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Opthalmology Flashcards

1
Q

glaucoma

A

optic neuropathy secondary to increased ocular pressure >21mmHg

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2
Q

patho of primary open angle glaucoma

A
  • Trabuecular network has increases resistance = high IOP = death to retinal ganglion
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3
Q

Ix Primary open angle glaucoma

A
  • slit lamp = cupping
  • Goldmann applanation tonometry
  • gonioscopy = visualise angle between iris and cornea
  • visual field assessment
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4
Q

Open Angle glaucoma tx

A
  • latanoprost drops (prostaglandin analogue)= increases uveoscleral outflow )negative = increased eyelash length)
  • BB timolol = reduces aqueous production
  • Surgery = trabeculectomy
  • 360 Laser = trabeculoplasty = NICE guidance
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5
Q

acute Closed Angle Glaucoma patho

A
  • iris bulges covering trabecular meshwork = acute narrowing of anterior chamber and sudden rise in IOP as preventing drainage
  • sight threatening = emergency
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6
Q

RF open angle glaucoma

A
  • Age
  • FHx
  • Black ethnic origin
  • Myopia (nearsightedness)
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7
Q

S+S acute angle closure glaucoma

A
  • 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
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8
Q

Meds that can precipitate acute closed angle glaucoma

A
  • adrenergics = noradrenaline
  • Anticholinergics = oxybutynin
  • TCA = amitriptyline
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9
Q

tx Acute Closed Angle Glaucoma

A
  • initial = lie down
  • IV acetazolamide= reduce aqueous production
  • pilocarpine drops = constricts pupil
  • iodipine drops
  • bilateral peripheral laser iridotomy = definitive
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10
Q

presentation closed angle glaucoma

A
  • fluctuant pain
  • headaches
  • blurred vision
  • halos around lights
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11
Q

Cataracts patho

A

opacification of lens
- nuclear = old age = middle
- cortical = wedge shaped spokes
- posterior subcapsular = steroids use

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12
Q

RF cataracts

A
  • aging
  • smoking
    = alcohol
  • dm
  • steroids
  • myotonic dystrophy
  • hypercalcaemia
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13
Q

dx cataracts

A

slit lamp

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14
Q

presentation cataracts

A
  • asymmetrical
  • slow reduction acuity
  • progressive blurring
  • colours more faded
  • starbursts around lights
  • loss of red reflex
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15
Q

tx cataracts

A
  • surgery = phacoemulsification
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16
Q

risks cataracts surgery

A
  • posterior capsule opacification
  • endophthalmitis
  • posterior capsule rupture
  • retinal detachment
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17
Q

diabetic retinopathy patho

A
  • hyper causes damage to endothelium/pericytes
  • changes vascular permeability
  • exudates and microaneurysms
  • retinal ischaemia = VEGF = new leaky vessels (neovascularization)
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18
Q

Ix diabetic retinopathy

A
  • slit lamo
  • retinal photography
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19
Q

sudden complete loss of vision in diabetes

A

vitreous haemorrhage
- Minor = floaters
- Severe = painless loss vision
- will see red opacity obscuring retina
- Mx = vitrectomy

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20
Q

moderate NPDR in DNTx DN

A
  • control BP and DM
  • anti VEGF injections
  • photocoagulation
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21
Q

hypertensive retinopathy staging

A

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

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22
Q

rf age related macular degeneration

A
  • age
  • cvd
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23
Q

4 layers of macula

A
  • Choroid layer
  • Bruchs membrane
  • Retinal pigment epithelium
  • Photoreceptors
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24
Q

S+S MD

A
  • 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
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25
Ix MD
- fluorescien angiography - photography - Optical coherence tomography - slit lamp
26
Mx dry MD
- conservative drusen = dry
27
Is wet MD neovascular or not
- Neovascular - new vessels develop from choroid layer and grow into retina = leak and cause oedema
28
MD wet treatment
- anti VEGF, steroids - wet = neovascularisation
29
retinal detatchment S+S
- flashes and floaters - decreased acuity and peripheral vision - curtain - distorted images = emergency - most common = rhegmatogenous
30
patho RD
- holes and tears in neurosensory layer retina - fluid separates sensory retina from RPE
31
Mx RD
- tilt head - laser photocoagulation - surgery = vitrectomy and gas/oil tamponade/scleral buckle with cryotherapy to secure
32
retinitis pigmentosa
- genetic - progressive retinal degeneration - tunnel vision and reduced visual acuity - fundoscopy = peripheral bone spicule pigmentation, optic disc pallor, vessel attenutation
33
S+S conjunctivitis
- itchy - sticky - uncomfortable red - weepy
34
conjunctivitis causes
- bacterial = staph, gonococcus (sexual transmission) = purulent discharge, more likely unilateral - viral = adenovirus = serous discharge, more likely bilateral
35
mx conj
- bacterial = chloramphenicol
36
dry eyes
- gritty eyes - idiopathic, RA, sjogrens - Dx = schirmer test, antibody tests, fluouroscein drops and blue light - mx = artificial tears, topical cyclosporin, punctal plugs
37
episcleritis is
benign and self limiting inflammation of episclera
38
S+S episcleritis
- red eye (localised or diffused) - watering - not painful - mild photophobia - engorged vessels
39
episcleritis patho and mx
inflammation of episclera = between sclera and conj - NSAIDs
40
differentiation in scleritis
- cotton wool application with phenylephrine drops - epi = vessels blanch
41
scleritis S+S
- severe eye pain - dull boring pain - red eye - POM - photophobia - fall in acuity - blue sclera (thin sclera)
42
scleritis general
inflammation of sclera - may lead to perforation - RA and granulomatosis common in - phenylephrine application - urgent referral, oral steroids, immunosuppression
43
Mx scleritis
- urgent refer - NSAIDs - steroids - Immunosuppress
44
anterior uveitis patho
- inflammation in anterior chamber of eye - AC infiltrated by neutrophils lymph and macro - hypopyon = fluid collection containing inflammatory cells
45
RF anterior uveitis
- seronegative spond - IBD - sarcoidosis - Behcets
46
S+S anterior uveitis
- red eye - blurred vision - painful - pus - lacrimation - miosis - ciliary flush 5 clinical signs - red eye - hypopyon = pus - flare (protein) - posterior synechiae = abnormal pupil - keratic precipitates
47
AU ix and mx
- slit lamp = red eye - urgent referral -steroids (normally topical) - pupil dialtion with cycloplegics (atropine)
48
GCA S+S
- headache - raised inflammatory markers - pale disc = anterior ischaemic optic neuropathy = arteritic (GCA) or non arteritic = insufficient blood supply, painless
49
optic neuritis
- inflammation optic nerve - MS = will respond to steroids - painful eye movements, decreased acuity, less red colours - RAPD - Ix = MRI - Mx steroids
50
RAPD
- swinging light test - normal eye = constricts - both eyes dilate = abnormal
51
central retinal artery occlusion
- Sudden painless loss in vision - RAPD - Pale retina with cherry red spot - stroke - carotid artery atherosclerosis = most common cause = CA doppler
52
central retinal vein occlusion
- sudden painless loss of vision - stormy sunset appearance
53
orbital cellulitis S+S
- severe ocular pain - POM - diplopia - visual disturbance - CT orbit = gold standard - IV Abx and surgical drainage (periorbital = no pain)
54
S+S trauma (small objects)
- severe eye pain - hyphema = blood - red eye - iris prolapse - urgent referral - XR or CT = NO MRI - numbing drops to examine = tetracaine
55
S+S opthalmic shingles
- vesicular rash around eye - neuralgia - rash on top of nose = hutchinsons sign
56
Ix and mx op shing
- clinical - fluroescein dye and UV light = dendritic ulcer - aciclovir
57
blepharitis
- inflammation - gritty sticky and red - seborrheic dermatitis - hot compress - tears
58
chalazion
- retention of cyst of meibomian gland - firm and painlesss
59
stye
- infection of glands - hot compress - abx drops if bacterial
60
down and out
3rd nerve palsy
61
4th enrve palsy
- stiff neck -
62
pointing in
6th nerve palsy
63
horners syndrome
- ptosis - miosis - anhidrosis sympathetic lesion - preganglionic = pancoast tumour - post ganglionic = carotid dissection = painful
64
fundoscopy findings diabetic retinopathy
- cotton wool spots - microaneurysms - hard exudates - blot haemorrhages - neovascularisation
65
grading diabetic retinopathy
- background = aneurysms, retinal haem, hard exudates, cotton wool - pre-proliferative = beading, multiple blot haem, IMRA - proliferative = neovascularisation and vitreous haem
66
complications diabetic retinopathy
- vision loss - retinal detatchment - vitreous haem - optic neuropathy - cataracts
67
Mx diabetic neuropathy
- non proliferative = monitor proliferative - PRP - Anti VEGF - Surgery
68
herpetic keratitis S+S, Mx
- primary = mild inflammation recurrent - painful red eye - photophobia - vessicles - watery dc and reduced acuity - fluorescein stain = dendritic corneal ulcer - mx = antivirals
69
hypertensive retinopathy findings
- cotton wool - silver wiring - hard exudates - arteriovenous nipping - papilloedema - retinal haemorrhages
70
keith wagener classification HTN ret
1 = mild narrowing arterioles 2 = focal constriction of blood vessels and av nicking 3 = cotton wool exudates and haem 4 = papilloedema
71
Bacterial keratitis
- emergency - bacterial infection cornea - contact lens use - corneal scrape - topical quinolone pseudomonas aerginosa most common

FINALS (32 decks)

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