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RACP Opthal > Opthal > Flashcards

Opthal Flashcards

1
Q

Six Week Old

Opthal findings

A

Fix and Follow - smiling and visually responsive

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2
Q

Six Months - Opthal

A

Reach for small objects (If intact motor)

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3
Q

12 months opthal

A

Reach for tiny 100/1000s

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4
Q

2-3 years opthal

A

Picture Matching - Kay Picture (Assuming developing language)

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5
Q

Onset of Nystagmus by 8-12 weeks?

A

Can be bilateral major visual defect or primary motor
Motor
Congenital nystagmus
Abnormal phase is drift off- fast turn is in ‘intact’
How long is still - 1/100 of second then perceive
30fps
Conjugate nystagmus less bad than divergent/see-saw

INO - Brainstem demyleniation
Adduction deficiet, nystagmus on abduction lateral gze
Sensory
Anything that reduces vision in first 4 months
Albinism
Bilateral Cateratcs

Saccadomania - Opsiclonus - multiplanar - encephalopathy (immune compromised onc patients) or neuroblastoma

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6
Q

Indication for referral for VA

A

6/12 or worse

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7
Q

Colour Vision Ax:

A

Boys - RG colour vision 1:20

Ischihara Plates
Closest colour matching

Optic neuritis (with inflammation of optic nerve - along with opthalmaplegia)

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8
Q

Visual Field

A

Test via toy
Expect 155 degrees
Refixation movement
Move from behind

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9
Q

Duction?

Version?

A

Duction is single eye movement

Version is movement of both

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10
Q

Squint?

Ambylopia?

A

Esotropia is IN

Exotropia is OUT

Light Reflex - ?Position
Nasal bridge - flat bridge = webbing = false impression - pseudostrabismus

Cover test - Cover the good eye, squinting eye will take up fixation, uncover
Eye that turns more often is suppressed/ambylopia

Ampylopia - reduced vision due to poor input/strabismus - suppressed to avoid diplopia

Cf. Adults who get diploplia

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11
Q

Leucocoria?

A

Cataract (Nuclear is early in lens development) If cause known - isolated lens protein genes- AD>XL>AR
Intrauterine infections - Rubella (not other TORCH stuff)

Retinal Detachment

Retinoblastoma - Rb - AD of single allelle - “best solid tumour” - Avoid Radiation - Systemic Chemo/Local Chemo/Intrarterial via femoral access/intravesicular

“Glint in the eye”

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12
Q

RAPD?

A

Relative afferent pupillary defect = swinging light test
Normal eye - direct and consenual
Bad eye - dilates

Optic Nerve analysis - compares AFFERENT pupil input in response
Non-organic vision loss
Optic Neuritis
If intact ‘disproves’ vision loss

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13
Q

Optic Nerve - What can you see?

A

Normal disc - clear
Severe pappilodema. - blurry edges and can’t see vessels on disc + haemorrhages
Septic Optic Dysplasia -Bilateral optic disc hypoplasia- Midline abnormalities - abesnt septum pellucidum, anterior pituarity (GH)

DRUSEN - Deposits - Elevate “swollen” disc - outline of disc is irregular - can still see vessels, ?Pseudopappilodema - with ?Benign intracranial hypertension

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14
Q

Field Defect patterns

A

Horizontal field defect - OPTIC NERVE (crescent across

Vertical cut off - Chiasmal or back (Where the nerves cross)

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15
Q

Globe defects for:

Marfans
Golden Harr

A

Golden Harr- Extra bit on globe - “Limbal dermoid” (Hemifacial microsomia/jaw/preauricular)

Corneal Dermoid (DDx Glaucoma/Cataract)

Marfans - “missing bit” subluxed lens due to zonule protein error of fibrillin?
Homocystinuria - Sulfur metabolism - zonule weakness

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16
Q

Opthalmic Squint?

A

Failure of binocular control
Abnormalities of convergence or divergence
High refractive error - over convergence by brain with increasing accomodation

Vs. failure of muscles

17
Q

Head Tilt?

A

Torticollis
Hearing Loss

Binocular driven - cover eye - straight head
For example SO(CNIV), can’t use ‘reading muscle” down and in - therefore will compensate by using up and out posture

18
Q

Mx of SQUINT

A 
Confirm
Measure vision
Document Diploplia
Measure deviation
Measure refraction
Investiage for ocular/nonocular disease

Then: Prescribe glasses
Prescribe patches/drops for ambylopia
Consider Surgery

Treat any amblyopia
Overcome diplopia
Maximis binocular depth - improve field
Improve cosmesis (Don’t look ‘shifty’)

REFER If
If Obvious then refer including if <6/12
Can’t exclude
If Any SQUINT after 6/12

19
Q

Watery or Sticky Eyes?

A

Screen for scleral redness - infection/inflammation
First few days with pus ++ - gonococcal conjunctivitis - Ophthalmia neonatorum - can penetrate/invade epithelial surface unlike staph

Red skin may be contact dermatitis - polyvisc or dry eye ointment aroudn skin - “water proofs”

Epiphoria - probe if >12/12
SPONTANEOUS RESOLUTION before

If ITCHY then allergic

If JUST watering without discharge consider glaucoma

20
Q

Acute painful red watery eye

A

Foreign body
Corneal abrasion
Subtarsal (vertical lines on fluorscein)

21
Q

Amazing Eye Facts?

Pulling a face when wind changes
Champagne cork to eyeball analogy
Blow out fracture?

A

“Trigger finger” tendon on superior oblique through pulley - over convergence and ‘stuck’

//

Eyeball held as per champagne cork with wire cage of tendons - not the eyelids
- increased pressure causes optic nerve ischaemia - painful eye movements, proptosis - swelling of conjunctiva

//

Can’t look up - tear drop sign

22
Q

Unequal Pupils?

A

Anisocoria:

Worse in high light or low light

If in high light then issue is still dilated eye - CNIII - Down and out due to unopposed LR (out) and SO (down)- straight out from brain stem

If worse in low level the issue is constricted eye - HORNERs - Oculosympathetic pathway
HORNERs is miosis (constricted)
Ptosis (droopy top eyelid)
If neck - not sweating
If congenital - different eye colours/heterochromia
Test Horners with 5% cocaine - Blocks Noradrenaline resorption - Dilation in normal eye -
DDx NEUROBLASTOMA (CXR/Urinary Catecholamine/?MRI/?MIBG)

23
Q

Colobomas in which genetics?

A

CHARGE Associatino

24
Q

Congenital Glaucoma

A 
Too much fluid
Big eye
Cloudy Cornea - due to torn epithelium and swelling
Tearing
Photophobia

Optic Nerve damage if left along time/adult
Corneal damage early

Medical Mx of eye drops - systemic absorption via nasal mucosa (alpha agonist - CV collapse) CI in <2yo, (beta blocker) - maximise local absorption by occlusion

Carbonic Anhydrase Inhibitor - Dimox = acteazolamide - Shared biochem for choroid plexus and cillary body (‘hypertension of the eye’)

25
Q

Aniridia - whats the relevance?

A

Do a microarray - ?chromosome 11
Do a renal U/S

May have WILMS Tumour

PAX6 Gene next to WT on 11q

26
Q

T21 Opthal?

A 
Any possibility- all eye problems are common
Squint
Cataract
Refractive errors
Blocked tear ducts
Glaucoma occasionally
27
Q

Cerebal palsy opthal?

A

50% strabismus

28
Q

Retinopathy of prematurity - opthal?

A

Zone of retinal maturity
Distance from optic nerve
Torturosity of vessels is PLUS disease.
Almost is pre-plus.

Treat: TYPE 1 Disease
That is : 
Zone I with any plus
Zone I stage 3 ROP
Zone II Stage 2 or 3 ROP with Plus

BOOST Trial - lower O2 will increase mortality but only reduce ROP slightly
91-95% better balance than lower targets

29
Q

Juvenile Chronic Arthritis - What Opthal Cx

A

Scarring between iris and lens with irits (Anterior uveitits)
@ risk of cataract and glaucoma
Rx inflammation with steroids (Also cataract and glaucome as ADR of steroids)
Max in PANAFY - Pauci-articular, ANA +ve, Female, Young

Screening until age 12
Pauci/Poly - ANA +ve 3-4/12 monthly r/v
Pauci/Poly - ANA -ve 6/12ly r/v
Systemic 12/12

RACP Opthal (1 decks)

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