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Vascular Surgery > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Causes of red eye?

A
  • Acute glaucoma
  • Uveitis
  • Infective keratitis
  • Conjunctivitis
  • Scleritis
  • Episcleritis
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2
Q

How to explode red eye?

A

-Painful: acute glaucoma, uveitis, scleritis and corneal abrasion
- VA: glaucoma and possibly uveitis and corneal abrasion
- Photophobia: uveitis and corneal abrasion
- Painless: conjunctivitis and episcleritis

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3
Q

Presentation of acute glaucoma

A
  • Red eye
  • Hazy cornea (oedema)
  • Loss of vision
  • Painful
  • Halos
  • N&V
  • Fixed mid-dilated pupil
  • Worse in the dark (pupil dilates causing angle to narrow)
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4
Q

Investigations of acute glaucoma

A
  • Can measure IOP
  • At bedside you can look for cupping of the optic disc
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5
Q

Management of acute glaucoma

A

ED:
- stage 1 is systemic acetazolamide (switch off aqueous production)
- stage 2 is pilocarpine drops (open channel)
- stage 3 is other things such as topical antihypertensives and steroids

Definitive:
-iridotomy

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6
Q

Presentation of uveitis

A

Inflammatory disease (rarely secondary to systemic infection such as TB or syphilis) ask about joint pain, rashes and bowel habit etc too

  • Red eye
  • Painful
  • Possible blurred vision
  • Photophobia
  • Lacrimation
  • Ciliary flush
  • Constricted or non-reactive pupil (inflammatory mediators cause constriction)
  • Hypopyon
  • Irregular pupil due to synechiae
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7
Q

Management of uveitis

A

ED:
- seen by ophthalmologists to ensure this isn’t an infective process before starting steroids

Definitive:
- topical steroids (dex) and dilating drops (cyclopentolate)

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8
Q

Presentation of corneal abrasion

A
  • Red eye
  • Pain
  • Possible loss of vision
  • Photophobia
  • Foreign body sensation
  • Hypopyon
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9
Q

Investigation for corneal abrasion

A
  • fluorescein drops with blue light
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10
Q

Managementof corneal abrasion

A

ED:
- abx: fluoroquinolones every hour for 48 hours, then QDS for 5 days
-antiviral: 5 x a day for 1-2 weeks
- lubricating eye drops
- opthal review immediately if covering >50% or pupil

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11
Q

Presentation of conjunctivitis

A
  • Red eye
  • No pain, photophobia or loss of vision
  • Itchy/gritty
  • Blepharitis
  • Adherent eye lids
  • Discharge
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12
Q

Management of conjunctivitis

A

Clean with cool boiled water and cotton wool
Bacterial self-resolves in a week and viral within 3 weeks
Some may give antibiotics
Antihistamines for allergic, topical or oral

Send neonates (< 28 dys to opthal for review ?chlamydia ?gonnorhoea)

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13
Q

Presentation of scleritis

A
  • Red
  • Possible loss of vision
  • Pain ON EYE MOVEMENT
  • Photophobia
  • Congested vessels
  • Can be associated with autoimmune disease
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14
Q

Management of scleritis

A

NSAIDs/steroids/immunosuppression

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15
Q

Presentation of episcleritis

A
  • Red-eye (usually localised)
  • Discomfort (not overly painful)
  • No photophobia or loss of VA
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16
Q

Management of episcleritis

A

Self-resolves in two weeks
Analgesia and lubricating eye drops if necessary

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17
Q

What is phenylephrine?

A

Vessels will disappear if in the episcleral layers

18
Q

Another cause of red eye to know about

A

Sub-conjunctival haematoma
Often due to valsava, not serious and self-resolve in a few weeks
Check no warfarin use etc

19
Q

Causes of sudden vision loss

A
  • RAO
  • CRVO
  • Optic neuritis
  • Vitreous haemorrhage
  • Retinal detachment
  • GCA
20
Q

Presentation of RAO

A

Sudden unilateral painless loss of vision like a curtain or shadow
Full, hemi or quadrant
RAPD (CRA supplies optic nerve)
Cherry red spot on a pale retina

21
Q

RAO management

A

Stroke/TIA clinic for workup

22
Q

Presentation of CRVO

A

Sudden painless unilateral loss of vision
CVD RFs
Ischemia or non-ischemic: ischemic has worse outcomes an typically has worse visions, RAPD, new vessel formation and high pressure
Shows retinal haemorrhages (stormy sunset)

23
Q

Management of CRVO

A

Seen by opthal and conservative
Macular oedema - anti VEGF
Neovascularisation - PC

24
Q

Presentation of optic neuritis

A

Central scotoma
Pain in eye movement
Red desaturation
RAPD
Progresses across a week or so, then plateaux and resolves over months
?MS ?SLE ?Sarcoidosis ?Syphyllis ?MM ?Lyme disease

25
Q

Management of optic neuritis

A

Everyone gets an MRI - can see ON lesion but also check for other MS lesions
Steroids

26
Q

Vitreous haemorrhage

A

Varying loss of vision from floater to quite significant blurriness
Some people report a red tinge
No RAPD or pain, obscure fundal exam
Can be secondary to ocular trauma, diabetic eye disease or retinal tear/detachment

27
Q

Management of vitreous haemorrhage

A

Resolves in 6 to 8 weeks. If not then vitrectomy
Can do USS to rule out retinal detachment

28
Q

Presentation of retinal detachment

A
  • Peripheral loss of vision like a shadow over hours to days
  • Flashers and floaters
  • Blurriness
  • Near sighted/trauma

(PVD is basically the same except you don’t get peripheral vision loss)

29
Q

Management of retinal detachment

A

Tear-cryotherapy/laser therapy to form adhesions
Detachment - vitrectomy, scleral buckling and pneumatic retinopexy

30
Q

Presentation of orbital cellulitis

A

Pre-septal cellulitis is in front of the eye i.e., confined to the eyelid

Very difficult to differentiate from orbital cellulitis

  • Peri-ocular redness
  • Ptosis
  • Proptosis
  • Loss of vision
  • Stye/chalazion
  • High IOP
  • Headache

If they have proptosis, change of vision, lack of pupil reflex or pain in movement then treat as orbital. Ask about tooth abscesses, sinusitis

31
Q

Management of orbital/pre-orbital cellulitis

A

Orbital - imaging and IV abx and consider need for lateral epi canthotomy

Pre-septal - 7 days of co-amoxiclav, often secondary to chalazion

32
Q

Other eyelid disorders

A

Blepharitis - inflammation of the eyelid margins; feels gritty, itchy and dry (warm compress and washing)

Stye - inflammation of eyelid gland such as either glands of Zeis (sebum) or glands of Moll (sweat), known as hordeolum externum, or of the Meibomian glands (oil), know as hordeolum internum; red lump at the base of the eyelash, if more internal/inwards/painful then it is internum (warm compress and analgesia, abx may be considered if persistent)

Chalazion - blocked Meibomian gland; more on the eyelid (warm compress and massage towards eyelash)

33
Q

Presentation of chronic glacuoma

A
  • gradual onset tunnel vision (loss of peripheral vision)
  • fluctuating pain
  • headaches
  • blurred vision
  • halos; particularly at night
34
Q

Glaucoma investigations

A

Measure IOP
- non-contact tonometry
- Goldman applanation tonometry is gold standard

Slit lamp, visual fields and IOP

35
Q

Management of chronic glaucoma

A

Treatment starts after an IOP of 24

  • NICE now recommend 360 degrees selective laser trabeculoplasty
  • Prostaglandin eye drops e.g. latanoprost
  • Other drops if necessary e.g. beta blocker, CAi or symphanometics
  • trabeculectomy may be considered
36
Q

Acute VS Chronic Glaucoma

A

Open-angle is due to the gradual increase in resistance of the trabecula meshwork, causing a gradual increase in IOP

Closed-angle is due to the iris bulging forward and closing off the anterior chamber from the trabecula meshwork

37
Q

Presentation of cataracts

A
  • usually asymmetrical
  • a gradual reduction in VA
  • a gradual blurring
  • colours are faded; more brown and yellow
  • starbursts!!
  • loss of red reflex
38
Q

Management of cataracts

A

Surgery

39
Q

Presentation of age-related macular degeneration

A

Unilateral loss of central vision
Reduced VA
Crooked or wavy appearance of straight lines (metamorphopsia)

40
Q

Investigations for AMD

A

Fundoscopy
VA
Amsler grid testing
Slit lamp
OCT - optical coherence tomography
Fluorescein angiography

41
Q

Type of AMD

A

Wet - neovascular (10%)
Dry - non-neovascular (90%)

42
Q

Management of AMD

A

Dry: no specific treatment
- stop smoking
- control BP
- vitamin supplementation (Zinc and vit ACE)

Wet:
- anti VEGF intravitreal injections

Vascular Surgery (5 decks)

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