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Finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is orbital cellulitis?
What is the cause?
What are the sx?
What is the treatment?

A

Inflammation within the oral cavity
Causes pressure on the optic nerve and blood vessels

Cause- ethmoidal sinusitis

Sx= visual involvement, opthalmoplegia
Systemic sx= pyrexia

Treatment= oral/IV abx, warm compression, +/- surgical drainage of abscess
It will be dealth with by the on call opthalmologist

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2
Q

What is a RAPD and what are the causes?

A

RAPD is tested by the swinging light test, it is where the pupil dilates instead of constricts

Two main causes= retinal problem or a problem woth optic nerve

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3
Q

What are the organisms associated w/ orbital cellulitis?

A

Staph or strep

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4
Q

What are the features of orbital cellulitis?

A

Lid- induration, warm, eryrhema, tenderness, unable to open eye

Additional features seen in orbital cellulitis- fever, proptosis, chemosis

Red flags of optic nerve compression…

  • reduced vision
  • reduced colour vision
  • relative afferent pupillary defectv
  • reduced visual fields
  • opthalmoplegia (pain on eye movements)
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5
Q

What Ix do you want to do for orbital cellulitis?

A 
FBC
CRP 
ESR 
Blood cultures
Imaging (CT head)
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6
Q

What is the most definitive management for orbital cellulitis?

A

CT head

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7
Q

What is the management of orbital cellulitis?

A

Admit patient
Broad spec abx
IV for 72 hours followed by PO for 1 week
ENT review for review of sinus drainage

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8
Q

What bone is most likely to be damaged in blowout fracture?

A

Maxillary bone

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9
Q

What clinical features/ investigations do you do for a blowout fracture?

A 
Eyelid swelling 
Pain
Reduced vision 
Diplopia
Surgical emphysema 
Enopthalmos or proptosis 
Hypoesthesia 
Management 
ABC
Abx 
Tetanus if open wound
Avoif nose blowing 
Refer to opthalmolohy and oromaxillofacial
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10
Q

What clinical features/ investigations do you do for a blowout fracture?

A 
Eyelid swelling 
Pain
Reduced vision 
Diplopia
Surgical emphysema 
Enopthalmos or proptosis 
Hypoesthesia 
Management 
ABC
Abx 
Tetanus if open wound
Avoif nose blowing 
Refer to opthalmolohy and oromaxillofacial
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11
Q

What should you think of with a contact lens wearer who has red eye which is itchy?

A

Bacterial keratitis

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12
Q

Keratitis can be bacterial, viral and fungal, what is the viral cause of keratitis?

A

Herpes simplex virus

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13
Q

What is the most common cause of bacterial keratitis in a contact lens wearer, what are the clinical features?

A

Pseudomonas aeuriginosa (most common in contact dermititis)

Clinic features...
Red eye 
Painful eye 
Purulent discharge 
Blurred vision 
Hypopyon 
White corneal opacity= corneal ulcer

Management is to stop wearing contact lenses until healed
Start them on topical abx drops- ofloxacin

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14
Q

What features make you think viral keratitis?

Trearment?

A

Watery discharge
History of cold sores
Would see dendritic ulcer on fluorescein staining

Acyclovir drops

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15
Q

What is glaucoma and what are the two main types?

A

Optic nerve damage due to raised IOP

Two main types- open angle glaucome and closed angle glaucoma

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16
Q

What is glaucoma and what are the two main types?

A

Optic nerve damage due to raised IOP

Two main types- open angle glaucome and closed angle glaucoma

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17
Q

What are the risk factors for acute angle closure glaucoma?

A

Female
Small eyes (long sighted, hypermetrophic)
Asian ethnicity
Age

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18
Q

What are the features of acute angle closure glaucoma?

A 
IOP>40mmHg 
Red eye
Cloudy cornea
Fixed, oval, irregularly dilated pupil
Pain
Watering
Reduced vision
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19
Q

What are the monocular causes of vision loss?

A 
Optic neuritis 
Acute cataract disease 
Acute corneal disease
Vitreous haemorrhage
Retinal vessel occlusion 
Retinal detachment 
Ischaemic optic neuropathy (GCA)
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20
Q

What are the binocular causes of vision loss?

A 
CVA 
Pituitary tumour 
Optic neurinitis
Severe papilloedema
Migraine
21
Q

What are the causes of retinal detachment?
What are the symptoms?
What is the management?

A

Causes=
Age, post op/trauma
Diabetic retinopathy

Symptoms= 
Floaters
Flashes
Field loss
Fall in acuity 
\+ absent red reflexes
22
Q

What is vitreous haemorrhage
What are the causes
What are the symptoms
What is the management

A

This is bleeding into the vitreous fluid in back compartment of the eye

The causes= proliferative diabetic retinopathy
Retinal tear
Retinal detachment

Symptoms= floaters and absence of red reflex

Management= refer to opthalmology, vitrectomy and reattachment if needed

23
Q

What are the symptoms/ signs of central retinal artery occlusion?

A 
Symptoms= Sudden, profound, entire vision loss 
Signs= RAPD, PD, retinal oedema, pale retina (ischaemic), cherry red spot, +/- carotid bruits 
Investigations= BP, FBC, ESR, glucose, carotid USS, cardiac echo
24
Q

What is the treatment of CRAO?

A

Refer to eye casualty
Rebreathe into bag (CO2 dilates vessels)
Ocular massage
Acetazolamide (decreases IOP)
Anterior chamber Paracentesis (decreases IOP) (wont be doing this as a junior)

25
Q

What are the features of CRVO?

What investigations would you do?

A 
Blurred, widespread vision loss 
Wideslread retinal haemorrhages
Oedema
Disc swelling
Tortuous veins
\+/- cotton wool spots

R/O causes of HT, DM, glaucoma, blood problems therefore you would do;

BP, FBC, ESR, glucose, IOP (tonometer)

26
Q

What are the causes of PAINLESS vision loss?

A

Retinal detachment
Vitreous haemorrhage
Retinal vessel occlusion

27
Q

What are the causes of acute red eye?

A

Haemorrhages- subconjunctiva, or retrobulbar

Subconjunctival= blood pools behind the conjunctiva

Retro bulbar= blood pools behind eyeball

Vascular congestion= episcleritis and scleritis (localised), or generalised (conjunctivitis, keratitis, uveitis)

28
Q

What is the difference between episcleritis and scleritis?

A 
Scleritis= deeper inflammation of the sclera and episclera 
Episcleritis= superficial inflammation of the episcler 
Scleritis= very painful 
Episcleritis= mild/achy pain 
Episcleritis= vision not affected 
Scleritis= blurring of vision and photophobia 
Episcleritis= blanches with phenylephrine 
Scleritis= no blanching with phenylephrine
29
Q

How do you treat episcleritis?

How do you treat scleritis?

A

Episcleritis=
Steroid drops/NSAIDs
It is self limiting

Scleritis=
Oral steroids
Needs referall

30
Q

What are the causes of acute generalised red eye?

A

Conjunctuvitis, keratitis, uveitis

31
Q

What are the causes of viral conjunctivitis?
What are the sx?
What is the treatment?

A

Adenovirus
HSV
Molluscum

Symptoms= gritty feeling, watery discharge

Treatment= artificial tears and simple painkillers

32
Q

What are the causes of bacterial conjnctivitis, what are the symptoms, what is the treatment?

A

Staph aureus

Strep pneumoniae

33
Q

What is the treatment of bacterial conjunctivitis?

A

Chloramphenicol

Fusidic acid drops

34
Q

What are the symptoms of keratitis?

How do you treat keratitis?

A

Blurry/impaired vision
Red eye which is painful
Constricted pupil
Photophobia

Treatment is with steroids (PO or topical) +/- antibiotics
Analgesia

35
Q

What are the causes of keratitis?
What are the risk factors?
What is the treatment?
What is the complication?

A

Infection- pseudomonas, HSV (do not give steroids if HSV, give acyclovir)
Trauma- FB, post op, perforation
Inflammation- RA/SLE/ wegners

Risk factors- dry eyes and contact lenses

Treatment= steroids if not HSV (dendritic ulcers indicate this) and abx, analgesia

Complication= corneal ulcer

36
Q

How do you manage someone with foreign body in eye?

A

They will present with sudden onset irritation and photophobia

You need to remove FB and give analgesia and prophylactic abx

37
Q

How do you manage chemical injury of the eye?

A

Immediate irrigation with water
Determine if acid/alkali (alkali is worse!)
Careful eye inspection
Opthalmology referall: topical abx, steroids, topicak dilators, analgesia, artificial tears

38
Q

What are you woried about with blunt trauma of the eye?

A

A blow out fracture
Will present with restricted eye movement and periorbitL swelling

You would want to investigate with CT/ xray

39
Q

What are the features of thyroid eye disease?

A

Periorbital oedema
Eyelid retraction
Expthalmos
Diplopia

40
Q

What are the causes of gradual visual loss of the eye?

A

Diabetic retinopathy
Age related macular degeneration
Cataracts
Glaucoma

41
Q

What is the most common cause of vision loss in the UK and what type of visual loss does it cause?

A

Age related macular degeneration

It causes a progressive, irreversible central vision loss

42
Q

What are the two types of age related macular degeneration?

A 
Dry AMD (90%)= gradual vision loss (years)
Wet AMD (10%) = sudden severe vision loss (months)- starts with distorted images
43
Q

What would you see on fundoscopy of someone with Dry macular degeneration?

A

Drusen

44
Q

What is wet/neovascular AMD characterized by?

A

New aberrant blood vessels underneath the retina which is driven by VEGf (a growth hormone which promotes angiogenesis and neovascularisation)

45
Q

What is amslers grid used in?

A

Age related macular degeneration

46
Q

What is a cataract?

What are the causes?

A

Clouded opacity on/within the lens due to liquefaction of lens content

Causes= age, trauma, metabolic (DM, wilsons), toxins (steroids, smoking), systemic disease (marfans, NFT2, atopic dermatitis)
Maternal infection
Hereditary

47
Q

What are the features of cataract?

A

Decreased acuity and blurring
Myopia (short sided)
Faded colours
Trouble with bright lights and night vision

48
Q

What is the management of cataract?

What are the complications of this management?

A 
Phacoemulsification 
Complications…
Retinal detachment 
Post capsule opacification 
Vitreous loss 
Endopthalmitis

Finals (24 decks)

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