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Zero to finals > Opthal > Flashcards

Opthal Flashcards

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
Q

most common cause of blindness in the UK

A

AMD

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26
Q

what is seen on fundocscopy in AMD

A

drusen

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27
Q

what test is used in AMD to assess distortion of straight lines

A

amsler grid

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28
Q

what is the pathophysiological difference between wet and dry AMD

A

in wet there is neovascularisation

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29
Q

what is used to diagnose AMD

A

optical coherence tomography

slit lamp exam

fluorescein angiography

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30
Q

what ix is used to differentiate between wet and dry AMD

A

fluourescein angiography

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31
Q

mx AMD

A

dry- avoid smoking, control BP, vitamin supplementation

wet- anti VEGF injections once a month

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32
Q

features of background diabetic retinopathy

A

microaneurysms
retinal haemorrhages
hard exudates
cotton wool spots

33
Q

features of pre proliferative diabetic retinopathy

A

venous beading
multiple blot haemorrhages
intraretinal microvascular abnormality

34
Q

proliferative diabetic retinopathy

A

neovascularisation
vitreous haemorrhage

35
Q

what is diabetic maculopathy

A

exudates in the macula
macular oedema

36
Q

cotton wool spots arise due to

A

nerve damage

37
Q

management of diabetic retinopathy

A

non proliferative= monitoring and diabetic control

proliferative=
pan retinal photocoagulation
anti VEG-F injections
surgery if severe

38
Q

treatment for macular oedema in diabetic retinopathy

A

intravitreal implant containing dexamethasone

39
Q

complications of diabetic retinopathy

A

vision loss
retinal detachment
vitreous haemorrhage

40
Q

features of hypertensive retinopathy

A

silver wiring- thickening of arterioles
AV nipping- compression of veins due to thickened arterioles
cotton wool spots
heard exudates
retinal haemorrhages
papilloedema

41
Q

classification system for hypertensive retinopathy

A

keith wagner

42
Q

keith wagner classification

A

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
Q

what feature on examination indicates cataracts

A

loss of red reflex

44
Q

what are symptoms of cataracts

A

slow reduction in visual acuity
progressive blurring of vision
colours becoming faded
starbursts around lights especially at night

45
Q

complication of cataract surgery and how its managed

A

endopthalmitis- inflammation of inner contents of eye due to infection, can lead to vision loss

mx by intravitreal abx

46
Q

how does the pupil contract

A

parasympathetic nervous system fibres travel along the optic nerve and use acetylcholine to constrict the pupil

47
Q

how does the pupil dilate

A

sympathetic nervous system fibres use adrenaline as a neurotransmitter to dilate the pupil

48
Q

causes of a dilated pupil

A

congenital
stimulants eg cocaine
anticholinergics eg oxybutynin
third nerve palsy
holmes adie pupil
raise IOP
acute angle closure glaucoma

49
Q

cause of a constricted pupil

A

horner syndrome
cluster headache
argyll robertson pupil
opiates
nicotine
pilocarpine

50
Q

third nerve palsy triad

A

ptosis
mydriasis
down and out position

51
Q

what happens to pupil in third nerve palsy

A

dilated/ mydriasis

52
Q

what muscles of the eye does the third nerve suply

A

parasympathetic

53
Q

what does third nerve palsy with sparing of the pupil inidicate

A

microvascular cause eg diabetes, hypertension, ischaemia

54
Q

causes of a third nerve palsy

A

tumor
cavernous sinus thrombosis
posterior communicating artery aneurysm
raised IOP

55
Q

horner syndrome triad

A

ptosis
miosis
anhydrosis

56
Q

how to differentiate between locations of horners syndrome

A

where anhydrosis occurs

central= anhydrosis of arm, trunk and face

pre ganglionic= anhydrosis of the face

post ganglionic= no anhydrosis

57
Q

central causes of horners syndrome

A

4 s

stroke
sclerosis (MS)
swelling (tumors)
syringomyelia

58
Q

pre ganglionic causes of horners

A

5 ts

tumor (pancoast)
trauma
thyroidectomy
top rib (cervical rib)

59
Q

post ganglionic causes of horners syndrome

A

4 cs

carotid aneurysm
carotid artery dissection
cavernous sinus thrombosis
cluster headache

60
Q

pneumonic for cause of horners syndrome

A

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
Q

how to test for horner syndrome

A

cocaine eye drops dont dilate the pupil

adrenaline eye drops dilate the pupil

62
Q

holmes adie pupil and cause

A

damage to post ganglionic parasympathetic fibres

dilated pupil
sluggish to react to light
responds to accomodation
slow to dilate after being constricted

63
Q

argyll robertson pupil is associated with

A

neurosyphillis

64
Q

argyll robertson pupil presents as

A

a constricted pupil that accomodates but doesnt react to light

65
Q

blepharitis mx

A

warm compresses and cleaning of eyelid margins

66
Q

blepharitis is due to dysfunction of

A

meibum glands

67
Q

how to differentiate stye and hordoleum internum

A

hordoleum internum is deeper, more painful and points towards the eyeball underneath the eyelid

68
Q

what is preseptal cellulitis

A

periorbital cellulitis

69
Q

difference between peri orbital and orbital cellulitis

how to differentiate

A

peri orbital involves eyelid and skin infection in front of the orbital septum

orbital involves tissues behind the orbital septum

differentiate by CT

70
Q

causes of painless red eye

A

conjunctivits
episcleritis
subconjunctival haemorrhage

71
Q

causes of painful red eye

A

acute angle closure glaucoma
scleritis
anterior uveitis
corneal abraison
keratitis
foreign body
traumatic or chemical injury

72
Q

who needs urgent referral when they have conjunctivitis

A

neonates under a month

73
Q

mx conjunctivitis

A

cloramphenicol or fusidic acid eyedrops if bacterial

antihistamine if allergic

otherwise self resolving

74
Q

conditions anterior uveitis is associated with

A

seronegative spondyloarthropathies
IBD
sarcoidosis
bechets disease

75
Q

anterior uveitis sx

A

painful red eye
reduced visual acuity
photophobia
excessive lacrimation
ciliary flush
miosis
hypopyon

76
Q

what is a hypopyon

A

a collection of white fluid in the anterior chamber of the eye

seen in anterior uveitis

77
Q

mx anterior uveitis

A

steroids
cycloplegics

78
Q

cycloplegic eye drop examples and use

A

cyclopentolate or atropine

used in anterior uveitis to dilate the pupil and reduce pain due to ciliary muscle spasm

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