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Opthalmology Flashcards

1
Q

Describe the pathophysiology of glaucoma

A

Excess fluid in the aqueous humour, resulting in increase intra-ocular pressure.

Acute angle closure glaucoma - iris folds out to obstruct drainage of fluid - fast development

Chronic open angle glaucoma - inability of trabecular mesh to absorb fluid - slow development

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2
Q

Describe the presentation of chronic open angle glaucoma

A
  1. Peripheral vision loss leading to tunnel vision
  2. May be asymptomatic
  3. Myopia - near sightedness
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3
Q

Describe the presentation of acute closed angle glaucoma

A
  1. Peripheral vision loss leading to tunnel vision
  2. Painful, red eye
  3. Headache
  4. Hazy cornea
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4
Q

Describe the fundoscopic findings in chronic open angle glaucoma

A
  1. Optic disc cupping
  2. Optic disc pallor
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5
Q

Give the management of chronic open angle glaucoma

A
  1. Latanoprost eye drops (prostaglandin analogue - increases absorption of aqueous humour)
  2. Timolol eye drops (B-blocker - prevents secretion of aqueous humour)
  3. Trabeculectomy - surgery
  4. Dorzolamide eye drops (carbonic anhydrase inhibitor)
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6
Q

Give the management of acute closed angle glaucoma

A
  1. Urgent opthalmology referral
  2. Pilocarpine eye drops (parasympatheticomimetic miotic medication - constrict pupil)
  3. Timolol eye drops
  4. Laser iridotomy - surgery (hole through iris to allow drainage of fluid) - definitive management to only be used after acute attack has resolved
  5. Intravenous acetazolamide
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7
Q

Describe the pathophysiology of macular degeneration

A

Either dry or wet

Leads to destruction of macula (most photoreceptor dense area of retina)

Dry: gradual atrophy of the retina (most common)
Wet: new vessel growth below the retina (more severe and acute)

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8
Q

Give the management of dry macular degeneration

A
  1. No good management
  2. Vit. A and vit. E supplementation
  3. Zinc supplementation
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9
Q

Give the management of wet macular degeneration

A
  1. Photodynamic lasers
  2. Anti- vascular endothelial growth factor (Anti-VEGF)
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10
Q

Give the fundoscopic findings in macular degeneration

A
  1. Drusen formation
  2. Blood vessel growth below retina
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11
Q

Give the pathophysiology of cataracts

A

Opacity and clouding of the lens, commonly seen in the elderly.

Presbyopia - loss of ability of lens to change shape and subsequent failure of accommodation

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12
Q

Give the presentation of cataracts

A
  1. Leucocoria (white pupil)
  2. Visual loss - gradual
  3. “Browning and yellowing” of colours
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13
Q

Give 1 complication of cataracts

A

Endopthalmitis - inflammation of aqueous/vitreous humour

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14
Q

Give the management of cataracts

A

Surgery - lens replacement

Managed conservatively until symptoms affect lifestyle

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15
Q

Describe the pathophysiology of congenital cataracts

A

Present from birth.

Associated with congenital rubella syndrome.

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16
Q

Give the presentation of congenital cataracts

A
  1. Clouding of lens
  2. Loss of red reflex - diagnosed in NIPE
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17
Q

Describe the management of congenital cataracts

A
  1. Urgent opthalmology referral - prevents amblyopia (vision loss due to brain neglecting the eye)
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18
Q

Give the pathophysiology of vitreous detachment

A

The vitrous gel becomes less firm and less able to maintain it’s shape with age.

This causes it to pull away from the retina.

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19
Q

Give the risk factors for vitreous detachment

A
  1. Age
  2. Traume
  3. Diabetes
  4. Eye surgery
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20
Q

Give the presentation of vitreous detachment

A
  1. Floaters
  2. Flashes
  3. Dark spots
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21
Q

Give the management of vitreous detachment

A
  1. Watch and wait
  2. Refer to opthalmology - to rule out retinal tears or detachment which would require surgery
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22
Q

Describe the presentation of blepharitis

A
  1. Affects all 4 eyelids
  2. Painful and gritty eyes
  3. Loss of eyelashes
  4. Recurrent chalazion and styes

Sx worse in morning

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23
Q

Describe the pathophysiology of blepharitis

A

Anterior blepharitis: Staph. infection or seborrhoeic dermatitis

Posterior blepharitis: meibomian gland dysfunction

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24
Q

Describe the management of blepharitis

A

Incurable

Lid hygiene, hot compress, tear substitutes, chloramphenicol drops

Unilateral blepharitis = red flag –> may indicate cancer

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25
Describe the presentation of styes
Discomfort and lump on the eyelid
26
Give the pathophysiology of styes
Infection at the base of an anterior eyelash Associated with recurrent blepharitis
27
Give the management of styes
1. Self-limiting 2. Hot compress 3. Puncture and drainage if recurrent 4. Antibiotics
28
Describe the presentation of a chalazion
Non-tender, uncomfortable red nodular lump on eyelid
29
Describe the pathophysiology of a chalazion
Inflammation of the meibomian glands of the posterior eyelid
30
Give the management of a chalazion
1. Lid massage 2. Warm compress 3. Surgery if troublesome
31
Describe the presentation, risks and management of entropion
Presentation: eyelid turned inward Risk: may cause corneal abrasion Management: tape eyelid down, eyelid drops, surgery
32
Describe the presentation, risks and management of ectropion
Presentation: eyelid turned outward, with inner aspect of eyelid exposed Risk: exposure keratitis Management: prophylactic antibiotic, steroids, surgery
33
Describe the pathophysiology of periorbital cellulitis
1. Common in children 2. Commonly caused by Haemophilus influenzae or Strep. pneumoniae
34
Describe the presentation of periorbital cellulitis
1. Peri-orbital redness, swelling, tenderness 2. Fever
35
Give the management of periorbital cellulitis
1. Urgent opthalmology referral to prevent development to orbital cellulitis 2. Oral co-amoxiclav (adult)
36
Give the presentation of orbital cellulitis
1. Painful eye movement 2. Proptosis 3. Reduced visual acuity
37
Describe the management of orbital cellulitis
1. CT to assess spread 2. LP to exclude meningitis 3. IV cefotaxime
38
Describe the aetiology of conjunctivitis
Viral - commonly adenovirus Bacterial - Staphylococcal or STI infection Allergic - acute allergy, hayfever
39
Give the presentation of conjunctivitis
Acute red eye! 1. Uncomfortable, not painful 2. Bloodshot eye 3. Itchy/gritty Viral: sore throat, clear eye discharge Allergic: clear eye discharge
40
Give the management of conjunctivitis
Viral: reassurance Bacterial: topic chloramphenicol Allergic: oral or topical antihistamine
41
Give the management of neonatal conjunctivitis
Urgent referral due to association with gonococcal infection.
42
Describe the presentation of subconjunctival haemorrhage
Sudden onset bright red eye with blood free to move in the subconjunctival space. Unilateral and otherwise asymptomatic.
43
Describe the aetiology of subconjunctival haemorrhage
Coughing Coagulation disorder Trauma Heavy lifting
44
Describe the management of subconjunctival haemorrhage
1. Self-limiting (resolve within 2 weeks) 2. Avoid aspirin and NSAIDs 3. Investigate for clotting disorder
45
Describe the presentation of episcleritis
Acute, non-painful reddening of the sclera
46
Describe the aetiology of episcleritis
Strongly associated with IBD and RA More common in younger people
47
Describe the management of episcleritis
1. Self-limiting 2. Cold compress 3. Lubricating eye drops
48
Describe the pathophysiology of scleritis
Full-thickness inflammation of the sclera.
49
Describe the aetiology of scleritis
Affects older people with pre-existing autoimmune conditions. Strong association with systemic vasculitis, RA and polymyalgia rheumatica.
50
Describe the presentation of scleritis
Severe eye pain which is worse on movement. Photophobia and reduced visual acuity.
51
Describe the management of scleritis
Opthalmic emergency 1. Urgent referral to opthalmology 2. NSAIDs and immunosuppressants to treat underlying cause
52
Which structures comprise the uvea?
Iris, ciliary bodies, choroid
53
Describe the aetiology of anterior uveitis
Strong association with IBD, RA and seronegative spondyloarthropathies. (e.g. may see young person with back pain and eye Sx - ankylosing spondylitis)
54
Describe the presentation of anterior uveitis
Acute, unilateral, intensely painful red eye 1. Reduced vision 2. Photophobia 3. Irregular pupil 4. Hypopyon (accumulation of leukocytes in anterior chamber, appearing as fluid level of pus)
55
Describe the management of anterior uveitis
1. Treat underlying cause 2. Prednisolone PO 3. Mydriatic (dilation) drops (e.g. atropine)
56
Describe the aetiology of keratitis
Viral: herpes simplex Bacterial: Pseudomonas or Staphylococcus Fungal: Candida or Aspergillus Contact lens acute red eye (CLARE) Exposure keratitis
57
Describe the risk factors for keratitis
1. Contact lens wearer 2. Smoker 3. Poor hygiene 4. Immunocompromised 5. Trauma
58
Give the presentation of keratitis
Unilateral, rapid onset moderate-severe pain in eye. Red eye with discharge.
59
Describe the management of keratitis
Corneal surface scrape for culture. Antibiotics (e.g. topical ciprofloxacin)
60
Describe the presentation of HSV keratitis
Usually in children. 1. Unilateral 2. Photophobia and light sensitivity
61
How are corneal abrasions diagnosed?
Fluorescin drops.
62
Describe the management of HSV keratitis
Aciclovir
63
Give the causes of mydriasis
Causes of mydriasis (large pupil) 1. third nerve palsy 2. Holmes-Adie pupil 3. traumatic iridoplegia 4. phaeochromocytoma 5. congenital 6. topical mydriatics (e.g. atropine)
64
Give the presentation of Horner's syndrome
Ipsilateral: 1. Ptosis (eyelid drooping) 2. Anhidrosis (lack of sweating) 3. Miosis (constricted pupil)
65
Give the pathophysiology of Horner's syndrome
Lesion of sympathetic chain supplying the eye (may be caused due to lung carcinoma)
66
Describe the management of diabetic retinopathy
Intravitreal VEGF inhibitors may be used in addition to panretinal laser photocoagulation to treat proliferative diabetic retinopathy
67
Give the presentation of retinal detachment
Sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally
68
Give the presentation of retinitis pigmentosa
Night blindness + tunnel vision
69
Give the causes of optic neuritis
1. MULTIPLE SCLEROSIS: the commonest associated disease (MRI indicated if suspected) 2. diabetes 3. syphilis
70
Give the presentation of optic neuritis
1.unilateral decrease in visual acuity over hours or days 2. poor discrimination of colours, 'red desaturation' 3. pain worse on eye movement 4. relative afferent pupillary defect 5. central scotoma
71
Give the management of optic neuritis
1. high-dose steroids 2. recovery usually takes 4-6 weeks
72
Give the presentation of Argyll-Robertson pupil
Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA) 1. small, irregular pupils 2. no response to light but there is a response to accommodate Caused by diabetes and syphilis.
73
Give the presentation of herpes simplex keratitis
Dendritic corneal ulcer: 1. red, painful eye 2. photophobia 3. epiphora 4. visual acuity may be decreased 5. fluorescein staining may show an epithelial ulcer
74
Give the management of herpes simplex keratitis
1. Immediate referral to an ophthalmologist 2. Topical aciclovir
75
Describe the pathophysiology of herpes zoster opthalmicus
Reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve.
76
Give the presentation of herpes zoster opthalmicus
1. vesicular rash around the eye, which may or may not involve the actual eye itself 2. Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
77
Give the management of herpes zoster opthalmicus
1. oral antiviral treatment for 7-10 days, ideally started within 72 hours. (intravenous antivirals may be given for very severe infection or if the patient is immunocompromised, topical antiviral treatment is not given in HZO, topical corticosteroids may be used to treat any secondary inflammation of the eye) 2. ocular involvement requires urgent ophthalmology review
78
Give the side effects of prostaglandin analogues
Key side effects of prostaglandin analogues include increased eyelash length, iris pigmentation and periocular pigmentation
79
What sign is shown here and what is it suggestive of?
Optic disc cupping - glaucoma
80
What is this?
Blepharitis
81
What is this?
Stye
82
What is this?
Chalazion
83
What signs are seen in retinal detachment?
Examination findings in retinal detachment include reduced visual acuity and loss of the red reflex
84
Describe the presentation of acanthomoebic keratitis
Pain out of proportion of clinical presentation, contact lens and recent freshwater swimming is classical of acanthamoebic keratitis
85
Describe the classifications of retinal detachment
Rhegmatogenous - traumatic tear leading to build-up of fluid behind retina Exudative - due to HTN, vasculitis, sarcoidosis, metastases Tractional - pulling on retina due to proliferative retinopathy (e.g. in diabetes)
86
Describe the presentation of retinal detachment
Floaters Flashes Field defects - indicate position and extent Painless drop in visual acuity - "falling curtain"
87
Describe the management of retinal detachment
Lie flat Laser photocoagulation therapy
88
Describe the pathophysiology of scleritis
Inflammation of the sclera (where eye muscles penetrate) with oedema of the conjunctiva, scleral thinning and vasculitic changes
89
Describe the aetiology of scleritis
Systemic disease - RA, granulomatosis with polyangiitis
90
Describe the presentation of scleritis
Constant, dull ache which bores into the eye - worse at night Pain on ocular movement Headache Photophobia
91
Describe the management of scleritis
Anterior - oral NSAID, high dose steroid Posterior/necrotising - prednisolone, systemic immunosuppression, opthalmology referral
92
Describe the pathophysiology of episcleritis
Inflammation below the conjunctiva with an inflammatory nodule
93
Describe the presentation of episcleritis
Moveable vessels, mild/no pain, red eye
94
Describe the management of episcleritis
NSAID, artificial tears
95
Describe the aetiology of optic neuritis
Strong association with MS! SLE Infectious - syphilis, lyme disease
96
Describe the presentation of optic neuritis
Acute unilateral vision loss Peri-ocular pain Flashes Reduced colour vision
97
Give 2 differentials for sudden unilateral vision loss
Optic neuritis Giant cell arteritis
98
Describe the management of optic neuritis
High dose IV methylprednisolone
99
Describe the fundoscopic findings in hypertensive retinopathy
Flame haemorrhages Cotton-wool spots Papilloedema Tortuous arteries with shiny walls
100
What visual field defect would be caused by a pathology at site A?
Unilateral central scotoma
101
What visual field defect would be caused by a pathology at site B?
Monocular vision loss
102
What visual field defect would be caused by a pathology at site C?
Bitemporal hemianopia
103
What visual field defect would be caused by a pathology at site D?
Contralateral hemianopia
104
What visual field defect would be caused by a pathology at site E?
Contralateral superior quadrantanopia
105
What visual field defect would be caused by a pathology at site F?
Contralateral inferior quadrantanopia
106
What visual field defect would be caused by a pathology at site G?
Contralateral homonymous hemianopia
107
What visual field defect is seen in posterior cerebral artery occlusion?
Contralateral homonymous hemianopia with sparing of the macula
108
Describe the pathophysiology of diabetic retinopathy
Damage to small blood vessels and endothelial cells in retina due to hyperglycaemia Increased vascular permeability leads to leakage, blot haemorrhages and hard exudate formation (lipid deposition) Microaneurysm formation Damage to nerve fibres causes cotton-wool spots
109
Describe the classification of diabetic retinopathy
Proliferative - neovascularisation occurs Non-proliferative - microaneurysm, blot haemorrhage, hard exudate, cotton wool spot formation
110
Describe the complications of diabetic retinopathy
Retinal detachment Vitreous haemorrhage Optic neuropathy
111
Describe the management of diabetic retinopathy
Laser photocoagulation Anti-VEGF (e.g. ranibizumab) Vitreoretinal surgery

Finals (11 decks)

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