Opthalmology Flashcards
decreased vision in left eye, eye pain,
central area of reduced vision (central scotoma) and a relevant afferent pupillary defect. what is the most likely diagnosis?
investigation?
management?
optic neuritis!!
RAPD = key sign, a pupil fails to constrict -> shows damage to optic nerve
central scotoma is seen in demyelinating lesions eg also in MS - associated with this
MRI!!! of brain and orbits with contrast
+ high dose steroids
reduced colour vision may be present
Central retinal artery occlusion typical presentation?
sudden, unilateral PAINLESS vision loss +/- RAPD
painless = distinguish from optic neuritis. CRA occlusion also does not have scotoma
anterior uveitis typical presentation?
small, irregularly shaped pupil with a potential hypopyon
Painful red eye
Photophobia!!!!
HLA-B27 conditions e.g. ankylosing spondylitis,
Blepharitis symptoms?
causes?
risk factors?
grittiness and discomfort, particularly around the eyelid margins
eyes may be sticky in the morning
eyelid margins may be red. Swollen eyelids may be seen in staphylococcal blepharitis
styes and chalazions are more common in patients with blepharitis
secondary conjunctivitis may occur
caused by gland dysfunction or sebbhorriec dermatitis/staph infection
rosacea = risk factor
manage w hot compresses and removal of lid debris
What investigations for Acute angle-closure glaucoma? (painful red eye, DILATED pupil (vs constricted in anterior uveitis) )
initial management?
definitive management?
tonometry to assess for elevated IOP
and gonioscopy
eye drops - eg timolol, pilocarpine or apraclonidine, IV acetazolamide
definitive = Laser peripheral iridotomy!!! (creating small hole in iris to relieve pressure)
picture of unilateral red eye. PAINFUL eye movements. history of joint pain treated. most likely diagnosis?
management?
most common association?
scleritis!!! - can also cause gradual reduction in vision
episcleritis is NOT painful!!
urgent review by opthalmologist
scleritis most commonly associated with rhuematoid arthritis!!! (but also sle, sarcoidosis)
what are the risk factors for retinal detachment?
diabetes mellitus!!!
(occurs as a result of breaks in the retina due to traction by the vitreous humour
these tears may proceed to detachment if left untreated)
myopia!!!!!
age
previous surgery for cataracts (accelerates posterior vitreous detachment)
eye trauma e.g. boxing
how does cataracts present?
insidious blurring of total visual field
why do contact wearers with painful red eye showing dilated vessels need to be urgently referred to eye casualty same day!!!?
most common pathogen causing?
to exclude keratitis
psuedomonas aueruginosa
Can also be acanthomeba after swimming in open water with lenses
age related macular degeneration
presentation?
findings in 2 subtypes?
management?
worsening of CENTRAL vision/ central scotoma type picture (in a 75 year old, this is more likely than optic neuritis). Worsening night time vision. Visual hallucinations.
Dry macular degeneration = DRUSEN = yellow spots
Wet macular degeneration = choroidal neovascularisation + red patches representing hemorrhage
slit-lamp microscopy is the initial investigation of choice, to identify any pigmentary, exudative or haemorrhagic changes affecting the retina
fluorescein angiography is utilised if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy.
supportive measures in dry version - Vitamin supplementation!!!! High dose of beta-carotene, vitamins C and E!!
VEGF in wet version - ranibizumab, bevacizumab and pegaptanib!!
*visual hallucinations may occur in ARMD
Blot hemorrhages and cotton wool spots are seen in what eye disease?
hypertensive retinopathy
(meanwhile microaneurysms seen in both Hypertensive retinopathy and diabetic retinopathy)
orbital cellulitis investigation?
CT with contrast
primary open angle glaucoma presentation?
risk factors?
treatment?
gradual worsening of peripheral vision
diabetes, myopia
offerselective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg !!
prostaglandin analogue (PGA) eyedrops should be used next-line = LATANOPROST.
Then consider beta blockers, carbonic anhydrase inhibitors
findings in moderate non proliferative diabetic retinopathy?
Mild NPDR
1 or more microaneurysm
Moderate NPDR
microaneurysms
blot haemorrhages!!!!!
hard exudates!!!!
cotton wool spots !!!!(‘soft exudates’ - represent areas of retinal infarction), venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
Severe NPDR
blot haemorrhages and microaneurysms in 4 quadrants
venous beading in at least 2 quadrants
IRMA in at least 1 quadrant
treatment of diabetic retinopathy?
laser photocoagulation
any evidence of maculopathy = VEGF
A 34-year-old man with a history of ankylosing spondylitis presents with a painful right eye associated with mild photophobia:
Cycloplegic drops have recently been given. What is the most likely diagnosis?
name some associated conditions
anterior uveitis!!!
unlike scleritis, anterior uveitis is treated with cyclopecig eyedrops!!! which helps dilate the pupil which is typically constricted!!! = key finding + steroids
ankylosing spondylitis!!!
reactive arthritis
ulcerative colitis, Crohn’s disease
Behcet’s disease
sarcoidosis: bilateral disease may be seen
19-year-old bitemporal hemianopia with predominately the lower quadrants being affected. What is the most likely lesion?
cranipharyngioma!!
Bitemporal hemianopia
lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
subscapular cataracts risk factors?
diabetes, steroids and hypermetropia
acute loss of vision, pain and redness with hypopon post cataract surgery. most likely diagnosis?
endopthalmitis
A 30-year-old man with a family history of early blindness is concerned that he is developing ‘tunnel vision’.
what is most likely diagnosis?
retinitis pigmentosa
A 22-year-old man is referred to urology with possible urinary retention. He is passing huge amounts of urine. Post void bladder ultrasound is normal.
what is the most likely visual field defect?
Lower bitemporal hemianopia
patient has diabetes insipidus due to a craniopharyngioma.
A 53-year-old man is admitted to the vascular ward for a carotid endarterectomy. His CT head report confirms a left parietal lobe infarct.
what is the most likely visual field defect?
Right inferior quadranopia
if there are hard exudates in macula and blot hemmorhages elsewhere in a patient with a history of diabetes and hypertension
no changes in vision
most likely diagnosis?
pre proliferative diabetic retinopathy
not proliferative as new blood vessels not forming
not diabetic maculopathy as this is SIGHT threatening, in severe diabetes, visual changes. Also blot hemmorhages are seen outside the macula
not hypertensive retinopathy as typical early changes eg AV nipping or silver wiring, arteriolar narrowing not seen. hard exudates are typically only seen in advanced disease, at which point one would expect a history of vision changes - also hemorrhages, cotton wool spots
A 67-year-old man who is known to have raised intraocular pressure is prescribed dorzolamide eye drops. What is the mechanism of action of this drug?
carbonic anhydrase inhibitor
75 YO diabetic. blurry vision, round figures around lights at night.
most likely diagnosis??
what are the typical symptoms of this condition?
cataracts (diabetes is risk factor)
Reduced vision
Faded colour vision: making it more difficult to distinguish different colours
Glare: lights appear brighter than usual
Halos around lights
*note, halos around lights may also be seen with acute closure angle glaucoma but this will also cause severe eye pain, red eye
most likely causative organism for keratitis in contact lens wearers?
features of keratitis?
pseudomonas
red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen!!! -> like in anterior uveitis
name a severe complication of scleritis
perforation of the globe (necrotising scleritis)
others: glaucoma, cataracts, raised intraocular pressure, retinal detachment, and uveitis
first line investigation forneovascular ARMD/ Wet armd?
fluorescein angiography
papilloedema signs on fundoscopy?
swelling of the optic disc, blurring of disc margins
central retinal vein occlusion symptoms + fundoscop findings?
fundoscopy findings in central retinal artery occlusion?
sudden, painless loss of vision and on fundoscopy, there would be widespread retinal haemorrhages (‘blood and thunder’ appearance) along with venous dilation and tortuosity.
cra occlusion -> pale retina with cherry red spot
anterior uveitis first line treatment?
steroid + cycloplegic (mydriatic) drops
Not antibiotics
accumulations of extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye, Is seen in what condition
Age related macular degeneration
most important modifiable risk factor for the development of thyroid eye disease
Smoking
Patient with diabetes, bilateral blurring of vision with thickening and distortion of fovea. Most likely diagnosis?
Diabetic maculopathy
Vision loss over the last 18 months In man. In the last 3 days, painless loss of vision in left eye with central scotoma. In amsler grid, straight lines appear wavy. Subretinal and itra retinal haemorrhages on fundoscopy. What condition is this?
Wet macular degeneration
On a background of dry age related macular degeneration.
Most effective intervention to slow progress of age related macular degeneration?
Stop smoking
Laser scars from treated diabetic retinopathy, how do they appear
White spots scattered throughout retina
What eye feature is a risk factor for retinal detachment?
Myopia - the retina is being stretched as the eyeball is longer in patients with myopia, making it more prone to tearing and detachment.
Treatment for severe polyarthritis from reactive arthritis?
Systemic corticosteroids
Name the rash seen on soles of feet in reactive arthritis
Keratoderma blennorrhagica
Treatment for herpes simplex keratitis
TOPICAL aciclovir
Not IV
Those with a positive family history of glaucoma should be screened annually from age?
40
Any change in vision with thyroid eye disease requires urgent review by a specialist
Central retinal artery occlusion causes? Treatment?
thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis)
IV methylpred !
Symptoms of posterior vitreous detachment
Flashes and floaters occurring in ageing population
Non sight threatening
Small risk of retinal detachment
Which medication for primary open angle glaucoma is First-line treatment in a patient with a history of heart block
Latanoprost
As you have to avoid beta blockers like Timolol
poor vision, gradually progressing.
obvious cataracts in both eyes but corrected visual acuity is only slightly reduced. most apporpriate management?
Referral for cataract surgery
Cataract removal operations should never be rationed on the basis of visual acuity
complication of pan retinal photocoagulation?
decrease in night vision
patient with Graves disease proptosis and erythema of the right eye. Visual acuity is 6/9 in both eyes. What complication is she most likely to have developed?
exposure keratopathy
except given other info, most likely will be dry rather than wet age related macular degeneration
pan retinal laser photocoagulation is used specifically for which type of diabetic retinopathy
proliferative diabetic retinopathy.
Complications of orbital cellulitis?
Cavernous sinus thrombosis and intracranial spread
Proliferative diabetic retinopathy specifically is treated with?
Pan retinal photocoagulation
Learn how the subtypes of central vein and central artery occlusion present
how to differentiate retinal detachment from vitreous hemorrhage? as they both cause flashes and floaters
in vitreous hemorrhage. A streak of red colour that spreads across your vision is typically present
