Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > opthalmology > Flashcards

opthalmology Flashcards

1
Q

Differentials for conjunctivitis

A
  • acute glaucoma (SEVERE pain, blurry, corneal clouding, dilated pupil)
  • episcleritis
  • uveitis
  • keratitis (cloudy vision, severe pain)
  • corneal ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define diabetic retinopathy and types of it.

A
  • microvascular complication of diabetes which affects your eye
  • major cause of visual loss + blindness
  • Early symptoms = asymptomatic SCREENING NEEDED (retinal imaging)

Types:

  1. Background
  2. Pre-proliferative
  3. Proliferative
  4. Maculopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathophysiology of retinopathy

A
  1. Hyperglycemia => activation of different pathways (high glucose delivered to retina by retinal arteries)
  2. Affects endothelial function => retinal ischemia
  3. Produces factors that increase permeability of blood vessels => factors leak into surrounding vessels => macula oedema
  4. Erythropoietin factor=> retinal neurovascularisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

examination findings of diabetic retinopathy

A

FUNDOSCOPY

background

  • hard exudate- cholesterol
  • microaneurysms (dots)
  • blot haemorrhages

pre-proliferative

  • cotton wool spots (ischaemia)

proliferative

  • little thin new vessels developing from optic disc (problems => tears can lead to bleeding in vitrious=> BLIND)

Maculopathy

  • affects direct vision
  • blots/dots (microaneurysms)
  • hard exudates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for retinopathy

A
  • Background => improve blood glucose control (don’t need glasses change as diabetes is causing changes lens shape) + WARN PATIENT ABOUT DIABETES
  • Pre-proliferative/proliferative => refer to eye doctor => PAN retinal photocoagulation (laser off ischaemic areas)
  • Maculopathy => Anti-VEGF injections , Grid photocoagulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

complications of retinopathy

A
  • vitreous haemorrhages- new vessels leaking
  • glaucoma- new vessels affect fluid flow => increase pressure in eye => damage optic nerve
  • retina detachment - new scar tissue growth pushes eye forwards
  • BLINDNESS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

define uveitis

A

inflammation of the uvea (iris, ciliary body, choroid)

  1. anterior uveitis (most common)
  2. intermediate uveitis (vitreous inflammed)
  3. posterior uveitis (retina/choroid inflammaed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

causes of uveitis

A
  • IDIOPATHIC (40%)
  • systemic inflammatory disorders (ankylosing spondylosis-young men, juvenile arthritis-women, MS, sarcoidosis, IBD, SLE, Behcet’s)
  • infection (TB, HSV, HZV)
  • trauma
  • neoplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

symptoms + signs of uveitis

A

symptoms:

  • cloudy/blurred vision
  • red around the limbus (cornea-sclera border)
  • moderate painful eye
  • photophobia
  • watery eye

signs:

  • pupil irregular/constricted
  • flashes and flares (leakage of proteins) - inflammatory cells in anterior chamber
  • keratic precipitate in cornea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

management for uveitis

A
  1. refer to opthamologist
  2. medical: (only given by opthamologist)
  • non-infectious => topical corticosteroids + cyclopentolate (paralyses cilliary body - relieves pain)
  • infectious => antimicrobial + corticosteroids + cyclopentolate
  • chronic/ SEVERE => immunosuppressants, TNF inhibitors, laser phototherapy, cryotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

prognosis + complications of uveitis

A
  • most resolve after treatment
  • some become chronic=> visual impairment, ocular complications, blindness

COMPLICATIONS:

  • cystoid macular oedema
  • secondary cataract
  • secondary glaucoma.​
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

define thyroid eye disease

A

autoimmune disease usually caused by hyperthyroidism (Grave’s) leading to eye inflammation (eye muscles, eyelids, tear glands, fatty tissue behind eye)

  1. active
  2. stable phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

symptoms of thyroid eye disease

A
  • red painful eye
  • diplopia (restricted ocular mobility)
  • dry/watery eyes
  • bulging/STARE eyes
  • PROPTOSIS (exopthalmos) not always present
  • lid retraction/ lid lag
  • difficulty closing eyes
  • reduced visiual acuity (more severe)

FHx, more common in females/40-60s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

investigations for thyroid eye disease

A
  • TFTs (T4/TSH levels)
  • anti-TSH/TPO/thyroglobulin antibodies (not very specific/sensitive)
  • CT/MRI orbital area
  • thyroid uptake scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management for thyroid eye disease

A
  • Mild (dry eye/diplopia) => conservative (drops)

Moderate

  1. corticosteroids (intravenous)
  2. orbital radiotherapy
  3. Surgical decompression

Severe (vision loss)

  • IV corticosteroids + urgent orbital decompression

Systemic disease:

  • anti-thyroid drugs (propylthiouracil, carbimazole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is conjunctivitis

A

inflammation of conjunctiva caused by infection or allergies usually affecting both eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes of conjunctivitis

A
  • viral (most common) - adenovirus
  • bacterial - strep. pyogenes, staph. aureaus, H. influenza
  • allergic
  • chemical/ contact lens associated
  • reactive arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

symptoms of conjunctivitis

A
  • eye redness (starts in one eye spreads to other)
  • eye discomfort - gritty, foreign body, burning
  • watery eyes/ discharge => temporary vision blurring

Bacterial => rapid redness, pus discharge with crusted eye lids

Viral => pink eye, watery discharge, previous URTI

Allergic => watery discharge, sneezing/runny/blocked nose, eyelid swelling

19
Q

signs of conjunctivitis

A

Inner upper eyelid

  • papillae- raised inflammtion with central vessel (Allergy/bacterial)
  • follicles- raised lymphocytes (yellow)- CVT/ chlamydia, toxic, viral

lesions on upper eyelid => HSV

Huthinson’s sign (lesions on nose) => HZV

Conjuctival membrane (yellow fibrin layer above conjuctiva) - severe infection

20
Q

investigations for conjuctivitis

A
  • usually none
  • if not resolved with treatment => swab => viral PCR for HSV/adenovirus or bacterial culture
21
Q

management for conjuctivits

A

Viral

  • self-limiting (7 days)
  • eye care - cool compress, saline-wash eye lids, lubricating eye drops
  • CONTAGIOUS so avoid contact with others + hygiene

Bacterial

  • delayed use of topical antibiotics (chloramphenicol)
  • eye care
  • avoid contact with others

Contact lens associated

  • stop using contact lens
  • eye care
22
Q

When to refer to opthamology (for red eye)

A

Red flag symptoms

  • reduced visual acuity
  • headache/photophobia - meningitis
  • recent trauma/ eye surgery
  • copious mucus discharge => gonnorrhea
  • worried about contact lens associated problems (keratitis)

Symptoms persist 7 days after treatment

23
Q

define scleritis

A
  • inflammation of sclera (white part of eye)
  • usually due to underlying systemic inflammation
  1. anterior uveitis (90%)- diffuse, nodular, necrotising
  2. posterior uveitis
24
Q

symptoms of scleritis

A
  • painful red eye
  • pain radiates to forehead, brow, jaw
  • pain worse on movement
  • watery eyes/ photophobia
  • associated with systemic inflammation
  • +/- gradual loss of vision

Posterior scleritis

  • worse symptoms but quiet, white eye
  • associated signs - proptosis, lid oedema, optic disc swelling, retinal detachment
25
Q

conditions associated with scleritis

A

connective tissue disorders

  • rhematoid arthritis (most common)
  • SLE
  • GPA (granulomatosis with polyangitis)
  • reactive arthritis
  • ankylosing spondylitis

gout

Syphillis

IBD

26
Q

Investigations for scleritis

A

Bloods:

  • FBC
  • ESR/CRP - inflammation
  • RA screen - Rheumatoid factors/ anti-CCP (specific)
  • Syphillis screen - rapid plasma reagin (antibodies to syphillis bacteria)

Imaging:

  • X-rays (chest/sacro-illiac joints)
  • CT/MRI of sinus/orbit
27
Q

management of scleritis

A
  • SUSPECTED scleritis => refer to OPTHAMOLOGIST
  • Treat cause (inflammation)
  1. Oral NSAIDs- ibuprofen
  2. Oral prednisilone
  3. Immunosuppressant drugs (methotrexate/azathioprine)
  4. Biologics - infliximab
  5. Surgery for complications
28
Q

Complications of scleritis

A
  • scleral thinning
  • raised IOP
  • uveitis
  • retinal detachment (posterior)
  • cataracts
29
Q

define optic neuritis

A

inflammation of optic nerve

30
Q

causes of optic neuritis

A
  • multiple sclerosis (autoimmune)
  • infections - lyme disease, measles,mumps, herpes
  • sarcoidosis
  • Behcet’s
  • drugs - methanol (antifreeze), ethambutol (treat TB)
31
Q

symptoms + signs of optic neuritis

A
  • reduced visual acuity
  • reduced colour vision
  • eye pain (worse on movement)
  • flashing lights
  • visual field loss
  • Uthoff’s sign - symptoms worse in hotter temp

Signs:

  • decreased pupilary light reaction/ RAPD
  • scotoma
32
Q

investigations for optic neuritis

A
  • usually clinical (visual acuity, visual field, colour vision)
  • if aypical:
  1. FBC, ESR, TFTs, autoantibodies, syphillis serology
  2. CXR- check for sarcoidosis/TB/malignancy
  3. MRI- check for MS risk
33
Q

management of optic neuritis

A
  • refer to opthamology/neurology
  • Corticosteroids - methylprednisilone , speeds up visual recovery
34
Q

complications for optic neuritis

A
  • optic nerve damage
  • permanenet visual loss
  • steroid side effects => prone to infection, mood changes, weight gain
35
Q

types of visual field defects

A
  • monocular blindness
  • bitemporal hemianopia
  • homonymous hemianopia (same side + half)
  • homonymous quadrantopia (same side + quarter)
36
Q

retinal causes of visual field loss

A
  • retinal detachment (flasher, floaters, curtains)
  • retinal artery/vein occlusion
  • age-related macular degeneration
  • drugs
    • chloroquine
    • vigabatrine (treat epilepsy)
37
Q

pre-chiasmal causes of visual field defects

  • one eye only, ipsilateral
A
  • optic neuritis
  • amaurosis fugax - temporary vision loss in both eyes
  • optic atrophy
  • retrobulbar optic neuropathy
  • trauma
  • glaucoma
38
Q

chiasmal causes of visual field defects (bitemporal hemianopia)

A
  • pituitary adenoma
  • suprasellar aneurysm
39
Q

post chiasmal causes of visual field defects (contralateral eye, homonymous hemianopia)

A
  • stroke
  • tumour
  • trauma
40
Q

causes of cranial nerve palsy

  1. CN III
  2. CN IV
  3. CN VI
A

Oculomotor

  • vasculitis
  • aneurysms (posterior communicating artery)

Trochlear

  • congenital
  • trauma
  • vascular tumour

Abducen’s

  • cranial pressure
  • vascular tumour
41
Q

symptoms of oculomotor nerve palsy

A
  • ptosis
  • eye down and out
  • mydriasis (dilated pupil), unreactive to light
42
Q

symptoms of

  1. CN IV palsy (superior oblique)
  2. CN VI palsy (lateral rectus)
A

CN IV palsy

  • prevents moving inwards and down
  • some diplopia

CN VI palsy

  • prevents eye moving outwards
  • diplopia
43
Q

investigations for visual field defects

A
  • visual field testing
  • Amsler grid - checks damage to macula/optic nerve
  • Full neurological examination
  • Special tests: static perimetry, kinetic perimetry
44
Q

management of visual field defects

A
  • treat cause (glaucoma => laser)
  • increasing head movements + scanning exercises
  • prisms
  • coloured markers l line guides to help with reading

Year 3 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions