Opthalmology Flashcards
What is contained in the anterior chamber
Cornea and Iris
What is contained in the posterior chamber
Lens
What cell produces aqueous humour
Ciliary body
What is the normal intraocular pressure of the eye
10-21 mmHg
What cause open-angle glaucoma
Gradual increase in resistance of the trabecula meshwork that the aqeous humour has to travel thorugh to get to the anterior chamber
Pressure slowly builds up
What happens to cause acute closed-angle glaucoma
The iris bulges forward and completely seals the trabecular meshwork from the anterior chamber
What is cupping of the disc and in which condition is this found
Dimpling in the disc
Caused by raised intraocular pressure
Signs of Glaucoma
Affectsa peripheral vision first -> tunnel vision
Fluctuating pain, headaches and halos around lights at night
HOw can we measure intraocular pressure
Goldmann Applanation tonometry
What is the role of fundosocpy
To check the optic disc (e.g., for cupping or detachment)
First line management of glaucoma
Prostaglandin eye drops
Latanoprost
INcreases uveoscleral outflow
Second line:
Timolol
Carbonic anhydrase inhibitors
Brimonidine (anympathomimetics)
What surgical intervention can be sued last line for glaucoma
Trabeculectomy
What medications can precipitate acut-closure glaucoma
Noradrenaline
Oxybutynin
Amitriptyline
Examination findings in acute angle glaucoma
Haxy cornea
Dilatation of affected puupil
Fixed pupil size
Initial management of acute angle glaucoma
Pilocarpine eye drops
Give Acetazolamide 500mg orally
Role of pilocarpine
Causes ciliary muscle contratcion by acting on muscarinic receptors
Role of timolol in glaucoma
Reduces production of aqeous humour
What is the definitive treatment of glaucoma
Laser Iridotomy
What causes diabetic retinopathy
Hyperglycaemia damages retinal small vessels causing microaneurysms -> bleeding.
Damage to nerve fibres cause cootton wool spots
Signs of diabetic retinopathy on fundoscopy
Cotton wool spots
Neovascularisation
Microaneurysms
Hard exudates around the fovea from lipid leakage
SIgns of non-proliferattive diabetic retinopathy
Microaneyrisms
Blot Haemorrhages
hard exudates and venoud bleeding
All issues with pre-existing blood vessels
Signs of proliferative diabetic retinopathy
Neovascularisation
Vitreous Haemorrhage
Signs of diabetic maculopathy
Macular oedema
Ischaemic maculopathy
Complications of diabetic retinopathy
Retinal detachment
Management of Diabetic retinopathy
Laser photocoagulation
Anti-VEGF like ranibizumab
Vitreoretinal surgery
Name two types of age related macular degeneration
Wet and Dry
What type of age related macular degeneration has the worst prognosis
Wet
Pathophysiology of age related macular degeneration
Atrophy of retinal pigment epithelium
Degeneration of photoreceptors
Why is Anti-VEGF used in age related macular degeneration
New vessels growing from the choroid layer into the retina can leak fluid (as they’re old) -> oedema -> vision loss.
VGEF stimulates this process
Presentation of age related macular degeneration
Gardual worsening of central visual field
Reduced visual acuity
Wavy appearance to straight lines
Onset of wet age related macular degeneration
within days you get vision loss
What examinations would you do to test fo rage related macular degeneration
Snellen chart
Check for scotomas
Amsler grid test
Fundoscopy
Key finding on fundosocpy for age related macular degeneration
Drusen proteins
What is a slip-lamp fundus examination
Makes a 3d visualisation of the globes of the eye
What is the GOLD standard to diagnsoe age related macular degeneration
Slit lamp
What is optical coherence tomography
Checks layers of the retina
What is the role of fluorescein angiogrpahy
CHecks vasulcaristaion of the eye (neovascularisation signs)
Management of dry AMD
Avoid smoking
Control BP
Management of wet AMD
Anti-VEGF medication within 3 months
What classification can be used to grade hypertensive retinopathy
Stage 1: Mild narrowing of arterioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Dtage 4: Papilloedema
What is AV nipping
Arterioles compress veins they cross due to hardening
What screen is used to check for congenital cataracts in neonates
Red Reflex
Signs of cataracts in presentation
Slow reduction in vision
Progressive blurring of vision
colours becoming more brown or yellow
Starbursts around lights
Glaucoma vs Macular degeneration
Glaucoma = peirpheral vision loss
Macular = central vision loss and wavy lines
What is a complictaion of cataract surgery
Endophthalmitis
Management of endophthalmitis
IV Antibiotics
What is the shape of the pupil in acute angle closure glaucoma
Vertical oval
What is Rubeosis Iridis
Neovascularisation in the iris from T2DM which can distort pupil shape
What causes tadpole pupil
Migraines
What pupil is seen nin neurosyphilis
Argyll-ROberttson pupil
What is Argyl-Robertson pupil
Doe snot constrict to light but does to distance
What can be used to test for horner’s syndrome
Cocaine eye drops
What are the two types of styes
Hordeolum externum (points out)
Hordeolum internum (points in towards the eyeball)
Management of a stye
Analgesia and hot compress
Second line: Chlorphenanicol
What is a Chalazion vs a stye
Chalazion form on inner side of eye lid but are chronic
What is Entropion
Where eyelids turn inwards with eyelashes retsing on eyeball
Management of Entropion
Tape down eyelid
Refer urgently to opthalmology as it can cause corneal ulceration
IN what disease in entropion commonly seen in
Trachoma (chlamidyia infetcion of the eye)
What is Ectropion
Eye lid inverts so we see the inner of the eye
Complication fo ectropion
Exposure keratopathy
Management of ectropion
Urgent same day referral to opthalmology
What is Trichiasis
Inwards growth of eyelashes
Management of trichiasis
Epilation
Management of periorbital cellulitis
Oral or IV antibiotics + admission for observation
Periorbital cellulitis vs orbital cellulitis
Periorbital = infection in front of the eye
Orbital = tissues behind orbital septum
Management of orbital cellulitis
Admission + IV Antibiotics
EMERGENCY
What lymph nodes are affected in conjunctivitis
Periauricular lymph nodes
Management of conjunctivitis
Re-assure (goes away after 2 weeks)
If not: Fusidic acid and chlorphenicol eye drops
Management of patients under 1 month of age with conjunctivties
Referral to opthalmology to check for gonococcal infection
Name a condition that can cause Chronic Anterior Uveitis
Syphilis
Describe the appearance of Anterior iUveitis
UNILATERAL:
Posterior Synechiae (abnormally shaped pupil with lobules)
Ciliary flush (redness around the iris)
Hypopyon (filling of the iris
If anyone with AS, IBD, RA etc presents with anterior uveitis, what should be done as first line management
Referral to Opthalmology as it is an emergency.
What treatment is given for anterior uveitis
Oral steroids
Describe the appearance of Episcleritis
Blood vessels around the outside of the eye
What conditions can cause episcleritis
Rheumatoid Arthritis
IBD
Presentation of Episcleritis
Foreign body sensation
Watering of an eye
Management of Episcleritis
Refer to Opthalmology
Scleritis vs Episcleritis
Inflammation of the FULL thickness of the sclera
What scleritis is associated with
RA
SLE
IBD
Sarcoidosis
Granulomatosis with polyangitis
Presentation of scleritis
Severe Pain
Pain with eye movement
Photophobia
Eye Watering
Reduced visual acuity
Management of scleritis
Topical NSAIDs
What species can cause infections with contact lenses
Pseudomonas
Management of herpes keratitis
Antiviral eye drops
Diagnosis of a corneal abrasion
A fluorescein stain
will collect on the abrasions
Management of corneal abrasions
Antibiotic Chlorphenicol
What layer of the cornea is affected in herpes keratitis
Epithelial layer of the cornea
Stromal layer
Complication of herpes keratitis
Corneal blindness
Presentation of herpes keratitis in the eye
Dendritic corneal ulcer
Diagnosing herpes keratitis
Fluorescein staining - dendritic corneal ulcer
Swabs for PCR
Management of Herpes Keratitis
Topical or oral aciclovir
Ganciclovir eye gel
How should corneal scarring by stromal keratitis be treated
A corneal transplant
What conditions may result in subconjunctival haeemorhages
Hypertension
Thrombocytopenia
Whooping Cough
Warfarin, NOACs, antiplatelets
Non-accidental injury
Are subconjunctival haemorrhages painful
No
But precipitated with coughing fit or heavy lifting
Management of subconjunctival haemorrhage
Resolve spontaneously without treatment
What is a posterior vitreous detachment
Where the vitreous gel comes away from the retina
Presentation of a vitreous haemorrhage
Painless
Spots of vision loss
Floaters
Flashing Lights
Management of a vitreous haemorrhage
No treatment
Presentation of retinal detachment
Peripheral vision loss.
Blurred or distored visions
Flashes and floaters
Management of retinal detachment
Refer to opthalmology for laser therapy
Citrectomy
Scleral buckling
What is the role of the central retinal vein
Drains blood from the retina
Why do we get neovascularisation in Central retinal vein occlusion
Blockage of the retinal vein causes macular oedema and retinal vessel damage, leading to neovascularisation
Presenttaion of central retinal vein occlusion
Sudden painless loss of vision
SIgns of central retinal vein occlusion
Flame and blot haemorrhages
Optic Disc Oedema
Macula Oedema
Management of retinal vein occlusion
Laser photocoagulation and anti-VEGF
Define presbyopia
Normal aging of the lens - changes to the refractive state of the eye
What is Blepharitis
Inflammation of the eye lifs
Complication of Blepharitis
Chalazion
Management of Blepharitis
Lid Hygeiene
What is Dacrocystitis
Lump on the size of the nose - lacrimal sac inflammation
Management of Dacrocystitis
Cephalosporins
Most common cause of viral conjunctivitis
Adenovirus
Management of Chlamidyial Conjunctivtities
Topical Erythromycin
Management of Gonorrhoeal conjunctivities
Topical penecillin
Management of Gonnorhoeal infections as an STD
IM Ceftriaxone
Presentation of Herpes simplex conjunctivities
Peri-auricular lymph node involvement
Unilateral symptoms
What can aggravate the pain in corneal abrasions
Blinking and eye movement as nerve endings are exposed
What is a blepharospasm
Inability to open the eye
Treatment of corneal abrasions
Chlorphenicol
Define keratitis
Corneal inflammation
Common cause of keratitis
Herpes or contacts
What is Keratoconus
Where a normal, domed shape cornea thins and bulges out
What drugs can cause cataracts
Steroids
What ethnicity is more commonly affected by open-angle glaucoma
Black africans
In what conditions are timolol contraindicated
Asthma, COPD and heart block
What type of drug is Acetazolamide
Carbonic Anhydrase Inhibitor - reduce aqueous production
Management of Uveitis (medical)
Dexamethasone and Cyclopentolate to dilate pupil
Signs of papilloedema on fundosocpy
Pallor and blurred margins of the optic disc
Signs of end stafe hypertensive retinopathy
Eye pain
What is the intraocular pressure in chronic open-angle glaucoma
Normal
What is a normal cup to disc ratio
<0.5
Over 0.5 = possible glaucoma + cupping
If chlamydial conjunctivitis is not treated by topical, what should be given
Oral Antibiotics - usually refractive to topical
Clinical Features of Cavernous Sinus Thrombosis
fever
Headache
Inability to tract objects due to CN III, V1, V2 and 6 compression
What arteries can GCA affect
Internal carotid or vertebral arteries
Ocular symptoms in Marfan Syndrome
Partial lens discolouration
In what AMD are drusen fibres seen
Dry
Where are Drusen deposits found in dry AMD
Between retinal pigment epithelium and Bruch’s membrane
Is retinal detachment painful?
No
What is the role of Latanoprost
Increases aquaeous humour efflux from the eye
Can visual field return in primary open-angle glaucoma?
No
Define Anisocoria
Unequal pupil sizes
What is a normal pupil size in light + dark
Light: 2-4 mm
Dark: 4-8 mm
What is Adie’s tonic pupil
Where a tonically dilated pupil reacts SLOWLY to light but responds to accommodation (whilst Argyll robertson does not respond to light at all)
Primary open-angle vs closed angle glaucoma symptoms
Primary is gradual onset vs rapid onset
Argyll Robertson pupil vs Holmes Adie Syndrome
Argyll Robertson pupil is bilateral vs Unilateral
Fundosocpy findings in Branch retinal vein occlusino
Retinal haeemorhages confined to a limited area of the retina
What is Retinitis Pigmentosa
The loss of cells in the retina over time - causes tunnel vision
How long are steroids given for HSV Opthalmicus
7-10 days
Onset of vision loss in vitreous haemorrhages
SUDDEN
CLinical features distinctive of retinitis pigmentosa
FAMILY HISTORY:
Night BLindness + Tunnel Vision
What is preferred in pregnant women, Chloramphenicol or Fusidic Acid
Topical Fusidic Acid
What is posterior vitreous detachment
This is the separation of the vitreous membrane form the retina that occurs as we age
Management of a posterior vitreous detachment
Referral to Opthalmologist within 24 hours
What type of cataracts are associated iwth steroid use
Subscapular cataracts
What is Hutchinson’s sign
Where vesicles in HSV are found on the tip of the nose - means ocular involvement in shingles
What condition is a central scotoma indicative of
Optic Neuritis
What is myopia
SHort-sightedness
WHat complication does Hutchinsob’s sign point to
Anterior Uveitis
Management of a teary discharge in a neonate
Reassurance - usually caused by lacrimal duct obstruction
What surgery is indicated for severe diabetic retinopathy
Vitreoretinal surgery
What infetcion can be cuased by wearing contact lenses
Acanthamboeba keratitis
What is the Amsler grid
Assess someone’s central visual field
What supplement can be given in Dry AMD
Beta-carotene
What distinguishes diabetic macullopathy
Central vision loss (as macula is affected)
Management of organic foreign bodies in th eeye
Immediate refferal to opthlamology
Is there pain in central retinal artery occlusion
No
What causes central retinal artery occlusion
Thromboembolism (e.g., from GCA)
Management of Herpes Zoster Opthalmicus
ORAL aciclovir
Risk Factors for Primary open angle glaucoma
Age
Diabetes
Family HIstory
Hypertension
Afro-Caribbean
When does vision loss in vitreous haemorrhage become worse
When lying down flat
What eye condition is typically associated with acute closed angle glaucoma
Long sightedness
In what condition is short-sightedness associated with
Primary open angle glaucoma
How is latanoprost hiven
Topically NOT orally
What causes cotton wool spots
Arteriolar occlusion (nothing to do with veins)
Triad for keratitis
Red Eye
Photophobia
Grittiness
Role of the Inferior Rectus
Adduction and lateral rotation of the eye
Innervation of Inferior rectus
CN III
Innervation of the superior oblique muscle
Trochlear nerve
Innervation of the inferior oblique nerve
CN III
ROle of the superior oblique nerve
Down and out
Role of inferior oblique muscle
Up and Out
First line management of a squint
Refer to Opthalmology
WHat is Marcus-Gunn Pupil
Where the pupil will dilate when light is shone on it rather than constrict
Other than the eye signs in adie holmes pupiles, what else can be elicited on examination
Absent leg reflexes
First line management at GP level for suspected AMD
Urgent referral to Opthalmology as Wet AMD is preventable
First line management of closed angle acute glaucoma in someone who has asthma
Latanoprost
What can we make the patient do to reduce ICP
Hyperventilation
First line management of red eye in contact lense wearers
Refer
When should a red eye be referred to secondary care
Evidence of:
Trauma
Visual Impairment
Abnormal pupillary reaction
Wears contact lenses
neonatal conjunctivitis vs blocked lacrimal ducts
Conjunctivtis: White of eye is RED
Lacrimal duct blockage: No redness
What causes an entropion
Usually benign swelling of tissue in the eye lid (from elderly people)