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Ophthalmology Flashcards

1
Q

What is blepharitis?

A

Inflammation of the eyelids

Commonly associated with dry eyes

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2
Q

Treatment for blepharitis

A

Hot compress
Removal of crust
Self-limiting

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3
Q

What is a stye?

A

Infection of a sweat gland

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4
Q

What is a chalazion? What is it called with associated infection?

A

Blockage of a meibomian gland

Hordeolum with associated infection

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5
Q

Treatment for preseptal cellulitis

A

Co-amoxiclav

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6
Q

Warning signs of an orbital cellulitis

A

Proptosis
Diplopia/ ophthalmoplegia
RAPD
Decreased acuity and colour vision

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7
Q

Management of orbital cellulitis

A 
Bloods- FBC, CRP
Sepsis 6 if indicated
CT-head
ENT- spread from ethmoidal sinuses 
IV abx- broad spectrum- Tazocin or cephtriaxone 
Consider surgical decompression
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8
Q

Causes of subconjunctival haemorrhage

A

Often trivial- sneezing, Valsalva manoeuvre, straining, rubbing
Anticoagulation or bleeding disorder

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9
Q

Management of subconjunctival haemorrhage

A

Reassurance
Lubricants if warranted
Do not mistake for retrobulbar haemorrhage

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10
Q

Topical abx used for the eye

A

Chloramphenicol

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11
Q

Corneal sign of abrasion

A

Positive fluorescein stain- shows an epithelial defect

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12
Q

What is a hyopyon?

A

Collection of pus in the anterior chamber

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13
Q

Serious complication of bacterial keratitis

A

Perforation and endophthalmitis

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14
Q

Management of bacterial keratitis

A

Corneal scrape for MC&S- often pseudomonas

Intensive antibiotics for 7 days every 30 minutes- often admitted due to intensity of treatment

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15
Q

Sign of HSV keratitis

A

Dendritic ulceration classically seen on fluorescein stain

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16
Q

What makes up the uvea?

A

Iris and ciliary bodies (anterior) and the choroid

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17
Q

Signs and symptoms of anterior uveitis

A 
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
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18
Q

Causes of anterior uveitis

A 
HLA B27/ ank spon
Sarcoidosis 
Idiopathic 
Infective- local, STI (including syphilis)
Cataract surgery
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19
Q

Management of anterior uveitis

A

Topical steroids and dilate (to stop sticking of the iris to the pupil)

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20
Q

Risk factors for cataracts

A 
Age
Smoking
Diabetes
UV exposure
Trauma
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21
Q

Signs of background diabetic retinopathy

A

Microaneurysms
Dot/blot haemorrhages
Hard exudates

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22
Q

Signs of pre-proliferative diabetic retinopathy

A

Cotton wool spots- retinal ischaemia
IRMA- intraretinal microabnormalities
Venous changes- beading, looping

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23
Q

Signs of proliferative diabetic retinopathy

A

Neovascularisation

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24
Q

Commonest cause of blindness in the UK (50% at 90y/o)

A

Age related macular degeneration

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25
Q

Appearance of wet AMD and percentage

A

10% of AMD
Neovascularisation, pre-retinal haemorrhage
Greyish macula
Cystoid macular oedema from leaky vessels

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26
Q

Appearance of dry AMD and percentage

A

90%

Drusen at the macula

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27
Q

Gradual loss of vision pathologies

A 
Diabetic retinopathy
Hypertensive retinopathy
AMD
Primary open-angle glaucoma
Cataracts
28
Q

Sudden loss of vision pathologies

A 
Central retinal artery occlusion
Acute closed angle glaucoma 
Retinal detachment 
Vitreous haemorrhage 
Optic neuritis
29
Q

Red eye pathologies

A 
Corneal abrasions
Subconjunctival haemorrhage
Conjunctivitis  
Anterior uveitis 
Glaucoma 
Keratitis
30
Q

How to identify a corneal abrasion

A

Fluoresceine stain and examination under cobalt blue light- epithelial defects will show up green

31
Q

How does a cycloplegic work?

A

Paralysis of the ciliary muscles to prevent lens movement- eg. in accommodation

32
Q

Management of corneal abrasion

A

Analgesia
Cycloplegic (one dose)
Topical abx for 7 days- chloramphenicol
Avoid contact lens use until fully healed and 24 hours after abx

33
Q

Management of subconjunctival haemorrhage

A

Discourage elective use of NSAIDs/aspirin
Lubricants for irritation
BP control

34
Q

Types of conjunctivitis and signs of each

A

Viral- follicles from lymphoid aggregation
Bacterial- purulent discharge
Allergic- papillae on the upper tarsal conjunctiva

35
Q

What is Talbot’s test?

A

Accommodation towards the nose causes pupil constriction and causes discomfort

Diagnoses iritis

36
Q

Investigations for anterior uveitis

A 
Routine bloods
CRP
Serum ACE- sarcoid
VLDR- syphilis
HLA-B27
CXR
Systemic disease work ups if necessary
37
Q

Symptoms of glaucoma

A

Painful red eye
Systemically unwell +/- nausea and vomiting
Haloes around lights- corneal oedema
Reduced vision

38
Q

Signs of glaucoma

A 
Red eye
Corneal oedema
Raised IOP
Fixed mid-dilated pupil
Shallow anterior chamber on slit lamp examination 
Closed angle on gonioscopy
39
Q

What is gonioscopy?

A

Assess the iridocorneal angle

40
Q

History clues for glaucoma

A

East Asian/ Chinese decent
Hypermetropia
Increasing age
Medications- SSRIs

41
Q

Management of an acute attack of glaucoma

A

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

42
Q

What is endophthalmitis?
Exogenous causes
Endogenous causes

A

Intraocular inflammation in the vitreous cavity or the anterior chamber
Exogenous- post-operative, keratitis, penetrating trauma
Endogenous- spread from anywhere in the body

43
Q

Signs of endophthalmitis

A

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

44
Q

How to identify causative organism in endophthalmitis

A

Aqueous tap and vitreal biopsy

45
Q

Management of cataracts

A

Phacoemulsification and IOL insertion

46
Q

Cataract locations

A

Cortical
Nuclear- commonest
Posterior subcapsular

47
Q

Normal IOP

A

10-21mmHg

48
Q

Normal flow of aqueous fluid in the eye

A 
Secretion by ciliary body
Posterior chamber between the iris and the lens
Through the pupil
Trabecular meshwork
Into the venous system
49
Q

Screening questions to ask any ophthalmology history

A

Do you wear glasses or lenses?
Any diagnosed issues with your eyes?
Any previous surgery?
Do you put any drops into your eyes?

50
Q

What is amblyopia?

A

Lack of visual pathway development due to deprivation of focused stimuli- resulting in a ‘lazy eye’

51
Q

What is exotropia?

A

A form of strabismus in which the eye points outwards

52
Q

Fluorescein staining of dry eye sign

A

Punctate epithelial erosions

53
Q

Cause of irregular meiotic pupil in anterior uveitis

A

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

54
Q

What are cotton wool spots a sign of?

A

Nerve ischaemia

55
Q

What is a normal cup: disc

A

<0.5

56
Q

What is a hypopyon?

A

Collection of pus in the anterior chamber

57
Q

What is a Holmes-Adie pupil?

A

Pupil dilation and slow to react to light- neurological condition which is usually idiopathic

58
Q

Argyll-Robertson pupil

A

Bilateral meiosis, accommodate but do not constrict to light
Late stage syphilis

59
Q

Marcus-Gunn pupil

A

RAPD due to damage to the afferent pathway in one of the eyes- MS

60
Q

What is Hutchinson’s sign

A

Vesicles extending to the tip of the nose is strongly suggestive of ocular involvement in shingles

61
Q

Signs and symptoms of retinal detachment

A

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

62
Q

Management of retinal detachment

A

Emergency to prevent macular destruction

Laser therapy along the tear or surgical fixation

63
Q

Signs of scleritis not episcleritis

A

Non-blanching with phenylephrine application

Bluish hue

64
Q

Treatment of amaurosis fugax

A

Form of TIA and should be treated with aspirin 300mg
Lifestyle control
Prompt referral for stroke evaluation to rule out secondary ischaemic events

65
Q

Central retinal artery occlusion signs and symptoms

A

Sudden and profound visual loss unilaterally
May be macular sparing
RAPD
Cherry red spot on ischaemic retinal whitening (due to underlying choroidal circulation)

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