Ophthalmology conditions Flashcards
What are cataracts?
Opacification of the lens of the eye
What causes cataracts?
Most are idiopathic (age-related)
What are the secondary causes of cataracts?
Local previous disease (eye traume, uveitis)
Systemic: Diabetes, Metabolic (e.g. Wilson’s), skin disease (e.g. scleroderma), drugs (e.g. steroids)
Congenital: Congenital rubella syndrome
What are the symptoms for cataracts?
Gradual-onset painless loss of vision
Glare from bright light
Vision may worsen in bright light
Some may experience monocular diplopia with haloes around light
Some may begin ti be able to read without glasses
Why could cataracts make it so that old people can then read without glasses?
A sclerotic cataract may increase the lens’ converging power
What are the signs of cataracts?
Loss of red reflex
Hazy lens appearance
Reduced visual acuity
What investigations are done for cataracts?
Usually unnecessary
What is conjunctivitis?
Inflammaiton of the conjunctiva
What is it called when the cornea becomes involved in conjunctivitis?
Keratoconjunctivitis
What is it called when the eye lid becomes involved in conjunctivitis?
Blepharoconjunctivitis
What are the 2 categories that cause conjunctivitis?
Infectious
Non-infectious
What causes infectious conjunctivitis?
Viruses Bacteria - S. aureus - Strep. pneumonia - H. influenzae
What are the risk factors for conjunctivitis?
Contact with an infected person Uniocular conjunctivitis Allergens/irritants Contact lenses Atopy Floppy eyelid syndrome
What are the symptoms of conjunctivitis?
Red eye Irritation, discomfort and grittiness/stickiness Discharge - Purulent (bacterial cause) - Water (viral cause) - Mucoid (allergic cause) Photophobia (corneal involvement)
What are the signs of conjunctivitis?
Blood shot eyes Dilated conjunctival vessels Conjunctival chemosis (swelling) Conjunctival follicles (round lymphocytes visible on eye lid) Conjunctival papillae (Allergy)
What are the investigations of conjunctivitis?
Diagnosis from examination / history
What is Glaucoma?
Optic neuropathy with typical field defect, usually associated with ocular hypertension >21 mmHg
What are the 2 main categories of glaucoma?
Open angle glaucoma
Closed angle glaucoma
What is open angle glaucoma?
Angle between iris and cornea is open but drainage is blocked, potentially due to blood or inflammatory cells
What is closed angle glaucoma?
Angle between iris and cornea is closed and the lens is pushed forwards.
This causes ocular hypertension which compresses/stretches the retinal nerve fibres causing visual disturbances
What are the primary causes of glaucoma?
Acute Closed-angle glaucoma (ACAG)
Chronic closed angle glaucoma (CCAG)
Primary open-angle glaucoma (POAC)
What are the secondary causes of glaucoma?
Trauma
Uveitis
Steroids
Rubeosis iridis (formation o fnew blood vessels on the surface of the iris)
Buphthalmos (Enlargement of eye ball congenitally)
What are the risk factors for open angle glaucoma?
> 50 years old
Family history
Afro-carribean ethnicity
What are the risk factors for closed angle glaucoma?
Female
Hyperopia (smaller anterior chamber)
Inuit/asian ethnicity
What are the symptoms of Acute Closed Angle Glaucoma?
Painful red eye
Vomiting
Impaired vision
Haloes seen around lights
What are the signs of acute closed angle glaucoma?
Red eye Hazy cornea Loss of red reflex Fixed and dilated pupil Eye is tender and hard on palpation Cupper optic disdc Visual field defect Moderated raised intra-ocular pressure
What are the symptoms of Primary open-angle glaucoma?
Asymptomatic
Peripheral visual field loss
What are the signs of primary open-angle glaucoma?
Potential disc cupping
What are the symptoms of congenital Glaucoma?
Buphthalmos
Watering
Cloudy cornea
What investigations are done for glaucoma?
Goldmann applanation tonometry to measure intra-ocular pressure (>21)
Slit-lamp biomicroscopy (ACAG shows shallow anterior chamber)
Gonioscopy (ACAG shows invisible trabecular meshwork)
Automatic static perimetry to test visual field (scotomas - visual field loss)
Pachymetry to measure central corneal thickness (CCT<590mm)
What is Uveitis?
Inflammation of the iris and ciliary body
What causes uveitis?
May be caused by infection (e.g. Herpes simplex)
May be a manifestation of systemic conditions (e.g. Reactive arthritis, Ankylosing spondylitis, IBD, sarcoidosis, behcet’s disease)
Sympathetic ophthalmia
What is sympathetic ophthalmia?
Inflammation of the contralateral eye weeks/months after penetrating injury
What causes sympathetic ophthalmia?
Recognition of eye antigens in the contralateral eye by T-cells that were activated by the initial penetrating injury to the eye
What are the risk factors for Uveitis?
Inflammation of Joints/Bowel/Skin
HLA-B27 positive
Ocular trauma
What are the symptoms of Uveitis?
Pain due to inflammation/during accomodation
Photophobia
Red eyes
Blurred vision
Lacrimation
Rarely associated with tubulointerstitial nephritis (flank pain, haematuria, proteinuria)
What are the signs of Uveitis?
Reduced visual acuity
Ciliary flush
Hypopyon (exudate and inflammatory cells in the inferior angle of the anterior chamber)
Small irregular pupil due to adhesions of the iris to the lens
Fundoscopy (exclude detachment)
Signs of complications (Increased IOP, cataract)
Signs of underlying aetiology
What are the investigations for Uveitis?
Investigations for associated systemic conditions
