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Finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What would defect be if there is lesion in the optic nerve prior to the optic chiasm

A

Complete blindness in that eye

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2
Q

What is anatomy of visual nerve pathway

A

Optic nerve leaves eye going to the optic chiasm
From optic chiasm it goes to the lateral geniculate nucleus via optic tract
From lateral geniculate nucleus it goes to visual cortex via optic radiations

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3
Q

What do you get if lesion in the optic tract

A

Sided homonymous hemianopia

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4
Q

What is optic nerve function

A

Carries visual information to the brain

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5
Q

What are 3 main functions of CN 3

A

Supply the levator palpabrae to lift eyelid
Parasympathetic innervation to constrict eyelid
Control muscles of eye

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6
Q

What muscles in eye does CN 3 innervate

A

Inferior rectus
Superior rectus
Medial rectus
Inferior oblique

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7
Q

What see in CN 3 palsy

A

Dilated pupil
Eye down and out
Ptosis

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8
Q

Difference between surgical and medical third nerve palsy in terms of presentation

A

In surgical you see mydriasis before down and out palsy as parasympathic supply on outside of nerve bundle which will be seen first however in ischaemia it affects centre of bundle first so there is muscle problem before mydriasis

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9
Q

What is function of abducens nerve

A

Supplies lateral rectus

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10
Q

What get in a 6th nerve palsy

A

Eye adducted

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11
Q

What is function of trochlear nerve

A

Supplies superior oblique

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12
Q

What is presentation of 6th nerve palsy

A

Double vision horizontally on gaze towards affected side

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13
Q

Presentation of 3rd nerve palsy (vision wise)

A

Multidirectional diplopia

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14
Q

What gives pain in eye with white corneal infiltrate in a contact lens user

A

Corneal ulcer

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15
Q

Management of corneal ulcer

A

Moxifloxacin drops

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16
Q

What is in horners syndrome

A

Miosis
Ptosis
Anhidrosis
Enopthalmos

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17
Q

What is enopthalmos

A

When eye sinks into socket

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18
Q

How to determine site of lesion in horners

A

Look at where the anhidrosis is
- on face, arm and trunk= central lesion
- just on face= preganglionic cervical area lesion
- absent= post gangionic carotid area

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19
Q

Causes of central horners

A

Stroke
MS
Encephalitis

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20
Q

Causes of preganglionic horners

A

Pancoasts tumour
Thyroidectomy
Cervical rib
Trauma

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21
Q

Causes of postganglionic horners

A

Carotid artery dissection
Carotid aneurysm

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22
Q

Presentation of vitreous haemorrhage

A

Seeing floaters
Reddish hue to vision
Sudden painless loss of vision

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23
Q

What is most common cause of vitreal haemorrhage

A

Proliferative diabetic retinopathy

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24
Q

Painless loss of vision in diabetic

A

Vitreous haemorrhage

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25
Q

Fundoscopy finding in dry age related macular degeneration

A

Drusen- lipid and protein debris
Yellow spots in bruchs membrane

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26
Q

Fundoscopy finding in wet age related macular degeneration

A

Choroidal neovascularisation

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27
Q

Difference in presentation of wet and dry ARMD

A

Wet can be more acute due to leakage of serous fluid

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28
Q

Main changes in vision seen in ARMD

A

Usually unilateral
- Difficulty in dark adaptation
- Central vision affected
- Small words appearing blurry
- Straight lines appearing curvy (metamorphopsia)

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29
Q

What do cotton wool spots indicate

A

Areas of retinal infarction
AKA soft exudate

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30
Q

What are 3 types of diabetic retinopathy

A

Non-proliferative
Proliferative
Maculopathy

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31
Q

What makes a diabetic retinopathy, proliferative

A

Presence of retinal neovascularisation

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32
Q

What is diabetic maculopathy

A

Diabetic changes over macula
- hard exudates
Macula oedema

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33
Q

Management of non-proliferative retinopathy

A

Regular observation
Severe- panretinal laser photocoagulation

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34
Q

Management of maculopathy

A

If visual acuity change then intra vitreal vascular endothelial growth factor inhibitor

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35
Q

Management of proliferative retinopathy

A

Panretinal laser photocoagulation
Intravitreal VEGF inhibitors

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36
Q

Presentation of acute angle closure glaucoma

A

Severe pain
Reduced visual acuity
Red eyes
Dilated
Haloes
Non reactive
Systemically unwell- abdo pain, nausea

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37
Q

What is used to determine pressure in the ocular

A

Tonoscopy

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37
Q

What is used to visualise the angle in AACG

A

Gonioscopy- lens added to slit lamp test

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38
Q

Management of acute angle closure glaucoma

A

Initial medical treatment- combination of drops including pilocarpine, timolol and brimonidine
IV acetazolamide
Once settled can do peripheral laser iridotomy

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39
Q

What is use of pilocarpine in glaucoma

A

Parasymphamomimetic- increased outflow of fluid

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40
Q

What is use of timolol in glaucoma

A

Decreases fluid production

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41
Q

What is use of actazolamide in glaucoma

A

Reduces secretions

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42
Q

Management of blepharitis

A

Hot compress

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43
Q

What is holmes adie pupil

A

Unilateral dilated pupil in women
Slowly reactive to light and accomodation

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44
Q

What is holmes adie syndrome

A

Holmes adie pupil with contaminant absent ankle and knee reflexes

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45
Q

Risk factors for cataracts

A

Age
Smoking
Alcohol
Long term steroid use

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46
Q

Presentation of cataracts

A

Faded colour vision
Glare- bright lights become very bright
Halos around lights
Absent red reflex

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47
Q

How visualise a cataract

A

Slit lamp examination

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48
Q

Management of cataracts

A

In early stages to prevent progression improve glasses and contact lens, use brighter lights
To cure it can use surgery which replaces the lens
- only do if severe impairment, impact on life

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49
Q

Most common cause of optic neuritis and 2 other causes

A

MS
DM and syphilis also causes

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50
Q

How image optic neuritis

A

MRI of brain and orbits with gadolinium contrast

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51
Q

Management of optic neuritis

A

IM corticosteroids
MRI of brain and orbits with contrast

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52
Q

Presentation of optic neuritis

A

Pain on movement of eyes
Scotoma
Relative afferent pupillary defect
Poor discrimination of colours (red desaturation)

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53
Q

What is herpes zoster opthalmicus

A

Reactivation of herpes zoster in the area supplied by opthalmic division of the trigeminal nerve
Effectively shings of V1

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54
Q

Presentation of herpes zoster opthalmicus

A

Eruption of vesicular rash around the eyes
Rash can be on top of the nose or side of nose

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55
Q

Management of herpes zoster opthalmicus

A

Urgent opthal referral
Oral aciclovir for 10 days

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56
Q

Presentation of episcleritis

A

Acute onset red eye localised to one area
Painless
Lacrimation

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57
Q

Presentation of scleritis

A

Painful red eye
Lacrimation
Worse when move eye
Violet or blue discolouration of eye
Can get blurred vision

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58
Q

What is scleritis vs episcleritis

A

Scleritis- Full thickness inflammation of the sclera
Episcleritis- Inflammation of the episclera- a membrane which lies on the sclera

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59
Q

Causes of episcleritis and scleritis versus anterior uveitis

A

Episcleritis
- RA
- SLE
- Vasculitis

Anterior uveitis
- HLS-B27 conditions
- behcets
- sarcoid

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60
Q

Management of episcleritis and scleritis

A

Urgent opthal referral
- NSAIDS orally most commonly
- may use steroid drops if refractory

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61
Q

What is keratitis

A

Inflammation of the cornea

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62
Q

What is conjunctivitis

A

Inflammation of the conjuntiva which is a layer over the cornea

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63
Q

What are pathogenic causes of keratitis

A

Bacterial
- staphylococcus
- pseudomona
Acanthamoeba
HSV

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64
Q

What pathogen can cause keratitis in contact lens wearers

A

Pseudomonas

65
Q

How can you get acanthamoeba keratitis

A

Swimming in contaminated water

66
Q

How can keratitis present

A

Red eye
Photophobia
Pain
Feel like smt in the eye

67
Q

Management of keratitis if contact lens wearer

A

Same day opthal referral
- Stop wearing them until it clears
- Topical quinolone
- cyclopegic

68
Q

How assess keratitis in a contact lens wearer

A

Slit lamp test

69
Q

What is anterior uveitis

A

Inflammation of the iris

70
Q

What is a hypopyon

A

Presence of inflammatory cells and pus in the anterior chamber of the eye

71
Q

What are cyclopegics

A

Drugs which dilate the pupil
Antimuscarinic activty- atropine

72
Q

What is the purpose of cyclopegics

A

Dilate the pupil which relieves pain and photophobia

73
Q

Presentation of anterior uveitis

A

acute onset
ocular discomfort & pain
photophobia
blurred vision
red eye

74
Q

What is management of anterior uveitis

A

Urgent opthal referral
- cyclopegics
- steroid eye drops

75
Q

What is seen in argylle robertson pupil

A

Small constricted pupils
React to accomadation reflex BUT NOT LIGHT

76
Q

How does central retinal vein occlusion present

A

Painless loss of vision in the eye
Widespread haemorrhage present in eye

77
Q

How does papilloedema appear on fundoscopy

A

Blurring of optic disc
Paton’s lines: concentric/radial retinal lines cascading from the optic disc (see in picture)

78
Q

Causes of acute vision loss

A

Ischaemic
- TIA
- retinal artery occlusion
- retinal vein occlusion
Vitreal haemorrhage
Retinal detachment
Vitreal detachment
Migraine

79
Q

Sudden loss of vision with curtain coming down

A

Ischaemic cause

80
Q

Rfs for vitreous haemorrhage

A

DM
Anticogulants

81
Q

What cause of vision loss presents with curtain coming in, seeing spider webs and floaters

A

Retinal detachment

82
Q

What cause of sudden vision loss presents with flashing lights

A

Posterior vitreous detachment

83
Q

Causes of blepharitis

A

Seborrheic dermatitis
Staph infections

84
Q

What is a chalazion

A

A blocked oil gland which presents as a painless lump

85
Q

What is a stye

A

Infection of the root of a hair follicle or oil gland in eyelid

86
Q

Difference between a chalazion and a stye

A

Chalazion is painless and firm
Styes due to infection are painful and tender

87
Q

Viral conjunctivitis causes

A

Adenovirus most commonly
HSV
VZV

88
Q

Bacterial conjunctivitis causes

A

Staph aureus
HIB
Strep pneumoniae

89
Q

Presentation of viral conjunctivitis

A

Recent URTI
Red eyes
Clear discharge
Preauricular lymph node swelling

90
Q

Presentation of bacterial conjunctivitis

A

Eyes stuck together
Red eyes
Prurulent dishcarge

91
Q

Management of conjunctivitis

A

Viral
- reassure
- avoid sharing towels etc
- avoid contact lens

Bacterial
- watch and wait
- chloramphenicol drops if needs be

92
Q

How does corneal abrasion present

A

Reduced acuity in eye
Photophobia
Pain

93
Q

How is corneal abrasion visualised

A

Using fluorescein in slit lamp test

94
Q

Management of corneal abrasion

A

Antibiotic eye drops to cover possible bacterial superinfection

95
Q

Management of age related macular degeneration

A

Both require opthal assessment and management
Dry
- vitamin supplementation- High-dose beta-carotene and vitamins C and E alongside zinc are

Wet
- Intravitreal anti-VEGF agents

96
Q

What is seen here

A

Hypertensive retinopathy

97
Q

What is AV nipping

A

arteriole is seen crossing a venule, which results in the compression of the vein with bulging on either side of the crossing.

98
Q

What can cause an acute deterioration in dry ARMD

A

Progression to wet ARMD- get central vision impaired and demarcated red patches on the retina

99
Q

How to differentiate between central and branch retinal vein occlusion

A

In central the bleeding would be widespread, in branching it is confined to 1 area

100
Q

How does herpes keratitis present

A

Red eye
Pain
Photophobia
Crusted lesions/ulcers on face

101
Q

What is a dendritic ulcer on cornea

A

Herpes keratitis
Appears with abnormal shape as opposed to normal corneal ulcers

102
Q

What factors demonstrate orbital cellulitis

A

reduced visual acuity
proptosis
pain with eye movements
any visual problem

103
Q

What acute red eye presents with small, fixed oval pupil, ciliary flush

A

Anterior uveitis

104
Q

Presentation of retinal detachment

A

Floaters and flashing
Painless loss of vision- curtain coming across vision
RAPD

105
Q

What is management of posterior vitreous detachment

A

Conservative but requires urgent referral

106
Q

What is definition of glaucoma

A

Group of eye diseases which may damage the optic nerve due to increased intraocular pressure

107
Q

What is first line for primary open angle glaucoma

A

Laser trabeculoplasty

108
Q

Which drugs for glaucoma reduce production of aqueous fluid

A

Carbonic anhydrase inhibitors
Beta blockers
Alpha adrenergic agonists

109
Q

Which drugs for glaucoma increase outflow of fluids

A

Muscarinic agonists
Prostaglandin analogues
Alpha agonists

110
Q

Which acute cause of vision loss presents with poor colour differentiation

A

optic neuritis

111
Q

What can cause unilateral papilloedema

A

Something compressing on optic nerve in that eye like a tumour
GCA

112
Q

Presentation of open angle glaucoma

A

Reduced peripheral vision
Reduced acuity
Insidious onset

113
Q

Which glaucoma drug can increase eyelash length and increase pigmentation in the eye

A

Prostaglandin analogues

114
Q

What is entropion vs ectoprion of eyelids

A

Entropion= in curling of eyelids
Extroption= out curling

115
Q

What is miopia

A

Short sightednesss where objects close are clear but those farther away can be very blurry

116
Q

What is hyperopia

A

Long sightedness where objects close are blurry but ones far away are clear

117
Q

How test for refractive errors

A

Check visual acuity with snellen chart, then use a pin hole occluder to see if this improves the acuity. If improves then requires optician review

118
Q

What is first investigation for blurred vision

A

Test visual acuity with a snellen chart then use a pinhole occluder to check if this improves it. If so need glasses so optician review

119
Q

What is hyphema

A

Blood in the anterior chamber of the eye

120
Q

Management of hyphema

A

Strict bed rest as movement can redistribute blood

121
Q

What concerned about most in ocular trauma

A

Orbital compartment syndrome

122
Q

Presentation of orbital compartment syndrome

A

Eye pain
Proptosis
Rock hard eyelids
RAPD

123
Q

Management of orbital compartment syndrome

A

Urgent canthotomy before even imaging
Where make a slit in skin lateral to the eye

124
Q

What presents with increased cup to disc ratio

A

Open angle glaucoma

125
Q

What is important point to remember with glaucoma and intraocular pressure

A

Not all patients with glaucoma have raised IOP and vice versa

126
Q

Presentation of blepharitis

A

Bilateral most commonly
- grittiness feeling
- eyes sticky in morning
- eyelids swollen

127
Q

What are gritty eyes

A

Where feel dry and scratchy

128
Q

Management of allergic conjunctivitis

A

Topical anti histamine

129
Q

Management of herpes keratitis

A

Topical aciclovir

130
Q

What presents with a pale retina and a cherry red spot

A

Central retinal artery occlusion

131
Q

Features of central retinal artery occlusion

A

Sudden painless visual loss
RAPD
Cherry red spot on a pale background

132
Q

What is screening process for glaucoma

A

If a positive family history then should get annual screening from age 40

133
Q

If childhood squints are not corrected what does it lead to

A

Lazy eye (amblyopia)

134
Q

If when apply gentle pressure to the eye, the injected vessels move, what is the cause

A

Episcleritis

135
Q

Differentiating between uveitis and glaucoma

A

Glaucoma= dilated pupil
Uveitis= small and fixed pupil

136
Q

What is gold standard investigation for wet ARMD

A

Fluorescein angiography to visualise neovascularisation

137
Q

What pathophysiologically does a RAPD suggest

A

Problem with optic disc/nerve

138
Q

Patient who has had mydriatic drops recently presents with an acutely painful eye and reduced acuity

A

Acute angle closure glaucoma

139
Q

What is a richard gunn pupil

A

Relative afferent pupillary defect

140
Q

What is it get a red painful eye with reduced vision after a surgery on the eyes

A

Endopthalmitis

141
Q

What causes sudden onset vision loss in a quadrant with floaters

A

Retinal detatchment

142
Q

What do if acute red eye but reduced visual acuity

A

Need to refer to opthal ED as shows cornea involved if visual acuity worse

143
Q

Main side effect of panretinal laser photocoagulation

A

Decrease in night vision
Reduction in visual field

144
Q

What is amsler grid useful for testing

A

Distortion of line perception in ARMD

145
Q

Signs on examination of anterior uveitis

A

Hypophyon- inflam cells and pus in anterior chamber of eye
Miosis from constriction of ciliary muscles
Abnormally shaped pupil
Ciliary flush where redness spreads outwards from the pupil

146
Q

What is retinitis pigmentosa

A

Genetic condition resulting in degeneration of the rods in retina which are responsible for nighttime vision and peripheral vision

147
Q

Retinitis pigmentosa on fundoscopy

A

Spiculated pattern of increased pigmentation in peripheral retina

148
Q

Management of vitreal haemorrhage

A

Refer for urgent eye assessment to rule out coexistent retinal detatchment

149
Q

Management of retinal tear

A

Need to re-adhere, can do via laser or cryo therapy

150
Q

Management of retinal detachment

A

Vitrectomy- remove vitreal fluid then reinject with air or oil to push retina back

151
Q

What type of drop is brimonidine

A

Alpha 2 receptor agonist

152
Q

Definitive management of acute angle closure glaucoma

A

Peripheral laser iridotomy once medical management settles acute phase

153
Q

Rfs for AACG

A

Pupil dilation- can be from mydriatic drops
Long sighted (hypermetropia)

154
Q

Management of primary open angle glaucoma

A

Treat if IOP >24, if less than regular follow-up
1st line- Selective laser trabeculoplasty
2nd line if CI- prostaglandin eye drops like latanoprost
3rd line- beta blocker, alpha agonist or carbonic anhydrase

155
Q

If not having laser trabeculoplasty for primary open angle glaucoma, what is first line eye drop

A

prostaglandin eye drops like latanoprost

156
Q

Main side effect of cataracts surgery

A

Endopthalmitis

157
Q

Main sign on examination of cataracts

A

Loss of red reflex

158
Q

Bacterial conjunctivitis management

A

Conservative
If no improvement after 5 days then topical chloramphenicol drops

159
Q

Herpetic conjuntivitis management

A

Refer to opthalmologist
Uncomplicated- warm compress and eye drops
Complicated- topical aciclovir

Finals (29 decks)

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