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Year 4 - NSS > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Uveitis
- Significance

A

Uvea significance

  1. Most vascular tissue in body
  2. Host of insults
    - Autoimmune
    - Infectious
  3. Relationship to retina
    - Supply
    - Inflammation
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2
Q

Uvea
- Structure

A

Uvea

  1. Iris
  2. Cilliary body
  3. Chorea
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3
Q

Cilliary body
- Functions
- Inflammation

A

Cilliary body
- Functions

  1. Aqueous humour production
  2. Lens control
  • Inflammation
    3. Ciclitis/ intermediate uveitis
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4
Q

Uveitis
- Causes

A

Uveitis causes

  1. Unknown
  2. Autoimmune
  3. Infectious
  4. Traumatic
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5
Q

Uveitis classifications

A

Uveitis classifications

  1. Anterior
    - Iritis
  2. Intermediate
    - Ciclitis
  3. Posterior
    - Choroiditis
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6
Q

Keratic precipitates
- Classes

A

Keratic precipitates
- Classes

  1. Granulomatous
  2. Non-granulomatous
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7
Q

Aqueous humour
- direction of currents

A

Aqueous humour
- direction of currents

  1. Convection to anterior
  2. Gravity to inferior
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8
Q

Anterior uveitis
- Symptoms

A

Anterior uveitis
- Symptoms

  1. Pain
    - dull, orbital
  2. Redness
  3. Vision
    - Blurred/reduces
  4. Flare
    - floating leukocytes
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9
Q

Anterior chamber
- how to detect cells

A

Anterior chamber
- Detecting cells

  1. Dark room
  2. Thin beam of light
    - Slit lamp
  3. Cells seen
    - Inflammatory exudate in aqueous
    - usually 99% water
  4. Beam seen (flare)
    - Proteins in aqueous
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10
Q

Anterior uveitis
- signs

A

Anterior uveitis

  1. Posterior Synechiae
  2. Circumcorneal congestion
  3. Keratic precipitates
  4. Hypopyon
    - Fibrin meniscus on lower iris
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11
Q

Intermediate uveitis
- Symptoms

A

Intermediate uveitis
- Symptoms

  1. Blurring of vision
  2. Floaters
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12
Q

Intermediate uveitis
- Signs

A

Intermediate uveitis
- Signs

  1. Cells in vitreous
  2. Snow balls
  3. Snow banking
  4. Sheathing of blood vessels
  5. Macular oedema
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13
Q

Macular oedema
Ix

A

Macular oedema ix

  1. OCT
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14
Q

Posterior uveitis
- Symptoms

A

Posterior uveitis
- Symptoms

  1. Blurring of vision
  2. Floaters
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15
Q

Posterior uveitis
- Signs

A

Posterior uveitis
- Signs

  1. Reduced acuity
  2. Light sensitivity
  3. Reduced colour vision
  4. Reduced vision in dark (nyctalopia)
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16
Q

CMV retinitis
- Significance

A

CMV retinitis
- Significance

  1. Immunosuppression
    - HIV
    - Transplant/chemo
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17
Q

Uveitis treatment
- Infectious Vs non infectious

A

Uveitis treatment
- Infectious Vs non infectious

  1. Treat both with steroid
    - Scarring and inflammation is most significant factor
  2. Treat with ABx first if infectious
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18
Q

Uveitis
- Ix

A

Uveitis
- Ix

  1. FBC U&E LFT
  2. Q Gold
    - TB
  3. Treponemal antibody
    - Syphilis
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19
Q

Anterior uveitis
- Tx

A

Anterior uveitis
- Tx

  1. Topical steroids
    - Subconjunctival steroids
  2. Cycloplegics
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20
Q

Steroid eye drops
- ADRs

A

Steroid eye drops
- ADRs

  1. Glaucoma
    - Gradual rise in pressure
    - Insidious
    - Irreversible
  2. Cataracts
    - Posteror sub-capsular
    - Breadcrumb appearance
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21
Q

Intermediate and posterior uveitis
- Tx

A

Intermediate and posterior uveitis
- Tx

  1. Periocular steroids
  2. Intravitreal steroid implants
    - Ozurdex
    +Adjuncts
  3. Pulse therapy
  4. Oral steroids
  5. Immunosuppression
    - Better ADRs than steroids
  6. Specific antimicrobial
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22
Q

Steroids
- Dangerous ADRs

A

Systemic steroids
- Dangerous ADRs

  1. Hyperglycaemia
  2. HTN
  3. Immunosuppression
  4. Osteoporosis
  5. Cushings
  6. Anxiety and irritability
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23
Q

Anterior Uveitis
- Complications

A

Anterior Uveitis
- Complications

  1. Posterior Synechiae
  2. Pupillary membrane
  3. Ocular hypertension
    - Glaucoma
  4. Hypotonia
  5. Cataract
  6. Cystoid macular oedema
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24
Q

Posterior uveitis
- Complications

A

Posterior uveitis
- Complications

  1. Retinal detachment
  2. Posterior Synechiae
  3. Scarring
  4. Glaucoma
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25
Q

High ocular pressure in uveitis
- Tx

A

High ocular pressure
- Tx

  1. Steroids
    - Take baseline level (can increase)
    - Priority is inflammation
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26
Q

Sympathetic opthalmitis
- Pathology

A

Sympathetic opthalmitis

  1. Trauma to eye
  2. Antigens to uveal pigment
  • Inflammation in contralateral eye
  • Vitiligo patches
  • Deafness
  • Meningism
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27
Q

Bony orbit
- Border names

A

Bony orbit borders

  1. Medial wall
  2. Lateral wall
  3. Floor
  4. Roof
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28
Q

Orbital foramina
- and contents

A

Orbital foramina

  1. Optic foramen
    - nerve
  2. Superior orbital fissure
    - most vessels
  3. Infra-orbital foramen
    - Infra-orbital nerve
    - Infra orbital artery
  4. Supra orbital notch
    - supra orbital nerve

5, Lacrimal groove
- Naso-lacrimal duct

  1. Lacrimal gland fossa
    - Lacrimal gland
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29
Q

Orbital bones

A

Orbital bones

  1. Roof
    - frontal
  2. Lateral wall
    - zygomatic
    - sphenoid
  3. Medial
    - lesser sphenoid
    - ethemoid
    - Lacrimal bone
    - nasal process of maxilla
  4. Floor
    - maxilla
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30
Q

Nasal duct
- Opening

A

Nasal duct opening
- Below inferior meatus

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31
Q

Orbital compartment syndrome

A

Orbital compartment syndrome
- Retrobulbar haemorrhage

  1. Proptosis
  2. Pain
  3. Blindness
  4. Ophthalmoplegia
  5. Miosis
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32
Q

Orbital septum
- Continuous with…

A

Orbital septum
- Continuous with periosteum of orbit

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33
Q

Horner’s syndrome
- Muscle

A

Horner’s syndrome
- Muscle

Superior tarsal muscle

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34
Q

Blowout fracture
- Symptoms

A

Blowout fracture
- Symptoms

  1. Pain
  2. Numbness to cheek, upper lip and gum
    - Infra-orbital nerve
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35
Q

Blowout fracture
- Pathology

A

Blowout fracture

  1. Eye breaks bones
    - medial
    - inferior
  2. Infra-orbital nerve damage
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36
Q

Stye Vs Chalazion (meimobian cyst)

A

Stye Vs Chalazion (meimobian cyst)

  1. Sebaceous
  2. Meimobian
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37
Q

Orbital Growths
- inside Vs Outside cone

A

Orbital Growths
- inside Vs Outside cone

  1. Axial proptosis
  2. Non-axial proptosis
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38
Q

Proptosis and lid-retraction
- Cause

A

Proptosis and lid-retraction
- Cause

  1. Thyroid eye disease
  2. Effects the muscles
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39
Q

Superior rectus and levator
- share…

A

Superior rectus and levator
- share…

Tendon sheath

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40
Q

Ocular muscles
- insertion

A

Ocular muscles
- insertion

  1. Rectus in front of axis
  2. Oblique behind axis
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41
Q

Sixth nerve palsy
- Anatomy

A

Sixth nerve palsy
- Anatomy

  1. Small nerve
  2. Passes over the clivus
    - Easily compressed
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42
Q

Black on the eye

A

Black on the eye

  • Choroid
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43
Q

Slit lamp
- 3D viewing

A

Slit lamp
- 3D viewing

  1. View straight ahead
  2. Light beam at an angle
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44
Q

Fundus
- Blind spot area
- No vessels area

A

Fundus

  1. Optic nerve
    - Blind spot area
  2. Fovea
    - No vessels area
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45
Q

Eye symptoms

A

Eye symptoms

  1. Foreign body sensation
  2. Photophobia
  3. Eye Pain
  4. Headache
  5. Lid irritation
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46
Q

Foreign body
- How to evert

A

Evert an eye

  1. Look down
  2. Cotton bud
  3. Pull up and over
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47
Q

Eye symptom
- Foreign body sensation

A

Eye symptom
- Foreign body sensation

  1. Foreign body
  2. Corneal abrasion
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48
Q

Eye symptoms
- Photophobia ddx

A

Photophobia

  1. Meningitis
  2. Iritis
  3. Migraine
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49
Q

Photophobia vs light sensitivity

A

Photophobia vs light sensitivity

  • Discomfort -> Photophobia
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50
Q

Eye pain
- DDX

A

Eye pain ddx

  1. Acute angle glaucoma
  2. Trauma
  3. Orbital cellulitis
  4. Scleritis
  5. Optic neuritis
  6. Corneal abrasion
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51
Q

Ophthalmology
- Headaches ddx

A

Ophthalmology
- Headaches ddx

  1. Migraine
  2. Cluster headache
    - Eye watering
  3. Trigeminal neuralgia
  4. ICP
    - VI palsy
    - Bilateral optic disc swelling (papilloedema)
    - Postural change
    - Presence on waking
    - Pulsatile tinnitus
  5. GCA
    - Temporal and tender
    - Jaw claudication
    - Scalp tenderness
    - Eye exam and markers
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52
Q

Lid irritation
Ddx

A

Lid irritation
Ddx

  1. Stye
    - Follicle/seb gland
    - Edge of eyelid and sore
    - Fusillic acid ointment
  2. Chalazion
    - Meim gland
    - Anywhere and painless
    - Warm compress
  3. Blepharitis
  4. Meimobian gland disease
  5. Eczema/skin conditions
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53
Q

Conjunctivitis
- causes and features

A

Conjunctivitis

  • Allergic
    1. Bilateral
    2. Trigger linked
    3. Itchy
  • Viral
    1. Often bilateral
    2. Coryzal symptoms
    3. Watery discharge
  • Bacterial
    1. Generally unilateral
    2. Purulent discharge
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54
Q

Visual disturbances
- Generalised blurring ddx

A

Visual disturbances
- Generalised blurring ddx

  1. Refractive errors
  2. Cataracts
  3. Medications
    - steroids
    - tetracycline
  4. Hormonal
    - pregnancy
    - period
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55
Q

Ophthalmology
- Central blurring ddx

A

Ophthalmology
- Central blurring ddx

  1. Macular diseases
    - Age related
    - Diabetic T2
  2. Drugs
    - Ethambutol
    - Hydroxychloroquine
    - Tamoxifen (deposits)
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56
Q

Ophthalmology
- Black spots, blobs, and curtains

A

Ophthalmology
- Black spots, blobs, and curtains

  1. Vitreous
  2. Retina traction and detachment
    - Flashing (immediate or ongoing)
  3. TIA
    - Transient!
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57
Q

Retina tear pathology

A

Retina tear pathology

  1. Vitreous traction
  2. Retina hole
  3. Vitreous behind retina
  4. Retina detachment
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58
Q

Double vision
- DDx

A

Double vision
-DDx

  1. Binocular
    - NMJ
    - Thyroid
  2. Monocular
    - In eye
    - Chalazion/stye/abrasion
    - Detachment
    - Vitreous
  3. Vertical or horizontal?
    - Nerves involved
    - Muscles involved? (Thyroid)
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59
Q

Ophthalmology
- Colour changes ddx

A

Ophthalmology
- Colour changes ddx

  1. Optic nerve disease
  2. Unilateral cataract
  3. Red desaturation (unilateral)
    - Optic neuritis
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60
Q

Ophthalmology
- Co-morbidities

A

Ophthalmology
- Co-morbidities

  1. Diabetes
    - Retina, CN palsy, ifct, vascular occlusion
  2. HTN
  3. Thyroid
    - retraction, lag, dry eye, neuropathy, motility
  4. Ankylosing s
    - Iritis
    - Steroid SEs
  5. Arthritis
    - RA, PA
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61
Q

Opthalmology Ix

A

Opthalmology Ix

  1. Field test
  2. OCT
  3. Blood
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62
Q

Visual tests

A

Visual tests

  1. Snellen
  2. Near visual acuity test
  3. Amsler grid
  4. Ishihara colour grid
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63
Q

Visual tests
- glasses

A

Visual tests
- glasses

  1. Best corrected vision
  2. Distance glasses/reading glasses
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64
Q

Testing eyes
- binocular/monocular

A

Testing eyes
- binocular/monocular

  1. Each eye
    - Eye occluder
  2. AND both eyes
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65
Q

Recording vision
- numerator and denominator

A

Recording vision

  1. Numerator is distance
  2. Denominator is reading
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66
Q

Eye test
- Escalating tests

A

Eye test
- Failing tests

  1. 6m, pinhole, 3m, 1m
  2. Fingers
  3. Hand movements
    - let me know when it stops
  4. Light projection
    - Top/bottom
    - Left/right
  5. Light perception
    - say yes when you see the light shining
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67
Q

Pupil exam
- 5 Stages

A

Pupil exam
- 5 Stages

STAND TO SIDE

  1. Inspection
  2. Direct light
  3. Indirect light
    - Consensual
  4. Swinging lights
  5. Accommodation
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68
Q

Pupil abnormalities

A

Pupil abnormalities

  1. Drugs
    - Opiates
    - Drops
  2. Horner’s
  3. III
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69
Q

Swinging light test

  1. Pathology
  2. Method
A

Swinging light test

  1. Pathology (Afferent pathway)
    Comparative defect L Vs R
    - Retina
    - Nerve
  2. Method
    - Swing over bridge of nose
    - 1,2,3 seconds
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70
Q

Visual field confrontation
- Peripheral method

A

Visual field confrontation
- Peripheral method

  1. Arm’s length
  2. Cover one eye
    - examiner same corresponding
  3. How many fingers
  4. Keep looking at eye
    - count fingers in field
  5. Can you see pin?
    - keep looking at my eye
  6. Keep your hand.
    - I will swap hands to use other hand
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71
Q

Visual field confrontation
- Central vision

A

Visual field confrontation
- Central vision

  1. Red pin
  2. Cover eye
  3. Start at centre
  4. Move very slowly
  5. Acknowledge blind spot
  6. Acknowledge return of pin
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72
Q

Fundoscopy
- Use

A

Fundoscopy
- Use

  1. Green on button
  2. Check position
    - examine at 0
  3. Use diffuse beam in dark
    Or smallest beam
  4. Approach patient from the side
  5. Can I rest my hand on your forehead
  6. Quick red reflex
  7. Very close to eye
    - follow blood vessels
    - reach optic disc
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73
Q

Glaucoma
- Definition

A

Glaucoma
- Definition

  1. Group of conditions
  2. Progressive optic neuropathy
  3. Optic nerve damage
  4. Visual field defects
  5. With/without pressure changes
74
Q

Glaucoma
- Definition

A

Glaucoma
- Definition

  1. Group of conditions
  2. Progressive optic neuropathy
  3. Optic nerve damage
  4. Visual field defects
  5. With/without pressure changes
75
Q

Glaucoma
- World significance

A

Glaucoma
- World significance

  1. Lead cause of Irreversible blindness
76
Q

Glaucoma
- World significance

A

Glaucoma
- World significance

  1. Lead cause of Irreversible blindness
77
Q

Glaucoma
- World significance

A

Glaucoma
- World significance

  1. Lead cause of Irreversible blindness
78
Q

Glaucoma
- World significance

A

Glaucoma
- World significance

  1. Lead cause of Irreversible blindness
79
Q

Glaucoma
- progression

A

Glaucoma
- progression

  1. Nasal step/temporal wedge
  2. Arcuate
  3. Tunnel vision
  4. Complete field loss
80
Q

Glaucoma
- presentation

A

Glaucoma
- presentation

  1. Bumping things
  2. Tripping and falling
81
Q

Glaucoma
DDx

A

Glaucoma
DDx

  1. GCA
  2. Anterior ischemic optic neuropathy
82
Q

Glaucoma
- Pathophysiology

A

Glaucoma
- Pathophysiology

  1. Blockage of aqueous drainage
  2. Poor blood supply to optic nerve
83
Q

Aqueous humour
- Function

A

Aqueous humour
- Function

  1. Nutrients to cornea
  2. Waste from cornea
84
Q

Glaucoma
- Disc signs

A

Glaucoma
- Disc signs

  1. Cup to disc ratio increase
  2. Bayonetting of blood vessels
85
Q

Glaucoma
- Types

A

Glaucoma
- Types

  1. Acute angle closure
    - primary or secondary
    - PAGG
  2. Open angle glaucoma
    - primary/secondary
    - POAG
    - NTG, PXF, PG
  3. Developmental glaucoma
    - congenital
    - reiters
  4. Secondary
    - traumatic
    - uveitic
    - steroid
86
Q

Open angle glaucoma
RFs

A

Open angle glaucoma
RFs

  1. IOP
  2. Age
  3. African descent
  4. FHx
  5. Myopia
87
Q

Angle closure glaucoma
RFs

A

Angle closure glaucoma
RFs

  1. Raised IOP
  2. Age
  3. Far East/Inuits
  4. Family history
  5. Hyperopia
88
Q

Glaucoma
- Tx principle

A

Glaucoma
-Tx principle

  1. Increase outflow
  2. Reduce inflow
89
Q

IOP
- Normal range

A

IOP
- Normal range

  1. Caucasian
    - 10-21mmHg (mean 16)
  2. Black
    - Higher
    - greater Central Corneal Thickness
90
Q

IOP
- Measurement

A

IOP
- Measurement

  1. Goldmannn Mires
    - inside of rings just touch
91
Q

IOP
- Reduction measures

A

IOP
- Reduction measures

  1. Laser
    - Trabeculoplasty
    - Cyclodiode
  2. Drops
    - Prostaglandins analogue
    - Beta blockers
    - Carbonic anhydrase inhibitors
    - Alpha 2 antagonists
  3. Surgery
    - Trabeculectomy
    (Enophthalmitis risk lifelong)
    - Bleb
92
Q

Acute closed angle glaucoma
- Ss

A

Acute closed angle glaucoma
Sx

Red eye
Pain
Blue tinged cornea

93
Q

Acute closed angle glaucoma
- Mx

A

Acute closed angle glaucoma
- Mx

  1. Stat IV Acetazolamide
  2. Laser peripheral iridotomy
94
Q

Glaucoma medication
- ADRs

A

Glaucoma medication
- ADRs

  1. Red eyes
95
Q

Poor vision
- Three questions

A

Poor vision
- Three questions

  1. Onset and consistency
  2. Distance
  3. Glasses? Recent eye test?
96
Q

Optic refection
1. Cornea
2. Lens
3. Axial length

A

Optic refection

  1. Cornea
    - 40 dioptres
  2. Lens
    - 20 dioptres
  3. Axial length
    - 23mm
97
Q

Accommodation reflex
- effect

A

Accommodation reflex
- effect

  1. Near distance light
    - not parallel like distant light
  2. Lens changes to refract light
98
Q

Refractive errors
3 types

A

Refractive errors
3 types

  1. Anomalous axial length
    - long or short sighted
    - most common
  2. Anomalous corneal power
    - eg after corneal graft/transplant
  3. Physiological? Pathological?
99
Q

Refractive errors
- Myopia

  1. Sight
  2. Pathology
  3. Management
A

Myopia

  1. Sight
    - Short sighted
  2. Pathophysiology
    - Long axial length
    (or high power cornea)
  3. Management
    - Concave lenses
100
Q

Refractive errors
- Hypermetropia

  1. Sight
  2. Pathology
  3. Management
A

Refractive errors
- Hypermetropia

  1. Sight
    - Long- sighted
  2. Pathology
    - Short axial length
    Or low powered cornea
  3. Management
    - Corrected with convex lens
101
Q

Refractive errors
- Astigmatism

  1. Sight
  2. Pathology
  3. Management
A

Refractive errors
- Astigmatism

  1. Sight
    - Two foci
    - Blurred vision
  2. Pathology
    - Two axes of curvature
    - Two foci
  3. Management
    - Spectacle undercorrection
    - Spectacle over correction
    - Refractive surgery
102
Q

Presbyopia
- Pathology
- Mx

A

Presbyopia

  • Pathology
    1. Old eye
    2. Declining amplitude of accommodation
  • Mx
    1. Reading glasses
    2. Bifocals/varifocals
103
Q

Logarithmic chart
- use

A

Logarithmic chart
- use

  1. Precise for treatments requiring a measure
    Eg. Macular degeneration
104
Q

Assessment of refraction
- examination

A

Assessment of refraction

  • Retinoscope
    (Automated or manual)
105
Q

Refraction in children
1 Squint DDx

2 Assessment

3 Mx

A

Refraction in children

  1. Squint
    - Hypermetropia?
  2. Assessment
    - Retinoscopy under cycoplegia
  3. Occlusion
    - Patch to make squinting eye develop
    - Diary for balancing eyes
  • Glasses for Hypermetropia
106
Q

Diabetic retinopathy
- RFs

A

Diabetic retinopathy
- RFs

  1. Duration of disease
  2. Glycemic control
  3. HTN
  4. Nephropathy

5.Pregnancy
6. Obesity
7. Smoking

107
Q

Diabetic retinopathy
- Pathogenesis

A

Diabetic retinopathy
- Pathogenesis

  1. Occlusion & Ischaemia

2.IRMA
- intra retinal microvascular abnormalities

  1. Cotton wool spots
  2. Irregular retinal veins
    - venous beading
  3. Lipid collection
  4. Oedema
108
Q

Diabetic retinopathy
- Leakage vs Occlusion

A

Diabetic retinopathy
- Leakage vs Occlusion

  • Leakage
    1. Loss of pericytes
  • Occlusion
    1. BM thickening
    2. Endothelial damage
    3. RBC changes & rouleaux
    4. Platelet aggregation
109
Q

Diabetic retinopathy stages

A

Diabetic retinopathy stages

  1. Background
  2. Pre proliferative
  3. Proliferative
110
Q

Background Diabetic Retinopathy

  • Features
  • Management
A

Background diabetic retinopathy

  • Features
    1. Micro aneurysm
    2. Dot and blot haemorrhages
  1. Hard exudate
  2. Cotton wool spots

Management
- Observation

111
Q

Diabetic retinopathy
- Pre-proliferative features
- Management

A

Diabetic retinopathy
- Pre-proliferative features

1.IRMA
- Intra-retinal microvascular abnormalities

  1. Venous loops
  2. Venous beading
  3. Clusters of large blot haemorrhages
  4. Multiple CW Spots

Management
- FU 4/12

112
Q

Diabetic retinopathy
- Proliferative phase

Criteria

A

Diabetic retinopathy
- Proliferative phase

  1. NVD
    - Neo-Vascularisation of the Disc
  2. > 1/3 of NVD
    - or any vitreous haemorrhage
  3. NVE (neo-vasc elsewhere)
    - >1/2 disk area
    - with vitreous or pre-retinal haemorrhage
113
Q

Proliferative Diabetic retinopathy
- Treatment

A

Proliferative Diabetic retinopathy
- Treatment

  1. Pan-Retinal-Photocoagulation (PRP)
  2. Within 2 weeks
114
Q

Diabetic maculopathy

  • Six classifications
A

Diabetic maculopathoes

  1. Focal
  2. Diffuse
  3. Ischemic
  4. Mixed
  5. CSMO
    - Clinically significant macular oedema
  6. Centrally involving
115
Q

Diabetic maculopathy
- Focal

  1. Features
  2. Treatment
A

Diabetic maculopathy
Focal

  • Features
    1 Well circumscribed areas of leakage
    2 Oedema
    3 Full/part rings of exudates
  • surrounding micro aneurysm
  • Treatment
    1 Focal laser
116
Q

Diabetic maculopathy
- Diffuse

  1. Features
  2. Treatment
A

Diabetic maculopathy
Diffuse

  • Features
    1. Diffuse retinal thickness
    2. Cystoid oedema
    3. MA
  • Treatment
    1. Grid laser
117
Q

Diabetic maculopathy
-Ischaemic

  1. Features
  2. Treatment
A

Diabetic maculopathy Ischemic

  • Features
    1. Reduced VA
    2. Normal clinically
    3. Macular ischemia on FFA
  • Management
    1. Observe
118
Q

Clinically significant macular oedema
- Definition
- Mx

A

Clinically significant macular oedema

  • Definition
    1. retinal thickening
    2. within 500 microns of fovea

Mx
1. Anti VEGF injections
2. Intra vitreal steroid implants

119
Q

Diabetes
- ocular complications

A

Diabetes
- ocular complications

  1. Retinopathy
  2. Iridopathy
  3. Unstable refraction
  4. Orbital infection
  5. Ocular ischaemic syndrome
  6. Recurrent stye
120
Q

Retinopathy treatment
1. Background
2. Pre-proliferative
3. Proliferative
- Active
- Stable
- DMO

A

Retinopathy treatment

  1. Background
    - 9-12/12 hospital FU
  2. Pre-proliferative
    - 4-6/12 FU
  3. Proliferative
    - Active
    ( PPR i 2/52)
    - Stable
    4-6/12 FU
    - DMO
    (Macular laser and PRP +- anti VEGF +- steroid implants)
121
Q

Vitreous haemorrhage

1 sx

  1. Mx
A

Vitreous haemorrhage

1 sx

  1. Mx
    - PRP same day for 2/52
    - Vitrectomy +endolaser + anti VEGF if persistent
122
Q

Rubeosis

Sx

Tx

A

Rubeosis

Sx

Tx

123
Q

Pupil reflexes

  1. APD
  2. RAPD
A

Pupil reflexes

  1. APD
    - Afferent pupillary defect
  2. RAPD
    - Relative afferent pupillary defect
    - Swinging light reflex test
124
Q

Afferent pupillary defects
- Causes

A

Afferent pupillary defects
- Causes

  1. Optic neuritis
  2. Demyelination
  3. Trauma
  4. Tumours
  5. Retinal abnormality
  6. Retinal detachment
  7. Glaucoma
  8. Artery/vein occlusion
125
Q

3rd nerve palsy
- Presentation

A

3rd nerve palsy
- Presentation

  1. Binocular diplopia
  2. Anisocoria
  3. Ptosis
  4. Compensation
    - Abnormal head posture
    - Turn to one side
126
Q

CN III Palsy
- Differentials

A

CN III Palsy
- Differentials

  1. Microvascular
    - DM
    - HTN
  2. Trauma
  3. SoL
  4. Aneurysm (PCom.Art.)
  5. ICP
  6. Horner’s
  7. Myasthenia gravis
  8. Thyroid eye
  9. Inter-nuclear ophthalmoplegia
127
Q

Papilledema

  1. S&S
  2. DDx
A

Papilledema

  • S&S
    1. Headaches
  • Worse on leaning forward
    2. N&V
    3. Visual changes and defects
  • DDx
    1. SoL
    2. Trauma
    3. Haemorrhage
    4. IIH
  • High BMI
  • COCP
  • Tetracycline
  1. Venous sinus thrombosis
    - Perform MR venogram
128
Q

Optic neuritis
- S&S
- Ix
- Tx

A

Optic neuritis

  • S&S
    0. Pain on eye movements
    1. RAPD
    2. Poor colour vision
    3. Large blind spot
  • Ix
    1. MRI
  • Tx
    1. Steroids
129
Q

Pediatric visual tests
- Charts

A

Pediatric visual tests
- Charts

  1. Sheridan Gardner Test
    - Picture cards
  2. Age-dependent
  3. Observation
    - Fixing on objects
    - Following objects
  4. Refractive errors
    - Cycloplegia
130
Q

Red Reflex
- Ix
- DDx

A

Red Reflex
- Ix
1. Opthalmoscope
- Direct/indirect white reflex

  • DDx
    1. Cataracts
  • TORCH
  • Galacktokinase
  • DM
  1. Coats disease
    - Telangiectic neo-vascular disease
  2. Retinoblastoma
  3. RoP
  4. Retinal detachment
131
Q

Squint/Strabismus

  1. Types
  2. Complications
A

Squint/Strabismus

  • Types
    0. Pseudo-squint
  1. In-turn-esotropia
  2. Out-turn-exotropia
  3. Hypo/hypertropia
  • Complications
    1. Amblyopia
    2. Refractive error
132
Q

Squint

  • Examinations
A

Squint
- Examinations

  1. Cover test
    - Cover one eye
  2. Cover-uncover test
    - Quickly moving
    - For latent squint (when shut)
133
Q

Strabismus
- DDx

A

Strabismus
- DDx

  1. Coloboma (keyhole pupil)
    - Failure of optic fissure to close
    - Nystagmus and squints
  2. Ptosis
  3. Horner’s syndrome
    - Neuroblastoma
    - Syringomyelia
    - Pheochromocytoma
134
Q

Epiphora
- Pathology
- Mx

A

Epiphora

  • Pathology
    1. Nasolacrimal duct non-canalisation
    2. Watery eye
  • Mx
    1. Self-resolving in first year
    2. Reassure and massage
  1. Syringe and probe
135
Q

LogMAR Chart
- Scoring
- Advantages

A

LogMAR Chart

  • Scoring
    1. 0.1 per line
    2. 0.02 per letter
  • Advantages
    1. Uniform reduction in size
    2. Reduced letter crowding
136
Q

Visual acuity

  1. Driving score
  2. Perfect score
A

Visual acuity

  1. Driving score
    - 0.3 LogMAR
    - 6/ Snellen
  2. Perfect score
    - 6/6
    - 0.0
137
Q

Visual acuity
- Preferential looking based tests

A

Visual acuity
Preferential looking based tests

  1. Keeler preferential looking cards
  2. Cardiff acuity cards
  3. Kay’s pictures
    - 2-4 yo
  4. LogMAR Keeler book
    - 4+ yo
    - letter based
138
Q

Testing low vision

A

Testing low vision

  1. Counting fingers (CF)
  2. Hand movements (HM)
  3. Perception of light (PL)
  4. No perception of light (NPL)
139
Q

Cover test
- Additional observations

A

Cover test
- Additional observations

  1. Compensatory head posture
  2. Lid aperture
  3. Ptsosis
  4. Pupils
140
Q

Cover test

A

Cover test

  1. Pen torch for reflections
  2. Fix on 3m target
    - non accommodation
  3. Occlude eye
141
Q

Strabismus
- measuring deviation size

A

Strabismus
- measuring deviation size

  1. Prism cover test
142
Q

Ocular motility test
- Grading

A

Ocular motility test
- Grading

1,2,3,4
- 4 if not moving past midline

143
Q

Visual development
- Fovea
- Visual cortex

A

Visual development

4-6 mo
- fovea development

7-9yo
- visual cortex plasticity ends

144
Q

Amblyopia
- Definition
- Consequence

A

Amblyopia
- Definition - ‘lazy eye’

  1. Reduction in vision in one eye
    - absence of any structural abnormality or ocular disease
  2. Cortical adaption
    - abnormal binocular environment
  • In adulthood can lead to functional blindness
145
Q

Amblyopia and strabismus
- mx

A

Amblyopia and strabismus
- mx

  1. Refractive adaption to prescription
    -18-20 weeks
  2. Patching
    - sight based dosing
  3. Surgery
    -can reccur
146
Q

Types of diplopia

A

Types of diplopia

  1. Monocular double vision
    - ghosting/blurry overlapping
  2. Horizonal binocular
  3. Vertical binocular
  4. Oblique binocular
147
Q

Occulomotor Nerve
- Branches

A

Occulomotor Nerve
- Branches

  • Superior
    1. LPS
    2. Superior rectus
  • Inferior
    1. MR. IR. IO
    2. Cilliary ganglion
148
Q

CN III Palsy
Mx

A

CN III Palsy
Mx

  1. Microvascular
    - underlying issue eg. DM
    - 6-9 mo recovery
  2. …
149
Q

CN IV Palsy
- Causes

A

CN IV Palsy

  • Causes
    1. RTC
    2. Horse riding
    3. Fall from height
  1. Congenital
    - Lax SO tendon
    - NB childhood head tilt
150
Q

CN IV Palsy
- Pres

A

CN IV Palsy
- Pres

  1. Hypertropia
  2. CHP head tilt w/chin depression
  3. Vertical diplopia
  4. Torsion
151
Q

CN VI Palsy
- Pres
-Causes

A

CN VI Palsy

  • Pres
    1. Esodeviation
  • especially distance
    2. CHP - face turned
    3. Horizontal diplopia
    4. Limited abduction

-Causes
1. Microvascular
2. ICP
3. Trauma

152
Q

Thyroid eye disease
- Mx

A

Thyroid eye disease
- Mx

  1. Euthyroid status
    - Radio
    - Medical anti-thyroid
    - Thyroidectomy
  2. Synthetic thyroid hormones
153
Q

Graves’ orbitopathy
- Pattern of myopathy

A

Graves’ orbitopathy
- Pattern of myopathy

  1. IR
  2. MR
    Others
154
Q

Ocular myasthenia gravis
- pattern

A

Ocular myasthenia gravis (OMG)

  • Pattern
    1. Precedes generalised MG
    2. Mimics any palsy
155
Q

Myasthenia gravis
- ix

A

Myasthenia gravis
- Ix

  1. Orthoptic
    - Sustained up gaze
    - Cogans lid switch
    - saccades
    - peek test
    - ice pack test
  2. General
    - AChR
    - MuSK
    - Electrodiagnostics
156
Q

Myasthenia gravis
Mx

A

Myasthenia gravis
Mx

  1. Anti cholinesterase
    - Pyridostigmine
  2. Immunosuppression
157
Q

Orbital tumours

A

Orbital tumours

  1. Optic nerve glioma
  2. Schwannoma
  3. Sarcoma
158
Q

Eye muscle surgeries

A

Eye muscle surgeries

  1. Resection
    - Strengthen action
  2. Recession
    - Weaken action
159
Q

Age-related Macular Degeneration
- Stages

A

Age-related Macular Degeneration
- Stages

  1. Early AMD
  2. Intermediate AMD
  3. Advanced Dry AMD
  4. Advanced Wet AMD
160
Q

Early AMD
- Features

A

Early AMD
- Features

  1. Medium-sized drusen
  2. Pigmentary abnormalities
161
Q

Intermediate AMD
-Features

A

Intermediate AMD
-Features

  1. > 1 Large druse/numerous medium drusen
  2. Geography atrophy
    - not extending to maular centre
162
Q

Advanced Dry AMD
-Features

A

Advanced Dry AMD
-Features

  1. Non-exudative atrophic
  2. Drusen and GA extend to the macular centre
  3. Gradual vision loss
163
Q

Advanced Wet AMD
-Featurest

A

Advanced Wet AMD
-Features

  1. Exudative/Neovascular
  2. Choroidal neovascularisation
  3. Rapid loss of vision
    - Days/weeks
164
Q

Macular degeneration
- Drusen

  1. Characteristics
  2. Types
A

Macular degeneration
- Drusen

  • Characteristics
    1. Yellow/white material
    2. Between RPE and Bruch’s membrane
  • Types
    1. Hard drussen
  • Small, hard, solid
  1. Soft drusen
    - Larger soft deposits
165
Q

AMD
- Progression

  1. Soft Drusen
  2. Pathology
A

AMD
- Progression

  1. Soft drusen lift RPE from Bruch’s membrane
  2. Hypoxia
  3. Inflammation
166
Q

Dry AMD
- Cascade of Events

A

Dry AMD
- Cascade of Events

  1. Drusen
  2. Inflammation
  3. Monocytes/macrophages
  4. VEGF
  5. Neovascularisation
    - Wet AMD
167
Q

AMD
- RPE Hyper-hypopigmentation

A

AMD
- RPE Hyper-hypopigmentation

  1. Phagocytic and metabolic insufficency
    - Post-mitotic RPE Cells
  2. Accumulation of lipfuscin
    - Age-pigment granules
  3. Damage
    - Proteins
    - Lipids
    - DNA
168
Q

Dry AMD

  • Epidemiology
  • Early Features
  • Advanced Features
A

Dry AMD

  • Epidemiology
    1. 80-90% of AMD
  • Early Features
  1. Initially no symptoms
  2. Drusen present
  • Advanced features
    3. Drusen then separate RPE from Bruch’s membrane
    4. Confluent drusen
  1. Macular degeneration
    - Gradual loss of VA
    - Loss. of contrast sensitivity
    - Abnormal dark progression
    - Mild occasional metamorphosia
  2. Geographic atrophy
    - Significant visual loss
169
Q

Dry AMD
- Features with high risk of progression

A

Dry AMD
- Features with high risk of progression

  1. Large drusen
  2. Reticular drusen
  3. Vitelliform lesions
  4. Atropy
  5. Scotomas
170
Q

Dry AMD
- Mx

A

Dry AMD
- Mx

  1. Self monitor
    - Amsler Grid (Metamorphosia)
  2. Routine sight tests
    - Community optometrist
171
Q

Wet AMD
- Prognosis

A

Wet AMD
- Prognosis

  1. Rapid visual loss in 3 months
  2. Functional blindness in 2 years
    - Untreated
  3. Monocular disease risk of binocular disease
172
Q

Wet AMD
- Pathology

A

Wet AMD
- Pathology

  1. VEGF stimulation
    - through Bruch’s membrane
  2. Fluid and blood leaks into retina
  3. Fibrous scar tissue
    - Disciform
    - Scotoma (blind spot)
  4. Central vision loss
173
Q

Wet AMD
- Anti-VEGF Agents

A

Wet AMD
- Anti-VEGF Agents

  1. Ranibizumab (Lucentis)
  2. Aflibercept (Eylea)
  3. Bevacizumab (Avastin)
  4. Brolucizumab) (Beovu)
174
Q

Wet AMD
- Fundoscopy

A

Wet AMD
- Fundoscopy

  1. Oedema
  2. Elevation of retina
  3. Cystic oedema of sensory retina
175
Q

Wet AMD
- OCT

A

Wet AMD
- OCT

  1. Fibrous scaring
  2. Sub-foveal atrophy/fibrosis
    - Secondary to scar
  3. Atrophy
    - RPE
    - Retina
  4. Cystic degeneration
    - Presence of fluid (dark space) below RPE
176
Q

Wet AMD
- Visual acuity and treatment

A

Wet AMD
- Visual acuity and treatment

  1. VA ≤ 6/96
    - If benefit expected
    - Anti-VEGF tx for nAMD only
  2. VA < 6/96
    - Refraction prior to ARMD
  3. VA > 6/12
    - Anti-VEGF tx
177
Q

Charles Bonnet Syndrome
- Features
- Epidemiology

A

Charles Bonnet Syndrome

  • Features
    1. People/animals
    2. Light patterns
  • Epidemiology
    1. 50% of ARMD
    2. Usually aware they aren’t real
178
Q

Eye exam
- Opthalmoscope

A

Eye exam
- Opthalmoscope

  1. Stabilise
  2. 15°
    - optic disc
    - macula
179
Q

Diabetic retinopathy
- R Staging

A

Diabetic retinopathy
- R Staging

R0

R1 Early disease
- Dot haemorrhage

R2 Moderate/advanced disease (Pre-proliferative)
- Blot haemorrhages
- Tortuous and beading vessel
- IRMA

R3 Proliferative

180
Q

Maculopathy
- M Staging

A

MaculopathyStaging

M0
-

M1
- Oedema
- Exudates greater/equal to half disc space

Year 4 - NSS (5 decks)

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