Opthalmology Flashcards
In what eye pathology is colour vision affected?
Optic neuritis
What is the most common ophthalmological manifestation of sarcoidosis?
Bilateral anterior uveitis
Which is painful - episcleritis or scleritis?
Scleritis
By what age does congenital lacrimal duct obstruction, causing recurrent watery/sticky eye, tend to resolve by?
1 year
What is mydriasis?
Dilatation of the pupil
What opthalmic feature is seen in congenital Horner’s syndrome?
Heterochromia
What are the features of Horner’s syndrome?
Miosis (small pupil)
Ptosis
Anhidrosis
Enophthalmos (sunken eye)
How do you distinguish between Horner’s and a third-nerve palsy?
Third nerve palsy = ptosis + DILITATION of the pupil
Horner’s = ptosis + CONSTRICTION of the pupil
If anhidrosis affects the face, arm and trunk, where is the lesion most likely to be in Horner’s syndrome?
S’s
Stroke Syringomyelia Multiple sclerosis Tumour Encephalitis
If anhidrosis only affects the face, where is the lesion most likely to be in Horner’s syndrome?
T’s
Pancoast tumour
Thyroidectomy
Trauma
Cervical rib
If there is no anhidrosis (but other features of Horner’s) where is the lesion most likely to be?
C’s
Carotid artery dissection
Carotid aneurism
Cavernous sinus thrombosis
Cluster headache
Which opthalmic pathology is the most common cause of floaters?
Posterior vitreous detachment
What is seen on fundoscopy in central retinal vein occlusion?
Retinal haemorrhages
What is seen on opthalmic imaging in central retinal artery occlusion?
A ‘cherry red spot’ on a pale retina
What are the causes of Argyll-Robertson pupil?
Neurosyphillis
DM
What should be checked in patients with subconjunctival haemorrhage, that are also on warfarin?
INR
How does retinitis pigmentosa present on fundoscopy?
Black bone-spicule pigmentation
What is the mot common cause of orbital cellulitis in children?
Ethmoidal sinusitis
How do you distinguish between orbital and preseptal cellulitis?
Proptosis
Decreased visual acuity and ocular motility
^^don’t usually occur in preseptal cellulitis
What are the characteristics of retinitis pigmentosa?
Night blindness and tunnel vision
What diseases are associated with retinitis pigmentosa?
Refsum disease: cerebellar ataxia, peripheral neuropathy, deafness, ichthyosis Usher syndrome Abetalipoproteinemia Lawrence-Moon-Biedl syndrome Kearns-Sayre syndrome Alport's syndrome
What is diabetic maculopathy?
Any structural abnormality due to diabetes affecting the macula
What is NPDR?
Non-proliferative diabetic retinopathy
What defines mild NPDR?
1 or more microaneurysm
What defines moderate NPDR?
Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
What defines severe NPDR?
Blot haemorrhages and microaneurysms in 4 quadrants
Venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
What are the causes of chorioretinitis?
Syphilis Cytomegalovirus Toxoplasmosis Sarcoidosis Tuberculosis
How does toxoplasmosis retinitis classically present?
White focal retinitis with overlying vitreous inflammation
What is the first line treatment in glaucoma?
Prostaglandin analogue (PGA) eyedrop - e.g. latanoprost
What is the second line treatment in glaucoma?
Beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop
What are the adverse effects of miotics (e.g. pilocarpine)?
Pupil constriction, blurred vision and headaches
Symapathomimetics - e.g. brimonidine - should not be taken with which drugs?
MAOI or tricyclic antibiotics
How do prostaglandin analogues work in the treatment of glaucoma?
Increases uveoscleral outflow
How do beta-blockers work in the treatment of glaucoma?
Reduces aqueous production
How do sympathomimetics work in the treatment of glaucoma?
Reduces aqueous production and increases outflow
How do carbonic anhydrase inhibitors work int he treatment of glaucoma?
Reduces aqueous production
How should bacterial conjunctivitis be treated in pregnancy?
Fuscidic acid eye drops
What is a Holmes-Adie pupil?
Benign condition most commonly seen in women.
Dilated pupil - unilateral in 80% of cases
Once the pupil has constricted it remains small for an abnormally long time
Slowly reactive to accommodation but very poorly (if at all) to light
What is Holmes-Adie syndrome?
Association of Holmes-Adie pupil with absent ankle/knee reflexes
What does Keith-Wagener classification system classify?
Degrees of hypertensive retinopathy
What is a stage I hypertensive retinopathy?
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
What is a stage II hypertensive retinopathy?
Arteriovenous nipping
What is a stage III hypertensive retinopathy?
Cotton-wool exudates
Flame and blot haemorrhages
What is a stage IV retinopathy?
Papilloedema
What is proliferative retinopathy?
Retinal neovascularisation - may lead to vitrous haemorrhage
It’s more common in T1DM, with rates of blindness being 50% within 5 years
What are the features of papilloedema on fundoscopy?
Venous engorgement: usually the first sign
Loss of venous pulsation: although many normal patients do not have normal pulsation
Blurring of the optic disc margin
Elevation of optic disc
Loss of the optic cup
Paton’s lines: concentric/radial retinal lines cascading from the optic disc
How is anterior uveitis?
Steroid + cycloplegic (mydriatic) eye drops
What is the most common ocular presentation of RA?
Keratoconjunctivitis sicca - characterised by dry, burning and gritty eyes caused by decreased tear production
What can cause blurred vision several years after cataract surgery?
Posterior capsule opacification
When should you refer a child with a squint to secondary care?
> 3/12 - intermittent squint at 3/12 is normal and does not need investigating
Where do drusen accumulate in the eye in AMD?
Bruch’s membrane and the retinal pigment epithelium
What are hard exudates?
Lipoprotein leaked from blood vessels
Seen in DM and HTN
Well-defined, yellow-white, often in rings
What are soft exudates?
Look like cotton-wool
Occur in infarcted retina
Due to swelling in the axons in the nerve fibre layer of the retina
What are the first/second/third line options for glaucoma?
First = Latanoprost Second = Timolol Third = Brimonidine or Brinzolamide
How does central retinal artery occlusion present?
Pale+++ retina and ‘cherry red spot’
What type of visual field defect is classical to glaucoma?
Arcuate scotoma
What type of visual field defect is classic of disease affecting the macula?
Central scotoma
What type of visual field defect is classic in toxic neuropathy?
Centrocaecal scotoma
What type of visual field defect is seen in retinitis pigmentosa?
Ring scotoma
What are the causes of cataracts?
Myotonic dystrophy Ageing DM Rubella/CMV/Syphillis Steroids Radiation Trauma
Which drug should be co-prescribed when ethambutol is prescribed for TB to reduce the risk of optic neuritis?
Pyridoxine (vitamin B6)
When should laser trabeculoplasty be considered in glaucoma?
When there has been x2 unsuccessful trials of pharmacological agents
How may optic neuritis be treated?
IV methylprednisolone
What type of lesion is Bell’s palsy?
Lower motor neurone problem
When should you suspect an UMN lesion with a Bell’s palsy-like presentation?
When the forehead is unaffected. Forehead will be affected in true Bell’s palsy
What is the criteria for the certification of blindness (severely sight-impaired)?
<3/60 with a full visual field, whilst wearing glasses as prescribed
What might aqueous flare indicate?
Anterior uveitis
What diagnosis should be suspected in paediatric proptosis?
Rhabdomyosarcoma
What test may improve VA in cataracts?
Pinhole test
