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Finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

MILD non-proliferative diabetic retinopathy (NPDR)

A

1+ microaneurysm

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2
Q

MODERATE NPDR

A

microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous looping

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3
Q

SEVERE NPDR

A

blot haemorrhages and microaneurysms in 4 quadrants, venous bleeding in 2 quadrants

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4
Q

Proliferative retinopathy

A

retinal neovascularisation - may lead to vitreous haemorrhages

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5
Q

Diabetic Retinopathy treatment

A

Control DM and BP
Anti- VEGF injections
Photocoagulation

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6
Q

Diabetic Maculopathy

A

Macular oedema

Ischaemic maculopathy

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7
Q

Complications of Diabetic Retinopathy

A

Retinal detachment
Vitreous haemorrhage (bleeding in to the vitreous humour)
Rebeosis iridis (new blood vessel formation in the iris)
Optic neuropathy
Cataracts

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8
Q

Hypertensive retinopathy classification system

A

Keith-Wagener

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9
Q

Keith Wagener classification grades

A

Hypertensive Retinopathy

1 - Mild generalized retinal arteriolar narrowing
2 - Definite focal narrowing and arteriovenous nipping
3 - -Signs of grade 2 plus retinal haemorrhages, exudates and cotton wool spots
4 - Severe grade three plus papilledema

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10
Q

Hypertensive retinopathy management

A

Management is focused on controlling the blood pressure and other risk factors such as smoking and blood lipid levels.

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11
Q

Hypertensive retinopathy signs

A 
Silver wiring
Hard exudates
Arteriovenous nipping
Papilloedema
Retinal haemorrhages
Cotton wool spots
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12
Q

Congenital cataracts - screening

A

Red reflex at neonatal examination

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13
Q

Cataracts rf

A 
Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia
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14
Q

Cataracts presentation

A

Very slow reduction in vision
Progressive blurring of vision
Change of colour of vision with colours becoming more brown or yellow
“Starbursts” can appear around lights, particularly at night time

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15
Q

Key sign of cataracts

A

Loss of red reflex

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16
Q

Distinctive signs - Cataracts vs glaucoma vs macular degeneration

A

Cataracts - reduced visual acuity, starbursts around light

Glaucoma - peripheral visual loss and halos around lights

Macular degeneration - Central loss of vision and crooked/wavy straight lines

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17
Q

Cataracts management

A

if needed, artificial lens

Phacoemulsification

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18
Q

What is Endophthalmitis and mx

A

comp. of cataract surgery - requires intravitreal antibiotics

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19
Q

Types of cataracts

A

Nuclear - old age

Cortical - wedge shaped spokes

Posterior subcapsular - steroid use

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20
Q

Inv for cataract

A

slit lamp

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21
Q

Glaucoma definition

A

optic neuropathy secondary to increased intra-ocular pressure (IOP) (>21mmHg)

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22
Q

open angle Glaucoma ivx

A

Perimetry

  • Slit lamp biomicroscopy “cupping”
  • Goldmann tonometry or non-contact Tonometry (pressures)
  • Gonioscopy (visualise iridoangle)
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23
Q

OA glaucoma treatment

A

Prostaglandin analogues like latanoprost (decrease uveoscleral outflow, increased eyelash length)

Beta blockers like timolol (reduced aqueous production, bad for asthmatics)

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24
Q

CO glaucoma risk fators

A

Dilation, cataracts, hypermetropia

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25
Q

AAC glaucoma treatment

A 
IV acetazolamide (reduce aqueous production)
Pilocarpine drops (pupil constrict)
Iridotomy (allow flow)
Analgesia/antiemetic
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26
Q

Pupil constriction mechanism

A

Parasympathetic
Acetylcholine (muscarinic receptors)
Oculomotor nerve (third nerve)
Miosis

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27
Q

Pupil dilation mechanism

A

Sympathetic, adrenaline,

mydriasis

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28
Q

Causes of mydriasis

A 
Third nerve palsy
Holmes-Adie syndrome
Raised intracranial pressure
Congenital
Trauma
Stimulants such as cocaine
Anticholinergic
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29
Q

Causes of Miosis

A 
Horners syndrome
Cluster headaches
Argyll-Robertson pupil (in neurosyphilis)
Opiates
Nicotine
Pilocarpine
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30
Q

Third Nerve Palsy

A

Ptosis (drooping upper eyelid)
Dilated non-reactive pupil
Divergent strabismus (squint) in the affected eye.

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31
Q

Causes of a full (surgical) Third Nerve Palsy

A 
Idiopathic
Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised intracranial pressure
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32
Q

Third nerve palsy sparing pupil causes

A

Diabetes
Hypertension
Ischaemia

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33
Q

Horner syndrome triad

A

Ptosis
Miosis
Anhidrosis

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34
Q

Location of lesion in horners

A

Anhidrosis in face - pre-ganglion
Anhidrosis in face and trunk - central

No anhidrosis - post-glanglionic

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35
Q

Congenital Horner syndrome

A

heterochromia

36
Q

Horner’s treatment

A

adrenalin eye drop

cocaine eyedrop

37
Q

Holmes Adie Pupil

A

unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction.

post-ganglionic parasympathetic fibres. The exact cause is unknown but may be viral.

38
Q

Argyll-Robertson Pupil

A

neurosyphilis. It is a constricted pupil that accommodates

does not react to light

39
Q

Lubricating eye drops

A

Hypromellose is the least viscous. The effect lasts around10 minutes.
Polyvinyl alcohol is the middle viscous choice. It is worth starting with these.
Carbomer is the most viscous and lasts 30 – 60 minutes.

40
Q

Blepharitis

A

inflammation of the eyelid margins.

comp styes and chalazions.

41
Q

Stye

A

Hordeolum externum

42
Q

Stye Tx

A

Styes are treated with hot compresses and analgesia. Consider topic antibiotics (i.e. chloramphenicol) if it is associated with conjunctivitis or persistent.

43
Q

Chalazion

A

Meibomian cyst

44
Q

Entropion

A

Entropion is where the eyelid turns inwards with the lashes against the eyeball.

corneal damage and ulceration.

A same-day referral to ophthalmology is required if there is a risk to sight.

45
Q

Ectropion

A

where the eyelid turns outwards

exposure keratopathy

46
Q

Trichiasis

A

Trichiasis is inward growth of the eyelashes.

pain and corneal damage and ulceration

47
Q

Periorbital Cellulitis mx

A

differentiate it from orbital cellulitis, which is a sight and life threatening emergency. CT scan

48
Q

Periorbital Cellulitis tx

A

h systemic antibiotics (oral or IV). Preorbital cellulitis can develop into orbital cellulitis

49
Q

Orbital Cellulitis presentation and mx

A

pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball (proptosis).

admission and IV antibiotics. They may require surgical drainage if an abscess forms.

50
Q

Painless acute red eye differentials

A

Painless Red Eye

Conjunctivitis
Episcleritis
Subconjunctival Haemorrhage

51
Q

Painful acute red eye differentials

A 
Glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury
52
Q

Bacterial conjunctivitis treatment

A

Chloramphenicol and fuscidic acid

53
Q

neonatal conjunctivitis

A

Patients under the age of 1 month of age with conjunctivitis need urgent ophthalmology review

gonococcal infection and can cause loss of sight and more severe complications such as pneumonia.

54
Q

Anterior uveitis acute causes

A

Acute anterior uveitis is associated with HLA B27 related conditions:

Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

55
Q

Chronic anterior uveitis is associated with:

A 
Sarcoidosis
Syphilis
Lyme disease
Tuberculosis
Herpes virus
56
Q

Anterior uveitis symptoms

A

Dull, aching, painful red eye
Ciliary flush

Reduced visual acuity

Floaters and flashes

miosis

Photophobia

Pain on movement

(lacrimation)

Abnormally shaped pupil

hypopyon

57
Q

Anterior uveitis management

A

Same day ophthalmologist referral

Steroids (oral, topical or intravenous)

Cycloplegic-mydriatic medications such as cyclopentolate or atropine eye drops.

Immunosuppressants such as DMARDS and TNF inhibitors

Laser therapy, cryotherapy or surgery (vitrectomy) are also options in severe cases.

58
Q

Episcleritis associations

A

rheumatoid arthritis and inflammatory bowel disease.

59
Q

Episcleritis presentation

A 
Typically not painful but there can be mild pain
Segmental redness (rather than diffuse). There is usually a patch of redness in the lateral sclera.

Foreign body sensation
Dilated episcleral vessels
Watering of eye
No discharge

60
Q

Episcleritis management

A

If in doubt about the diagnosis, refer to ophthalmology.

Episcleritis is usually self limiting and will recover in 1-4 weeks. In mild cases no treatment is necessary. Lubricating eye drops can help symptoms.

Simple analgesia, cold compresses and safetynet advice are appropriate.

More severe cases may benefit from systemic NSAIDs (e.g. naproxen) or topical steroid eye drops.

61
Q

Scleritis presentation

A 
Severe pain
Pain with eye movement
Photophobia
Eye watering
Reduced visual acuity
Abnormal pupil reaction to light
Tenderness to palpation of the eye
62
Q

Scleritis management

A

Consider an underlying systemic condition

NSAIDS (topical / systemic)
Steroids (topical / systemic)

Immunosuppression appropriate to the underlying systemic condition (e.g. methotrexate in rheumatoid arthritis)

63
Q

Scleritis ass. conditions

A 
Rheumatoid arthritis
Systemic lupus erythematosus
Inflammatory bowel disease
Sarcoidosis
Granulomatosis with polyangiitis
64
Q

Corneal abrasion inv.

A

fluorescein stain

slit lamp examination

65
Q

Corneal keratitis causes

A

Viral infection with herpes simplex
Bacterial infection with pseudomonas or staphylococcus
Fungal infection with candida or aspergillus
Contact lens acute red eye (CLARE)
Exposure keratitis is caused by inadequate eyelid coverage (e.g. eyelid ectropion)

66
Q

Herpes keratitis presentation

A 
Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced visual acuity. This can vary from subtle to significa
67
Q

Herpes keratitis inv

A

fluorescein will show a dendritic corneal ulcer

Herpes keratitis

Swabs

68
Q

Herpes keratitis mx

A

Aciclovir (topical or oral)
Ganciclovir eye gel

Topical steroids may be used alongside antivirals to treat stromal keratitis

A corneal transplant

69
Q

Subconjunctival Haemorrhage rf

A

Hypertension
Bleeding disorders (e.g thrombocytopenia)
Whooping cough
Medications (warfarin, NOACs, antiplatelets)
Non-accidental injury

70
Q

Posterior vitreous detachment presentation

A

Painless
Spots of vision loss
Floaters
Flashing lights

It is essential to exclude and assess the risk of a retinal tear or detachment with a thorough assessment of the retina

no treatment necessary

71
Q

Retinal detachment rf

A 
Posterior vitreous detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
Family history
72
Q

Retinal detachment presentation

A

Peripheral vision loss. This is often sudden and like a shadow coming across the vision.
Blurred or distorted vision
Flashes and floaters

73
Q

retinal tear management

A

Laser therapy

Cryotherapy

74
Q

retinal detachment mx

A

Vitrectomy
Pneumatic retinopexy
Scleral buckling

75
Q

Retinal vein occlusion presentation

A

sudden painless loss of vision.

76
Q

Retinal vein occlusion fundoscopy

A

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

77
Q

Retinal vein occlusion management

A

Same day referal

Laser photocoagulation
Intravitreal steroids (e.g. a dexamethasone intravitreal implant)
Anti-VEGF therapies (e.g. ranibizumab, aflibercept or bevacizumab

78
Q

central retinal artery occlusion presentation

A

sudden painless loss of vision.

relative afferent pupillary defect

Fundoscopy will show a pale retina with a cherry-red spot.

79
Q

GCA management

A

Giant cell arteritis is an important potentially reversible cause.

Testing involves an ESR and temporal artery biopsy and treatment is with high dose steroids

80
Q

Central retinal artery occlusion mx

A

Ocular massage

Removing fluid from the anterior chamber to reduce intraocular pressure.

Inhaling carbogen (a mixture of 5% carbon dioxide and 95% oxygen) to dilate the artery

Sublingual isosorbide dinitrate to dilate the artery

81
Q

Retinitis Pigmentosa presentation

A

night blindness.

They get decreased central and peripheral vision. (peripheral first)

82
Q

Retinitis Pigmentosa mx

A

Referral to an ophthalmologist for assessment and diagnosis
Genetic counselling
Vision aids
Sunglasses to protect the retina from accelerated damage
Driving limitations and informing the DVLA
Regular follow up to assess vision and check for other potentially reversible conditions that may worsen the vision such as cataracts

83
Q

Dry eyes test

A

Schirmer - filter paper next to conjunctiva

84
Q

Dry eyes mx

A

Artificial tears

85
Q

Episcleritis vs scleritis dx

A

phenylnephrine drops - blanches in episcleritis

86
Q

Cranial nerve defects

A

3rd - unilateral ptosis

fourth - bilateral look to one side

Sixth unilateral adduction

Finals (18 decks)

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