Opthalmology Flashcards
What is cataract
any opacity in the lens
cataract risk factors
age
db
smoking
alcohol
Presentation of cataract
blurred vision
unilateral - unnoticed but depth perception affected
bilateral - gradual painless loss of vision ±glare with bright lights, ±monocular diplopia, haloes, faded colours
cataracts management
mydriatic drops
sunglasses
surgery - phacoemulsification
day case with local anaesthetic
- incision -> phacoemulsion-> artifical lens
Types of uveitis
anterior - iritis
posterior - choroiditis
intermediate - vitrous
What is subconjunctival haemorrage, who is it common in?
harmless pool of blood behind conjunctiva from small bleed
common in elderly women
ask about anti-coags
Presentation of conjunctivitis
itchy, burning, watering eyes
sticky discharge causes eyes to stick
conjunctiva red and inflamed
conjunctivitis management
symptomatic - artificial tears and antihistamines (emedastine)
topical abx used in bacterial to reduce length and transmission risk
Abx if ?sexual, contact lens, immunocomp
(chloramphenicol or fusidic acid)
Investigations for red eye
Gonioscopy - evalutaed internal drainage system ?glaucoma
Slit lamp - see leucocytes in anterior chamber if iritis
?culture if suspected sexual cause or recurrent unresponsive conjunctivitis
Iritis presentation
pain, blurred vision, photophobia, non sticky discharge, red eye
iritis management
refer
prednisolone drops to reduce inflam
cyclopentolate - keeps pupils dilated to prevent adhesions between lens and iris and also to relieve spasms of ciliary body
Acute closed angle glaucoma presentation
onset hours/days
- blurred vision, haloes
- painful red eye
- generally unwell
- N&V
- headache
Management of acute closed angle glaucoma
B Blockers triad (supress aqueous production)
-timolol, pilocarpine, IV acetazolamide
Monitor IOP
peripheral iridectomy once IOP under control - removal of piece of iris
Episcleritis Presentation
Inflammatory nodule
Blue sclera below cone shaped wedge of engored vessels
dull acbe in eyes, tender
Episcleritis managemtn
Symptomatic relief - artificial tears and topical/systemic NSAIDs
Scleritis presentation
constant severe dull ache that bores into eye
painful ocular movements
?headache and photophobia
scleritis management
referral
anterior: NSAIDs ± oral pred
posterior: more aggressive
Ketatitis causes
bacterial: pseduomonas aeruginsoa, staph
fungal: aspergillus, candida
viral: HSV
Keratitis presentation
PAIN, photophobia, decreased visual acuity
discharge
Keratitis management
treat causative organism
How would a patient with open angle glaucoma present?
asymptomatic until visual fields badly impaired
loss of vision peripherally -> tunnel vision
Why is there a need for screening high risk groups for open angle glaucoma?
doesnt present until visual fields are badly impaired
What are high risk groups for open angle glaucoma
+ve FH
Diabetic
thyroid eye disease
How would you confirm a diagnosis of open angle glaucoma?
Tonometry: pressure >21
Central corneal thickness measurement
gonioscopy: ant chambre assessment
Visual fields
Optic nerve
Medical management of OAG
1) prostaglandin analogues: increase uveoscleral outflow
2) B blockers: decrease production of aqueous
3) Alpha adrenergic agonists: decrease production of aqueous and increase uveoscleral outflow
4) carbonic anhydrase inhibs: decrease aqueous production
5) miotics: decrease resistance to aqueous outflow
Examples and SE of prostaglandin analogues
latanoprost, travoprost
- Eyelash growth
- iris colour change
- Red eye
Examples and SE of B blockers for use in open angle glaucoma
Timolol, betaxolol
- dry eyes
- corneal anaesthesia
- *asthmatics *HF
Exampes and side effects of alpha adrenergic agonists
Dorzolaminde, brimonidine
- fatigue
- dyspepsia
side effects and examples of miotics
pilocarpine
- decreased acuity
- brow ache (ciliary muscle spasm)
Surgical option for open angle glaucoma
trabeculectomy
Synonyms for squint
strabismus, tropia
types of squint
esotropia - inward (convergence)
exotropia - outward (divergent)
hypertropia - upwards
hypotropia - downwards
How do you diagnose a squint
cover test - movement of uncovered (bad) eye to correct fixation when good eye is covered
corneal reflection - reflection from bright light falls asymmetrically on cornea
Management of squint
glasses
patch/drops(atropine) in good eye to encourage use of bad eye
Operation: resection and recession of rectus muscles
What would the eye look like in a 3rd nerve palsy?
down and out
what woudl the eye look like in a 4th nerve palsy?
up
pt might tilt head
what would the eye look like in a 6th nerve palsy?
diplopia in horizontal plane
medial deviation
eye cant move laterally from horizontal plane
What is amblyopia
reduction in visual acuity due to problem in focussing in early childhood - brain isnt stimulated to develop correctly
list 3 causes of amyblyopia
*squint
refractive defects
congential cataracts
how would you diagnose amblyopia?
snellen chart
lack of red reflex
How would you manage amblyopia?
strabismus: patch and drops
refractive error: glasses
congential cataracts: surgery
Causes of CRAO
atherosclerosis
embolism
inflammation
thrombophilic disorders
How would a patient with CRAO present?
sudden painless unilateral visual loss
What would you expect to find on examination of a patient with suspected CRAO
pale retina with cherry red spot
afferent pupil defect
?carotid auscultation for bruits, murmers, radial pulse for AF
How would you manage a patient with CRAO
occular massge with in 100mins of onset
surgical removal of aqueous
acetazolamide (intraocular hypotensive)
What long term management would you advise for patient with CRAO
opthalmolmic follow up
low vision aid clinic
carotid endarterectomy
DVLA notification
How would optic neuritis present?
1) unilateral reduced vision
2) eye pain
3) impared colour vision
What would you expect to find on examination of a patient with optic neuritis?
- reduced vision
- decreased pupillary light reaction in affected eye
- abnormal sensitivity and colour vision
- papillitis
- scotoma
How would you manage optic neuritis
corticosteroids in acute phase
methylprednisolone speeds up visual recovery in acute phase
what is drusen?
lipid deposit under retina - yellow appearance
what are the types of macular degeneration?
wet - choroidal neovascularization
dry- geographic atrophy
how would wet macula degen present?
blurred vision
metamorphopsia
poor night vision
central vision loss
what would u find on examination of pt with wet macular degen
macular drusen
XS vessels (fluorescein angiography)
haemorrhage
Amsler grid shows waving lines
How woudl u manage wet macular degen
anti-VEGF injections
how would dry macular degen present?
gradual visual loss - difficulty reading
central scotoma
what would you expect to find OE in dry macular degen
macular drusen
retinal pigment epithelium clumping or atrophy
how would you manage dry macular degen
zinc, vit A/C/E
