Opthalmology Flashcards
Black bone spicule-shaped pigmentation in the peripheral retina is seen on fundoscopy in which condition?
Retinitis Pigmentosa.
Cherry red’ spot on a pale retina is seen in which condition of painless visual loss?
Central Retinal Artery Occlusion.
Condition with red eye and small irregular pupil?
Anterior Uveitis.
- Ocular discomfort & pain (may increase with use)
- Pupil may be small +/- irregular due to sphincter muscle contraction
- Photophobia (often intense)
-Blurred vision - Red eye
- Hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
Associated with HLA-B27:
- Ankylosing spondylitis
- Reactive arthritis
- Ulcerative colitis, Crohn’s disease
- Behcet’s disease
- Sarcoidosis: bilateral disease may be seen
Argyll-Robertson pupil is seen in which condition?
A mnemonic used for the Argyll-Robertson Pupil (ARP) is Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA).
- Small, irregular pupils
- No response to light but there is a response to accommodate
Causes:
- Diabetes mellitus
- Neurosyphilis
Chalazion vs Stye?
Chalazion is not classically painful. It’s a hard residual lump. A chalazion (Meibomian cyst) is a retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously but some require surgical drainage.
Stye is an acute infection of one of the glands (is likely painful, and acute in nature). The stye may become a chalazion if the inflammation dies down, but the swelling doesnt.
Mx for a stye?
Management includes hot compresses and analgesia. CKS only recommend topical antibiotics if there is an associated conjunctivitis.
Episcleritis vs Scleritis?
Episcleritis and scleritis present in similar ways - unilateral red eye (usually not, or only mildly, painful) with tearing and no photophobia. Vision is not commonly affected.
The main method of differentiating the two presentations is the use of phenylephrine or neosynephrine eye drops. These drops will cause blanching of the blood vessels in Episcleritis, but not in scleritis.
Phenylephrine blanches the conjunctival and episcleral vessels but not the scleral vessels.
If the eye redness improves after phenylephrine a diagnosis of episcleritis can be made.
In episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera
in scleritis, vessels are deeper, hence do not move
phenylephrine drops may be used to differentiate between episcleritis and scleritis.
Mx for herpes zoster ophthalmicus?
- Oral antiviral treatment (Aciclovir) for 7-10 days.
(intravenous antivirals may be given for very severe infection or if the patient is immunocompromised).
- topical antiviral treatment is not given in HZO
- topical corticosteroids may be used to treat any secondary inflammation of the eye
Which condition will show a stormy sunset on fundoscopy?
Central Retinal Vein Occlusion.
- sudden painless vision loss
- optic disc swelling
- Multiple flame-shaped and blot retinal haemorrhages ‘stormy sunset’
CRVO occurs when there is a blockage in the central retinal vein, leading to impaired venous drainage from the retina. This results in increased pressure within the blood vessels, causing them to leak blood and fluid into the surrounding tissues.
Posterior vitreous detachment vs vitreous haemorrhage?
Posterior vitreous detachment:
- Flashes of light (photopsia) - in the peripheral field of vision
- Floaters, often on the temporal side of the central vision
Vitreous Haemorrhage:
- Large bleeds cause sudden visual loss
- Moderate bleeds may be described as numerous dark spots
- Small bleeds may cause floaters
On Fundus examination, you see a mixture of white and red retinal lesions. Dx?
Classic pizza pie appearance in keeping with a diagnosis of chorioretinitis.
A patient with cytomegalovirus is susceptible to the development of chorioretinitis, which is an inflammation of the choroid and the retina. It is a form of posterior uveitis.
Holmes-Adie pupil?
Holmes-Adie pupil is a benign condition that is often seen in women. It describes a dilated pupil that will respond (constrict) to accommodation but very slowly reacts to light. The pupil is also very slow to dilate back to normal size. Deep tendon reflexes may also be reduced or absent.
Features of optic neuritis?
- Multiple sclerosis: the commonest associated disease
- Diabetes
- Syphilis
- Unilateral decrease in visual acuity over hours or days.
- Poor discrimination of colours, ‘red desaturation’
- Pain worse on eye movement
- Relative afferent pupillary defect
RAPD: This is demonstrated by the ‘swinging light test’. In a relatively dark room, a light is shone on the unaffected eye. This would cause both pupils to constrict as normal. However, when the light is swung over to the affected eye, both pupils will dilate.
First line Mx for primary open angle glaucoma?
Latanoprost is a prostaglandin analogue which works by increasing the outflow of aqueous humour from the eye, thereby reducing intraocular pressure. It is recommended as first-line treatment.
