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Finals Revision > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is Blepharitis?

A

Inflammation of the rims of eyelids

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2
Q

Aetiology of Blepharitis

A

Chronic staphylococcal infection + Meibomian gland dysfunction

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3
Q

Presentation of Blepharitis

A

Gradual onset gritty/dry eye, crusting on lashes, red conjunctivae, red rimmed thickened lid margins, blocked/oozing Meibomian glands

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4
Q

Management of Blepharitis

A

Eyelid hygiene, massage, hot compresses

Topical Chloramphenicol

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5
Q

What is a Chalazion?

A

Granuloma of Meibomian gland

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6
Q

Presentation of Chalazion

A

Eyelid swellng/lump, tender red eye, watery eye, heaviness of eyelid

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7
Q

Management of Chalazion

A

Warm compresses, Chloramphenicol, Surgical incision

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8
Q

What is a stye?

A

Infection of the lash follicle

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9
Q

What is the most common tumour of the eyelid?

A

Basal Cell Carcinoma

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10
Q

Which muscles does the 3rd cranial nerve (oculomotor) supply?

A 
Levator palpebrae superioris, Superior rectus, Inferior rectus, Medial rectus, Inferior oblique
Constrictor pupillae (constricts pupil)
Ciliary muscles (adapts to short range vision)
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11
Q

Causes of 3rd nerve palsy

A

Raised ICP- compressed against temporal bone

Posterior communicating artery aneurysm, Cavernous sinus infection/trauma, Diabetes, MS, MG

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12
Q

Presentation of 3rd nerve palsy

A

Ptosis, eye down & out, unable to elevate, depress or adduct eye, fixed dilated pupil

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13
Q

Management of 3rd nerve palsy

A

Treat the cause

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14
Q

Aetiology of Retinal Tear/Detachment

A

Neurosensory layer detaches from epithelium

Most preceded by posterior vitreous detachment

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15
Q

Risk factors for Retinal Tear/Detachment

A

Myopia, FH, previous Hx, age, lattice degeneration, Marfan’s, diabetic retinopathy, maculopathy

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16
Q

Presentation of Retinal Tear/Detachment

A

New onset floaters/flashes, sudden onset painless progressive visual loss, RAPD, altered red reflex

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17
Q

Management of Retinal Tear/Detachment

A

Urgent referral
Cryotherapy/Photocoagulation for tears
Surgery for detachment
Topical Abx + steroids

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18
Q

Aetiology of Diabetic Retinopathy

A

Microvascular occlusion –> Retinal ischaaemia –> Arteriovenous shunts + neovascularisation
Leakage –> intraretinal haemorrhages + oedema
Visual loss due to macular oedema, foveal ischaemia and foveal haemorrhage

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19
Q

Presentation of Diabetic Retinopathy

A

Gradual reduction in central vision

Haemorrhages cause sudden onset dark painless floaters

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20
Q

Features of Background Diabetic Retinopathy

A

Microaneurysms, Blot haemorrhages, Hard exudates

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21
Q

Features of Pre-proliferative Diabetic Retinopathy

A

Cotton wool spots, >3 blot haemorrhages, venous beading/looping, dark cluster haemorrhages

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22
Q

Features of Mild vs Moderate vs Severe Non-proliferative Diabetic Retinopathy

A

Mild: 1 or more microaneurysms
Moderate: microaneurysms, blot haemorrhages, hard exudates, cotton wool spots, venous beading/looping
Severe: blot haemorrhage + microaneurysms in 4 quadrant, venous beading in at least 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant

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23
Q

Features of Proliferative Diabetic Retinopathy

A

Retinal neovascularisation, fibrous tissue forming anterior to retinal disc

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24
Q

How often are diabetics screened for Diabetic Retinopathy?

A

Annually

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25
Q

Management of Diabetic Retinopathy

A

Glycaemic + BP control
Smoking cessation
Laser treatment, intravitreal steroids, anti-VEGF, vitrectomy for bleed

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26
Q

What is Diabetic maculopathy?

A

Grouped exudate within the macula

Any exudate or retinal thickening within 1 disc diameter of the foveola

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27
Q

Management of diabetic maculopathy

A

Laser

Intravitreal triamcinolone

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28
Q

What is the arterial supply to the eye?

A

Opthalmic artery from internal carotid

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29
Q

What s the venous supply of the eye?

A

Superior and inferior opthalmic veins- drain into cavernous sinus

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30
Q

Differentials of a red eye

A 
Keratitis
Scleritis
Uveitis
Endopthalmitis
Acute glaucoma
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31
Q

Causes of blue sclera

A

Rheumatoid arthritis

Marfan’s syndrome

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32
Q

Causes of proptosis/exopthalmos

A

Eye forwards- thyroid disease

Eye downwards- lacrimal gland tumour

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33
Q

Causes of purulent eye discharge

A

Infection, allergy

34
Q

Causes of bloody eye discharge

A

Severe infection

Tumour

35
Q

Cause of sudden visual loss

A

Vascular/inflammatory eg retinal vein occlusion

36
Q

Causes of transient visual loss

A

Vascular cause- GCA/retinal emboli

37
Q

Causes of central visual loss

A

Macular or optic nerve disease

38
Q

Causes of peripheral visual loss

A

Glaucoma, CVA, retinitis pigmentosa

39
Q

Causes of colour vision loss

A

Optic neuritis, cataract, drug toxicity

40
Q

Cause of poor night vision

A

Retinitis pigmentosa

41
Q

Causes of loss of red reflex

A

Cataracts, Retinoblastoma

42
Q

What is Amaurosis fugax?

A

Transient and painless loss of vision in one eye - transient retinal ischaemia

43
Q

What are the most common causative organisms for infectious conjunctivitis?

A

Adenovirus, Herpes, Staph, Strep, Moraxella, Chlamydia, Gonorrhoea

44
Q

Management of infectious conjunctivitis

A

Topical antibiotics- Chloramphenicol

45
Q

What are red flags of a red eye?

A

Impaired vision, pain/photophobia, lack of ocular discharge

46
Q

What is uveitis?

A

Inflammation of the uveal tract (iris + ciliary body + choroid)
Anterior (iritis) or Posterior

47
Q

Causes of Uveitis

A

Autoimmune disease eg Sarcoidosis, infections, infiltrative (neoplastic), trauma, ischaemic, immunosuppression

48
Q

How do you determine if Uveitis is granulomatous or not?

A

Whether or not there are keratic precipitates

49
Q

Presentation of Anterior Uveitis

A

Unilateral painful red eye, photophobia, pain worse when reading, blurred vision, tear production, headache

50
Q

Presentation of Intermediate Uveitis

A

Painless floaters, reduced vision

51
Q

Presentation of Posterior Uveitis

A

Gradual visual loss, bilateral blurred vision and floaters

52
Q

Management of Uveitis

A 
Cytoplegic-mydriatic drugs- 1% Atropine- relieves pain and prevents adhesions
Corticosteroids
Immunosuppressors- Ciclosporin
Laser phototherapy, Cryotherapy
Vitrectomy
53
Q

What is Glaucoma?

A

Damage to the optic nerve head with progressive loss of retinal ganglion cells and their axons

54
Q

Aetiology of open angle glaucoma

A

Flow is reduced through trabecular meshwork (absorbs aqueous humour) –> painless chronic degenerative obstruction

55
Q

Aetiology of closed angle glaucoma

A

Iridocorneal angle closed by forward displacement of the foot of iris against the cornea –> aqueous humour cannot flow from posterior to anterior angle –> rapid and painful build up

56
Q

Risk factors for Glaucoma

A

Raised IOP, myopia, diabetes, FH, Female, prolonged steroid use, uveitis, hypertension, trauma
Mydriatic drops can be a precipitant of closed-angle

57
Q

Investigation in Glaucoma

A

Gonioscopy- measure angle between cornea + iris

58
Q

How is Glaucoma screened for?

A

Annual screening from age 40 if family history

59
Q

Presentation of open-angle glaucoma

A

Majority asymptomatic
Chronic progressive bilateral peripheral visual loss then tunnel vision
Intraocular pressure 11-21

60
Q

Management of Glaucoma

A
  1. Increase uveoscleral outflow- Prostaglandin analogues- Latanoprost
  2. Reduce aqueous production- B Blockers- Timolol
  3. Trabeculectomy/Laser surgery
    DVLA!
61
Q

Presentation of closed-angle glaucoma

A

Severe and rapid pain, blurred vision, coloured haloes, N&V, red eye
Hard globe- raised IOP

62
Q

What is the world’s leading cause of blindness?

A

Cataracts

63
Q

Risk factors for cataracts

A

Age, smoking, diabetes mellitus, systemic corticosteroids, uveitis, UV exposure, malnutrition
Paeds: Rubella, metabolic, trauma

64
Q

Presentation of cararacts

A

Gradual painless loss of vision, diplopia, glare, haloes, defects in red reflex

65
Q

Management of cataracts

A

Surgery- lens extraction + replacement
Phacoemulsification
DVLA

66
Q

What is Age-related Macular Degeneration?

A

Ageing changes without any other obvious precipitating cause in the macula age > 55

67
Q

Risk factors for Age-related Macular Degeneration

A

Smoking, age, FH, hypertension, aspirin use, exposure to sunlight, previous cataract surgery, alcohol, obesity, hyperopia, CV disease

68
Q

Pathophysiology of Age-related Macular Degeneration

A

Dry- Drusen- collection of lipid + proteins beneath retinal pigment epithelium + within Bruck’s membrane
Atrophy of light-sensitive cells, neovascular AMD

69
Q

Presentation of Age-related Macular Degeneration

A

Can be asymptomatic
Painless deterioration and blurring of central vision
Metamorphosia- straight lines blurry
Scotoma- grey/black patch over central vision
Light glare, loss of contrast
Photopsia- flashing/flickering lights
Visual hallucinations- Charles Bonnet

70
Q

Management of Age-related Macular Degeneration

A

1 week referral
Wet- VEGF- Ranibizumab, Photocoagulation/Photodynamic therapy
Dry- vit A/C/E or zinc

71
Q

Differentials of dry eye

A

Hyposecretive- Sjogren’s, lymphoma, sarcoidosis, lacrimal gland obstruction, CNVII damage, anticholinergics, beta blockers, SSRIs, diuretics, antihistamines
Evaporative- Blepharitis, Parkinson’s, thyroid eye disease, vitamin A deficiency, contact lenses

72
Q

Risk factors for dry eyes

A

Female, old age, HRT, contact lenses

73
Q

Investigations for dry eyes

A

Tear break-up time with fluorescein

Schirmer’s test- filter paper wetting in 5mins < 5mm

74
Q

Causes of Papilloedema

A

SOL eg neoplasia, infection, haemorrhage, idiopathic intracranial hypertension, hydrocephalus

75
Q

Causes of Horner’s syndrome

A

Central- MS, stroke
Pre-ganglionic- Pancoast tumour
Post-ganglionic- Carotid artery disseciton

76
Q

What does papilloedema signify?

A

Raised intracranial pressure

77
Q

Presentation of Horner’s syndrome

A

Ptosis, Meiosis (contricted pupil), anhidrosis, pseudo-enopthalmos

78
Q

Key difference between Horner’s syndrome and 3rd nerve palsy in terms of presentation

A

Horner’s: constricted pupil

3rd nerve palsy: dilated pupil

79
Q

Features of hypertensive retinopathy

A

Arterial narrowing- ‘copper wiring’
Arteriovenous nipping
Vascular leakage
Haemorrhage + exudates
Macular star- thin white streaks around macula
Disc swelling, cotton wool spots, blot (flame) haemorrhages

80
Q

Management of hypertensive retinopathy

A

Manage the hypertension

81
Q

Presentation of Retinitis pigmentosa

A

Night blindness + tunnel vision

82
Q

Fundoscopy findings in Retinitis pigmentosa

A

Black bone spicule-shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium

Finals Revision (13 decks)

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