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ALS > Opthal > Flashcards

Opthal Flashcards

1
Q

Age-Related Macular Degeneration

A

Degeneration of retinal photoreceptors, dry (drusen on Bruch, 90%) vs wet (worst, choroidal neovascularization)

RF - age, smoking, FHx, CVD risk factors

= bilateral, v acuity (^close up), issues at night, photopsia (flickering/ flashing), line distortion (amsler grid testing), charles-bonnet, see red patches (wet)

Inv - sit lamp, colour fundus photo baseline, optical coherence tomography, fluorescein angiography to guide wet treatment

-> anti-VEGF and photocoagulation for wet, Zinc, Vit A/C/E

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2
Q

ARMD: Pathophysiology

A

Macula: generates high-def colour vision in the central visual field, four layers

Choroid (base, contains vessels that supply the macula)
Bruch’s membrane
Retinal pigment epithelium
Photoreceptors

In wet there is new vessels formation in choroid which causes leakage of fluid, oedema and faster vision loss

In both types there are drusen (lipid and protein deposition), depletion of photoreceptors and atrophy of retinal pigment epithelium

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3
Q

Blepharitis

A

Inflammation of the eyelid margins

RF - rosacea

Cause - meibomian gland dysfunction, seborrhoeic dermatitis, staph infection

= bilateral grittiness, discomfort, sticky in mornings, red margins, swollen eyelid if staph

-> hot compress BD, remove debris, artificial tears

Comp - stye, chalazion

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4
Q

Diabetic Retinopathy: Features

A

Microaneurysm - bulges in blood vessel due to damage

Blot haemorrhage - ^vascular permeability

Hard exudates - yellow deposits of lipids and proteins due to vascular permeability

Cotton wool spots - fluffy white, retinal infarction cause damage to nerve fibres

Venous beading - walls are no longer straight/ parallel

IRMA - dilated and tortuous capillaries, act as shunt between arterial and venous vessels

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5
Q

Diabetic Retinopathy: Stages

A

Non- proliferative

Mild = microaneursysm
Moderate = MA, BH, HE and CWS and VB
Severe - BH and MA in 4 quadrants, VB in 2, IRMA in 1

Proliferative
= neovascularisation, fibrous tissue, ^T1

Maculopathy
= macular oedema, ^T2

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6
Q

Diabetic Retinopathy: Management

A

Most common cause of blindness 35-65yrs

-> optimize control, regular review, pan-retinal laser photocoagulation (SE: v field, v night), VEGF inhibitors (ranibizumab), vitreoretinal surgery

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7
Q

Diabetic Retinopathy: Complications

A

Vision loss
Retinal detachment
Vitreous haemorrhage
Rubeosis iridis (leads to neovasc glaucoma)
Optic neuropathy
Cataracts

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8
Q

Hypertensive Retinopathy: Features

A

Silver wiring - walls of arterioles thicken and sclerose, ^light reflex

AV nipping - arterioles compress the veins they cross (because of above)

Haemorrhages - dot/ blot deep in inner nuclear layer, flame in nerve fiber layer

Papilloedema - ischaemia to optic nerve so it swells, blurring of the margins

Same as diabetics - hard exudates, cotton wool spots

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9
Q

Hypertensive Retinopathy: Stages

A

Stage 1 - mild narrowing of arterioles, silver wiring
Stage 2 - AV nipping
Stage 3 - CWS, exudates, flame/ blot haem (macular star around fovea)
Stage 4 - papilloedema

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10
Q

Glaucoma

A

Damage to optic nerve 2nd to ^intra-ocular pressure

Normal IOP = 10-21

Aqueous humour produced by ciliary body
Enters anterior chamber
Leaves by canal of Schlemm in trabecular meshwork

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11
Q

Open-Angle Glaucoma

A

Gradual ^resistance to flow through trabecular mesh

RF - age, FHx, black, myopia (near), HTN, DM, steroids

= insidious, peripheral field lost (nasal scotomas to tunnel vision), v visual acuity

Inv - optic disc cupping (cup >0.6 size of disc), disc pallor, bayonetting of vessels, non-contact or applanation tonometry for IOP

-> 360° selective laser trabeculoplasty if IOP 24+, PG analogue eyedrops (lantanoprost) if not, then timolol

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12
Q

Angle-Closure Glaucoma

A

Iris bulges forwards and seals off tm, ^pressure in ant. and post. chamber, pushes iris even further forwards

RF - age, F, hypermetria (far, short eye), pupil dilatation, east Asian, anti-Ach meds, TCAs

= severe eye pain, red, blurred vision, v acuity, halos around lights, hazy cornea, semi-dilated fixed pupil, hard eyeball, worse watching tv in dark room

Inv - tonometry, gonioscopy (visualise angle)

-> urgent referral, combined drops (pilocarpine, timolol, apraclonidine) + IV acetazolamide, laser iridotomy to fix

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13
Q

Allergic Conjuctivitis

A

Cause - seasonal (pollen) or perennial (dust, detergent)

= bilateral conjunctival redness and swelling, itching, atopic history

-> top/ PO antihistamine, top mast cell stabiliser 2nd

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14
Q

Anterior Uveitis

A

Iritis, inflammation of the anterior uvea

RF - HLA B27 (IBD, ank spond, reactive arth), Behcet’s, trauma, sarcoid, syphilis, TB, cancer

= acute red eye, pain, photophobia, blurred vision, lacrimation, small irregular pupil, ciliary flush, hypopyon (fluid level due to inflam cells), floaters (pus cells)

-> urgent review, cycloplegics (atropine, cyclopentolate), steroid drops

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15
Q

Argyll-Robertson Pupil

A

Causes - syphilis, DM

= small irregular pupil, accommodates but doesn’t react to light

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16
Q

Holmes-Adie Pupil

A

Benign, ^F, issue with parasympathetic ganglion

= unilateral dilated pupil, no reaction to light, slow reaction to accommodation, may have absent knee/ ankle reflexes

17
Q

Cataracts

A

Lens gradually opacifies

Causes - age (nuclear), smoking, alcohol, trauma, DM, long-term steroids (subcapsular), radiation, myotonic dystrophy, v Ca

= blurred vision, faded colour vision, glare and halos on lights, defect in red reflex

-> surgery based on symptoms/ QoL/ patient choice

Comp of surgery - posterior capsule thickening or rupture, retinal detachment, endophthalmitis

18
Q

Central Retinal Vein /Artery Occlusion

A

Artery
Cause - thromboembolism or arteritis
= sudden, painless, unilateral vision loss, RAPD, cherry red spot on pale retina

Vein
RF - age, HTN, CVD, glaucoma, polycythaemia
= sudden, painless, unilateral vision loss, severe retinal bleeds seen

19
Q

Corneal Disorders

A

= pain, sensation of foreign body, lacrimation, red

Abrasion: defect in epithelium due to local trauma, fluorescein staining
-> top Abx

Ulcer: bacterial/ fungal/ viral/ acanthamoeba keratitis
RF - contact lenses, vit A def

Foreign body
-> refer if suspect penetration, sig orbital trauma, chemical, organic material, severe pain, vv acuity

20
Q

Episcleritis

A

Acute onset inflammation of episclera

Cause - most idiopathic, IBD, RA

= painless red eye, segmental redness

Inv - gentle pressure on sclera (mobile vessels), phenylephrine injection (redness improves)

-> conservative

21
Q

Eyelid Disorders

A

Stye: infection of eyelid glands
-> hot compress, analgesia

Chalazion: retention cyst of meibomian gland
= firm painless lump
-> spont, drainage

Entropion: in-turning of the eyelids
Ectropion: out-turning of the eyelids

22
Q

Herpes Simplex Keratitis

A

Commonly presents with dendritic corneal ulcer

= red painful eye, photophobia, lacrimation, v acuity

-> urgent referral, top acyclovir

23
Q

Herpes Zoster Ophthalmicus

A

Reactivation of VZV in the ophthalmic division of trigeminal nerve, 10% shingles cases

= vesicular rash around eye, Hutchcinson’s sign (rash on nose, strong RF for ocular involvement)

-> urgent review, PO acyclovir 7-10d <72hrs, top steroids

24
Q

Horner’s Syndrome

A

Causes
Central lesions: anhidrosis of face, arm and trunk
S - Stroke, Syringomyelia, MS

Pre-ganglionic lesions: anhidrosis of face
T - pancoast’s Tumour, Thyroidectomy, Trauma

Post-ganglionic: no anhidrosis
C - Carotid artery dissection, Carotid aneurysm, Cluster headache, Cavernous sinus thrombosis

= miosis, ptosis, enophthalmos (sunken eye), anhidrosis

25
Q

Infective Conjuctivitis

A

Bacterial = purulent discharge, lids stuck together
Viral = serous discharge, recent URTI, preauricular nodes

-> self limiting, top chloramphenicol, fusidic acid if pregnant, don’t wear contacts

26
Q

Keratitis

A

Inflammation of cornea, microbial is sight-threatening

Cause
Bacterial - staph aureus, pseudomonas in contact lenses
Acanthamoebic - contact lenses, soil or contaminated water (^^pain)
Also, fungal, parasitic, viral (HSV), photokeratitis (welders), exposure

= red eye, pain, gritty, foreign body sensation, photophobia

-> refer same-day if contact lenses (excl. microbial), stop wearing lenses, top Abx (quinolones), cyclopentolate for pain

27
Q

Nasolacrimal Duct Obstruction

A

Imperforate membrane in lacrimal duct

= persistent watery eye in infant

-> massage duct, resolve by 1yr

28
Q

Ocular Trauma

A

Hyphema: blood in anterior chamber, risk of ^IOP
-> urgent referral, bed rest

Orbital compartment syndrome: emergency
= eye pain, swelling, proptosis, hard eyelid, RAPD
-> urgent lateral canthotomy to decompress orbit

29
Q

Optic Neuritis

A

Cause - MS (50% with ON get MS within 15yrs), DM, syphilis

= hrs-days, unilateral v acuity, red desaturation and poor colour discrimination, pain on eye movement, RAPD, central scotoma

Inv - MRI brain and orbits with gadolinium contrast

-> high dose steroids, recover 4-6wks

30
Q

Orbital Cellulitis

A

Infection of fat and muscles posterior to the orbital septum (not involving globe), emergency

RF - 7-12yrs, no Hib vaccine, pre-septal cellulitis, facial infection

Cause - spreading URTI e.g., sinus (strep, staph, Hib)

= red swollen eye, severe pain, visual loss, proptosis, ophthalmoplegia

Inv - FBC, CT with contrast, blood culture, swab

-> admit, urgent senior review, IV Abx

31
Q

Papilloedema

A

Optic disc swelling caused by ^ICP

Cause - space-occupying lesion (neoplasm, vascular), malignant HTN, idio IC HTN, hydrocephalus, ^CO2

Inv - fundoscopy (venous engorgement, loss of venous pulsation, blurring of disc margin, loss of the optic cup, Paton’s lines)

32
Q

Posterior Vitreous Detachment

A

Separation of vitreous membrane from the retina

RF - age (fluid becomes more viscous), myopia (near, longer)

= no pain or vision loss, flashes and floaters

-> assessment <24hrs, no treatment, better in 6m

33
Q

Pre-septal/ Peri-orbital Cellulitis

A

Infection of soft tissue anterior to orbital septum

Causes - staph aureus, staph epidermidis, strep

= <10yrs, red swollen painful eye, no proptosis/ visual disturbance/ ophthalmoplegia

Inv - contrast CT (excl. orbital)

-> all need hospital assess, PO co-amoxiclav

34
Q

Retinal Detachment

A

Neurosensory tissue that lines the back of the eye separates from the pigment epithelium

RF - DM, myopia, age, prev cataract surgery, trauma

= new floaters or flashes, sudden and progressive visual field loss (curtain or shadow), painless, RAPD (if optic nerve involved), straight lines appear curved

Inv - fundoscopy (no red reflex, pale retinal folds), slit-lamp, indirect ophthalmoscopy

-> urgent referral <24hrs for new flashes/ floaters

35
Q

Retinitis Pigmentosa

A

Inherited condition, decrease rods and cones

= night blindness, tunnel vision (loss of peripheral retina)

Inv - fundoscopy (black bone spicule pigmentation)

36
Q

Scleritis

A

Full-thickness inflammation of the sclera

RF - RA, SLE, sarcoidosis, granulomatosis with polyangiitis

= red eye, painful, teary, photophobia, gradual v vision

-> same-day assessment, oral NSAIDs, steroids if severe

37
Q

Strabismus

A

Squints, misalignment of the visual axes

Concomitant: imbalance in extraocular muscles (convergent > divergent)
Paralytic: paralysis of extraocular muscles

Inv - corneal light test (light 30cm from face, reflect asymmetrically), cover test

-> refer to secondary care, patches

Comp - amblyopia (brain fails to fully process inputs from one eye, favours the other over time)

38
Q

Sudden Loss of Vision

A

Causes - amaurosis fugax (thrombus, embolus, arteritis), vitreous haemorrhage, retinal detachment, retinal migraine

39
Q

Vitreous Haemorrhage

A

Bleeding into the vitreous humour, heals by 1% a day once bleeding stops

Causes - proliferative diabetic retinopathy, vitreous detachment, trauma

= sudden painless vision loss, red hue, floaters or dark spots

Inv - dilated fundoscopy, sit lamp (RBC in anterior vitreous)

ALS (22 decks)

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