Opthalmology Flashcards
glaucoma
optic neuropathy secondary to increased ocular pressure >21mmHg
patho of primary open angle glaucoma
- Trabuecular network has increases resistance = high IOP = death to retinal ganglion
Ix Primary open angle glaucoma
- slit lamp = cupping
- Goldmann applanation tonometry
- gonioscopy = visualise angle between iris and cornea
- visual field assessment
Open Angle glaucoma tx
- latanoprost drops (prostaglandin analogue)= increases uveoscleral outflow )negative = increased eyelash length)
- BB timolol = reduces aqueous production
- Surgery = trabeculectomy
- 360 Laser = trabeculoplasty = NICE guidance
acute Closed Angle Glaucoma patho
- iris bulges covering trabecular meshwork = acute narrowing of anterior chamber and sudden rise in IOP as preventing drainage
- sight threatening = emergency
RF open angle glaucoma
- Age
- FHx
- Black ethnic origin
- Myopia (nearsightedness)
S+S acute angle closure glaucoma
- severely painful red eye
- blurred vision
- halos around lights
- headache, N+V
- red eye, hazy cornea
- decreased acuity
- mid dilated pupil, fixed size pupil
- Hard eyeball
Meds that can precipitate acute closed angle glaucoma
- adrenergics = noradrenaline
- Anticholinergics = oxybutynin
- TCA = amitriptyline
tx Acute Closed Angle Glaucoma
- initial = lie down
- IV acetazolamide= reduce aqueous production
- pilocarpine drops = constricts pupil
- iodipine drops
- bilateral peripheral laser iridotomy = definitive
presentation closed angle glaucoma
- fluctuant pain
- headaches
- blurred vision
- halos around lights
Cataracts patho
opacification of lens
- nuclear = old age = middle
- cortical = wedge shaped spokes
- posterior subcapsular = steroids use
RF cataracts
- aging
- smoking
= alcohol - dm
- steroids
- myotonic dystrophy
- hypercalcaemia
dx cataracts
slit lamp
presentation cataracts
- asymmetrical
- slow reduction acuity
- progressive blurring
- colours more faded
- starbursts around lights
- loss of red reflex
tx cataracts
- surgery = phacoemulsification
risks cataracts surgery
- posterior capsule opacification
- endophthalmitis
- posterior capsule rupture
- retinal detachment
diabetic retinopathy patho
- hyper causes damage to endothelium/pericytes
- changes vascular permeability
- exudates and microaneurysms
- retinal ischaemia = VEGF = new leaky vessels (neovascularization)
Ix diabetic retinopathy
- slit lamo
- retinal photography
sudden complete loss of vision in diabetes
vitreous haemorrhage
- Minor = floaters
- Severe = painless loss vision
- will see red opacity obscuring retina
- Mx = vitrectomy
moderate NPDR in DNTx DN
- control BP and DM
- anti VEGF injections
- photocoagulation
hypertensive retinopathy staging
1 =mild generalized retinal arteriolar narrowing
2 = definite focal narrowing and av nipping
3 = 1 plus haemorrhages, exudates and cotton wool spots
4 = 3 plus papilloedema
rf age related macular degeneration
- age
- cvd
4 layers of macula
- Choroid layer
- Bruchs membrane
- Retinal pigment epithelium
- Photoreceptors
S+S MD
- gradual loss central vision
- reduced acuity
- metamorphosia = wavy straight lines
- struggle to read small text
- drusen = yellow deposits of proteins and lipids between RPE and bruch
- atrophy of rpe
- degeneration of photoreceptors
- scotoma
Ix MD
- fluorescien angiography
- photography
- Optical coherence tomography
- slit lamp
Mx dry MD
- conservative
drusen = dry
Is wet MD neovascular or not
- Neovascular
- new vessels develop from choroid layer and grow into retina = leak and cause oedema
MD wet treatment
- anti VEGF, steroids
- wet = neovascularisation