Opthalmology Flashcards
red eye, semi-dilated non reactive pupil, and a hazy cornea, pain, haloes, after dilation, painful presentation.
rf?
RF for more chronic form of this disease?
what are mydriatic agents (dilating) that trigger this?
Acute angle glaucoma closed. TX - timolol, iv acetazolamide, pilocarpine, brimonidine
definitive tx: laster irdotomy
tonometr - pressure
af: headahce,
rf: long sighted (cant see near things, acute)(hypermetropia), pupil dilation, lens growth
primary angle - latanprost first to treat.
myopia - short sighted (cant see far in advance, chronic glaucoma)
dilating agents: phenylephrine, atropine, cyclopentolate,
acute painful red eye
blurred vision and photophobia other sx?
tx?
with sx of urethritis/ joint pain?
if gritty:
anterior uveitis/ irits - TX atropine, C/s drops, cycloplegic drops (mydriatic)
SX: small, fixed oval pupil, ciliary flush, hypopyon.
reiter’s syndrome
keratitis
miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)
Horner’s syndrome
Horner’s syndrome with heterchromia
Congenital horner’s syndorme
sudden or gradual vision loss, widespread retinal haemorrhages (‘blood and thunder’ appearance) and cotton wool spots due
Central retial vein occlusion -CX HTN, polycythaemia, glaucoma,
sudden, painless, unilateral vision loss. (RAPD),
pale retina with a cherry-red spot at the fovea
Central retinal A occlusion - due to vTE RF, arteritis
Gradual central VL, loss of near objects, adaptation to night, flickering of lights, distortion of line perception
subacute - wet macular degen, Anti VEGF
Gradual - drusen and dry mac degen
6 month old, recurrent, sticky eye
congenital nasolacrimal duct obstruction - reassure, resolved by 1 YO
light sensitivity and difficulty focusing on close objects, single dilated pupil, abscent knee jerk reflex, women
Holme-Adie pupil (Huge add pupil), slow to react to light, can be benign
18 YO F, ataxia, eye pain on movement, cant see red, central scotoma
Optic neuritis. AF: MS, DM, syphillis. TX- 4-6 weeks steroids, MRI
central scotoma
bilateral dry, gritty and sore eyes. finds minimal relief with the frequent use of lubricating eye drops.
painless lump on lid with gradual swelling?
painful, red bump, pus?
Meibonium gland blepharitis (need oily and watery part of tears). differs from chalazion - painless lump
stye - external hordeolum
internal is infecton of meibomian cyst (can leave chalazion.
painless VL cx?
one with flashes of flight, perpheral VL and floaters?
dense shadow starting peripherally after flashes an dfloaters?
can cause varing amounts of VL/ dark spots/ floaters?
Posterior vitreous detachment - floaters
RD - dense shadow. straight lines appear curved
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters - vitreous haemorrhage
Blurring of vision again years after cataract surgery
pain immediately after op?
Posterior capusle opacification
endopthalmitis
Associated conditions of episcleritis
scleritis conditions?
IBD, RA
scleritis: RA (most common), SLe, sarcoid, granulomatosis with polyangitis
Causes of peripheral VL? Tunnel vision?
Glaucoma
Retinal detatchment - dark shadow starts - peripherally and central VL, flashes before
Chorioradioretinitis - do HIV
Bitemp haemianopia - pit tumour
Retinitis pigmentosa - night VL
Causes of papilledaema? (usually bilateral)
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
Rare causes include
hypoparathyroidism and hypocalcaemia
vitamin A toxicity
painless, gradual swelling caused by a blocked oil gland, typically on internal eye lid
Chalazion
painful, red, and sudden bump caused by a bacterial infection in a hair follicle or oil gland.
when do you tx with antibiotics?
Stye - external hordeolum
Internal - could lead to a chalazion
tx if associated with conjunctivitis
child with Red/green colour change, eye swelling, pain eye movements, mild proptosis
most common cx
no pain on eye movement?
RF?
Orbital cellulitis - common cause is ethmoidal sinusitis, lack of HiB influenzae vaccine, Recent eyelid infection/ insect bite on eyelid (periorbital cellulitis). do CT
no pain - preseptal cellulitis
no vaccine/ ear infection,
TXof bacterial conjuctivitis? pregnant women?
Chloramphenicol normally
Fusidic acid for pregnant women
cx of central scotoma?
MS, cotton wool spots (HTN), methyl acohol, ethambutol, quinine, vascular blockages,
zerpes zoster opthalmicus - what is hutchinson’s sign?
TX?
rash on tip of nose indicates likihood of eye involvement (cornea)
antiviral P/O 7-10 days within 72 hrs
Marfan’s syndrome, sudden VL - cx?
lens dislocation (upwards)
others: EDS, homocystinuria
subacute unilateral VL with eye pain on movements, RAPD, colour desaturation?
optic neuritis AF: MS, cenral scotoma
do MI brain/ orbits
red eye, photophobia, gritty senation (hc of contact lens), foggy and washed out
typical cx?
keratitis
bacerial - staph A
lens - pseudomonas aeruginosa
cx of cataracts
hypocalcaemia, radiation, myotonic dystrophy, smoking, trauma, DM, CS long term
definition of endophatlmitis?
inflammation of aqueous/ vitreous humour
worsening vision over months with metamorphopsia and central scotoma?
wet AMRD
dry AMRD characterised by?
drusen
episcleritis vs scleritis?
pain
phenylephrine drops - vessels blanch in episcleritis
IDB - episcleritis
RA - AF scleritis
most common rheumatoid manifestation in eyes?
keratoconjunctivits sicca
younh woman, blurred vision, painful movement, loss of red vision. what ix?
defect VL?
other cx?
MRI - optic neuritis af MS
central scotoma
CLS, temp arteriti, infective (syphillis, tb,
amiodarone, ethambutol,
dm2 went to GP had fundoscopy and then developed sudden painful eye with VL in the evening driving in dark?
AACG - mydriatic drops/ dilation at nigh can worsen sx
single dilated pupil, once light is shone, stays constricted for long time? but reacts to accommodation
what is the syndrome?
Holmes-adie pupil
syndrome: with abscent ankle/ knee reflex
Argyl Robertson syndrome?
ARP, PRA
B/L dilated eyes that dont respond to light but do accommodate. Af - neurosyphillis/ dm - most common in UK
high intraocula pressure with Hx of T2dM and peripheral VL.
dx?
tx first line?
primary open angle glaucoma - tx first latanprost. SE borwn pigmentation, increases lash length
Primary open angle tx:
pilocarpine - dilator or constrictor?
brimonidine - when to avoid
pilocaripine is miotic (constrictor)
avoid brimonidine if on TCA/ MAOi. SE. high K
dilated eye cx?
third nerve palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital
Argyl robertson pupil :
ARP PRA. small irregular pupils that do not respond to light. Af: neurosyphillis/ dm
Horner’s cx:
central
pre-ganglionic
post ganglionic?
central - anhydrosis trunk, face, arm.
STROKE
SYRINGOMYLIA, MS/ tumour
pregang- anhydrosis on face T
tumour (pancoast), thyroidectomy, cervical rib
post gang- no anhidrosis.
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache
hypertensive eye classes on fundoscopy?
SAFE?
Silver lining 1
AV Nipping 2
Flame Shaped Hem 3
Edema 4
SAFE
