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Final year Medicine > Opthal > Flashcards

Opthal Flashcards

1
Q

Iriritis (anterior uveitis) features

A

Most idiopathic
Some autoimmune
affectds iris and ciliary body

Blurring vision
Unilateral pain
constricted pupil
Edema eyelid
red eye
photophobia
decreased acuity
Redness eyelash
clear to hazy cornea
small irregular reaction of pupils
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2
Q

Iritiis treatment

A 
Steroid drops
Analegesia
NSAIDs
Cycloplegics
Darkness
Rest 
Warm compress
Shields/dark glasses
follow up
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3
Q

Episcleritis

A 
Not serious
mildly pink - focal
tearing
no discharge
vision unaffected
no pain
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4
Q

Scleritis

A 
Very serious
Red eye - diffuse
no discharge
photophobia
v painful - can wake from sleep
anorexia
pain -> temple/brow
vision can be affected.
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5
Q

Episcleritis mx

A

ix :2.5% phenylephrine
-> eye goes white.

Mx: NSAIDS

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6
Q

Scleritis mx

A

steroids.

Uveitis clinic

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7
Q

Conjunctivitis causes

A 
inflam of conjunctiva
bac/viral
allergies
chlamydia
chemical burns
FB
flash burns
irritants
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8
Q

Conjunctivitis features

A 
Hyperemia
Uni/bilateral
Slight pain
Gritty sensation
Mucopurulent discharge
Eyelids/lash matting
Eyelid oedema
Normal acuity
Clear cornea
normal pupil 
RED/PINK conjunctiva
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9
Q

Conjuncitivitis MX

A 
Ix: Red++ pus -> Swab
Mx:
Abx, ointment
Culture 
cleanse eyes, remove debris
Educate - 
explain contagious
admin teach
asepsis
wipe nose -> outer corner
cleanse lid baby shampoo
avoid eye makeup
follow up.
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10
Q

Periorbital cellulitis

A

Infection of cells round eye
Life threatening
? laceration, insect bite
Pneumococcal, staphy, strep.

Marked periorbital oedema and erythema
Severe pain -worse w movement
Conjunctival infection
Fever
Decreased Acuity
Decreased pupil reflexes
Paralysis EOM
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11
Q

Periorbital cellulitis IX

A

CT scan
Culture
Gram stain swab discharge
Blood culture

Mx: Refer seconadry care
Oral Abx - coamoxiclav

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12
Q

orbital cellulitis

A 
Redness swelling
severe eye pain
visual disturbance
proptosis
opthalmoplegia
odema, ptosis

true orbital infection
eye and life threatening
staph aureus
admit - IV abx, surgery.

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13
Q

Acute glaucoma

A

increased IOP
+ nerve damage
-> reduced visual field.

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14
Q

Cataract causes, features + signs

A 
Gradual Lens becomes cloudy
Reduced/blurry vision. 
Glare
Faded colour vision.
Halos around lights
F>M
30% >65 
Age

Causes
smoking, DM, Age, Alcohol, myotonic dystrophy, radiation, steroids, hypocalcaemia

Signs: loss of red reflex

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15
Q

Cataracts types

A

Types: nuclear - change in Ref. Index lens - age
Polar - inherited, localised
Subcapsular - steroids - deep to lens capsule
Dot opacities - normal/DM/myotonic dystrophy

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16
Q

Cataracts IX

A

Ix: Opthalmoscopy - dilate pupil - normal fundus and optic nerve.

slit lamp - visible cataracts

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17
Q

Cataracts MX

A

Early: conservative

  • Stronger glasses/contact lens
  • use brighter lighting

Surgery:

  • if visual loss, QOL reduced, pt choice
  • info on various eye drops, eyewear, lenses,
  • Remove cloudy lens- replaced with artifical one.

Complications

  • posterior capsule opacification (thickening)
  • retinal detachment
  • posterior capsule rupture
  • endopthalmitis - aq/vitreous humour inflam.
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18
Q

Central retinal artery occlusion

A 
Sudden painless unilateral vision loss
Thromboembolism/arteritis
Afferent pupillary defect
Cherry red spot on pale retina. 
retinal whitening.
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19
Q

Central retinal artery occlusion

A 
Refer to opthalmology
ESR, CRP
FBC 
AI screen,
cardiac function.

Urgent refferal to stroke centre

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20
Q

Central vein occlusion

A

age
more common
Causes: glaucoma, PCV, HTN
several retinal haemorrhages.

Branch retinal vein occlusion - flame hs, cotton wool spots, hard exudates, oedema, dilated tortuous veins, microanyerysms

tx: steroid implant. 
laser tx
aflipercept
raibizumab, 
Follow up avery 6-8 w
21
Q

POAGlaucoma RFs

A

Primary open angle causes

  • 2% over 40s
  • genetics
  • black
  • myopia
  • hTN
  • DM
  • Corticosteroids
22
Q

Features of glaucoma

A

Peripheral visual field loss - nasal scotomas-> tunnel vision
decreased acuity

Fundoscopy:

  1. Optic disc Cupping
    cup: disc >0.7
  2. Optic disc pallor - optic atrophy
  3. Bayonetting vessels
    - break as disappear into deep cup, reappear at base
  4. Cup notching, disc haemorrhages.
23
Q

Ix Glaucoma

A

automated perimetry - visual field
Slit lamp exam - baseline fundus/optic nerve
Applanation tonometry - IOP >24mmHg
central corneal thicknes measurement
Genioscopy -
assess risk of future visual impairment (IOP, CCT, fhx, Life expectancy)

24
Q

Mx primary open angle glaucoma

A
  1. Prostaglandin analogue eye drop (LATANOPROST) od. increases uveoscleral outflow. SEs: Brown iris, incresaed eyelash length

2nd line: Beta blocker(timolol) reduce aq production. - avoid Asthma/heart block

Sympathomimetic: brimonidine (a2 blocker) - reduces aq production, increase outflow.
Avoid if takng MAOI/TCA
SE:hyperemia

Carbonic anhydrase inhibitor (acetazolamide/Dorzolamide) - reduce aq production

Miotics: Pilocarpine(musc blocker) - increased uveosceral flow.
-SEs: constricted pupil, headache, blurred vision.

  1. Surgery if refractory
25
Q

Acute angle closure glaucoma RFs

A

Impairment in outflow.

-RFS Hypermetropia, pupil dilatation, lens growth.

26
Q

Acute angle closure glaucoma Features

A 
PAIN - ocular/headache
decreased acuity
worse in dark (mydriasis)
hard, red eye
haloes around lights
semi dilated non reacting pupil
corneal oedema
- dull hazy cornea
-N+V/abdo pain possible
27
Q

Acute angle closure glaucome mx

A 
Urgent refferal to opthal
Medical mx: Piliocarpine 
Timolol
Apraclonidine (a2 agonist) 
IV acetazolamide

Surgery:
Laser periperal iridotomy

28
Q

Keratitis

A

red eye, tearing, photophobia, central clouding, intense pain

29
Q

keratitis mx

A

Ix: Corneal scraping
C+S, FBC, HIV.

Mx: Empirical Abx - tobramycin eye drops 14mg/ml
Cefalozin
non infectious - Opthal referral
etc.

30
Q

Types of Macular degeneration

A

Dry 90% - drusen (round yellow spots in Bruchs membrane)
Wet (10%) - exudative - choroid neovascularisaition - leakage of serous fluid/blood -> rapid loss of vision. Worse prognosis.

Early - Non exudative - age related maculopathy- drusen - alterations to Retinal pigment epithelium

Late Macular degeneration - neovascularisation. exudative.

31
Q

RFs ARMD

A

Age
Smoking
Fhx
IHD

32
Q

Symptoms and signs of ARMD

A

Near field loss
deterioration of dark adaptation
fluctuations in disturbacne
photopsia (flashing lights, glare)

signs:
Distortion of line perception - Amsler grid testing
Fundoscopy - drusen-> scar late
demarcated red matches - wet ARMD

33
Q

ix ARMD

A

Slit lamp microscopy
colour fundus photography - baseline
Flurescein angiography - if neovascuaalr
ocular coherence tomography

34
Q

Mx ARMD

A

zinc, vit A, C E
ranibizumab, bevacizumab (anti VEGF) 4weekly injections - wet.
Laser photocoagulation

35
Q

Retinal detachment

A 
RFS; posterior vitreous , age, Myopia, cataract surgery
flashes of light/floaters
-> dense shadow -> peripheral -> central
veil/curtain
straight lines - curved
central vision loss

visual acuity test, slit lamp, opthalmoscopy

Cyopexy, vitrectomy surgery

36
Q

Vitreous haemorrhage

A 
Bleeds -> sudden vision loss.
red hue to vision
painless
Dark spots 
small - floaters
Caused: Diebetes, bleeding disorders

Dilated fundoscopy, slit lam - red cells in anterior vitreiosu. p, USS, - retinal detachment. Fluorescein - neovascularisation, orbital CT - open glove injury

, Anticoagulants
LASER: several weesks. for blood to clear.

37
Q

Diabetic retinopathy stages

A
  1. Microaneurysms BG Retinoapthy
  2. Hard exudates
  3. PPR Cotton wool spots -> opthalmic referral
  4. Multiple frond like new vessels (proliferative) white fibrous tissue near.

Tx: Pan retinal photocoagulation

38
Q

Painless red eye causes

A

Conjunctivitis - diffuse injection. swollen conjunctiva, debris. Bacteria > discharge
Subconjunctival haemorrhage - flat , red patch.
episcleritis- sectoral area of injection. remove with swab
dry eye - blepharitis crusting, matted eyelashes.

39
Q

Painful red eye

A

scleritis worsening symptoms . CTDs
Uveitis -circumciliary injection. hazy cornea, hypopyon, reduced acuity,
Corneal abrasion - eye red, pain, watering, stains with flurescein - defeect.
Coreneal ulcer - hazy, pain, watering, fluffy defect.
AACG: pain, injection, redueced acuity, haloes, mid dilated unreactive pupil
foregin bodies.

40
Q

Fundoscopy

3Cs

A

Contour - clear borders of optic disc. (blurred = papilloedema)
Colour - orange-pink w pale centre - healthy . Pale = optic atrophy - optic neuritis, advanced glaucoma, ischaemia.
Cup - cup to disc ration >0.7 glaucoma
4 quadrants retina, macula

41
Q

Hypertensive retinopathy stages

A
  1. silver wiring (arteriolar narrowing)
  2. AV nipping (bulging retinal veins where artery is crossing)
  3. Cotton wool spots (small fluffy white lesions infarcts of neuro retinal layer)
    Flame haemorrhages - ruptured arterioles, venules (ddx, lowplts, retinal vein occlusion, trauma).
    hard exudates - yellow waxy
  4. Papilloedema.
42
Q

Classification of diabetic retinopathy

A

Background retinopathy
-Microaneurysms 1 or more (MILD NPDR)

Moderate NPDR
-microaneurysms
-blot haemorrhages
-hard exudates
-cotton wool spots, venous looping, 
beading, intraretinal mv abns,

Severe NPDR
-blot and microaneurysms in 4 quadrants
-venous bleeding in 2
IRMA in at least 1

Proliferative - retinal neovascularisation - can lead to vitreous haemorrhage. T1DM

Maculopathy
- hard exudates
more common - t2dm

43
Q

Horners syndrome
Presentation
Casues

A

Miosis
PTosis
enophthalmos
anhidrosis

Central lesions

  • anhidrosis in face arm and trunk
  • stroke, syringomyelia.MS, tumour , encephalitis
Pre ganglionic lesions
-Anhidrosis just face
-Pancoasts tumour
thyroidectomy
trauma
cervical rib 
Post ganglionic 
no anhidrosis
-carotid artery dissection
carotid aneurysm
cavernous sinus thrombosis
cluster headache
44
Q

Bilateral grittiness, sticky eyelids worse in mornings

A

Blepharitis
tx: hot compresses soften eyelid margin,
lid hygeine - mechanical removal of debris (cotton buds in cooled boiled waater)
artificial tears

45
Q

Dry eye syndrome

A

grittiness bilaterally worse end of the day

pain

46
Q 
1 week worseining vision
pain on eye movement
muting of colours
similar episode 6m ago
RAPD
A

INO
Optic neuritis (central scotoma) MS, DM , syphilis.
-periorbital , retro ocular pain

Mx: High dose steroids
4-6w recovery

MRI - if >3 white matter lesions
5y risk of MS is 50%

47
Q

Reading, blurred vision
6/12 snellen chart

iX?

A

Pin hole occluder

-identifies refractive errors.

48
Q

painful swelling eyelid,

yellow head pointing at lid margin>

A

Stye -> Analgesia + warm compress

49
Q

8 wk old watery eyes since birth .

A

Nasolacrimal duct obstruction
- Tx teach massage of lacrimal duct.
Should resolve at 1 yr.
unresolved - refferal for probing under GA.

Final year Medicine (18 decks)

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