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5th year > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Acuity. What’s numerator (top) and denominator?

A

Numerator = At what distance they can read

Denominator = At what distance one could normally readeg. 6/9 = they can read at 6m what could normally be read at 9m

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2
Q

If can’t read at 6m, procedure?

A

6m –> 3m –> 2m –>1m Count fingersHand movement
Perceives light
No light perception: abbreviated to no PL

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3
Q

What is a Hordeolum?

A

StyeHordeolum externum =

Abscess/infection in lash follicle. Points outwards Mx Fusidic acid

Hordeolum internum = Abscess of meibomian glands-

Points inwards opening onto conjunctiva- Leaves a residual swelling called a chalazion/meibomian cyst when they subside.

Mx: Incision & curettage under LA

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4
Q

Entropion?

A

Lid inturning due to degeneration of lid fascial attachments and their muscles.
Inturned eyelashes irritate the cornea

Mx = botulinum toxin

Surgery

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5
Q

Ectropion?

A

Lower lid eversion, causes eye irritation, watering and exposure keratitis.
Associated with old age, facial palsy
Mx with Plastic surgery

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6
Q

Dendritic ulcer

A

Herpes simplex corneal ulcer.
Visualise with blue light

Sx: Photophobia/watering

Mx: Most resolve spontaneously within 3 weeks, but rational for treatment is to minimise stromal dmg/scarring - Topical/oral acyclovir 5 times day for 10 days

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7
Q

Orbital cellulitis

A

Infection spread locally eg.. from paranasal sinuses, eyelid or external eye

Staphs, pneumococcus or GAS

P/C
child with inflammation of orbit + lid swelling
pain + reduced range of movement
Exopthalmos
systemic signs eg. fever
Tenderness over sinuses

Rx: IV Abx eg. cefuroxime (20mg/kg/8h)

Complications:

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8
Q

Cause & Symptom of total afferent defect?

A

sx: No direct response but intact consensual response
- cannot initiate consensual response in Contralateral eye
- Dilatation on moving light from normal to abnormal eye
Cause = Total CN II lesion

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9
Q

RAPD aka. Causes

A

AKA Marcus Gunn Pupil

1) Optic Neuritis
2) Optic atrophy
3) Retinal disease

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10
Q

Efferent defect: feature & causes

A

Features:
Dilated pupil which does not react to light, but can initiate consensual response in CL pupil.
–> 3rd nerve palsy so also Opthalmoplegia + ptosis

Cause:

  • 3rd nerve palsy
  • -> Pupil often spared in a vascular lesion (eg. DM) as pupillary fibres run in the periphery
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11
Q

Fixed dilated pupil differential?

A

1) Mydriatics eg. tropicamide
2) Iris trauma
3) Acute glaucoma
4) CNIII compression: tumour/coning

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12
Q

Holmes-Adie pupil

A
  • Dmg to postganglionic parasympathetic fibres
  • -> a ‘tonic’ pupil
  • Idiopathic: may have viral origin
  • Young women pc sudden blurring of near vision
  • Initially unilateral, followed by bilateral pupil dilatation
  • Dilatation has no response to light, with sluggish respones to accomodation
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13
Q

Parasympathetic pathway in eye?

A
  • Pretectal nucleus midbrain - inferior division of CNIII - Ciliary ganglion- Short ciliary nerves to iris sphincter muscle - cause vasoconstriction
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14
Q

Sympathetic pathway eye?

A

Hypothalamus - C8-t1 ciliospinal centre - Superior cervical ganglion in Cavernous sinus - Opthalmic divison of V1, Trigeminal nerve - Nasociliary nerve - Long ciliary nerve to iris dilator muscle

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15
Q

Holmes-adie syndrome?

A

Tonic pupil + absent knee/ankle jerks + reduced BP (+ impaired sweating)

Caused by ?inflammatory dmg to neurons in ciliary ganglion and dmg to dorsal root ganglion (loss of autonomic control)

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16
Q

Horner’s syndrome Features?

A

Dmg to sympathetic nerve on ipsilateral side

PEAS

Ptosis (partial) - superior tarsal muscle

Enopthalmos

Anhydrosis

Small pupil (Miosis)

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17
Q

Horner’s syndrome causes?

A

Central (anhydrosis at face,arm,trunk)

  • MS
  • Wallenberg’s lateral medullary syndrome
  • Brain tumours/encephalitis

Pre-Ganglionic (neck)- anhydrosis at face

  • Pancoast’s tumour: T1 nerve root lesion
  • Trauma: CVA insertion
  • Cervical rib

Post-ganglionic (no anhydrosis)

  • Cavenous sinus thrombosis
  • -> usually secondary to spreading facial infection via the opthalmic veins- CN 3/4/5/6 palsies
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18
Q

Argyll Robertson Pupil?

  • Features
  • Cause
A

Features:

  • Small, irregular pupils
  • Accomodate, but do not react to light (like her…Prostitute’s pupil)
  • Atrophied and depigmented iris

Causes:

  • DM
  • Quaternary syphillis
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19
Q

Optic Atrophy features?

A

AKA Optic Neuropathy

  • Reduced acuity
  • Reduced colour vision (especially red)
  • Central scotoma
  • Pale optic disc
  • RAPD
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20
Q

Optic Atrophy Causes?

A

CAC VISION

Congenital

  • -> Leber’s hereditary optic neuropathy
  • Hereditary sensory motor neuropathy, friedrich’s ataxia, DIDMOAD, Retinitis Pigmentosa

Alcohol & other toxins:
- Ethambutol, lead, b12 def.

Compression:

  • Neoplasia: optic glioma, pituitary adenoma
  • Glaucoma
  • Paget’s

Vascular: DM, GCA, thromboembolic

Inflammatory: MS, devic’s, DM

Sarcoid

Infection: HZV, TB, syphilis

Oedema: Papilloedema

Neoplastic infiltration: lymphoma, leukaemia

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21
Q

Commonest cause of Optic neuropathy?

A

MS & Glaucoma

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22
Q

Signs of serious Red-eye disease?

A

Photophobia (ant.uveitis)

Poor vision (a.glau/ant uveitis)

Corneal fluorescein staining (dendritic ulcer)

Abnormal Pupil (large in acute glaucoma, small in anterior uveitis)

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23
Q

Acute Closed angle glaucoma aetiology/symptoms?

A

Blocked drainage of aqueous from ant.chamber via canal of schlemm.

  • Pupil dilatation (@night) worsens blockage
  • Intraocular pressure rises from 15-20–> 60mmHg

nb. Normal range 10-21mmHg

Sx: Prodrome: rainbow haloes around light at night time

  • Severe pain with N/v
  • Reduced acuity and blurred vision

O/E: Cloudy cornea with circumcorneal injection

FIXED DILATED IRREGULAR PUPIL
- IOP up makes eye feel hard

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24
Q

Acute closed angle glaucoma risk factors

A
  • Hypermetropia (longsightedness)
  • Shallow ant.chamber
  • Female
  • FH
  • Increased Age

Drugs:

  • Anti-cholinergics
  • Sympathomimetics
  • TCAs
  • Anti-histamines
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25
Q

Acute closed angle glaucoma Mx?

A

Ix: Tonometry: increased IOP (>40mmHg)

Acute Mx:

1) Refer to Opthalmologist
2) Pilocarpine 2-4% drops stat : Miosis opens blockage
3) Topical bB (timolol) - reduces aqueous formation
4) Acetazolamide 500mg IV stat: reduces aqueous formation
5) analgesia and antiemetics

Subsequent Mx:
- Bilateral YAG peripheral iridotomy once IOP reduces medically (laser to create a hole in iris - allows aqueous to drain)

(Yttrium alumninium garnet)

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26
Q

Anterior uveitis/iritis pathophys?

A

Uvea = pigmented part of eye, composed of iris, ciliary body and choroid
- Iris + ciliary body = anterior uvea

–> Iris inflammation involves ciliary body too.

Associations:

  • Seronegative arthritis: AS. psoriatic, Reiter’s
  • Still’s / JIA
  • IBD (particular UC)
  • Sarcoidosis
  • Behcet’s
  • Infections: TB, Leprosy, syphilis, HSV, CMV, Toxo
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27
Q

Ant.uveitis sx / O/E

A

Sx:

  • Acute pain
  • PHOTOPHOBIA
  • Blurred vision (Aq. precipiates)

O/E:

  • Small pupil initially, irregular later
  • Circumcorneal injection
  • Hypopyon : Pus in ant.chamber
  • White (keratic) precipitates on back of cornea
  • Talbots test: Increased pain on convergence
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28
Q

Anterior uveitis Mx

A

1) refer to opthalmologist
2) Prednisolone drops
3) Cyclopentolate drops: dilates pupils and prevents adhesions between iris and lens (Synechiae)

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29
Q

Episcleritis?

A

Inflammation below conjunctiva in the episclera

Sx: Localised reddening, can be moved over sclera

  • PAINLESS/mild discomfort
  • Acuity preserved

Causes:
Usually idiopathic
May complicate RA/SLE

Mx: Topical/systemic NSAIDs

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30
Q

Scleritis

A

PAINFUL vasculitis of sclera

  • -> Worse on eye movement
  • -> generalised scleral inflammation
  • -> Conjunctival oedema (chemosis)
Causes:
Wegener's
RA
SLE
Vasculitis

Mx:

  • Refer to specialist
  • Most need corticosteroids or immunosuppressants

Complications: Scleromalacia (thinning) –> globe perforation

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31
Q

Conjunctivitis causes

A

Bacterial (Sticky): Staph, strep, haemophilus, Chlamydia, gonococcus (VERY purulent, particular in neonates)

Viral (Watery) : Adenovirus)

Allergic

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32
Q

Conjunctivitis Mx

A

Bacterial: Chloramphenicol 0.5% ointment

Allergic: Anti-histamine drops: eg. emedastine

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33
Q

Corneal abrasion Ix + Rx?

A
  • Epithelial breech

Ix: Slip lamp: florescein stains defect green

Rx: Chloramphenicol ointment for infection prophylaxis

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34
Q

Corneal ulcer causes

A

Bacterial, herpetic, fungal, protozoa, vasculitis (RA)

Dendritic ulcer = Herpes simplex

Acanthamoeba: protazoal infection affecting contact lens wearers swimming in pools

Ix: Green with fluorescein on slit lamp

Rx: refer immediately to specialist who will

1) Take smears/cultures
2) Abx drops, topical/oral aciclovir
nb. Steroids may worsen symptoms

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35
Q

What is Hutchinson’s sign? Characteristics of the condition it’s a part of?

A

Nose-top zoster involvement due to involvement of nasociliary branch in opthalmic shingles. Increases change of globe involvement as nasociliary nerve also supplies globe.

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36
Q

Sudden lost of vision differentials?

A

HELP

Headache associated: GCA

Eye movements hurt: Optic neuritis

Lights/flashes preceding visual loss; detached retina

Like curtain descending: TIA, GCA

Poorly controlled DM: Vitreous bleed from new vessels

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37
Q

Optic neuritis signs and symptoms

A

signs: reduced acuity, reduced colour vision. Enlarged blind spot. Optic disk may be normal, swollen or blurred. Afferent defect.

Symptoms:

  • Unilateral loss of acuity of hrs-days
  • Decreased colour discrimination (dyschromatopsia)
  • Eye movements may hurt
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38
Q

Optic Neuritis causes

A 
MS (45-80% over 15yrs)
DM
Drugs: Ethambutol, chloramphenicol
Vitamin deficiency
Infection: Zoster, lyme disease
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39
Q

Optic neuritis Rx

A

High dose methyl pred IV for 72h, then oral pred for 11/7

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40
Q

Vitreous haemorrhage Source + Presentation

A

Source:
New vessels - DM
Retinal tears/detachment/trauma

Presentation:
Small bleeds - small black dots/ ring floaters
- Large bleeds can obscure vision –> NO red reflex, retina can’t be visualised.

Mx:

  • VH undergoes spontaneous absorption
  • Vitrectomy may be performed in dense VH
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41
Q

Central Retinal Artery Occlusion?

A

P/C:

  • Dramatic unilateral visual loss in seconds
  • Afferent pupil defect (may precede retinal changes
  • Pale retina with CHERRY RED MACULA

Causes:

  • GCA
  • Thromboembolism: Clot, infective, tumour

Rx:

  • If seen w/i 6hrs, aim is to increase retinal blood flood by decreasing IOP:
  • Ocular massage
  • Surgical removal of aqueous
  • Anti-hypertensives (local+systemic)
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42
Q

Central retinal vein occlusion

A

Commoner than arterial occlusion

Causes: Arteriosclerosis, increased BP, DM, PCV

P/C: Sudden unilat visual loss with RAPD

Fundus: STORMY SUNSET appearance:

  • Tortuous dilated vessels
  • Haemorrhages
  • Cotton wool spots

Complications:

  • Glaucoma
  • Neovascularisation

Prog: possible improvement for 6mo/1yr due to neovascularisation

Mx:
Depends on if ischaemic (RAPD) or non-ischaemic (No RAPD)
Mx neovascularisation with laser photocoagulation

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43
Q

Brach retinal vein occlusion

A

P/C: Unilateral visual loss

Fundus: Segmental fundal changes

Complications: Retinal ischaemia –> VEGF release and neovascularisation (Rx: Laser photocoag. )

44
Q

Retinal detachment Presentation

A

4 F’s:

Floaters

Flashes

Field Loss

Fall in acuity

Painless

45
Q

Causes of Transient visual loss?

A

Vascular: TIA/ Migraine

MS

Papilloedema

Subacute glaucoma

46
Q

Causes of gradual visual loss?

A

Common

  • Diabetic retinopathy
  • ARMD
  • Cataracts
  • Open angle glaucoma

Rare

  • Retinitis pigmentosa (night blindness + funnel vision)
  • Hypertension
  • Optic atrophy
47
Q

ARMD?

A

Commonest cause of blindness > 60yrs
- 30% of >75yrs will have dry AMD

Risk factors:

  • Smoking
  • Increased Age
  • Genetic factors

Dry (Geographic atrophy) or Wet (Subretinal Neovascularisation)

48
Q

ARMD Presentation

A

Elderly pts presenting with central visual loss

49
Q

ARMD Types?

A

Dry ARMD: Geographical atrophy:

  • -> Drusen: fluffy white spots around macula
  • -> Degeneration of Macula
  • -> Slow visual decline over 1-2yrs

Wet ARMD: Subretinal neovascularisation

  • Aberrant vessels grow into retina from choroid and lead to haemorrhage
  • Rapid visual decline (Sudden/days/wks) with distortion
  • Fundoscopy shows macular haemorrhage which leads to scarring
  • Amsler grid detects distortion
50
Q

ARMD Ix + Mx?

A

Ix:
OCT - Optical coherence tomography - gives high resolution images of the retina

Mx:

  • -> Dry: wait & see
  • Antioxidant vitamines (C,E) + Zinc may help early ARMD
  • -> Wet: Photodynamic therapy
  • Intravitreal VEGF inhibitors:
  • Bevacizumab (Avastin) –> Not licsenced, very cheap
  • Ranibizumab (Lucentis)
51
Q

What is Tobacco-alcohol amblyopia?

A

Optic atrophy + loss of red/green discrimination/scotoma

Due to toxic effect of cyanide radicals (smoking) when combined with thiamine deficiency

52
Q

Chronic Open angle glaucoma - Pathogenesis + Risk groups

A

Depends on susceptibility of pts retina and optic nerve to increased IOP

  • -> IOP >21mmHg reduced blood flow and damage to optic nerve
  • Optic disk atrophy (Pale) + cupping (increased cup to disk (nerve fibres))
Screen if high risk:
>35 yrs
Afro-caribbean
FH
Drugs: Steroids
Comorbidities: DM, HTN, migraines
Myopia
53
Q

Chronic open angle glaucoma: Ix

A

Ix:

  • tonometry: IOP >21mmHg
  • Fundoscopy: Cupping of optic disc
  • Visual field assessment: Peripheral loss
54
Q

Chronic open angle glaucoma Mx

A

MDT involving optometrists, OT, opthalmologist & general physicians to control co-morbidites
- Life-long f/up

Medical:
Eye drops to reduce IOP to baseline
1)Beta blockers (Timolol/betaxolol) reduce aqueous production
Caution in asthma/ CHF

2) Prostaglandin analogues
Latanoprost, travoprost
–>Increase uveoscleral outflow

3) Alpha agonists
eg. Brimonidine, aproaclonidine
- Reduce aqeuous production + increase uveoscleral outflow

4) Carbonic anhydrase inhibitors
- Acetazolamide PO

5) Miotics : Pilocarpine

Surgical

1) Laser trabeculoplasty
2) Surgery (Trabeculectomy)
- -> In both - new channels allow aqueous to flow into conjunctival bleb

55
Q

Commonest causes of blindness worldwide?

A

Trachoma (contagious bacterial infection of eye)

Cataracts

Glaucoma

Keratomalacia: Vit.A def.

Onchoerciasis

Diabetic retinopathy

IN UK: DM leading cause of blindness up to 60yrs, followed by ARMD in older

56
Q

Pathogenesis of diabetic retinopathy?

A

1) Cataracts: Lens absorbs glucose which is converted to sorbitol by aldose reductase therefore DM accelerates cataract formation

2) Retinopathy
- Microangiopathy leads to occlusion
- Occlusion leads to ischaemia, leading to new retinal vessel formation
- New vessels may bleed (Vitreous haemorrhage) or carry fibrous tissue with them (retinal detachment)
- Occlusion also leads to cotton wool spots (ischaemia)
- Vascular leakage leads to oedema and lipid exudates
- Rupture of microaneurysms: Blot haemorrhage

57
Q

Diabetic retinopathy: Screen & Ix?

A

Screening:

  • All diabetics shoudl be screen annually
  • Fundus photography
  • Refer those with maculopathy, NPDR and PDR to opthalmologist
  • -> 30% with NPDR develop PDR in 1 yr

Ix: Fluoroscein angiography - fluorescein dye injected into bloodstream - dye highlights blood vessels of eye so they can be photographed

58
Q

Diabetic retinopathy: stages & fundoscopy findings?

A

1) Background : Leakge
- Dots: Microaneurysms
- Blot haemorrhages
- Hard exudates

2) Pre-proliferative: Ischaemia
- Cotton wool spots
- Venous beading (best predictor for having proliferative)/ venous loops
- Dark haemorrhages
- Intra-retinal microvascular abnormalities

3) Proliferative
- New vessels
- Pre-retinal/vitreous haemorrhage
- Retinal detachment

(4) Maculopathy)
- -> Caused by macular oedema
- Reduced acuity may be only sign
- Hard exudates w/i one disc width of macula

59
Q

Cranial nerve palsies associated with diabetes?

A

CNIII & VI (occulomotor/abducens)

In diabetes, CNIII palsy - the pupil may be spared as its nerve fibres run peripherally and receive blood from the pial vessels

60
Q

Cataracts Causes + presentation?

A 
Causes:
- Age: 75%>65
- DM
- Steroids
Congenital:
--> Idiopathic
--> Infection: Rubella
--> Metabolic: Wilson's, galactosaemia
--> Myotonic dystrophy

Presentation:

  • Increasing myopia
  • Blurred vision leading to gradual visual loss
  • Dazzling in sunshine/bright lights
  • Monocular diplopia
61
Q

Cataracts Ix

A

Ix

  • Visual acuity
  • Dilated Fundoscopy
  • Tonometry
  • Blood glucose to exclude DM
62
Q

Cataracts Mx

A

Conservative:

  • Glasses
  • Mydriatic drops and sunglasses may give some relief

Surgery:

  • Consider if symptoms affect liftstyle or driving
  • Day case surgery under LA
  • -> Phacoemulsion (US breaks up and sucks up cataract) + lens implant

1% risk of serious complications

  • Anterior uveitis
  • VH
  • Retinal detachment
  • secondary glaucoma
  • Endopthalmitis (leads to blindness in 0.1%)

Post-op capsule thickening is common
–> early treatment with laser capsulotomy

Post-op eye irritation common and requires drops

63
Q

What is Retinitis pigmentosa?

Modes of inheritance?

Associations?

A

Retinitis pigmentosa (RP) is an inherited, degenerative eye disease that causes severe vision impairment due to the progressive degeneration of the rod photoreceptor cells in the retina.

Night blindness + funnel vision

Most prevalent inherited degeneration of the macula. Affects 1/2000

Various modes of inheritance:

  • Mostly AR
  • AD has best prognosis
  • X-linked has worst prognosis

Associations:

  • Friedrich’s ataxia
  • Refsum’s disease
  • Kearns-Sayre syndrome
  • Usher’s syndrome (RP + deafness)
64
Q

Retinitis pigmentosa Presentation & Fundoscopy

A

P/C:

  • Night blindness
  • Decreased visual fields –> Tunnel vision
  • Most are registrable blind (
65
Q

Retinoblastoma

Inheritance + Signs?

A

Commonest intraocular tumour in children 1:15 000

Inheritance:

  • Hereditary/Non-heritary tpyes
  • AD mutation of a RB gene (TSG)

Signs:

  • Stabismus
  • Leukocoria (White pupil) - absent red reflex

Associations:
- Increased risk of soteosarcoma/ rhabdomyosarcoma

Rx:

  • Depends on size
  • Options include chemo, radio, enucleation
66
Q

Blepharitis?

A

Chronic inflammation of eyelid

Causes: Staphs, seborrhoeic dermatits

Features:

  • Red, gritty eyes
  • Scales on lashes
  • Often associated with rosacea

Rx:

  • Clean crusts of lashes with warm soaks
  • May need fusidic acid drops
67
Q

Ptosis causes?

A

True ptosis is intrinsic LPS weakness

Bilateral:

  • Congenital
  • Senile
  • Myastenia gravis
  • Myotonic dystrophy

Unilateral:

  • CN III palsy
  • Horner’s (partial)
  • Mechanical : Xanthelasma, trauma
68
Q

Lagopthalmos?

A

Difficulty in lid closure over whole globe which may lead to exposure keratitis

Causes: Exopthalmos, facial palsy, injury

Rx: Lubricate eyes with liquid paraffin ointment

69
Q

Pinguecula

Pterygium?

A

Benign Yellow vascular nodules either side of cornea

Pterygium is similar but grows over cornea leading to reduced vision.

Associated with dusty wind blown life styles and sun exposure

70
Q

Exopthalmos/proptosis Causes

A

Common:

  • Grave’s: Anti-TSH Abs lead to retro-orbital inflammation & lymphocyte infiltration –> swelling
  • Orbital cellulitis
  • trauma

Other:

  • Idiopathic orbital inflammatory disease
  • Vasculitis: Wegener’s
  • Neoplasm:
  • -> Lymphoma
  • -> Optic glioma assoc with NF-1
  • Capillary haemangioma
  • Mets
  • Carotico-cavernous fistula (may follow carotid aneurysm rupture with reflux of blood into cavernous sinus)
71
Q

Myopia: Problem, Cause, Solution?

A

Short-sightedness:

Problem:

  • Eye too long
  • Distant objects focussed before retina

Causes:

  • Genetic
  • Excessive close work in early decades

Solution
- ConCAVE (for short people)

72
Q

Hypermetropia: Problem, solution?

A

Problem:

  • Eye too short
  • When eye relaxed and non accomodating, objects focused behind retina
  • Contraction of ciliary muscles to focus image may lead to tiredness of gaze and possibly a convergent squint in children

Solution
- Convex lenses

73
Q

Astimagtism: Problem and solution?

A

Problem:

  • Cornea or lens doesn’t have same degree of curvature in both horizontal and vertical planes
  • Image of object is distorted longitudinally or vertically

Solution
Correcting lenses

74
Q

Presbyopia?

A

With age: Lens becomes stiff and less easy to deform & accomodate

  • Starts at 40, complete by 60
  • Use ConVEX lenses
75
Q

Esotropia?

A

Convergent squint

Commonest type in children

May be idiopathic or due to hypermtropia

76
Q

Exotropia?

A

Divergent squint

Older children

Often intermittent

77
Q

Non-paralytic squint: Diagnosis and Management?

A

Diagnosis:

  • Corneal reflection (Hirschburg tes) - should fall centrally and symmetrically on each cornea
  • Cover test: movement of uncovered eye to take up fixation

Mx: 3 O’s

  • Optical: Correct refractive errors
  • Orthoptic: Patching good eye encourages uses of squinting eye
  • Operation: resection and recession of rectus muscles helps alignment and cosmesis
78
Q

Paralytic squint?

A

Diplopia most on looking in direction of pull of paralysed muscle eg. Right medial rectus paralysis, diplopia on looking left

  • Eye WON’T fix on covering
79
Q

CNIII Palsy?

A

Ptosis (LPS)

Fixed dilated pupil (no parasympathetic)

Eyes look DO (Down and out) –> Only muscles still function are superior oblique (down and out) and LR (Out)

Causes:
Medical: DM, MS, infarction
Surgical: Increased ICP, cavernous sinus thrombosis, PCAI

80
Q

CNIV (Trochlear) Palsy

A

SO4 - normally looks down and out

  • Diplopia going down stairs
  • Head tilt to make up for rotation

Test: can’t depress in adduction (when looking out)

Causes:
Peripheral: DM (30%), Trauma (30%), Compression

Central: MS, Vascular, SOL

81
Q

CNVI (Abducens) Palsy

A

LR6 - Normally looks laterally

  • Eye medially deviated and cannot abduct
  • Diplopia in horizontal plane

Causes:

  • Peripheral: DM, Compression, Trauma
  • Central: MS, vascular, SOL

Rx:
- Botulinum toxin can eliminate need for surgery

82
Q

Eye trauma/ Foreign body Mx?

A
  • Record acuity of both eyes
  • Take detailed Hx of event
  • If unable to open injured eye, instil LA (eg. tetracaine 1%)
  • X-ray orbit if metal FB suspected
  • Fluorescein may show corneal abraisions
  • Chloramphenicol drops 0.5% to prevent infection (usually coagulase -ve staph)
  • Eye patch
83
Q

Hyphaema?

A

Blood in anterior chamber

Small amounts clear spontaneously, but may need evacuation.

Complicated by corneal staining/glaucoma (pain)
- Keep IOP low and minitor

84
Q

Orbital blowout facture?

A

BLunt injury - sudden increase in orbital pressure with herniation of orbital contents into maxillary sinus

P/C:
Opthalmoplegia + diplopia: tethering of inferior rectus and inferior oblique

Loss of sensation to lower lid skin: Infraorbital nerve injury

Ipsilateral epistaxis:
- dmg to anterior ethmoidal artery

Fracture reduction and muscle release necessary

85
Q

Floaters causes?

A

Retinal detachment (+ flashes (photopsia)
VH
Diabetic retinopathy
Hypertension
Old retinal branch vein occlusion
Syneresis (Degenerative opacities in vitreous)

86
Q

Haloes?

A

Usually just diffractive phenomena

May be caused by hazy ocular media - cataract, corneal oedema, acute glaucoma

Haloes + eye pain = Acute glaucoma

Jagged haloes which change shape (scintillating scotoma) are usually migrainous

87
Q

Allergic eye disease

A

1) Seasonal allergic conjunctivitis
- Small papillae on tarsal conjunctivae
Mx: Antihistaminedrops/ Cromoglycate (inhibits mast cell degranulation)

2) Perennial allergic conjunctivitis
- same as above

3) Giant papillary conjunctivitis:
- Same as above PC but caused by iatrogenic foreign bodies eg. Contact lenses, prosetheses, sutures

88
Q

Mx of allergic eye disorders?

A

1) remove allergen where possible

2) General measures
- -> Cold compress
- -> Artificial tears
- -> Oral antihistamines eg. loratadine 10mg/d

3) Eye drops
- Antihistamine
- Mast cell stabilisers : Cromoglycate
- Steroids (beware glaucoma)
- NSAIDs : Diclofenac

89
Q

Trachoma?

A

Tropical bacterial eye infection

  • Caused by chlamydia trachomatic
  • Spread by flies
  • Inflammatory reaction under lids –> scarring –> Lid distortion –> Entropion –> Eyelashes scratch cornea –> ulceration –> Blindness

Tx: Tetracycline 1% ointment

90
Q

Onchoceriasis?

A

River blindness

Caused by microfilariae of nematode onchocerca volvulus, spread by flies

Fly bites –> Microfilarieae infection –> Invade eye –> Inflammation & fibrosis –> Corneal opacities

Rx: Ivermectin

91
Q

Xeropthalmia/keratomalacia

A

Vit. A deficiency

P/C
Night blindness + dry conjunctivae (Xerosis)
Corneal ulceration and perofration

Rx: Vitamin A/ palmitate reverses early corneal changes

92
Q

Hypertensive retinopathy classification?

A

Keith-Wagener classification:

1) Tortuosity and silver wiring
2) AV nipping
3) Flame haemorrhages and cotton wool spots
4) Papilloedema

grade 3/4 = malignant hypertension

93
Q

Systemic inflammatory diseases - Conjunctivitis:

A

Conjunctivitis: SLE, Reactive arthritis, IBD

94
Q

Systemic inflammatory diseases - Scleritis/episcleritis?

A

RA

Vasculitis

SLE

IBD

95
Q

Systemic inflammatory diseases - Iritis/anterior uveitis?

A

Ank spond

JIA (ANA +ve)

IBD

Sarcoid

96
Q

Systemic inflammatory diseases - Retinopathy?

A

Dermatomyositis

97
Q

Keratoconjunctivitis Sicca?

A

AKA Sjogren’s (+ dry eyes/mouth)

  • Reduced tear production (Schirmer’s
98
Q

Vascular occlusion

A

Emboli: Amaurosis fugax, GCA, carotid atheroemboli

Microemboli: Roth spots (IE)

99
Q

HIV/AIDS Ocular changes?

A

CMV retinits: Pizza-pie fundus + flames

HIV retinopathy: Cotton wool spots

100
Q

GCA

A

High dose steroids before confirmed Dx based on clinical hx.

Involve rheumatologists with mx

Send bloods like ESR, CRP

Biopsy may miss disease due to skip lesions

101
Q

Homonymous quadrantanopias?

A

•homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)

102
Q

Bitemporal hemianopia?

A
  • 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
103
Q

NPDR new classification?

A

Mild NPDR
•1 or more microaneurysm

Moderate NPDR
•microaneurysms
•blot haemorrhages 
•hard exudates
•cotton wool spots, 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

104
Q

Central vs peripheral visual field loss in elderly?

A
  • Macular degeneration is associated with central field loss

* Primary open-angle glaucoma is associated with peripheral field loss

105
Q

Lens dislocation causes?

A 
Causes
•Marfan's syndrome: upwards
•homocystinuria: downwards
•Ehlers-Danlos syndrome
•trauma
•uveal tumours
•autosomal recessive ectopia lentis

5th year (14 decks)

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