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Opthalmology Flashcards

1
Q

What is amaurosis fugax?

A

Transient monocular vision loss (TMVL). Usually ischaemic/vascular cause

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2
Q

How do we typically treat amaurosis fugax?

A

As it usually has a thrombotic cause, we give 300mg aspirin as with TIAs/strokes

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3
Q

Which of central retinal vein and central retinal artery occlusion is more common?

A

Central retinal vein occlusions are more common

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4
Q

What would you see on fundoscopy for central retinal vein occlusion?

A

Retinal haemorrhages

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5
Q

Causes of central retinal vein occlusion?

A

Glaucoma
Hypertension
Polycythaemia

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6
Q

What would you see on fundoscopy for central retinal artery occlusion?

A

Pink cherry spot

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7
Q

Causes of central retinal artery occlusion?

A

Arteritis

Thromboembolism

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8
Q

Does TIA cause monocular vision loss?

A

No. It causes a hemianopia

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9
Q

What causes vitreous haemorrhage?

A

Diabetes
Bleeding disorders
Anticoagulants

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10
Q

Vitreous haemorrhage features

A

Sudden vision loss
Dark spots
Small bleeds cause floaters

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11
Q

Retinal detachment features

A

Dense shadow that starts peripherally and progresses toward the central vision
Straight lines appear curved
Central vision loss
Veil/curtain over field of vision

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12
Q

Posterior vitreous detachment features

A

Flashes of light (photpsia) in peripheral fields of vision

Floaters (often on temporal side)

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13
Q

How can we stage hypertensive retinopathy

A

Keith-Wagener classification

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14
Q

Hypertensive retinopathy stages

A

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

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15
Q

Features of cataracts

A

Gradual onset of reduced vision
Faded colour vision
Glare (lights appear brighter)
Halos around lights

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16
Q

What signs might you see in cataracts

A

A defect in the red reflex

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17
Q

Management of cataracts

A

Non-surgical: stronger contacts/glasses

Surgical: Removal of the lens and replacing it with an artificial one

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18
Q

Causes of cataracts

A 
Normal aging (most common)
Smoking
DM
High alcohol consumption
Long-term corticosteroids
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19
Q

What are cataracts?

A

Opacification of the lens of the eye making it more difficult for light to reach the back of the eye (retina)

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20
Q

What is argyll-robertson pupil?

A

Bilaterally small pupils that accommodate but don’t react to bright light

Mneumonic
ARP = Accomodation reflex present
PRA = Pupillary reflex absent

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21
Q

What causes argyll-robertson pupil?

A

Neurosyphilis and diabetes mellitus

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22
Q

What is the pathology of Horner’s syndrome?

A

Damage to the sympathetic trunk on the same side as symptoms

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23
Q

Horner’s syndrome symptoms?

A

Miosis (pupil constriction)
Ptosis (droopy eyelid)
Enopthalmos (inset eyeball)
Anhidrosis (decreased sweating)

All on one side

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24
Q

Adie pupil symptoms

A

Tonically dilated pupil
Slowly reactive to light with a more definite accommodation response
Holmes-Adie pupil often associated with absent knee/ankle reflexes

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25
What is the pathology of adie pupil syndrome?
Damage to the parasympathetic innervation of the eye
26
What is Hutchinson's pupil?
Unilaterally dilated pupil unresponsive to light
27
What causes Hutchinson's pupil?
``` Compression of the occulomotor nerve of the same side Intracranial mass (e.g. tumour, haematoma) ```
28
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
29
What causes Marcus-gunn pupil?
Damage to the optic nerve or severe retinal disease
30
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 ```
31
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 ```
32
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
33
What is herpes zoster ophthalmicus?
Reactivation of varicella-zoster virus in division of trigeminal nerve
34
How do you treat HZO?
Oral antiviral treatment for 7-10 days | Topical corticosteroids can be used to treat secondary inflammation
35
What characterises ARMD?
Degeneration of retinal photoreceptors
36
What would you see on fundoscopy in dry ARMD?
Drusen (yellow round spots in Bruch's membrane)
37
What might you see on fundoscopy in wet ARMD?
Well demarcated red patches representing sub-retinal fluid leakage or haemorrhage Neovascularisation
38
What is the treatment for dry ARMD?
Anti-oxidants Zinc Vitamins A, C and E Stop smoking
39
What is the treatment for wet ARMD?
Anti-VEGF (vascular endothelial growth factor) - e.g. ranibizumab. 4 weekly injection
40
What causes primary open angle glaucoma?
Increased resistance to aqueous outflow through the trabecular meshwork caused by slow blockage of the drainage canals
41
What causes closed angle glaucoma?
The iris blocks the drainage angle which the eye would usually use to decrease fluid buildup
42
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
43
What IOP indicates glaucoma?
>24mmHg on Goldmann-type applanation tonometry
44
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)
45
What is blepharitis?
Inflammation of the eyelid margins
46
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 ```
47
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
48
How do we treat nasolacrimal duct obstruction?
Teach parents to massage the lacrimal duct
49
What causes a dendritic ulcer?
Herpes simplex keratitis
50
What are the features of herpes simplex keratitis?
``` Red, painful eye Photophobia Epiphora Decrease in visual acuity Fluorescein staining may show an epithelial ulcer ```
51
How do we manage herpes simplex keratitis?
Immediate referral to ophthalmologist | Topical aciclovir
52
What increases the risk of corneal ulcers?
Contact lens use | Steroid eye drops
53
What are the features of a corneal ulcer?
Eye pain Photophobia Watering of the eye
54
How do we treat styes?
Warm steaming or soaking with a warm flannel
55
What causes styes?
Generally a staphylococci infection of the glands of the eyelids
56
What are the features of a chalazion (meibomian cyst)?
Firm painless lump on the eyelid Often follows an internal stye Usually a prolonged history
57
How do we treat a chalazion?
Often resolves spontaenously | Surgical drainage in some cases
58
What is an ectropion?
An out-turning of the eyelids
59
What is an entropion?
An in-turning of the eyelids
60
What are risk factors for primary open angle glaucoma?
``` Genetics Black patients Myopia HTN DM Corticosteroids ```
61
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
62
Features of bacterial conjunctivitis (as opposed to in viral)?
Purulent discharge | Eyes may be stuck together in the morning
63
Features of viral conjunctivitis (as opposed to in bacterial)?
Watery discharge Recent URTI Preauricular lymph nodes
64
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 ```
65
What are factors that predispose individuals to acute angle-closure glaucoma?
Hypermetropia (long-sightedness) Pupillary dilation Lens growth with age
66
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)
67
Treatment for acute closed-angle glaucoma?
Urgent ophthalmology referral Acetazolamide Topical pilocarpine
68
What causes optic neuritis?
MS Diabetes Syphilis
69
Features of optic neuritis?
``` Unilateral decrease in vis. acuity over hours/days Poor discrimination of colours Pain worse on eye movement Central scotoma RAPD ```
70
How do we treat optic neuritis?
High dose steroids | Recovery takes 4-6 weeks
71
What condition is both scleritis and episcleritis associated with?
Rheumatoid arthritis?
72
How can you differentiate between scleritis and episcleritis?
Scleritis is painful, episcleritis is not
73
What features are there of scleritis/episcleritis?
``` Red eye Watery eye Photophobia Gradual decrease in vision Pain (scleritis only) ```
74
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
75
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) ```
76
Causes of papilloedema?
``` Space occupying lesion Malignant hypertension Raised ICP Hydrocephalus Hypercapnia ```
77
Pre-septal vs orbital cellulits
``` Orbital cellulitis has: Restricted eye movement Proptosis Increased IOP Signs of optic neuropathy ```
78
Subconjunctival haemorrhage
Looks awful, red sclera but usually just conservative management If significant trauma, think about base of skull fracture
79
Pre-septal vs orbital cellulits
``` Orbital cellulitis has: Restricted eye movement Proptosis Increased IOP Signs of optic neuropathy ```
80
Subconjunctival haemorrhage
Looks awful, red sclera but usually just conservative management If significant trauma, think about base of skull fracture

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