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Nephrology > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Giant cell arteritis

A

Optic nerve ischaemia > sudden blindness

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2
Q

Iritis associations

A

AS, reiters, etc

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3
Q

Scleritis/ episcleritis

A

RA, SLE, vasculitis

Episcleritis not painful

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4
Q

Hypertensive retinopathy

A

BP accelerates atherosclerosis in retinal vessels.
Silver wiring - Hardened arteries are shiny and ‘nip’ veins where they cross
Cotton wool spots - Narrowed arterioles > blocked > localized retinal infarction
Leaks from these in severe HTN > hard exudates or macular oedema.
Papilloedema or flame haemorrhages
suggest accelerated hypertension

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5
Q

Infective endocarditis

A

Roth spots - small retinal infarcts

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6
Q

Retinal vein occlusion

A

HTN, age, hyperviscosity
Stormy sunset (fundus) - central vein, if branch then wedge of retina
Acute drop acuity

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7
Q

AIDS HIV

A

CMV retinitis, lone cotton wool spots - HIV retinopathy

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8
Q

Acute glaucoma

A 
Both ciliary and conjunctival vessels injected.
Entire eye is red.
Injected iris
Pupil dilated, fixed
Cornea hazy
Anterior chamber very shallow
High intraocular pressure

Open angle - blockage in drainage of aqueous humour
> increased IOP
Chronic
Tx - prostaglandin analogue (latanoprost) - relaxes ciliary muscules > lowers IOP
laser - open angle

Closed - angle between iris and cornea too small (lens being pushed against iris) > block
Acute - IV acetazolomide - carbonic anhydrase inhibitor - diuresis
pilocarpine drops
peripheral iridotomy - closed angle

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9
Q

Iritis

A

Injected iris
Pupil adhesions so irregular
Redness most marked around cornea, which
doesn’t blanch on pressure.
Usually unilateral.
Causes: AS, RA, Reiter’s, sarcoidosis, HSV, herpes zoster, and Behçet’s disease.
NB: a similar scleral appearance but without
papillary or anterior chamber involvement
may be scleritis (eg RA, SLE, vasculitis).
Refer -steroid eye drops

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10
Q

Conjunctivitis

A 
Often bilateral.
Conjunctival vessels injected, greatest toward
fornices, but blanching on pressure.
Mobile over sclera.
Purulent discharge.
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11
Q

Subconjunctival

haemorrhage

A

Causes: HTN; leptospirosis; bleeding
disorders; trauma; snake venom; haemorrhagic
fevers.

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12
Q

Dendritic ulcer

A

Photophobia & watering.
If steroid drops are used without aciclovir cover, corneal invasion and scarring may occur, risking blindness.
1% fluorescein drops stain the lesion. :
Aciclovir 3% eye ointment 5≈ daily.

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13
Q

Ophthalmic shingles

A

Pain and neuralgia in the distribution of
cranial nerve V1 dermatome
blistering rash. In 50% of those with HZO the
globe is affected (corneal signs ± iritis in >40%—
sectoral iris atrophy

Nose-tip (Hutchison’s sign) -nasociliary branch of the trigeminal nerve also supplies the globe >likely eye affected.
The eye can be affected with little rash elsewhere.

Varicella zoster virus (VZV) may persist in the eye.
The different patterns of retinal disease caused
by VZV relate to immune status.

Oral antivirals improve symptoms (additional antiviral drops are not needed) but cannot be relied on to prevent postherpetic neuralgia.
Famciclovir offers the best dose schedule (750mg once daily for 1wk; SE vomiting; headache) but is much more expensive than aciclovir (800mg 5 times daily
PO for 7 days—it has more serious SE such as hepatitis and renal failure).

Start within 4 days of onset. It is wise for all to see a specialist if the nose-tip is involved, or the eye turns red within 3 days, to exclude anterior uveitis with a
slit lamp. Prolonged steroid eyedrops may be needed.

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14
Q

Retinoblastoma

A

most common primary intraocular tumour in children
Strabismus and leukocoria
Autosomal dom
RB gene
5% occur with a pineal or other tumour
Secondary malignancies such as osteosarcoma and rhabdomyosarcoma
are more frequent

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15
Q

Third nerve palsy (oculomotor)

A

Ptosis (levator palpebrae), proptosis (as recti tone), fixed pupil dilatation (constrictor pupillae), with the eye looking down and out.

cavernous sinus lesions
superior orbital fissure syndrome
diabetes
posterior communicating artery aneurysm.

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16
Q

Fourth nerve palsy (trochlear)

A

Diplopia
patient may hold his head tilted (ocular torticollis).

The eye looks upward, in adduction and cannot look down and in ( paralysed).
Causes: Trauma 30%, diabetes 30%, tumour, idiopathic.

Trochlear - superior oblique - this looks down and out

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17
Q

Sixth nerve palsy (abducens)

A

There is diplopia in the horizontal plane.
Lateral rectus
Medially deviated and cannot move laterally from midline

Causes: Tumour raising ICP (compresses
the nerve on the edge of the petrous temporal bone), trauma to base of skull, vascular, or MS
Botulinum toxin can eliminate need for strabismus surgery in selected VI palsies

18
Q

Absent direct response RAPD

A

Problem with afferent pathway
Optic neuritis, optic atrophy, retinal disease
Consensual response present

If the pupil dilates during swinging test – Marcus Gunn pupil

19
Q

Horner’s syndrome

A

disrupting sympathetic fibres

miosis, partial ptosis, and the pupil does not dilate
in the dark.
Unilateral facial anhydrosis may indicate a lesion proximal to the carotid plexus—
if distal, the sudomotor (sudor = sweat) fibres
will have separated, so sweating is intact.
Congenital Horners: iris heterochromia

20
Q

Holmes–Adie pupil

A

Initially monolateral, then bilateral, pupil dilatation with
delayed responses to near vision effort, with delayed redilation.

Young woman, with sudden blurring of near vision, and a dilated pupil, slow responses to accommodation, and, especially, to light (looks unreactive,
unless an intense light is used for >15min), ie a tonic pupil.

Slit lamp exam:
Iris shows spontaneous wormy movements (iris streaming).

Holmes–Adie syndrome: Tonic pupil, absent knee/ankle jerks and low BP

21
Q

Argyll Robertson pupil

A

neurosyphilis, diabetes
bilateral miosis, pupil irregularity
no response to light
response to accommodation (the prostitute’s pupil
accommodates but does not react).
The iris is spongy, the pupils dilate poorly, and there may be ptosis.

22
Q

Myopia

A

Short sighted
Eyeball long
Concave spectacles

23
Q

Hypermetropia

A

Long sighted
Eye short
Convex glasses

24
Q

Presbyopia

A

ciliary muscle reduces tension in the lens, allowing it to get more convex, for close focusing. Lens stiffens.

25
Q

Marfans syndrome

Sudden painless loss of vision

A

Lens disolocation

Marfan's syndrome: upwards
homocystinuria: downwards
Ehlers-Danlos syndrome
trauma
uveal tumours
autosomal recessive ectopia lentis
26
Q

Tunnel vision

A

glaucoma, retinitis pigmentosa

27
Q

Cataracts operation complications

A

Retinal detachment/ rupture
Endophthalmitis
Posterior capsule opacification

28
Q

Chalazion

A

meibomian cyst and is typically on the internal eyelid.

29
Q

hordeolum externum

A

infection of the glands of the external eyelid

stye

30
Q

blepharitis

A

inflammation of the eyelid margins typically leading to a red eye. no lump.

31
Q

Marcus gunn pupil

A 
RAPD
lesion of optic nerve, MS, glaucoma
effected eye - no response
other eye - constricts
effected eye - dilates
32
Q

Anterior ischaemic optic neuropathy

A 
Sudden loss of vision
Pale optic disc
Posterior ciliary arteries > inflammation > optic nerve damage
PREDNISOLONE
GCA, htn, hyperlipid
33
Q

Retinal artery occlusion

A

Sudden loss of vision

Urgent tx < 6 hours

34
Q

Vitreous haemorrhage

A

Neovascularisation, retinal tears or detach,
Floaters
Absorbs back normally

35
Q

Optic neuritis

A

Loss of red vision
Painful eye movements
> MS
Methylprednisolone

36
Q

Central retinal vein occlusion

A

whole vein > visual loss

Stormy sky

37
Q

Central artery occlusion

A

Sudden visual loss
Pale retina
Cherry spot macula
within 6h of onset aim is to increase retinal blood fl ow by
reducing intraocular pressure by ocular massage, surgical removal of aqueous
from the anterior chamber or the use of antihypertensive treatment

38
Q

Retinal detachment

A 
Post trauma, cataracts, tumours
> myopic eyes
4Fs - flashes, floaters, field loss, fall in acuity
Painless curtain falling 
> urgent surgery
39
Q

Amaurosis fugax

A

Transient loss of vision

Vascular causes eg TIA

40
Q

ARMD

A

cheif cause of blindness
lose central vision
dry - drusen
wet - neovascularisation - tx vegf inhibitors

41
Q

Open angle glaucoma

A

tunnel vision

first line: prostaglandin analogue (PGA) eyedrop
second line: beta-blocker, carbonic anhydrase inhibitor, or sympathomimetic eyedrop
if more advanced: surgery or laser treatment can be tried2

42
Q

Retinitis pigmentosa

A

Sporadic, AR, some AD

Nephrology (26 decks)

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