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Phase 4 Question Knowledge > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Glaucoma

A

Optic nerve damage from rise in IOP

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2
Q

Glaucoma patho

A
  • Imbalance in aq humour production / drainage - usually blockage
  • increased pressure on retina / optic nerve - damage to peripheral retina first, then central, cupping of optic disc
  • normal pressure 10-21 mmHg
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3
Q

Open angle glaucoma

A
  • chronic
  • degeneration of trabecular meshwork -> increased resistance -> increased IOP, degeneration of optic nerve

RFs
- older, FHx, black, myopia (near sighted)

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4
Q

Open angle glaucoma Px

A
  • asym - dx on screening
  • tunnel vision (lose peripheries)
  • pain
  • headaches
  • blurred vision
  • halos around lights (worse at night)
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5
Q

Open angle glaucoma Screening

A
  • strong FHx - every 2yrs from 30yo
  • every 5yrs >40yo, every 2yrs >60
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6
Q

Open angle glaucoma Ix

A

Fundoscopy
- optic disc cupping - ratio >0.5
- pale disc - atrophy
- vessel bayonetting
- haemorrhage at risk
- vertical thinning

Visual field assessment
- loss of peripheral vision

Non-contact tonometry
- puff of air, estimate IOP (raised)

Goldmann applanation tonometry
- gold std for IOP - device on slit lamp in contact with cornea

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7
Q

Open angle glaucoma Mx

A
  • start when IOP >24
  • 360-degree selective laser trabeculoplasty
  • Latanoprost eye drops - prostaglandin
  • Timolol - BB
  • Acetazolamide - carbonic anhydrase inhibitor
  • Brimonidine - sympathomimetics
  • Trabeculectomy
  • plastic tube shunt
  • Inform DVLA
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8
Q

Acute angle closure glaucoma (AACG)

A
  • acutely raised IOP from physically obstructed outflow (iridocorneal angle)

Pupillary block
- lens pushes against iris, blocks aq humour flow through pupil, iris / lens pushed anteriorly - closes iridocorneal angle + blocks trabecular meshwork

Closure of outflow angle
- pupil dilates, iris thickens, IC angle reduces, can close spontaneously

  • retina damaged from stretching, decreased blood supply

RFs
- hyperopic (far-sighted) - shallow anterior chambers
- older, F>M, FHx, Chinese
- meds causing pupil dilation - antihistamines

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9
Q

AACG Px

A
  • red, painful eye
  • N+V, headache
  • halo around lights
  • sx worse with pupil dilatation - eg will be watching TV in dark room
  • pupil sluggish + dilated
  • eye hard to palpation
  • reduced visual acuity
  • hazy cornea (oedema)
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10
Q

AACG Ix

A
  • tonometry - IOP >60
  • gonioscopy - look at angle (lens on slit lamp)
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11
Q

AACG Mx

A
  • lie on back w/o pillow, urgent ophthal referral
  • timolol - topical BB
  • prednisolone
  • oral/IV acetazolamide
  • oral glycerol + IV mannitol
  • pilocarpine - miotic eye drops
  • analgesia +/- antiemetics
  • laser iridotomy - both eyes
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12
Q

Age-related macular degeneration (ARMD)

A

Degeneration of macula (central retina) -> blindness

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13
Q

ARMD Patho

A

Degeneration of retinal photoreceptors, formation of drusen, atrophy of retinal pigment epithelium

Dry / atrophic - 90% - early
Drusen, changes in pigmentation of retinal pigment endothelium

Wet / exudative - 10% - late
choroidal neovascularisation, VEGF, oedema, rapid vision loss

RFs
older, F>M, smoker, FHx, IHD, HTN, dyslipidaemia, DM

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14
Q

ARMD Px

A
  • reduction in visual acuity - near field / central
  • worse vision at night
  • day to day change in vision
  • photopsia - flashing lights
  • glare around objects
  • visual hallucinations -> Charles-Bonnet syndrome
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15
Q

ARMD Ix

A
  • Snellen - reduced acuity
  • Amsler grid testing - line crooked
  • Fundoscopy - Drusen, red patches in wet ARMD
  • Slit lamp - pigmentary/exudative/haemorrhagic changes
  • colour fundus photography
  • fluorescein angiography
  • indocyanine green angiograph - see choroidal circulation
  • optical coherence tomography (OCT) - 3d retina
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16
Q

ARMD Mx

A
  • stop smoking, control BP
  • zinc, vit A, C, E
  • Anti-VEGF
  • laser photocoagulation (risk of acute visual loss)
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17
Q

Diabetic retinopathy

A

Retinal deterioration from blood vessel damage due to high blood sugar levels

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18
Q

Diabetic retinopathy Px

A
  • painless reduction of central vision
  • dark painless floaters - haemorrhages
  • painless visual loss - severe haemorrhage
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19
Q

Diabetic retinopathy Ix

A
  • visual acuity
  • spots in red reflex - vitreous haemorrhage
  • fundoscopy
  • dilated retinal photography + ophthalmoscopy
  • OCT / fluorescein angiography
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20
Q

Diabetic retinopathy Mx

A
  • optimise BMs, BP, lipids, healthy diet, stop smoking

maculopathy
- anti-VEGF

non-proliferative
- observation / panretinal laser photocoagulation

Proliferative
- panretinal laser photocoagulation
- anti-VEGF

Vitreous haemorrhage
- vitreoretinal surgery

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21
Q

Diabetic retinopathy fundoscopy

A

Blot haemorrhages
Hard exudates
Microaneurysms
Venous beading
Cotton wool spots
Intraretinal microvascular abnormalities
Neovascularisation

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22
Q

Diabetic retinopathy classification

A

Non-proliferative
- Mild - 1+ microaneurysms
- Moderate - microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading
- Severe - blot haemorrhages + microaneurysms in 4 quadrants, venous beading in 2 quadrants, IMRA in any quadrant

Proliferative
- neovascularisation
- fibrous tissue
- vitreous haemorrhage

Diabetic maculopathy
- macular oedema
- ischaemic maculopathy
- hard exudates

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23
Q

Diabetic retinopathy Cx

A

Retinal detachment
Vitreous haemorrhage
Rebeosis iridis - new blood vessel formation in iris
Optic neuropathy
Cataracts

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24
Q

Hypertensive retinopathy

A

damage to small blood vessels in retina from systemic HTN

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25
Q

Hypertensive retinopathy Px

A
  • can be asym
  • double vision / blurred vision / reduced acuity / visual field defects
  • headaches
  • eye pain
  • N+V
  • end organ damage - HF, AKI, chest pain
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26
Q

Hypertensive retinopathy Ix

A
  • BP
  • fundoscopy
  • OCT / fluorescein angiography
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27
Q

Hypertensive retinopathy fundoscopy

A
  • silver / copper wiring
  • AV nipping
  • cotton wool spots
  • hard exudates
  • retinal haemorrhages
  • papilloedema
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28
Q

Hypertensive retinopathy Keith-Wagener classification

A

Stage 1 - mild narrowing of arterioles, increased light reflex (silver wiring)

Stage 2 - focal constriction of blood vessels + AV nipping

Stage 3 - cotton wool exudates, flame + blot haemorrhages (may collect around fovea - macular star)

Stage 4 - papilloedema

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29
Q

Hypertensive retinopathy Mx

A
  • control BP
  • stop smoking
  • control lipids
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30
Q

Cataracts

A
  • lens opacifies
  • lens fibres aggregate, deposit, cause clouding

Causes
smoking, alcohol, age, trauma, DM, long-term steroids, radiation, myotonic dystrophy, hypocalcaemia

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31
Q

Cataracts Px

A
  • gradual onset, asymmetrical
  • reduced visual acuity
  • faded colour vision
  • starbursts around lights - at night
  • loss of red reflex
  • white/brown lens when light shone on eye
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32
Q

Cataracts Ix

A
  • ophthalmoscopy - normal fundus / optic nerve
  • slit lamp
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33
Q

Cataracts Mx

A
  • surgery
  • stronger glasses, brighter lights in meantime
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34
Q

Cataracts surgery cx

A
  • posterior capsule opacification
  • retinal detachment
  • posterior capsule rupture
  • endophthalmitis - inflammation of aq/vit humour - intravitreal abx to tx
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35
Q

Blepharitis

A
  • inflammation of eyelid margins

Causes

  • meibomian gland dysfunction - lack of oil, drying of eyes
  • seborrhoeic dermatitis / staph infection

Px

  • bilateral
  • gritty, sticky eyes
  • red eyelid margins
  • swollen - staph

Mx

  • hot compress
  • lid hygiene - cotton wool buds, warm water, baby shampoo
  • artificial tears - dry eyes
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36
Q

Stye

A
  • painful red lump on eyelid edge - like acne

Types
External - infection of glands of zeis / moll
Internal - infection of meibomian glands

Px
external - tender red lump along eyelid +/- pus
internal - deeper, more painful, may point inwards

Mx
- hot compress
- analgesia
- topical abx if conjunctivitis

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37
Q

Chalazion

A
  • meibomian gland blocked - meibomian cyst

Px
- swelling in eyelid
- may be painless / tender
- red

Mx
- hot compress
- analgesia
- topical abx if inflamed
- surgical drainage if the above fails

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38
Q

Entropion

A
  • eyelid turns in

Mx
- tape eyelid down, eye drops to prevent eye drying
- surgery - definitive
- same day ophthal referral if risk to sight

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39
Q

Ectropion

A
  • eyelid turns out, usually bottom

Mx
- mild - no tx
- eye drops
- surgery
- same day ophthal referral if risk to sight

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40
Q

Trichiasis

A
  • inward growth of eyelash

Px
- painful
- red, watery eye
- feels like FB in eye

Mx
- remove eyelash
- electrolysis, cryotherapy, laser tx if recurrent growth
- same day referral if risk to sight

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41
Q

Abnormal pupil shape causes

A
  • trauma, eg cataracts surgery
  • anterior uveitis - adhesions
  • AACG - vertical oval shape
  • rubeosis iridis - neovascularisation of iris
  • coloboma - congenital malformation
  • tadpole pupil - spasm in iris - migraines
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42
Q

Mydriasis causes

A
  • 3rd nerve palsy
  • Homes-Adie syndrome
  • raised ICP
  • congenital
  • trauma
  • phaeochromocytoma
  • drugs - atropine, cocaine, amphetamines, TCAs
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43
Q

Miosis causes

A
  • Horner syndrome
  • cluster headaches
  • Argyll-Robertson pupil
  • opiates
  • nicotine
  • pilocarpine
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44
Q

3rd nerve palsy

A
  • ptosis
  • dilated pupil
  • divergent strabismus - down + out eye

Causes
- idiopathic
With sparing of pupil (microvascular - psym fibres spared):
- DM, HTN, ischaemia
Full palsy - compression
- tumour, trauma, cavernous sinus thrombosis, PCA aneurysm, raised ICP

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45
Q

Horner syndrome

A
  • damage to sympathetic nerves system supplying face
  • ptosis, miosis, anhidrosis

Central lesions - anhidrosis of arm, trunk, face (4 Ss)
- Stroke
- MS
- Swelling (tumours)
- Syringomyelia
- also encephalitis

Pre-ganglionic lesions - anhidrosis of face (4 Ts)
- Tumour - eg Pancoast
- Trauma
- Thyroidectomy
- Top rib - cervical rib

Post-ganglionic lesions - no anhidrosis (4 Cs)
- Carotid aneurysm
- Carotid artery dissection
- Cavernous sinus thrombosis
- Cluster headache

Congenital Horner syndrome
- associated with heterochromia

Ix
- Cocaine eye drops? - cause dilatation in normal eye, not in Horner’s
- adrenaline eye drops - as above

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46
Q

Holmes Adie Pupil

A
  • benign, part of Holmes-Adie syndrome - neuro disorder with absent ankle / knee reflexes

Px
- unilateral in 80%
- dilated pupil
- once pupil constricts, small for a while
- slow reaction to accommodation, barely any to light

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47
Q

Argyll-Robertson pupil

A
  • Syphilis, also DM

Px
- small, irregular pupils
- no response to light, response to accommodation

48
Q

Conjunctivitis

A

inflammation of conjunctiva - layer of tissue on inside of eyelids / sclera

bacterial / viral / allergic

49
Q

Conjunctivitis Px

A
  • uni/bilateral
  • red eye
  • bloodshot
  • itchy / gritty
  • discharge
  • NO pain, photophobia, reduced acuity

Bacterial
- purulent discharge, worse in morning (eyes stuck together)
- can start unilateral, then spread
- highly contagious

Viral
- clear discharge, other viral sx, lymph nodes,
- highly contagious

50
Q

Red eye ddx

A

Painless
- conjunctivitis
- episcleritis
- subconjunctival haemorrhage

Painful
- glaucoma
- anterior uveitis
- scleritis
- corneal abrasions / ulceration
- keratitis
- FB
- trauma / chemical injury

51
Q

Conjunctivitis Mx

A
  • usually resolves alone 1-2 wks
  • wash hands, don’t share towels, clean eyes
  • bacterial - abx eye drops - chloramphenicol / fusidic acid topical (pregnancy)
  • no contact lenses, topical fluorescein to identify corneal staining
  • neonate <1mo - urgent ophthal review - ?gonococcal infection -> loss of sight, pneumonia
52
Q

Allergic conjunctivitis

A
  • contact with allergens

Px
- bilateral
- swelling
- watery discharge
- itch
- Hx of atopy
- seasonal / perennial

Mx
- antihistamines - topical / oral
- topical mast-cell stabilisers - for chronic sx

53
Q

Anterior uveitis

A

Inflammation of anterior part of uvea - iris, ciliary body, choroid

54
Q

Anterior uveitis causes

A

Acute - HLA B27
- Ankylosing spondylitis
- IBD
- Reactive arthritis

Chronic - >3mo - granulomatous (macrophages)
- sarcoidosis (?bilateral)
- syphilis
- lyme disease
- TB
- herpes virus

55
Q

Anterior uveitis Px

A
  • unilateral
  • spontaneous acute sx
  • dull, aching, painful eye
  • red eye
  • ciliary flush - ring of red from cornea outwards
  • reduced acuity
  • flashes, floaters
  • miosis
  • photophobia
  • pain on movt
  • lacrimation
  • abnormal shaped pupil - adhesions
  • hypopyon - WBCs in ant chamber - yellow fluid
56
Q

Anterior uveitis Ix

A
  • slit lamp
57
Q

Episcleritis

A
  • benign self-limiting inflammation of episclera (just beneath conjunctiva)
  • RA / IBD association, not usually infection
58
Q

Anterior uveitis Mx

A
  • same day ophthal assessment
  • steroids - oral / topical / IV
  • cyclopentolate / atropine eye drops - cycloplegic (paralyse ciliary muscles) + mydriatic (dilate pupil)
  • immunosuppressants - DMARDs, TNF inhibitor
  • laser therapy, cryotherapy, surgery (vitrectomy)
59
Q

Episcleritis Px

A
  • acute, unilateral
  • painless / mild pain
  • red eye - red patch
  • FB sensation
  • dilated episcleral vessels - move with gentle pressure
  • eye watering, no discharge
60
Q

Episcleritis Ix

A
  • phenylephrine drops - blanch conjunctival / episcleral vessels (not scleral)
61
Q

Episcleritis Mx

A
  • if doubt, ophthal referral
  • self-limiting - 1-4wks
  • lubricating eye drops for sx
  • analgesia, cold compress
  • severe - NSAIDs, steroid eye drops
62
Q

Scleritis

A
  • full thickness inflammation of sclera
  • generally non-infective
  • if necrotising - can perforate

RFs
- RA, SLE, IBD, sarcoidosis, granulomatosis with polyangiitis

63
Q

Scleritis Px

A
  • red eye
  • painful
  • watering
  • photophobia
  • gradual reduction in vision
  • abnormal pupil reaction to light
  • eye tender to palpation
64
Q

Scleritis Mx

A
  • same day ophthal referral
  • NSAIDs - oral / topical - 1st line
  • Steroids - oral / topical - more severe
  • immunosuppressants - resistant cases
65
Q

Corneal abrasions

A
  • scratches / damage to cornea

Causes
- Contact lenses (beware pseudomonas)
- FB
- fingernails, eyelashes, entropion
- chemical - acid

66
Q

Corneal abrasion Px

A
  • hx of FB / contact lens
  • painful red eye
  • FB sensation
  • watery eye
  • blurred vision
  • photophobia
67
Q

Corneal abrasion Ix

A
  • fluorescein stain - yellow / orange in abrasion/ulcer
  • slit lamp
68
Q

Corneal abrasion mx

A
  • if ?sight-threatening - ophthal referral
  • remove FB
  • analgesia
  • lubricating eye drops
  • abx - chloramphenicol eye drops
  • cyclopentolate eye drops - dilate pupil - may help sx
  • 24hr follow up, heal in 2-3d
  • chemical - 20-30min irrigation, urgent ophthal referral
69
Q

Indications for ophthal referral with corneal FB

A
  • penetrating eye injury
  • significant orbital trauma
  • chemical
  • organic FB - eg seeds, soil
  • FB near centre of cornea
  • red flags - severe pain, irregular / non-reactive pupils, reduced visual acuity
70
Q

Keratitis

A

Inflammation of cornea - potentially sight-threatening

71
Q

Keratitis causes

A
  • Viral - herpes simplex
  • Bacteria - pseudomonas / staph
  • Fungal - candida / aspergillus
  • Amoebic - acanthamoebic keratitis - eg contaminated water - pain out of proportion to findings
  • Parasitic - onchocercal keratitis - river blindness
  • Contact lens acute red eye (CLARE)
  • Exposure keratitis - from inadequate eyelid coverage (eg ectropion)
72
Q

Corneal ulcer

A
  • defect in cornea, 2ndary to infection (eg abrasion from trauma)

RFs
- contact lenses
- vit A deficiency

Px
- eye pain, photophobia, watering of eye

Ix
- fluorescein stain - focal stain

Mx
- if contact lenses - same day ophthal referral - slit lamp to r/o microbial keratitis
- topical abx - quinolones
- cyclopentolate - pain relief

73
Q

Herpes simplex keratitis

A
  • most common cause of keratitis
  • usually only epithelial layer, stromal keratitis if deeper

Px
- painful red eye
- photophobia
- vesicles around eye
- FB sensation, watering eye
- reduced acuity

Ix
- fluorescein - dendritic corneal ulcer
- slit lamp
- corneal swabs / scrapings - PCR / viral culture

Mx
- acyclovir topical / oral
- ganciclovir eye gel
- topical steroids - stromal keratitis
- if corneal scarring - corneal transplant

74
Q

Subconjunctival haemorrhage

A
  • rupture + bleeding of small vessels in conjunctiva - bleed in between sclera + conjunctiva
75
Q

Subconjunctival haemorrhage causes

A
  • trauma
  • heavy lifting / coughing
  • straining, eg constipated
  • HTN, bleeding disorders, whooping cough, blood thinners, NAI
76
Q

Subconjunctival haemorrhage Px

A
  • patch of bright red blood
  • painless
  • no vision loss
77
Q

Subconjunctival haemorrhage Mx

A
  • resolve spontaneously in 2wks
  • Ix for ?underlying condition
  • lubricating eye drops - if FB sensation
78
Q

Posterior vitreous detachment

A

detachment of vitreous gel from retina

RFs
- older
- myopic (near sighted - longer axial length)

79
Q

Posterior vitreous detachment Px

A
  • ?asym
  • painless
  • spots of vision loss
  • floaters
  • flashing lights
80
Q

Posterior vitreous detachment Ix

A
  • same day ophthal assessment - r/o retinal detachment
  • ophthalmoscopy - Weiss ring - ring-shaped floater around optic nerve
81
Q

Posterior vitreous detachment Mx

A
  • no tx - brain adjusts
82
Q

Retinal detachment

A
  • retina separates from underlying pigment epithelium / choroid
  • choroid supplies blood to retina -> detachment is sight-threatening
  • usually due to retinal tear - then vitreous fluid gets under retina

RFs
- posterior vit detachment, diabetic retinopathy, trauma, retinal malignancy, older, FHx, myopia, previous cataracts surgery

83
Q

Retinal detachment Px

A
  • painless
  • peripheral vision loss - sudden, like shadow
  • blurred / distorted vision
  • flashes / floaters
  • macula involvement -> central vision loss
  • optic nerve involvement - RAPD
84
Q

Retinal detachment Ix

A
  • same day ophthal assessment
  • fundoscopy - loss of red reflex, pale/opaque/wrinkled retinal folds
  • slit lamp, indirect ophthalmoscopy
85
Q

Retinal detachment Mx

A

Retinal tears - create adhesions between retina / choroid
- laser therapy
- cryotherapy

Retinal detachment - reattach retina
- vitrectomy
- scleral buckling
- pneumatic retinoplexy

86
Q

Retinitis pigmentosa

A
  • congenital, inherited degeneration of rods / cones in retina
87
Q

Retinitis pigmentosa Px

A
  • most cases, sx start in childhood
  • night blindness
  • tunnel vision / loss of peripheral vision
88
Q

Retinitis pigmentosa Ix

A
  • fundoscopy - bone-spicule pigmentation, arteriole narrowing, waxy/pale optic disc
89
Q

Retinitis pigmentosa Mx

A
  • genetic counselling
  • vision aids
  • sunglasses
  • DVLA
  • potential tx - vitamins, antioxidants, oral acetazolamide, steroid injections, anti-VEGF, gene therapy
90
Q

Central retinal vein occlusion (CRVO)

A

thrombus forms in retinal vein, blocks blood drainage from retina

91
Q

CRVO patho

A
  • can be blockage in 1/4 branches, or blockage in central vein (whole retina affected)
  • blood pools, fluid leaks, macula oedema, retinal haemorrhages, damage, VEGF, neovascularisation

RFs
- HTN, high cholesterol, DM, smoking, glaucoma, SLE

92
Q

CRVO Px

A
  • sudden painless loss of vision, unilateral usually
93
Q

CRVO Ix

A
  • fundoscopy - flame + blot haemorrhages, optic disc oedema, macula oedema
  • FBC, ESR, BP, BMs
94
Q

CRVO Mx

A
  • majority conservative
  • to prevent neovascularisation - laser photocoagulation, intravitreal steroids, anti-VEGF
95
Q

Central retinal artery occlusion (CRAO)

A

blockage of central retinal artery

96
Q

CRAO Patho

A
  • central retinal artery, branch of ophthalmic artery, branch of internal carotid

Causes
- atherosclerosis - older, FHx, smoking, alcohol, HTN, DM…
- GCA - >50yo, F>M, PMR

97
Q

CRAO Px

A
  • sudden painless loss of vision
  • RAPD
98
Q

CRAO Ix

A
  • fundoscopy - pale retina, cherry-red spot macula
  • ESR, temporal artery biopsy
99
Q

CRAO Mx

A
  • GCA - prednisolone 60mg
  • ?ocular massage, inhale carbogen, sublingual GTN
  • ?thrombolysis
  • tx RFs
100
Q

Vitreous haemorrhage

A
  • bleeding into vitreous humour

causes
- proliferative diabetic retinopathy
- posterior vit detachment
- ocular trauma

101
Q

Vitreous haemorrhage Px

A
  • acute, painless visual loss / haze
  • red hue in vision
  • floaters, shadows, dark spots
  • decreased acuity
  • may have complete visual loss
102
Q

Vitreous haemorrhage Ix

A
  • fundoscopy - haemorrhage
  • slit lamp
  • USS - r/o retinal tear, detachment
  • fluorescein angiography - neovascularisation
  • orbital CT - if injury
103
Q

Vitreous haemorrhage Mx

A
  • tx cause
  • blood clears 1%/d
104
Q

Sudden loss of vision DDx

A
  • ischaemic / vascular (amaurosis fugax) - atherosclerosis, embolus, dissection, anterior ischaemic optic neuropathy, vasculitis, TIA, CRVO, CRAO
  • vitreous haemorrhage
  • posterior vit detachment
  • retinal detachment
105
Q

Blurred vision

A
  • loss of clarity of vision

Causes
- refractive error
- cataracts
- retinal detachment
- ARMD, AACG, optic neuritis, amaurosis fugax

Ix
- snellen chart
- visual fields
- fundoscopy

Mx
- opticians if refractive
- ophthal referral if other sx

106
Q

Herpes zoster ophthalmicus (HZO)

A
  • reactivation of VZV in ophthalmic division of trigeminal nerve

Px
- vesicular rash around eye +/- eye
- hutchinson’s sign - rash on tip / side of nose

Mx
- oral antivirals
- topical corticosteroids
- ophthal review if eye involvement

Cx
- conjunctivitis, keratitis, episcleritis, anterior uveitis, ptosis, post-herpetic neuralgia

107
Q

Nasolacrimal duct obstruction

A
  • imperforate membrane at lower end of duct -> persist watery eye in infant

Mx
- parents massage lacrimal duct
- in 95% sx resolve by 1yo
- ophthal referral for ?probing

108
Q

Hyphema

A
  • blood in anterior chamber of eye
  • raised IOP - sight-threatening, block IC angle, trabecular meshwork
  • urgent ophthal referral
  • admit, bed rest
109
Q

Orbital compartment syndrome

A
  • eg after retrobulbar haemorrhage

Px
- eye pain, swelling
- proptosis
- rock hard eyelids
- RAPD

Mx
- lateral canthotomy

110
Q

Optic neuritis

A

inflammation of optic nerve (often demyelination) -> loss of vision

Causes
MS, diabetes, syphilis, ischaemic optic neuropathy

111
Q

Optic neuritis Px

A
  • unilateral decrease in visual acuity - blurred / foggy
  • poor colour discrimination - red desaturation
  • pain worse on eye movt
  • RAPD
  • central scotoma (blind spot)
  • red eye
112
Q

Optic neuritis Ix

A
  • ophthalmoscopy / slit lamp - often negative
  • MRI brain + orbits with gadolinium contrast
113
Q

Optic neuritis Mx

A
  • high dose steroids
114
Q

Papilloedema

A
  • optic disc swelling caused by raised ICP
  • almost always bilateral

Causes
- SOL, malignant HTN, IIH, hydrocephalus, hypercapnia, hypoparathyroidism, hypocalcaemia, vit A toxicity

115
Q

Papilloedema fundoscopy findings

A
  • venous engorgement
  • loss of venous pulsation
  • blurring of optic disc margin
  • elevation of optic disc
  • loss of optic cup
  • Paton’s lines
116
Q

RAPD

A
  • relative afferent pupillary defect / Marcus-Gunn pupil
  • lesion is anterior to optic chiasm - optic nerve / retina

Causes
- retina - detachment
- optic nerve - neuritis, eg MS

O/E
- swinging light test - affected eye dilates when light shone on it, constricts when light shone on normal eye

117
Q

Tunnel vision causes

A
  • papilloedema
  • glaucoma
  • retinitis pigmentosa
  • choroidoretinitis
  • optic atrophy after tabes dorsalis
  • hysteria

Phase 4 Question Knowledge (30 decks)

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