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EOY4 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

A px reporting unilateral reduced visual acuity and reduced coloured vision indicates what?

A

Optic neuritis

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2
Q

What is a central scotoma?

A

Scotoma = area of diminished visual acuity surrounded by field of normal vision
Central scotoma suggest optic nerve lesion affecting central vision

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3
Q

What are some causes of a scotoma?

A

MS
Diabetes Mellitus
HTN
Vitamin deficiency

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4
Q

How is optic neuritis managed?

A

High dose steroids

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5
Q

Compression of the optic chiasm causes which visual defect?

A

Bitemporal hemianopia

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6
Q

Lesion of the left temporal lobe will cause which visual defect?

A

Right homonymous superiority quadrantanopia (due to involvement of inferior fibres of the optic radiation)

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7
Q

Which lobe of the brain is affected in a homonymous inferiority quadrantanopia?

A

Parietal lobe

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8
Q

What is hyphaema?

A

Blood in the anterior chamber of the eye

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9
Q

What is the blockage of aqueous drainage from the anterior chamber of the eye called?

A

Acute Glaucoma

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10
Q

What are pilocarpine drops used for?

A

Glaucoma
Pilocarpine is a miotic which’s ctivates cholinergic receptors to open the trabecular meshwork so aqueous humor can drain from the eye

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11
Q

How does the lens change shape in order to focus on objects?

A

By contraction of the ciliary muscles

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12
Q

What are the three layers of the eyeball?

A

Sclera: tough protective layer
Choroid: supplies the retina with nutrients
Retina: contains light sensitive rod and cone cells

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13
Q

What type of drug is acetazolaide and what is it’s mechanism of action?

A

Carbonic anhydrase inhibitor

Decreases production of aqueous so lowers intraocular pressure

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14
Q

How should suspected orbital cellulitis be investigated?

A

CT of the orbit
Blood cultures
FBC

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15
Q

How should conjunctivitis be managed?

A 
Usually self resolves
Lubricating eye drop
Remove contact lens until free of symptoms
Careful hand washing to avoid spread
Wash with warm water and cotton wool
If allergic type: antihistamines
Abx only if gonococcal/ chlamydia
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16
Q

Anterior uveitis is associated with which conditions?

A

HLA B-27 linked conditions: ankylosing spondylitis, reactive arthritis, IBD

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17
Q

The uvea involves which components of the eye?

A

Pigmented part: iris, ciliary body and choroid

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18
Q

Dendritic corneal ulcers are pathognomonic for which condition?

A

Herpes simplex keratitis

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19
Q

What should the intraocular pressure be?

A

Between 10-21 mmHg

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20
Q

What is glaucoma?

A

Optic nerve damage due to raised intraocular pressure, due to a disruption in the drainage of aqueous humour

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21
Q

What is the difference between closed angle and open angle glaucoma?

A

Closed angle: acute onset, when iris bulges forwards and blocks the outflow of aqueous, ophthalmic emergency

Open angle: chronic, gradual blockage of trabecular meshwork

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22
Q

What are some risk factors for acute closed angle glaucoma?

A 
Increasing age
Long sightedness
Shallow anterior chamber
Asians
Female
Family Hx
Anticholinergics
Pupillary dilation
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23
Q

Timolol, pilocarpine and acetazolamide are all used in the treatment of what condition?

A

Acute angle glaucoma

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24
Q

How does pilocarpine work and what is it’s function?

A

Acts on the parasympathetics of the eye
To induce ciliary muscle contraction to open up the trabecular meshwork to increase the outflow of aqueous
This will reduce intraocular pressure

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25
Q

Optic disc cupping is a sign of what?

A

Glaucoma

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26
Q

How does the visual loss of chronic glaucoma present?

A

Initially peripheral and so progresses to tunnel vision

Outer part of optic nerve affected first

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27
Q

What type of drug is lantanoprost?

A

Prostaglandin analogue eye drop, increases the outflow of aqueous to reduce intraocular pressure

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28
Q

What are some side effects of prostaglandin analogue eye drops?

A

Browning of the iris
Eyelid pigmentation
Eyelash growth

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29
Q

Iris pigmentation, eyelid pigmentation and eyelash growth are all side effects of which type of eye drop?

A

Prostaglandin analogues e.g. lantanoprost

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30
Q

Which eye drops are first line in chronic glaucoma?

A

Prostaglandin analogues

Then beta blockers and carbonic anhydrase inhibitors

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31
Q

What are some risk factors for cataracts?

A 
Age
UV exposure
Steroids
Diabetes
Smoking
Alcohol
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32
Q

Absence of a red reflex suggest what pathology?

A

Cataracts

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33
Q

Giant cell arteritis is strongly associated with which condition?

A

Polymyalgia rheumatica

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34
Q

How does giant cell arteritis typically present?

A

New onset headache
Jaw claudication
Tender temporal arteries and scrap
Visual loss monocular (often transient amaurosis fugax)

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35
Q

How would giant cell arteritis be diagnosed?

A

Raised ESR and CRP

Temporal node biopsy

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36
Q

Why may temporal node biopsy not always diagnose giant cell arteritis?

A

Skip lesions May me a diagnosis is missed

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37
Q

How would optic neuritis present?

A

Pain, especially on movement
Reduced acuity, central scotoma
Red colour desaturation
RAPD

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38
Q

How is optic neuritis managed?

A 
IV steroids (high dose for 3 days, then lower dose for 11 days)
Consider brain MRI to look at risk of developing MS
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39
Q

How would central retinal artery occlusion look on fundoscopy?

A

Pale retina

With red fovea (“cherry red spot”)

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40
Q

How would retinal vein occlusion look on fundoscopy?

A

“Stormy sunset”
Widespread haemorrhages
Torturous dilated veins
Optic disc swelling

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41
Q

How can retinal vein occlusion be managed?

A

Anti-VEGF intravitreal injections
Intravitreal steroids
Mx of underlying causes e.g. HTN, diabetes, SLE, high cholesterol, smoking

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42
Q

How does retinal detachment present?

A 
4 F’s
Flashes
Floaters
Field loss
Fall in acuity
(Painless)
43
Q

Which subtype of age related macular degeneration is most common?

A

Dry AMD

44
Q

What are drusen and what condition are they seen in?

A

Yellow lipid deposits in the retina

Seen in dry AMD

45
Q

What is the difference between dry and wet AMD?

A

Dry AMD is atrophy of retina over time, characterised by drusen on fundoscopy. But it can progress into the wet form

Wet AMD is due to new blood vessel growth in the choroid layer, which can easily leak and cause haemorrhage and oedema. The end point is scar formation

46
Q

How should dry AMD be managed to reduce the likelihood of progression to wet AMD?

A

Lifestyle changed: quit smoking, healthy diet, BP control
Vitamin supplements (zinc, A, C, E)
Education
Visual rehabilitation to maximise remaining vision

47
Q

How is wet AMD managed?

A

Monthly anti-VEGF injections

48
Q

Diabetic retinopathy is classified as proliferative and non-proliferative depending on what?

A

Whether new blood vessel growth has occurred

49
Q

What are some fundoscopy features of diabetic retinopathy?

A 
Microaneurysms
Venous beading
Cotton wool spots
Boot haemorrhages 
Neurovascularisation 
Hard educates
50
Q

How should diabetic retinopathy be managed?

A

Optimal diabetic control
Anti VEGF injections
Intravitreal steroids
Laser surgery

51
Q

What is retinitis pigmentosa?

A

Congenital inherited condition where there is degeneration of the rods and cones in the retina

52
Q

How does retinitis pigmentosa typically present?

A

Primarily in males
In childhood
Night blindness (as rods degenerate more than cones)
Tunnel vision (peripheral vision lost before central vision)

53
Q

What are some risk factors for developing chronic open angle glaucoma?

A

Family history
Increasing age
African American race

54
Q

How will chronic glaucoma present?

A

Often asymptomatic and picked up on routine screening
Optic disc cupping on fundoscopy
Peripheral visual field defect (central vision is spared, but vision eventually becomes tunnel vision)

55
Q

How is acute angle glaucoma managed?

A

“Kitchen sink approach”
Timolol + acetazolamide + pilocarpine
Analgesia and antiemetics
Once IOP is reduced, laser iridotomy (typically on both eyes)

56
Q

Floaters and flashing lights are classic symptoms of what?

A

Retinal detachment

57
Q

What is a Marcus Gunn pupil?

A

One showing a relative affect pupillary defect

Usually seen in optic nerve or tract lesions

58
Q

Which is painful: stye or chalazion?

A

Stye

(“Stye stings”

59
Q

What is the difference between a stye and a chalazion?

A

Stye is a pimple like inflammation of the sebaceous gland/ lash follicle causing a lump by the lash follicle that is painful and superficial to the tarsal plate

Chalazion is inflammation of the meibomian gland on the eyelid, it is not painful

60
Q

What muscles are responsible for eyelid movement, and what is their innervation?

A

Orbicularis oculi, innervated by the facial nerve. This closes the eye.
Levator palpebrae superioris, innervated by the oculomotor nerve. This opens the eye.

61
Q

What are the functions of the ciliary body?

A

To secrete aqueous fluid

To control the shape of the lens (via its sphincter muscles that are tethered to the lens via zolune fibres)

62
Q

What is presbyopia?

A

Reduced vision due to age
Our lens hardens with time and does not change shape as well, which means it is harder to accommodate and see near objects

A prosthetic lens can improve far vision but cannot change shape so patients would still need reading glasses for near vision

63
Q

What is the mechanism of action of timolol?

A

A beta blocker which reduces aqueous production by the ciliary body

64
Q

What type of drug is pilocarpine?

A

A muscarinic agonist that increases uveoscleral outflow

65
Q

Ptosis can be caused by Horner’s syndrome or cranial nerve 3 palsy. How would the two present differently?

A

Horners: ptosis + miosis + anhydrosis

CN3 palsy: eye is down and out (only SO and LR muscles function), pupil is dilated

66
Q

Does low or high calcium cause cataracts?

A

Low calcium

67
Q

What drug can cause mydriasis?

A

Atropine

Also cocaine and amphetamines

68
Q

Which type of conjunctivitis is most common?

A

Viral in adults

Bacterial in children

69
Q

What is the most common causative organism of viral conjunctivitis?

A

Adenovirus

Usually follows an URTI

70
Q

What is the typical presentation of viral conjunctivitis?

A 
Watery discharge
Signs of URTI
Conjunctival follicles
Pre auricular lymphadenopathy 
Typically spreads to other eye
71
Q

What is the typical presentation of bacterial conjunctivitis?

A

Mucopurulent discharge
Wake up with eyes stuck together
Red bumps on conjunctiva
Unilateral

72
Q

What is the primary treatment for blepharitis?

A

Good lid hygiene, clean with baby shampoo
Warm compresses
Liberating drops
If severe, chloramphenicol drops

73
Q

What is the common presentation of blepharitis?

A

Gritty sensation in the eyes
Tearing
Stinging
Redness

74
Q

What are steroid eye drops a risk factor for?

A 
Corneal ulcers
(The steroid drops reduce inflammation so would reduce the immune response to and infection infiltrating any corneal defect/ abrasion)
75
Q

How is a corneal abrasion treated?

A

Analgesia
Lubricating drops (to encourage epithelial healing)
Topical chloramphenicol (to prevent bacterial superinfection)
Avoid contact lenses until healed
Follow up in 1 week to check healed

76
Q

How are corneal abrasions and ulcers diagnosed?

A

Fluoroscein drops and blue light will stain any lesions green

77
Q

What are risk factors for corneal ulcers?

A

Contact lens wearing
Trauma
Steroid eye drops

78
Q

What is the likely cause of an eye that is down and out, with a blown pupil and ptosis?

A

Cranial nerve 3 palsy

Compressive nerve lesions tend to involve the pupil, while vascular lesions spare it

79
Q

What is the cocaine test for?

A

Used to diagnose Horners pupil (should dilate the pupil but won’t if Horners)

80
Q

A Marcus Gunn pupil is due to a defect in which part of the pupillary light reflex?

A

Due to a lesion anterior to the optic chiasm I.e. optic nerve or retina

81
Q

What are some causes of a RAPD?

A

Retinal detachment

Optic neuritis

82
Q

When you accommodate, do the zonules relax or contract?

A

Ciliary body contacts and the zonules relax allowing the lens to relax and become rounded and more powerful

83
Q

What are the 2 functions of the ciliary body?

A

Changes shape of the lens to allow accommodation

Produces aqueous fluid which nourishes the avascular lens and the cornea

84
Q

Which type of conjunctivitis is least likely to occur bilaterally?

A

Bacterial
(Allergic type is likely to affect both eyes, and viral is very contagious so typically starts in one eye and spreads to the other)

85
Q

How can periorbital cellulitis be differentiated from orbital cellulitis?

A

Both will have red and swollen eye
Orbital cellulitis will have proptosis, pain on eye movement and reduced acuity which periorbital cellulitis will not have

86
Q

What is the management of herpes zoster ophthalmicus?

A

Oral antiviral treatment 7-10 days (not topical)

87
Q

What is a Holmes Adie syndrome?

A

Benign condition mostly seen in women

Usually unilateral dilated pupil that very poorly reacts to light and slowly accommodates

88
Q

What investigations are done for age related macular degeneration, and what will they show?

A

Amsler grid (distorted lines represent areas of macular exudation, and darkened scotomas represent atrophied areas of the macula)
OCT (confirm fluid in the retina, and scar formation)
Fluroscein angiography

89
Q

What is the most common cause of blindness in the UK?

A

ARMD

90
Q

What’re some risk factors for ARMD?

A 
Increasing age
Smoking
Hypertension 
CVD
DM
Obesity 
Low vitamin intake
91
Q

What are some features of dry AMD?

A

Drusen

Geographic atrophy

92
Q

What are some features of wet AMD?

A

Neovascularisation
Exudate and haemorrhage
Disciform scar

93
Q

Distorted lines on Amsler grid is suggestive of what condition?

A

Age related macular degeneration

94
Q

Optic disc nerve cupping is pathognomonic of what?

A

Chronic glaucoma

95
Q

What are some examples of eye drops that cause pupillary dilation (mydriatics)?

A

Antimuscarinics (reduce parasympathetic stimulation of CN3)

Cyclopenate, atropine, tropicamide

96
Q

What type of eye drops are indicated in anterior uveitis?

A

Cyclopegic and antimuscarinic drops e.g.atropine, cyclopenate, tropicamide

97
Q

What eye drop is used as a mydriatic prior to examining the eye?

A

Tropicamide (antimuscarinic with shortest duration of action)

98
Q

What is an example of a sympathetic agonist eye drop?

A

Phenylephrine

99
Q

When would mydriatic eye drops be cointraindicsted?

A

In untreated narrow angle glaucoma

Also allergy, atropine CI in HTN

100
Q

When using a mydriatic eye drop, what would you warn the patient of?

A

That it will sting the eye for a few seconds
They will blur vision so do not drive until this has warn off
Can cause whitening of the eyes due to vasoconstriction

101
Q

What conditions are episcleritis and scleritis associated with?

A

SLE, Rheumatoid arthritis, IBD, reactive arthritis, psoriatic arthritis, ankylosing spondylitis

102
Q

How will the presentation of episcleritis differ to scleritis?

A

Both acute red eye
Episcleritis is not painful
Scleritis is extremely painful, especially on eye movement
Episcleritis will bleach with phenylephrine drop (scleritis won’t as the vessels are deeper)

103
Q

Red eye that bleaches with phenylephrine drops is characteristic of what?

A

Episcleritis

EOY4 (15 decks)

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