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Finals (HV) > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

List the causes of Marcus-Gunn Pupil?

A

Any lesion anterior to the optic chiasm (the optic nerve or retina)

Optic nerve- Optic neuritis
Retina- detachment

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2
Q

What is the finding in Marcus-Gunn Pupil?

A

The affected and normal eye appear to dilate when light is shone in affected eye

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3
Q

What is the afferent pathway of the pupillary light reflex?

A

Retina > Optic nerve > Lateral geniculate body > Midbrain

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4
Q

What is the efferent pathway of the pupillary light reflex?

A

Edinger westphal nucleus (midbrain) > oculomotor nerve

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5
Q

What is the most common cause of blindness in adults aged 35-65?

A

Diabetic retinopathy

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6
Q

What is the pathophysiology of diabetic retinopathy?

A

Hyperglycaemia is thought to cause increased retinal blood flow and abnormal metabolism in the retinal vessel walls. This precipitates damage to endothelial cells and pericytes

Endothelial dysfunction causes the characteristic exudates.

Pericyte predisposes to the formation of microaneurysms.

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7
Q

What are the 3 classifications of diabetic retinopathy?

A
  1. Non-proliferative diabetic retinopathy
  2. Proliferative diabetic retinopathy
  3. Maculopathy
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8
Q

List the features that may be seen in fundoscopy in non-proliferative diabetic retinopathy?

A

Microaneurysms
Blot haemorrhages
Hard exudates
Cotton wool spots (soft exudates)

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9
Q

List the features that may be seen on fundoscopy in proliferative diabetic retinopathy?

A

Retinal neovascularisation
Fibrous tissue forming anterior to retinal disc

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10
Q

What type of diabetic retinopathy is more common in T1DM?

A

Proliferative DR

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11
Q

What type of diabetic retinopathy is more common in T2DM?

A

Maculopathy

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12
Q

What is the mx for maculopathy?

A
  • Optimise glycaemic control, blood pressure and hyperlipidemia
  • Regular review by ophthalmology
  • Change in visual acuity then intravitreal vascular endothelial growth factor (VEGF) inhibitors (RANIBIZUMAB)
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13
Q

What is the mx for non-proliferative retinopathy?

A
  • Optimise glycaemic control, blood pressure and hyperlipidemia
  • Regular review by ophthalmology
  • If severe/very severe consider panretinal laser photocoagulation
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14
Q

What is the mx for proliferative retinopathy?

A

panretinal laser photocoagulation

intravitreal VEGF inhibitors

severe or vitreous haemorrhage: vitreoretinal surgery

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15
Q

What is a potential complication of pan-retinal laser photocoagulation?

A

Decrease in night vision

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16
Q

What is scleritis?

A

full-thickness inflammation of the sclera.

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17
Q

List the RF of scleritis?

A

Rheumatoid arthritis: the most commonly associated condition

Systemic lupus erythematosus

Sarcoidosis

Granulomatosis with polyangiitis

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18
Q

List the features of scleritis?

A

Painful red eye
watering
photophobia
gradual decrease in vision

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19
Q

How is scleritis differentiated from episcleritis?

A

classically painful (in comparison to episcleritis)

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20
Q

What is the mx of scleritis?

A

same-day assessment by an ophthalmologist

oral NSAIDs are typically used first-line

oral glucocorticoids may be used for more severe presentations

immunosuppressive drugs for resistant cases

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21
Q

What is the 1st line mx for scleritis?

A

Oral NSAIDs

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22
Q

List 3 differentials for painful acute vision loss?

A

Acute glaucoma
Optic neuritis
GCA

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23
Q

List 3 differentials for painless acute vision loss?

A

Central retinal Artery Occlusion
Central retinal Vein occlusion
Retinal detachment
Vitreous haemorrhage
Retinal migraine

24
Q

List the RF of CRVO?

A

Increasing age
HTN
CVS
Glaucoma
Polycythaemia

25
Q

What will be seen on fundoscopy in CRVO?

A

Widespread uraemia
Severe retinal haemorrhage (stormy sunset)

26
Q

How are the retinal haemorrhages described in CRVO?

A

‘Stormy sunset’

27
Q

What is the tx for majority of CRVO cases?

A

Conservative mx

28
Q

What is tx for macular oedema?

A

Intravitreal anti VEGF

29
Q

What is tx for retinal neovascularisation?

A

Laser photocoagulation

30
Q

What is the cause of CRAO?

A

Occurs due to thromboembolism or arteritis

31
Q

What are the features of CRAO?

A

Sudden painless vision loss (unilateral)
RAPD
‘cherry spot’ on pale retina

32
Q

What fundoscopy finding is present in CRAO?

A

‘cherry spot’ on pale retina

33
Q

What is mx for CRAO?

A

Treat underlying cause

34
Q

what is the mx for an acute presentation of CRAO?

A

Intra-arterial Thrombolysis

35
Q

What are the RF vitreous haemorrhage?

A

Diabetes
Bleeding disorders
Anticoagulants

36
Q

What are the features of Retinal detachment?

A

Sudden onset, painless and progressive visual field loss, described as a curtain or shadow progressing to the centre of the visual field from the periphery

Straight lines appear curved

+/- RAPD

new onset floaters or flashes, as these indicate pigment cells entering the vitreous space or traction on the retina respectively

37
Q

List the RF for retinal detachment?

A

Diabetes
Myopia
Age
Previous surgery for cataracts
Eye trauma e.g. boxing

38
Q

What are the common causes for vitreous haemorrhage?

A

proliferative diabetic retinopathy (over 50%)
posterior vitreous detachment
ocular trauma: the most common cause in children and young adults

39
Q

At what rate is blood typically cleared from the retina?

A

approximate rate of 1% per day.

40
Q

What are the sx of vitreous haemorrhage?

A

painless visual loss or haze (commonest)
red hue in the vision
floaters or shadows/dark spots in the vision

41
Q

What is papilloedema?

A

Optic disc swelling, that is caused by increase in intracranial pressure

42
Q

List 3 causes of papilloedema?

A

Space occupying lesion
Malignant HTN
Idiopathic intracranial HTN
Hydrocephalus
Hypercapnia

rare: Hypoparathyroidism, Vit A toxixity

43
Q

What signs/findings will be seen on fundoscopy in papilloedema?

A

Venous engorgement
Loss of venous pulsation
Blurring of optic disc margin
Elevation of optic disc
Loss of optic cup
PATON’S LINE

44
Q

What is often the 1st sign seen on fundoscopy in papilloedema?

A

Venous engorgement

45
Q

What is ARMD?

A

Characterised by degeneration of retinal photoreceptors that result in the formation of Drusen

46
Q

What is the most common cause of blindness in the UK?

A

ARMD

47
Q

List the types of ARMD?

A
  1. Dry ARMD
  2. Wet ARMD
48
Q

What type of ARMD is most common?

A

Dry ARMD (90%)

49
Q

How is dry ARMD characterised?

A

Characterised by Drusen- yellow round spots in bruchs membrane

50
Q

Which type of ARMD is atrophic?

A

Dry

51
Q

Which type of ARMD is exudative or neovascular?

A

Wet ARMD

52
Q

Which type of ARMD is acute?

A

Wet

53
Q

How is wet ARMD characterised?

A

Characterised by choroidal neovascularisation

54
Q

What are the sx of ARMD?

A

Vision loss
- Gradual- Dry ARMD
- Subacute- Wet ARMD
Poor vision at night
Reduced visual acuity (struggles to see peoples faces)
Glare
Photopsia

55
Q

What is the mx of Dry ARMD?

A

Smoking cessation
Zinc and Antioxidant Vit A

56
Q

What is the mx of Dry ARMD?

A

Anti VEGF injections (Monthly)

57
Q
A

Finals (HV) (15 decks)

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