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Final > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Opthalmoscopy: what must you do first.

  • what kind of agent
  • warning
  • C.I.
A

Dilate the pupil with parasympathomimetic (Tropicamide - lasts for 20 min - 12h)

Warn about driving as affects ciliary muscles inhibiting accommodation for near vision

Head injury (require pupil reflex)

Risk of closed angle glaucoma

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2
Q

4 C of normal Optic disc

A

Colour - yellow/orange

Contour - well defined, flat

Cup - small depression in centre of optic disc. less than 0.5 of disc diameter. No vessels or nerve fibres

Circulation - not tortuous, not attenuated (reduced)

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3
Q

What is red reflex

A

reflection from orange retina

Sign of cataract or central tumour

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4
Q

Pale disc?

A

optic atrophy - prev damage to nerve

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5
Q

Elevated/swollen disc

A

papilloedema

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6
Q

Large cup

A

If over 50% of dis diameter -> chronic glaucoma

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7
Q

Attenuated (reduced vessels)

A

Central retinal artery occlusion

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8
Q

What is the optic disc?

A

The blind spot.

This is point of entry of BV and Optic nerve

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9
Q

What is Macula and Fovea

A

Area where visual acuity is the highest. Just temporal to Optic disc. No vessels.

Centre is Fovea - Just Cone (colour and acuity) receptors

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10
Q

Retina

  • What
  • abnormal signs
A

Layer at the back of eyeball with photoreceptors

Haemorrhages, Exudates, Drusen (lipid deposits), Scarring, Retinitis Pigmentosa (loss of photoreceptors - black deposits)

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11
Q

Signs of vascular disease in Retina

A

Flame haemorrhages: superficial (Retinal vein occlusion)

Blot haemorrhages: deeper (Diabetic)

Dot haemorrhage: micro aneurysms (Diabetic)

Preretinal (boat shaped) haemorrhages (Diabetic, SAH)

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12
Q

Hard Vs Soft exudate

A

Hard (true exudate) = leakage of fluid into retina

Soft = micro infarcts & cotton wool spots (fluffy/white)

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13
Q

What are drusen

A

Lipid deposits - Pale, Round, Grey spots seen at the macula

Seen in elderly, age related macula degeneration

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14
Q

What is retinitis Pigmentosa?

What is seen

A

Inherited retinal degeneration, spidery black pigmentation in peripheral retina

Tunnel vision and night blindness

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15
Q

Scotoma (relative & absolute)

Quadra/Hemianopia

A

Scotoma = blind spot

  • Relative = decrease
  • Absolute = total

Quarter loss /
Half loss

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16
Q

What is meant my congruity?

A

How well formed the shape of the defect is. gets better closer to visual cortex

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17
Q

Bitemporal hemianopia

  • Cause
  • diagnosis
A

compression of the optic chiasm

upper more than lower = pituitary tumour

lower more than upper = craniopharyngioma

Remember this as UP London City

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18
Q

Homonymous quadrantanopia

A

superior homonymous quadrantanopia = lesion in temporal lobe

inferior homonymous quadrantanopia = lesion in the parietal lobe

PITS - parietal inferior temporal superior

incongruous = optic tract

congruous = the optic radiation/cortex

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19
Q

Homonymous hemianopia (ssam e.g. left field in both eyes)

A

Brain lesion (Bleed or tumour) on Contralateral side to lesion

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20
Q

Central scotoma

A

Lesion in Optic nerve -> Optic neuritis

e.g demyelination in MS, toxins like methyl-alcohol

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21
Q

What is slit lamp for

A

Visualising Anterior segment of eye (vitreous body/lens)

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22
Q

Slit lamp signs

A

Flare = inflammation

Cells in vitreous (tobacco dust) = retinal tear

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23
Q

Outer layer of eye

A

Cornea over lens, sclera over rest

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24
Q

Anterior segment

  • where
  • what humor
A

Anterior to lens

Contains aqueous humor

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25
Q

Posterior segment

  • where
  • layers
  • Humor
A

Behind lens

Sclera (outer), choroid, Retina

Vitreous humour

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26
Q

What adjusts the lens

A

Ciliary muscles and fibres

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27
Q

What is Macula and fovea.

A

Macula is thickest part of retina with high conc of cones (c for colour)

Small depression in centre of macula

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28
Q

Photoreceptor types

A

Cones: Colour vision and acuity, central retina

Rods: night vision, outer retina

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29
Q

Referral for:

  • Sudden loss of vision
  • Sudden diplopia
  • Gradual loss of vision
A

Urgent telephone to Opthal for sudden acute changes

Gradual = optometrist

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30
Q

Cause of Gradual visual loss

A

Cataract, Glaucoma, Age-related Macula degeneration (chronic + degenerative)

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31
Q

What is used for visual acuity

A

Snellen chart

  • Do test at 6m
  • Top line is what can be done at 60m (6/60 if can read)

second from bottom is what should be read at 6m. This is aim (6/6)

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32
Q

White discolourations of pupil?

A

Cataract

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33
Q

What is cataract

RF

A

Clouding in lens. progressive

Aging, Downs, sunlight, smoking

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34
Q

Job of lens

A

Accommodation to focus vision

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35
Q

Presentation of Cataract

A 
Change in vision 
- Myopia (short-sightedness)
- Blurred vision
- glare
- double vison
- poor vision in bright light
- Loss of colour vision
Changing astigmatism
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36
Q

Cataract surgery

  • when
  • anaesthesia
  • what is done
A

Opacity impacts everyday life

Local

Lens is remover through small incision and intaocular lens inserted

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37
Q

Cataract surgery complications

A

Vitreous prolapse/rupture

Intraocular haemorrhage

Post-op: inflammation, lens dislocation, infection

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38
Q

What is the optic ‘angle’

A

Space between the posterior surface of cornea and anterior surface of Iris (coloured bit) where aqueous humour leaves the eye

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39
Q

Glaucoma classifications

  • angle
  • cause
  • onset
A

Open Vs closed angle

Primary Vs Secondary

Acute Vs Chronic

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40
Q

Aqueous production + function

  • note don’t confuse with vitreous
A

Made by the ciliary body

Circulates and nourishes lens

Leaves via angle and enters episcleral veins

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41
Q

Intra-ocular pressure

A

Balance between aqueous production and drainage

normal 21mmHg

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42
Q

Chronic open angle glaucoma (most common glaucoma)

  • def
  • type of visual loss
A

Chronic, progressive changes in optic nerve causing visual field loss

Peripheral loss (Tunnel vision)

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43
Q

Triad of signs/sympt in Glaucoma

A

1) Raised IOP - over 21mmHg (Eye ache)
2) Abnormal disc (inc cup, haemorrhage, loss of neurones)
3) VF defect (tunnel)

Chronic may be asymptomatic

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44
Q

Chronic open angle glaucoma pathophys

A

alteration of trabecular meshwork in angle impairing outflow of aqueous

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45
Q

Chronic open angle glaucoma RF

A 
Age over 40
Afro-Caribbean 
FH 
Steroids
Vascular disease (HTN, DM. Thought to be possible cause for trabecular dysfunction)
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46
Q

Optic disc in Chronic open angle glaucoma

A

Severe cupping of optic disc (over 0.5 of optic disc)

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47
Q

Vision loss in Chronic open angle glaucoma.

  • Pattern
  • When
A

Progressive into tunnel pattern of vision

Asymptomatic/Acuity preserved until late.

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48
Q

Screening methods for Chronic open angle glaucoma

A

IOP - inc (using tonometry)

VF testing - reduced

Fundoscopy - cupping

All 3 to reduce false +ve rate

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49
Q

Chronic open angle glaucoma management (*note, observe is done 1st)

A

Drops:

  • PG analogues (latanoprost) 1st line
  • Beta block (timolol)

Laser therapy (target ciliary body)

Surgical trabeculaectomy

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50
Q

Management strategy in Chronic open angle Glaucoma

A

Counsel (life long Tx, driving)

Target 20% reduced IOP

PG agonist/BB 1st line

Review 6 weekly

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51
Q

Prostagalndin analogue mechanism

A

Increase trabecular (uveoscleral) outflow

E.G Latanoprost

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52
Q

Beta blocker mechanism

A

Decrease aqueous prod by blocking symp fibres in Ciliary body

E.G Timolol

SE: bradycard, hypotension, bronchospasm

CI: Heart block, COPD, Asthma

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53
Q

Carbonic anhydrase inhibitors mechanism

A

Decrease aqueous production

E.G: Dorzolamide

CI: renal & liver failure

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54
Q

Age related macular degeneration types

A

Retinal atrophy (dry) - slow progression/deterioration ATROPHIC

New vessel growth under Retina (wet) - fast degeneration NEOVASCULARISATION

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55
Q

What does visual acuity rely on

A

1) Functional photoreceptors (Rods/cones)
2) Healthy retinal pigment epithelium
3) Perfusion of Choroid (capillary layer)

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56
Q

What is 1st sign of Age related macular degeneration & what is it

A

Drusen

Lipid waste material from photoreceptors accumulating in and below Retinal Pigment Epithelium (white deposits)

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57
Q

Dry AMD

  • Features
  • Progression
A

Ophthalmoscope: Atrophy of retinal pigment epithelium (can see choroidal arteries underlying)

Visual field loss: central scotoma, preserved peripheral vision

Frequently deteriorate, Require vision aids

Not much can be done to Tx

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58
Q

Wet AMD

  • Features
  • Management
A

Opthalmoscope:

  • Leaking vessels below retina
  • Exudates, haemorrhages and scarring

Visual Field loss

  • localised retinal detachment = distorted central vision
  • eventual central scotoma

Intravitreal anti-TNF-beta, anti-VEGF

59
Q

Age related macular degeneration RF

A

sunlight, smoking, older, fam Hx

STOP SMOKING!!!

60
Q

Sudden visual loss causes

A

Tend to be

Vascular:

  • Branch/Central retinal artery/vein occlusion
  • Anterior ischemic optic neuropathy

Inflammatory:
- Optic neuritis (multiple sclerosis)

Retinal detachment

61
Q

Blood supply to eye

A

From internal carotid and also middle meningeal

Opthalmic artery is branch of internal carotid. Central retinal comes off this

62
Q

Branch and Central retinal artery occlusion

  • Presentation
  • Cause
  • Management
A

Sudden total loss of vision (central) or loss of top/bottom half (branch)

Relative afferent pupil defect (Marcus Gunn - swinging flashlight)

Embolic (carotid atheroma, cardiac origin)
GCA
Thrombophilic conditions

Cant be improved. Secondary prevent: aspirin, smoking, HTN, Cholesterol, AF

63
Q

Branch and Central retinal artery occlusion Opthalmoscopy

A

Embolus visible at optic disc

Thin (attenuated) Retinal arteries

Retinal oedema (pallor temporal to disc)

After 3 months disc becomes pale (necrosis)

64
Q

Investigation retinal emboli

A

Carotid doppler (stenosis over 70% needs stent)

Fasting serum lipids (cholesterol)

± Clotting screen, CT head

65
Q

Transient monocular visual loss =

Pres

Investigate

Tx

A

Amaurosis Fugax (ocular TIA)

Curtain over vision for around 30 mins

Carotid doppler, USS

Aspirin, Clopidogrel

66
Q

Micro-aneurysm complication

Tx of microaneurysm and management of complication

A

vitreal leak = reduced vision

Laser around margin, investigate source: HTN, emboli

Watch/wait, vitrectomy (remove vitreous from eye)

67
Q

Branch retinal vein occlusion

  • Pres
  • Cause
  • Opthalmoscope
A

Sudden Visual blurring, Visual field defect (blood leak)

Athero, HTN, DM, Smoking, Thrombophilias

Flame haemorrhages, leaking veins.
Arteries are INTACT

68
Q

Branch retinal vein occlusion Tx

A

Laser photocoagulation

Minimally invasive destroy/seal leaking blood vessels in retina (esp helpful if neovascularisation - can destroy)

69
Q

Causes of intravitreal haemorrhage

A

Retinal vein (branch/central) occlusion, Diabetic retinopathy, juxtafoveal telangiectasia, Microaneurysm/Macroaneurysm

70
Q

Central retinal vein occlusion

  • Presentation (symptoms)
  • Opthalmoscopy (signs)
  • Prognosis
A

Mild/Severe loss of vision
Marcus-Gunn pupil, Rubeosis (neovascularisation of the iris)

Flame haemorrhages, Swollen optic disc, dilated/tortuous veins, blot haemorrhages, macular oedema

1/3 progress to retinal ischaemia

71
Q

Rubeosis def + causes

A

Neovascularisation on iris

Diabetic retinopathy, CRVO, ocular ischaemia, retinal detachment
Immediate

AGGRESSIVE PRP (panretinal photocoagulation) +/- vitrectomy

72
Q

Anterior ischaemic optic neuropathy

  • Assoc
  • Presentation
  • Investigations
  • Fundoscopy
  • Treatment
A

GCA

Sudden onset profound loss of vision ± Marcus-Gunn

ESR, CRP, FBC (may want biopsy of temporal artery if GCA suspected as cause)

Pale, swollen optic disc

High dose steroids

73
Q

Optic neuritis:

  • Assoc
  • Ophthalmoscopy
  • Recovery
A

Multiple sclerosis

May appear normal
Swollen, hyperaemic optic nerve (excess blood vessels)

Spontaneous 6-8 weeks recovery (Steroid Tx may speed recovery)

74
Q

Retinal detachment

  • pathophys
  • cause
  • presentation
  • treatment
A

Potential space between photoreceptors and retinal epithelium fills with fluid causing detachment

Normally due to retinal tear.

Flashes, Floaters, field loss

Requires surgery to stop complete detachment

75
Q

Causes of retinopathy

A

HTN

DM

76
Q

HTN retinopathy on ophthalmoscopy (Think what high BP will do)

A

Microinfarct (cotton wool spots)

Arteriovenous nipping (vein disappears under artery)

Flame/blot haemorrhage

Microaneurysms

Exudate

Papilloedema (disc swelling)

77
Q

Malignant HTN retinopathy

A

Microinfarct

Tortuous veins

Hyperaemic, swollen disc

Elsching’s spots (choroidal infarct)

Macular exudate star

78
Q

Accelerated/malignant HTN

- Causes

A

Exacerbated essential HTN
Renal artery stenosis
Phaeo, Cushing’s, Conns

79
Q

Accelerated/malignant HTN

  • Causes of poor vision
  • Treatment complications
A

Acute optic nerve damage
Macular oedema
Retinal artery closure
Choroidal detachment

dropping BP too fast = ischaemic neuropathy + blindness

80
Q

Flame Vs Blot haemorrhages

A

Haemorrhages are flame or blot shaped depending on depth in retina

81
Q

Diabetic retinopathy

  • def
  • pathology
A

The retinal consequences of microvascular leaked and occlusion

hyperglycaemia = inc viscosity of blood, loss of antithrombogenic endothelium = ischaemia/thrombus

Pericyte loss/damage by hyperglycaemia = capillary leakage

Ischaemia = inc VEGF promoting novasc, inc capillary permeability (Proliferative Diabetic retinopathy = sight threatening)

82
Q

Diabetic retinopathy RFs

A 
Poor glycemic control
HTN
Carotid stenosis
Pregnancy
Renal disease
Anaemia
83
Q

Diabetic retinopathy

  • symptoms
  • signs
A

Dark blots in vision (moderate disease)
Blurred vision
Floaters
Vision loss

Microaneurysms (seen in mild)
Cotton wool spots, lipid exudates (moderate)
Retinal haemorrhages (flame/dot/blot)

Proliferative DR: Neovascularisation of retina/optic disc.

84
Q

Proliferative Diabetic retinopathy pathophys

A

Neovascularisation of retina or optic disc.

New vessel fragile and prone to haemorrhage -> sudden vision loss

Inc in fibrosis -> retinal detachment vision loss

85
Q

What causes cotton wool spots

A

Poor perfusion/ischaemia

86
Q

How is severity rate in DR

A

Number of quadrants affected

Is there intra-retinal bleeding (none in mild - just micro aneurysms)

87
Q

HTN retinopathy

- Triad

A

1) High BP
2) Visual disturbance
3) optic disc swelling/piplloedema

88
Q

Diabetic retinopathy Tx

A
  • Anti-VEGF (ranibizumab_
  • Macular laser therapy (burns/reduces leaking BV under the macula)
  • Pan-retinal Photocoagulation therapy (controlled destruction of retina)
89
Q

Screening in Diabetic retinopathy

A

Onset over 30 -screen 5 yearly

Onset under 30 screen annually

90
Q

Red eye Red flag

A

Impaired vision
Pain/Photophobia
Lack of ocular discharge

91
Q

Red eye causes over view:

A

Inflammation:

  • sclera: scleritis
  • intraocular: uveitis

Intraocular infection: Endopthalmitis

Raised IOP: Acute Glaucoma

92
Q

Blephritis

  • Pres
  • Signs
  • Tx
A

Gritty, irritable eyes
Watery discharge
Foreign body sensation eyelid

Loss of eyelashes, poor tear film, notched upper lid, ingrowing eyelash

Lubrincants (poor tear film), lid hygiene and topical Abx if needed

93
Q

Stye Vs Chalazion

Tx

A

Granuloma of Meibomian glands (hard non-tender)

Infected lash follicle = Stye (red, tender)

Hot spoon bathing

94
Q

Herpes Zoster (shingles) Opthalmaticus

  • Pathophys
  • Signs
  • Tx
A

Opthalmic division of trigeminal.

If tip of nose affected normally so is eye (nasocilliary nerve)

Severe corral inflammation, clouding and thinning

Oral&Topical Acyclovir

95
Q

What can cause Conjuctivitis?

A

Infection: Viral, Bacterial.

Allergy

Chemical irritation (pH imbalance)

96
Q

Symptoms of Conjuctivitis

A

Red eye, swollen lid.

Discharge

  • Watery: viral, allergic
  • Purulent: bacterial
97
Q

Conjuctivitis

  • Viral cause
  • Bacterial cause
  • Neonatal potential cause
  • Allergic causes
A

Adenovirus commonly

Staph, Strep

Chlamydial (risk chlamydial pneumonitis)

Topical NSAID/Steroids, Eye drops

98
Q

Treatment of Bacterial Conjuctivitis

A

Chloramphenicol eye drops

Fusidic acid

99
Q

Chlamydia Conjuctivitis

  • Complication
  • Tx
A

Corneal scarring - blindness

Neonates - birth
Adults - unwashed hands

Systemic erythromycin

100
Q

Opthalmia neonatorum:

  • Def
  • Causes
A

Defined as conjunctivitis in first 3 weeks of life (from birth canal)

Chlamydia
Gonorrhoea
S-Aureus
Herpes simplex

101
Q

Chronic conjuncatavitis

Assoc with?
Risk of?
Tx?

A

Atopy

Corneal ulceration

Topical steroids

102
Q

Corneal disorders

A

Trauma
Infective (Viral, Bacterial)
Allergic

103
Q

Corneal infection (Keratitis)

  • Viral cause + signs + tx
  • Bacterial cause and signs + tx
A

Herpes simplex, foreign body sensation, watery discharge, Topical acyclovir

Staph/Pseudomonas, Red eye, Loss of vision, hazy cornea, Specialist Tx with intense ABx

104
Q

What makes up the Uvea?

A

Iris
Ciliary body
Choroid

105
Q

Anterior Uveitis: Assoc diseases

A

Seroneg (HLAB27) arthropathies

  • IBD
  • Psoriatic
  • Ankylosing Spondylitis

Sarcoidosis, Syphilis, Behcet’s (vasculitis)

106
Q

Anterior Uveitis

  • Pres
  • clinical signs
  • What should be checked for
A

Acute & Unilateral
Pain
Red eye
Photophobia

Small pupil
Normal/Decreased acuity
Intense redness of globe

Systemic dises: Joint, Chest (sarcoid), skin disease symptoms

107
Q

Episcleritis:

  • where is this
  • pres
  • Tx
A

Vascular layer between sclera and conjunctiva

Irritation/localised redness, no discharge/LOV

NSAIDs helpful

108
Q

Scleritis

  • Assoc
  • Pres
A

Rare and serious assoc with vasculitis & RA (thinning of sclera -> blue)

Very painful
Assoc with LOV

109
Q

Acute angle-closure glaucoma

  • Who
  • Sign
  • Pres
A

Often elderly, Female, Long-sighted

Very high IOP

Unilateral, Painful, Red eye, Profuse LOV, Photophobia
Nausea + vomiting

110
Q

Normal Aqueous flow

A

Aq prod n ciliary body and flows between lens/iris through pupil into anterior chamber

Leaves eye at angle to canal of Schlemm through trabecular meshwork

111
Q

Acute angle-closure glaucoma mechanism

A

If pupil is dilated (e.g. dark room) Iris is pushed against the cornea and angle closes

Rapid build up of pressure

In long sighted, the lens shape pre-desposes to Acute angle-closure glaucoma (impairs Aq flow out of pupil)

112
Q

Acute angle-closure glaucoma symptoms

A

Very red eye
Corneal oedema
Mid-dilated pupil
Poor vision

113
Q 
Very red eye
Corneal oedema
Mid-dilated pupil
Poor vision
 investigations
A

Gonioscopy (examination anterior angle) - trabecular meshwork not visible

Slit-lamp - shallow anterior chamber, signs of glaucoma (large cup + nerve fibre loss)

114
Q

Acute angle-closure glaucoma

A

1) lower pressure: Topical carbonic anhydrase inhibitors (acteazolamide)/Beta-blockers (Timolol)
2) Constrict pupil: colinergic agonists - Pilocarpine
3) Prevent recur: laser surgery to provide bypass

115
Q

Discharge Ddx:

  • Watery eye
  • Purulent/mucus
  • Bloody
A

Inc lacrimation (foreign body in cornea), blocked tear duct

Infection, allergy

Severe infection, Tumour

116
Q

Severe pain Ddx

A

Acute glaucoma
Scleritis

May also be seen in migraine, cluster headache

117
Q

Vision loss Ddx (always serious)

Transient
Profoud
Rapid
Slow
Central
Peripheral
Loss colour
Bilateral
A 
Transient:
Retinal emoli (Amourosis fugax)

Profound:
GCA

Rapid:
Vascular (haemorrhage), Retinal detachment

Slow:
Dry macular degeneration

Central:
Optic nerve disease (neuritis in MS), DR

Peripheral:
Glaucoma, CVD

Loss of colour:
Optic neuritis

Bilateral:
Glaucoma

118
Q

What serious eye diseases are asymptomatic in early stages

A

Chronic glaucoma

Diabetic retinopathy

HTN

Papilloedema

119
Q

What controls pupil size (muscle, ANS)

A

Constrict:

  • Sphincter pupillae muscle
  • CN3
  • parasympathetic tone controls size

Dilate:

  • Dilator pupillae
  • sympathetic nNS
120
Q

Small pupil (Miosis) causes

A

Opiates, pontine haemorrhage, topical pilocarpine (pressure - glaucoma)

121
Q

Mydriasis (dilated pupils) causes

A

Sympathomimetics (amphetamine, cocaine), anticholinergics, topical mydriatics

122
Q

What is Horner’s triad

Causes

A

Miosis (constriction), Anhidrosis, partial ptosis

Brainstem: stroke, carotid dissection

Pancoast’s tumours

123
Q

What is seen in CNIII palsy

Causes

A

Large pupil
Ptosis
Down and out eye

Aneurysm to posterior communicating artery, uncle herniation post truma - send for neurosurgical review

124
Q

Eye + Pupil in acute glaucoma

A

Bilateral large pupils and red eyes

125
Q

Pupil in anterior uveitis

A

small in affected eye and red eye

pupil can become unreactive and stuck to lens

126
Q

Pupil 3 reflexes

A

Light: constrict/miosis

Dark: dilate/mydriasis

Near: Miosis, accommodation (ciliary focusing of lens)

127
Q

Normal light response

R optic nerve problem (afferent: retina -> brain)

A

Shine light into R. Both pupils constrict. R by direct. L by consensual

Neither pupil responds when affected eye stimulated. Both pupils respond when light shone into L.

128
Q

Marcus-Gunn pupil

What is it?
Underlying cause?

A

Relative afferent pupillary defect

Swinging flashlight test. When shone in normal eye both will constrict (efferent pathways fine), when shone in affected eye (afferent lesion) there is dilation

Partial injury to one optic nerve caused by large retinal lesions (detachment, central artery/vein occlusion optic neuritis, advanced glaucoma

129
Q

Causes of central scotoma

A

Macular disease
Optic neuritis
Optic nerve ischaemia (GCA - part of optic nerve loses blood supply

130
Q

Visual field loss in glaucoma

A

1) nasal and peripheral

2) tunnel vision as superior and inferior defects join

131
Q

Chiasmal compression visual field

A

Bitemporal hemianopia

Pituitary - from below = upper field affected more

Craniopharyngioma - compress from above = lower quadrantanopia

132
Q

PITS

A

Parietal lesion = inferior quadrantanopia

Temporal lesion = superior quadrantanopia

133
Q

Horizontal conjugation

How is this achieved

What can cause intranuclear ophthalmoplegia

A

Communication between CNIII and CNVI means allows confluent horizontal gaze

Via medial longitudinal fasicululus (jerky nystagmus if damaged)

134
Q

Retinitis pigmentosa:

What is it?
Pres
Onset

Management

A

Hereditory, progressive dystrophy of photoreceptors in retina

Ring scotoma, night vision problems. central vision is spared until late

Onset 10-30yrs

Manage to slow progress

  • refer to Opthal
  • DVLA inform
  • Acetazolomide (oral carbonic anhydrase inhibition’s) + Beta Carotene
135
Q

Dry eyes:

Causes

A

Aging

Medication (diuretics, antidep, antihist, beta blockers)

Systemic illness (RA, SLE, Sjogren’s - hyposecretive)

Increased evaporation (low humidity, low blink rate, allergic conjunctivitis)

136
Q

Treatment of dry eyes

A

Artificial tears

137
Q

When to inform DVLA

A

Decreased acuity
1st unprovoked seizure (6M), Serious head injury (1M)
TIA (3M), ACS/CABG 1M

138
Q

Causes of sudden painless vision loss:

flashes of light or floaters

sudden visual loss, dark spots, Cheese and Tomato Pizza look

afferent pupillary defect, ‘cherry red’ spot on a pale retina

severe retinal haemorrhages are usually seen on fundoscopy

A

retinal detachment

vitreal haemorrhage

central retinal vein occlusion

central retinal artery occlusion

Other causes: Ischemic optic neuritis (atherosclerosis, GCA),

139
Q

Open angle glaucoma Vs Closed angle Glaucoma

A

In open angle the iris is clear of the trabecular meshwork, in closed angle it is over the meshwork (e.g. when pupil is dilated)

140
Q

Anterior Uveitis

  • Onset
  • what is felt
  • visual efects
  • pupil
A

acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush

141
Q

Sudden Red painful eye, Dilated pupil

What is likely diagnosis

A

Acute angle closure glaucoma

142
Q

What is Pilocarpine and what are SE

A

Miotic (pupil constrictor)

Constricted pupil, headache and blurred vision

143
Q

What is Prostitutes pupil?

A

Argyll Roberston

Neurosyphilis giving a constricted pupil (non-reactive to light)

Also seen in Diabetic neuropathy

Final (26 decks)

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