Opthalmology Flashcards
Define glaucoma
Refers to damage of the optic nerve caused by significant increased intraocular pressure.
Caused by a blockage to the drainage of aqueous humour.
Define open angle glaucoma
Gradual increase in resistance to aqueous outflow through the trabecular meshwork, leading to slow chronic onset of glaucoma
Define acute angle-closure glaucoma
The iris bulges forwards sealing off the trabecular meshwork preventing aqueous drainage, leading to continual build up of pressure creating an ophthalmological emergency
Risk factors for open angle glaucoma
Increased age
FH
Black ethnicity
Near sightedness
History of open angle glaucoma
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
Investigations in open angle glaucoma
Intraocular pressure - non-contact (puff of air), goldmann (better way)
Fundoscopy
Visual field assessment
Management of open angle glaucoma
Aims to reduce pressure
Prostaglandin eye drops - lantanoprost
Beta-blockers - timolol
Carbonic anhydrase inhibitors - dorxolamide
Sympathomimetic - brimonidine
Trabeculectomy
Risk factors for acute angle closure glaucoma
Age
Female
FH
Chinese and east Asian
Shallow anterior chamber
Noradrenalin
Oxybutynin and solifenacon
Amitriptyline
History of acute angle closure glaucoma
Appears generally unwell
Severely painful red eye
Blurred vision
HAlos around lights
Associated headache
Nausea and vomiting
Clinical signs of acute angle closure glaucoma
Red-eye
Teary
Hazy cornea
Decreased visual acuity
Dilation of pupil
Fixed pupil size
Firm eyeball
Management of acute angle closure glaucoma
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
Define age related macular degeneration
Condition causing progressive deterioration in vision, 90% of cases are dry and 10% are wet.
What is seen on fundoscopy of macula degeneration
Drusen - yellow deposits of proteins and lipids appearing between the retinal pigment and Bruch’s membrane.
Atrophy
Degeneration
Define wet age related macula degeneration
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
Risk factors for macula degeneration
AGE!
Smoking
White or chinese
FH
Cardiovascular disease
History of macula degeneration
Gradual worsening of central visual field loss
Reduced visual acuity
Crooked or wavy appearance to straight line
Wet presents more acutely
Clinical signs of macula degeneration
Reduced acuity
Scotoma - central vision loss
Amsler grid test - assess distortion
Investigations in macula degeneration
Fundoscopy
Slit-lamp
Optical choerence tomograph
Fluorescein angiography
Management of dry macular degeneration
Lifestyle
Avoid smoking
Control blood pressure
Vitamin supplementation!
Management of wet macular degeneration
Anti-VEGF - ranibizumab, bevacizumab and pegaptanib
Injected in to the vitreous chamber
Define diabetic retinopathy
A condition where the blood vessels in the retina are damaged by prolonged exposure to high blood sugar levels.
Classification of diabetic retinopathy
Proliferative - neovascularisation, vitreous haemorrhage
Non-proliferative - mild, moderate, severe,
Fundoscopy in diabetic retinopathy
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.
Complications of diabetic retinopathy
Rentinal detachment
Vitreous haemorrhage
Reeosis iridis - new blood vessel formation in the iris
Optic neuropathy
Cataracts
Management of diabetic retinopathy
Diabetic control
Laser photocoagulation
Anti-VEGF
Vitreoretinal surgery
Define hypertensive retinopathy
Damage to the small blood vessels in the retina relating to systemic hypertension - either chronic or malignant
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
Classification of hypertensive retinopathy
Keith-Wagener classification
Stage 1 - mild narrowing
2 - focal constriction
3 - cotton wool, exudates and haemorrhages
4 - papilloedema
Management of hypertensive retinopathy
Control hypertension
Lifestyle improvement
Define cataracts
Where the lens of the eye becomes cloudy and opaque, causing reduced visual acuity
Risk factors for cataracts
Age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia
History of cataracts
Asymmetrical
Very slow reduction in vision
Progressive blurring
Change of colour vision - more brown or yellow
Starbursts apear around light
Management of cataracts
Artificial lens replacemtn
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
Causes of abnormal pupil shape
Trauma
Anterior uveitis
Acut angle closure glaucoma
Rubeosis iridis
Coloboma - congenital malformation
Tadpole pupil - spasm in migraine
Caused of dilated pupils
Third nerve palsy
Holmes-Adie syndrome
Raised intracranial pressure
Congenital
Trauma
Stimulants - cocaine
Anticholinergics
Causes of constricted pupil
Horner syndrome
Cluster headache
Argyll-Robertson pupil - neurosphilis
Opiates
Nicotine
Pilocarpine
Features of a third nerve palsy
Ptosis - drooping eyelid
Dilated non-reactive pupil
Divergent strabismus - squint
Down and out position
Define surgical third nerve palsy
Full third nerve palsy caused by compression or trauma - includes parasympathetic fibres, therefore pupil is fixed dilated
Causes of a surgical third nerve palsy
Idiopathic
Tumour
Trauma
Cavernous sinus thrombosis
Posterior communicating artery aneurysm
Raised intracranial pressure
Triad in horner syndrome
Ptosis
Miosis
Anhidrosis
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
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
Define argyll-robertson pupil
Specific finding in neurosyphilis
Constricted pupil that accommodates to distance but does not react to light
Define blepharitis
Inflammation of the eyelid margins
Presentation of blepharitis
Gritty
Itchy
Dry sensation in the eyes
Can lead to styes and chalazions
Managemnt of blepharitis
Hot compress
Gentle cleaning
Lubricating eye drops - hypromellose, polyvinyl alcohol
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
Presentation of a stye
Tender lump along the eyelid - may contain pus
Management of styes
Hot compress
Analgesia
topical antibiotics - chloramphenicol (if associated with conjunctivitis or persistent)
Define chalazion
Blockage of the Meibomian gland - typically not tender swelling in the eyelid
Analgesia - surgical drainage
Define entropion
Where the eyelid turns inwards with the lashes against the eye ball - corneal damage, ulceration
Surgical intervention
Define ectropion of the eye
Where the eyelid turns outward with the inner aspect of the eyelid exposed. - exposure jeratopahty
Lubricating eyedrops and surgery
Define trichiasis
Inward growth of the eyelashes
Removal of eyelashes
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
Differentiate preorbital and orbital cellulitis
CT head
Orbital - pain on eye movement, changes in vision, abnormal pupil reactions, forward movement of the eyeball
MAangemnet of preorbital cellulitis
Systemic antibiotics
Define orbital cellulitis
Infection around the eyeball that involves tissues behind the orbital septum
Managmeent of orbital cellulitis
Opthalmology!
IV antibiotics
Surgical drainage
Define conjunctivitis
Inflammation of the conjunctiva - the thin layer of tissue covering the sclera
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
Management of conjunctivitis
Self resolving
Good hygiene
If bacterial - chlorampheniol and fusidic acid
If allergic - Antihistamines
Define anterior uveitis
Infalmmation in the anterior part of the uvea - the iris, ciliary body and chorid (layer between the retina and scleera)
Associations with acute anterior uveitis
HLAB 27
Ankylosing spondylitis
Inflammatory bowel disea
Reactive arthritis
Associations with chronic anterior uveitis
Sarcoidosis
Syphilis
Lyme disease
Tuberculosis
Herpes virus
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
Management of anterior uveitis
Steroids
Cycloplegic-mydriatic meds -cycophentolate
DMARDS and TNF inhibitors
Laser therapy
Cryotherapy
Surgery
Define episcleritis
Benign self-limiting inflammation of the episclera - outermost layer of the sclera just underneath conjunctiva
History of episcleritis
Unilaterl
Pinful
Segmental redness
Foreign body sensation
Dilated episcleral vessels
Watering of eye
No discharge
Management of episcleritis
Self limiting
Lubricating eye drops
Analagesia
cold compress
NSAIDs or topical steroid drops if severe
Define scleritis
Inflammation of the full thickness of the sclera - can lead to necrotising scleritis or perforation
Associations with scleritis
Rheumatoid arthritis
SLE
IBD
Sarcoidosis
Granulomatosis with plolyangitis
History of scleritis
Acute onset
Bilateral
Severe pain
Pain on eye movement
Photophobia
Eye watering
Reduced acuity
Abnormla pupil reaction
Tenderness
Management of scleritis
NSAIDs
Steroids - topical
Immunosuppression
Manage underlying condition
Define corneal abrasions
Scratches or damage to the cornea
Common causes of corneal abrasions
Contact lenses
Foreign bodies
Fingerneails
Eyelashes
Entropion
History of corneal abraision
History of foreign body
Painful red eye
Sensation of foreign body
Watering eye
Blurring vision
Photophobia
Investigations in corneal abrasions
Fluorescein stain - collects in abrasions or ulcers turning them yellow
Slit lamp - significant abrasions
Investigations in corneal abrasions
Fluorescein stain - collects in abrasions or ulcers turning them yellow
Slit lamp - significant abrasions
Management of corneal abrasions
Removal of foreign body
Simple analgesia
Lubricating eye drops
Antibiotic eye drops
Cyclopntolate
Chemical abrasions need irrigation
Define herpes Keartitis
Inflamamtino of the cornea - normally caused by herpes, but can also be bacterial, fungal, contact lens, or exposue
History of keratotos
Painful red eye
Photophobia
Vesicles around the eye
Foreign body sensation
Watering eye
Reduced acuity
Investigations in keratitis
Fluorescein stain
Slit-lamp
Swabs or scraping
Managment of hepes keratitis
Aciclovir
Ganciclovie
Topical steroids
Corneal transplant
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.
Risk factors for subconjunctival haemorrhage
Hypertension
Bleeding disorders
Whooping cough
Medications - warfarin, DOAC, antiplatelets
NAI
History of subconjunctival haemorrhage
Bright red blood underneath conjunctiva
Painless
Nost affecting vision
May be precipitating event
Management of subconjunctival haemorrhage
Resolve spontaneously
Lubricaitng eye drops
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.
History of posterior vitreous detachment
Painless
Spots of vision loss
Floaters
Flashing lights
Management of posterior vitreous detachment
None necessary
Predisposes to retinal tear and detachment
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
Risk factors for retinal detachment
Posterior vitreous detachment
Diabetic retinopathy
Trauma to the eye
Retinal malignancy
Older age
FH
History of retinal detachment
Painless vision loss
Sudden shadow coming across vision
Peripheral vision loss
Blurred or distorted vision
Flashes and floaters
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
Define retinal vein occlusion
Occlusion occurs where a thrombus forms in the retinal veins blocking drainage.
History of retinal vein occlusion
Sudden painless loss of vision
Risk factors for retinal vein occlusion
Hypertension
High cholesterol
Diabetes
Smoking
Glaucoma
SLE
Fundoscopy of retinal vein occlusion
Flame and blot haemorrhages
Optic disc oedema
Macula oedema
Management of retinal vein occlusion
Prevention of complications
Laser photocoagulation
Intravitreal sterouds
Anti-VEGF
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.
Risk factors for central retinal artery occlusion
Giant cell arteritis
Age
FH
Smoking
Alcohol
HTN
Diabetes
Poor diet
Inactivity
Obesity
History of central retinal artery occlusion
Sudden painless loss of vision
Relative afferent pupillary defect
Fundoscopy in central retinal artery occlusion
Pale retina
Cherry red spot
Management of central retinal artery oclussion
Manage giant cell arteritis
Can attempt to dislodge thrombus - ocular massage, remove fluid
Lifestyle manage
