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Opthal Flashcards

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1
Q

what is glaucoma

A

damage to the optic nerve cause by raised intraocular pressure due to blockage in aqueous humor trying to escape the eye

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2
Q

types of glaucoma

A

acute angle closure
opne angle

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3
Q

norma intraocular pressure

A

10-21 mmhg

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4
Q

open angle glaucoma pathophysiology

A

reduced flow of aqueous humor through the trabecular meshwork

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5
Q

acute angle closure glaucoma pathophysiology

A

the iris is pushed forward and seals off the trabecular meshwork so aqueous humor cannot drain at all

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6
Q

how is optic disc cupping identified

A

the optic cup:optic disc ration is usually 0.5, if the optic cup takes up more than half the disc this is raised IOP

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7
Q

risk factors for open angle glaucoma

A

age
family hx
near sightedness- myopia

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8
Q

what is myopia

A

near sightedness

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9
Q

glaucoma symptoms

A

gradual loss in peripheral vision (tunnel vision)
haloes around lights especially at night
blurred vision
headaches

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10
Q

how is IOP measured

A

tonometry

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11
Q

what does gonioscopy measure

A

the angle between the iris and cornea

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12
Q

what IOP warrants mx in glaucoma

A

> 24 mmhg

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13
Q

mx glaucoma

A

laser trabeculoplasty

prostaglandin analogue eg latanoprost to increase uveoscleral outflow

beta blocker and carbonic anhydrase eye drops to reduce aqueous humor production

trabeculectomy if these are not effective

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14
Q

what do prostaglandin analogue eye drops do in glaucoma and give and example

A

latanoprost

reduce uveoscleral outflow

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15
Q

what do beta blocker eye drops do in glaucoma and give an example

A

timolol

reduce aqueous humor production

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16
Q

what do prostaglandin analogues do in glaucoma and give an example

A

dorzolamide

reduce aqueous humor production

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17
Q

what ethnicity is at higher risk of open angle vs acute angle closure glaucoma

A

open angle= black afro caribbean

acute angle closure= chinese and east asian

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18
Q

what medications can precipitate acute angle closure glaucoma

A

andrenergic eg noradrenaline
anticholinergic eg oxybutynin
TCA eg amtriptyline

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19
Q

acute angle closure glaucoma symptoms

A

acutely painful red eye
hazy cornea
headache
nausea
vomitting
blurred vision
haloes around lights
hazy cornea
mid dilated pupil
fixed size pupil

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20
Q

inital management of acute angle closure glaucoma

A

lay the patient flat without a pillow
pilocarpine eye drops
acetazolamide
analgesia and antiemetics

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21
Q

moa pilocarpine eye drops

A

act on muscarinic receptors causes pupil constriction and ciliary muscle contraction to increase flow of aqueous humor

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22
Q

acetazolamide moa

A

carbonic anhydrase inhibitor- reduces production of aqueous humor

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23
Q

definitive management of acute angle closure glaucoma

A

laser iridotomy

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24
Q

symptoms of AMD

A

gradual loss of central vision- scotoma
reduced visual acuity
wavy appearance of straight lines

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25
most common cause of blindness in the UK
AMD
26
what is seen on fundocscopy in AMD
drusen
27
what test is used in AMD to assess distortion of straight lines
amsler grid
28
what is the pathophysiological difference between wet and dry AMD
in wet there is neovascularisation
29
what is used to diagnose AMD
optical coherence tomography slit lamp exam fluorescein angiography
30
what ix is used to differentiate between wet and dry AMD
fluourescein angiography
31
mx AMD
dry- avoid smoking, control BP, vitamin supplementation wet- anti VEGF injections once a month
32
features of background diabetic retinopathy
microaneurysms retinal haemorrhages hard exudates cotton wool spots
33
features of pre proliferative diabetic retinopathy
venous beading multiple blot haemorrhages intraretinal microvascular abnormality
34
proliferative diabetic retinopathy
neovascularisation vitreous haemorrhage
35
what is diabetic maculopathy
exudates in the macula macular oedema
36
cotton wool spots arise due to
nerve damage
37
management of diabetic retinopathy
non proliferative= monitoring and diabetic control proliferative= pan retinal photocoagulation anti VEG-F injections surgery if severe
38
treatment for macular oedema in diabetic retinopathy
intravitreal implant containing dexamethasone
39
complications of diabetic retinopathy
vision loss retinal detachment vitreous haemorrhage
40
features of hypertensive retinopathy
silver wiring- thickening of arterioles AV nipping- compression of veins due to thickened arterioles cotton wool spots heard exudates retinal haemorrhages papilloedema
41
classification system for hypertensive retinopathy
keith wagner
42
keith wagner classification
stages of hypertensive retinopathy 1- mild narrowing of arterioles 2- focal constriction of blood vessels and AV nicking 3- cotton wool patches, exudates and haemorrhages 4- papilloedema
43
what feature on examination indicates cataracts
loss of red reflex
44
what are symptoms of cataracts
slow reduction in visual acuity progressive blurring of vision colours becoming faded starbursts around lights especially at night
45
complication of cataract surgery and how its managed
endopthalmitis- inflammation of inner contents of eye due to infection, can lead to vision loss mx by intravitreal abx
46
how does the pupil contract
parasympathetic nervous system fibres travel along the optic nerve and use acetylcholine to constrict the pupil
47
how does the pupil dilate
sympathetic nervous system fibres use adrenaline as a neurotransmitter to dilate the pupil
48
causes of a dilated pupil
congenital stimulants eg cocaine anticholinergics eg oxybutynin third nerve palsy holmes adie pupil raise IOP acute angle closure glaucoma
49
cause of a constricted pupil
horner syndrome cluster headache argyll robertson pupil opiates nicotine pilocarpine
50
third nerve palsy triad
ptosis mydriasis down and out position
51
what happens to pupil in third nerve palsy
dilated/ mydriasis
52
what muscles of the eye does the third nerve suply
parasympathetic
53
what does third nerve palsy with sparing of the pupil inidicate
microvascular cause eg diabetes, hypertension, ischaemia
54
causes of a third nerve palsy
tumor cavernous sinus thrombosis posterior communicating artery aneurysm raised IOP
55
horner syndrome triad
ptosis miosis anhydrosis
56
how to differentiate between locations of horners syndrome
where anhydrosis occurs central= anhydrosis of arm, trunk and face pre ganglionic= anhydrosis of the face post ganglionic= no anhydrosis
57
central causes of horners syndrome
4 s stroke sclerosis (MS) swelling (tumors) syringomyelia
58
pre ganglionic causes of horners
5 ts tumor (pancoast) trauma thyroidectomy top rib (cervical rib)
59
post ganglionic causes of horners syndrome
4 cs carotid aneurysm carotid artery dissection cavernous sinus thrombosis cluster headache
60
pneumonic for cause of horners syndrome
4s 4t 4c central= 4s pre ganglionic= 4t post ganglionic= 4c stroke sclerosis syringomyelia swelling trauma tumor (pancoast) top rib thyroidectomy cavernous sinus thrombosis carotid aneurysm carotid artery dissection cluster headache
61
how to test for horner syndrome
cocaine eye drops dont dilate the pupil adrenaline eye drops dilate the pupil
62
holmes adie pupil and cause
damage to post ganglionic parasympathetic fibres dilated pupil sluggish to react to light responds to accomodation slow to dilate after being constricted
63
argyll robertson pupil is associated with
neurosyphillis
64
argyll robertson pupil presents as
a constricted pupil that accomodates but doesnt react to light
65
blepharitis mx
warm compresses and cleaning of eyelid margins
66
blepharitis is due to dysfunction of
meibum glands
67
how to differentiate stye and hordoleum internum
hordoleum internum is deeper, more painful and points towards the eyeball underneath the eyelid
68
what is preseptal cellulitis
periorbital cellulitis
69
difference between peri orbital and orbital cellulitis how to differentiate
peri orbital involves eyelid and skin infection in front of the orbital septum orbital involves tissues behind the orbital septum differentiate by CT
70
causes of painless red eye
conjunctivits episcleritis subconjunctival haemorrhage
71
causes of painful red eye
acute angle closure glaucoma scleritis anterior uveitis corneal abraison keratitis foreign body traumatic or chemical injury
72
who needs urgent referral when they have conjunctivitis
neonates under a month
73
mx conjunctivitis
cloramphenicol or fusidic acid eyedrops if bacterial antihistamine if allergic otherwise self resolving
74
conditions anterior uveitis is associated with
seronegative spondyloarthropathies IBD sarcoidosis bechets disease
75
anterior uveitis sx
painful red eye reduced visual acuity photophobia excessive lacrimation ciliary flush miosis hypopyon
76
what is a hypopyon
a collection of white fluid in the anterior chamber of the eye seen in anterior uveitis
77
mx anterior uveitis
steroids cycloplegics
78
cycloplegic eye drop examples and use
cyclopentolate or atropine used in anterior uveitis to dilate the pupil and reduce pain due to ciliary muscle spasm

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