Opthalmology Flashcards
A 78 year old man presents with a painful scalp on combing his hair, and with a recent history of homonymous hemianopia?
Temporal arteritis
A 58-year-old diabetic presents with sudden vision loss. The red reflex is absent and his retina is difficult to visualise at fundoscopy
Vitreous haemorrhage
-commonly seen in diabetics
A 72-year-old man, who is hypertensive, presented yesterday with a sudden loss of vision, which he described as like a ‘curtain coming down’. His vision has returned within 24 hours.
TIA
A 16-year-old young woman presents with a transient sudden visual loss and painful eye movements. Fundoscopy is normal
Optic neuropathy
CARDINAL SIGN IS RAPD
A 26 year old man presents with painful red eyes with a transient loss of vision
Uveitis
- pupil is smaller than the affected side
- a hypopyn may be seen in severe cases when keratic precipitates will be visible on slit lamp examination
RAPD is the cardinal sign of what?
Optic neuropathy
Aggregates of cells on the posterior surface of the cornea?
Hypopyn
Aterio-venous nipping and papilloedem
Hypertensive retinopathy
Haemorrhages, hard exudates and microaneurysms?
Background diabetic retinopathy
Cotton wool spots, venous beading/looping, deep/dark cluster haemorrhages, intra-retinal microvascular abnormalities (IRMAs)
Pre-proliferative (severe non-proliferative) diabetic retinopathy
A 55 year old man describes sudden onset of severe pain in one eye associated with vomiting coming on in the evening. He has noticed impaired vision and haloes around lights. Examination reveals an inflamed and tender eye with a fixed and semi-dilated pupil
Acute angle closure glaucoma
Treatment for glaucoma?
IV acetazolamide and pilocarpine to constrict the pupil
Dendritic corneal ulceration
Herpes simplex associated ulcerative keratitis
Opthalmia neonatorum
Conjunctivitis of the newborn
A 24-year old man presents to his GP complaining of itching burning eyes and lacrimation. On examination you find mild erythema in both eyes, but visual acuity is normal. He is also complaining about painful eye movements
Viral conjunctivitis
A 65 year old man complains about sudden-onset left eye pain, which started while driving his car. On examination the eye is red and visual acuity is reduced. He claims to see a ‘halo’ around lights and describes his visual loss as ‘looking through frosted glass’
Closed angle glaucoma
‘Halos’ and visual loss like ‘looking through frosted glass’
Closed angle glaucoma
A 48 year old man with a recent injury of his left cheek was admitted with marked left-sided periorbital swelling, red eye and blurred vision. He has high fever and is drowsy
Acute cellulitis
Treatment for acute cellulitis?
Emergency
Anti-staph antibiotics, such as flucloxacillin in combination with penicillin
Bilateral itchy eyes with profuse watery discharge. The tarsal conjunctiva reveals a follicular appearance. Normal visual acuity
Viral conjunctivitis
-presence of FOLLICLES helps differentiate it from other causes of conjunctivitis
Painful red eye with a mucopurulent discharge. There is circumcorneal redness, with a hypopyon and a white opacity of the cornea
Keratitis
When is a hypopyon seen?
When pus cells accumulate in the anterior chamber of the eyes
Unilateral red eye pain, photophobia and mild reduction in visual acuity, and a small pupil?
Iritis
-the pupil is smaller than the unaffected side
Where are keratic precipitates seen?
These are aggregates of cells on the posterior surface of the cornea
Severely painful red eye in an elderly man with reduced visual acuity, nausea and vomiting. The pupil is fixed and semi-dilated. There is intense engorgement of the corneal and episcleral vessels with corneal oedema.
Acute glaucoma
Which condition is most commonly seen in older patients with long-sightedness?
Glaucoma
Photophobia and acute painful erythema limited to the inferolateral quadrant of the eye in a 35 year old woman
Scleritis
- usually self-limiting over 7-10 days
- can prescribe artificial tear or even mild topical steroids if the discomfort is severe
- episcleritis can also be limited to a particular area of the sclera but it is characteristically less painful and more of an irritation
Holmes-Adie pupil
Characterised by a dilated pupil, which shows a delayed and incomplete constriction to light
If this occurs in association with reduced deep tendon reflexes, it is called Holmes-Adie syndrome
A 35 year old female patient presented with photophobia and an enlarged left pupil, which showed a delayed and incomplete constriction to light. Accomodation was relatively normal. A pilocarpine test was positive and no other neurological abnormality was found?
Holmes-Adie syndrome
Treatment for anterior uveitis?
Topical steroids and mydriatics
e.g. pred. forte and cyclopentolate
Treatment for meibomian cyst?
chalazion
Apply heat and massage daily
- self limiting
- no role for topical antibiotics
In predisposed individuals, certain drugs can induce angle closure. Name some examples
Nebulised ipratropium and TCA
because of their anti-muscarinic effects
Short-acting mydriatic
Tropicamide (most commonly used)
What is phenylephrine?
Intermediate acting mydriatic
Long acting mydriatic
Cyclopentolate and atropine
In which condition would adrenaline dilate the pupil?
Horner’s syndrome (pupil is sensitised to effects of adrenalina)
Hypromellose
Artificial tears
-you could use these in Sjogrens
Initial treatment for chronic glaucoma?
Topical beta blocker (e.g. timolol)
-if this doesn’t work, you can try parasympathomimetics (e.g.pillocarpine), carbonic anhydrase inhibitors (e.g. dorzolamide) and prostaglandin analogues (e.g. latanoprost). If medical treatment fails –> trabeculectomy
Complete third nerve palsy and dilatation of the pupil?
Yes
Results from loss of heterozygosity of the normal Rb gene?
Retinoblastoma
Rb was actually the first tumour suppressor gene to be discovered lol
“Cat’s eye” appearance of pupil (white/grey) and loss of red reflex
Retinoblastoma
Blue sclera
Ehlers-Danlos syndrome
Brushfield spots
Down syndrom
Band keratopathy
Hypercalcemia
Lisch nodules
Neurofibromatosis
Bitot’s spots
Vitamin A deficiency
Kayser-Fleischer rings
Wilson’s disease
The presence of inflammatory cells in the aqueous is hallmark of what?
Anterior uveitis
This is typified by the presence of drusen (waste products from the retinal pigment epithelium)
Macular degeneration
A 34 year old man presents to his GP complaining of pain in both eyes, which is worse when he presses on them through closed eyelids. He is sensitive to bright lights and has noticed that both his eyes look red, although there has been no discharge. In examination his visual acuity is normal. His conjunctiva look red
Anterior uveitis
Treatment for autosomal dominant hereditary optic atrophy
Fundoscopy: scrambled egg appearance to the macula
Laser therapy
