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Alice's finals cards > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What causes glaucoma?

A

Optic nerve damage that is caused by a significant rise in intraocular pressure due to a blockage in aqueous humour trying the escape the eye

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2
Q

What are the 2 types of glaucoma?

A

Open angle and closed angle

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3
Q

Where is aqueous humour produced?

A

The ciliary body

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4
Q

What is normal intraocular pressure?

A

10-21 mmHg

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5
Q

What happens in acute angle-closure glaucoma?

A

The iris bulges forward and seals off the trabecular meshwork (where the aqueous humour drains) which leads to a continuous build up of pressure. This is an ophthalmology emergency

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6
Q

What is “cupping” in glaucoma?

A

caused by increased in pressure in the eye. In the centre of the optic disc is an optic cup. When there is raised intraocular pressure the indent becomes larger and the cup becomes wider and deeper. A cup greater than 0.5 the size of the optic disc is abnormal

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7
Q

How does open angle glaucoma present?

A

Affects peripheral vision first which gradually closes in until it becomes tunnel vision

Fluctuating pain, headaches, blurred vision and halos of light appearing, especially at night

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8
Q

How can intraocular pressure be measured?

A

Non-contact tonometry (the puff of air test)

Goldmann applanation tonometry (gold standard)

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9
Q

How is glaucoma diagnosed?

A

Goldmann applanation tonometry

Fundoscopy

Visual field assessment

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10
Q

When is treatment commenced in glaucoma?

A

When the pressure is greater than 24mmHg

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11
Q

What is the management for open angle glaucoma?

A

Prostaglandin analogue eye drops - lantanoprost

Beta-blockers (timolol) reduce the production of aqueous humour

Carbonic anhydrase inhibitors (dorzolamide)

Trabeculectomy

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12
Q

What are the notable side effects of prostaglandin analogue eye drops?

A

Eyelash growth
Eyelid pigmentation
Iris pigmentation (browning)

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13
Q

Which medications can precipitate acute angle-closure glaucoma?

A

Adrenergic medications such as noradrenalin
Anticholinergic medications such as oxybutynin and solifenacin
Trycyclic antidepressants such as amitriptyline

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14
Q

How does acute angle-closure glaucoma present?

A

Severely painful red eye
Blurred vision
Halos around lights
Associated headache, nausea and vomiting

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15
Q

What does an eye with acute angle-closure glaucoma look like?

A 
Red-eye
Teary
Hazy cornea
Decreased visual acuity
Dilatation of the affected pupil
Fixed pupil size
Firm eyeball
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16
Q

How should acute angle-closure glaucoma be managed?

A

Lie patient on back without pillow
Give pilocarpine eye drops (2% blue eyes, 4% brown eyes)

Oral or IV acetazolamide which is a carbonic anhydrase inhibitor

Laser iridotomy is the definitive treatment

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17
Q

What is the key finding associated with macular degeneration which is found on fundoscopy?

A

Drusen

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18
Q

What are the 2 types of age related macular degeneration?

A

Dry (90%) and Wet (10%)

Wet has worse prognosis

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19
Q

What is the presentation of macular degeneration?

A

Gradual worsening of central visual field loss
Reduced visual acuity
Crooked or wavy appearance to straight lines

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20
Q

How can macular degeneration be investigated?

A

Snellen chart
Scotoma (central patch of visual loss)
Amsler grid test (crooked straight lines)
Fundoscopy (drusen)

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21
Q

What is the management for dry macular degeneration?

A

Avoid smoking
Control blood pressure
Vitamin supplementation

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22
Q

What is the management of wet macular degeneration?

A

Anti- VEGF medications injected directly into the vitreous chamber.

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23
Q

What causes diabetic retinopathy?

A

The retina are damaged by prolonged exposure to hyperglycaemia. Vessels become leaky leading to microaneurysms and venous beading

Damage to nerve fibres causes fluffy white patches called cotton wool spots

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24
Q

What are the two categories of diabetic retinopathy?

A

Proliferative and non-proliferative

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25
Q

What is the management of diabetic retinopathy?

A

Laser photocoagulation

Anti-VEGF medications

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26
Q

What are the signs in the retina which are caused by hypertensive retinopathy?

A

Silver wiring or copper wiring (walls of the arterioles become thickened)

Ateriovenous nipping

Cotton wool spots

Retinal haemorrhages

Papilloedema

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27
Q

What is the classification system for hypertensive retinopathy?

A

Keith-Wagener Classification

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28
Q

What are cataracts?

A

The lens in the eye becomes cloudy and opaque. This reduces the visual acuity by reducing he light which enters the eye

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29
Q

How are congential cataracts screened for?

A

By checking the red reflex in neonatal examination

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30
Q

What are the risk factors for cataracts?

A 
Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia
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31
Q

What is the presentation of cataracts?

A

Very slow reduction in vision
Progressive blurring of vision
“starbursts” can appear around lights, particularly at night

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32
Q

How are cataracts managed?

A

Surgical removal and replacement

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33
Q

What is the serious complication of cataract surgery and how is it managed?

A

Endophtalmitis- inflammation of the inner contents of the eye, usually due to infection.

Treated by intravitreal antibiotics

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34
Q

What does a 3rd nerve palsy cause?

A

Ptosis
Dilated non-reactive pupil
Divergent strabismus

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35
Q

Which muscles does the 3rd nerve supply?

A

All of the extraocular muscles except the lateral rectus and superior oblique

Also supplies the levator palpaebrae superioris

36
Q

What does a third nerve palsy with sparing of the pupil suggest?

A

A microvascular cause because the parasympathetic fibres are spared

37
Q

What does a full nerve palsy suggest?

A

Physical compression

38
Q

What are the features of horner syndrome?

A

Ptosis
Miosis
Anhidrosis

39
Q

What is damaged in horner’s syndrome?

A

The sympathetic nervous system

40
Q

What is the relation between the location of the lesion and anhydrosis?

A

Central lesion= anhydrosis of the arm and trunk as well as the face
Pre-ganglionic= anhydrosis of the face
Post-ganglionic= do not cause anhydrosis

41
Q

How is horner’s syndrome tested for?

A

Cocaine eye drops. Causes a normal pupil to dilate but not in horner’s

42
Q

What is holmes adie pupil?

A

Dilated pupil which is sluggish to react to light with slow dilatation of the pupil following constriction. Over time the pupil will get smaller. This is caused by damage to the post ganglionic fibres

43
Q

What is Argyll-Robertson pupil?

A

Finding in neurosyphilis

No light reflex but does have an accommodation.

44
Q

What is blepharitis?

A

Inflammation of the eyelid margins

45
Q

What is the management if blepharitis?

A

Hot compresses, gentle cleaning and eyedrops

Polyvinyl alcohol is the eyedrops people start with

46
Q

What is a Stye?

A

Infection of the glands of zeis or glands of Moll. Presents as a tenser red lump along the eyelid which may contain pus

47
Q

How are styes managed?

A

Hot compresses, analgesia and chloramphenicol

48
Q

What is an entropion?

A

The eyelid turns inwards so the eyelashes are against the eyeball

49
Q

What are the complications of entropion?

A

Corneal damage and ulceration

50
Q

What is the management of entropion?

A

Initially taping the eyelid down to prevent it turning inwards. Definitive management is with surgical intervention

51
Q

What is ectropion?

A

The eyelid turns out so the inner aspect of the eyelid is exposed

52
Q

What is a complication of ectropion?

A

Exposure keratopathy

53
Q

What is the management of ectropion?

A

Lubricating eyedrops

May require surgery

54
Q

How are periorbital and orbital cellulitis differentiated?

A

CT scan

55
Q

How is periorbital cellulitis managed?

A

systemic antibiotics

56
Q

What are the 3 types of conjuctivitis?

A

Bacterial
Viral
Allergic

57
Q

How does conjuctivitis present?

A

Red eyes
Bloodshot
Itchy or gritty sensation
Discharge from the eye

58
Q

How does the discharge look different between bacterial and viral conjunctivitis?

A

Bacterial is purulent

Viral presents with clear discharge

59
Q

How is conjuctivitis managed?

A

Usually resolves without treatment after 1 or 2 weeks

Use cooled, boiled water and cotton wool

Choramphenicol and fuscidic acid eye drops

60
Q

What is anterior uveitis?

A

Inflammation in the anterior part of the uvea. The uvea involves the iris, ciliary body and choroid. It involves inflammation and immune cells in the anterior chamber of the eye

61
Q

Which conditions is anterior uveitis associated with?

A

HLA b27 conditions:
Ankylosis spondylitis
Inflammatory bowel disease
Reactive arthritis

62
Q

How does anterior uveitis present?

A 
Unilateral symptoms
Dull, aching, painful red eye
Ciliary flush
Miosis
Photophobia
Lacrimation
Hypopynon (you can see the collection of white cells in the iris as a fluid line)
Floaters
63
Q

What is the management of anterior uveitis?

A

Steriods

Cycloplegic-mydriatic medications

64
Q

What is episcleritis?

A

Self limiting inflammation of the episclera

65
Q

What is the presentation of episcleritis?

A

Not painful
Segmental redness
Foreign body sensation

66
Q

What is the management of episcleritis?

A

Should resolve in 1-4 weeks

Analgesia, cold compresses and safetynet advice

67
Q

What is scleritis?

A

Inflammation of the full thickness of the sclera

68
Q

How does scleritis present?

A 
Severe pain
Pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation of the eye
69
Q

What is the management of scleritis?

A

NSAIDs
Steroids
Immunosupression

70
Q

If a corneal abrasion is caused by contact lenses, what is the likely causative organism?

A

Pseudomonas

71
Q

How is corneal abrasion diagnosed?

A

Flurorescein stain

72
Q

How is corneal abrasion managed?

A

Simple analgesia
Lubricating eyedrops
Abx eyedrops (chloramphenicol)

73
Q

What is keratitis?

A

Inflammation of the cornea

74
Q

What is the most common cause of keratitis?

A

Herpes simplex keratitis

75
Q

How is herpes keratitis diagnosed?

A

Fluroescein stain will show a dendritic corneal ulcer

Slit-lamp examination is required to diagnose keratitis

76
Q

How is herpes keratitis treated?

A

Aciclovir
Ganciclovir
Steroids

77
Q

What is the presentation of posterior vitreous detachment?

A

Painless
Spots of vision loss
Floaters
Flashing lights

78
Q

What is the presentation of retinal detachment?

A

Peripheral vision loss
Blurred vision
Flashes and floaters

79
Q

What is the presentation of retinal vein occlusion?

A

Sudden, painless loss of vision

80
Q

What are the fundoscopy results for retinal vein occlusion

A

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

81
Q

What is the management of retinal vein occlusion?

A

Laser photocoagulation
Intravitreal steroids
Anti-VEGF therapies

82
Q

How does blockage of the central retinal artery present?

A

Sudden painless loss of vision

Relative afferent pupillary defect

83
Q

What is seen on fundoscopy when there is central retinal artery occlusion

A

Pale retina with a cherry red spot

84
Q

What can be a cause of central retinal artery occulsion?

A

Giant cell arteritis

85
Q

How is central retinal artery occlusion managed?

A

Removing fluid from anterior chamber

Inhaling carbogen to dilate the artery

86
Q

What is the presentation of retinitis pigmentosa?

A

Night blindness

Peripheral vision is lost before central vision

87
Q

What is seen on fundoscopy in Retinitis pigmentosa

A

Bone-spicule

Alice's finals cards (21 decks)

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