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
What are the features of CRVO? | What investigations would you do?
``` 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
What are the causes of PAINLESS vision loss?
Retinal detachment Vitreous haemorrhage Retinal vessel occlusion
27
What are the causes of acute red eye?
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
What is the difference between episcleritis and scleritis?
``` 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
How do you treat episcleritis? | How do you treat scleritis?
Episcleritis= Steroid drops/NSAIDs It is self limiting Scleritis= Oral steroids Needs referall
30
What are the causes of acute generalised red eye?
Conjunctuvitis, keratitis, uveitis
31
What are the causes of viral conjunctivitis? What are the sx? What is the treatment?
Adenovirus HSV Molluscum Symptoms= gritty feeling, watery discharge Treatment= artificial tears and simple painkillers
32
What are the causes of bacterial conjnctivitis, what are the symptoms, what is the treatment?
Staph aureus | Strep pneumoniae
33
What is the treatment of bacterial conjunctivitis?
Chloramphenicol | Fusidic acid drops
34
What are the symptoms of keratitis? | How do you treat keratitis?
Blurry/impaired vision Red eye which is painful Constricted pupil Photophobia Treatment is with steroids (PO or topical) +/- antibiotics Analgesia
35
What are the causes of keratitis? What are the risk factors? What is the treatment? What is the complication?
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
How do you manage someone with foreign body in eye?
They will present with sudden onset irritation and photophobia You need to remove FB and give analgesia and prophylactic abx
37
How do you manage chemical injury of the eye?
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
What are you woried about with blunt trauma of the eye?
A blow out fracture Will present with restricted eye movement and periorbitL swelling You would want to investigate with CT/ xray
39
What are the features of thyroid eye disease?
Periorbital oedema Eyelid retraction Expthalmos Diplopia
40
What are the causes of gradual visual loss of the eye?
Diabetic retinopathy Age related macular degeneration Cataracts Glaucoma
41
What is the most common cause of vision loss in the UK and what type of visual loss does it cause?
Age related macular degeneration It causes a progressive, irreversible central vision loss
42
What are the two types of age related macular degeneration?
``` Dry AMD (90%)= gradual vision loss (years) Wet AMD (10%) = sudden severe vision loss (months)- starts with distorted images ```
43
What would you see on fundoscopy of someone with Dry macular degeneration?
Drusen
44
What is wet/neovascular AMD characterized by?
New aberrant blood vessels underneath the retina which is driven by VEGf (a growth hormone which promotes angiogenesis and neovascularisation)
45
What is amslers grid used in?
Age related macular degeneration
46
What is a cataract? | What are the causes?
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
What are the features of cataract?
Decreased acuity and blurring Myopia (short sided) Faded colours Trouble with bright lights and night vision
48
What is the management of cataract? | What are the complications of this management?
``` Phacoemulsification Complications… Retinal detachment Post capsule opacification Vitreous loss Endopthalmitis ```