Presentation of age related macular degeneration

A

Gradual worsening of central visual field loss
Reduced visual acuity
Wavy appearances to straight lines

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4
Q

Signs of wet age related macular degeneration

A

Loss of vision over days

Full visual loss is over 2-3 years

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5
Q

How is ARMD diagnosed

A

Slit lamp fundus examination

Fluorescein angiography - useful to show up any oedema and neovascularisation

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6
Q

Management of Dry ARMD

A

No specific treatment
Focus on lifestyle management to slow progression:
- avoid smoking
- control blood pressure
- vitamin supplementation with zinc and anti oxidant vitamins

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7
Q

Management of wet ARMD

A

Anti Vascular endothelial growth factors (VEGF) - this stops formation of new blood vessels

Injections of this into the vitreous chamber once a month

Examples: ranibizumab

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8
Q

What is glaucoma?

A

Optic nerve damage caused by a significant rise in intraocular pressure

This is caused by a blockage in the aqueous humour trying to escape the eye

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9
Q

Two types of glaucoma and what happens in each

A

Open angle - resistance of drainage of aqueous humour through the trabecular meshwork, causing slow gradual increase in pressure
Closed angle - bulging of iris sealing off the trabecular meshwork from the anterior chamber, preventing aqueous humour from being able to drain. This causes rapid continual build up of pressure and is an ophthalmology emergency

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10
Q

Risk factors for open angle glaucoma

A

Increasing age
Family history
Black ethnic origin
Myopia (near sightedness)

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11
Q

Presentation of open-angle glaucoma

A

Often asymptomatic - and diagnosed by routine screening when attending for an eye check
Loss of peripheral vision
Gradual onset of fluctuating pain, headaches, blurred vision and halos around lights

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12
Q

How would you assess the intraocular pressure when diagnosing glaucoma

A

Using Goldman application tonometry
Fundoscopy - looking for optic disc cupping
Visual field assessment - check for peripheral field loss

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13
Q

Medications used in management of open angle glaucoma and how they work

A

1st line - prostaglandin analogue eye drops (e.g, latanoprost), these increase uveoscleral outflow

2nd line - all eye drop drugs reduce aqueous humour production
Beta blockers e.g timolol
Carbonic anhydrase inhibitors e.g, dorzolamide, acetazolamide
Sympathomimetics e.g, brimonidine

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14
Q

What other options are available for management of open angle glaucoma when eye drops are ineffective

A

Trabeculaectomy surgery - involves creating a new channel from the anterior chamber through the sclera to a location under the conjunctiva (bleb). From here it can be reabsorbed into general circulation

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15
Q

Which medications can precipitate an acute angle-closure glaucoma

A

Noradrenaline
Anticholinergic medications - oxybutynin
Tricyclic antidepressants e.g, amitriptyline (these have anticholinergic effects)

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16
Q

Presentation of acute angle closure glaucoma

A 
Severely red painful eye 
Blurred vision 
Halos around lights 
Headache 
Nausea 
Vomiting
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17
Q

What examination findings may you find on a patient with closed angle glaucoma

A 
Red eye 
Hazy cornea 
Decreased visual acuity 
Dilation of affected pupil 
Firm eyeball on palpation
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18
Q

Management of acute closure angle gluacoma

A

Urgent same day assessment by ophthalmologist

Can give pilocarpine eye drops whilst awaiting ambulance - this acts to constrict the pupil which allows a pathway for the flow of aqueous humour from the ciliary body

IV acetazolamide (carbonic anhydrase inhibitor) initial therapy

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19
Q

What is a cataract

A

Where the lens in the eye becomes cloudy and opaque leading to reduced visual acuity

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20
Q

Presentation of cataracts

A

Asymmetrical
Slow reduction in vision
Progressive blurring of vision
Change of colour vision - colours becoming more brown or yellow
“Starbursts” can appear around lights, particularly at night time

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21
Q

What is the key sign of cataract on examination

A

Loss of red reflex

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22
Q

Management of cataracts

A

Conservative in early stages

Cataract surgery in later stages - replacement with artificial lens

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23
Q

What is the main complication of cataract surgery to be aware of?

A

Endophthalmitis - inflammation of the inner contents of the eye, usually caused by infection post surgery

It can lead to loss of vision and loss of the eye itself

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24
Q

What is a Marcus-Gunn pupil

A

Relative Afferent papillary defect (RAPD)

Sign of asymmetrical optic nerve disease

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25
Q

Differential diagnosis for painless red eye

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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26
Q

Differential diagnosis for painful red eye

A 
Glaucoma 
Anterior uveitis 
Scleritis 
Corneal abrasions or ulceration 
Keratitis 
Foreign body
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27
Q

Presentation of conjunctivitis

A

Red bloodshot eyes
Itchy or gritty sensation
May be purulent discharge from the eye in bacterial causes

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28
Q

Management of conjunctivitis

A

Usually resolves in 1-2 weeks
Advice on good hygiene to avoid spreading disease e.g, avoid sharing towels and encourage hand washing after rubbing eyes
Can clean eyes using cooled boiled water and cotton wool
Avoid wearing contact lens
Chloramphenicol abx eye drops - if bacterial cause

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29
Q

What do you need to consider in neonatal conjunctivitis

A

Gonococcal infection from pregnancy

This can cause loss of sight and requires urgent ophthalmology review

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30
Q

Allergic conjunctivitis management

A

1st line - Topical antihistamines eye drops

2nd line - topical mast cell stabilisers e.g, sodium cromoglicate

31
Q

What is keratitis

A

Inflammation of the cornea

32
Q

What is the most common cause of keratitis

A

Herpes simplex infection - called herpes simplex keratitis

33
Q

How does herpes simplex keratitis usually present

A 
Painful red eye 
Photophobia 
Foreign body sensation in eye 
Reduced visual acuity 
Dendritic corneal ulcer
34
Q

What is anterior uveitis

A

Inflammation in the anterior part of the uvea - involving the iris, ciliary body and choroid

35
Q

How does anterior uveitis usually present

A 
Dull, aching painful red eye 
Ciliary flush - ring of red spreading from the cornea outwards 
Reduced visual acuity 
Photophobia 
Miosis (constricted pupil)
Pain on movement 
Excessive lacrimation 
Hypopyon - collection of WCC in the anterior chamber
36
Q

What is blepharitis?

A

Inflammation of the eyelid margins

37
Q

Presentation of blepharitis

A

Gritty, itchy dry eyes

Red inflamed eyelids

38
Q

Management of blepharitis

A

Hot compress and gentle cleaning of the eyelid margins with baby shampoo
Lubricating eye drops can be used to relieve symptoms

39
Q

What is a stye

A

Hordeolum externum
Inflammation of the meibomian glands in the eyelids

Causing red tender lump along the eyelid which may contain pus

40
Q

Difference between a stye and a chalazion

A

Stye’s are typically painful

Chalazion are typically painless

41
Q

Difference between orbital and periorbital cellulitis

A

With periorbital cellulitis - normal visual acuity, and no pain with eye movements

Orbital cellulitis (ophthalmic emergency) - severe ocular pain and visual disturbance

42
Q

What the most common causes of central retinal artery occlusion?

A

Where there is something that blocks the flow of blood through the central retinal artery

This is most commonly caused by atherosclerosis
It can also be caused giant cell arteritis - where vasculitis affecting the ophthalmic or central retinal artery causes reduced blood flow

43
Q

Features of central retinal artery occlusion

A

Sudden painless loss of vision

Relative afferent pupillary defect

44
Q

Fundoscopy findings on central retinal artery occlusion

A

Pale retina - due to lack of perfusion

Cherry red spot - which is the macula that shows the red colour choroid below and contrasts with the pale retina

45
Q

What happens in central retinal vein occlusion?

A

Blockage of the retinal vein causes pooling of blood into the retina
This results in leakage of fluid and blood causing macular oedema and retinal haemorrhages
This damage to the retina causes the release of VEGF - which stimulates the development of new blood vessels (neovascularisation)

46
Q

Presentation of central retinal vein occlusion

A

Painless loss of vision

47
Q

Fundoscopy findings on central retinal vein occlusion

A

Flame and blot haemorrhages
Optic disc swelling
Macula oedema

48
Q

What happens in retinal detachment

A

Where the retina separates from the choroid underneath

Usually due to a retinal tear which allows vitreous fluid to get under the retina and fill the space between the retina and the choroid

49
Q

Why is retinal detachment a ophthalmic emergency?

A

The retina relies on the choroid for blood supply
As it detaches from the choroid during retinal detachment
This makes it a sight threatening emergency

50
Q

How does retinal detachment usually present

A

Painless
Peripheral vision loss - like a shadow coming down on vision
Blurred or distorted vision
Flashes and floaters

51
Q

What is posterior vitreous detachment

A

Common condition particularly in elderly patients

Where the vitreous gel comes away from the retina

52
Q

Presentation of posterior vitreous detachment

A

Painless
Floaters
Flashing lights
Cobweb across vision

53
Q

Management of posterior vitreous detachment

A

Referral - to rule out retinal detachment
Conservative - symptoms improve over time as brain adjusts
If there is associated retinal tear or detachment then they may need surgery

54
Q

Fundoscopy findings of hypertensive retinopathy

A

Silver wiring - thickened sclerosed arterioles
AV nipping - where arterioles cause compression of veins where they cross due to sclerosis and hardening of arterioles
Cotton wool spots - caused by dead nerve fibres
Hard exudates - due to leaking lipids into retina
Retinal haemorrhages - damaged vessels bleeding into retina
Papillodema- caused by ischaemia to the optic nerve causing swelling

55
Q

Keith-Wagener Staging of hypertensive retinopathy

A

Stage 1 - mild narrowing of arterioles
Stage 2 - constriction/sclerosis of blood vessels and AV nicking
Stage 3 - cotton wool spots, exudates and haemorrhages
Stage 4 - papillodema

56
Q

Pathophysiology of diabetic retinopathy

A

Hyperglycaemia leads to damage to the retinal small vessels and and endothelial cells

Increased vascular permeability leads to blood vessels to leak. This causes the formation of microaneurysms, blot haemorrhages and hard exudates

57
Q

Pathophysiology of cotton wool spots

A

Damage to nerve fibres

58
Q

Difference between non proliferative and proliferative diabetic retinopathy

A

Whether new blood vessels have developed or not

Non proliferative/pre proliferative can develop into proliferative

59
Q

Classification of non-proliferative diabetic retinopathy

A

Mild - microaneuryms present
Moderate - microaneuryms, blot haemorrhages, hard exudates, cotton wool spots and venous beading
Severe - blot haemorrhages plus microaneuryms in 4 quadrants, venous beading in 2 quadrants

60
Q

Complications of diabetic retinopathy

A

Retinal detachment

Vitreous haemorrhage

61
Q

What is diabetic maculopathy

A

Condition which is separate from pre proliferative/proliferative retinopathy
Based on location of disease rather than severity
Occurs with macula oedema and ischaemia
More common in type II diabetics

62
Q

What is retinitis pigmentosa

A

Congenital inherited condition where there is degeneration of rods and cones in the retina

In most cases the rods degenerate more than the cones, leading to night blindness

63
Q

Features of retinitis pigmentosa

A

Night blindness
Tunnel vision - due to loss of peripheral retina
Fundoscopy - multiple black bony spicule shaped pigmentation

Family history is often positive

64
Q

Features of horner’s syndrome

A

Miosis (small pupil)
Ptosis
Enophthalmos
Anhidrosis (loss of sweating on one side)

65
Q

How can you tell the difference between the causes of horner’s syndrome?

A

Central lesion cause - anhidrosis of face, arm and trunk
All the S’s - stroke, syringomyelia, MS

Pre-ganglionic lesion cause - anhidrosis of face only
All the T’s - pancoast Tumour, Thyroidectomy, Trauma

Post-ganglionic lesion - no anhidrosis
All the C’s - Carotid artery dissection, Carotid aneurysm, Cavernous sinus thrombosis, Cluster headache

66
Q

What is Argyll-Robertson pupil?

A

Small irregular pupil seen in patients with syphilis

Patients have an absent pupillary reflex but accommodation reflex is still present

67
Q

Causes of 6th nerve palsy

A

Raised ICP

Vasculitis
Cavernous sinus thrombosis

68
Q

Significance of pupil dilation in 3rd nerve palsy

A

Parasympathetic system travels along outside of CN3 pathway
If there is exterior compression causing CN3 palsy, it will also be causing pupil dilation due to compression of parasympathetic nervous system
Cause is more likely due to an aneurysm or tumour/mass if this is the case
Urgent MRI is needed

69
Q

Causes of 3rd nerve palsy

A

Vasculitis - e.g, diabetes/hypertension
Aneurysms
Mass e.g, tumour

70
Q

Why can aneurysms in the brain cause 3rd nerve palsy?

A

Path of CN3 travels very close to circle of willis where berry aneurysms are common

The aneurysm then pushes on nerve causing palsy and parasympathetic compression (pupil dilation)

71
Q

Common cause of 4th nerve palsy

A

Congenital - lots of children born with it

Vasculitis
Mass

72
Q

Ophthalmic presentation of myasthenia gravis

A

Bilateral drooping of eyelids (ptosis)
Diplopia

No abnormalities in eye movements

73
Q

Management of anterior uveitis

A

Steroid eye drops (prednisolone acetate) - reduce infection

Mydriatic eye drops (cyclopentolate) - dilate pupil to reduce pain

Year 5 (17 decks)

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