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Ophthalmology SOH > Ophthalmology conditions > Flashcards

Ophthalmology conditions Flashcards

1
Q

Papilloedema - definition

A 
Optic disc swelling secondary to raised ICP
Subarachnoid space (which surrounds optic nerve) has excess CSF
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2
Q

Papilloedema - cause

A

Accumulation of CSF or inadequate drainage of CSF which leads to a raised ICP
Brain tumour
Head injury

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3
Q

Papilloedema - clinical features

A 
Headache
Nausea/vomiting 
Blurred vision
Decreased colour perception 
Transient black outs of vision 
Loss of vision 
Painless
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4
Q

Papilloedema - opthalmoscopy

A

Poorly defined disc contour
Optic disc elevated above retinal surface
Very swollen optic disc
No central cup
Swollen nerve fibres
Enlarged optic disc
Acute phase: cotton wool spots, haemorrhages

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5
Q

Horner’s syndrome - causes

A

Sympathetic innervation gets compressed and so the innervation is impaired

  • root of neck trauma
  • carotid dissection
  • IJV enlargement
  • pancoast tumour
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6
Q

Horner’s syndrome - clinical features of pupil

A

Miosis

  • small pupils
  • excess constriction of the pupils as the sympathetics aren’t working to dilate the pupils
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7
Q

Horner’s syndrome - additional clinical features

A

Ptosis
- drooping of eyelid
Reduced sweating
Increased warmth and redness

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8
Q

Chemosis (acute allergic conjunctivitis) - definition

A

Swelling of the conjunctiva

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9
Q

Chemosis (acute allergic conjunctivitis) - clinical features

A

Eye is very inflammed
Watery discharge
Itchy
Puffy swollen eyes

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10
Q

Chemosis (acute allergic conjunctivitis) - cause

A

Type 1 hypersensitivity reaction

- release of inflammatory mediators cause symptoms

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11
Q

Hydrocephalus - cause

A

Accumulation of CSF

Subsequent enlargement of the ventricles and an increase in ICP

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12
Q

Hydrocephalus - who gets it

A

Young babies

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13
Q

Hydrocephalus - clinical features

A

Bones of developing skull move apart and the head may enlarge significantly

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14
Q

Optic neuritis - who gets it

A

People with MS

Most commonly females

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15
Q

Optic neuritis - clinical features

A

Pain on eye movements
Progressive unilateral vision loss
Colour vision defect

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16
Q

Optic neuritis - definition

A

Inflammation of the optic nerve

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17
Q

Optic neuritis - ophthalmoscopy

A

Disc is very pale

Loss of blood vessels

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18
Q

CRAO - definition

A

Central retinal artery occlusion
This artery supplies the inner 2/3rds of the retina
It is an end artery, so if blocked there is no blood supply to the majority of the retina. this causes swelling in the retina.

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19
Q

CRAO - causes

A

Atherosclerosis
Hypertension
Aneurysm
Stroke

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20
Q

CRAO - clinical features

A 
Sudden loss of vision
Painless 
Very profound loss of vision 
- won't be able to read top line of snellen chart
- won't be able to count your fingers
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21
Q

CRAO - ophthalmoscopy

A

Retina is pale and milky due to oedema
Retinal nerve fibre layer becomes swollen
Cherry red spot at macula
Cup is very dense and bright white
Blood is struggling to get through circulation - follow an artery and it may disappear

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22
Q

CRAO - management

A

If it presents within 24 hours of onset then try and ocular massage
- aim to push the embolus further down the vascular tree to a retinal branch artery instead of central retinal artery
Anti-platelet therapy

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23
Q

Branch retinal artery occlusion - clinical features

A

Bottom half of vision is lost

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24
Q

Branch retinal artery occlusion - ophthalmoscopy

A

Only the top half of the retina looks pale

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25
Q

Amaurosis fugax - definition

A

Short lasting CRAO

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26
Q

Amaurosis fugax - clinical features

A

Short lasting vision loss (5 mins)
Painless
Darkness/blackness coming down from vision like a set of dark curtains

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27
Q

Amaurosis fugax - ophthalmoscopy

A

No abnormalities

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28
Q

Amaurosis fugax - management

A

Urgent referral to stroke clinic

Aspirin

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29
Q

CRVO - definition

A

Central retinal vein occlusion

Blood travels in with no problems but the blood becomes trapped and can’t get back out

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30
Q

CRVO - causes

A

Atherosclerosis
Hypertension
Hyperviscosity
Raised IOP

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31
Q

CRVO - clinical features

A

Sudden onset loss of vision
Painless
Visual outcome is variable - might not loose complete vision

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32
Q

CRVO - ophthalmoscopy

A 
Congested fundus 
Dilated, torturous veins 
Cotton wool spots (areas of ischaemia) 
Widespread haemorrhage 
Can be difficult to see the optic disc
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33
Q

CRVO - investigations

A

OCT scan

- where the fovea dip is usually present, there is a ‘hill’ due to intra-retinal fluid build up over the fovea

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34
Q

CRVO - management

A

Laser treatment

Anti VEGF injections

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35
Q

Occlusion of optic nerve head circulation - definition

A

Posterior ciliary arteries (which supply optic nerve head) become occluded

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36
Q

Occlusion of optic nerve head circulation - types

A

Giant cell arteritis

Atherosclerosis

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37
Q

Occlusion of optic nerve head circulation - clinical features

A

Sudden, profound vision loss

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38
Q

Occlusion of optic nerve head circulation - ophthalmoscopy

A

Swollen disc
Pale disc
Margins are fluffy and not well defined

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39
Q

Vitreous haemorrhage - definition

A

Bleeding into the vitreous cavity

40
Q

Vitreous haemorrhage - clinical features

A

Sudden loss of vision
Floaters in the eye
Loss of red reflex

41
Q

Vitreous haemorrhage - ophthalmoscopy

A

Red areas

42
Q

Vitreous haemorrhage - management

A

Identify cause of haemorrhage

43
Q

Retinal detachment - clinical features

A

Painless
Sudden loss of vision
Sudden onset flashes and floaters

44
Q

Retinal detachment - ophthalmoscopy

A

Retinal tear

45
Q

Retinal detachment - management

A

Usually surgical

46
Q

wet ARMD - definition

A

Age related macular degeneration
New blood vessels grow under the retina and macula
This causes a break in the choroid layer and leakage causes a build up of fluid/blood which lifts the macula up from its normally flat position

47
Q

Wet ARMD - clinical features

A

Sudden vision loss
Central visual loss
Dark spots in the centre of pts vision due to blood/fluid under the macula
Symptoms are often unilateral to begin with but always end up bilateral

48
Q

Wet ARMD - ophthalmoscopy

A

Retinal oedema
Localised elevation
Exudates in and around macula
Detachment of retinal pigment epithelium

49
Q

Wet ARMD - management

A

Dietary supplements
Anti-VEGF injections
- stops new blood vessels from growing

50
Q

Dry ARMD - definition

A

Dry age related macular degeneration
Build up of waste products (drusen) below the retinal pigment epithelium which causes the retina to be pulled away from the choroid
There is no leakage of fluid and no blood

51
Q

Dry ARMD - clinical features

A

Gradual decline in vision

Central vision gets lost gradually (scotoma)

52
Q

Dry ARMD - ophthalmoscope

A

Yellow/white deposits

53
Q

Dry ARMD - management

A

Supportive treatment

Low vision aids (magnifiers)

54
Q

Cataract - definition

A

Clouding of the lens in the eye which leads to a decrease in vision

55
Q

Cataract - causes

A 
Age related 
Trauma 
Diabetes
Obesity 
Drug induced - SE of steroids
56
Q

Cataract - clinical features

A 
Gradual decline in vision
Hazy, blurred vision 
Faded colours 
Halos around light 
Trouble with bright light 
Trouble seeing at night
57
Q

Cataract - management

A

Surgical removal of lens with intra-ocular lens implant (if pt symptomatic)

58
Q

Diabetic retinopathy - types

A

Non proliferative

Proliferative

59
Q

Non proliferative diabetic retinopathy - definition

A

Early stage
Tiny blood vessels within the retina leak blood or fluid.
This causes retina to swell or deposits to form

60
Q

Non proliferative diabetic retinopathy - ophthalmoscopy

A 
Micro-aneurysm 
Dot and blot haemorrhages 
Hard exudates (yellow) 
Cotton wool patches 
Abnormalities of venous calibre 
Intra-retinal microvascular abnormalities (IRMA)
61
Q

Proliferative diabetic retinopathy - definition

A 
New vessel formation 
- may grow on disc (NVD)
- may grow elsewhere in retina (NVE)
Fibrosis 
Scarring (which shrinks the retina and pulls it off)
62
Q

Proliferative diabetic retinopathy - ophthalmoscopy

A

New vessel formation
- grows into the vitreous
Smal dot haemorrhages in macula
White/black laser scars

63
Q

Why do new vessels form in proliferative diabetic retinopathy?

A

Due to ischaemia

64
Q

Proliferative diabetic retinopathy - management

A 
Laser ischaemic tissue 
- sacrifice some of the peripheral retina in order to save the central retina 
PRP
- pan retino photocoagulation 
Macular grid

Ablate retina
Surgery

65
Q

Hypertensive retinopathy - definition

A

Hypertension must be very severe for this to occur

66
Q

Hypertensive retinopathy - ophthalmoscopy

A 
Cotton wool spots 
Hard exudates 
Retinal haemorrhages 
Optic disc oedema 
Weakened blood vessels
67
Q

Idiopathic intracranial hypertension - BP levels

A

Normal

68
Q

Idiopathic intracranial hypertension - ophthalmoscopy

A

Bilateral disc swelling

No crisp edge to the disc

69
Q

Glaucoma - definition

A

Progressive optic neuropathy

- optic nerve gets damaged by the pressure of the fluid inside your eye

70
Q

Glaucoma - cause

A

Increased intra-ocular pressure (IOP) causes damage to nerve fibres
This leads to optic nerve dysfunction

71
Q

Glaucoma - types

A

Open angle

Closed angle

72
Q

Glaucoma - ophthalmoscopy

A

Increased cup size due to loss of nerve fibres
Cup:Disc ratio >0.7
Other features of optic disc should be normal

73
Q

Glaucoma - management

A

Eye drops which decrease aqueous humour production (this decreased IOP) e.g. bimatoprost

Prostanoids eg latanoprost

Beta blockers - block ciliary body and therefore reduce aqueous humour production

Carbonic anhydrase inhibitors - block ciliary body and therefore reduce aqueous humour production

Parasympathomometic eg pilocarpine

Laser treatment

74
Q

Closed angle glaucoma - gradual/sudden vision loss

A

Sudden

75
Q

Closed angle glaucoma - definition

A

Aqueous humour struggles to get through the canal of schlemm and so backs up and builds up.
This pushes the iris forward and the iris further blocks the canal of schlemm
Pressure continues to increase
Plugging of drain as iris has anatomically blocked the drainage canal

76
Q

Closed angle glaucoma - clinical features

A 
Sudden vision loss
Painful, red eye 
Headache
Nausea
Vomiting 
Cloudy cornea
77
Q

Closed angle glaucoma - examination

A

Limbus injection of vessels
Cloudy cornea
Pupil mid dilated

78
Q

Open angle glaucoma - definition

A

Iridocorneal angle is open but there is clogging up of the canal of schlemm
Aqueous humour is not draining so the pressure increases and damage occurs
Clogged drain

79
Q

Open angle glaucoma - clinical features

A

Often asymptomatic

Gradual visual loss

80
Q

What is the commonest cause of blindness in the western world?

A

ARMD

81
Q

Which is more common: Wet or dry ARMD ?

A

Dry

82
Q

Anterior uveitis - clinical features

A 
Dull achy pain
- pain may be referred to brow 
red eye (limbus) 
Reduced vision
Photophobia
83
Q

Anterior uveitis - examination

A

Ciliary injection around the limbus
Hypopyon (clumps of white inflammatory cells)
Small or irregular pupil

84
Q

Anterior uveitis - management

A

Topical steroids

Mydratics - cyclopentolate

85
Q

Thyroid eye disease - extra ocular features

A 
Proptosis 
Lid retraction
Lid lag
Lid pigmentation
Swelling of periorbital fat
86
Q

Thyroid eye disease - ocular features

A

Chemosis (oedema of conjunctiva)

Glaucoma

87
Q

Blepharitis - anterior (name the 2 types)

A

Seborrhoeic

Staphylococcal

88
Q

Blepharitis - anterior - seborrhoeic

A

Scales on the lashes
Lid margin is more red than deeper part of lid
No ulceration

89
Q

Blepharitis - anterior - staphylococcal

A 
Infection involving the lash follicle
Lashes are distorted 
- ingrowing of lashes
Can get a sty 
Ulcers of lid margin
90
Q

Blepharitis - posterior

A 
Meibomian gland dysfunction
- lid margin and lashes unaffected
redness is in deeper part of lid 
Meibomian cysts 
Assoc with acne rosacea
91
Q

Episcleritis - associated condition

A

Gout

92
Q

Episcleritis - clinical features

A

Recurrent

Can cause nodular bumps on eye surface

93
Q

Episcleritis - management

A

Self limiting

94
Q

Scleritis - definition

A

Serious disease

Assoc with serious systemic vasculitides

95
Q

Scleritis - clinical features

A

Painful

96
Q

scleritis - management

A

Injection of deep vascular plexus
Phenylephrine test
Oral NSAIDs
Oral Steroids

Ophthalmology SOH (12 decks)

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