Ophthalmology Conditions Flashcards
how does blepharitis present?
gritty eyes
bilateral
anterior ve posterior blepharitis?
anterior = usually a bacterial infection (Staph)
dandruff in eyelashes
posterior = meibomian gland dysfunction, glands become blocked so tear film becomes unstable
how is blepharitis managed?
primarily targeted at lid hygiene
warm compress
artificial tears for comfort
bacterial conjunctivitis?
thick sticky discharge
red eye
usually unilateral but progresses to bilateral
papillae
what usually causes bacterial conjunctivitis?
staph aureus
strep pneumonia
h. influenzae (esp children)
how is bacterial conjunctivitis managed?
usually self limiting
chloramphenicol drop if severe or persistent
how does viral conjunctivitis present?
watery discharge
may have had a recent cold/URTI
follicles on lids
what usually causes viral conjunctivitis?
adenovirus
how is viral conjunctivitis managed?
self limiting but very contagious
good lid hygiene
how does chlamydial conjunctivitis present?
on-going red eye (2 or more weeks)
rice grain follicles on lids
unresponsive to previous treatment
how is chlamydial conjunctivitis managed?
oxytetracycline
what condition may present with blue/green discolouration in the eye?
keratitis
how does keratitis present?
pain usually unilateral redness photophobia reduced vision epiphora
characteristic feature of bacterial keratitis? how is this managed?
hypopyon
required debridement and admission for hourly drops of fluroquinolones
requires corneal scrape to determine antibiotic sensitivities
what usually causes viral keratitis and how does this present?
adenoviral
herpes simplex = terminal end bulbs
herpes zoster = involvement of ophthalmic division of the trigeminal nerve (unilateral vesicular rash, Hutchinson’s sign)
how is viral keratitis managed?
HSV = acyclovir HZ = ocular lubricants and systemic pain relief
main risk factor for keratitis?
contact lens wearer
how does anterior uveitis present?
pain
circumlimbal redness
reduced vision (especially accommodation)
photophobia (can be recurring)
what are the 5 types of anterior uveitis?
autoimmune infective (HSV, HZ) malignancy trauma idiopathic
which autoimmune conditions are associated with anterior uveitis?
reiters (reactive arthritis)
UC
ankylosing spondylitis
sarcoidosis
what is reiters syndrome?
reactive arthritis with triad
- uveitis
- urethritis
- arthritis
signs of anterior uveitis on investigation?
cells and flare in anterior chamber seen on slit lamp investigation
keratic precipitates
hypopyon
synechiae (misshapen pupil)
how is anterior uveitis managed?
topical steroids (prednisolone acetate) and cyclopentolate
how does cataract present?
gradual deterioration (over several years) in vision
glare
painless
opacity in the lens
what can cause cataract?
most are age related
congenital
traumatic
drug induced
how is cataract managed?
surgery
lens replacement
what is glaucoma?
group of diseases characterised by progressive neuropathy resulting in characteristic visual field defects due to damage to individual bundles of nerve fibres in the optic nerve head)
what increases risk of angle closure glaucoma?
+ve family history
Chinese ethnicity
shallow anterior compartment
hypermetropic eye prescription
how does angle colure glaucoma present?
sudden pain nausea vomiting often in the evening pupil mid-dilated redness cells and flare very high intraocular pressure (40+ mmHg)
how is angle closure glaucoma managed?
pilocarpine and acetazolamide
peripheral iridotomy
what are the important 3 Cs in assessing glaucoma?
contour
colour
cup
(when looking at the optic disc)
what are the 3 classifications of diabetic retinopathy?
no retinopathy
non-proliferative (mild, mod, severe)
proliferative
describe the 3 stages of diabetic retinopathy
background retinopathy = microaneurysms, microhaemorrhages, hard exudates
pre-proliferative = cotton wool spots, dot and blot haemorrhages, abnormalities in venous calibre
proliferative = new vessel formation on fundus, can have rubeosis iridis (new vessels on the irido-corneal angle)
how is diabetic retinopathy managed?
optimise medical management of diabetes
lasers (sacrifice peripheral retina to maintain central vision)
surgery (vitrectomy) - to prevent traction on new blood vessels causing haemorrhage
dry vs wet macular degeneration?
dry = most common, no treatment but less severe than wet, drusen visible on examination wet = sudden loss of central vision, distortion of straight lines, haemorrhage and exudates
risk factors for ARMD?
female
Caucasian
age
smoking
treatment for wet ARMD?
anti VEGF injections
how does retinal detachment present?
sudden reduced vision like veil/curtain coming down
flashing lights
floaters
painless
may have history of trauma
may have RAPD
detachment is often visible on examinaiton
how is retinal detachment treated?
emergency surgery
how does central retinal artery occlusion present?
sudden painless loss of vision RAPD may have carotid artery disease cherry red spot rarely recovers
how does branch retinal vein occlusion?
may be asymptomatic or be aware of a blind spot
often history of uncontrolled hypertension
how does central retinal vein occlusion present?
visual loss
how is central retinal vein occlusion managed?
anti VEGF
address risk factors
what is amaurosis fugax?
transient central retinal artery occlusion
transient complete loss of vision
short duration (few mins) followed by a full recovery
how does giant cell arteritis present?
headache
jaw claudication
scalp tenderness
malaise
can affect the eyes
- arteritic ischaemic optic neuropathy (AION)
- non-arteritic ischaemic optic neuropathy (NAION)
how does AION present?
sudden visual loss (severe)
pale, swollen optic disc
how is AION managed?
irreversible but emergency treatment with steroids to prevent bilateral vision loss
how does NAION present?
hyperaemic
swelling
altitudinal visual field defect
atherosclerosis
how is NAION managed?
treat the cause
what is papilloedema and how does it present?
optic disc swelling secondary to raised ICP nausea vomiting headaches transient visual loss enlarged blind spot may have CN VI palsy due to raised ICP usually in young females with high BMI
how is papilloedema managed?
identify cause (usually benign intracranial hypertension) best treatment = weight loss acetazolamide also an option
what condition is the patient likely to have is they have optic neuritis?
multiple sclerosis
how does 4th nerve palsy present?
will struggle to focus down and in (think walking downstairs while reading)
how will a 6th nerve palsy present?
poor abduction of eye
common story in sub-conjunctival haemorrhage?
red eye
noticed it waking up this morning
no pain
normal vision
