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Phase 4 - Katherine > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What do you need to do for opthalmoscopy ?

A

dilate pupil by relaxing sphincter muscles
-Eg Atropine
[Tropicamide /
Cyclopentolate ]

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2
Q

Things to describe in the optic disk

A

Colour
Contour
Cup
Circulation

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3
Q

Name 3 causes of retinal haem

A

diabetic retinopathy, SAH, vasalva haemorrhage, hypertensive retinopathy,

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4
Q

What would a bright yellow ring around a central leak in opthamoscopy indicate ? mx if near macula?

A

fluid leakage

laser

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5
Q

What are cotton wool spots -

A

micro infarcts

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6
Q

What are drusen?

A

pale, round and grey. Seen at the macula in the elderly
-> sign of age-related macula degeneration

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7
Q

spidery black pigmentation in peripheral retina?

A

Retinitis pigmentosa
-inherited retinal degeneration

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8
Q

What is a scotoma
Cause of a central?

A

blind spot

lesion in the optic nerve between nerve head and chiasm
-Eg optic neuritis, MS

Macular degeneration leads to a central scotoma

/Users/eleanorpatterson/Desktop/The-illustration-of-the-location-of-central-scotoma-simulation-on-the-goggle.png

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9
Q

What is meant by congruity?

A

refers to the agreement of shape of the defect.
The closer to the visual cortex - the more congruous

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10
Q

What is a junctional scotoma

A

Lesion at junction of optic nerve and chiasm
->contralateral nasal fibres compressed because the nasal fibres dip into the optic nerve before travelling down the optic tract.

/Users/eleanorpatterson/Desktop/Simplified-diagram-of-the-anterior-visual-pathways-and-chiasmal-decussation-A-bundle.png

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11
Q

What is a slit lamp used for

A

examining the anterior segment of the eye (i.e. infront of the vitreous body)

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12
Q

Small depression in centre of macula

A

fovea

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13
Q

Central/thickest part of retina, high concentration of cones

A

macula

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14
Q

Central retina, colour vision and acuity

A

Cones

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15
Q

Outer retina, night vision

A

rods

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16
Q

Highly pigmented and vascular layer below RPE, provides O2 req of outer retina

A

Choroid

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17
Q

How can you test acuity

A

snellen chart

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18
Q

What is a cataract

A

Any opacity or clouding of the lens, progressive over years, usually bilat

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19
Q

Name 3 rfs of cataract

A

Sunlight, age, smoking, alcohol, corticosteroid, DM

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20
Q

What is meant by ‘the angle’ in open angle glaucoma

A

Space between posterior surface of cornea and anterior surface of iris.

Where the aqueous humour leaves the eye.

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21
Q

Where is aqueous humour produced?
what does it do?

A

Ciliary body, circulates and nourishes lens.

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22
Q

What is chronic open angle glaucoma? (its the most common)
O/E?

A

Chronic, progressive, optic neuropathy with characteristic changes in optic nerve head and corresponding visual field loss

3 THINGS:
- enlargement of optic disc cup (loss of neurones)
- Progressive visual field loss -> tunnel vision
- raised intraocular pressure (>21) - however this is not always present because some people can have normal pressure glaucoma

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23
Q

Triad of glaucoma

A

Raised IOP (>21mmHg) - not always present

Abnormal disc - cup:disc ratio - (cup gets bigger ) asymmetry, disc haemorrhage etc

VF defect - tunnel vision

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24
Q

3 Ix in screening of chronic open angle glaucoma

A

IOP - low specificity, high FPR

VF test - high FPR

Fundoscopy - cupping - high FPR

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25
Q

Drops for open angle glaucoma

A

Beta blockers - timolol
[reduces aqueous production] - B for BLOCK production

Prostaglandin analogue - latanoprost
[increases outflow]

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26
Q

If drops dont work / lack of compliance what can you do for glaucoma ?
Post these mx?

A

Laser therapy (trabeculoplasty)
/
Surgery (trabeculotomy)

-> Dexamethasone (can’t find this in nice guidelines)

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27
Q

what 3 things is visual acuity dependent on?

A

Functional photoreceptors (rods/cones)

Healthy retinal pigment epithelium (RPE)

Perfusion of choroid (capillary layer)

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28
Q

First thing you develop in macular degeneration

A

drusen

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29
Q

Seen on opthalmoscope of dry macular degeneration?
visual field loss?

A

On opthalmoscope
-Atrophy of RPE (visible choroidal arteries)
-drusen

Visual field loss
Central scotoma with preserved peripheral vision

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30
Q

Seen on opthalmoscopy of wet macular degeneration? Visual field loss?

A

Choroidal neovascular membrane (CNVM)
Leaking vessels below retina
Exudates and haemorrhage and scarring

distorted central vision (objects distorted or appear smaller) and eventually central scotoma

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31
Q

Mx of wet MD

A

Anti-VEGF injections

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32
Q

DDx of sudden visual loss

A

vascular - occlusions of vein/artery

Inflammatory - optic neuritis (MS)

Retinal detachment

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33
Q

presentation of retinal artery occlusion ? Key single thing O/E

A

Sudden, total loss of vision (central retinal artery)

or sudden latitudinal (top half or bottom half) loss (branch retinal artery)

RAPD - swinging flashlight

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34
Q

Name 3 Ix in retinal emboli

A

Carotid artery doppler

fasting serum lipids

+/-
ECG (+ ECHO if young and calcific embolus)
FBC
EST
CT head
Clotting screen

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35
Q

What is amaurosis fungax

A

Loss of vision for 30 mins (ocular TIA)

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36
Q

Exam q
Cherry red spot at fovea + retinal oedema

Why do you see the cherry red spot?

A

central retinal artery occlusion

The cherry red spot is seen because the layer of retina is thinnest at the fovea, so when this layer starts to die you can see the dense vascular choroidal vessels below which appears red.

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37
Q

What is ocular ischaemic syndrome?

What is the presentation?
Name 3 signs of ocular ischaemic syndrome

A

It is a chronic condition affecting the anterior and posterior compartments of the eye as well as other structures supplied by the ophthalmic artery. It may occur due to due to hypoperfusion as a result of carotid stenosis.

Presentation:

  • gradual or sudden visual loss

Signs:

Anterior signs:
- Rubeosis (abnormal vessel growth on iris)
- Dilated episcleral vessels
- Corneal oedema

Posterior signs:
- Blot haemorrhages (peripheral/midperipheral)
- Microaneurysms
- Dilated veins

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38
Q

What Ix do you have to do with microaneurysms and why ?

A

fluorescein angiography to check for perfusion and leak

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39
Q

microaneurysms are often watch and wait but if there it is leaking and fovea is threatened what mx? Ix?

A

Laser around margin

Ix
HTN, lipids, source of emboli, consider aspiirn

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40
Q

Name 2 things seen on opthamoscopy of branch retinal vein occlusion

A

Flame haemorrhages
Leaking veins
Intact arteries

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41
Q

What do you need to do with branch retinal vein occlusion ix?

A

Must establish integrity of foveal arcade!

= fluorescein angiography

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42
Q

1st / 2nd line mx for branch retinal vein occlusion? What is it that you are treating?

A

The treatment is needed to reduce macular oedema secondary to branch retinal vein occlusion.

THE NEW GUIDELINES:
- first line is anti-VEGF injections e.g. Ranibiumab. to prevent neovascularisation
- second line is modified grid laser photocoagulation

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43
Q

How do you identify retinal non perfusion

A

RAPD

Extensive blots and microinfarcts

Fluorescein angiography

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44
Q

name 2 things seen on ophthalmoscopy of central retinal vein occlusion?

A

Widespread flame haemorrhages
swollen optic disc
dilated tortuous veins
extensive blot haemorrhages worse centrally
macular oedema - this is what we are treating because it leads to blindness!!!

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45
Q

mx of central retinal vein occlusion

A

Anti-VEGF injections e.g. Ranibizimab

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46
Q

What is rubeosis? Mx/

A

new vessles forming on iris

Immediate AGGRESSIVE PRP (panretinal photocoagulation) +/- vitrectomy

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47
Q

What is AION?

Usual association with Anterior ischaemic optic neuropathy

A

It is sudden visual loss due to disruption of the blood supply to the head of the optic nerve.

GCA - this arteritis reduces blood supply to the optic nerve

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48
Q

Optic neuritis key assoc?

A

MS

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49
Q

Usual cause of retinal detachement? what happens? what does it lead to?
Name 2 sx

When can these symptoms be normal?

A

Retinal tear

Potential space between photoreceptors and RPE fills with fluid

Retina lifted or detached which leads to a field defect.

flashes -> retinal traction

floaters -> vitreous haemorrhage

field loss -> detached retina

Flashes and floaters can occur with age as your vitreous volume shrinks. This leads to posterior vitreous detachment which doesn’t cause problems in most people.

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50
Q

Mx of retinal detachment

A

Surgery

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51
Q

What is hypersensitive retinopathy? Name 3 features of hypertenisive retinopathy

Management?

A

HR = HTN leading to damage of the retinal blood vessels.

Arteriolar changes = Arteriovenous crossing change (nipping) - vein disappears under artery as arterial wall is thickened, atherosclerosis of arteries, Heightened reflex on artery (silver wiring)

Advanced changes = Microinfarcts (cotton wool spots), Flame haemorrhages

Mx = manage BP!

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52
Q

Name 2 comps of hypertensive retinopathy

A

Retinal vein occlusion (B/C) (due to compression from atherosclerotic arteries)

Retinal artery occlusion (due to atherosclerosis)

AION - Anterior ischemic optic neuropathy

Exacerbation of diabetic retinopathy

Retinal macroaneurysms

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53
Q

Whats the issue with dropping BP too quick in accelerated hypertension

A

may lead to ischaemic optic neuropathy and blindness

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54
Q

2 parts of diabetic retinopathy causing damage?

A

microvascular leakage

occlusion

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55
Q

stages getting worse of diabetic retiopathy and features of each

A

Background - balloon-like swellings are growing (micro aneurysms) on the retinal vessels.

  • Dots, blots (<3), hard exudates

Pre-proliferative - the vessels nourishing the retina swell and can become blocked, encouraging the formation of new vessels via VEGF

  • Cotton wool spots (ischaemic nerve fibres), blots 4+, venous beading

Proliferative - VEGF being released to create new blood vessels but these are immature only with a lamina propria so they leak more and more!

Neovascularisation - vitreous haemorrhage

Dots and blots are ruptured microaneurysms in the retinal layer!

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56
Q

Visual loss in diabetic retinopathy

A

PATCHY VISUAL LOSS (like cow spots)

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57
Q

Name 2 sign on opthalmoscopy of diabetic macular oedema

A

Retinal thickening

Exudates approaching fovea

Microaneurysms close to the fovea

58
Q

Increasing levels of Mx of diabetic retinopathy

A

Optimise glycaemic control and BP +

Observation

Background = No treatment! observation plus glycemic control

Pre-proliferative = Regular slit lamp to look for evidence of retinal ischaemia. Consider pan-retinal photocoagulation as approaches proliferative

Proliferative = pan-retinal photocoagulation, if further advanced then vitrectomy

59
Q

Mx of diabetic retinopathy not responding to treatment? SE of this?

A

Vitrectomy

SE - haemorrhage, cataract

60
Q

How often monitor diabetic retinopathy ?
in preg?

A

12 months

every trimester

61
Q

red flags of red eye

A

Impaired vision

Pain/photophobia

Lack of ocular discharge

62
Q

What is Blepharitis, how does it present?

A

inflamation of eye lid

Gritty, irritable eyes
Watery discharge
Foreign body sensation eyelid

63
Q

What is a stye

A

infection of lash follicle

64
Q

Mx of blepharitis

A

lubricants

hygeine + topical abx

hot spoon bathing

removal of any debris from eye

65
Q

Sx of herpes zoster in eye

A

Severe corneal inflammation (keratitis)
Vascularisation
Corneal clouding
Corneal thinning

LOOKS LIKE A ZOMBIE FUCKER

66
Q

Usual cause malposition of eye lid (in/out turned) ?
mX?

A

Lid laxity in elderly

Surgical

67
Q

Key feature of sub-conjunctival haemorrhage ?

A

Sudden onset, bright red (stays bright red as Hb is easily oxygenated from atmosphere),

68
Q

Mx sub conjunctival haemorrhage

A

No treatment required BUT if following trauma check for orbital/ocular injury

69
Q

Sx of conjunctivitis? visual change?

A

Red eye, discharge, swollen eyelid

vision unaffected

70
Q

Usual cause of viral conjunctivitis?
mx?

A

adenovirus (although many others)

self limiting

71
Q

Name 1 cause of bacterial conjunctivitis and mx?

A

staphylococcus, streptococcus, haemophilus, neisseria

Chloramphenicol / fusidic acid eye drops

72
Q

What might you query if recurrent conjunctivitis?

A

nasolacrimal duct obstruction

73
Q

Which conjunctivitis is important in neonates

A

Chlamydial -> neonatal -> risk of chlamydial pneumonitis

Starts in one eye and spreads to other

74
Q

Chlamydial conjunctivitis - spread? most important comp?

A

flies

conjunctival scarring

75
Q

Mx of adult conjunctival infection with GU sx

A

Must identify and treat underlying GUI

Treatment is systemic erythromycin

76
Q

How to remember the 4 types of hypersentitivity

A

ACDE

1 - Allergic, Anaphylaxis, Atopy

2 - antiBody

3- immune Complex

4- Delayed

77
Q

Mx of allergic conjunctivitis

A

topical steroids

78
Q

how does allergic conjunctivitis present?

A

V. swollen conjunctiva
V. itchy eyes

Usually unilateral! Different to non-allergic conjunctivitis

79
Q

How can you check for corneal abrasions

A

fluorescein dye

80
Q

What is the 3rd main cause of keratitis (corneal infection) other than viral / bacterial

A

Acanthamoeba

81
Q

What is keratitis?

Dx of viral keratitis organism? Ix?
Sx?

A

Keratitis = inflammation of the cornea

Herpes simplex

Characteristic shape (dendrite) that stains with fluorescein

Foreign body sensation, *photophobia, watery discharge

82
Q

Mx of viral keratitis? What should you not use

A

Topical aciclovir

NO Topical steroid as leads to enlarging dendritic ulcer caller amoeboid ulcer

83
Q

Should you use steroids for a red eye?

A

DON’T USE STEROIDS FOR A RED EYE WITHOUT SPECIALIST OPINION

Risk of enlarging dendritic ulcer caller amoeboid ulcer

84
Q

Bacterial keratitis is rare but what Sx? Sign? Mx?

A

Painful red eye + loss of vision

Hazy cornea with central abscess

REQUIRES SPECIALIST
Intense dual ABX
[cef + gent]

85
Q

Iritis (acute anterior uveitis) has acouple key associations…name 2

A

Sero-neg arthropathies (HLA-B27)
-IBD
-Psoriatic arthritis
-Ankylosing spondylitis

Granulomatous disease
-Sarcoidosis
-Syphilis

Behcet’s disease (multisyst, mouth ulc)

86
Q

Q - Someone has Acute anterior uveitis and mouth ulcers ? mx?

A

behcet’s

Steroids

Mydriatics - eg atropine

Immunosupression Eg ciclosporin / azathioprine

87
Q

Mx of iritis (acute anterior uveitis)>

A

atropine - dilates
steroid eye drops - eg dexamethasone

Refer to ophthalmology

88
Q

Unilateral, painful, red eye with profound loss of vision + nausea + vomiting
Photophobia

Often in elderly

A

Acute angle-closure glaucoma

Very high IOP (normal range = 10-21mmHg)

89
Q

Sx of acute angle-closure glaucoma ?
Mech?

A

Very red eye
Corneal oedema
Mid-dilated pupil
Poor vision

Aqueous is produced in ciliary body. The aqueous has to travel between the lens and cornea to get to the anterior chamber. When the lens comes into contact with the iris it cannot get though and the fluid builds up in the posterior chamber. This causes the iris to bulge and close the space between the iris and cornea which then blocks the exit of fluid from the eye. This occurs when the pupil is mid-dilated

-> iris is pushed against cornea and angle closes
-> rapid build up of pressure

90
Q

Name 2 Ix in Acute angle-closure glaucoma

A

Gonioscopy (examination anterior angle) - trabecular meshwork not visible

Slit-lamp - shallow anterior chamber, signs of glaucoma (large cup + nerve fibre loss)

/Users/eleanorpatterson/Desktop/Screenshot 2019-08-31 at 18.25.32.png

Static perimetry - VF loss

91
Q

2 parts of acute Mx of Acute angle-closure glaucoma

A

Lower the pressure
-Topical carbonic anhydrase inhibitors
(Acetazolamide ‘Diamox’)
-topical beta-blockers

Constrict the pupil
Pilocarpine drops

92
Q

How can you prevent recurrence of Acute angle-closure glaucoma

A

Laser ± surgery
Laser iridotomy

93
Q

Are you more worried about bilat or unilat red eye

A

Bilateral red eye is less serious than unilateral (conjunctivitis, blepharitis)

94
Q

Name 2 Asx eye conditions in early disease

A

Chronic glaucoma
Diabetic retinopathy
HTN
Papilloedema

95
Q

Name and DDx of small bilateral pupils

A

miosis

Opiates, pontine haemorrhage, topical pilocarpine (pressure - glaucoma)

96
Q

Name and DDx of bilatreal large pupils

A

mydriasis

Sympathomimetics (amphetamine, cocaine), anticholinergics, topical mydriatics

97
Q

Seen in horners

A

Miosis (check with poor dilation on dark), anhidrosis, partial ptosis (paralysis of miller’s muscle - superior tarsal muscle)

98
Q

What are you thinking horners might be caused by? Ix/

A

brainstem stroke/carotid dissection/Pancoast’s tumour

CT/MRI head, neck and thorax

99
Q

CNIII palsy sx? DDx? Mx?

A

blown pupil, ptosis, down and out pupil

aneurysm of posterior communicating artery
uncal herniation post trauma

neurosurgery immediately

100
Q

Pupil sparing CNIII palsy usually is

A

diabetes / vascular disease

101
Q

3 pupil reflexes?

A

Reaction to light (constriction-miosis)
Direct
Consensual

Reaction to dark (dilatation-mydriasis)

Reaction to near
Miosis
Convergence
Accommodation (focussing by ciliary muscle)

102
Q

Light response when R side CNII optic nerve damage

A

Right sided afferent pupillary defect.

Neither pupil responds when affected eye stimulated.

Both pupils respond when light shone into L.

[https://www.youtube.com/watch?v=WwB2jyj2lYM]

103
Q

light response response when R side CNIII oculomotor damage

A

Right sided efferent pupillary defect. [Resting anisocoria]

Light in R - no direct response, normal consensual.

Light in L - normal direct response, no consensual response

[https://www.youtube.com/watch?v=WwB2jyj2lYM]

104
Q

2 DDx cause of RAPD

A

large retinal lesions
(retinal detachment, central retinal artery occlusion, ischaemic central vein occlusion)

optic neuropathies
advanced glaucoma, optic neuritis, anterior ischaemic optic neuropathy)

105
Q

3 things that happen with a normal near response

A

convergence, miosis and accommodation

106
Q

VF loss in retinal problems

A

Uniocular defects, mirroring problem.

E.g. superior temporal detachment -> inferior nasal field defect

superior retinal artery occlusion -> inferior altitudinal (bottom half) defect

107
Q

VF loss in macular pathology

A

central scotoma

108
Q

VF loss in optic nerve pathology

A

central scotoma

109
Q

VF loss in optic neuritis

A

Reduced acuity, central scotoma, loss of colour vision, RAPD

110
Q

VF loss in early vs late glaucoma

A

Early = arcuate, nasal step

advanced = tunnel vision

111
Q

VF loss in chiasmal compression? 2 causes and slight difference?

A

Classically bitemporal hemianopia (nasal crossing fibres)

Pit tumour compresses from below (inferior fibres) = bitemporal upper quadrantanopia

Craniopharyngioma compresses from above = bitemporal lower quadrantanopita

112
Q

Junctional scotoma VF loss

A

Pit tumour may compress Optic nerve and chiasm

-> central scotoma in one eye and superior temporal defect in other

113
Q

WHat happens in retinitis pigmentosa ?

Presentation?

Age of onset?

A

Hereditary, progressive dystrophy of photoreceptorsin retina and RPE

ring scotoma and night vision problems
(Loss of peipheral vision)

10-30 yrs

114
Q

Mx of retinitis pigmentosa

A

Refer to ophthalmology + genetic counselling

Screen complications (cataracts, glaucoma, macular oedema)

Inform DVLA + wear sunglasses

Vitamin A/beta-carotene, acetazolamide (oral carbonic anhydrase inhibitor)

115
Q

Name 2 key DDx of wet eyes

A

Blockage at punctum/lacrimal duct
[Test with injection of sterile saline]

Reflex lacrimation due to dry eye
[Prescribe lubricating eye drops]

Dacryocystitis
Inflammation of lacrimal sac due to infection

116
Q

Name 2 causes of dry eyes

A

Aging
Medication (diuretics, antidep, antihist, beta blockers)
Systemic illness (RA, SLE, Sjogren’s - hyposecretive)
Blepharitis (decreased tear production)
Allergic conjunctivitis (decreased tear production)
Increased evaporation (low humidity, low blink rate, allergic conjunctivitis)

117
Q

Ix in dry eyes

A

Slit-lamp

Schirmer’s test

assessment of corneal damage (Fluorescein stain)

118
Q

Viral vs bac vs allergic conjunctivitis

A

viral
gritty feeling
watery discharge
lymph nodes

Bac
Gritty
purulent
lymph nodes

Allergic
Itchy
stringy
No lymph nodes
- usually unilateral

119
Q

45y female happened to notice redness on the lateral part of her eye. There was a bit of discomfort associated, but no pain, watering or discharge. No loss of vision.

The redness was confined to the lateral globe, and the blood vessels in the affected area were slightly dilated but not obscured by the redness.

Likely Diagnosis?
Treatment?

A

Episcleritis

NSAIDS - Diclofenac (topical)

NSAIDS - oral
useful in (rare) severe disease

[Acute or gradual onset
Often unilateral, localized eye redness
+/- discomfort, photophobia, tenderness ]

120
Q

How is scleritis different from episcleritis?

A

more severe than episcleritis

may be associated with connective tissue disease (rheumatoid arthritis, polyarteritis nodosa, SLE)

121
Q

Scleritis symptoms

A

Intense Pain

Blurred vision

Swollen sclera

Choroidal effusions (if affecting posterior part of globe)

122
Q

Mx of scleritis

A

Referral to Ophthalmology

Steroids (high dose, systemic Indomethacin)

Cytotoxic therapy (in severe disease)

123
Q

Name 2 Scleritis complications

A

Scleral thinning (scleromalacia)
Scleral perforation
Keratitis
Uveitis
Cataract formation
Glaucoma

124
Q

2 rfs for bacterial keratitis

A

contact lens

dry eyes

prolonged use of topical steroids

125
Q

Key Ix for bacerial keratitis

A

Scrapes
gram-staining and culture

126
Q

A 56-year-old lady presents with photophobia, redness of the eye and blurred vision. She has no previous eye history. She has been diagnosed with sarcoidosis and is currently on systemic prednisolone
OE
Diffuse Redness
Abnormal Pupil
Photosensitivity & Pain on accommodation
White spots in the cornea

Dx?
Sx?
Signs?

A

Uveitis

Symptoms PPRP
Pain (less in posterior uveitis)
Photophobia
Redness of eye
Poor vision

Anterior Uveitis:
Keratitic Precipitates
Hypopyon
dilated Iris vessels
Posterior synechiae

127
Q

What is the key organism causing uveitis should be aware of

A

TB

128
Q

A 78-year-old hypermetropic lady presents to the main casualty unit one evening with severe pain in her right eye which came on suddenly, associated with N&V. It feels like she’s looking through frozen glass and notices glaring rings around bright lights.
OE
injected eye
dilated pupil
blurred vision

Likely Diagnosis?
Treatment?

A

Closed Angle Glaucoma

Immediately
Acetazolamide ‘Diamox’ (IV then Oral)
Pilocarpine (topical) x3 every 5m
β-blockers (topical)

Surgery (YAG laser)
Iridotomy or Iridectomy

second eye treated Prophylactically

129
Q

Name 3 sx of closed angle glaucoma

A

Raised intra-ocular pressure
Red eye
Rainbow halos around lights
Photophobia
Pain (and headache)
Discharge (watery)
Blurred vision

Systemically upset:
Nausea
Abdominal Pain

130
Q

70 year old woman presentes with sudden loss of vision in her right eye. She has noted increasing headaches and funny sensation over her scalp when she combs her hair. She complains of jaw pain when she eats.
O/E: VA CF, RAPD +ve, optic disc swollen. Left eye normal.

What is the likely diagnosis?

Treatment?

How would you confirm?

Precautions with mx?

A

What is the likely diagnosis?
Giant Cell Arteritis causing ischaemic neuropathy

Treatment?
IV steroids prior to any Ix

How would you confirm?
ESR, CRP, Temporal Artery Bx

Precautions?
Latent TB (CXR), BP, BMs, Bone and PPI

131
Q

80 year-old lady
sudden vision loss in her left eye
described “a curtain came down over her eye”
vision came back within 12 hours.
PMHx of IHD & poorly managed hypertension. She also suffered a TIA a year ago
OE
Retinal exam – to left
Acuity 6/12 in left eye, 6/6 in right
Carotid bruit

Dx?

A

Amaurosis fugax

132
Q

Amaurosis fugax mx of cause

Embolic

Carotid Stenosis

Hypercoagulability

Vasculitis (GCA)

Vasospasm

A

Embolic
Aspirin (75mg/day)

Carotid Stenosis
Carotid Endarterectomy (if >70% carotid stenosis)

Hypercoagulability
Warfarin

Vasculitis (GCA)
Steroids

Vasospasm
Nifedipine

133
Q

36 yeard old patient presents with 3-day history of floaters, flashing lights and then a dense, curtain-like field loss in his left eye. He’s known to be myopic, but has no other PMHx.
OE
Visual Acuity left eye 6/60, right eye 6/9

Dx?
2 Rfs?
Management?

A

Retinal Detachment

Risk Factors
Myopia
Cataract surgery
recent severe eye Trauma
previous Detachment in other eye

Refer to ophthalmology for surgical opinion

134
Q

Name 2 uses of Acetazolamide - what type of drug is it?

A

Carbonic anhydrase inhibitor

Retinitis pigmentosa

Acute glaucoma

135
Q

What is uveitis?

A

Inflammation of the uvea: iris, ciliary bodies, choroid

anterior = iritis
middle = cyclists
posterior = choroiditis

Mostly these are non-infective - related to something going on in the rest of the body

136
Q

Differentials of a red, painful eye.

Which ones are emergencies?

A

Keratitis
Conjuctivitis
Uveitis
Scleritis
Episcleritis
Close angle glaucoma

Emergencies:
- closed angle glaucoma
- keratitis
- uveitis

137
Q

Can you regain the sight in central retinal artery occlusion?

A

NO

138
Q

Can you regain sign in central retinal vein occlusion?

A

Ischaemic - no
Non-ischaemic - yes

139
Q

What is a corneal ulcer vs abrasion?

A

Abrasion is a break in the basement membrane. Ulcer occurs when this becomes infected and tunnels into the stroma.

140
Q

When do you get a red optic disc?
When do you get a white optic disc?

A

When it is congested or inflamed - papilloedema, optic neuritis and vein occlusion.

Optic atrophy!

141
Q

What is the red reflex? When can it be absent?

A

Examining for any blockages in the media. The media is the line that passes from the anterior top of the eye (cornea) all the way to the macula. The structures in between this area are the cornea, sclera, anterior chamber, lens, vitreous humour, and the macula.

Blockage can occur at any level e.g. cataract on the lens, ulcer on the cornea, haemorrhage in the vitreous compartment. The larger the absent portion of the red reflex, the more important.

Phase 4 - Katherine (26 decks)

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