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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
Management of diabetic retinopathy
Diabetic control Laser photocoagulation Anti-VEGF Vitreoretinal surgery
26
Define hypertensive retinopathy
Damage to the small blood vessels in the retina relating to systemic hypertension - either chronic or malignant
27
Fundoscopy in hypertensive retinopathy
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
28
Classification of hypertensive retinopathy
Keith-Wagener classification Stage 1 - mild narrowing 2 - focal constriction 3 - cotton wool, exudates and haemorrhages 4 - papilloedema
29
Management of hypertensive retinopathy
Control hypertension Lifestyle improvement
30
Define cataracts
Where the lens of the eye becomes cloudy and opaque, causing reduced visual acuity
31
Risk factors for cataracts
Age Smoking Alcohol Diabetes Steroids Hypocalcaemia
32
History of cataracts
Asymmetrical Very slow reduction in vision Progressive blurring Change of colour vision - more brown or yellow Starbursts apear around light
33
Management of cataracts
Artificial lens replacemtn
34
Define endophthalmitis
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
35
Causes of abnormal pupil shape
Trauma Anterior uveitis Acut angle closure glaucoma Rubeosis iridis Coloboma - congenital malformation Tadpole pupil - spasm in migraine
36
Caused of dilated pupils
Third nerve palsy Holmes-Adie syndrome Raised intracranial pressure Congenital Trauma Stimulants - cocaine Anticholinergics
37
Causes of constricted pupil
Horner syndrome Cluster headache Argyll-Robertson pupil - neurosphilis Opiates Nicotine Pilocarpine
38
Features of a third nerve palsy
Ptosis - drooping eyelid Dilated non-reactive pupil Divergent strabismus - squint Down and out position
39
Define surgical third nerve palsy
Full third nerve palsy caused by compression or trauma - includes parasympathetic fibres, therefore pupil is fixed dilated
40
Causes of a surgical third nerve palsy
Idiopathic Tumour Trauma Cavernous sinus thrombosis Posterior communicating artery aneurysm Raised intracranial pressure
41
Triad in horner syndrome
Ptosis Miosis Anhidrosis
42
Define Horner syndrome
Damage to the sympathetic nervous system supplying the face - arise from the spinal cord, and post ganglionic nerves travel alongside internal carotid artery
43
Define Holmes Adie pupil
Unilateral dilated pupil that is sluggish to react to light with slow dilation following constrication. Caused by post-ganglionic parasympathetic fibre damage
44
Define argyll-robertson pupil
Specific finding in neurosyphilis Constricted pupil that accommodates to distance but does not react to light
45
Define blepharitis
Inflammation of the eyelid margins
46
Presentation of blepharitis
Gritty Itchy Dry sensation in the eyes Can lead to styes and chalazions
47
Managemnt of blepharitis
Hot compress Gentle cleaning Lubricating eye drops - hypromellose, polyvinyl alcohol
48
Define a stye
Hordeolum externum - infection of the glands of Zeis or glands of Moll - sebeacious glands and sweat glands at the base of eyelashes
49
Presentation of a stye
Tender lump along the eyelid - may contain pus
50
Management of styes
Hot compress Analgesia topical antibiotics - chloramphenicol (if associated with conjunctivitis or persistent)
51
Define chalazion
Blockage of the Meibomian gland - typically not tender swelling in the eyelid Analgesia - surgical drainage
52
Define entropion
Where the eyelid turns inwards with the lashes against the eye ball - corneal damage, ulceration Surgical intervention
53
Define ectropion of the eye
Where the eyelid turns outward with the inner aspect of the eyelid exposed. - exposure jeratopahty Lubricating eyedrops and surgery
54
Define trichiasis
Inward growth of the eyelashes Removal of eyelashes
55
Define periorbital cellulitis
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
Differentiate preorbital and orbital cellulitis
CT head Orbital - pain on eye movement, changes in vision, abnormal pupil reactions, forward movement of the eyeball
57
MAangemnet of preorbital cellulitis
Systemic antibiotics
58
Define orbital cellulitis
Infection around the eyeball that involves tissues behind the orbital septum
59
Managmeent of orbital cellulitis
Opthalmology! IV antibiotics Surgical drainage
60
Define conjunctivitis
Inflammation of the conjunctiva - the thin layer of tissue covering the sclera
61
History of conjunctivitis
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
Management of conjunctivitis
Self resolving Good hygiene If bacterial - chlorampheniol and fusidic acid If allergic - Antihistamines
63
Define anterior uveitis
Infalmmation in the anterior part of the uvea - the iris, ciliary body and chorid (layer between the retina and scleera)
64
Associations with acute anterior uveitis
HLAB 27 Ankylosing spondylitis Inflammatory bowel disea Reactive arthritis
65
Associations with chronic anterior uveitis
Sarcoidosis Syphilis Lyme disease Tuberculosis Herpes virus
66
History of anterior uveitis
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
Management of anterior uveitis
Steroids Cycloplegic-mydriatic meds -cycophentolate DMARDS and TNF inhibitors Laser therapy Cryotherapy Surgery
68
Define episcleritis
Benign self-limiting inflammation of the episclera - outermost layer of the sclera just underneath conjunctiva
69
History of episcleritis
Unilaterl Pinful Segmental redness Foreign body sensation Dilated episcleral vessels Watering of eye No discharge
70
Management of episcleritis
Self limiting Lubricating eye drops Analagesia cold compress NSAIDs or topical steroid drops if severe
71
Define scleritis
Inflammation of the full thickness of the sclera - can lead to necrotising scleritis or perforation
72
Associations with scleritis
Rheumatoid arthritis SLE IBD Sarcoidosis Granulomatosis with plolyangitis
73
History of scleritis
Acute onset Bilateral Severe pain Pain on eye movement Photophobia Eye watering Reduced acuity Abnormla pupil reaction Tenderness
74
Management of scleritis
NSAIDs Steroids - topical Immunosuppression Manage underlying condition
75
Define corneal abrasions
Scratches or damage to the cornea
76
Common causes of corneal abrasions
Contact lenses Foreign bodies Fingerneails Eyelashes Entropion
77
History of corneal abraision
History of foreign body Painful red eye Sensation of foreign body Watering eye Blurring vision Photophobia
78
Investigations in corneal abrasions
Fluorescein stain - collects in abrasions or ulcers turning them yellow Slit lamp - significant abrasions
78
Investigations in corneal abrasions
Fluorescein stain - collects in abrasions or ulcers turning them yellow Slit lamp - significant abrasions
79
Management of corneal abrasions
Removal of foreign body Simple analgesia Lubricating eye drops Antibiotic eye drops Cyclopntolate Chemical abrasions need irrigation
80
Define herpes Keartitis
Inflamamtino of the cornea - normally caused by herpes, but can also be bacterial, fungal, contact lens, or exposue
81
History of keratotos
Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced acuity
82
Investigations in keratitis
Fluorescein stain Slit-lamp Swabs or scraping
83
Managment of hepes keratitis
Aciclovir Ganciclovie Topical steroids Corneal transplant
84
Define subconjunctival haemorrhage
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
Risk factors for subconjunctival haemorrhage
Hypertension Bleeding disorders Whooping cough Medications - warfarin, DOAC, antiplatelets NAI
86
History of subconjunctival haemorrhage
Bright red blood underneath conjunctiva Painless Nost affecting vision May be precipitating event
87
Management of subconjunctival haemorrhage
Resolve spontaneously Lubricaitng eye drops
88
Define posterior vitreous detatchment
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
History of posterior vitreous detachment
Painless Spots of vision loss Floaters Flashing lights
90
Management of posterior vitreous detachment
None necessary Predisposes to retinal tear and detachment
91
Define retinal detachment
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
Risk factors for retinal detachment
Posterior vitreous detachment Diabetic retinopathy Trauma to the eye Retinal malignancy Older age FH
93
History of retinal detachment
Painless vision loss Sudden shadow coming across vision Peripheral vision loss Blurred or distorted vision Flashes and floaters
94
Management of retinal detachment
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
Define retinal vein occlusion
Occlusion occurs where a thrombus forms in the retinal veins blocking drainage.
96
History of retinal vein occlusion
Sudden painless loss of vision
97
Risk factors for retinal vein occlusion
Hypertension High cholesterol Diabetes Smoking Glaucoma SLE
98
Fundoscopy of retinal vein occlusion
Flame and blot haemorrhages Optic disc oedema Macula oedema
99
Management of retinal vein occlusion
Prevention of complications Laser photocoagulation Intravitreal sterouds Anti-VEGF
100
Define central retinal artery occlusion
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
Risk factors for central retinal artery occlusion
Giant cell arteritis Age FH Smoking Alcohol HTN Diabetes Poor diet Inactivity Obesity
102
History of central retinal artery occlusion
Sudden painless loss of vision Relative afferent pupillary defect
103
Fundoscopy in central retinal artery occlusion
Pale retina Cherry red spot
104
Management of central retinal artery oclussion
Manage giant cell arteritis Can attempt to dislodge thrombus - ocular massage, remove fluid Lifestyle manage

Med Finals - Medicine (10 decks)

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