Opthalmology Flashcards
What are the differentials for painless loss of vision
Ischaemia/thrombosis - thrombosis, emboli, temporal arteritis (including central retinal vein occlusion or central artery occlusion)
Vitreous haemorrhage
Retinal detachment
Retinal migraine
What is Amaurosis fugax and what is it a sign of?
A temporary loss of vision in one or both eyes due to lack of blood flow to the retina
Sign of ischaemia/vascular problem of the eye
Wide list of differentials such as thrombus, GCA, AION
What is an anterior ischaemic optic neuropathy and what is its classical presentation?
Sudden loss of vision due to an interruption of blood flow to the front (anterior) of the optic nerve, also known as the optic head
Presentation- loss of vision, usually upon waking up in the morning
What are the fundoscopy findings of an anterior ischaemic optic neuropathy?
If it is arteritic then pallid swelling of the optic disc and a peripapillary cotton-wool spot
Non-arteritic- hyperemic swelling of the optic disc with flamed shaped peripapillary haemorrhage
What is and what are the Symptoms of optic neuritis?
Inflammation of the optic nerve
Features - subacute loss of vision, unilateral loss of acuity, colour vision affected (red appears less red). RAPD. Pain worse on eye movement
What condition is optic neuritis associated with?
Multiple sclerosis
Fundoscopy findings of central retinal artery occlusion
Cheery spot on pale retina
A cherry spot on fundoscopy is associated with what condition?
Central retinal artery occlusion
Management of central retinal artery occlusion
If seen within 100 mins of onset - try to increase retinal blood flow
Emergency treatment aims to reduce intraocular pressure
Surgery
Fundoscopy findings or central retinal vein occlusion
Severe retinal haemorrhages
Features of virtuous haemorrhage
Sudden painless loss of vision
Virteous floaters
Small black dot of tiny ring like forms
Painless visual loss or haze, red hue in vision and floaters is the typical presentation of what?
Virteous haemorrhage
Floaters, flashes, field loss, fall in acuity is the typical presentation of what?
Retinal detachment
What is the classical presentation of retinal detachment?
Floaters, flashes, field loss, fall in acuity
Painless, may be like a curtain falling as the lowe half of the retina detaches upwards
What are the fundoscopy findings of retinal detachment?
Grey, opalescent retina, ballooning forward
Red eye differentials
Acute angle closure glaucoma Anterior uveitis Scleritis Conjunctivitis Subconjunctival haemorrhage Endophthalmitis
Presentation of acute angle closure glaucoma
Severe pain (ocular or headache)
Decreased visual acuity, patient sees haloes
Semi-dilated pupil
Hazy cornea
Anterior uveitis presentation
Acute onset
Pain
Blurred vision and photophobia
Small, fixed, oval pupil
Scleritis presentation
Severe pain (may be worse on movement) and tenderness May be underlying autoimmune disease (RA)
Conjunctivitis presentation
Purulent discharge if bacterial, clear discharge if viral
Man with ankylosing spondylitis presents with red eye, acute onset, small and irregular pupil, photophobia and blurred vision probably has what?
Anterior uveitis
What conditions is anterior uveitis associated with?
HLA-B27 conditions
Ank spond. Reactive arthritis U.C / crohns Bachets Sarcoidosis
Management of anterior uveitis
Urgent review by opth
Cycloplegics - dilates pupils - atropine
Steroid eye drops
What is glaucoma?
Optic neuropathies associated with raised intraocular pressure
Classified based on whether the peripheral iris is covering the trebcular Methwold which is important in the drainage of aqueous humour from the anterior chamber of the eye. In open-angle = iris is clear of the mesh work
Presentation of acute closure glaucoma
Painful red eye Headaches N+V Haloes around light, burning and blurred vision Dilated pupil
Ophthalmoscopy findings of glaucoma
Cupping of the optic disc
Mid dilated pupil
Management of acute glaucoma
Referral to opthalmology
Reduce IOP - topical agents (muscarinic agonist - pilocarpine +/- B blocker - timolol)
Laser peripheral iridotomy
Management of chronic glaucoma
Topical treatment - prostaglandin analogues (latanorprost), b-blockers (timolol) a2-agonists (brimonidine)
Combine eye drops
Laser trabeculoplasty if medical management insufficient
