Opthalmology Flashcards
What is amaurosis fugax?
Transient monocular vision loss (TMVL). Usually ischaemic/vascular cause
How do we typically treat amaurosis fugax?
As it usually has a thrombotic cause, we give 300mg aspirin as with TIAs/strokes
Which of central retinal vein and central retinal artery occlusion is more common?
Central retinal vein occlusions are more common
What would you see on fundoscopy for central retinal vein occlusion?
Retinal haemorrhages
Causes of central retinal vein occlusion?
Glaucoma
Hypertension
Polycythaemia
What would you see on fundoscopy for central retinal artery occlusion?
Pink cherry spot
Causes of central retinal artery occlusion?
Arteritis
Thromboembolism
Does TIA cause monocular vision loss?
No. It causes a hemianopia
What causes vitreous haemorrhage?
Diabetes
Bleeding disorders
Anticoagulants
Vitreous haemorrhage features
Sudden vision loss
Dark spots
Small bleeds cause floaters
Retinal detachment features
Dense shadow that starts peripherally and progresses toward the central vision
Straight lines appear curved
Central vision loss
Veil/curtain over field of vision
Posterior vitreous detachment features
Flashes of light (photpsia) in peripheral fields of vision
Floaters (often on temporal side)
How can we stage hypertensive retinopathy
Keith-Wagener classification
Hypertensive retinopathy stages
Stage 1
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
Stage II AV nickiing Stage III Cotton-wool exudates Flame and blot haemorrhages
Stage IV
Papilloedema
Features of cataracts
Gradual onset of reduced vision
Faded colour vision
Glare (lights appear brighter)
Halos around lights
What signs might you see in cataracts
A defect in the red reflex
Management of cataracts
Non-surgical: stronger contacts/glasses
Surgical: Removal of the lens and replacing it with an artificial one
Causes of cataracts
Normal aging (most common) Smoking DM High alcohol consumption Long-term corticosteroids
What are cataracts?
Opacification of the lens of the eye making it more difficult for light to reach the back of the eye (retina)
What is argyll-robertson pupil?
Bilaterally small pupils that accommodate but don’t react to bright light
Mneumonic
ARP = Accomodation reflex present
PRA = Pupillary reflex absent
What causes argyll-robertson pupil?
Neurosyphilis and diabetes mellitus
What is the pathology of Horner’s syndrome?
Damage to the sympathetic trunk on the same side as symptoms
Horner’s syndrome symptoms?
Miosis (pupil constriction)
Ptosis (droopy eyelid)
Enopthalmos (inset eyeball)
Anhidrosis (decreased sweating)
All on one side
Adie pupil symptoms
Tonically dilated pupil
Slowly reactive to light with a more definite accommodation response
Holmes-Adie pupil often associated with absent knee/ankle reflexes
What is the pathology of adie pupil syndrome?
Damage to the parasympathetic innervation of the eye
What is Hutchinson’s pupil?
Unilaterally dilated pupil unresponsive to light
What causes Hutchinson’s pupil?
Compression of the occulomotor nerve of the same side Intracranial mass (e.g. tumour, haematoma)
Marcus-gunn pupil symptoms?
Relative afferent pupillary defect seen during the swinging light examination of pupil response - the pupils constrict less and therefore appear to dilate when light is swung from unaffected to affected eye
What causes Marcus-gunn pupil?
Damage to the optic nerve or severe retinal disease
What is associated with anterior uveitis?
HLA-B27
So conditions linked to it include: Ankylosing spondylitis Reactive arthritis UC Crohn's Behcet's disease Sarcoidosis
What are the features of anterior uveitis?
Acute onset Occular discomfort/pain Pupil may be irregular (oval shaped) and small Photophobia Blurred vision Red eye Lacrimation Visual acuity impaired
How do you manage anterior uveitis?
Urgent referral to opthalmology
Cycloplegics (dilates the pupil to relieve pain/photophobia) - examples include atropine and cyclopentolate
Steroid eye drops
What is herpes zoster ophthalmicus?
Reactivation of varicella-zoster virus in division of trigeminal nerve
How do you treat HZO?
Oral antiviral treatment for 7-10 days
Topical corticosteroids can be used to treat secondary inflammation
What characterises ARMD?
Degeneration of retinal photoreceptors
What would you see on fundoscopy in dry ARMD?
Drusen (yellow round spots in Bruch’s membrane)
What might you see on fundoscopy in wet ARMD?
Well demarcated red patches representing sub-retinal fluid leakage or haemorrhage
Neovascularisation
What is the treatment for dry ARMD?
Anti-oxidants
Zinc
Vitamins A, C and E
Stop smoking
What is the treatment for wet ARMD?
Anti-VEGF (vascular endothelial growth factor) - e.g. ranibizumab. 4 weekly injection
What causes primary open angle glaucoma?
Increased resistance to aqueous outflow through the trabecular meshwork caused by slow blockage of the drainage canals
What causes closed angle glaucoma?
The iris blocks the drainage angle which the eye would usually use to decrease fluid buildup
What are the symptoms/signs of primary open-angle glaucoma?
Symptomless for a long period
Typically presents with an increased ocular pressure on routine measurement
Increased intraocular pressure
Visual field defect
Pathological cupping of the optic disc
What IOP indicates glaucoma?
> 24mmHg on Goldmann-type applanation tonometry
Treatment for primary open angle glaucoma?
First line:
Prostaglandin analogues (latanoprost)
Beta-blockers (timolol)
Can give pilocarpine as well (this can cause blurry vision, headache and a constricted pupil)
What is blepharitis?
Inflammation of the eyelid margins
What are the features of blepharitis?
Bilateral Grittiness and discomfort Eyes may be sticky iin the morning Eyelid margins may be red Styes/chalazions common
How do we manage blepharitis?
Hot compresses twice a day
Lid hygiene - cotton wool buds dipped in cooled boiled water to remove debris
Artificial tears
How do we treat nasolacrimal duct obstruction?
Teach parents to massage the lacrimal duct
What causes a dendritic ulcer?
Herpes simplex keratitis
What are the features of herpes simplex keratitis?
Red, painful eye Photophobia Epiphora Decrease in visual acuity Fluorescein staining may show an epithelial ulcer
How do we manage herpes simplex keratitis?
Immediate referral to ophthalmologist
Topical aciclovir
What increases the risk of corneal ulcers?
Contact lens use
Steroid eye drops
What are the features of a corneal ulcer?
Eye pain
Photophobia
Watering of the eye
How do we treat styes?
Warm steaming or soaking with a warm flannel
What causes styes?
Generally a staphylococci infection of the glands of the eyelids
What are the features of a chalazion (meibomian cyst)?
Firm painless lump on the eyelid
Often follows an internal stye
Usually a prolonged history
How do we treat a chalazion?
Often resolves spontaenously
Surgical drainage in some cases
What is an ectropion?
An out-turning of the eyelids
What is an entropion?
An in-turning of the eyelids
What are risk factors for primary open angle glaucoma?
Genetics Black patients Myopia HTN DM Corticosteroids
How do we manage entropion?
If left untreated it can cause corneal ulcer, so:
We definitely manage using surgery
In the meantime we can use eye lubricants and tape to pull the eyelid outwards
Features of bacterial conjunctivitis (as opposed to in viral)?
Purulent discharge
Eyes may be stuck together in the morning
Features of viral conjunctivitis (as opposed to in bacterial)?
Watery discharge
Recent URTI
Preauricular lymph nodes
Management of infective conjunctivitis?
Self-limiting - resolves in 1-2 weeks Topical abx commonly offered (chloramphenicol) Topical fusidic acid if pregnant Contact lenses should NOT be used Do NOT share towels School exclusion not necessary
What are factors that predispose individuals to acute angle-closure glaucoma?
Hypermetropia (long-sightedness)
Pupillary dilation
Lens growth with age
Features of acute angle-closure glaucoma?
Severe pain (ocular, headache)
Decreased visual acuity
Symptoms worse with mydriasis (e.g. watching tv in a dark room)
Hard, red eye
Haloes around lights
Corneal oedema results in dull/hazy cornea
Systemic upset (nausea/vomiting/abdo pain)
Treatment for acute closed-angle glaucoma?
Urgent ophthalmology referral
Acetazolamide
Topical pilocarpine
What causes optic neuritis?
MS
Diabetes
Syphilis
Features of optic neuritis?
Unilateral decrease in vis. acuity over hours/days Poor discrimination of colours Pain worse on eye movement Central scotoma RAPD
How do we treat optic neuritis?
High dose steroids
Recovery takes 4-6 weeks
What condition is both scleritis and episcleritis associated with?
Rheumatoid arthritis?
How can you differentiate between scleritis and episcleritis?
Scleritis is painful, episcleritis is not
What features are there of scleritis/episcleritis?
Red eye Watery eye Photophobia Gradual decrease in vision Pain (scleritis only)
What is Hutchinson’s sign?
Rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement in HZO
What might you observe on fundoscopy in papilloedema?
Venous engorgement Loss of venous pulsation (???) Blurring of the optic disc margin Elevation of optic disc Loss of the optiic cup Paton's lines (retinal lines that cascade away from the optic disc)
Causes of papilloedema?
Space occupying lesion Malignant hypertension Raised ICP Hydrocephalus Hypercapnia
Pre-septal vs orbital cellulits
Orbital cellulitis has: Restricted eye movement Proptosis Increased IOP Signs of optic neuropathy
Subconjunctival haemorrhage
Looks awful, red sclera but usually just conservative management
If significant trauma, think about base of skull fracture
Pre-septal vs orbital cellulits
Orbital cellulitis has: Restricted eye movement Proptosis Increased IOP Signs of optic neuropathy
Subconjunctival haemorrhage
Looks awful, red sclera but usually just conservative management
If significant trauma, think about base of skull fracture
