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Med Finals - Medicine > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Define glaucoma

A

Refers to damage of the optic nerve caused by significant increased intraocular pressure.
Caused by a blockage to the drainage of aqueous humour.

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2
Q

Define open angle glaucoma

A

Gradual increase in resistance to aqueous outflow through the trabecular meshwork, leading to slow chronic onset of glaucoma

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3
Q

Define acute angle-closure glaucoma

A

The iris bulges forwards sealing off the trabecular meshwork preventing aqueous drainage, leading to continual build up of pressure creating an ophthalmological emergency

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4
Q

Risk factors for open angle glaucoma

A

Increased age
FH
Black ethnicity
Near sightedness

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5
Q

History of open angle glaucoma

A

Asymptomatic for a long time
Diagnosed on screening at optometrists
Peripheral vision loss
Tunnel vision
Fluctuating pain
Headaches
Blurred vision
Halos appearing around lights - particularly at light

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6
Q

Investigations in open angle glaucoma

A

Intraocular pressure - non-contact (puff of air), goldmann (better way)
Fundoscopy
Visual field assessment

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7
Q

Management of open angle glaucoma

A

Aims to reduce pressure
Prostaglandin eye drops - lantanoprost
Beta-blockers - timolol
Carbonic anhydrase inhibitors - dorxolamide
Sympathomimetic - brimonidine

Trabeculectomy

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8
Q

Risk factors for acute angle closure glaucoma

A

Age
Female
FH
Chinese and east Asian
Shallow anterior chamber
Noradrenalin
Oxybutynin and solifenacon
Amitriptyline

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9
Q

History of acute angle closure glaucoma

A

Appears generally unwell
Severely painful red eye
Blurred vision
HAlos around lights
Associated headache
Nausea and vomiting

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10
Q

Clinical signs of acute angle closure glaucoma

A

Red-eye
Teary
Hazy cornea
Decreased visual acuity
Dilation of pupil
Fixed pupil size
Firm eyeball

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11
Q

Management of acute angle closure glaucoma

A

Opthalmology!!
Lie on back
Pilocarpine - Causes ciliary muscle contraction and constricts pupil, causes closure to open up
Acetazolamide - reduces production of aqueous humour

Pilocarpine
Hyperossmotic agents - glycerol or mannitol
Timolol
Dorxolamide
Brimonidine

Laser iridotomy

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12
Q

Define age related macular degeneration

A

Condition causing progressive deterioration in vision, 90% of cases are dry and 10% are wet.

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13
Q

What is seen on fundoscopy of macula degeneration

A

Drusen - yellow deposits of proteins and lipids appearing between the retinal pigment and Bruch’s membrane.

Atrophy
Degeneration

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14
Q

Define wet age related macula degeneration

A

There is development of new vessels growing from the choroid layer into the retina - these leaf fluid or blood and cause oedema resulting in more rapid vision loss

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15
Q

Risk factors for macula degeneration

A

AGE!
Smoking
White or chinese
FH
Cardiovascular disease

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16
Q

History of macula degeneration

A

Gradual worsening of central visual field loss
Reduced visual acuity
Crooked or wavy appearance to straight line

Wet presents more acutely

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17
Q

Clinical signs of macula degeneration

A

Reduced acuity
Scotoma - central vision loss
Amsler grid test - assess distortion

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18
Q

Investigations in macula degeneration

A

Fundoscopy
Slit-lamp
Optical choerence tomograph
Fluorescein angiography

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19
Q

Management of dry macular degeneration

A

Lifestyle
Avoid smoking
Control blood pressure
Vitamin supplementation!

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20
Q

Management of wet macular degeneration

A

Anti-VEGF - ranibizumab, bevacizumab and pegaptanib
Injected in to the vitreous chamber

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21
Q

Define diabetic retinopathy

A

A condition where the blood vessels in the retina are damaged by prolonged exposure to high blood sugar levels.

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22
Q

Classification of diabetic retinopathy

A

Proliferative - neovascularisation, vitreous haemorrhage
Non-proliferative - mild, moderate, severe,

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23
Q

Fundoscopy in diabetic retinopathy

A

Cotton wool spots - damage to nerve fibres
Blot haemorrhages - increased vascular leakage
Hard exudates - yellow/white deposits of lipids
Microaneurysms - weak vascular walls lead to bulges - look like strings of beads
Neovascularisation - new development of blood vessels.

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24
Q

Complications of diabetic retinopathy

A

Rentinal detachment
Vitreous haemorrhage
Reeosis iridis - new blood vessel formation in the iris
Optic neuropathy
Cataracts

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25
Q

Management of diabetic retinopathy

A

Diabetic control
Laser photocoagulation
Anti-VEGF
Vitreoretinal surgery

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26
Q

Define hypertensive retinopathy

A

Damage to the small blood vessels in the retina relating to systemic hypertension - either chronic or malignant

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27
Q

Fundoscopy in hypertensive retinopathy

A

Silver wiring or cpper wiring - thick sclerosed vessels
Arteriovenous nipping - Compression of veins by arterioles
Cotton wool spots - ischaemia and infarction
Hard exudates - lipids
Retinal haemorrhages
Papilloedema

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28
Q

Classification of hypertensive retinopathy

A

Keith-Wagener classification
Stage 1 - mild narrowing
2 - focal constriction
3 - cotton wool, exudates and haemorrhages
4 - papilloedema

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29
Q

Management of hypertensive retinopathy

A

Control hypertension
Lifestyle improvement

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30
Q

Define cataracts

A

Where the lens of the eye becomes cloudy and opaque, causing reduced visual acuity

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31
Q

Risk factors for cataracts

A

Age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia

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32
Q

History of cataracts

A

Asymmetrical
Very slow reduction in vision
Progressive blurring
Change of colour vision - more brown or yellow
Starbursts apear around light

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33
Q

Management of cataracts

A

Artificial lens replacemtn

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34
Q

Define endophthalmitis

A

Rare but serious complication of cataract surgery - inflammation of the inner contents of the eye caused by infection
Intravitreal antibiotic are required but it can lead to vision loss

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35
Q

Causes of abnormal pupil shape

A

Trauma
Anterior uveitis
Acut angle closure glaucoma
Rubeosis iridis
Coloboma - congenital malformation
Tadpole pupil - spasm in migraine

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36
Q

Caused of dilated pupils

A

Third nerve palsy
Holmes-Adie syndrome
Raised intracranial pressure
Congenital
Trauma
Stimulants - cocaine
Anticholinergics

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37
Q

Causes of constricted pupil

A

Horner syndrome
Cluster headache
Argyll-Robertson pupil - neurosphilis
Opiates
Nicotine
Pilocarpine

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38
Q

Features of a third nerve palsy

A

Ptosis - drooping eyelid
Dilated non-reactive pupil
Divergent strabismus - squint
Down and out position

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39
Q

Define surgical third nerve palsy

A

Full third nerve palsy caused by compression or trauma - includes parasympathetic fibres, therefore pupil is fixed dilated

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40
Q

Causes of a surgical third nerve palsy

A

Idiopathic
Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised intracranial pressure

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41
Q

Triad in horner syndrome

A

Ptosis
Miosis
Anhidrosis

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42
Q

Define Horner syndrome

A

Damage to the sympathetic nervous system supplying the face - arise from the spinal cord, and post ganglionic nerves travel alongside internal carotid artery

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43
Q

Define Holmes Adie pupil

A

Unilateral dilated pupil that is sluggish to react to light with slow dilation following constrication.
Caused by post-ganglionic parasympathetic fibre damage

44
Q

Define argyll-robertson pupil

A

Specific finding in neurosyphilis
Constricted pupil that accommodates to distance but does not react to light

45
Q

Define blepharitis

A

Inflammation of the eyelid margins

46
Q

Presentation of blepharitis

A

Gritty
Itchy
Dry sensation in the eyes
Can lead to styes and chalazions

47
Q

Managemnt of blepharitis

A

Hot compress
Gentle cleaning
Lubricating eye drops - hypromellose, polyvinyl alcohol

48
Q

Define a stye

A

Hordeolum externum - infection of the glands of Zeis or glands of Moll - sebeacious glands and sweat glands at the base of eyelashes

49
Q

Presentation of a stye

A

Tender lump along the eyelid - may contain pus

50
Q

Management of styes

A

Hot compress
Analgesia
topical antibiotics - chloramphenicol (if associated with conjunctivitis or persistent)

51
Q

Define chalazion

A

Blockage of the Meibomian gland - typically not tender swelling in the eyelid
Analgesia - surgical drainage

52
Q

Define entropion

A

Where the eyelid turns inwards with the lashes against the eye ball - corneal damage, ulceration
Surgical intervention

53
Q

Define ectropion of the eye

A

Where the eyelid turns outward with the inner aspect of the eyelid exposed. - exposure jeratopahty
Lubricating eyedrops and surgery

54
Q

Define trichiasis

A

Inward growth of the eyelashes
Removal of eyelashes

55
Q

Define periorbital cellulitis

A

Inflammation of the eyelid and skin infrom of the orbital septum - caused by infection. Must be differentiated from obrital cellulits whicht is sight and life threatening

56
Q

Differentiate preorbital and orbital cellulitis

A

CT head
Orbital - pain on eye movement, changes in vision, abnormal pupil reactions, forward movement of the eyeball

57
Q

MAangemnet of preorbital cellulitis

A

Systemic antibiotics

58
Q

Define orbital cellulitis

A

Infection around the eyeball that involves tissues behind the orbital septum

59
Q

Managmeent of orbital cellulitis

A

Opthalmology!
IV antibiotics
Surgical drainage

60
Q

Define conjunctivitis

A

Inflammation of the conjunctiva - the thin layer of tissue covering the sclera

61
Q

History of conjunctivitis

A

Unilateral - or bilateral
Red eyes
Blood shot
Itchy or gritty sensation
Discharge from the eye

Typically
Not painful
No photophobia
Nor reduced visual acuity

62
Q

Management of conjunctivitis

A

Self resolving
Good hygiene
If bacterial - chlorampheniol and fusidic acid

If allergic - Antihistamines

63
Q

Define anterior uveitis

A

Infalmmation in the anterior part of the uvea - the iris, ciliary body and chorid (layer between the retina and scleera)

64
Q

Associations with acute anterior uveitis

A

HLAB 27
Ankylosing spondylitis
Inflammatory bowel disea
Reactive arthritis

65
Q

Associations with chronic anterior uveitis

A

Sarcoidosis
Syphilis
Lyme disease
Tuberculosis
Herpes virus

66
Q

History of anterior uveitis

A

Unilateral symptosm that start spontaneously without trauma or precipitating event
Dull aching pain
Ciliary flush
Reduced visual acuity
Floaters flashes
Sphincter muscle contraction - miosis
Photophobia
Pain on movement
Excessiv lacrimation
Abnormally shaped pupil
Hypopyon - which cells in anterior chamber seen as yellow fluid

67
Q

Management of anterior uveitis

A

Steroids
Cycloplegic-mydriatic meds -cycophentolate
DMARDS and TNF inhibitors
Laser therapy
Cryotherapy
Surgery

68
Q

Define episcleritis

A

Benign self-limiting inflammation of the episclera - outermost layer of the sclera just underneath conjunctiva

69
Q

History of episcleritis

A

Unilaterl
Pinful
Segmental redness
Foreign body sensation
Dilated episcleral vessels
Watering of eye
No discharge

70
Q

Management of episcleritis

A

Self limiting
Lubricating eye drops
Analagesia
cold compress
NSAIDs or topical steroid drops if severe

71
Q

Define scleritis

A

Inflammation of the full thickness of the sclera - can lead to necrotising scleritis or perforation

72
Q

Associations with scleritis

A

Rheumatoid arthritis
SLE
IBD
Sarcoidosis
Granulomatosis with plolyangitis

73
Q

History of scleritis

A

Acute onset
Bilateral
Severe pain
Pain on eye movement
Photophobia
Eye watering
Reduced acuity
Abnormla pupil reaction
Tenderness

74
Q

Management of scleritis

A

NSAIDs
Steroids - topical
Immunosuppression
Manage underlying condition

75
Q

Define corneal abrasions

A

Scratches or damage to the cornea

76
Q

Common causes of corneal abrasions

A

Contact lenses
Foreign bodies
Fingerneails
Eyelashes
Entropion

77
Q

History of corneal abraision

A

History of foreign body
Painful red eye
Sensation of foreign body
Watering eye
Blurring vision
Photophobia

78
Q

Investigations in corneal abrasions

A

Fluorescein stain - collects in abrasions or ulcers turning them yellow
Slit lamp - significant abrasions

78
Q

Investigations in corneal abrasions

A

Fluorescein stain - collects in abrasions or ulcers turning them yellow
Slit lamp - significant abrasions

79
Q

Management of corneal abrasions

A

Removal of foreign body
Simple analgesia
Lubricating eye drops
Antibiotic eye drops

Cyclopntolate
Chemical abrasions need irrigation

80
Q

Define herpes Keartitis

A

Inflamamtino of the cornea - normally caused by herpes, but can also be bacterial, fungal, contact lens, or exposue

81
Q

History of keratotos

A

Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced acuity

82
Q

Investigations in keratitis

A

Fluorescein stain
Slit-lamp
Swabs or scraping

83
Q

Managment of hepes keratitis

A

Aciclovir
Ganciclovie
Topical steroids
Corneal transplant

84
Q

Define subconjunctival haemorrhage

A

Common condition where one of the small blood vessels within the conjunctiva ruptures and release blood into the space between the sclera and conjunctiva
Appear after episodes of strenuous activity such as heavy coughing or weight lifting.

85
Q

Risk factors for subconjunctival haemorrhage

A

Hypertension
Bleeding disorders
Whooping cough
Medications - warfarin, DOAC, antiplatelets
NAI

86
Q

History of subconjunctival haemorrhage

A

Bright red blood underneath conjunctiva
Painless
Nost affecting vision
May be precipitating event

87
Q

Management of subconjunctival haemorrhage

A

Resolve spontaneously
Lubricaitng eye drops

88
Q

Define posterior vitreous detatchment

A

A condition where the vitreous gel comes away from the retina - vitreous body isthe gel inside the eye that maintains the structure of the eyeball and keeps the retina pressed on the chorid.

89
Q

History of posterior vitreous detachment

A

Painless
Spots of vision loss
Floaters
Flashing lights

90
Q

Management of posterior vitreous detachment

A

None necessary
Predisposes to retinal tear and detachment

91
Q

Define retinal detachment

A

Where the retina seperates from the choroid underneath - usually due to a tear that allow vitreoud fluid to get underneath
This is a sigh threatening emergency

92
Q

Risk factors for retinal detachment

A

Posterior vitreous detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
FH

93
Q

History of retinal detachment

A

Painless vision loss
Sudden shadow coming across vision
Peripheral vision loss
Blurred or distorted vision
Flashes and floaters

94
Q

Management of retinal detachment

A

Tears - create adhesion between retina and chorid with laser or cryo
Detachment - reattach
Vitrectomy - remove parts of vitreous body
Scleral bulking - silicone bulking
Pneumatic retinopexy - inject gas bubble

95
Q

Define retinal vein occlusion

A

Occlusion occurs where a thrombus forms in the retinal veins blocking drainage.

96
Q

History of retinal vein occlusion

A

Sudden painless loss of vision

97
Q

Risk factors for retinal vein occlusion

A

Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
SLE

98
Q

Fundoscopy of retinal vein occlusion

A

Flame and blot haemorrhages
Optic disc oedema
Macula oedema

99
Q

Management of retinal vein occlusion

A

Prevention of complications
Laser photocoagulation
Intravitreal sterouds
Anti-VEGF

100
Q

Define central retinal artery occlusion

A

Occlusion tot he central retinal artery which is a branch of the opthalmic artery branching off the internal carotid artery. Most commonly caused by atherosclerosis but can be giant cell arteritis.

101
Q

Risk factors for central retinal artery occlusion

A

Giant cell arteritis
Age
FH
Smoking
Alcohol
HTN
Diabetes
Poor diet
Inactivity
Obesity

102
Q

History of central retinal artery occlusion

A

Sudden painless loss of vision
Relative afferent pupillary defect

103
Q

Fundoscopy in central retinal artery occlusion

A

Pale retina
Cherry red spot

104
Q

Management of central retinal artery oclussion

A

Manage giant cell arteritis
Can attempt to dislodge thrombus - ocular massage, remove fluid
Lifestyle manage

Med Finals - Medicine (10 decks)

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