Ophthalmology Flashcards
What is blepharitis?
Inflammation of the eyelids
Commonly associated with dry eyes
Treatment for blepharitis
Hot compress
Removal of crust
Self-limiting
What is a stye?
Infection of a sweat gland
What is a chalazion? What is it called with associated infection?
Blockage of a meibomian gland
Hordeolum with associated infection
Treatment for preseptal cellulitis
Co-amoxiclav
Warning signs of an orbital cellulitis
Proptosis
Diplopia/ ophthalmoplegia
RAPD
Decreased acuity and colour vision
Management of orbital cellulitis
Bloods- FBC, CRP Sepsis 6 if indicated CT-head ENT- spread from ethmoidal sinuses IV abx- broad spectrum- Tazocin or cephtriaxone Consider surgical decompression
Causes of subconjunctival haemorrhage
Often trivial- sneezing, Valsalva manoeuvre, straining, rubbing
Anticoagulation or bleeding disorder
Management of subconjunctival haemorrhage
Reassurance
Lubricants if warranted
Do not mistake for retrobulbar haemorrhage
Topical abx used for the eye
Chloramphenicol
Corneal sign of abrasion
Positive fluorescein stain- shows an epithelial defect
What is a hyopyon?
Collection of pus in the anterior chamber
Serious complication of bacterial keratitis
Perforation and endophthalmitis
Management of bacterial keratitis
Corneal scrape for MC&S- often pseudomonas
Intensive antibiotics for 7 days every 30 minutes- often admitted due to intensity of treatment
Sign of HSV keratitis
Dendritic ulceration classically seen on fluorescein stain
What makes up the uvea?
Iris and ciliary bodies (anterior) and the choroid
Signs and symptoms of anterior uveitis
Pain Photophobia Red eye (conjunctival injection) Hypopyon Blurred vision Irregular meiotic pupil- the iris swells and sticks to the pupil- appears to not dilate in areas
Causes of anterior uveitis
HLA B27/ ank spon Sarcoidosis Idiopathic Infective- local, STI (including syphilis) Cataract surgery
Management of anterior uveitis
Topical steroids and dilate (to stop sticking of the iris to the pupil)
Risk factors for cataracts
Age Smoking Diabetes UV exposure Trauma
Signs of background diabetic retinopathy
Microaneurysms
Dot/blot haemorrhages
Hard exudates
Signs of pre-proliferative diabetic retinopathy
Cotton wool spots- retinal ischaemia
IRMA- intraretinal microabnormalities
Venous changes- beading, looping
Signs of proliferative diabetic retinopathy
Neovascularisation
Commonest cause of blindness in the UK (50% at 90y/o)
Age related macular degeneration
Appearance of wet AMD and percentage
10% of AMD
Neovascularisation, pre-retinal haemorrhage
Greyish macula
Cystoid macular oedema from leaky vessels
Appearance of dry AMD and percentage
90%
Drusen at the macula
Gradual loss of vision pathologies
Diabetic retinopathy Hypertensive retinopathy AMD Primary open-angle glaucoma Cataracts
Sudden loss of vision pathologies
Central retinal artery occlusion Acute closed angle glaucoma Retinal detachment Vitreous haemorrhage Optic neuritis
Red eye pathologies
Corneal abrasions Subconjunctival haemorrhage Conjunctivitis Anterior uveitis Glaucoma Keratitis
How to identify a corneal abrasion
Fluoresceine stain and examination under cobalt blue light- epithelial defects will show up green
How does a cycloplegic work?
Paralysis of the ciliary muscles to prevent lens movement- eg. in accommodation
Management of corneal abrasion
Analgesia
Cycloplegic (one dose)
Topical abx for 7 days- chloramphenicol
Avoid contact lens use until fully healed and 24 hours after abx
Management of subconjunctival haemorrhage
Discourage elective use of NSAIDs/aspirin
Lubricants for irritation
BP control
Types of conjunctivitis and signs of each
Viral- follicles from lymphoid aggregation
Bacterial- purulent discharge
Allergic- papillae on the upper tarsal conjunctiva
What is Talbot’s test?
Accommodation towards the nose causes pupil constriction and causes discomfort
Diagnoses iritis
Investigations for anterior uveitis
Routine bloods CRP Serum ACE- sarcoid VLDR- syphilis HLA-B27 CXR Systemic disease work ups if necessary
Symptoms of glaucoma
Painful red eye
Systemically unwell +/- nausea and vomiting
Haloes around lights- corneal oedema
Reduced vision
Signs of glaucoma
Red eye Corneal oedema Raised IOP Fixed mid-dilated pupil Shallow anterior chamber on slit lamp examination Closed angle on gonioscopy
What is gonioscopy?
Assess the iridocorneal angle
History clues for glaucoma
East Asian/ Chinese decent
Hypermetropia
Increasing age
Medications- SSRIs
Management of an acute attack of glaucoma
IV acetazolamide 500mg to rapidly decrease aqueous inflow and reduce the pressure in the posterior chamber
Topical drops- timolol, iopidine, pilocarpine and pred forte 1%
Analgesia and antiemetics as necessary
Once IOP medically managed then peripheral iridotomy
What is endophthalmitis?
Exogenous causes
Endogenous causes
Intraocular inflammation in the vitreous cavity or the anterior chamber
Exogenous- post-operative, keratitis, penetrating trauma
Endogenous- spread from anywhere in the body
Signs of endophthalmitis
Reduced visual acuity
RAPD
Lid oedema, conjunctival injection and chemosis
Anterior eye- corneal oedema, hypopyon and AC cells
Posterior eye- poor red reflex, vitreous cells and hazy fundal view
How to identify causative organism in endophthalmitis
Aqueous tap and vitreal biopsy
Management of cataracts
Phacoemulsification and IOL insertion
Cataract locations
Cortical
Nuclear- commonest
Posterior subcapsular
Normal IOP
10-21mmHg
Normal flow of aqueous fluid in the eye
Secretion by ciliary body Posterior chamber between the iris and the lens Through the pupil Trabecular meshwork Into the venous system
Screening questions to ask any ophthalmology history
Do you wear glasses or lenses?
Any diagnosed issues with your eyes?
Any previous surgery?
Do you put any drops into your eyes?
What is amblyopia?
Lack of visual pathway development due to deprivation of focused stimuli- resulting in a ‘lazy eye’
What is exotropia?
A form of strabismus in which the eye points outwards
Fluorescein staining of dry eye sign
Punctate epithelial erosions
Cause of irregular meiotic pupil in anterior uveitis
Swelling of the iris, sticks to the pupil and when the pupil dilates it doesn’t appear to in the areas that are stuck to the iris
What are cotton wool spots a sign of?
Nerve ischaemia
What is a normal cup: disc
<0.5
What is a hypopyon?
Collection of pus in the anterior chamber
What is a Holmes-Adie pupil?
Pupil dilation and slow to react to light- neurological condition which is usually idiopathic
Argyll-Robertson pupil
Bilateral meiosis, accommodate but do not constrict to light
Late stage syphilis
Marcus-Gunn pupil
RAPD due to damage to the afferent pathway in one of the eyes- MS
What is Hutchinson’s sign
Vesicles extending to the tip of the nose is strongly suggestive of ocular involvement in shingles
Signs and symptoms of retinal detachment
Floaters secondary to vitreous debris
Photopsia from reduced vision or persistent vitreous traction
New visual loss- ‘falling curtain’
Central vision may remain intact if no fovea involvement
Signs
Horseshoe shaped tear in surrounding subretinal fluid
Management of retinal detachment
Emergency to prevent macular destruction
Laser therapy along the tear or surgical fixation
Signs of scleritis not episcleritis
Non-blanching with phenylephrine application
Bluish hue
Treatment of amaurosis fugax
Form of TIA and should be treated with aspirin 300mg
Lifestyle control
Prompt referral for stroke evaluation to rule out secondary ischaemic events
Central retinal artery occlusion signs and symptoms
Sudden and profound visual loss unilaterally
May be macular sparing
RAPD
Cherry red spot on ischaemic retinal whitening (due to underlying choroidal circulation)
