opth Flashcards
AMD treatment
Wet = anti VEGF injections, Dry = zinc
blepharitis Mx
eye hygiene and warm compress
hypertensive retinopathy grades
A 73 year old male presents with recurrent episodes of pain around their right eye. The eye is not red but there is some redness medial to the right canthus. He complains of some blurring of his vision due to tearing but he has no vision loss, floaters or flashes. This is his third episode.
What is the most appropriate management plan?
Dacrystorhinostomy
This patient has features of dacrocystitis which is an infection of the lacrimal sac due to gram-positive bacteria. It typically occurs due to nasal-lacrimal duct obstruction leading to stagnation of tears which then gets infected. Management of recurrent cases requires surgical fixation of the duct obstruction.
A 76 year old man presents 4 days after cataract surgery to his right eye with a painful red right eye.
On examination he has a severely injected conjunctiva and a white fluid level in the anterior chamber.
What is the most likely diagnosis?
A red eye post-surgery should prompt the diagnosis of endophthalmitis, which is infection inside the patient’s eye. This patient also has a hypopyon, described in the stem as a ‘white fluid level’, which is a collection of pus in the anterior chamber and indicates intraocular inflammation
CRAO doesn’t usually have
floaters
A patient who presents with sudden visual loss, floaters, and a curtain falling over the vision with a history of poorly controlled diabetes is likely experiencing a
vitreous haemorrhage. The inability to visualise the fundus on ophthalmoscopy due to dense opacities further supports this.
Vitreous haemorrhage presents and is associated with
sudden, painless loss of vision. However, it is typically associated with the use of anticoagulants and a history of diabetes. Rather than floaters and flashes of light, “dark spots” are often described by patients, referring to moderate bleeds.
Retinal detachment features - sudden, painless loss of vision occurs.
Often preceded by symptoms of posterior vitreous detachment: flashes of light and the presence of floaters.
risk factors and Mx of retinal detachment
Severe myopia is a risk factor, as is previous cataract surgery. Urgent referral to the ophthalmology team is warranted for consideration of surgery.
jaw claudication and weight loss support
GCA diagnosis
Redness, blurred vision, pain and mild photophobia in a patient that wears contact lenses and is an alcoholic should raise a strong suspicion of
bacterial keratitis. His social history suggests that he may often fall asleep before removing his lenses, increasing his risk. A broad spectrum topical antibiotic, such as gatifloxacin, should be commenced and an urgent referral made to the ophthalmologist. The patient should stop wearing contact lenses until advised otherwise by an ophthalmologist.
penetrating foreign body looking for injury Ix
CT orbit
B USS used to detect
retinal detachment
gonococcal conjunctivitis features
usually within 3 days of birth, mother would not have tender inguinal lump (this occurs with chalmydia, onset of this conjunctivitis neonatorum is 4-28 days )
anti phospholipid syndrome causing CRAO test with
anti-cardiolipin antibodies
treatment for acute progression acute progression of dry ARDM to wet ARMD
Intra-vitreal anti-vascular endothelial growth factor (VEGF) injection
This patient is presenting with acute progression of dry ARDM to wet ARMD. When treating wet ARMD, prevention of further neovascularisation is essential. This is achieved through anti-VEGF agents such as Bevacizumab, which can be injected directly into the vitreous to increase its bioavailability to the choroid
An 86 year old woman attends eye casualty. She has a background of type 2 diabetes mellitus, Grave’s disease, hypertension, angina and atrial fibrillation for which she takes warfarin. She complains of floaters and dark streaks across her visual field which came on suddenly one day ago
vitreous haemorrhage - DM
A 27 year old man attends A&E. He presented with a 2 day history of sudden onset vision loss in his right eye. On moving his right eye, he experiences pain behind his eye. He has a relative afferent pupillary defect of his right eye and a loss of his central visual field. His ability to distinguish between colours, particularly red, is diminished. Fundoscopy reveals a unilateral right sided papilloedema.
Given the likely diagnosis, what is the single best investigation?
MRI head
This patient is suffering from optic neuritis – an inflammatory demyelinating condition of the optic nerve. An MRI head is an important investigation to investigate for any further demyelinating plaques in the CNS that may suggest multiple sclerosis. 40-70% of optic neuritis cases will have, or go on to develop multiple sclerosis
A rapidly growing, well differentiated lesion on eyelid that is “dome shaped” in appearance is descriptive of
keratoacanthoma. It is considered to be a well differentiated form of squamous cell carcinoma
A 45-year-old man presents to the emergency department with acute weakness of the right side of his face. He is unable to to raise his eyebrow on the right and he notes difficulty in chewing. He also has a dry right eye. Upper and lower neurological examination is unremarkable, as is examination of the tympanic membrane.
Which of the following is a likely complication from the underlying diagnosis?
Keratoconjunctivitis sicca
Bell’s palsy can result in failure of the eyelids to close properly, which can cause the affected eye(s) to dry and sustain damage. This can lead to keratoconjunctivitis sicca
A 50 year old female presents to the GP Practice complaining of a painful left eye. She reports onset of pain this morning which has worsened over several hours. She also mentions that bright lights exacerbate the pain and her vision has become blurred.
On examination, you note hyperaemia and an irregularly shaped pupil.
Which of the following is the most appropriate management option?
urgent specialist referral due to anterior uveitis
washing contact lenses in sink can cause
Acanthamoeba is a serious parasitic infection with the main risk factor being contact lens use. Inadequate lens hygiene, such as washing lenses in the sink rather than with a sterile solution increases the risk of infection - red painful eye with reduced VA and hypopyon
painful, red, watery eye with foreign body sensation, and green dendritic ulcer on staining indicative of
The dendritic ulcer described is characteristic of herpes simplex keratitis.
infective endocarditis eye sign
Roth spots- retinal haemorrhage with white centre
A 49-year-old woman presents to her general practitioner with difficulty driving at night due to ‘excessive glare’, blurring and double-vision. She has a background of type 1 diabetes mellitus and ulcerative colitis for which she has required 2 courses of steroids this year. She drinks 5-8 units of alcohol a week and smokes 10 cigarettes a day. On examination, there is reduced red reflex in the left eye and reduced acuity in the left eye. Eye movements, visual fields pupillary reflexes are normal. The patient’s double vision improves when the left eye is covered.
What is the most likely diagnosis?
Cataracts
Although the majority of cataracts occur in older patients over the age of 60, this patient has key risk factors that increase her risk of cataracts - a history of diabetes, smoking and steroid use. She has the typical symptoms of progressive loss and blurring of vision, difficulty in driving at night due to glare and monocular diplopia.
GCA can lead to
anterior ischaemic optic neuropathy
Fundoscopy reveals a pale retina with a red spot in the macula.
Which of the following is the next best investigation to evaluate the underlying cause of her condition?
CRAO- carotid artery doppler (carotid atherosclerosis is most common cause)
virtuous haemorrhage in T2DM definitive treatment
vitrectomy
long and short sightedness are RF for
Hypermetropia (longsightedness), not myopia, is a risk factor for acute angle closure glaucoma as patients usually have decreased axial length of the eyeball and a shallow anterior chamber. Myopia is a risk factor for chronic open angle glaucoma.
anterior uveitis treatment
Topical cyclopentolate and topical corticosteroids
Difficulty in reading text and recognising faces, and problems with vision in dim light are typical features of
dry AMD.
hypopyon with recent cataract surgery
endopthalmitis most likely, rather than anterior uveitis
The emergency management of acute angle closure glaucoma is with
IOP-lowering agents such as IV acetazolamide, pilocarpine or beta blockers.
Zinc and antioxidant vitamin supplementation can
slow the progression of dry age-related macular degeneration but does not reverse existing damage.
In individuals with age-related macular degeneration and acute onset of central vision loss,
what is first line
intravitreal VEGF inhibitor injections represent first-line treatment according to NICE guidelines.
Atropine use can precipitate
acute angle closure glaucoma by causing mydriasis and narrowing the iridocorneal angle, obstructing aqueous outflow.
Thyroid eye disease, often associated with Graves’ disease, may require
oral corticosteroids like prednisolone.
Photopsia (flashes of light) is reported by some patients during a
posterior vitreous detachment.
Suspected bacterial keratitis requires
urgent specialist referral, as it is sight-threatening.
Oligoclonal bands in cerebrospinal fluid suggest
multiple sclerosis, particularly in patients with recurrent optic neuritis.
Retinal detachment occurs when the retina separates from the back of the eye, leading to visual disturbances like
field impairment, flashes of light, or a curtain-like shadow over vision.
Scleritis presents with
severe eye pain, redness, and photophobia, often worsening with eye movement, and may be linked to systemic inflammatory diseases.
A patient with severe ocular pain, redness, tenderness on eye movement, photophobia, and reduced visual acuity, along with a tender eye that worsens with motion and an abnormal pupil reaction to light, may be suffering from
scleritis, which is a sight-threatening condition often associated with systemic autoimmune disorders.
Post-operative or traumatic bacterial inoculation into the eye can lead to
endophthalmitis, a sight-threatening condition that requires urgent ophthalmological referral and intravitreal antibiotics.
Adult East Asian women presenting with sudden-onset headache, nausea, blurred vision, and redness in one eye, accompanied by a recent history of taking antimuscarinic medication, may indicate
acute angle closure glaucoma. Initial treatment includes intravenous Acetazolamide and topical Timolol, along with urgent ophthalmology referral.
Atropine sulfate eye drops is used to
dilate the pupil before eye exams.
AACG management initially
when IV steroids in GCA
if eye involvement, if not then oral
surfers ear appearance and investigation
ear canal stenosis, CT head
hypothyroid is associated with
blepharitis due to meibomian gland dysfunction
