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opthalamology Flashcards

1
Q

what is blepharitis?

A

chronic inflammation of lid margin

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2
Q

who is at more risk of blepharitis?

A
  • More common and severe in elderly
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3
Q

what are the symptoms of blepharitis?

A

Symptoms: often intermittent with exacerbations and remissions occurring over long periods
- Burning, itching – maybe crusting
- Worse in mornings – more crusty
- Both eyes are affected
- Recurrent hordeolum – styes
- Contact lens intolerance

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4
Q

what conditions are associated to blepharitis?

A

dry eye disease
seborrheic dermatitis
rosacea

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5
Q

how do you manage blepharitis?

A
  • Requires ongoing maintenance, self care – eyelid hygiene and warm compresses
  • Diluted baby shampoo with warm water and wipe along margins
  • If self care is ineffective  topical antibiotic eg chloramphenicol
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6
Q

what is chalazion?

A

Meibomian cyst

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7
Q

what is the pathophysiology of chalazion?

A

The cyst is a sterile, inflame granuloma caused by obstruction of sebaceous gland
Pathophys: causes gland to enlarge and rupture spontaneously or persist as chronic nodule
- May develop acutely with oedematous erythematous eyelid or arise as firm, painless nodule
- If secondary infection: can spread from preseptal cellulitis requiring oral/ IV Abx  orbital or periorbital cellulitis

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8
Q

what is the management of Meibomian cyst (chalazion)?

A

Management: mainly self limiting
- Warm compress and gently massage – go towards eye lid to follow normal path of drainage
- If persistent: refer to ophthalmologist  incision and curettage
- No treatment if meibomian cyst is small and asymptomatic

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9
Q

what is the other name for a stye?

A

hordeolum

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10
Q

what is a stye/ hordeolum?

A

acute localised infection or inflammation of eyelid margin. Bacterial infection is usually caused by staph infection

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11
Q

where is an external stye located?

A

on eyelid margin

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12
Q

what causes an external stye?

A
  • Infection of eyelash follicle and associated with sebaceous apocrine gland
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13
Q

where is an internal stye?

A

occurs on conjunctival surface of eyelid

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14
Q

what causes an internal stye?

A
  • Infection of meibomian gland – situated within tarsal plate
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15
Q

how do you manage a stye?

A
  • Self care: usually self limiting and rarely causes serious complications
  • Warm compress 5-10 mins 2-4x daily
  • Do not attempt to puncture stye – no squeezing
  • Avoid eye makeup/ contact lens
  • Painful styes: eyelash form infected follicle removed, incision and drainage, topical Abx ( chlorophenicol)
  • Refer: if not improving or large/ painful
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16
Q

what is ectropion?

A

outward rotation of eyelid margin

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17
Q

what can cause ectropion?

A

Pathophys: most commonly due to horizontal lid laxity – loss of elasticity and muscle tone
- Other aetiology: due to skin trauma, burns, skin tumours, actinic changes to skin due to prolonged sun exposure
- Paralytic causes: facial palsies

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18
Q

what are the symptoms of ectropion?

A

Symptoms: sore red and watery eye

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19
Q

what is the management of mild ectropion?

A
  • Mild: no treatment but advise rubbing eye lids may cause more lid laxity  tapping lids closed at night when risk of corneal exposure
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20
Q

what can be used to manage moderate ectropion?

A
  • Ocular lubricants: for tear deficiency related to symptoms – drops in day and ointment in day
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21
Q

what is entropion of the eyelid?

A

inward rotation of tarsus and lid margin- usually lower eyelid

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22
Q

what is the pathophys of entropion?

A

Pathophys: loss of elasticity and muscle tone of eyelids usually with AGE
- LASHES THEN come into contact with ocular surface
- Presents as foreign body sensation and irritation eith red watery eye and blurring of vision

23
Q

what ways can manage entropion?

A
  • Tapping eyelid to check
  • Injecting muscles of eyelid with BOTOX
  • Lubricating eye to protect front of eye
  • Severe  refer and small operation can be performed to turn eyelid back to normal position
24
Q

what is ptosis?

A

droopy eye
>2mm of cornea covered by eyelid

25
Q

what is pseudoptosis?

A

one eye affected

26
Q

what could be unilateral differentials of ptosis?

A

involutional changes, congenital, 3rd nerve palsy, Horner’s syndrome, trauma to levator muscle

27
Q

what could be bilateral ptosis differentials?

A

involutional changes, congenital, myasthenia gravis (one side can be more affected), myotonic dystrophy, mitochondrial myopathies, dermatochalasis, trauma to levator muscle

28
Q

what allows for eyelid elevation?

A

: oculomotor nerve innervates: levator palpebrae and supreriorns as well as superior tarsal palate

29
Q

what chain allows for pupil constriction?

A
  • Pupil constriction: parasympathetic
30
Q

what chain allows for pupil dilation?

A

sympathetic

31
Q

what allows for extra-ocular movements?

A
  • Extra-ocular movements: innervates trochlear (superior oblique), abducens (lateral rectus) and oculomotor (medial rectus, superior rectus, inferior rectus and inferior oblique)
32
Q

when is dermatochalasis frequent?

A

patients with recurrent blepharitis which have now resolved

33
Q

what is dermatochalasis?

A
  • Excessive skin on upper and lower eye lid
  • Complicated with entropion and blepharitis
34
Q

what is involutional ptosis?

A

drooping of eyelids seen in elderly - normal

35
Q

what are the genetic components of myotonic dystrophy?

A

Pathophys: trinucleotide repeats (DM1) and tetranucleotide repeats (DM2) – seen through generations
- Normally have 5-30 repeats, this has 50 to 2000 repeats
faulty genes

36
Q

describe the muscle weakness that is seen within myotonic dystrophy?

A
  • Muscle weakness and wasting (lower motor neurone) – bilateral ptosis, wasting of muscles in hands, face, jaw – little lines on forehead (comes in towards cheekbones) , hatchet jaw (comes in but droopy)
37
Q

describe the prolonged contractions/ delayed relaxation seen within myotonic dystrophy?

A
  • Prolonged contraction/ delayed relaxation: percussion myotonia, difficulty in relaxing – grip (when grip hands, they do not release instantly like you would once told to release – hands may spasm after release)
38
Q

apart from muscle weakness, delayed relaxation/ prolonged contraction, what else is seen within myotonic dystrophy?

A
  • Male pattern balding
  • Cataracts – can be in one eye
  • Diabetes – type 1
  • Gynaecomastia
  • Low IQ
  • Heart conduction defects – heart block, AF, arrhythmias
39
Q

what is the pathology behind horners syndrome?

A

Pathophys: sympathetic supply to eye interrupted and the parasympathetic overrides the affected side
- Sympathetic chain runs form base of skull to coccyx – can affect any nearby structures on route eg aorta

40
Q

what are the symptoms seen within horners syndrome?

A

Symptoms: ptosis, meiosis (small pupils), enophthalmos (sunken in eyes), anhydrosis (little or no sweating of that side of face)

41
Q

what central aetiologies can lead to horners?

A
  • CVA – central vascular accident – interruption of blood flow to brain
  • Syringomyelia - Syringomyelia is a neurological disorder in which a fluid-filled cyst (syrinx) forms within the spinal cord. The syrinx can get big enough to damage the spinal cord and compress and injure the nerve fibres
  • Meningitis and encephalitis
  • Brain/ spinal cord tumour
  • Trauma – central
42
Q

what preganglionic pathologies (in chest) cause horners?

A
  • Cervical rib – should not be there
  • Lymphadenopathy
  • Thyroid mass – goitre, tumour, surgery
  • Lung apex pathology eg Pancoast tumour
  • Thoracic aorta, subclavian aneurysm – aortic dissection
  • Trauma – chest
43
Q

what post ganglionic pathologies cause horners (neck and upwards in spine)

A
  • Carotid artery dissection/ aneurysm
  • Cavernous sinus thrombosis
  • Middle ear infection
  • Cluster headaches
  • Trauma – neck and head
44
Q

what are the symptoms of myasthenia gravis?

A

Symptoms: better in morning and worsening in evening – fatiguability
- Ocular – ptosis and diplopia (double vision)  first symptom
- Bulbar – dysphagia, dysphonia and dysarthria
- Facial – droopy mouth, less forehead lines,
- Limb, trink, resp weakness  as it progresses

45
Q

what tests demonstrate fatigability indicating myasthenia gravis?

A
  • Simpsons; look up and observe for worsening ptsosis
  • Repeatedly test flap arm for a minute and then test power (initially push down on chicken elbows and then flap arms for 30x times and then push down again on chicken elbows  should easily push to sides)
  • Reflexes and sensation are usually in tact
  • Muscle wasting can occur if prolonged activity
46
Q

what conditions is myasthenia gravis associated with?

A
  • Associated with other AI conditions especially thyroid
47
Q

what investigations are done for myasthenia gravis?

A
  • TENSILON test – using edrophonium and atropine will improve symptoms in seconds
  • Acetylcholine receptor antibodies
  • EMG – assess fatiguability
  • Imaging of thymus – CT  this makes the auto antibodies
  • Spirometry – access resp muscle involvement – FVC or single breath counting
48
Q

how do you manage myasthenia gravis?

A
  • Pyridostigmine – acetylcholinesterase inhib
  • Steroids and immunosuppressives – azathioprine, methotrexate
  • Thymectomy if hyperplasia oh thyoma
49
Q

what is labert - eaton myasthenic syndrome?

A
  • Antibodies to pre-synaptic voltage gates calcium channels in NMJ
  • Associated with AB to voltage gated calium channels
50
Q

what symptoms are seen with lamert -eaton myasthenic syndrome?

A

Symptoms: weakness in arms and legs

51
Q

what is lambert-eaton myasthenic syndrome associated to?

A
  • 60% have associated malignancy usually small cell lung cancer
52
Q

what are the signs of 3rd nerve palsy?

A

Symptoms:
- Ptosis
- Mydriasis – enlarged pupil
- Eye facing down and out
- Enophthalamus

53
Q

what can cause 3rd nerve palsy?

A

Aetiology: diabetes, atherosclerosis, posterior communicating artery aneurysm, SoL, brain infection/ inflammation, cavernous sinus thrombosis, MS

54
Q
A

neuro (12 decks)

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