Opthalmology 👁 Flashcards
Which HLA protein is anterior uveitis associated with
B27
What conditions are associated with anterior uveitis
IBD
reactive arthritis
Ankylosis spondylitis
Sarcoidosis
Behçet’s disease
Symptoms of anterior uveitis
Red eye
Acute inset eye pain
Small irregular pupil
Photophobia
Blurred vision
increased lacrimation
Mx anterior uveitis
Urgent review by ophthalmology
Steroid eye drops
Symptoms of conjunctivitis
Purelent discharge
Sticky eyes
Viral = clear discharge may follow an URTI
allergic = itchy swollen eyes
Symptoms of episcleritis
Red eye
Classically not that painful
Watering photophobia
Symptoms of scleritis
Red eye
A lot more pain
Gradual decreased vision
Watering
Photophobia
Ix of episcleritis and scleritis
Phenylephrine drops
Mx of scleritis
NSAID
corticosteroids
Symptoms central retinal artery occlusion
Sudden unilateral vision loss
Painless
Characteristic finding of central retinal artery occlusion
Cherry red spot
Symptoms of central retinal vein occlusion
Sudden unilateral painless vision loss
On fundoscopy what would u see for central retinal vein occlusion
Stormy sunset
Symptoms of retinal detachment
Black curtain peripherally and moving into central vision
Flashers (photopsia) and floaters
Central vision loss painless
Symptoms of vitreous haemorrhage
Floaters / dark spots in Vision
Painless visual loss/haze
Symptoms of dry macular degeneration
Reduction in visual acuity esp for close objects
Poor night vision and dark adaptation
Flickering or flashing lights
On fundoscopy for DARMD
Drusen
Symptoms of wet macular degeneration
Sudden vision loss
Fundoscopy for WARMD
red patches
Mx for WARMD
Anti- VEGF
Symptoms of acute angle closure glaucoma
Severe ocular pain or headache
Nausea and vomiting
Decreased acuity
Fixed-dilated non reacting pupil
Red eye
Mx acute angle closure glaucoma
Eye drop combo to improve outflow
Beta blocker to decrease humour production
If acetazolamide decreased secretion
Laser iridotomy definitively
Symptoms of temporal arthritis
Headache
Jaw Claudia turn
Tender palpable temporal artery
Virtual disturbance - bad sign however
Acute onset
Ix temporal arthritis
CRP raised
Temporal artery biopsy - skip lesion
Mx temporal arthritis
High dose steroid
Describe CN3 palsy
Ptosis
Eye down and out
Pupil may be dilated
Supplies 4/6 main intrinsic eye muscles
Describe CN4 palsy
Diplopia
Subjective tilting of objects £ patient may develop a head tilt to compensate
Eye deviated up and out
Supplies superior oblique
Describe CN6 palsy
Results in defective abduction
Horizontal diplopia
Supplies lateral rectus
CN5 palsy
Afferent branch of corneal reflex
what ocular side effects can steroids have
raised intraocular pressure
glaucoma
accelerated cataract formation
risk factors for ARMD
AGE
male
smoking
family hx
cardiovascular risk factors
symptoms of ARMD
reduced visual acuity
poor vision at night
photopsia - perceived flickering of lights
glare
what is bacterial keratitis
bacterial infection of cornea
often precipitated by minor trauma, contact lens use or ocular surgery
symptoms of bacterial keratitis
pain
foreign body sensation
tearing or purulent discharge
red eye
corneal ulcer
mx bacterial keratitis
referral to ophthalmologist immediately
what is bell’s palsy
idiopathic syndrome affecting the facial nerve
what are the characteristic features of bells palsy
acute onset
unilateral
lower motor neuron facial weakness sparing extraocular muscles and muscles of mastication
Corneal Arcus
White blue or opaque ring
Differentiating scleritis from episcleritis
Scleritis will have painful ocular movement
Severity of pain
Nonblanching vessels
What is retinitis pigmentosa
INHERITED condition causing retinal degeneration
Clinical features of retinitis pigmentosa
Pts often present at a young age with tunnel vision
Also classically complain of reduced visual acuity in dim light
Fundoscopy findings for retinitis pigmentosa
Peripheral pigment deposits
Optic disc pallor
Retinal vessel attenuation
What is corneal abrasion
Defined as a defect in the corneal epithelium
What is orbital cellulitis
Infection of the structures behind the orbital septum
Risk factors for orbital cellulitis
Trauma
Surgical - ocular, adnexal or sinus
Sinus disease - ethmoid sinus is most common site of infection
Other facial infections
Symptoms of orbital cellulitis
Periocular pain and swelling
Fever
Malaise
Signs of orbital cellulitis
Erythematous, swollen and tender eyelid
Chemosis
Proptosis
Restricted eye movements +/- diplopia
Management of orbital cellulitis
Admission for IV abx and close monitoring
What is pre septal cellulitis
Infection of tissue anterior to orbital septum
Much more common than orbital cellulitis
Less severe
Risk factors for preseptal cellulitis
Trauma
Infection of adjacent facial structures
Clinical features of preseptal cellulitis
Typical patient is a child with an erythematous swollen eyelid, mild fever and erythema surrounding the orbit
Important findings that suggest pre septal rather than orbital
No proptosis
Normal eye movements
No chemosis
Normal optic nerve function
Management preseptal cellulitis
Young or systemically unwell should be admitted for IV abx
Otherwise outpatient treatment with abx
What is optic neuritis
Inflammation of the optic nerve
Mostly occurs in adult women and people who live in high latitude
Causes of optic neuritis
Demyelinating lesions (MS most common)
Autoimmune disorders
Infectious conditions
Clinical features of optic neuritis
Clinical diagnosis consists of the classic triad of
Visual loss
Periocular pain
Dyschromatopsia
Treatment of optic neuritis
First line is IV methylprednisolone
myopia
short-sightedness
stereopsis
depth perception
amblyopia
lazy eye
hypermetropia
longsightedness
what is ischaemic optic neuropathy
broad term that describes optic nerve damage due to a lack of blood supply
clinical features of ischaemic optic neuropathy
generally, patients present with sudden onset monocular vision loss and colour blindness
o/e relative afferent pupillary defect is often elicited
fundoscopy findings with ischaemic optic neuropathy
optic disc swelling in the acute phase
pale optic disc in chronic phase that suggests optic atrophy
photopsia
a flash of light or something that appears to float in the eye
clinical features of posterior vitreous detachment
patients may present complaining of photopsia and floaters
very similar presentation to retinal detachment so fundoscopy is key
investigating optic neuritis
MRI head
what is chronic open angle glaucoma
refers to optic neuropathy with the death of optic nerve fibres with or without raised intraocular pressure
risk factors for chronic open-angle glaucoma
raised IOP
hypertension
diabetes mellitus
corticosteroids
fundoscopy findings of chronic open-angle glaucoma
pale optic disc
optic disc cupping
aim of management of chronic open-angle glaucoma
primary aim of mx is to reduce IOP by reducing aqueous production or increasing uveoscleral outflow
treatment is recommended if IOP is >24 mmHg
first line mx chronic open-angle glaucoma
surgical : 360 degree selective laser trabeculoplasty (SLT)
second line mx chronic open-angle glaucoma
medical therapy when SLT is not possible
starts with prostaglandin analogues with topical beta blockers as the next step
first-line mx chronic open-angle glaucoma
surgical: 360-degree selective laser trabeculoplasty (SLT)
what visual field defect indicates glaucoma
arcuate visual field defect
what is a carotid cavernous fistula
an abnormal communication between the carotid artery and the cavernous sinus
presentation of carotid cavernous fistula
the eye is usually proptosed (protuded) with an injected conjunctiva and may be pulsatile
red eye
“whooshing noise”
visual defect when optic nerve is affected
monocular visual loss
visual defect when the optic tract is affected
contralateral homonymous hemianopia
visual defect when the optic chiasm is affected
bitemporal hemianopia
visual defect when the optic radiation is affected
contralateral homonymous hemianopia
3 most important differentials of red eye
acute angle-closure glaucoma
anterior uveitis
scleritis
definitive test for diagnosing acute angle closure glaucoma
gonioscopy
