Opthalmology Flashcards
1
Q
A px reporting unilateral reduced visual acuity and reduced coloured vision indicates what?
A
Optic neuritis
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
3
Q
What are some causes of a scotoma?
A
MS
Diabetes Mellitus
HTN
Vitamin deficiency
4
Q
How is optic neuritis managed?
A
High dose steroids
5
Q
Compression of the optic chiasm causes which visual defect?
A
Bitemporal hemianopia
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)
7
Q
Which lobe of the brain is affected in a homonymous inferiority quadrantanopia?
A
Parietal lobe
8
Q
What is hyphaema?
A
Blood in the anterior chamber of the eye
9
Q
What is the blockage of aqueous drainage from the anterior chamber of the eye called?
A
Acute Glaucoma
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
11
Q
How does the lens change shape in order to focus on objects?
A
By contraction of the ciliary muscles
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
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
14
Q
How should suspected orbital cellulitis be investigated?
A
CT of the orbit
Blood cultures
FBC
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
16
Q
Anterior uveitis is associated with which conditions?
A
HLA B-27 linked conditions: ankylosing spondylitis, reactive arthritis, IBD
17
Q
The uvea involves which components of the eye?
A
Pigmented part: iris, ciliary body and choroid
18
Q
Dendritic corneal ulcers are pathognomonic for which condition?
A
Herpes simplex keratitis
19
Q
What should the intraocular pressure be?
A
Between 10-21 mmHg
20
Q
What is glaucoma?
A
Optic nerve damage due to raised intraocular pressure, due to a disruption in the drainage of aqueous humour
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
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
23
Q
Timolol, pilocarpine and acetazolamide are all used in the treatment of what condition?
A
Acute angle glaucoma
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
25
Optic disc cupping is a sign of what?
Glaucoma
26
How does the visual loss of chronic glaucoma present?
Initially peripheral and so progresses to tunnel vision
| Outer part of optic nerve affected first
27
What type of drug is lantanoprost?
Prostaglandin analogue eye drop, increases the outflow of aqueous to reduce intraocular pressure
28
What are some side effects of prostaglandin analogue eye drops?
Browning of the iris
Eyelid pigmentation
Eyelash growth
29
Iris pigmentation, eyelid pigmentation and eyelash growth are all side effects of which type of eye drop?
Prostaglandin analogues e.g. lantanoprost
30
Which eye drops are first line in chronic glaucoma?
Prostaglandin analogues
| Then beta blockers and carbonic anhydrase inhibitors
31
What are some risk factors for cataracts?
```
Age
UV exposure
Steroids
Diabetes
Smoking
Alcohol
```
32
Absence of a red reflex suggest what pathology?
Cataracts
33
Giant cell arteritis is strongly associated with which condition?
Polymyalgia rheumatica
34
How does giant cell arteritis typically present?
New onset headache
Jaw claudication
Tender temporal arteries and scrap
Visual loss monocular (often transient amaurosis fugax)
35
How would giant cell arteritis be diagnosed?
Raised ESR and CRP
| Temporal node biopsy
36
Why may temporal node biopsy not always diagnose giant cell arteritis?
Skip lesions May me a diagnosis is missed
37
How would optic neuritis present?
Pain, especially on movement
Reduced acuity, central scotoma
Red colour desaturation
RAPD
38
How is optic neuritis managed?
```
IV steroids (high dose for 3 days, then lower dose for 11 days)
Consider brain MRI to look at risk of developing MS
```
39
How would central retinal artery occlusion look on fundoscopy?
Pale retina
| With red fovea (“cherry red spot”)
40
How would retinal vein occlusion look on fundoscopy?
“Stormy sunset”
Widespread haemorrhages
Torturous dilated veins
Optic disc swelling
41
How can retinal vein occlusion be managed?
Anti-VEGF intravitreal injections
Intravitreal steroids
Mx of underlying causes e.g. HTN, diabetes, SLE, high cholesterol, smoking
42
How does retinal detachment present?
```
4 F’s
Flashes
Floaters
Field loss
Fall in acuity
(Painless)
```
43
Which subtype of age related macular degeneration is most common?
Dry AMD
44
What are drusen and what condition are they seen in?
Yellow lipid deposits in the retina
| Seen in dry AMD
45
What is the difference between dry and wet AMD?
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
How should dry AMD be managed to reduce the likelihood of progression to wet AMD?
Lifestyle changed: quit smoking, healthy diet, BP control
Vitamin supplements (zinc, A, C, E)
Education
Visual rehabilitation to maximise remaining vision
47
How is wet AMD managed?
Monthly anti-VEGF injections
48
Diabetic retinopathy is classified as proliferative and non-proliferative depending on what?
Whether new blood vessel growth has occurred
49
What are some fundoscopy features of diabetic retinopathy?
```
Microaneurysms
Venous beading
Cotton wool spots
Boot haemorrhages
Neurovascularisation
Hard educates
```
50
How should diabetic retinopathy be managed?
Optimal diabetic control
Anti VEGF injections
Intravitreal steroids
Laser surgery
51
What is retinitis pigmentosa?
Congenital inherited condition where there is degeneration of the rods and cones in the retina
52
How does retinitis pigmentosa typically present?
Primarily in males
In childhood
Night blindness (as rods degenerate more than cones)
Tunnel vision (peripheral vision lost before central vision)
53
What are some risk factors for developing chronic open angle glaucoma?
Family history
Increasing age
African American race
54
How will chronic glaucoma present?
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
How is acute angle glaucoma managed?
“Kitchen sink approach”
Timolol + acetazolamide + pilocarpine
Analgesia and antiemetics
Once IOP is reduced, laser iridotomy (typically on both eyes)
56
Floaters and flashing lights are classic symptoms of what?
Retinal detachment
57
What is a Marcus Gunn pupil?
One showing a relative affect pupillary defect
| Usually seen in optic nerve or tract lesions
58
Which is painful: stye or chalazion?
Stye
| (“Stye stings”
59
What is the difference between a stye and a chalazion?
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
What muscles are responsible for eyelid movement, and what is their innervation?
Orbicularis oculi, innervated by the facial nerve. This closes the eye.
Levator palpebrae superioris, innervated by the oculomotor nerve. This opens the eye.
61
What are the functions of the ciliary body?
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
What is presbyopia?
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
What is the mechanism of action of timolol?
A beta blocker which reduces aqueous production by the ciliary body
64
What type of drug is pilocarpine?
A muscarinic agonist that increases uveoscleral outflow
65
Ptosis can be caused by Horner’s syndrome or cranial nerve 3 palsy. How would the two present differently?
Horners: ptosis + miosis + anhydrosis
CN3 palsy: eye is down and out (only SO and LR muscles function), pupil is dilated
66
Does low or high calcium cause cataracts?
Low calcium
67
What drug can cause mydriasis?
Atropine
| Also cocaine and amphetamines
68
Which type of conjunctivitis is most common?
Viral in adults
| Bacterial in children
69
What is the most common causative organism of viral conjunctivitis?
Adenovirus
| Usually follows an URTI
70
What is the typical presentation of viral conjunctivitis?
```
Watery discharge
Signs of URTI
Conjunctival follicles
Pre auricular lymphadenopathy
Typically spreads to other eye
```
71
What is the typical presentation of bacterial conjunctivitis?
Mucopurulent discharge
Wake up with eyes stuck together
Red bumps on conjunctiva
Unilateral
72
What is the primary treatment for blepharitis?
Good lid hygiene, clean with baby shampoo
Warm compresses
Liberating drops
If severe, chloramphenicol drops
73
What is the common presentation of blepharitis?
Gritty sensation in the eyes
Tearing
Stinging
Redness
74
What are steroid eye drops a risk factor for?
```
Corneal ulcers
(The steroid drops reduce inflammation so would reduce the immune response to and infection infiltrating any corneal defect/ abrasion)
```
75
How is a corneal abrasion treated?
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
How are corneal abrasions and ulcers diagnosed?
Fluoroscein drops and blue light will stain any lesions green
77
What are risk factors for corneal ulcers?
Contact lens wearing
Trauma
Steroid eye drops
78
What is the likely cause of an eye that is down and out, with a blown pupil and ptosis?
Cranial nerve 3 palsy
| Compressive nerve lesions tend to involve the pupil, while vascular lesions spare it
79
What is the cocaine test for?
Used to diagnose Horners pupil (should dilate the pupil but won’t if Horners)
80
A Marcus Gunn pupil is due to a defect in which part of the pupillary light reflex?
Due to a lesion anterior to the optic chiasm I.e. optic nerve or retina
81
What are some causes of a RAPD?
Retinal detachment
| Optic neuritis
82
When you accommodate, do the zonules relax or contract?
Ciliary body contacts and the zonules relax allowing the lens to relax and become rounded and more powerful
83
What are the 2 functions of the ciliary body?
Changes shape of the lens to allow accommodation
| Produces aqueous fluid which nourishes the avascular lens and the cornea
84
Which type of conjunctivitis is least likely to occur bilaterally?
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
How can periorbital cellulitis be differentiated from orbital cellulitis?
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
What is the management of herpes zoster ophthalmicus?
Oral antiviral treatment 7-10 days (not topical)
87
What is a Holmes Adie syndrome?
Benign condition mostly seen in women
| Usually unilateral dilated pupil that very poorly reacts to light and slowly accommodates
88
What investigations are done for age related macular degeneration, and what will they show?
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
What is the most common cause of blindness in the UK?
ARMD
90
What’re some risk factors for ARMD?
```
Increasing age
Smoking
Hypertension
CVD
DM
Obesity
Low vitamin intake
```
91
What are some features of dry AMD?
Drusen
| Geographic atrophy
92
What are some features of wet AMD?
Neovascularisation
Exudate and haemorrhage
Disciform scar
93
Distorted lines on Amsler grid is suggestive of what condition?
Age related macular degeneration
94
Optic disc nerve cupping is pathognomonic of what?
Chronic glaucoma
95
What are some examples of eye drops that cause pupillary dilation (mydriatics)?
Antimuscarinics (reduce parasympathetic stimulation of CN3)
| Cyclopenate, atropine, tropicamide
96
What type of eye drops are indicated in anterior uveitis?
Cyclopegic and antimuscarinic drops e.g.atropine, cyclopenate, tropicamide
97
What eye drop is used as a mydriatic prior to examining the eye?
Tropicamide (antimuscarinic with shortest duration of action)
98
What is an example of a sympathetic agonist eye drop?
Phenylephrine
99
When would mydriatic eye drops be cointraindicsted?
In untreated narrow angle glaucoma
| Also allergy, atropine CI in HTN
100
When using a mydriatic eye drop, what would you warn the patient of?
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
What conditions are episcleritis and scleritis associated with?
SLE, Rheumatoid arthritis, IBD, reactive arthritis, psoriatic arthritis, ankylosing spondylitis
102
How will the presentation of episcleritis differ to scleritis?
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
Red eye that bleaches with phenylephrine drops is characteristic of what?
Episcleritis
