Opthalmology Flashcards
In very general terms, what can cause conjunctivitis?
bacterial or viral infection of the conjunctiva
Give 3 important causes of painful red eye
Anterior uveitis
Acute angle glaucoma
Scleritis
Keratitis
Foreign body
Name of the eye-drop medication for conjunctivitis
Chloramphenicol or fusidic acid
what general advice will you give to child and mother for conjunctivitis?
avoid towel sharing
regular hand washing
don’t rub eye
keep it clean
If a 5 day old neonate has conjunctivitis, what important causal organism should you consider?
Chlamydia trachomatis
Most important diagnosis to consider in absence of red reflex
Retinoblastoma
‘cotton wool spot’ with small new vessels around the optic disc area
a) what is a ‘cotton wool spot’?
b) what stage of diabetic retinopathy is described here?
a) ischaemic nerve fibres
b) proliferative
other than cotton wool spot, name 3 other possible findings in diabetic retinopathy
Microaneurysms
Blot or flame-shaped haemorrhages
Hard exudates
best way of preventing diabetic retinopathy
Good glycaemic control
Gradual deterioration of the centre of vision in diabetic retinopathy - what do you expect is happening
Maculopathy
Other than maculopathy, name 2 other eye conditions that diabetic patients are at risk of
Cataracts
Glaucoma
Vitreous haemorrhage
Retinal detachment
How is the severity of hypertensive retinopathy classified?
Keith-Wagner staging 1-4
Name 4 findings on the retina characteristic of severe hypertensive retinopathy
Silver wiring
AV nipping
Cotton wool spot
Flame-shaped haemorrhages
Papilloedema
What are changes consistent with grade 2 hypertensive retinopathy
AV nipping
Arteriolar constriction
238/122 BP, blurred vision, palpitations
Fundoscopy: absence of venous pulsation, blurring of disc margins
a) What is this ophthalmological sign?
b) What endocrinological disease might be causing this presentation?
a) papilloedema
b) phaeochromocytoma
Pt losing their vision - state 6 questions to ask
pain?
central or peripheral?
sudden or gradual?
bilateral or unilateral?
red eye?
symptoms of stroke?
trauma?
Name 2 differential diagnoses other than cataract for loss of vision
Retinal detachment
Optic neuritis
Vitreous haemorrhage
GCA
TIA
Retinal vein occlusion
Retinal artery occlusion
Name 2 risk factors for the development of cataracts
Diabetes
Eye trauma
Uveitis
Long term steroids
Congenital
One positive finding on cataract examination
Clouding of the lens
Absent red-light reflex
a) What is the surgical procedure used for the treatment of cataracts?
b) Name 1 complication
Phaco-emulsification
Posterior capsule rupture
What is used to measure intraocular pressure?
screening and gold-standard
Non-contact tonometry (screening)
Goldmann applanation tonometry (gold-standard)
What does gonioscopy assess in open-angle glaucoma, and what can it distinguish between?
Iridocorneal angle (distinguishes open and closed)
Name 2 common risk factors for open-angle glaucoma
Myopia
Black
Increasing age
FHx
Name 4 medical treatments used to treat open-angle glaucoma
Eye drops:
1st line - Prostaglandin analogue e.g. latanoprost increases uveoscleral outflow
Beta blocker e.g. timolol
Carbonic anhydrase inhibitors e.g. dorzolamide
Sympathomimetics e.g. brimonidine
all reduce production of aqeuous humour
If a pts vision deteriorates, what organisation will you advise them to get in contact with
DVLA
‘lamp posts and door frames look wiggly’
what type of ARMD do you suspect?
Wet
What investigations or examinations would you perform for suspected ARMD? (2)
Amsler chart
Slit-lamp fundoscopy
Flurescein angiography
4 changes found in the macular area of the retina in wet ARMD?
Drusen
Atrophic change
Choroidal neovascularisation
Leaking blood vessels (causing oedema)
Management option for wet ARMD and route
Anti-vascular endothelial growth factor injected intravitreal
What 4 pieces of counselling or advice will you offer a patient with ARMD?
Inform DVLA
Stop smoking
Eat diet rich in green vegetables
Should only affect central vision
State 1 risk factor for acute angle closure glaucoma
Chinese
Female
Increasing age
Family history
4 positive features O/E in AACG
Decreased visual acuity
Hazy cornea
Fixed dilated pupil
Red eye
Why is there blurred vision in AACG
Corneal oedema
Why can AACG resolve when going to bed
Pupil constricts on going to sleep and so pulls iris out of the angle
Name 2 agents in immediate treatment of AACG
pilocarpine eye drops
acetazolamide
What is the definitive management of AACG
Laser iridotomy
State 3 causes for sudden painless loss of vision
Retinal detachment
Vitreous haemorrhage
CRAO
CRVO
cerebrovascular accident
Loss of upper half of visual field in right eye
Area of retina that has detached?
Lower half
Other than visual field loss, name 2 other symptoms a pt may experience in retinal detachment
Floaters, flashes, decreased visual acuity
Who is at greater risk of retinal detachment between pts w/ myopia or hypermetropia
Myopia (thinning of retina as it is stretched over larger area)
Name 2 options for treatment for retinal detachment
Laser therapy
Cryotherapy
Vitrectomy
Name 4 steps in the general examination of a patient’s eyes
Acuity
Pupil response
Fundoscopy
Visual field
Other than eyes, name 2 other parts of your examination in high suspicion of central retinal artery occlusion
Blood pressure
Auscultate carotids for bruits
Auscultate heart for murmur
Pulse for AF
What is the commonest cause of central retinal artery occlusion?
Thromboembolism from carotid artery or heart
Pupillary responses in CRAO
Relative afferent pupillary defect
Classical finding on fundoscopy of CRAO
Pale retina with cherry-red spot at the macula
Immediate management of CRAO
IV high-dose steroids (if due to GCA then 6 hour window to save sight)
What virus causes shingles?
Varicella zoster virus (Human herpes virus 3)
4 symptoms a patient may have prior to eruption of shingles rash
Burning, itching, paraesthesia, headache, fever, myalgia
Nerve affected in shingles that causes lesions to extend down to tip of patients nose - significance / what is this sign called?
Nasociliary nerve - means there will likely be corneal involvement (Hutchinson’s sign)
What chemical agent is used to visualise any ulceration of cornea?
Fluorescein
What is the classical shape of ulcers that form on the cornea in opthalmic shingles?
Dendritic
what is vital to test for as part of your eye examination in opthalmic shingles and why?
Corneal sensation - can leave the eye exposed to corneal ulceration
Treatment for proliferative diabetic retinopathy
Pan-retinal photocoagulation
Treatment for optic neuritis
High dose steroids
Pathophysiology of acute angle glaucoma
The iris bulges forward and seals off the trabecular meshwork from the anterior
chamber
This prevents aqueous humour from draining
Increasing the ocular pressure
Which further exacerbates the angle closure, and places pressure on the optic nerve
