ophtho questions Flashcards
investigations angle-closure glaucoma
- gonioscopy (assesses angle between iris and cornea)
- tonometry
investigations angle-closure glaucoma
- gonioscopy (assesses angle between iris and cornea)
- tonometry
presentation acute angle closure glaucoma
- severely painful red eye
- blurred vision
- halos around lights
- associated headache, nausea and vomiting
- pupil in fixed dilated position
presentation cataracts
gradual onset:
- reduced vision
- faded colour
- glare
- halos around lights
- defect in red reflex
presentation cataracts
gradual onset:
- reduced vision
- faded colour
- glare
- halos around lights
- defect in red reflex
what is hutchinson’s sign in opthalmology
- rash seen in herpes zoster
- on tip or side of nose -> strong risk factor for ocular involvement
main cause optic neuritis
- multiple sclerosis
presentation retinal detachment
- painless
- peripheral vision loss - ‘curtain over visual field’
- blurred or distorted vision
- flashes and floaters
risk factors retinal detachment
- diabetes mellitus
- myopia (short sighted)
- age
- previous surgery for cataracts
- trauma
management anterior uveitis
steroid + cycloplegic eyedrops
presentation optic neuritis
- visual loss
- periocular pain
- reduced colour vision
- pain on eye movement
grading - diabetic retinopathy
- non-proliferative
- mild - microaneurysms
- moderate - microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading
- severe - blot haemorrhages + microaneurysms in 4 quadrants, venous beading in 2 quadrants, IMRA in any quadrant
- proliferative
- neovascularisation
- vitreous haemorrhage
- diabetic maculopathy
- macular oedema
- ischaemic maculopathy
presentation primary open angle glaucoma
- tunnel vision
what are drusen?
yellow deposits of protein and lipids on the macula
high numbers seen in ARMD
which is more common - wet vs dry ARMD
dry
characterised by drusen
management dry AMRD
avoid smoking
control blood pressure
anti-oxidant vitamin supplementation + zinc
pathophysiology OAG
increase resistance in trabecular meshwork, aqueous humour can’t exit eye
risk factors POAG
raised IOP
myopia
afro-caribbean
steroids
diabetes
presentation OAG
superior before inferior vision loss -> tunnel vision
cup:disk ratios (normal + definition cupping)
normal <0.3
cupping >0.7
investigations POAG
golfmann applanation tonometry - gold standard
non-contact tonometry (puff of air)
fundoscopy
management POAG
first line - surgical - 360 degree laser trabeculoplasty
latanoprost - increase uveoscleral outflow
beta-blockers e.g. timolol
carbonic anhydrase inhibitors e.g. dorzolamide
sympathomimetics e.g. brimonidine
risk factors AACG
increasing age
female
east asian
fhx
long sightedness/hypermetropia
presentation AACG
severe painful red eye
blurred vision
halos around lights
ass. headache, nausea and vomiting
pupil in fixed dilated position
investigations AACG
gonioscopy - assess angle between iris and cornea
goldmann applanation tonometry
management AACG
eye drops - parasympathomimetic (pilocarpine), beta-blockers, alpha-2 agonist (brimonidine)
IV acetazolamide
laser peripheral iridotomy
presentation blepharitis
bilateral
gritty, itchy, dry
sticky eyes in morning
styes + chalazions more common
presentation cataracts
painless loss of vision - asymmetrical
starbursts around lights, at night
loss of red reflex
complications cataract surgery
endophthalmitis
management endophthalmitis
vancomycin
what is the central retinal artery a branch of?
ophthalmic artery, branch of internal carotid
presentation central retinal artery occlusion
sudden onset painless loss of vision
relative afferent pupillary defect
cherry red spot on fundoscopy
causes central retinal artery occlusion
atherosclerosis
giant cell arteritis
management central retinal artery occlusion
ocular massage
removing fluid from anterior chamber
inhaling carbogen
sublingual isosorbide dinitrate
what is ophthalmia neonatorum
infection of conjunctiva contracted by neonates due to chlamydia or gonorrhoea passed from mother
causes keratitis
viral - herpes simplex
bacterial - pseudomonas (contact lenses) or staph
fungal - candida
exposure keratitis
presentation bacterial keratitis
painful red eye
foreign body sensation
corneal ulcer
presentation herpes keratitis
painful red eye
foreign body sensation
vesicles around eye
diagnosis herpes keratitis
stain with fluorescin
corneal swabs or scrapings isolate virus
treatment optic neuritis
IV methylprednisolone
investigations peri-orbital/orbital cellulitis
CT orbit
blood tests
peri-orbital vs orbital cellulitis
peri-orbital
- no proptosis
- normal eye movements
- no chemosis
- normal optic nerve function
presentation retinal detachment
painless
peripheral vision loss - curtain over visual field
blurred or distorted vision
flashes and floaters
risk factors retinal detachment
DM
myopia
age
previous cataract surgery
investigation retinal detachment
ultrasound
management retinal detachment
urgent referral to opthalmology
laser therapy
reattach retina
presentation retinal vein occlusion
painless loss of vision or visual field defect
more gradual than CRAO
on fundoscopy - stormy sunset
presentation scleritis
painful red eye
pain on eye movement
worse at night
eye watering
ass. with rheum conditions
risk factors scleritis
rheumatoid arthritis
SLE
sarcoidosis
granulomatosis with polyangiitis
management scleritis
NSAIDs
corticosteroids for severe/necrotising scleritis
episcleritis presentation + management
segmental redness
mild/no pain
manage with analgesia, cold compress, safety netting
what treatment is contraindicated in thyroid eye disease?
radioactive iodine ablation therapy
what is in uveal tract
choroid
ciliary body
iris
presentation anterior uveitis/iritis
painful red eye - dull pain
photophobia
blurred vision
floaters and flashers
lacrimation
posterior synechiae pull iris into abnormal shapes
cloudiness aqueous humour
management anterior uveitis
ophthalmologist referral
cycloplegic mydriatic drops
features hypertensive retinopathy
arteriovenous nipping - arteries crossing veins
hard exudates - lipids leaked into retina
retinal haemorrhages
cotton wool spots - ischaemia in retina damaging nerve fibres
papilloedema
features diabetic retinopathy
blot haemorrhages + hard exudates
venous beading
cotton wool spots
neovascularisation
management orbital cellulitis
IV cefotaxime or clindamycin
indications for referral to ophthalmology RE foreign body
high velocity injury
sharp object
significant orbital or peri-ocular trauma
chemical injury
organic material e.g. seed, doil
red flags
management proliferative diabetic retinopathy
laser photocoagulation
intravitreal VEGF inhibitors e.g. ranibizumab
