Opthalmology Flashcards

1
Q

Gradual loss of vision: DDx

A
  • Cataract
  • Macular degeneration
  • Diabetic retinopathy
  • Hypertensive retinopathy
  • Chronic glaucoma
  • Optic nerve compression / damage
  • Global - trachoma (chlamydia)
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2
Q

Red eye: DDx

A
  • Glaucoma
  • Conjunctivitis
  • Uveitis
  • Sub conjunctival haemorrhage
  • Corneal abrasion / ulcer
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3
Q

Sudden loss of vision: DDx

A
  • Vitreous haemorrhage
  • Retinal detachment
  • Central retinal artery occlusion
  • Central retinal vein occlusion
  • Temporal arteritis
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4
Q

Optic atrophy (pale optic discs): DDx

A
  • Glaucoma
  • Ischaemia - stroke, vasculitides (temporal arteritis)
  • Inflammation - optic neuritis (MS)
  • Drugs - ethambutol, etoh
  • Tumour compressing optic nerve
  • Congenital aplasia of optuc nerve
  • Hereditary optic neuropathy (Leber’s)
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5
Q

Swollen discs on fundoscopy: DDx

A
  • Papilloedema (optic disc swelling caused by raised ICP)
    • SOL
    • Intracranial bleed
    • Venous sinus thrombisis
    • Aqueductal stenosis
  • Optic atrophy (in acute stage)
    • Glaucoma
    • Ischaemia - stroke, vasculitides (temporal arteritis)
    • Inflammation - optic neuritis (MS)
    • Drugs - ethambutol, etoh
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6
Q

What are the characteristics of diabetic retinopathy on fundoscopy?

A
  • Background: hard exudates, (dots) microaneurysms, blot haemhorrhages
  • Pre-proliferative: cotton wool spots (retinal ischaemia), macular oedema
  • Proliferative: neoangiogenesis

(Meeran)

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7
Q

How is diabetic retinopathy classified based on fundoscopic appearance?

A

Non-proliferative diabetic retinopathy:

  • Mild: Indicated by the presence of at least 1 microaneurysm
  • Moderate: Includes the presence of hemorrhages, microaneurysms, and hard exudates
  • Severe (4-2-1): Characterized by hemorrhages and microaneurysms in 4 quadrants, with venous beading in at least 2 quadrants and intraretinal microvascular abnormalities in at least 1 quadrant

Proliferative diabetic retinopathy:

  • Neovascularization: Hallmark of PDR
    • preretinal hemorrhages, hemorrhage into the vitreous, retinal detachments, macular oedema

(Emedicine)

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8
Q

What are the clinical / fundoscopic stage of macular degeneration?

A
  • Early - macular pigmentary changes, <63um drusen (lipid deposits under retina), normal / near-normal vision
  • Intermediate - 63-125 um drusen
  • Late - >125um drusen, decreased central vision

(BMJ)

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9
Q

Summarise the epidemiology of macular degeneration

A

3rd most common cause of visual impairment

Incidence increases with age

UK Prevalence 2.4% total, 4.8% >65y, 12.2% >80y

(BMJ, UpToDate)

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10
Q

Explain the risk factors of macular degeneration

A

Strong RFS: age, FHx, smoking, cataract surgery

Weak RFs: CV disease, obesity, HTN, genetic

(BMJ)

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11
Q

Identify appropriate investigations for macular degeneration

A

Eye testing: Amsler grid (look at grid, any subjective change? ie distortions or dark areas

Imaging: optical coherence tomography (test for subretinal / intraretinal fluid)

(BMJ)

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12
Q

Generate a management plan for macular degeneration

A
  • Conservative
    • Observation + specialist referral
    • Risk factor modification (stop smoking, balanced diet
  • Medical
    • if intermediate: high dose antioxidant (‘AREDS’ formulation)
    • if severe exudative:
      • intravitreal injection with vascular endothelial growth factor inhibitors
      • thermal laser photocoagulation

(BMJ)

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13
Q

Identify the possible complications of macular degeneration

A

Short: injection-related endopthalmitis / retinal detachement / lens trauma

Long: laser-related photosensitivity, progression of AMD (–> blindness)

(BMJ)

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14
Q

Summarise the prognosis for patients with macular degeneration

A

Morbidity: progression

5y risk of progression 1.3% if early, 18% if intermediate, 43% if severe

(BMJ)

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15
Q

What is glaucoma? What are the different types?

A

Impaired drainage of the aqueous humour through the trabecular network –> build up –> increased intra ocular pressure (not always) –> optic nerve damage

  • Open-angle: normal anatomical angle between the iris and cornea, implying the obstruction to aqueous humour outflow is within the trabecular network. Most common form. –> increased intraocular pressure –> peripheral vision loss, then central vision loss
  • Closed-angle: narrowed angle between the iris and cornea (due to lens pushing forward) impairs aqueous humour drainage into the trabecular network. –> rapid increase in intraocular pressure –> rapid-onset eye pain, eye redness, blurred vision, headaches, nausea
  • Normal-tension: like open-angle glaucoma but with normal intraocular pressure (11-21 mmHg)
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16
Q

Explain the risk factors of glaucoma

A

Open angle

  • Strong RFs: raised intraocular prressure, age>50, FHx glaucoma, black ethnicity
  • Weak RFs: mypopia, DM, HTN

Closed angle:

  • Strong RF: female, hyperopia, shallow peripheral anterior chamber, PMH angle closure glaucoma, asian ethnicity
  • Weak RFs: elderly, FHx, drugs that induce angle narrowing (Local; atropine. Systemic; sulfonamides, phenothiazines)

(BMJ)

17
Q

Identify appropriate investigations for glaucoma

A

Slit lamp examination (look for optic nerve damage)

Tonometry (measure intraoccular pressure)

Optical coherence tomography (of angle + retina, test for angle closure

18
Q

Generate a management plan for glaucoma (closed angle vs open angle)

A

Closed-angle

  • Acute
    • Medical:
      • 1st line: carbonic anhydrase inhibitor (acetazolamide) and/or topical beta-blocker (tomolol drops) and/or topical alpha2-agonist (brimonidine)
          • cholinergic agonist (pilocarpine)
          • hyperosmotic agent (mannitol IV)
      • 2nd line: anterior chamber paracentesis
  • Chronic: laser peripheral iridotomy (alleviates block by allowing aqueous humour to bypass pupil)

Open-angle

  • Acute:
    • Medical:
      • 1st line: topical prostaglandin analogues (lanaprost)
        • or carbonic anhydrase inhibitor / topical beta-blocker / alpha2-agonist (as above)
      • 2nd line: laser trabeculoplasty
    • Surgical:
      • Trabeculectomy or aqueous shunt (create passage for aqueous humour drainage)

(BMJ)

19
Q

Identify the possible complications of glaucoma

A

Short: retinal vein occlusion, fellow eye attack

Long: optic atrophy (peripheral vision loss, then central)

20
Q

Generate a management plan for conjunctivitis

A

Management of infective conjunctivitis

  • Conservative: self-limiting, usually settles w/i 1-2w, take out contact lenses, don’t share towel, school exclusion not necessary
  • Medical:
    • topical chloramphenicol (drops /3h) or topical fusidic acid (in pregnancy, BD)

Management of allergic conjunctivitis

  • topical or systemic antihistamines
  • topical mast-cell stabilisers, e.g. Sodium cromoglicate and nedocromil

(passmedicine)

21
Q

Give causes of a complex opthalmoplegia

A
  • Grave’s disease (exopthalmos)
  • Myasthenia gravis
  • Orbital Guillain-Barre Syndrome (Miller-Fischer Syndrome)
  • Retro-orbital tumour

(Meeran)

22
Q

How is proliferative retinopathy managed?

A

Either

  • Panretinal photocaogulation (laser ablation of periphery to prevent new vessels bleeding into vitreous –> blindness. Preserves macular)

Or

  • anti-VEGF injections (needed regularly, expensive)
  • (Meeran)*
23
Q

What are the main features of Refsum’s Disease?

A

Retinitis pigmentosa + cerebellar ataxia + peripheral neuropathy + rasied CSF protein

+/- anosmia, arrhytmias, ichythosis (fishscale skin)

Onset in young adults

24
Q

What are the fundoscopic characteristics of hypertensive retinopathy? (Graded)

A
  • Grade 1: silver wiring (borderline HTN)
  • Grade 2: AV nipping
  • Grade 3: cotton wool spots + flame haemorrhages
  • Grade 4: papilloedema

(Meeran)

25
Q

Give causes of papilloedema

A
  • SOL
  • Idiopathic intracranial hypertension
  • Malignant hypertension
  • Hydrocephalus
  • Hypercapnoea

(passmedicine)