Opthalmology Flashcards
What is seen mainly in background DR
HMA
Dot and blot haemorrhage and microanuerysms
What is seen in pre proliferative DR
Denser HMA
Cotton wool spots
What is seen in proliferative diabetic retinopathy
HMA
Cotton wool spots and hard exudates
Neovascularisation at disk and elsewhere
What is seen in HTN retinopathy and what is the Pathophys of each
Silver / copper wiring = hardening and sclerosing of arterioeles
AV nipping - scleroses arterioles cause compression of veins
Cotton wool spots due to infarction of nerve fibres
Hard exudates due to damaged vessels leaking lipids
Papilloedema due to is he is of optic nerve
What are important complications of diabetic retinopathy
Retinal detachment
Vitreous haemorrhage
Optic neuropathy
Cataract
Staging of HTN retinopathy
Called Keith wagener classification
1- narrowing of arteiroles
2- focal constriction of blood vessels and AV nipping
3-cotton wool patches, exudates and haemorrhages similar to DM
4- Papilloedema
Risk factors for open angle glaucoma
Increasing age and family history
Black ethnic origin
Myopia
Risk factors for closed angle glaucoma
Age and family history
Females are more affected
Chinese and East Asian people
Pathophys of open angle glaucoma
Increase in resistance of aqueous humour outflow through trabecular meshwork
Presentation of open angle glaucoma
Peripheral vision loss over time
May have pain, headaches and blurred vision
Pathophysiology of close angle glaucoma
Iris bulges forward and blocks flow of aqueous humour through trabecular meshwork
Presentation of closed angle glaucoma
Acute history of severely painful red eye
Blurred vision with reduced visual acuity
Halos around lights and nausea and vomiting
Managment of closed angle glaucoma
Must have same day referral for opthalomology
Primary care- lie patient on the back without a pillow
Give pilocarpine eye drops (2% for blue eyes 4% otherwise)
Acetazolamide 500 mg oral and analgesia and anti emetic
Secondary care: combination of eye drops is pilocarpine, timolol and apraclonidine
IV acetozalomide and hyperosmotic agent like mannitol
Definitive treatment of closed angle glaucoma
Laser iridotomy
What is acetazolamide and what does it do
Carbonic anhydride inhibitor which reduces the production of aqueous humour
What is pilocarpine and what does it do
Miotic agent/muscarinic receptor antagonist which opens up outflow of aqueous humour
What do beta blockers do for eyes
Reduce aqueous humour production
What do carbonic anhydrase inhibitors do
Reduce aqueous humour production
What is brimondine and what does it do
Sympathomimetic/alpha agonist which reduces aqueous humour production and increases uveosacral outflow
What is the Pathophysiology of age related macular degeneration
What about wet ARMD
Deposition of drusen (yellow deposits of protein and lipid) between retinal pigment and Bruch membrane
Wet involves neovascularisation from choroid to retina
Risk factors for ARMD
Age, FH, white or Chinese, smoking and cardiovascular risk
What is the presentation of ARMD
Central vision loss, reduced visual acuity and crooked appearance to straight lines
What ix are used for AMRD
Snellen chart for visual acuity
Amsler grid test for straight lines
Fundoscopy to find drusen
Slit lamp bio microscopic funds examination is gold standard
Risk factors for hypocalciemia
Age
Smoking
Alcohol
Diabetes
Steroids
Hypocalciemia
Presentation of cataract
Very slow reduction and blurring of vision
Change in colour vision to colours becoming more brown and yellow
Starburst
Loss of red reflex
What conditions are associated with HLA-B27
Ankylosis spondylitis
IBD
Reactive arthritis
What is the presentation seen in Ant Uveitis
Dull aching red eye
Ciliary flush
Reduce visual acuity
Floaters and flashes
Pain on movement
Abnormally shaped pupil
Hypopyon (white level in anterior chamber
Presentation of retinal detachment
Painless loss of peripheral vision
Sudden shadow comes down across vision
Blurred or distorted
Flashes and floaters
Straight lines appeared curved
Presentation of pos vitreous haemorrhage
Painless spots of vision loss
Spider wen or curtain coming down
Presentation of vitreous haemorrhage
Painless visual loss and lowered visual acuity
Red hue I’m vision
New floaters
Risk factors for retinal detachment
Pos vitreous detachment
Diabetic retinopathy
Myopia
Causes of vitreous haemorrhage
Proliferative diabetic retinopathy
Posterior vitreous detachment
Example of prostaglandin analogue, MOA and side effects
Latanoprost
Iincreases uveosacral outflow
Hypertrichosis (long eyelashes)
Hyperpigmentation
