Opthalmology Flashcards
What is anterior uveitis?
Also referred to as iritis. It is an inflammation of the anterior portion of the urea (iris and ciliary body).
It is associated with HLA-B27.
What are the features of anterior uveitis?
Acute onset Pain Pupil small +/- irregular Photophobia Blurred vision Red eye Lacrimation
What is the management of anterior uveitis?
Urgent review by ophthalmology
Cycloplegics (dilate pupil to ease pain) - atropine, cyclopentolate
Steroid eye drops
What is the difference between retinal artery and retinal vein occlusion s?
Central retinal vein occlusion:
- more common than arterial
- causes: glaucoma, polycythaemia, hypertension
- severe retinal haemorrhages seen on fundoscopy
Central retinal artery occlusion:
- due to thromboembolism or arteritis
- features include affront pupillary defect, cherry red spot on pale retina
What is blepharitis?
Inflammation of the eyelid margin either due to meibomian gland dysfunction or seborrhoeaic dermatitis or infection.
More common in people with rosacea
What are the features of blepharitis
Bilateral
Gritty eyes
Stick in the morning
Swollen eyelids
What is open angle glaucoma
It is an increase in the intraocular pressure due to blockage of the aqueous humour.
what are the risk factors of open-angle glaucoma?
- increasing age
- myopia
- family history
- black ethnic origin
Describe the presentation of open-angle glaucoma
- halos around light (usually worse at night)
- peripheral vision loss
- fluctuating pain
- headaches
- blurred vision
What are the investigations for open-angle glaucoma?
- Non-contact tonometry
2. Goldmann applanation tonomertry
What is the diagnosis of open-angle glaucoma?
- Goldmann applanation tonometry
- Optic disc cupping on fundoscopy
- Peripheral vision loss
What is the management of open-angle glaucoma?
- Prostaglandin analogues e.g. latanoprost
- Topic beta-blockers e.g. timolol
- Carbonic anhydride inhibitors e.g. dorzolamide
- Sympathomimetics e.g. brimonidine
Surgery (trabeculectomy)
What is acute angle closure glaucoma
Increased intraocular pressure due to iris bulging forward and blocking the trabecular network meaning that aqueous humour cannot get out.
What are the risk factors for acute angle closure glaucoma?
- increasing age
- female
- East Asian/Chinese ethnicity
- family history
- shallow anterior chamber
- hypermetropia
Medications: adrenergic (NA), Antcholinergics (oxybuynin), TCA (amitriptyline)
What is the presentation of acute angle-closure glaucoma?
- systemically unwell appearance
- halos around light
- severely painful red eye
- blurred vision
- associated nausea, headache and vomiting
Describe the examination findings of acute angle closure glaucoma
- hazy cornea
- red eye
- pupil fixed and dilated
- teary eye
- decreased visual acuity
What is the initial management of acute angle closure glaucoma in primary care
Same day referral to opthalmology (ambulance)
- lie them on their back with no pillow
- pilocarpine Eye drops
- acetazolomide 500mg
- analgesics
- anti-emetics
What is the secondary care management of acute angle closure glaucoma?
- pilocarpine eye drops
- azetazolamide
- hyperosmotic agents
- carbonic anhydride inhibitor (dorzolamide)
- beta blocker (timolol)
- sympathomimetic (brimonidine)
Gold standard surgery: laser iridotomy
What are the opthalmological features of Graves’ disease?
- increasing Diplopia on looking up
- lid retraction and proposes (one sided)
- reduced gaze in one eye
What is seen on fundoscopy for non-proliferative diabetic retinopathy?
MILD: microaneurysms
MODERATE: Cotton wool spots, Microaneurysms, Hard exudate, Blot haemorrhages and venous beading.
SEVERE: blot haemorrhages plus microaneurysms in 4 quadrants venous beading in 2 quadrants
What is seen on fundoscopy in proliferative diabetic retinopathy?
Neovascularisation and virteous haemorrhage
What is seen on fundoscopy in diabetic maculopathy?
macular oedema and ischaemic maculopathy
What is the management of diabetic retinopathy?
Lasar photocoagulation
Anti-VEGF medicaitons such as ranibizumab
Viteroretinal surgery
What is the presentation of cataracts?
Assymetrical:
Very slow reduction in vision
Progressive blurring of vision
Change of colour of vision with colours becoming more brown or yellow
STARBURTS can appear around lights
No red reflex
What is the presentation of age related macular degeneration?
Gradual worsening central visual field loss
Reduced visual acuity
Crooked or waxy appearance to straight lines
What is the presentation of retinal detachment?
Peripheral vision loss (sudden and like a shadow)
Blurred or distorted vision
FLASHES and FLOATERS
What is the diagnosis and management of retinal detachment?
Vitrectomy
Scleral buckling
Pneumatic retinopexy
US B-Scan for diagnosis
What is the presentation of scleritis?
Acute onset of symptoms: Severe pain Pain with eye movement Photophobia Eye watering Reduced visual acuity Abnormal pupil reaction to light Tenderness to palpation of eye
What is the management of scleritis?
Same day ophthalmologist assessment.
NSAIDs
Steroids
Immunosuppression
What is the presentation of optic neuritis?
Unilateral reduced vision developing over hours to days. Key features:
- central scotoma
- pain on eye movement
- impaired colour vision
- relative afferent pupillary defect
What is the difference between episcleritis and scleritis?
Scleritis is painful
Vision worse going down the stairs = which nerve palsy?
Superior oblique therefore Trochlear nerve SO4
What does dendritic ulcers on fluorescein stain suggest?
Herpes simplex keratitis
