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6th Year Surgery MJ > opthal > Flashcards

opthal Flashcards

1
Q

Retinal vessel occlusion - ARTERY - 3 x types

A

CRAO
Branch retinal artery occlusion
Cilioretinal artery occlusion

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2
Q

Retinal vessel occlusion - VENOUS - 2 x types

A

CRVO

Branch retinal vein occlusion

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3
Q

CRAO sx (2) + fundoscopy findings

A

sudden painless TOTAL loss of vision + RAPD

F-globally pale retina + cherry red macula

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4
Q

Branch retinal artery occlusion

A

sudden painless PARTIAL loss of vision
NO RAPD
F-focal ischaemic region corresponding to visual loss

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5
Q

Cilioretinal artery occlusion

A

Painless CENTRAL vision loss

  • 15-30% population
  • equally if CRA present and CRAO occurs, central vision may be retained
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6
Q

Retinal vessel occlusion -ARTERY -IX + MX

A

IX: CVS RF HX (echo, carotid dopplers), T.A. biopsy, ESR
MX: eyeball massage, carbogen therapy (inhale 5% CO2, 95% O2), haemodilution, vasodilators, decrease intraocular pressure

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7
Q

Retinal vessel occlusion -VENOUS - IX + MX

A

Ix: fluorescein angiography (ischaemic vs non-ischaemic CRVO)
Mx (only ischaemic CRVO): pan-retinal photocoagulation

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8
Q

CR VEIN O 2x types + sx

A

Ischaemic + Non-Ischaemic
Ischaemic - sudden painless TOTAL loss of vision (usu unilat) + RAPD
fundoscopy -widespread hyperemia, severe retinal H ‘stormy sunset’
Non-isch - SUBACUTE mild-mod loss of vision + NO RAPD

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9
Q

BRVO sx

A

ASYMPT - unless involving macula

-cause = blockage of retinal veins at AV crossings

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10
Q

endopthalmitis

A

red eye, pain and reduced vision following intraocular surgery

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11
Q

anterior uveitis

A

acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush

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12
Q

hyp retinopathy stage I

A

arteriolar narrowing + tortuosity, incr light reflex, silver wiring

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13
Q

hyp retinopathy stage II

A

AV nipping

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14
Q

hyp retinopathy stage III

A

cotton wool exudates + flame + blot H

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15
Q

hyp retinopathy stage IV

A

papilloedema

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16
Q

RAPD/Marcus-Gunn pupil how is it found, what is finding + what is it caused by

A
  • swinging light test –> affected + normal eye BOTH DILATE when light shone onto affected eye
  • causes: retina detatchment, optic neuritis eg MS
17
Q

pathway of pupillary light reflex - afferent and efferent

A

afferent: retina → optic nerve → lateral geniculate body → midbrain
efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

18
Q

retinal detachment 4Fs

A

Floaters
Flashes
Field loss
Fall in acuity

-sudden painless loss of vision - char by dense shadow starting peripherally + progressing centrally

19
Q

horners - central lesions SSS

A 
anhidrosis of FACE, ARM, TRUNK
Stroke
MS
Syringomyelia
Tumour
Encephalitis
20
Q

Horners - pre ganglionic TTT

A 
Anhidrosis of FACE
pancoast Tumour
Thyroidectomy
Trauma
Cervical rib
21
Q

Horners - post ganglionic CCCC

A 
no anhidrosis
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache
22
Q

immediate mx of AACG

A

combination of eye drops, for example:
-a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
a beta-blocker (e.g. timolol, decreases aqueous humour production)
-an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
-intravenous acetazolamide- reduces aqueous secretions

23
Q

definitive mx of AACG

A

laser peripheral iridotomy

-creates tiny hole in peripheral iris –> aqueos humour flowing to angle

24
Q

define + causes of tunnel vision

A 
Tunnel vision is the concentric diminution of the visual fields
-Causes:
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
25
Q

papilloedema define

A

optic disc swelling caused by incr IOP - almost always BILATERAL

26
Q

papilloedemA on fundoscopy

A
  • venous engorgement: usually the first sign
  • loss of venous pulsation: although many normal patients do not have normal pulsation
  • blurring of the optic disc margin
  • elevation of optic disc
  • loss of the optic cup
  • Paton’s lines: concentric/radial retinal lines cascading from the optic disc
27
Q

causes of papilloedema

A
  • space-occupying lesion: neoplastic, vascular
  • malignant hypertension
  • idiopathic intracranial hypertension
  • hydrocephalus
  • hypercapnia
28
Q

what is most common cause of blindness >60Y

A

ARMD - 90% Dry, 10% Wet

29
Q

ARMD key features

A
  • Degeneration of the CENTRAL RETINA (MACULA) is the key feature with changes usually BILATERAL
  • ARMD is characterised by degeneration of retinal photoreceptors that results in the formation of DRUSEN which can be seen on fundoscopy and retinal photography
  • It is more common in -OLD - FEMALES
30
Q

ARMD RF

A
  1. old age
  2. smoking
  3. FHx
  4. CVD RF
31
Q

Blepharitis define + cause

A

= inflammation of the eyelid margins.

    • It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)
  • Blepharitis is also more common in patients with rosacea
32
Q

Blepharitis features

A 
BILATERAL
GRITINESS + DISCOMFORT 
-eyes sticky in AM
-eyelid margins red
-styes + chalazions more common in pts with Bleph
-secondary conj may occur
33
Q

Blepharitis Mx

A
  1. softening of the lid margin using hot compresses twice a day
  2. ‘lid hygiene’ - mechanical removal of the debris from lid margins
  3. cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used
  4. an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled
  5. artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film
34
Q

classification of squints by where eye deviates toward on cover test

A 
Squints may be classified as to where the eye deviates toward
the nose: esotropia
temporally: exotropia
superiorly: hypertropia
inferiorly: hypotropia
35
Q

3rd N P vs HS

A

Ptosis + dilated pupil = third nerve palsy

ptosis + constricted pupil = Horner’s

36
Q

Optic Neuritis Sx CRAP

A 
EYE MVMNTS HURT
Central scotoma
RAPD
Acuity loss - central vision, colour vision
Pain on mvmnt
37
Q

optic neuritis causes

A

MS
DM
Drugs- ethambutol, chloramphenicol
Inf - VZV, Lyme

38
Q

Argyll-Robertson Pupil

A

Acommodation reflex present (ARP) but (PRA) pupillary reflex absent

6th Year Surgery MJ (6 decks)

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