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3B > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is keratitis?

A

Corneal inflammation

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2
Q

What are the causes of keratitis and their respective treatments?

A
  • Viral: HSV (dendritic shape when use fluorescein) - topical acyclovir
  • Bacterial: s.aureus/pseudomonas - abx drops
  • Trauma/foreign body: remove after topical analegesics
  • Allergic ‘marginal keratitis’
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3
Q

What are corneal abrasions and how do you treat them?

A

Corneal abrasions are small scratches on the cornea (causing a gritty feeling, in a red eye with photophobia)
Rx: topical abx erythromycin and NSAIDs

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4
Q

How do corneal ulcers present?

A

Extreme pain, squinting, reduced vision, increased tears

+/- anterior uveitis signs - miosis, aqueous flare and redness

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5
Q

How would you dx corneal ulcers?

A

Slit lamp with fluorescein dye

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6
Q

How do you treat corneal ulcers?

A

Remove infective cause - abx
(G+ve - chloramphenicol // G-ve - ofloxacin)
- Patch/bandage contact lens as aggrevated by dryness
- If not healing they may need surgical debridement

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7
Q

What is glaucoma?

A

Optic neuropathy due to raised IOP

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8
Q

Define acute-closed angle glaucoma

A

when the anterior angle of the anterior chamber narrows causing a sudden increase in IOP

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9
Q

How does scleritis present?

A

Very painful red eye
Headache, photophobia
Generalised inflammation of the sclera with oedema of the conjunctiva
Scleral thinning - makes it look blue
Non-blanching with cotton bud/phenylephrine

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10
Q

50% of people with scleritis have systemic disease.

Give examples of the systemic diseases

A
  • Sjogrens
  • Ra
  • Wegeners (granulomatosis with polyangitis)
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11
Q

How do you treat scleritis?

A

Reduced the inflammation
PO prednisolone
- If they have systemic disease you can use methotrexate/azathioprine or rituximab

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12
Q

What is the urea made up of?

A

Iris
Ciliary body
Choroid

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13
Q

What diseases is anterior uveitis associated with?

A

AI diseases - ank spondylitis, IBD, reactive arthritis

JIA in children

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14
Q

How might the presentation of anterior uveitis differ from ACAG?

A

AU - may have an irregular constricted pupil
Less hazy cornea
Ciliary flush

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15
Q

How do you treat anterior uveitis?

A

Steroid drops

0.5%-1% prednisolone drops

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16
Q

How would you treat a bacterial cause of conjunctivitis?

A

Chloramphenicol drops

or fusidic acid drops

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17
Q

How would you treat a chlamydial infection of the conjunctiva/trachoma?

A

PO Azithromycin

18
Q

What is keratitis usually caused by?

A

HSV

19
Q

What is the key feature of viral keratitis?

A

Dendritic ulcers that stain with fluorescein

20
Q

How do you treat viral keratitis?

A

Topical aciclovir

21
Q

What are some of the causes of corneal ulcers?

A 
Inflam: vasculitis/RA 
Infective: 
B 
V - HSV/varicella 
F - candida/aspergillus 
Parasites
22
Q

How do you treat acute closed angle glaucoma

A

M:
1) T BB = timolol
2) T carbonic anhydrase inhibitors = acetazolamide
3) Pilocarpine (miosis - constriction of pupil)
4) IV mannitol (osmotic diuresis)
S: lazer iridotomy

23
Q

How do you investigate acute closed angle glaucoma?

A

1) Gonioscopy
2) Slit lamp (shallow anterior chamber)
3) Static perimetry (look for visual field loss)

24
Q

Describe diabetic retinopathy

A

Retinal disease due to progressive diabetic microvascular leakage (loss of pericytes) + occlusion (due to endothelial cell damage, RBC changes and increased platelet stickiness)

25
Q

How do you treat diabetic retinopathy?

A

Intravitreal anti-VEGF (ranibizumab + afilbercept)

Macular laser therapy

Pan retinal photocoagulation

26
Q

How do you screen for chronic open angle glaucoma

A

1) Tomometry - IOP
2) Perimetry - visual field defect
3) Fundoscopy - Disc/cupping

27
Q

Give an example of a topical carbonic anhydrase inhibitor

A

T carbonic anhydrase inhibitors
= acetazolamide
or dozolamine

28
Q

How does retinal detachment present?

A 
4F's 
Flashing lights 
Floaters 
Field loss 
Fall in acuity

‘A dense shadow that starts peripherally and progressed towards the centre of vision.’

29
Q

Give some causes of painless sudden loss of vision

A

Ischaemic optic neuropathy
Occlusion of central retinal artery/vein
Viterous haemorrhage
Retinal detachment

30
Q

How can retinal detachment be treated?

A

With lazer photocoagulation therapy

- vitrectomy + gas tamponade

31
Q

What is a vitreous haemorrhage?

A

Its the extravasation of blood into areas around the vitreous humour of the eye
Bleeding into the vitreous humour

32
Q

Give some of the common underlying causes of vitreous haemorrhage

A
  • Proliferative diabetic retinopathy
  • Posterior vitreous detachment
  • Ocular trauma
  • Neovascular age-related macular degeneration
33
Q

How would you examine someone with vitreous haemorrhage?

A

Measure:

  • Intraocular pressures + Visual acuity
  • Dilated fundoscopy
  • Slit lamp - would show blood in the anterior vitreous
  • Gonioscopy ? new vessels in the angular drainage?
  • USS
  • Orbital CT
34
Q

Management of vitreous haemorrhage

A

Urgent referral to ophthalmology

  • X retinal detachment - bed rest with head up
  • Laser photocoagulation
  • Anterior retinal cryotherapy
35
Q

What are the fundoscopy signs of primary open-angle glaucoma?

A

1) Optic disc cupping
2) Optic disc pallor
3) Bayonetting of vessels (vessels have breaks as they disappear into the cup and reappear at the base)
4) Disc haemorrhages

36
Q

What would you see on fundoscopy with papilloedema?

A 
Venous engorgement 
Loss of venous pulsation 
Blurring of the optic disc margin 
Elevation of optic disc 
Loss of optic cup
37
Q

Give some RF for age-related macular degeneration

A

Advancing age
Smoking
FHx
Others: ischaemic CVD - HTN, DM and high cholesterol

38
Q

How does age-related macular degeneration present?

A

Reduction in visual acuity - near things
Difficulties in dark adaptation
Fluctuations in visual disturbance
- Photopsia = perception of flickering/flashing lights

39
Q

What investigations do you do with ARMD?

A
  • slit lamp microscopy

- Fluorescein angiography (for neovascular ARMD and can guide the anti-VEGF rx)

40
Q

How do you treat dry ARMD?

A

Zinc with anti-oxidant vitamins A, C, E (reduce the progression of disease in 1/3rd)

41
Q

How do you treat wet ARMD?

A

1) Anti-Vascular endothelial GF (VEGF) - intravitreal injections
= Ranibizumab / afilbercept

2) Laser photocoagulation

3B (21 decks)

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