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Opthal 1 Flashcards

1
Q

What are the 4 major causes of blindness in the world?

A

cataract
vitamin A deficiency
trachoma
onchocerciasis

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2
Q

What is cataract? how does it present?

A

opacification of the lens - becomes cloudy

Blurred vision
Unilateral cataracts = loss of stereopsis = affects distance judgement

Bilateral cataracts = gradual vision loss of vision +/- dazzle +/- monocular diploplia

haloes around eyes

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3
Q

Causes/RFs for cataracts?

A 
AGE!
UV exposure
Smoking
Diabetes
Trauma
Alcohol
Long term Steroids
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4
Q

Types of cataracts?

A

Nuclear sclerosis - distance vision more affected

Cortical

Subcapsular

Posterior subcapsular

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5
Q

Investigations of cataracts?

A

Dilated fundus examination - fundus and optic nerve normal

Intra-ocular pressure - normal or may be elevated with glaucoma

Glare vision test - significant cataract

slit-lamp examination of anterior chamber - cataract visible

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6
Q

Management of cataracts?

A

Conservative - stronger glasses and good lighting

Phacoemulsification +/- intra-ocular lens implant

Catarct-induced swelling of lens = peripheral iridotomy

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7
Q

Complications of cataracts/ cataract surgery?

A

Capsular rupture with vitreous loss = corticosteroids

Thickening of Posterior Capsule/Retinal detachment

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8
Q

Reasons for paeds cataracts?

A

TORCH
genetic
metabolic

Urgent ophthalmology referral for surgical consideration

Intervention needed within latent period of visual development 1st 6 weeks of life

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9
Q

What is diabetic retinopathy? What age group normally affected?

A

Most common cause of blindness 35-65

Chronic and progressive sight threatening disease of retinal microvasculature caused by prolonged hyperglaycaemia

Hyperglycaemia causes increased retinal blood flow and abnormal metabolism = endothelial dysfunction and damage

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10
Q

What is proliferative retinopathy?

A

Vascular occlusion caused by hyperglycaemia = ischaemia

= new vessels in the retina, optic disc and iris(rubeosis) = proliferative retinopathy

High risk = new vessels occupying 1/4 or 1/3 of area = risk of vitreous haemorrhage

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11
Q

How does diabetic retinopathy present?

A

Asymptomatic
Gradual reduced vision
Dark painless floaters (haemorrhage)

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12
Q

What are some characteristic opthalmoscope findings in diabetic retinopathy?

A

Retinal/Blot haemorrhages - rupture of weakened capillaries

Microaneurysms - weakened walls

Cotton wool spots - build up of axonal debris due to poor metabolism

hard exudates - cholesterol/lipoprotein

neovascularization - new vessels to hypoxic retina

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13
Q

How do you classify non-proliferative diabetic retinopathy?

A

Mild : atleast 1 microaneurysm

Moderate : haemorrhages or microaneurysms present, hard exudates, cotton wool spots, venous beading/looping

Severe (4:2:1 rule) : haemorrhages or microaneurysms in all 4 quadrants, venous bleeding in 2, IRMA (intraretinal microvascular abnormalities) in 1

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14
Q

What is maculopathy in diabetic eye disease?

A

Leakage from the vessels close to the macula cause oedema and can sig. threaten vision

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15
Q

With regards to diabetic retinopathy, who is need of urgent assessment and treatment?

A
  • NPDR
  • Proliferative retinopathy
  • Maculopathy
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16
Q

Causes of papilloedema?

A

optic disc swelling causes by raised ICP, most likely BILATERAL

If unilateral - more likely demyelinating optic neuritis

Space occupying lesions : malignancy, haemorrhage, AV malformations
Infections/abscess
Hydrocephalus
Malignant hypertension
Idiopathic Intracranial Hypertension
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17
Q

What does a relative afferent pupil defect suggest? How would you test for it?

A

swinging-light test - defect suggests optic nerve/retinal defect

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18
Q

Examination findings for papilloedema?

A

Disc swelling/nerve swelling
Venous engorgement
Absent venous pulsation
Visual acuity and field defects/enlarged

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19
Q

How was is dilation and constriction of pupil regulated?

A

Dilation = sympathetic NS

Constriction = parasympathetic

Afferent pathway = CN2

Efferent pathways = oculomotor

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20
Q

How would you distinguish an efferent defect in pupil inequality from an afferent defect?

A

Afferent : no response to light, but CONSENSUAL response is intact
If pupil dilates = MARCUS GUNN pupil

Efferent : ptosis, fixted dilated pupil and eye looks down and out

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21
Q

What is Holmes-Adie pupil? Syndrome?

A

Benign condition most commonly seen in women

Unilateral dilated pupil in 80% of cases

Delayed responses to near vision effort and delayed redilation

SYNDROME : holmes-adie pupil with absent ankle/knee reflexes

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22
Q

What is Horner’s syndrome?

A

Disrupting sympathetic fibres, so the pupil is miotic (smaller), and there is partial ptosis, pupil doesn’t dilate in the dark

Unilateral facial anhidrosis (decreased sweating)

enopththalmos

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23
Q

What are some causes of Horner’s?

A

Posterior inferior cerebellar artery or basilar artery occlusion

MS

Cavernous sinus thrombosis

Pancoast’s tumour

Hypothalamic lesions

Cervical adenopathy

Mediastinal masses

Aortic aneurysm

24
Q

What is Argyll Robertson pupil?

A

Occurs in neurosyphilis and diabetes

bilateral miosis, pupil irregularity and no response to light but RESPONSE TO ACCOMODATION

ARP but PRA
accommodation reflex present but pupillary reflex absent

25
What are some causes of sudden vision loss?
Transient vision loss - vision loss for less than 24 hours ``` Vascular : TIA (amaurosis Fugax), migraine MS Subacute glaucoma Papilloedema vitreous haemorrhage ```
26
How would you assess sudden painless loss of vision?
HELLP Headache assoc? (GCA, check ESR) Eye movements hurt? (optic neuritis) Lights/flashes preceding visual loss? (detached retina) Like a curtain descending? (amaurosis fugax) Poorly controlled DM
27
What is AION?
Anterior ischaemic optic neuropathy Optic nerve is damaged if posterior ciliary arteries are blocked by inflammation or atheroma Arteritic AION = GCA - other eye is at risk until steroids given
28
Presentation of central retinal artery occlusion?
Dramatic visual loss within seconds of occlusion 90% acuity is finger counting or worse Afferent pupil defect appears within second may precede retinal changes by 1h Retina appears white with cherry red spot at the macula
29
Treatment of central retinal artery occlusion?
If seen within 6hrs - aim to increase retinal blood flow by reducing intraocular pressure = ocular massage, surgical removal of aqueos from anterior chamber or use antihypertensives
30
How would central retinal vein occlusion present?
Whole central retinal vein thrombosed - visual loss (less sudden than central retinal artery occlusion) If ischaemic = cotton wool spots, swollen optic nerve, macular oedema and risk of neovascularization, neovascular glaucoma non-ischaemia = better acuity, and prognosis, can convert to ischaemic in 30%
31
What can be done to manage central retinal vein occlusion?
Aim to prevent rubeotic glaucoma and a painful eye (beracizumab and ranbizumab) lasers an dex intravitreal implants
32
Investigation of central retinal vein occlusion?
fluorescein angiogram for confirmation of diagnosis - degree of ischaemia and planning pan retinal photocoagulation
33
What are causes of Vitreous haemorrhage?
Source from retinal new vessels (diabetes, branch or central retinal vein occlusion), retinal tears, retinal detachment or trauma
34
Presentation of vitreous haemorrhage?
Painless vision loss - varies from haziness and floaters to complete vision loss (severity of haemorrhage) Worse in the morning red hue
35
What is retinal detachment?
Neurosensory layer of retina separating from retinal pigment epithelium
36
What often precedes retinal detachment?
Preceded by posterior vitreous detachment - liquified vitreous seeps under retina to cause the detachment
37
What are the types of retinal detachment?
Rhegmatogenous - detachment due to full thickness break in retina : caused by posterior vitreous detachment Exudative - no break in retina (serous/haemorrhagic fluid build up in subretinal space- malignancy, inflammation Traction - mechanical force on retina (haemorrhage/surgery/injury) - commonly seen in proliferative diabetic retinopathy
38
Risk factors for retinal detachment?
Myopia - eyeball longer and retina thinner increasing age Fhx Lattice degeneration
39
Presentation of retinal detachment?
4Fs Floaters Flashes Field Loss Fall in acuity
40
How would you investigate retinal detachment?
Visual acuity testing Slit-lamp - shafer's sign = pigment in anterior vitreous Weiss ring - thickening of posterior vitreous Indirect ophthalmoscopy - grey opalescent retina, ballooning forward
41
Treatment of retinal detachment?
Vitrectomy - relieves traction and drain subretinal fluid Treat tears and holes - cryotherapy and laser Photocoagulation Topical abx and corticosteroids
42
What is glaucoma?
Group of eye conditions causing damage to the Optic nerve leading to progressive loss of retinal ganglion cells and their axons --> loss of visual field If intra-ocular pressure increase is found life-long follow-up is needed
43
Types of glaucoma?
Primary vs Secondary Open angle vs closed angle Acute vs Chronic
44
What is primary open angle glaucoma?
IOP > 21 Progressive glaucomatous optic neuropathy usually bilateral
45
Presentation of primary open angle glaucoma?
Insidious onset -> often picked up on routine appointment vision loss - usually peripheral optic disc cupping - loss of optic disc substance may have RAPD in severe glaucoma
46
How would you investigate open angle glaucoma?
Tonometry - Goldmann = intra-ocular pressure elevated if above normal range of 10-21 direct and indirect ophthalmoscopy slit-lamp visual field testing - scotomas indicating loss of nerve fibre layer gonioscopy - differentiate if angle between iris and cornea is open or closed
47
How would you treat open angle glaucoma?
latanoprost - prostaglandin analogues ophthalmic beta-blockers - timolol ophthalmic carbonic anhydrase inhibitors - brinzolamide topical ophthalmic alpha-2 adrenergic agonists - brominidine laser trabeculoplasty
48
What is angle closure glaucoma? RFs?
Acutely raised IOP due to physically obstructed anterior chamber -> blocked aqueous outflow = increase IOP Hypermetropia - long sightednessm pupillary dilation, lens growh with ageing
49
How does close angle glaucoma present?
Severely painful red eye + headache + N&V Fixewd mid dilated oval pupil Reduced vision Hazy cornea - oedema decreased visual acuity
50
How would you investigate angle closure glaucoma?
Gonioscopy - differentiate between appositional (reversible) versus synechial (irreversible) slit-lamp - shallow ant chamber, signs of glaucoma, splinter haemorrhage, nerve fibre loss Very high IOP on tonometry
51
management of closed angle glaucoma?
Acetazolamide - reduce aqueous secretions Pilocarpine - pupillary constriction Topical beta-blocker - timolol mannitol laser peripheral iridotomy
52
What are some causes of secondary glaucoma?
Inflammatory debris Intraocular haemorrhage Neovascularisation Uveitis Rubeosis Iridis Corticosteroids *traumatic = when red cells block trabecular meshwork
53
What is age-related macular degeneration? Characterised by?
Chief cause of registrable blindness 3 structures affected : retina pigment membrane, bruchs membrane (innermost part of choroid), choriocapillaris (behind bruchs membrane) Dry - slow progress, , pigmentary changes to RPE, drusen, no treatment wet - choroidal neovascularisation - leakage of fluid and blood at macula causing scarring - rapid deterioration
54
Treatment for wet ARMD?
Intravitreal vascular endothelial growth factor inhibitors (VEGF) Laser photocoagulation intravitreal steroids antioxidants/vitamins
55
Investigation of ARMD?
Amsler grid - focal area of distortion optical coherence tomography - intraretinal fluid; subretinal fluid; pigment epithelial detachment; loss of normal retinal pigment epithelium

Opthalmology (2 decks)

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