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Finals > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Types of strabismus

A

Paralytic: CN3, CN4 or CN6
Convergent = esotropia, most common in children
Divergent = exotropia, in older children, often intermittent

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2
Q

Complication of esotropic squint

A

Brain suppresses deviated image and pathway may not develop

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3
Q

Diagnosis of strabismus - 2

A

Corneal reflection - should be symmetrical

Cover test - squinting eye will move to take up fixation when normal eye is covered

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4
Q

Management of strabismus - 3

A

Optical - determine refractory state with cyclopentolate, and check for any abnormalities. Give glasses to correct refractory error
Orthoptic - patch good eye
Operation - on rectus muscles to align, or botulinum toxin

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5
Q

Appearance of CN3 palsy and causes

A

CN3 - cavernous sinus lesion, diabetes, posterior communicating artery aneurysm
Complete ptosis and down and out, fixed and dilated (unless diabetes or htn when pupil is spared)

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6
Q

Appearance of CN4 palsy and causes

A

Diplopia, head tilted - ocular torticolis
Look up in adduction and cannot look down and in
Caused by trauma, diabetes or tumour

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7
Q

Appearance of CN6 palsy and causes

A

Diplopia
Medically deviated and cannot move laterally
Caused by tumour increasing ICP and compressing nerve on edge of petrous temporal bone, trauma to base of skull, diabetes

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8
Q

3 requirements for good outcomes with strabismus

A

<7yo
Conscientious and disciplined treatment
Optimal glasses

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9
Q

Pupil reflex pathway

A

Optic nerve afferent - oculomotor nerve efferent

SNS pupil dilatation via ciliary nerves

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10
Q

Cause of afferent defects - 3

A

Optic neuritis
Optic atrophy
Retinal disease

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11
Q

Causes of fixed dilated pupil - 5

A 
CN3 palsy
Trauma
Myriatics
Acute glaucoma
Coning
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12
Q

Condition causing delayed response to light

A

Tonic (Adie) pupil - lack of parasympathetic innervation. Initially uni then bilateral

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13
Q

What is Horner’s syndrome

A

Disrupted sympathetic fibres
Miotic pupil with no dilation in the dark
Partial ptosis
Anhydrosis

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14
Q

Causes of Horner’s syndrome - 6

A 
Posterior inferior cerebellar artery occlusion 
MS
Pancoast’s tumour
Hypothalamus lesion
Mediastinal mass
Aortic aneurysm
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15
Q

Cause of bilateral miosis and other features

A

Argyll Robertson pupil - neurosyphilis and diabetes

Bilateral miosis, poor pupil dilatation, pupil irregularity

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16
Q

2 features that determine refraction in eye

A

Distance between cornea and retina

Curvature of lens and cornea

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17
Q

Pathophysiology of myopia and treatment

A

Short sighted - eyeball long, so closer to eye = focus further back and on retina
Concave glasses

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18
Q

Pathophysiology of hypermetropia and treatment

A

Long sighted - eyeball short so distant objects focus behind retina
Ciliary muscles contract to make lens more convex, which makes tiredness and convergent squint
Treat with convex glasses

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19
Q

What is astigmatism

A

Irrregularly shaped cornea

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20
Q

What is the age related sight change

A

Presbyopia - lens stiffens so ciliary muscles cannot reduce tension in it and make it more convex

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21
Q

When to get help in sudden loss of vision - 3

A

Retinal artery occlusion <6h
Visual loss <6h unknown cause
GCA

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22
Q

5 questions in sudden vision loss

A

HELLP
Headache - ESR for GCA
Eye movements hurt - optic neuritis
Like a curtain - amaurosis fugax precedes vision loss from GCA/emboli
Lights/flashes - detached retina
Poorly controlled DM - vitreous haemorrhage

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23
Q

Optic neuropathies - what and 4 signs

A

Damage to optic nerve:
Monocular vision loss with central scotoma
Afferent pupillary defect
Dyschromatopsia
Papillitis then optic atrophy on fundoscope (pale disc)

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24
Q

2 causes of optic neuropathy

A

GCA

Anterior ischaemic optic neuropathy - inflammation or atheroma block posterior vascular supply

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25
Q

What is GCA

A

Medium to large vessel vasculitis
Associated with polymyalgia rheumatica,
Mostly women >50
Sx - headache, malaise, jaw claudication, tender scalp
Eye - amaurosis fugax, blurring, dipolopia
Monocular visual loss

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26
Q

Management GCA

A

High ESR and CRP
FBC - anaemia, thrombocytopoenia
High dose prednisolone
USS, biopsy temporal artery within 1w of starting steroids - may miss as skip lesions

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27
Q

What is optic neuritis and 3 causes and treatment

A

Subacute loss of unilateral vision over hours to days
Afferent defect, pain on movement and dyschromatopsia
Caused by diabetes, syphilis, often first presentation of MS
Treat with high dose methylprednisolone then prednisolone

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28
Q

4 causes of transient vision loss

A

Vascular - microemboli from atherosclerotic plaque in heart or carotid arteries
MS
Subacute glaucoma
Papilloedema

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29
Q

Form of stroke affecting eye and initial investigations

A

Central retinal artery occlusion = sudden vision loss. Afferent pupil defect presents before retinal change (white with red spot)
Look for thromboembolic source - atherosclerosis, AF, DM, smoking, carotid bruit

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30
Q

Manage central retinal artery occlusion

A

Stroke protocol

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31
Q

3 causes of sudden loss of vision in 1 eye

A

Migraine
Acute glaucoma
Retinal detachment

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32
Q

RF for retinal vein occlusion - 5

A 
Arteriosclerosis
BP
Diabetes
Polycythaemia
Glaucoma
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33
Q

Mechanism of visual loss in retinal vein occlusion

A

Thrombosed = visual loss due to ischaemia and macular oedema

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34
Q

Different types of retinal vein occlusion

A

Central - painless blurred vision, at level of optic nerve. Ischaemic or non-ischaemic
Branch - asymptomatic if macula not affected

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35
Q

Manage retinal vein occlusion

A

Manage complications - retina neovascularisation (more likely to haemorrhage) and chronic macular oedema
Intravitreal anti-VEGF if vision loss

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36
Q

Causes of vitreous haemorrhage - 4

A

Retinal neovascularisation - DM, CRVO, BRVO
Retinal tear
Retinal detachment
Trauma

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37
Q

Sx of vitreous haemorrhage

A 
Vitreous floaters (black dots)
No red reflex if large, retina may not be seen
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38
Q

Investigate VH and treat

A

B-scan US for course

Normally undergoes spontaneous absorption, or vitrectomy if dense or torn/detached retina

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39
Q

7 causes of gradual vision loss

A 
Diabetic retinopathy
Cataracts
Macular degeneration
Glaucoma
Hypertension
Optic atrophy
Slow retinal detachment
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40
Q

Biggest cause of vision loss

A

Age related macular degeneration

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41
Q

Pathophysiology of macular degeneration

A

Pigment, drusen and bleeding into macula. Over time, progresses to retinal atrophy and central retinal degeneration which causes a loss of central vision

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42
Q

Risk factors for ARMD - 5

A 
Family history
Age
Smoking
CVD
Cataract surgery
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43
Q

What are drusen? Appearance on fundoscopy

A

Optic nerve head axonal degeneration
= intracellular mitochondrial calcification
= some rupture and extruded into extracellular space, depositing calcium,
and drusen form
Optic disc edge irregular with lumpy yellow matter
No optic cup
Vessels have abnormal branching patterns

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44
Q

2 types of ARMD

A

Wet - exudative - choroidal neovascularisation membranes develop and leak fluid and blood = scar. Vision deterioration and distortion.
Dry - non-exudative - slow progressive visual loss from drusen and macular changes

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45
Q

Manage dry ARMD

A

Prevention

Antioxidant vitamins

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46
Q

Manage wet ARMD

A

Fluorescein angiogram then 4-6w reviews
Intravitreal anti-VEGF decreases cell proliferation and blood vessel formation and leak
Laser photocoagulation if specific signs
Intravitreal steroids

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47
Q

3 causes of optic atrophy and sign on opthalmoscope

A

Pale disc
RIOP in glaucoma
Retinal damage - choroiditis, retinitis pigementosa
Ischaemia in retinal artery occlusion

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48
Q

Causes of choroidoretinitis

A

Granulomatous reaction from toxoplasmosis, TB, sarcoidosis

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49
Q

What is glaucoma?

A

Optic neuropathy with death of many retinal ganglion cells and optic nerve axons

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50
Q

RF for glaucoma

A 
RIOP
Black race
Family history
Age
Hypertension and diabetes
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51
Q

Why screen for glaucoma

A

Not symptomatic until visual fields severely impaired

Lifelong follow up in RIOP

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52
Q

Diagnosis of glaucoma

A

Intraocular pressure using tonometry
Central corneal thickness
Visual field measurement
Optic nerve assessment with fundus examination
Cup:disc ratio reduced as loss of disc substance

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53
Q

Who to screen for glaucoma - 5

A 
>35yo
Family history
Afro-Caribbean 
Myopia 
Diabetic/thyroid eye disease
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54
Q

Drug treatment for glaucoma

A

Increase uveoscleral outflow with prostaglandin analogues, a-adrenergic agonist and miotics (pilocarpine)
Decrease aqueous production with b blockers, a-adrenergic agonists and carbonic anhydrase inhibitors

Sympathomimetics - caution in htn, heart diseases or closed angle glaucoma

Laser therapy increase aqueous outflow to decrease IOP
Trabeculectomy

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55
Q

What are cataracts ?

A

Opacity in the lens, leading cause of blindness

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56
Q

RF for cataracts

A 
Age
Smoking, alcohol, sunlight
Trauma
Radiation 
HIV+
Earlier in:
Genetic
Diabetes
Steroids
High myopia
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57
Q

Classifying cataracts

A

Opthalmoscopic lens appearance

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58
Q

Presentation of cataracts - 4 adult, 4 children

A

Often unnoticed if unilateral, but can lose distance judgement
Blurred, gradual painless loss of vision
Dazzle in light and haloes at night
Monocular diplopia
Children: white pupil, squint, nystagmus, amblyopia

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59
Q

Manage cataracts and disadvantages

A

Mydriatic drops, or surgery to remove cataract and replace with artificial lens (LA or GA)
Likely to still have glare, may need distance glasses, often have macular degeneration too which limits outcome

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60
Q

Care after cataract surgery and 7 post op complications

A

Antibiotics and anti-inflammatory drops for 3-6w, and change glasses
Eye irritation - require altered drops/lubricant
Post-op posterior capsule thickening/opacification - may need capsulotomy with laser
Astigmatism more noticed, correct during surgery if noticed in pre-op biometry
Enopthalmitis, anterior uveitis
Vitreous haemorrhage, retinal detachment, glaucoma (+- permanent vision loss)

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61
Q

Prevention for cataracts - 3

A

Sunglasses to decrease UV-B
Reduce oxidative stress (antioxidants eg vitamin c, caffeine)
Stop smoking

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62
Q

When to operate on congenital cataracts and why, and what else to do

A

<6w in the latent period of visual development to prevent significant deprivation amblyopia
Do TORCH screen

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63
Q

What is TORCH

A

Infection screen in newborns:

Toxoplamosis, Rubella, Cmv, Herpes, HIV

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64
Q

Structure of the retina

A

Outer pigmented layer in contact with choroid
Inner sensory layer in contact with vitreous
Macula at centre of posterior part

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65
Q

Causes of retinal detachment and other risk factor

A

Trauma: tear - fluid from vitreous space into subretinal space, between sensory and outer pigmented epithelium
Exudative: vasculitis, macular degeneration, hypertension, tumour, cause retina to detach without tear
Tractional: proliferative retinopathy pulls on retina.
Higher myopia = higher risk

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66
Q

Presentation of retinal detachment, and on opthalmoscope

A

Painless
4 Fs:
Floaters
Flashes
Field loss
Fall in acuity - like curtain Falling
Field defect indicates position and extent of detachment (superior detachment = inferior field loss)
Central vision loss = macular pulled off - doesn’t always recover
Ballooning grey opalescent retina on opthalmoscope

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67
Q

Prognostic factors in retinal detachment

A

Site and extent
Time to definitive treatment
Cause of underlying pathology

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68
Q

Differentials for retinal detachment - 4

A

Retinal artery occlusion
Posterior vitreous detachment
Vitreous haemorrhage
Migraine

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69
Q

Management of retinal detachment and rate of recurrence - 4

A

Rest - lie flat if superior detachment, or 30 degrees up if inferior
Laser photocoagulation therapy
Urgent surgery - retinopexy, vitrectomy and gas tamponade, with scleral silicone implants
Cryotherapy or laser coagulation secures retina
5-10% recurrence post-op

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70
Q

What is retinitis pigmentosa

A

Inherited degeneration in the retina

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71
Q

Presentation of retinitis pigementosa

A

Night blindness, then peripheral and central daytime vision loss
Complete blindness in late stages when photoreceptors affected

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72
Q

Common causes of floaters - 3

A

RBCs - new vessels form on retina can lead to vitreous haemorrhage, trauma, retinal detachment
WBCs - posterior choroiditis
Tumour seeding - melanoma or retinoblastoma

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73
Q

Manage floaters

A

Urgent referral as may be retinal detachment

Examine vitreous and retina and treat cause

74
Q

Cause of flashing lights

A

Intraocular or cerebral in response to mechanical tissue disturbance

75
Q

What is posterior vitreous detachment and sx

A

Degenerative changes in vitreous cause separation from retina
Monochromatic photopsia in peripheral temporal fields, more obvious in dim light and eye movements
Vision unchanged, no field defects, increase in floaters

76
Q

Caution in posterior vitreous detachmen

A

Fundus check as retinal tears can happen as a consequence

77
Q

Structure of macula

A

Lateral to optic disc

Fovea is a pit in the middle, and in the middle of this is foveola where cones are narrow, long and densely packed

78
Q

Key role of macula

A

Visual acuity

79
Q

Wha can cause blurred and distorted central vision, in relation to macula

A

Macular hole - break in macular region of retinal tissue, affecting fovia
>55yo
15% chance of another in other eye

80
Q

Cause of macular hole - 4

A

Age related reduction in water in vitreous, causing traction on retinal tissue
High myopia
Trauma
Retinal detachment

81
Q

Macular hole on exam

A

Tiny punched out area in centre of macula
Yellow-white deposits at base
Grey halo of detached retina surrounds it

82
Q

Test for macular disease

A

Amsler grid reveals distortion
Optical coherence tomography diagnoses and stages holes
Fluorescein differentiates macular hole from cystoid macular oedema

83
Q

Treat macular hole

A

Vitreo-retinal surgeon
Surgery - vitrectomy removes vitreous and internal limiting membrane over hole is peeled. Air bubble provides tamponade to macula back into position
1-2w post-op face down

84
Q

Complications of macular hole - 3

A

Cataracts
Retinal detachment
Widening of hole

85
Q

What is vascular retinopathy

A

Arteriopathic - AV nipping - arteries nip veins where they cross as they share CT sheath
Or
Hypertensive - arteriolar vasoconstriction causes superficial retinal infarction, causing cotton wool spots and flame haemorrhages. These can leak to cause hard exudates, macular oedema and papilloedema

86
Q

Eye signs with infective endocarditis

A

Roth spots - retinal infarcts

87
Q

Wilson’s disease eye sign

A

Keyser-Fleischer ring

88
Q

Hyper and hypothyroid eye sign

A 
Myxoedema = eyelid and periorbital oedema = exophalmos
Hypothyroid = lens opacity
89
Q

Eye sign with hyperparathyroidism

A

Corneal and conjunctival calcification

90
Q

Sore eyes in gout?

A

Monosodium urate deposits in conjunctiva

91
Q

Systemic causes of uveitis

A

Granulomatous diseases - TB, sarcoid, toxoplasmosis

92
Q

Systemic causes of choroidoretinitis

A

TB, sarcoid, toxoplasmosis, syphilis, CMV

93
Q

Sarcoid eye signs

A

Uveitis, choroidoretinitis

CN palsy and lacrimal gland swelling

94
Q

Eye signs of collagen/vasculitic diseases

A

Conjunctivitis - SLE and reactive arthritis
Episcleritis - SLE and polyarteritis nodosa
Scleritis - RA
Uveitis - Ank spond and reactive arthritis
Orbital oedema and heliotrope rash with retinal haemorrhages - dermatomyositis

95
Q

SLE eye signs

A

Conjunctivitis and episcleritis

96
Q

RA eye signs

A

Scleritis

97
Q

Ank spond eye signs

A

Anterior uveitis

98
Q

Reactive arthritis eye signs

A

Conjunctivitis, uveitis

99
Q

Dermatomyositis eye signs

A

Orbital oedema
Retinal haemorrhages
Heliotrope rash

100
Q

Sjögren’s syndrome eye and mouth complications and test, and manage

A

Keratoconjunctivitis sicca
Reduced tear formation with Schirmer filter paper test, causing gritty feeling - give pilocarpine and ciclosporin if moderate/severe
Decreased salivation = dry mouth (xerostomia)

101
Q

Main eye risk with HIV and treat

A

CMV retinitis
Retinal spots and flame haemorrhages
Asymptomatic or blindness
IV ganciclovir

102
Q

Cotton wool spots in HIV? And 2 other HIV complications

A

HIV retinopathy - microvasculopathy not retinitis
Candidiasis of aqueous and vitreous
Kaposi’s sarcoma on lids or conjunctiva

103
Q

Causes of retinopathy - 9

A 
Vascular eg hypertensive 
Metabolic eg diabetes or thyroid 
Granulomatous disease eg sarcoid or TB
Vasculitic eg SLE
Sjogren’s
Radiation
Carotid artery disease
Central or branch retinal vein occlusion
Retinal telangiectasia/Coat’s disease
104
Q

Eye changes in pregnancy - 7

A

Corneal sensitivity decreased
Lid pigmentation
Reduced tear production
Reduced IOP - good if glaucoma
Reduced AI activity - good if AI disease
Retinopathy - DM gets worse, proliferative changes
Pre-eclampsia - blurred, scotoma, photopsia, diplopia
Occlusive vascular disorders - hypercoagulable so higher risk of retinal vein or artery occlusion

105
Q

Why screen for DM retinopathy in DM patients?

A

Not symptomatic until advanced disease when little can be done

106
Q

2 structural eye changes in diabetes

A

Ocular ischaemia - new blood vessel formation, can block drainage of aqueous - cause glaucoma
Age related cataracts form faster

107
Q

Vascular pathogenesis in diabetes in eye

A

Microangiopathy in capillaries:

  • vascular occlusion causes ischaemia and new vessel formation (proliferative)
  • retraction of fibrous tissue makes retinal detachment more likely
  • occlusion causes ischaemia of nerve fibres and cotton wool spots
  • microaneurysms cause oedema and hard exudates. Rupture at nerve fibre level cause flame haemorrhages, or blot haemorrhages when deep in retina
108
Q

Classification of diabetic retinopathy - 3

A

Non-proliferative: microaneursms, haemorrhages (flame or blots), hard exudates (yellow patches)
- significant ischaemia = engorged torturous veins, cotton wool spots, large blot haemorrhages

Proliferative: neovascularisation on optic disc and retina, can cause vitreous haemorrhages

Maculopathy: oedema from vessels near macula threaten vision

109
Q

Screening for diabetic retinopathy

A

At diagnosis, every year

With dilated fundus photography

110
Q

6 things that accelerate retinopathy in diabetes

A 
Pregnancy
Raised BP
Dyslipidaemia
Renal disease
Smoking
Anaemia
111
Q

Manage diabetic retinopathy - 4

A

Lower BP to <140/80 or <130/80 if end organ damage
Glycaemic control
Photocoagulation by laser for maculopathy and proliferative retinopathy, surgical review if pre-proliferative or haemorrhages
Anti-VEGF drugs for macular oedema

112
Q

When to refer with maculopathy - 3

A

Exudate or retinal thickening in optic disc
Exudates in macula
Microaneurysm or haemorrhage near centre of fovea with poor visual acuity

113
Q

Causes of optic disc swelling

A 
Papilloedema
Malignant hypertension
SOL
Cavernous sinus thrombosis
Optic neuritis
Central vein occlusion
Opaque myelinated nerve fibres
114
Q

Examining optic disc - 3 features

A

3Cs
Colour (pink/yellow with pale centre)
Contour
Cup (1/3 of disc diameter) - wider and deeper in glaucoma

115
Q

Papilloedema associated features and investigate

A

Bilateral, from RICP. Present due to other features eg NV, headache
Also CN11 palsy and transient visual obscurations
Inv: MRI for SOL, LP for opening pressure and CSF analysis, BP/haemorrhages

116
Q

What is pseudopapilloedema

A

Disc margins blurred, disc appears elevated
Benign, associated with hypermetropia and astigmatism
No true oedema and veins normal and pulsate

117
Q

Papilloedema appearance

A

Discs swollen forward and outwards into surrounding retina
Disc margins hidden
Retinal vessels congested or concealed from oedema impairing translucency

118
Q

Assess neuroretinal rim?

A 
Pale = optic atrophy
Fuzzy = swollen disc
119
Q

Considering drug applications to eye- 6

A 
Drops not retained as long as ointment, apply /2h
5m between doses to prevent overspill
Ointment good for night
Don’t use for >1 month 
Consider manual dexterity
120
Q

Antibiotics for eyes?

A

Chloramphenicol, fusidic acid, neomycin

121
Q

Drug for pupil dilation?

A

Mydriatics = cycloplegics - for dilating pupil and paralysing ciliary muscle, so blurred vision
Prevent adhesion formation in anterior uveitis
Can dilate for exam, lasts 3h

122
Q

Drug for acute glaucoma?

A

Miotics - constrict pupil and increased drainage of aqueous, for acute glaucoma

123
Q

Examine painful eye?

A

Local anaesthetic for examining painful eye with blepharospasm

124
Q

Use of steroids and NSAIDs drops

A

Inflammation, under opthamologist guidance
For allergy, episcleritis, scleritis, iritis
Increase IOP so can precipitate glaucoma
Can induce progression of dendritic ulcer - checkwith slit lamp first

125
Q

Drugs that can cause:

  • dry eye
  • corneal deposits
  • lens opacity
A

Dry eye - b blocker, anticholinergics, any eye drops
Corneal deposits - amiodarone, chlorpromazine
Lens opacity - steroids

126
Q

Drugs that cause glaucoma or papilloedema

A

Glaucoma - steroid drops, mydriatics, anticholinergics (tricyclics, Parkinson’s)
Papilloedema - steroids, OCP, tetracyclines

127
Q

Drugs that cause retinopathy

A

Ethambutol
Isoniazid
Chloroquine

128
Q

ADR of pilocarpine - 6

A 
Parasympathetic sweating
Brow-ache from spasm
Urinary frequency
BP increase
Palpitations
Visual disturbance
129
Q

Infection causing entropion

A

Chlamydia trachomatis causes scarring of inner eye lids, damaging cornea, then distortion eyelids, so lashes ulcerate cornea

130
Q

Signs on exam for allergic conjunctivitis, and treatments

A

Small papillae on tarsal conjunctiva

Antihistamine and mast cell stabiliser drops

131
Q

Allergic eye disease that threatens vision?

A

Atopic keratoconjunctivitis - severe pain redness and reduced vision
Causes conjunctival papillae and scarring, and eventually corneal opacification and neovascularisation
Associated with atopic dermatitis

132
Q

Conjunctivitis from foreign body? and treatment

A

Giant papillary conjunctivitis

Remove and treat with topical mast cell stabilisers or steroids

133
Q

Managing allergic eye disorders

A
  1. Remove allergen
  2. General - artificial tears, cold compress, oral antihistamines
  3. Drops - antihistamines, mast cell stabiliser (inhibit degranulation), steroids, NSAIDs
134
Q

Advantage of eye drops? - 2

A

Rapid action

Fewer SEs as topical

135
Q

3 complications from contact lenses

A

Keratoconjunctivitis
Giant papillary conjunctivitis
Pseudomonas infection

136
Q

Causes of dry eyes and test

A

= keratoconjunctivitis sicca
Reduced tear production:
- by lacrimal glands in old age
- Sjogren’s
- sarcoidosis, amyloidosis
Excess evaporation (exposure) or mucin deficiency
Schirmer’s test - strip of filter paper put overlapping lower lid, tears should soak >15mm in 5 mins

137
Q

Categories of watery eyes - 3

A
  1. Decreased drainage - punctal stenosis/obstruction or canaliculitis
  2. Increased lacrimation - environment, injury
  3. Pump failure - positive and negative pressure changes in lacrimal sac on blinking suck tears in. Entropion, ectropion or CNS cause (myasthenia, CN7 palsy)
138
Q

Signs of retinoblastoma - 3

A

Strabismus
Leukocoria
No red reflex

139
Q

Retinoblastoma inheritance

A

Aut dom with 80% penetrance

RB gene is tumour suppressor gene

140
Q

Complications of retinoblastoma extra-ocular

A

Secondary malignancies - osteosarcoma, rhabdomyosarocma

141
Q

Manage retinoblastoma

A

Chemotherapy, if bilateral
Radiotherapy: external beam radiotherapy or brachytherapy
Cryotherapy and thermotherapy if small
Enucleation if large, long standing retina detachment, optic nerve invasion or extra-scleral extension

142
Q

Vision 6:24 what does it mean

A

Acuity: they see at 6m what normal person can see at 24m

143
Q

What is accommodation

A

Change of lens shape for distance vision using ciliary muscles

144
Q

Dye in eye and what for

A

Fluorescein - blue, yellow when touches eye, so defect on epithelium looks green

145
Q

5 top causes of blindness in developed country

A

ARMD, glaucoma, cataracts, diabetic retinopathy, refractive error

146
Q

Orbital vs pre-septal cellulitis

A

Orbital - behind orbital septum

Preseptum in front of orbital septum

147
Q

Manage orbital cellulitis

A

Cephalosporins flucloxacilin, metronidazole

CT of orbits

148
Q

Carotico-cavernous fistula?

A

Carotid artery rupture causes reflux of blood into cavernous sinus
Pulsatile exophthalmos with bruit and eye vessel engorgement

149
Q

Causes of relative afferent pupillary defect - 3

A

Optic neuritis
Retinal disease
Optic atrophy

150
Q

4 causes of Horner’s syndrome

A

PICA
MS
Cavernous sinus thrombosis
Pancoast tumour

151
Q

Late sign in cataracts

A

Loss of red reflex

152
Q

Sx of cataracts 4

A

Glare
Diplopia
Lack of colour appreciation
Reduced acuity

153
Q

3 types of cataract

A 
Nuclear sclerotic (myopic)
Cortical
Posterior subcapsular (diabetes, steroids)
154
Q

Early complications of cataracts surgery 5

A 
Anterior inflammation (give steroid drops)
Endophthalmitis (sight threatening)
Corneal oedema
Iris prolapse
Wound leak
155
Q

3 late complications of cataracts surgery

A

Posterior capsule opacification (laser surgery)
Cystoid macular oedema
Retinal detachment

156
Q

IOP in open angle glaucoma

A

Raised in primary open angle glaucoma

Can be normal

157
Q

Sx of glaucoma

A

Asymptomatic, late sign loses peripheral vision

158
Q

RF for glaucoma - 4

A

Family
Afrocaribbean
Diabetes/thyroid eye disease
Myopia

159
Q

Investigate glaucoma

A

Goldmann visual field tests - nasal and superior fields lost, then arcuate scotoma
Optic cupping

160
Q

Manage glaucoma - 6

A

Prostaglandin analogue - increase outflow
A adrendergic agonist - increase outflow
B blockers - reduce aqueous production
Carbonic anhydrase - reduce aqueous production
Miotic - reduce resistance
Trabeculostomy/trabeculectomy

161
Q

5 questions for red eye

A 
Vision loss
Pain
Distribution of redness
Discharge and type
Photophobia
162
Q

Sx and treat corneal abrasion

A

Pain, photophobia

Chloramphenicol

163
Q

Ulcer of cornea management

A

Smear, scrape, gram stain

Chloramphenicol and cyclopentolate drops

164
Q

3 types of corneal ulcer

A

Bacterial
Herpetic
Fungal

165
Q

Manage acute closed angle glaucoma

A 
Admit
Lie supine for 1h and limit fluid intake 
Acetazolamide IV then PO 
Pilocarpine
Surgery
166
Q

Sx of scleritis

A

Conjunctival oedema
Deep scleral injection
Pain not relieved by NSAIDs

167
Q

Scleritis bloods

A

ANCA ANA ESR

168
Q

Treat scleritis

A

PO steroid

Immunosuppression

169
Q

Episcleritis sx and manage

A

Dull ache
Tender eye
Redness localised to one area
PO or topical NSAIDs

170
Q

Pus or blood in anterior chamber and association

A

Pus - hypopyon - anterior uveitis

Blood - hyphaema

171
Q

Chronic or advanced anterior uveitis sx

A

Adv - hypopyon

Chronic - synechiae - adhesions

172
Q

Manage ant uveitis 3

A

Steroid drops
Cyclopentolate
Rheum referral

173
Q

inv central retinal vein occlusion

A

RAPD
IOP
Gonloscopy
Bloods

174
Q

Central retinal vein occlusion sx and 2 types

A

Sudden painless loss of vision - metamoprphia

Ischaemic or non ischaemic

175
Q

Manage CRVO - 2

A

Anti VEGF

Laser to make more ischaemic

176
Q

Central retinal artery occlusion sx and sign in exam

A

Sudden painless loss of vision
Cherry red spot as macula spared
Associated with atherosclerosis

177
Q

2 manage CRAO

A

Ocular massage and anterior chamber paracentesis

178
Q

2 Risk factors or retinal detachment

A

Aphakia or pseudophakia

Myopia

179
Q

Chemical injury of eye - which is worse

A

Alkali - liquefactive necrosis - can continue to track through eye
Acid - coagulative necrosis makes a barrier

180
Q

Manage of chemical injury in eye - 5

A 
Irrigate
Topical steroids
Chloramphenicol 
Cyclopentolate
Vitamin a if limbus ischaemia

Finals (13 decks)

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