Opthalmology Flashcards
Symptoms of acute angle closure glaucoma
Pain Headache Blurred vision Halo around light Nausea Red eye Unreactive pupil Increased intraocular pressure
Symptoms of a blowout fracture
Fractured orbital floor
Upward gaze palsy
Diplopia on upward gaze
Causes of sudden loss of vision
Retinal artery occlusion Retinal vein occlusion Amaurosis fugax Migraine Episcleritis Optic neuritis Retinal detachment
Normal intra-ocular pressure
10-21mm/Hg
Diabetes is a risk factor for which eye diseases
Cataracts glaucoma Retinal vein occlusion Diabetic retinopathy Pre-proliferative retinopathy Maculopathy 3rd N palsy
What is aniscoria
Unequal pupil size
What is presbyopia
Refractive error due to failure of accommodation with age
What is myopia
Short sightedness (long eyeball)
What is hypermetropia
Long sightedness (short eyeball)
What is astigmatism
Variation in corneal curvature
What are mydriatics
Act to dilate the pupils
Tropicamide = short acting
Cyclopentolate = long acting
What are miotic agents
Contstrict pupils
- pilocarpine
What is schirmer’s test
Rate at which strip of paper suspended from lower eyelid is wetted by tears
What is Sjögren’s syndrome
Systemic autoimmune disease
Immune cells attack exocrine glands that produce tears and saliva
Do pupils change time with age
Yes - become smaller
Signs + symptoms of Horner’s syndrome
Miosis Ptosis Absence of sweating Enopthalmos Bloodshot conjunctiva (Distinguish peripheral and central lesions by instilling1% cocaine)
What is retinoblastoma
Mutation in Rb-1 on long arm of c.13 Autosomal dominant Rapidly developing cancer Increased risk of extra-retinal cancer 95% cure by surgery
What eye condition is a common complication of child birth
Subconjunctival haemorrhage
High pressure –> burst vessels in conjunctiva
No tx needed
Symptoms of viral conjunctivitis
Watery eye
Itch
Pink eye
Often associated with URTI or cold
What is ophthalmia neonatorum
Bacterial conjunctivitis contracted by newborns during vaginal delivery.
Caused by N. gonorrhoea or chlamydia
Can cause blindness
What is hypopion
Pus In anterior chamber of eye
Symptoms of keratitis
Infection and inflammation of cornea Pain Redness Discharge Photophobia Foreign body sensation Tearing Burred vision Decreased visual acuity Corneal erosion
What is dacryoadenitis
Inflammation of lacrimal glands
Swelling eyelid
Pain
Excess tears
What is trichiasis
Abnormally positioned eyelashes that grow backward into the eye
–> irritation, red, watery eye
Reiters syndrome triad
Reactive arthritis
Urethritis
Conjunctivitis
What is ulcerative keratitis
A corneal ulcer
Infection involving disruption of the epithelium
What is episcleritis
Irritation + inflammation of the episclera
May be associated with RA, SLE, IBD, HSV, gout
Characteristics of diabetic retinopathy
Hard exudates
Microaneurysms
New vessel formation
Causes of cataracts
Diabetes Hypoparathyroidism Blunt injury Steroids Eczema myotonic dystrophy Galactosaemia Congenital toxoplasmosis Wilson's disease
What is scleritis
Serious inflammatory disease affecting the sclera
Occurs in SLE, RA, wergeners granulomatosis
Symptoms of retinal detachment
Photopsia (flashes of light) Sudden dramatic increase in floaters Dense shadow progressing from periphery Straight lines appear curved Central loss of vision
Symptoms of acute angle closure glaucoma
Sudden onset eye pain Red eye Decreased visual acuity Halo around lights Like looking through frosted glass Vomiting
Features of primary open angle glaucoma
Asymptomatic
Peripheral visual field loss
Cupped optic disc
Chronic angle closure glaucoma symptoms and signs
Un-noticed visual loss
Increased or normal IOP
Cupped optic disc
Risk factors for retinal vein occlusion
Glaucoma Hypertension Diabetes Haematological disorders Systemic inflammatory conditions
Common syx and signs of retinal vein occlusion
Sudden painless loss of vision
Flame haemorrhage
Cotton wool spots
Swollen optic disc
Risk factors for retinal artery occlusion
Emboli from carotid or heart valve
Thrombosis
Arteritis
Symptoms and signs of retinal artery occlusion
Sudden painless loss of vision Curtain coming down Pale oedematous retina Cherry red spots on macula Narrowed arteries White emboli
Symptoms of anterior uveitis
Photophobia Red eye Watery eye Lacrimation Miosis Blurred vision
Causes of anterior uveitis
Herpes simplex Herpes zoster RA ankylosing spondylitis Sarcoidosis Behçet's disease
Commonest cause of blindness in <65yo
Diabetic eye disease
What is thrombotic ischaemia
A severe form of secondary glaucoma.
= Neovascular glaucoma due to new vessel formation in angle of anterior chamber.
Occurs in DM - proliferative retinopathy
Treatment of an acute attack of angle closed glaucoma
Acetazolomide
Features of background diabetic retinopathy
Capillary Microaneurysm (dot)
blot haemorrhage
hard exudate
Features of pre-proliferative diabetic retinopathy
Capillary Microaneurysm (dot) blot haemorrhage hard exudate AND Venous haemorrhages Cotton wool spots (soft exudates)
Features of proliferative diabetic retinopathy
New vessels (neovascularisation) - thin walls, prone to rupturing Fibrosis
Plus all other features - dot and blot haemorrhages, hard and soft exudates
Features of diabetic maculopathy
Hard exudates involving the macula
Presentation of retinal detachment
Visual floaters
Reduced visual acuity
Visual loss like a curtain coming across
What is an oculogyric crisis
Dystonic reaction Often associated with drugs Presents with restlessness, agitation, confusion Fixed upward deviation Of the eyes \+/- fixed flexion deformity of the neck \+/- open mouth and protruding tongue
When do flame shaped retinal haemorrhages occur
Hypertensive retinopathy
microvascular abnormalities associated with Hypertension on Funduscopy
arterial narrowing (copper or silver wiring),
arteriovenous nipping
Flame shaped haemorrhage
Malignant hypertension: hard exudates appear as a 'macular star' (thin white streaks radiating around the macula), disc swelling, cotton wool spots, flame haemorrhages arterial or venous occlusions
What is a Scotcoma
Visual field defect surrounded by normal vision
A lesion atthe optic nerve produces what visual field defect
Monocular visual field loss
Lesion at the optic chiasm produces what visual field defect
Bitemporal hemianopia
A lesion of the right optic tract produces what visual field defect
Left homonymous hemianopia
Confusion at the temporal radiation produces what visual field defect
Homonymous upper quadrantinopia
Lesion at the parietal radiation produces what visual field defect
Lower homonymous quadrantinopia
A lesion at the occipital pole produces what visual field defect
Homonymous hemianopia with central sparing
Signs of optic neuropathy
Optic disc pallor Reduced visual acuity Loss of red colour vision Central scotoma RAPD
Causes of optic atrophy
Chronic glaucoma Demyelination - e.g. MS Trauma Compression - e.g. Tumour Diabetes Methanol / ethambutol Retinal artery occlusion Retinal vein occlusion
What are miosis and mydriasis
Miosis = pupil constriction Mydriasis = pupil dilation
Management of acute angle closure glaucoma
Refer immediately - day or night. Lie the patient down Topical agents include: - Beta blockers, eg timolol 0.5%, one dose - Steroids, eg prednisolone 1%, - Apraclonidine 0.5-1% - pilocarpine 1-2%, **Acetazolamide IVI ** Offer analgesia ± antiemetics
Surgical - peripheral iridotomy / iridectomy
Investigation and management of acute angle closure glaucoma
Examination - red eye + non-reactive mid-dilated pupil.
Palpation of the globe - hard
Measure the IOP >21 mmHg
slit lamp
