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FINALS REVISION > Ophthalmololology > Flashcards

Ophthalmololology Flashcards

1
Q

What is glaucoma?

A

optic neuropathy, usually due to raised intra-ocular pressure

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2
Q

what is acute angle closure glaucoma

A

optic nerve damage secondary to rise in intra-ocular pressure due to impairment in aqueous fluid outflow

iris bulges forward and seals off trabecular meshwork

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3
Q

what are the RFs for AACG

A

hypermetropia
lens growth with age
pupillary dilatation
shallow anterior chamber, chinese ethnicity

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4
Q

what symptoms of AACG

A
  • painful red eye
  • headache
  • blurry vision
  • worse on mydriasis (pupil dilation) (TV in dark)
  • dull cornea (corneal oedema)
  • hard, red eye
  • haloes around lights
  • fixed semi-dilated pupil
  • systemic upset - nausea, vomiting, abdo pain
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5
Q

what initial treatment of AACG

A
  • lie patient on back without pillow
  • pilocarpine eye drops
  • acetozolamide
  • timolol
  • analgesia and anti-emetic
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6
Q

what secondary care treatment of AACG

A
  • pilocarpine
  • acetozolamide
  • hyperosmotic agents (mannitol/glycerol)
  • timolol
  • dorzolamide
  • brimonidine
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7
Q

what surgical treatment for AACG

A

bilateral laser iridotomy

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8
Q

how does pilocarpine work

A

miotic agent
works on muscarinic receptors in iris sphincter, causes constriction of pupil
also causes ciliary muscle contraction

both actions cause pathway to open up for fluid to leave through trabecular meshwork

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9
Q

how does acetozolamide work

A

carbonic anhydrase inhibitor

- reduces aqueous fluid production

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10
Q

how does timolol work

A

beta blocker reduces aqueous fluid production

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11
Q

how does brimonidine work

A

sympathomimetic, reduces aqueous fluid production

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12
Q

what investigation for AACG

A

gonioscopy and tonometry

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13
Q

what complications of AACG

A

sight loss

central retinal artery/vein occlusion

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14
Q

what is blepharitis associated with

A

rosacea

seborrheic dermatitis

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15
Q

what eye drops in blepharitis

A

hypromellose
polyvinyl alcohol
carbomer

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16
Q

what symptoms of blepharitits

A 
bilateral grittiness discomfort
eyelid margins red
swollen eyelid
sticky eye in morning
styes and chalazions
secondary conjunctivitis
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17
Q

what are cataracts

A

cloudiness and opacification of lens

reduced light entering through lens

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18
Q

what are the symptoms of cataracts

A 
gradual onset: 
reduced vision
faded colour vision
glare - lights appear brighter than usual
haloes around lights
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19
Q

what key sign of cataracts

A

loss of red reflex

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20
Q

what investigations for cataracts

A

ophthalmoscopy - normal fundus and optic nerve

slit lamp - cataracts visible

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21
Q

what RFs for cataracts

A 
age
smoking
alcohol
trauma
diabetes
long term steroids
radiation exposure
myotonic dystrophy
hypocalcaemia
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22
Q

what mgmt of cataracts

A

conservative if mild symptoms

cataract replacement surgery

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23
Q

what complications following cataract surgery

A

endopthalmitis
retinal detachment
posterior capsule rupture
posterior capsule opacification

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24
Q

how is endopthalmitis treated

A

intravitreal antibiotics

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25
Q

what happens if endopthalmitis is untreated

A

loss of vision/loss of eye itself

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26
Q

which classification of cataract is most associated with steroid use

A

subcapsular

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27
Q

what are the two main causes of central retinal artery occlusion

A

thrombosis secondary to atherosclerosis

giant cell arteritis

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28
Q

what are the RFs for central retinal artery occlusion

A

same RFs as atherosclerosis (smoking hyperlipidaemia HTN obesity diabetes age FH gender etc.)

GCA/PMR

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29
Q

how does central retinal artery occlusion present

A

sudden painless loss of vision

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30
Q

what investigations for central retinal artery occlusion and what findings

A

fundoscopy - pale retina and cherry red spot (macula)

ESR raised
temporal artery biopsy if GCA suspected

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31
Q

what management for central retinal artery occlusion

A 
GCA - prednisolone 60mg
thrombosis
- ocular massage
- removal of fluid from anterior chamber to decrease IOP
- carbogen (dilates artery)
- isosorbide dinitrate (dilate artery)
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32
Q

what long term management of central retinal artery occlusion

A

treat RFs

secondary prevention of cardiovascular disease

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33
Q

what is conjunctivitis and how does it present

A

inflammation of conjunctiva
presents with:
sore gritty red eyes with sticky discharge

NOT PAINFUL
no photophobia/visual loss

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34
Q

what are the two main causes of infectious conjunctivitis and how do they present

A

bacterial - sticky purulent discharge

viral - serous discharge, preauricular lymphadenopathy, associated with recent URTI

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35
Q

how is bacterial conjunctivitis treated

A

usually resolves within 2 weeks
advise on good hygiene to avoid spreading
- no sharing towels
- no contact lens
- no school exclusion
- clean eyes with cooled boiled water and cotton wool
topical chloramphenicol eyedrops (fucidic acid if preg)

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36
Q

how is neonatal conjunctivitis treated

A

if under 1m, urgent ophthalmology review
associated with gonococcal infection
can cause loss of sight/pneumonia

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37
Q

how is allergic conjunctivitis treated

A

topical antihistamines or mast cell stabilisers (sodium cromoglicate)
avoid contact with allergens

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38
Q

how does allergic conjunctivitis present and how is it treated

A 
bilateral symptoms
itchy red eyes
swelling of conjunctival sac and eyelid
history of atopy
may be seasonal/perennial (dust mite etc.)

treatment:
avoid contact with allergens
1st line: topical/oral antihistamines
2nd line: sodium cromoglicate (mast cell stabiliser, takes weeks to work)

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39
Q

explain the pathophys of diabetic retinopathy and the findings on ophthalmoscopy

A

chronic hyperglycaemia causes damage to retinal vasculature and endothelial cells.
this increases vascular permeability, leading to:

  • hard deposits
  • blot haemorrhages
  • microaneurysms
  • venous beading
  • cotton wool spots (nerve fibre damage, retinal infarction (pre-capillary arteriolar occlusion))
  • intraretinal microvascular abnormalities
  • neovascularisation
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40
Q

what are the three classifications of diabetic retinopathy

A

non-proliferative and proliferative

non-proliferative:

  • hard deposits
  • microaneurysms
  • blot haemorrhages
  • cotton wool spots
  • venous beading
  • severe: intraretinal microvascular abnormalities

proliferative:

  • neovascularisation
  • vitreous haemorrhage
  • fibrous tissue forming anterior to retinal disc

diabetic maculopathy

  • macular oedema (hard to read, distinguish faces)
  • ischaemic maculopathy
41
Q

what is the 4-2-1 rule of severe non-proliferative diabetic retinopathy

A
  • blot haemorrhages + microaneurysms in all 4 quadrants
  • venous beading in at least 2 quadrants
  • intraretinal microvascular abnormalities in any quadrant
42
Q

what treatment for all patients with diabetic retinopathy

A
  • optimise glycaemic control, BP, lipid levels

- regular ophthalmology review

43
Q

what treatment for patients with diabetic maculopathy

A

if reduced visual acuity

- VEGF inhibitors

44
Q

what treatment for non-proliferative diabetic retinopathy

A

if severe/very severe:

- panretinal laser photocoagulation

45
Q

what treatment for proliferative DR?

A
  • panretinal laser photocoagulation
  • intravitreal VEGF inhibitors
  • vitreous haemorrhage - vitroretinal surgery
46
Q

what symptoms of diabetic retinopathy

A
  • floaters (result of small haemorrhages)
  • blurred vision and distortion (central vision if macula affected)
  • decreased visual acuity
  • loss of vision (severe haemorrhage -> sudden)
  • blindness
47
Q

what investigations in diabetic retinopathy

A

slit lamp ophthalmoscopy

visual acuity testing (baily-lovie chart)

48
Q

what is most common cause of visual loss in patients with diabetic retinopathy

A

diabetic macular oedema

49
Q

give two examples of VEGF inhibitors

A

ranibizumab

bevacizumab

50
Q

what is posterior vitreous detachment and how does it present

A

detachment of posterior vitreous membrane from retina

  • sudden painless floaters
  • flashes of light
  • blurred vision
  • cobwebs
  • curtain coming down indicates retinal detachment
51
Q

what investigations for posterior vitreous detachment

A

ophthalmoscopy - weiss ring

urgent referral to ophthalmoscopy to exclude retinal tear/detachment

52
Q

how is posterior vitreous detachment treated

A

will resolve naturally within 6 months

if retinal tear/detachment - surgical treatment

53
Q

what are the complications of vitreous detachment

A

vitreous haemorrhage

retinal detachment

54
Q

how is diabetic maculopathy treated

A

intravitreal VEGF-inhibitors if there is a change in visual acuity

55
Q

what is retinal detachment and what is the most common pathyophys

A

separation of retina from choroid underneath
rhegmatogenous - tear in retina allows vitreous fluid to enter space between choroid and retina and separate the two layers

56
Q

what RFs for retinal detachment

A
  • age
  • myopia
  • previous cataract surgery
  • posterior vitreous detachment
  • eye trauma
  • family history
  • previous retinal tear/detachment in either ear
57
Q

how does retinal detachment present

A

sudden painless loss of peripheral vision (curtain coming down)
flashes/floaters
blurred/distorted vision
visual acuity may be reduced to hand movements if macular involvement

58
Q

what is the immediate mgmt of suspected retinal detachment

A

immediate referral to ophthalmology

  • slit lamp
  • indirect ophthalmoscopy, pigment cells, vitreous haemorrhage
  • red reflex lost on fundoscopy
59
Q

what examination and investigation findings would you expect in retinal detachment

A
  • reduced peripheral visual acuity
  • central acuity reduced to hand movements if macular involvement
  • RAPD if optic nerve involvement
  • red reflex lost on fundoscopy
  • retinal folds pale, opaque, wrinkled
  • fundoscopy may appear normal if small break?
60
Q

what treatment for retinal tears

A
  • cryotherapy

- laser therapy

61
Q

what treatment for retinal detachment

A

vitrectomy
scleral buckling
pneumatic retinoplexy

62
Q

what is periorbital/preseptal cellulitis

A

infection of tissues anterior to orbital septum

63
Q

how does periorbital cellulitis present

A

swollen painful red eye
swollen red eyelid
may get ptosis

64
Q

how does orbital cellulitis present

A 
chemosis
proptosis
painful, restricted eye movements
proptosis
RAPD
65
Q

what investigations for periorbital cellulitis

A
  • raised inflammatory markers
  • swab any discharge
  • contrast CT orbit if orbital cellulitis suspected
66
Q

what is the mgmt for periorbital cellulitis

A

secondary care referral
admit for monitoring
oral Abx - co-amox

67
Q

what RFs for orbital cellulitis

A
  • recent URTI
  • previous sinus infection
  • lack of Hib vaccination
  • periorbital cellulitis
  • ear/facial infection
68
Q

how does orbital cellulitis present

A
  • redness and swelling around eye
  • severe eye pain
  • painful eye movements/ophthalmoplegia
  • reduced visual acuity
  • proptosis
  • nausea, vomiting, drowsiness
  • RAPD
69
Q

how is orbital cellulitis diagnosed

A
  • FBC - WCC raised CRP raised
  • ophthalmological assessment
  • CT with contrast - inflammation of orbital tissues deep to septum. Sinusitis
  • Blood cultures and culture of swab for organism
70
Q

how is orbital cellulitis managed

A

admit to hospital for IV Abx

surgical drainage if abscess

71
Q

what is open angle glaucoma

A

increased resistance through the trabecular meshwork
decreased outflow of aqueous humour.
gradual increase in IOP

72
Q

what are the RFs for open angle glaucoma

A

age
FH
afrocaribbean
myopia

73
Q

what are the symptoms of open angle glaucoma

A
  • gradual onset tunnel vision
  • blurred vision
  • headaches
  • gradual onset fluctuating pain
  • haloes worse at night
74
Q

what screening investigation for open angle glaucoma

A

non-contact tonometry

75
Q

what are the main gold-standard investigations for open angle glaucoma

A
  • goldmann applanation tonometry (>21mmHg)
  • fundoscopy (cupping of optic disc)
  • visual field testing (peripheral visual loss)
76
Q

what treatments for open-angle glaucoma

A
  1. latanoprost
  2. timolol
  3. dorzolamide
  4. brimonidine

trabeculectomy

77
Q

how does latanoprost work and what side effects

A

latanoprost is prostaglandin analogue

- increases uveoscleral outflow

78
Q

how does timolol work

A

beta blocker

- reduces production of aqueous humour

79
Q

how does dorzolamide work

A

carbonic anhydrase inhibitor

- reduces production of aqueous humour

80
Q

how does brimonidine work

A

sympathomimetic

- reduce production of aqueous humour AND increases uveoscleral outflow

81
Q

what is keratitis

A

inflammation of cornea

82
Q

what are the symptoms of keratitis

A
  • painful red eye
  • gritty, foreign body sensation
  • photophobia
  • hypopyon may be seen
83
Q

what are the different types of keratitis

A

bacterial

  • S. Aureus
  • Pseudomonas in contact lens wearers

amoebic
- acanthamoebic keratitis (soil, contaminated water)

  • fungal
  • parasitic
  • viral (herpes simplex keratitis)
84
Q

what management for bacterial keratitis

A
  • refer to ophthalmology as sight threatening
  • stop wearing contact lenses until symptoms fully resolved
  • topical Abx - quinolones (ciprofloxacin)
  • cycloplegics for pain relief (cyclopentolate)
85
Q

what complications of keratitis

A

corneal scarring
visual loss
endophthalmitis
perforation

86
Q

what is herpes keratitis

A

caused by herpes simplex

87
Q

what symptoms of herpes keratitis

A
  • painful red eye
  • eye watering
  • foreign body sensation
  • photophobia
  • reduced visual acuity
  • vesicles around eye
88
Q

what investigations for herpes keratitis

A

fluorescein staining - dendritic ulceration
slit-lamp examination required to diagnose
swabs for viral culture/PCR

89
Q

what management for herpes keratitis

A
  • urgent same day ophthalmology referral
  • topical acyclovir
  • ganciclovir gel
  • topical steroids if stromal keratitis
    corneal transplant may be required if scarring due to stromal keratitis
90
Q

what is iritis/ant uveitis

A

inflammation of iris and ciliary bodies

91
Q

what RFs for ant uveitis

A 
HLA-B27
TB
sarcoidosis
HSV
syphilis
Lyme disease
Behcet's (HLA-B51)

can also be trauma, infective, ischaemic, malignancy related

92
Q

what symptoms/signs of ant uveitis

A
  • painful red eye, worse on movement
  • blurred vision
  • floaters and flashes
  • lacrimation
  • photophobia (ciliary muscle spasm)
  • miosis (small pupil)
  • irregular pupil (posterior synechiae)
  • ciliary flush
  • hypopyon
93
Q

what investigations for anterior uveitis

A

full slit-lamp assessment

94
Q

what management in ant uveitis

A

urgent ophthalmology referral

cycloplegic-mydriatics
- cyclopentolate/atropine eye drops
steroid eye drops

DMARDs, TNF inhibitors
vitrectomy, laser surgery, cryotherapy

95
Q

how does cyclopentolate work in ant uveitis

A

anti-muscarinic

relaxes pupil

96
Q

what does cycloplegic mean and how is it relevant in ant uveitis

A

antimuscarinic
paralyses ciliary muscle
stops ciliary muscle spasm and associated pain

97
Q

what does mydriatic mean

A

dilates pupils

reduces pain

98
Q

what complications of ant. uveitis

A

cataracts

visual loss

FINALS REVISION (17 decks)

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