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Fourth Year > Ophthalmology Conditions > Flashcards

Ophthalmology Conditions Flashcards

1
Q

Dry eye syndrome can result from a deficiency in? (3)

A

Any of the three components of the tear film i.e.:

  1. Outer lipid layer.
  2. Middle aqueous layer.
  3. Inner mucin layer.
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2
Q

How does aqueous tear deficiency (aka Keratoconjunctivitis sicca) cause severely dry eyes?

A

Lacrimal gland dysfunction.

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3
Q

Causes of lacrimal gland dysfunction?

A
  1. Inflammation - especially autoimmune.
  2. Scarring of secretory ducts.
  3. Excision of lacrimal gland.
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4
Q

How does keratoconjunctivitis sicca differ from Primary Sjogren’s syndrome?

A

Pure keratoconjuctivitis sicca only involves the lacrimal gland.

Sjogen’s - involves other gland e.g. salivary.

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5
Q

How does secondary Sjogren’s differ from primary?

A

Secondary occurs in conjunction with a systemic autoimmune disorder e.g. RA.

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6
Q

How does mucin deficiency i.e. xeropthalmia occur?

A

Large numbers of goblet cells are damaged by extensive conjunctival scarring e.g. alkali burns, cicatrising conjunctival disease), hypovitaminosis A.

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7
Q

Consequences of severe dry eyes?

A
  • Corneal epithelial loss.
  • Scarring.
  • Vascularisation.
  • Corneal thinning (melt) - rare.
  • Corneal perforation - rare.
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8
Q

How is dry eye syndrome managed?

A
  • Humidifying environment/ reducing tear evaporation by altering glasses.
  • Tear supplements.
  • Lacrimal punctal occlusion - temporary (silicone plugs) or permanent (cautery).
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9
Q

How might inappropriate watering of the eye arise?

A
  1. Failure of lacrimal drainage system - epiphora.

2. Oversecretion of tears - lacrimation.

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10
Q

Failure of the lacrimal pump to allow drainage is usually due to?

A
  • Facial nerve palsy.

- Ectropion.

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11
Q

Causes of inadequate lacrimal drainage?

A
  • Obstruction.

- Lacrimal pump failure.

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12
Q

Signs of nasolacrimal duct obstruction?

A
  • Mucocele of lacrimal sac.
  • Dacrocystits.
    Both of which appear at medial canthus.
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13
Q

What is a mucocele of the lacrimal sac?

A

Non-infected swelling of the lacrimal sac.

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14
Q

What is dacrocystitis?

A

Lacrimal sac infection.

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15
Q

Causes of watering eyes?

A
  • Blepharitis.
  • Dry eyes (paradoxically).
  • Entropion, ectropion and ingrowing eyelashes.
  • Congenital or acquired nasolacrimal duct obstruction (e.g. dacrocystitis, mucocele).
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16
Q

What is proptosis?

A

Forward displacement of the eye due to a space occupying effect.

17
Q

Lesions where would cause axial proptosis?

A

Behind the eyeball.

18
Q

Lesions where would cause non-axial proptosis?

A

Lesions not behind the eyeball (e.g. lacrimal gland tumour, mucocele).

19
Q

Thyroid eye disease is usually associated with which conditions?

A

Hyperactive thyroid e.g. Graves disease or Graves ophthalmopathy.

20
Q

What causes thyroid eye disease?

A

infiltration of orbital tissues by inflammatory cells and oedema.

21
Q

What are the main symptoms of thyroid eye disease?

A
  • Proptosis.
  • Diplopia.
  • Lid lag and retraction.
22
Q

More severe consequences of thyroid eye disease?

A
  • Corneal exposure leading to vision loss.

- Optic nerve compression leading to vision loss.

23
Q

Management of thyroid eye disease?

A

TREATMENT OF UNDERLYING THYROID DYSFUNCTION DOES NOT INFLUENCE THE COURSE OF OCULAR DISEASE.

  • Lubrication.
  • Diplopia: prisms, surgery.
  • Retraction: surgery.
  • Severe proptosis and optic nerve compression (-> vision loss): Systemic immunosuppression, orbital RTx, surgical orbital decompression.
24
Q

Infection within the orbit is usually associated with infection where?

A

Paranasl sinus.

25
Q

symptoms/ signs of orbital cellulitis?

A
  • Proptosis.
  • Reduced ocular movement.
  • Redness and swelling of eyelid.
  • Conjunctival injection.
  • Systemic signs of infection e.g. pyrexia, malaise.
26
Q

What are the most likely causative organisms of orbital cellulitis?

A
  • Haemophilus influenzae (young children esp.).
  • Strep. pneumoniae.
  • Anaerobes.
27
Q

How is orbital cellulitis treated?

A

IV ABx immediately to prevent intracranial spread and sight loss.

28
Q

Failure to respond to IV antibiotics in orbital cellulitis likely indicates what?

A

Development of an orbital abscess - CT.

29
Q

Eye displacement backwards is known as?

A

Enophthalmos.

30
Q

Entrapment of orbital tissues within a fracture site (floor) leads to double vision, worse on?

A

Up- and down-gaze.

31
Q

Signs of orbital wall fracture and entrapment of orbital tissues?

A
  • Hx of trauma e.g. squash ball.
  • Diplopia worse on up- and down-gaze.
  • Initial haematoma.
  • Enophthalmos.
  • Altered cheek sensation if infraorbital nerve damaged.
32
Q

Why should systemic antibiotics be given for orbital wall fractures?

A

They are essentially compound fractures.

Fourth Year (28 decks)

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