opthalmology Flashcards
painful red eye, fixed mid-dilated pupil
pain on pupillary reaction- non reactive
hx HTN, diabetes
dx?
other classic symptoms?
mx? if have asthma then mx?
Acute angle closure glaucoma
symptoms worse with mydriasis (e.g. watching TV in a dark room)
emergency- need to reduce IOP
combination of eye drops, for example:
a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
a beta-blocker (e.g. timolol, decreases aqueous humour production)
an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
intravenous acetazolamide: reduces aqueous secretions
ATHMA: LATANOPROST FIRST LINE
Definitive management:
laser peripheral iridotomy
creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle
sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
temporary vision loss that resolves in a few minutes.
cause?
dx?
Amaurosis fugax
caused by atheroembolism from the carotid arteries. This patient has persistent vision loss.
acute painless vision loss
fundoscopy would reveal a cherry-red macula and a white/pale retina.
afferent pupillary defect
Central retinal artery occlusion
patient on warfarin and has a subconjunctival haemorrhage
mx?
check INR
Subconjunctival haemorrhage could be an early and clinically important tool in detecting warfarin over anticoagulation
lady had intravitreal injection for age-related macular degeneration(AMD).
Now has a painless bloodshot left eye with bleeding under the conjunctiva.
dx?
Iatrogenic subconjunctival haemorrhage is common post intravitreal injections
optic neuritis description?
other conditions you see this in?
central scotoma
classic triad:
visual loss over hours or days, periocular pain, and dyschromatopsia, aka impaired COLOUR VISION (change in colour perception)
multiple sclerosis
side note- central scotoma with metamorphopsia is in keeping with wet age related macular degeneration
sudden painless loss of vision with image?
Retinal detachment- features of viterous detachment
side note- viterous detachment (r/f HTN, diabetes) first- floaters and flashes. this can lead to retinal detachment- progressive from the peripheral towards central vision, appearing as a veil or curtain!!
most common ocular manifestation of rheumatoid arthritis?
Keratoconjunctivitis sicca
characterised by dry, burning and gritty eyes caused by decreased tear production
26-year-old contact lens wearer
left eye, it is red, painful and has a gritty sensation.
dx?
keratitis: red eye, photophobia and gritty sensation
side note: corneal uptake of fluorescein indicates corneal ulceration
wearing contact lenses is a r/f
63-year-old man
gradual loss of vision
intraocular pressure of 25mmHg
optic disc cupping
visual loss in peripheral areas.
dx? tx
primary open-angle glaucoma
lananoprost: divert overflow
timolol: reducing aqueous production
type 1 diabetes mellitus
sudden onset loss of vision in her right eye
only thing you can see is redness in the vitreous.
vitrous haemorrhage due to Proliferative retinopathy is more common in T1DM
eye pain, photophobia
dendritic corneal ulcer.
dx? tx?
herpes simplex keratitis
topical aciclovir
Holmes-Adie pupil
unilateral in 80% of cases- dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light
dry macular degeneration. Drusen can be seen around the macula.
woke up with a watery, red eye
Episcleritis
progressive, subacute vision loss with features such as loss of central vision like difficulty seeing in dark
clinical finding of distorted line perception on Amsler grid testing
DRY!! Age-related macular degeneration
AMY LIKES DRY GIN
features of horners?
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
mydriatic drops to see eye
driving home, decreased visual acuity
dx?
acute closed angle glaucoma- secondary to mydriatic drops
another name for stye?
hordeolum externum
holmes adie syndrome?
association of Holmes-Adie pupil with absent ankle/knee reflexes
unilateral in 80% of cases
dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light
HOMER IS SO SLOW
Marcus-Gunn pupil?
Most commonly caused by damage to the optic nerve or severe retinal disease.
Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye.
bilateral sore eyelids
eyelid margins are erythematous at the margins but are not swollen. stuck together with crusts
dx?
tx?
1st line of treatment for blepharitis is hot compresses
‘lid hygiene’ - mechanical removal of the debris from lid margins
hypertension, type 2 diabetes, and previous myocardial infarction.
preproliferative diabetic retinopathy
hard exudates, cotton wool spots
side note: for proliferative- needs neovascularisation
past medical history of cytomegalovirus
2-week history of blurring of vision, sensitivity to light, floaters and redness
fundus examination, you can see a mixture of white and red retinal lesions.
dx? what other tests need to be done?
Pizza pie appearance on fundoscopy = chorioretinitis
HIV!!!
RED AND WHITE IS PIZZA AND CHORIO sounds like chirzo on pizza
bacterial conjunctivitis in pregnant women
Topical fusidic acid
STYE- HORDEOLUM EXTERNUM
31-year-old lady
red left eye
not painful
a gritty sensation
feels the need to blink to clear her vision
Discharge from that eye
dx?
Conjunctivitis
most likely to predict future eye involvement in patients with previous herpes zoster ophthalmicus?
Hutchinson’s sign : presence of rash on tip of nose.
most common cause of Argyll-Robertson pupil in the UK
diabetes
24-year-old man
left eye pain wears contact lenses
‘got something stuck in his eye’
left cornea appears hazy
pupillary reaction is normal
KERATITIS
Retinitis pigmentosa
FEATURES?
night blindness + tunnel vision
chronic unilateral conjunctivitis resistant to treatment?
Orbital lymphoma
37-year-old Arabic woman
increasing haziness over her vision with both eyes
fundoscopy which reveals a lack of the red reflex in both eyes.
Chvostek sign and Trousseau sign are both positive.
whats going on?
signs of hypocalcemia
cataracts due to hypocalcemia
Blurring of vision again years after cataract surgery ?
posterior capsule opacification
cells remaining after cataract surgery grow over the back (posterior) of the capsule
6-month-old
recurrent sticky left eye.
negative swab
been treated twice with chloramphenicol drops which did not improve symptoms.
dx?
mx?
Congenital tear (lacrimal) duct obstruction
self-resolves by 1 year of age
Anterior uveitis tx?
steroid + cycloplegic (mydriatic) drops
cataract op 4 days ago
Post-operative red eye in association with pain and visual loss
Red eye, pain and visual loss following intraocular surgery are red flags for endophthalmitis and warrant urgent ophthalmic review
which one is painful?
what medicaiton can be used to tell them apart?
scleritis
Phenylephrine 10% eye drops can be used to distinguish between episcleritis and scleritis. It blanches the redness in episcleritis but doesn’t in scleritis.
addition of fluorescein dye on the eye which is dry
outcome?
Punctate fluorescein staining of the cornea is common in patients with dry eyes
stye mx, when to give abx?
warm compress and analgesia
Topical antibiotics are only recommended for stye if associated conjunctivitis
allergic conjunctivitis.
every summer, watery eyes
Tx?
TOPICAL ANTIHISTAMINE
describe drusen in dry macular degeneration?
small accumulations of extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye
light test results for optic neuritis
swinging light test’
afferent pupillary defect
As there is a defect in the afferent nerve on the left side the pupils constrict less than normal, giving the impression of dilation.
entropian vs ectropion
orbital compartment syndrome - following eye injury after playing squash
mx?
immediate canthotomy
an assessment should be made for orbital compartment syndrome as this may require immediate decompression prior to imaging etc
Optic neuritis causes
multiple sclerosis: the commonest associated disease
diabetes
syphilis
infective conjunctivitis
bacteria vs viral
causes?
adenoviral- viral
Painless, monocular loss of vision in Marfan’s syndrome?
lens dislocation
