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FINALS > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Cause of cherry-red spot at the macula

A

Often seen in Central retinal artery occlusion (CRAO)

suspect CRAO if there is sudden painless loss of vision

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2
Q

Sight-threatening causes of red eye

A

Acute glaucoma
Anterior uveitis
Corneal ulcer
Neonatal conjunctivitis
Trauma
Chemical injuries
Scleritis
Endophthalmitis

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3
Q

Pt presents with:

painful red eye, constricted fixed oval pupils, photophobia and decreased vision

A

Acute Uveitis

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4
Q

Conditions associated with anterior uveitis

A

Acute ant. uveitis associated with HLA B27 related conditions:

Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

Chronic anterior uveitis associated with:

Sarcoidosis
Syphilis
Lyme disease
Tuberculosis
Herpes

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5
Q

What is the “Uvea” made up of?

A

Iris
Ciliary body
Choroid

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6
Q

Management of anterior uveitis

A

Refer SAME DAY (urgent) referral to ophthal
- steroids
- Cycloplegic meds (paralyzing ciliary muscles - reducing pain associated with ciliary spasm) and mydriatic meds (dilates the pupils)
- e.g. cyclopentolate & atropine
- Immunosuppressants (DMARDS, TNF inhibitors)

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7
Q

What is a hypopyon

A

collection of white blood cells in the anterior chamber, seen as a yellowish fluid collection settled in front of the lower iris, with a fluid level

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8
Q

What is Acute Angle Closure Glaucoma

A

Glaucoma = optic nerve damage caused by a significant rise in intraocular pressure

Angle-closure refers to when the iris bulges forward and seals off the trabecular meshwork from the anterior chamber - preventing Aq. humour from being able to drain away

OPHTHAL EMERGENCY

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9
Q

What is open-angle galucoma

A

Where there is a gradual increase in resistance through the trabecular meshwork.

This makes it more difficult for aqueous humour to flow through the meshwork and exit the eye.

Therefore the pressure slowly builds within the eye and this gives a slow and chronic onset of glaucoma.

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10
Q

What is normal Intraocular pressure

A

10-21mmHg

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11
Q

What causes “cupping” of optic disc? What is an abnormal optic cup to disc ratio?

A

Raised intraocular pressure e.g. glaucoma

If the optic cup is > 0.5 size of the optic disc = abnormal

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12
Q

Risk factors for glaucoma

A

Increasing age
Family history
Black ethnic origin
Nearsightedness (myopia)

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13
Q

Clinical features of open angle glaucoma

A

Often asymptomatic, gradual onset, picked up during screening at optician
Peripheral vision affected –> tunnel vision
Halo around lights at night
Fluctuating pain/headaches
blurred vision

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14
Q

How to measure intraocular pressure

A

Tonometry (non-contact or goldman application)

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15
Q

At what introcular pressure is treatment started in open angle glaucoma

A

> =24 mmHg

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16
Q

Management of open angle glaucoma

A

Prostaglandin analogues (Latanoprost)
Topical beta-blockers (Timolol)
Carbonic anhydrase inhibitors (Dorzolamide)
Sympathomimetics (Brimonidine)

Trabeculectomy

17
Q

Medications that can precipitate closed-angle glaucoma

A

Adrenergic meds (e.g. noradrenaline)
Anticholinergic meds (e.g. oxybutynin)
TCAs (which have anticholinergic effects)

18
Q

Initial management for acute angle closure glaucoma (before ophthal review)

A

Lie pt on their back
Pilocarpine eye drops (2% for blue eyes, 4% for brown eyes)
Acetazolemide 500mg orally
Analgesia
Antiemetics

19
Q

Definitive treatment of acute angle closure glaucoma

A

Laser iridotomy (creates a hole in the iris so Aq humour can drain)

20
Q

Features of optic neuritis

A

Unilateral decrease in visual acuity over hours/days
Red desaturation
Pain worse on eye movement
RAPD
Central Scotoma

21
Q

What is a central scotoma and what causes it?

A

blind spot directly in the center of your vision (directly in your line of sight)

Caused by: disorders of the optic nerve, choroid or retina, such as macular degeneration

22
Q

5 year risk of developing multiple sclerosis after episode of optic neuritis

A

50%

23
Q

Why is orbital cellulitis a medical emergency

A

risk of cavernous sinus thrombosis and intracranial spread

24
Q

Where is affected in orbital cellulitis and periorbital cellulitis?

A

Periorbital = eyelid + skin, anterior to the orbital septum

Orbital = infection around eyeball, involving tissues behind septum

25
Q

Features differentiating orbital cellulitis from periorbital cellulitis

A

Pain on eye movement
Reduced eye movements
Changes in vision
Abnormal pupil reactions
Proptosis
Systemically unwell

CT Scan can differentiate

26
Q

Complications of orbital cellulitis

A

Orbital abscess
Extra-orbital extension of infection (rare but V bad)
Visual loss - from optic neuritis or central rential v./a. occlusion
Intracranial involeent (meningitis, abscess, thrombosis in cavenous sinuses)

27
Q

Treatment of orbital cellulitis

A

ADMIT
Prompt CT, ENT and ophthalmic opinion
AbX - cefotaxime IV + metronidazole +/- vancomycin
May need surgical drainage if very severe

28
Q

What bacterial is typical for bacterial keratitis

A

Staphlococcus aureus
Contact lens wearer: Pseudomonas aeruginosa

29
Q

What is endophthalmitis

A

purulent inflammation of the intraocular fluids (vitreous and aqueous) usually due to infection

(Tx = intravitreal abx, sometimes vitrectomy)

30
Q

New onset flashes or floaters

A

Should be urgently referred to ophthal
Could be retinal detachment

31
Q

Retinal detachment - the 4 Fs

A

Floaters
Flashers
Field loss
Failing acuity

32
Q

Papilloedema - findings on fundoscopy

A

Venous engorgement
Blurring of the optic disc margin
Elevation of the optic disc
Paton’s lines: concentrial retinal lines cascading from the optic disc

33
Q

Clinical features of vitreous haemorrhage

A

painless visual loss or haze
red hue in the vision
floaters or shadows/dark spots in the vision

34
Q

Clinical features of retinal detachment

A

Dense shadow that starts peripherally progresses toward the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss

35
Q

Clinical features of vitreous detachment

A

(May precede retinal detachment)
Flashes / Floaters - often on the temporal side of central vision

FINALS (19 decks)

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