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special senses > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

glaucoma definition

A

optic nerve damage by increased intraocular pressure
caused by blockage in aqueous humour drainage

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2
Q

2 types of glaucoma

A

open-angle
acute angle-closure

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3
Q

chamber of eye filled with

A

vitreous humour

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4
Q

where anterior chamber

A

between cornea and iris

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5
Q

where posterior chamber

A

between lens and iris

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6
Q

between anterior and posterior chamber filled

A

aqueous humour

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7
Q

passage of aqueous humour

A

aqueous humour produced by ciliary body, supplies nutrients to cornea. flows through posterior chamber and around iris to anterior chamber. drains through trabecular meshwork to canal of schlemm at angle between cornea and iris. then enters circulation

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8
Q

intraocular pressure
- normal
- created by

A

10-21 mmHg
created by resistance to flow through trabecular meshwork

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9
Q

pathophysiology of open angle glaucoma

A

there is a gradual increase in resistance to flow through the trabecular meshwork. The pressure slowly builds within the eye.

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10
Q

patho acute angle closure glaucoma

A

the iris bulges forward and seals off the trabecular meshwork from the anterior chamber, preventing aqueous humour from draining. There is a continual build-up of pressure and an acute onset of symptoms

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11
Q

how serious acute angle closure glaucoma

A

opthalmological emergency

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12
Q

fundoscopy glaucoma

A

cupping of optic disc
optic cup in centre of optic disc….this becomes wider and deeper - cupping
cup-disk ratio >0.5 = bad

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13
Q

risk fx for open angle glaucoma

A

Increasing age
Family history
Black ethnic origin
Myopia (nearsightedness)

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14
Q

clinical fx glaucoma

A

asx - detected by routine eye test
gradual onset tunnel vision (peripheral vision affected)
fluctuating pain
headaches
dipolopia
halos around lights, worse at night

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15
Q

how measure intraocular pressure

A

non contact tonometry - puff of air at cornea and measure corneal response
goldmann applanation tonometry (gold standard) - device makes contact and applies pressure to cornea

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16
Q

diagnosis based on glaucoma

A

Goldmann applanation tonometry for the intraocular pressure
Slit lamp assessment for the cup-disk ratio and optic nerve health
Visual field assessment for peripheral vision loss
Gonioscopy to assess the angle between the iris and cornea
Central corneal thickness assessment

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17
Q

glaucoma when tx

A

> 24mmHg

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18
Q

mx options of glaucoma

A

360 degrees selective laser trabeculoplasty - improve drainage
prostaglandin analogue eye drops (latanoprost) - increase uveoscleral outflow
Beta-blockers (e.g., timolol) reduce the production of aqueous humour
Carbonic anhydrase inhibitors (e.g., dorzolamide) reduce the production of aqueous humour
Sympathomimetics (e.g., brimonidine) reduce the production of aqueous fluid and increase the uveoscleral outflow

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19
Q

surgery tx of glaucoma

A

trabeculectomy - creating a new channel from the anterior chamber through the sclera to a location under the conjunctiva, causing a bleb on the conjunctiva. From here, it is reabsorbed into the general circulation.

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20
Q

s/e of prostaglandin eye drops

A

eyelash growth, eyelid pigmentation and iris pigmentation (browning)

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21
Q

risk fx for acute angle closure glaucoma

A

Increasing age
Family history
Female (four times more likely than males)
Chinese and East Asian ethnic origin
Shallow anterior chamber

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22
Q

marked difference in risk fx of glaucoma

A

Open-angle glaucoma is more common in black people, while angle-closure glaucoma is rare in this group

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23
Q

certain meds precipitate acute angle closure glaucoma

A

Adrenergic medications (e.g., noradrenaline)
Anticholinergic medications (e.g., oxybutynin and solifenacin)
Tricyclic antidepressants (e.g., amitriptyline), which have anticholinergic effects

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24
Q

clinical fx acute angle closure glaucoma

A

Severely painful red eye
Blurred vision
Halos around lights
Associated headache, nausea and vomiting

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25
Q

examination acute angle closure glaucoma

A

Red eye
Hazy cornea
Decreased visual acuity
Mid-dilated pupil
Fixed-size pupil
Hard eyeball on gentle palpation

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26
Q

acute angle closure glaucoma mx

A

emergency admission
Lying the patient on their back without a pillow
Pilocarpine eye drops (2% for blue and 4% for brown eyes)
Acetazolamide 500 mg orally
Analgesia and an antiemetic, if required

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27
Q

MOA pilocarpine

A

muscarinic recepors in sphincter muscles in iris and causes pupil constriction (miotic agent)…ciliary muscle contraction…open up pathway for flow of aqueous humour from ciliary body and into trabecular meshwork

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28
Q

acetozolamide moa

A

carbonic anhydrase inhibitor that reduces the production of aqueous humour

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29
Q

secondary care mx of acute angle closure glaucoma

A

Pilocarpine eye drops
Acetazolamide (oral or intravenous)
Hyperosmotic agents (e.g., intravenous mannitol) increase the osmotic gradient between the blood and the eye
Timolol is a beta blocker that reduces the production of aqueous humour
Dorzolamide is a carbonic anhydrase inhibitor that reduces the production of aqueous humour
Brimonidine is a sympathomimetics that reduces aqueous humour production and increases uveoscleral outflow

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30
Q

definitive tx of acute angle closure glaucoma

A

Laser iridotomy ….allows aqueous humour to flow from posterior to anterior chamber

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31
Q

age related macular degeneration definition

A

a progressive condition affecting the macula

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32
Q

2 types of AMD

A

Wet (also called neovascular), accounting for 10% of cases
Dry (also called non-neovascular), accounting for 90% of cases

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33
Q

macula where found

A

centre of retina

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34
Q

macula role

A

high definition colour vision in central visual field

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35
Q

macula layers

A

4 layers -
Choroid layer (at the base), which contains the blood vessels that supply the macula
Bruch’s membrane
Retinal pigment epithelium
Photoreceptors (towards the surface)

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36
Q

AMD fundoscopy

A

Drusen - yellowish deposits of proteins and lipids between retinal pigment epithelium and Bruch’s membrane…frequent and larger amounts
Atrophy of the retinal pigment epithelium
Degeneration of the photoreceptors

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37
Q

pathophysiology wet AMD

A

new vessels develop (VEGF) from the choroid layer and grow into the retina (neovascularisation). These vessels can leak fluid or blood, causing oedema and faster vision loss

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38
Q

risk fx AMD

A

Older age
Smoking
Family history
Cardiovascular disease (e.g., hypertension)
Obesity
Poor diet (low in vitamins and high in fat)

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39
Q

AMD clinical fx

A

unilateral
Gradual loss of central vision and ability to read small text
Reduced visual acuity
Crooked or wavy appearance to straight lines (metamorphopsia)

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40
Q

WET AMD v DRY AMD

A

wet - more acutely within days, and progress to complete vision loss within 2-3 yrs and progress to b/l

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41
Q

glaucoma v AMD

A

Glaucoma is associated with peripheral vision loss and halos around lights. AMD is associated with central vision loss and a wavy appearance to straight lines. This helps you tell them apart in exams.

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42
Q

AMD examination

A

Reduced visual acuity using a Snellen chart
Scotoma (an enlarged central area of vision loss)
Amsler grid test can be used to assess for the distortion of straight lines seen in AMD
Drusen may be seen during fundoscopy
Slit lamp exam
Optical coherence tomography
Flurescein angiography

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43
Q

AMD mx

A

specialist opthalmological review
dry - no tx, monitor, avoid smoking and control BP, vitamin supplement
wet - anti-VEGF meds((e.g., ranibizumab, aflibercept and bevacizum) - intravitreal, once/mth

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44
Q

pathophysiology diabetic retinopathy

A

hyperglycaemia…damages retinal small vessels and endothelial cells
increased vascular permeability, leaky blood vessels, blot haemorrhages, hard exudates (lipids and proteins)
and microaneurysms and venous beading
damage to nerve fibres…cotton wool spots on retina
Intraretinal microvascular abnormalities form - dilated and tortous capillaries act as shunt between arterial and venous vessels
Neurovascularisation - release of growth factors

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45
Q

characteristic fx of diabetic retinopathy on fundoscopy

A

cotton wool spots
microaneurysms
neovascularisation
blot haemorrhages
hard exudates

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46
Q

diabetic retinopathy grading fundus

A

Background – microaneurysms, retinal haemorrhages, hard exudates and cotton wool spots
Pre-proliferative – venous beading, multiple blot haemorrhages and intraretinal microvascular abnormality (IMRA)
Proliferative – neovascularisation and vitreous haemorrhage

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47
Q

key fx of proliferative diabetic retinopathy

A

neovascularisation

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48
Q

diabetic maculopathy fx

A

Exudates within the macula
Macular oedema

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49
Q

complications diabetic retinopathy

A

Vision loss
Retinal detachment
Vitreous haemorrhage (bleeding into the vitreous humour)
Rubeosis iridis (new blood vessel formation in the iris) – this can lead to neovascular glaucoma
Optic neuropathy
Cataracts

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50
Q

diabetic retinopathy mx

A

non proliferative - diabetic control and monitor
proliferative - Pan-retinal photocoagulation - laser tx (little spots on background of fundus), anti-VEGF, vitrectomy
macular oedema - dex

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51
Q

two causes of hypertensive retinopathy

A

slowly with chronic hypertension or develop quickly in response to malignant hypertension

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52
Q

clinical fx on fundus hypertensive retinopathy

A

silver/copper wiring - walls of arterioles thinkened and sclerosed
AV nipping - compression of veins from arterioles
cotton wool spots - ischaemia of retina
hard exudates - damaged vessels leaking lipids onto retina
retinal haemorrhages - damaged vessels rupturing
papilloedema - ischaemia to optic nerve

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53
Q

classification hypertensive retinopathy

A

Keith-Wagener Classification
Stage 1: Mild narrowing of the arterioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema

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54
Q

hypertensive retinopathy mx

A

control BP
manage risk fx

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55
Q

role of lens

A

focus light on retina

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56
Q

lens location

A

held in place by suspensory ligaments attached to ciliary body

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57
Q

lens size change

A

The ciliary body contracts and relaxes to change the shape of the lens. When the ciliary body contracts, it releases tension on the suspensory ligaments, and the lens thickens. When the ciliary body relaxes, the suspensory ligaments tension, and the lens narrows.

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58
Q

how lens nourised

A

aqueous humour

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59
Q

congenital cataracts screen

A

red reflex tested during neonatal exam

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60
Q

risk fx for cataracts

A

Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia

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61
Q

cataracts defin

A

opaque eye lens…reduce visual acuity

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62
Q

presentation cataracts

A

usually asymmetrical
Slow reduction in visual acuity
Progressive blurring of the vision
Colours becoming more faded, brown or yellow
Starbursts can appear around lights, particularly at night
loss of red reflex

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63
Q

cataracts mx

A

Cataract surgery involves drilling and breaking the lens to pieces, removing the pieces and implanting an artificial lens. It can be performed as a day case under local anaesthetic

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64
Q

cataracts after tx monitor for

A

continued reduced visual acuity…
macular degeneration
diabetic retinopathy

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65
Q

endopthalmitis define

A

inflammation of inner corners of eye…usually caused by infections
rare but serious confplication of cataract surgery….lead to vision loss
tx with intravitreal abx

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66
Q

causes of abnormal pupil shape

A

trauma to sphincter muscles in iris
anterior uveitis resulting in adhesions
acute angle closure glaucoma (vertical oval)
rubeosis iridis (associated with poorly controlled DM)
coloboma (congenital malformation)
tadpole pupil (muscle spasm in part of dilator muscle or iris, also present with migraines and horners syndrome)

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67
Q

causes of mydriasis

A

Congenital
Stimulants (e.g., cocaine)
Anticholinergics (e.g., oxybutynin)
Trauma
Third nerve palsy
Holmes-Adie syndrome
Raised intracranial pressure
Acute angle-closure glaucoma

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68
Q

causes of miosis

A

Horner syndrome
Cluster headaches
Argyll-Robertson pupil (neurosyphilis)
Opiates
Nicotine
Pilocarpine

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69
Q

third nerve palsy clinical fx

A

Ptosis (drooping upper eyelid)
Dilated non-reactive pupil
Divergent strabismus (squint) in the affected eye, with a “down and out” position

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70
Q

causes of third nerve palsies

A

can be idiopathic
not affect pupil - microvascular cause as parasympathetic fibres spared…due to DM, HTN, ischaemia
if fully affected..compression of parasympathetic fibres….due to trauma, tumour, cavernous sinus thrombosis, posterior communicating artery aneurysm, raised ICP

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71
Q

oculomotor nerve pathway

A

The oculomotor nerve travels directly from the brainstem to the eye in a straight line. It travels through the cavernous sinus and close to the posterior communicating artery.

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72
Q

horners syndrome triad

A

Ptosis
Miosis
Anhidrosis (loss of sweating)

may have exopthalmus

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73
Q

patho of horners syndrome

A

by damage to the sympathetic nervous system supplying the face.

The sympathetic nerves arise from the spinal cord in the chest. These are pre-ganglionic nerves. They enter the sympathetic ganglion at the base of the neck and exit as post-ganglionic nerves. The post-ganglionic nerves travel to the head alongside the internal carotid artery.

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74
Q

location of horners syndrome and clinical fx

A

central lesions - before exit spinal cord…anhidrosis of arm, trunk and face
pre ganglionic lesions…anhidrosis of face
post ganglionic lesions…not cause anhidrosis

75
Q

cause of horners syndrome
- central lesions

A

S – Stroke
S – Multiple Sclerosis
S – Swelling (tumours)
S – Syringomyelia (cyst in the spinal cord)

76
Q

cause of horners syndrome
- pre ganglionic lesions

A

T – Tumour (Pancoast tumour)
T – Trauma
T – Thyroidectomy
T – Top rib (a cervical rib growing above the first rib and clavicle)

77
Q

causes of horners syndrome
- post ganglionic lesions

A

C – Carotid aneurysm
C – Carotid artery dissection
C – Cavernous sinus thrombosis
C – Cluster headache

78
Q

congenital horner syndrome marked characteristic

A

heterochromia

79
Q

tx of horner syndrome

A

cocaine eye drops - stops NA re uptake. causes a normal eye to dilate as noradrenalin stimulates the dilator muscles of the iris
low-dose adrenalin eye drops (0.1%) will dilate the pupil in Horner syndrome but not a normal pupil.

80
Q

holmes-adie pupil patho

A

damage to post ganglionic parasympathetic fibres

81
Q

holmes-adie pupil sx

A

Dilated
Sluggish to react to light
Responsive to accommodation (the pupils constrict well when focusing on a near object)
Slow to dilate following constriction (“tonic” pupil)

82
Q

holmes-adie syndrome

A

a Holmes-Adie pupil with absent ankle and knee reflexes.

83
Q

argyll-robertson pupil finding in

A

neurosyphilis

84
Q

argyll-robertson pupil clinical fx

A

is a constricted pupil that accommodates when focusing on a near object but does not react to light. They are often irregularly shaped

85
Q

blepharitis define

A

inflammation of eyelid margins
can be associated with dysfunction of the Meibomian glands, which are responsible for secreting meibum (oil) onto the surface of the eye

86
Q

blepharitis sx

A

a gritty, itchy, dry sensation in the eyes
can lead to styes and chalazions

87
Q

blepharitis mx

A

warm compress
gentle cleaning of eye to remove debris

88
Q

stye infection cause

A

Hordeolum externum is an infection of the glands of Zeis or glands of Moll. The glands of Moll are sweat glands at the base of the eyelashes. The glands of Zeis are sebaceous glands at the base of the eyelashes.
Hordeolum internum is infection of the Meibomian glands. They are deeper, tend to be more painful and may point inwards towards the eyeball underneath the eyelid.

89
Q

stye sx

A

tender red lump along eyelid may contain pus

90
Q

stye tx

A

hot compresses and analgesia
topical abx (chloramphenicol)

91
Q

chalazion patho

A

meibomian gland blocked and swells…aka meibomian cyst

92
Q

chalazion sx

A

swelling in eyelid, not tender usually

93
Q

chalazion tx

A

warm compress and gentle message towards eyelashes to encourage drainage

94
Q

entropion what

A

eyelid turns inwards with lashes pressed against eye…pain, corneal damage, ulceration

95
Q

entropion mx

A

tape eyelid down to prevent it from turning inwards and lubricating eye drops
definitive - surgery, same day referral to opthal if sight affected

96
Q

ectropion what

A

eyelid turns outwards, exposing inner aspect. affects bottom lid usually…can result in exposure keratopathy…not enough lubrication

97
Q

ectropion mx

A

regular lubricating eye drops
may require surgery
same day opthalmology referral if risk to sight

98
Q

trichiasis what

A

inward growth of the eyelashes. It results in pain and can cause corneal damage and ulceration

99
Q

trichiasis mx

A

removing the affected eyelashes. Recurrent cases may require electrolysis, cryotherapy or laser treatment to prevent them from regrowing. A same-day referral to ophthalmology is required if there is a risk to sight.

100
Q

periorbital cellulitis what

A

an eyelid and skin infection in front of the orbital septum (in front of the eye)

101
Q

periorbital cellulitis sx

A

red hot swollen skin around eyelid and eye

102
Q

how differentiate pre orbital or orbital cellulitis

A

referred urgently to ophthalmology for assessment. A CT scan can help distinguish them.

103
Q

peri orbital cellulitis tx

A

systemic abx
consider admission as can develop orbital cellulitis if immunocompromised

104
Q

orbital cellulitis what

A

an infection around the eyeball involving the tissues behind the orbital septum

105
Q

orbital cellulitis sx

A

pain with eye movement, reduced eye movements, vision changes, abnormal pupil reactions, and proptosis (bulging forward of the eyeball).

106
Q

orbital cellulitis mx

A

requires emergency admission under ophthalmology and intravenous antibiotics. Surgical drainage may be needed if an abscess forms.

107
Q

source of infection conjunctivitis

A

bacterial
viral
allergic

108
Q

presentation conjunctivitis

A

uni/or bi
Red, bloodshot eye
Itchy or gritty sensation
Discharge
bacterial - purulent discharge, worse in morning when stuck together, highly contagious
viral - clear discharge, URTI sx, tender pre auricular LN’s
allergic - itching and watery discharge

109
Q

causes of acute painful red eye

A

Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Corneal abrasions or ulceration
Keratitis
Foreign body
Traumatic or chemical injury

110
Q

causes of acute painless red eye

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

111
Q

mx of conjunctivitis

A

1-2 weeks
hygeine
clean eyes with cooled boiled water and cotton wool
chloramphenicol or fusidic acid eye drops
<1 yr - urgent opthalmology assessment ,may be caused by gonococcal infection, can result in permanent visual loss

112
Q

allergic conjunctivits mx

A

antihistamines
topical mast cell stabilisers

113
Q

uvea consists of

A

iris, ciliary body and choroid

114
Q

choroid is layer between

A

retina and sclera

115
Q

cause of anterior uveitis

A

autoimmune
infection
trauma
ischaemia
malignancy

116
Q

anterior uveitis patho

A

inflammation in anterior chamber of eye…infiltrated by neutrophils, lymphocytes and macrophages.

117
Q

O/E anterior uveitis

A

Hypopyon refers to a fluid collection containing inflammatory cells seen at the bottom of the anterior chamber on inspection.

118
Q

anterior uveitis associations

A

Seronegative spondyloarthropathies (e.g., ankylosing spondylitis, psoriatic arthritis and reactive arthritis)
Inflammatory bowel disease
Sarcoidosis
Behçet’s disease

119
Q

anterior uveitis presentation

A

Painful red eye (typically a dull, aching pain)
Reduced visual acuity
Photophobia (due to ciliary muscle spasm)
Excessive lacrimation (tear production)

120
Q

anterior uveitis examination findings

A

Ciliary flush (a ring of red spreading from the cornea outwards)
Miosis (a constricted pupil due to sphincter muscle contraction)
Abnormally shaped pupil due to posterior synechiae (adhesions) pulling the iris into abnormal shapes
Hypopyon (inflammatory cells collected as a white fluid in the anterior chamber)

121
Q

anterior uveitis mx

A

urgent assessment by opthalmologist
1st line - steroids, cycloplegics (eg: atropine eye drops…reduce ciliary spasm)

122
Q

episcleritis define

A

benign and self-limiting inflammation of the episclera, the outermost layer of the sclera, just below the conjunctiva.

123
Q

age episcleritis

A

young and middle age adults

124
Q

episcleritis associated conditions

A

RA, IBD

125
Q

episcleritis presentation

A

acute-onset unilateral features:

Localised or diffuse redness (often a patch of redness in the lateral sclera)
No pain (or mild pain)
Dilated episcleral vessels

126
Q

sx indicating scleritis

A

photophobia
discharge
affected visual acuity

127
Q

how differentiate episcleritis and scleritis

A

phenylephrine eye drops helps differentiate between episcleritis and scleritis. It will cause blanching of the episcleral vessels, causing the redness to disappear. It will not affect scleral vessels and will not impact the redness in scleritis

128
Q

episcleritis mx

A

self limiting, resolve in 1-2 weeks
mild - no tx
sx relieved with analgesia, lubricating eye drops
severe - steroid eye drops

129
Q

scleritis define

A

inflammation of sclera

130
Q

most severe type of scleritis

A

necrotising scleritis, which can lead to perforation of the sclera

131
Q

scleritis causes

A

most idiopathic
less commonly an infection - pseudomonas or staph aureus

132
Q

scleritis associated conditions

A

RA
vasculitis - granulomatosis with polyangiitis

133
Q

scleritis presentation

A

gradual onset
Red, inflamed sclera (localised or diffuse)
Congested vessels
Severe pain (typically a boring pain)
Pain with eye movement
Photophobia
Epiphora (excessive tear production)
Reduced visual acuity
Tenderness to palpation of the eye

134
Q

scleritis mx

A

urgent referral for assessment from opthalmologist
assessed for underlying systemic condition
NSAIDS
steroids
immunosuppression
if infectious - abx

135
Q

corneal abrasions causes

A

Damaged contact lenses
Fingernails
Foreign bodies (e.g., metal fragments)
Tree branches
Makeup brushes
Entropion (inward turning eyelid)

136
Q

chemical abrasions clinical fx and mx

A

vision loss
irrigation and opthalmology input

137
Q

which infection abrasions with contact lenses

A

pseudomonas

138
Q

presentation abrasions

A

hx of trauma
Painful red eye
Photophobia
Foreign body sensation
Epiphora (excessive tear production)
Blurred vision

139
Q

inv of corneal abrasion

A

flourescein stain -yellow/orange stain and collect…viewed under cobalt blue light

140
Q

corneal abrasions mx

A

heal over 2-3 days
Management options include:

Removing foreign bodies
Simple analgesia
Lubricating eye drops
Antibiotic eye drops (e.g., chloramphenicol)
Close follow-up

Hypromellose drops are the least viscous (the effects last around 10 minutes)
Polyvinyl alcohol drops are the middle viscous choice
Carbomer drops are the most viscou

141
Q

keratitis define

A

inflammation of cornea

142
Q

keratitis causes

A

Viral infection (e.g., herpes simplex)
Bacterial infection (e.g., Pseudomonas or Staphylococcus)
Fungal infection (e.g., Candida or Aspergillus)
Contact lens-induced acute red eye (CLARE)
Exposure keratitis, caused by inadequate eyelid coverage (e.g., ectropion)

143
Q

most common cause of keratitis

A

herpes simplex
can primary or recurrent - when virus lied dormant in trigeminal ganglion
can lead to stromal necrosis, vasculariation and scarring…corneal blindness

144
Q

keratitis clinical fx

A

mild symptoms of blepharoconjunctivitis (inflammation of the eyelid margins and conjunctiva).
if recurrent -
Painful red eye
Photophobia
Vesicles (fluid-filled blisters)
Foreign body sensation
Watery discharge
Reduced visual acuity

145
Q

how keratitis diagnosed

A

slit lamp exam with florescein staining shows dendritic corneal ulcer
corneal scrappings - viral testing

146
Q

keratitis mx

A

urgent assessment
topical or oral antiviral
corneal transplant

147
Q

subconjuctival haemorrhage patho

A

small blood vessel within conjuctiva ruptures…release blood into space between sclera and conjunctiva
after episodes of strenuous activity or trauma or idiopathic

148
Q

subconjunctival haemorrhage risk fx

A

Hypertension
Bleeding disorders (e.g., thrombocytopenia)
Whooping cough
Medications (e.g., antiplatelets, DOACs or warfarin)
Non-accidental injury

149
Q

clinical fx of subconjuctival haemorrhage

A

bright red blood patch underneath conjunctiva
painless and does not affect vision
precipitating event

150
Q

subconjunctival haemorrhage mx

A

clinical hx diagnosed
check BP and INR
resolve spontaneously without tx
lubricating eye drops for irritation

151
Q

posterior vitreous detachment define

A

the vitreous body comes away from the retina

152
Q

posterior vitreous detachment age

A

older age more common

153
Q

patho posterior vitreous detachment

A

The vitreous humour is the gel inside the vitreous chamber of the eye. It maintains the structure of the eyeball and keeps the retina pressed on the choroid. With age, it becomes less firm and able to maintain its shape.

154
Q

presentation posterior vitreous detachment

A

painless
floaters
flashing lights
blurred vision

155
Q

mx posterior vitreous detachment

A

no tx, brain adjusts

156
Q

predisposing conditions from posterior vitreous detachment

A

retinal tears and detachment

157
Q

retinal detachment patho

A

involves the neurosensory layer of the retina (containing photoreceptors and nerves) separating from the retinal pigment epithelium (the base layer attached to the choroid). This is usually due to a retinal tear, allowing vitreous fluid to get under the neurosensory retina and fill the space between the layers.

158
Q

why retinal detachment serious

A

neurosensory retina relies on blood vessels of choroid for blood supply…so then disrupt and can cause permanent damage to photoreceptors…sight threatening

159
Q

risk fx retinal detachment

A

Lattice degeneration (thinning of the retina)
Posterior vitreous detachment
Trauma
myopia
Diabetic retinopathy
Retinal malignancy
Family history

160
Q

retinal attachment clinical fx

A

painless
peripheral vision loss sudden and shadow
blurred or distorted vision
flashes and floaters

161
Q

retinal detachment mx

A

immediate opthalmology referral
retinal tears - laser therapy, cryotherapy
retinal detachment - reattach retina and reduce traction or pressure via vitrectomy, scleral buckle or pneumatic retinopexy

162
Q

retinal vein occlusion patho

A

when thrombus form in retinal veins, blocking drainage of blood from retina…in central retinal vein or branch retinal veins
this blockage causes venous congestion…increased pressure and blood leaking into retina…macular oedema and retinal haemorrhages

163
Q

sites of retinal vein occlusion

A

The branch retinal veins drain into the central retinal vein, which runs through the optic nerve to drain into either the superior ophthalmic vein or cavernous sinus. Blockage of one of the branch veins affects the area drained by that branch. Blockage in the central vein causes problems with the whole retina.

164
Q

2 types of retinal vein occlusion

A

ischaemic or non ischaemic
ischaemia - release of VEGF…neovascularisation

165
Q

risk fx retinal vein occlusion

A

Hypertension
High cholesterol
Diabetes
Smoking
High plasma viscosity (e.g., myeloma)
Myeloproliferative disorders
Inflammatory conditions (e.g., SLE)

166
Q

clinical fx retinal vein occlusion

A

painless blurred vision or vision loss
if branch retinal vein = affected area of retina
if branch draining macula = central vision lost

167
Q

fundoscopy retinal vein occlusion

A

Dilated tortuous retinal veins
Flame and blot haemorrhages
Retinal oedema
Cotton wool spots
Hard exudates

168
Q

ddx fundoscopy of retinal vein occlusion

A

retinal vein occlusion - ‘blood and thunder’ appearance
CMV retinitis - ‘pizza pie’ appearance

169
Q

retinal vein occlusion mx

A

referred immediately
tx macular oedema and prevent neovascularisation = anti VEGF (ranibizumab and aflibercept), dexamethasone intravitreal implant, laser photocoagulation

170
Q

central retinal artery branch

A

branch of opthalmic artery which is brain of ICA

171
Q

causes central retinal artery occlusion

A

atherosclerosis
giant cell arteritis

172
Q

risk fx central retinal artery occlusion

A

for CVD - atherosclerosis
for giant cell arteritis - white ethnicity, older age, female, polymyalgia rheumatica

173
Q

central retinal artery occlusion clinical fx

A

sudden painless loss of vision ‘curtain coming down’
a relative afferent pupillary defect, where the pupil in the affected eye constricts more when light is shone in the other eye than when it is shone in the affected eye. The input is not sensed by the ischaemic retina when testing the direct light reflex but is sensed during the consensual light reflex.

174
Q

central retinal artery occlusion fundoscopy

A

pale retina with cherry red spot…spot is fovea which has thinner surface

175
Q

ddx for sudden painless vision loss

A

retinal detachment
central retinal artery occlusion
central retinal vein occlusion
vitreus haemorrhage

176
Q

central retinal artery occlusion initial mx

A

referred immediately
giant cell arteritis - ESR nand temporal artery biopsy, tx with high dose steroids

177
Q

central retinal artery occlusion mx options

A

Ocular massage (massaging the eye)
Anterior chamber paracentesis (removing fluid from the anterior chamber to reduce the intraocular pressure)
Inhaled carbogen (5% carbon dioxide and 95% oxygen) (to dilate the artery)
Sublingual isosorbide dinitrate (to dilate the artery)
Oral pentoxifylline (to dilate the artery)
Intravenous acetazolamide (to reduce the intraocular pressure)
Intravenous mannitol (to reduce the intraocular pressure)
Topical timolol (to reduce the intraocular pressure)

178
Q

retinitis pigmentosa define

A

a genetic condition causing degeneration of the photoreceptors in the retina, particularly the rods…many different genetic causes

179
Q

presentation retinitis pigmentosa

A

varies
mostly start in childhood
rods more than cones degenerate - night blindness and peripheral vision loss

180
Q

retinitis pigmentosa fundoscopy

A

‘bone spicule’ pigmentation - sharp ponted appearance in mid periphery
narrowing of arterioles and waxy or pale appearance to optic disc
v characteristic for osce’s

181
Q

retinitis pigmentosa associated systemic disease

A

Usher syndrome also causes hearing loss
Bassen-Kornzweig syndrome also causes progressive neurological impairments
Refsum disease also causes peripheral neuropathy, hearing and ichthyosis (scaly skin)

182
Q

retinitis pigmentosa mx

A

referral
genetic counselling
vision aids
sunglasses to protect retina
DVLA inform

183
Q
A

special senses (4 decks)

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