Opthalmology Flashcards
Management of anterior uveitis
Urgent referral
Treated with steroid and cycloplegic eye drops
Treatment of herpes simplex keratitis
Topical aciclovir
Ptosis and dilated pupil
Ptosis and constricted pupil
Dilated: Third nerve palsy
Constricted: Horners
What eye condition can be present in cases of seborrhoeic dermatitis
Blephritis
Catarscts
Endopthalmitis
Ciliary flush and painful red eye with photophobia and reduced vision
Anterior uveitis
Failure to correct childhood quints may lead to…
Amblyopia
Reduction in aqueous secretion and induction of pupillary constriction
Acute angle closure glaucoma
3 presentations of horners syndrome
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery
Paipilloedema
Grade 4
What does macular degeneration NOT cause
Tunnel vision
What condition are dursen found in
Dry macular degeneration
Squint management
Refer to opthalmology
Known precipitant of acute angle closure glaucoma
Mydriatic drops
Sudden painless loss of vision with a dense shadow starting peripherally and progressing centrally with spider webs and flashing lights
Retinal detacthment
Sudden painless loss of vision with severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
What is hutchinsons sign
Vesicles extending to the tip of the nose
Strongly associated with ocular involvement in shingles
Difference between vessels in episcleritis and scleritis
Episcleritis: vessels are mobile when gently pressure is applied on the sclera
Scleritis: vessels are deeper so they do not move
Painless, transient monocular blindness together with the description of a ‘black curtain coming down’
amaurosis fugax
Difference between acute angle closure glaucoma and primary open angle closure glaucoma
Acute: hypermetropia
Primary: myopia
Contraindication for a lumbar puncture
Raised ICP
Relevant afferent pupillary deficit and central scotoma
Optic neuritis (MS)
Decreasing vision over months with metamorphopsia and central scotoma
Wet age related macular degeneration
Presentation of ‘red eye’ in glaucoma and uveitis
Glaucoma: severe pain, haloes, ‘semi-dilated’ pupil
Uveitis: small, fixed oval pupil, ciliary congestion
Side effect of steroid eye drops
Fungal infections which can cause corneal ulcers
Emergency management of primary open angle glaucoma
Direct parasympathomimetic (pilocarpine) to contract ciliary muscle Beta blocker (TIMOLOL) to reduce aqueous production Alpha 2 agonist (apraclonidine)
IV acetazolamide
Blunt ocular trauma with associated hyphema is a high risk scenario of what?
Raised intraocular pressure
Management of contact lens wearers with a painful red eye
Referred to eye casualty to exclude microbial keratitis
Side effects of Lantanoprost
Increases eyelash length, iris and periocular pigmentation
Contact lenses during conjunctivitis?
Do not wear
Screen for childhood squint?
Corneal light reflection test
Definite treatment for acute angle closure glaucoma
Laser peripheral iridotomy
Management of a patient with an organic foreign body in their eye (eg grass seed)
Immediate referral to opthalmology for assessment (due to infection risk)
Dark spots in vision with no pain and PMHx T2DM
Vitreous haemorrhage
Red eye which is not painful
Episcleritis
Test for age related macular degeneration
Amsler grid testing
What do drusen look like?
Yellow deposits in the retina
Management and presentation of orbital cellulitis
Swelling and painful red eye with fever and limited ocular movements
Admit for IV antibiotics
2 complications of orbital cellulitis
Cavernous sinus thrombosis
Intracranial spread
Wet age related macular degeneration on fundoscopy
Well demarcated red pathces
Treatment of wet age related macular degeneration
anti-VEGF
Herpes simplex keratitis on examination with stain
Dendritic ulcer
What investigation is used to guide treatment for age related macular degeneration
Fluorescein angiography
Anisocoria worse in bright light - where is the problem
In the pupil which is dilated
Parasympathetic and sympathetic - what do they each do to the pupils?
Parasympathetic causes pupil constriction (ciliary ganglion)
Sympathetic causes pupil dilation
Risk factor for vitreous haemorrhage
Warfarin and other blood thinning agents
What investigation is used to identify refractive errors
Use of a pin hole occluder
Presentation of acute closed-angle glaucoma
Fixed dilated pupil, conjunctival infection, halos around lights, blurry vision, headaches, vomiting, dull cornea
What are cotton wool spots?
Pre-capillary arteriolar occlusion (areas of retinal infarction)
Treatment for allergic conjunctivitis
First line: Topical or systemic antihistamines
Second line: Topical mast cell stabilisers e.g. sodium cromoglicate and nedocromil
Risk factors for anterior uveitis
Ankylosing spondylitis
Crohns
Organism in contact lens keratitis
Pseudomonas aeruginosa
Sudden painless loss of vision with a red spot and pale retina on fundoscopy
Central retinal artery occlusion
Definite management of acute angle closure glaucoma
Laser peripheral iridotomy
Management of primary open angle glaucoma
Latanoprost (prostaglandin analogue) to increase outflow
Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming
Acanthamoebic keratitis
4 features of horners
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
Screening if a FHx of glaucoma
Annual screening from age 40 years
Sudden onset visual loss with flashers and floaters
Posterior viterous detachment
Blurry vision for a few months with halos surrounding light with PMHx T2DM
Cataract
Carbon dioxide and ICP
Raised CO2 may cause raised ICP (therapeutic hyperventilation to induce hypocapnia used in emergencies)
Define mydriatic
Dilated pupil
What is argull-Robertson pupil
Seen in neurosyphilis
Small irregular pupils, no response to light but response to accommodation
Give 4 causes of dilated pupils
Third nerve palsy
Atropine
Holmes-Adie pupil
Traumatic iridoplegia
Trau
Risk factor for subscapular cataracts
Steroid use
Two stages of diabetic retinopathy
Pre-proliferative
Proliferative: neovascularisation, vitreous haemorrhage
3 features of keratitis
Red eye, photophobia, gritty sensation
1st line treatment for blepharitis
Hot compress and mechanical removal of debris
What is a holmes adie pupil?
Viral or bacterial infection damages the parasympathetic nerves
What condition is diagnosed by the swinging light test
Marcus-Gunn Pupil
What is chalazion
A meibomian cyst presents as a firm painless lump in the eyelid
Presentation of optic neuritis
Visual loss, eye pain and red desaturation
central scotoma
Visual field loss in macular degeneration vs primary open angle glaucoma
Macular degeneration: central field loss
Primary open angle glaucoma: peripheral field loss
Blurry vision with wavy/crooked lines and central visual field loss
Age related macular degeneration
Does calcium affect cataract development?
Yes, hypOcalcemia increases the risk of cataracts
4 risk factors for cataracts
Downs
Diabetes
Steroids
Uveitis
Retinopathy presentation
Painless reduction in visual acuity
Episcleritis vs Scleritis
Episcleritis is painless
Scleritis is painful
