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year 5 > opthalmology > Flashcards

opthalmology Flashcards

1
Q

amblyopia

A

reduced vision in a structually normal eye

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2
Q

anirdia

A

absence of iris

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3
Q

anterior chamber

A

aqueous chamber lying between cornea and iris

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4
Q

aphakia

A

absence of lens

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5
Q

aqueous humour

A

secretion of the ciliary body which flows through the pupil into the anterior chamber and largely leaves the eye via the drainage angle

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6
Q

arcuate scotoma

-what and feature of?

A

an arc shaped blind spot running from the blind spot to the peripheral visual field

  • position determined by course of damaged retinal nerve fibres
  • feature of chronic glaucoma
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7
Q

astigmatism

A

refractive error that prevents the light rays from coming to a single focus on the retina because of the irregular corneal curvature
- near and far sight are blurry

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8
Q

blepharitis

A

inflammation of the eyelids, most commonly the lid margins

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9
Q

blepharospasm

A

spasm which may be tonic or chronic, of the orbicularis oculi muscle (closes the eyelid)

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10
Q

buphthalmos

A

the large eyeball in infantile glaucoma

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11
Q

blind spot

A

each eye has a normal blind spot which corresponds to the optic nerve head

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12
Q

blind spot

A

each eye has a normal blind spot which corresponds to the optic nerve head

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13
Q

canal of schlemm

A

a circular drainage canal (a venous sinus) into which aqueous humour drains from the trabecular meshwork before discharging into the anterior ciliary veins

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14
Q

canthus

A

the angle at either end of the eyelid aperture, specified as outer or inner

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15
Q

cataract

A

opacity of the lens

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16
Q

chemosis

A

conjunctival oedema and swelling

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17
Q

choroid

A

thin, highly vascular membrane covering the posterior 5/6 of the eyeball between the retina and sclera

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18
Q

conjunctiva

A

mucous membrane lining the inner surfaces of the eyelids and the anterior part of the sclera

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19
Q

conjunctival concretion

A

cluster of small hard yellowish-white calcified matter mostly in the clear membrane on the inside of the eyelid

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20
Q

convergence

A

movement of the eyes turning inwards towards each other

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21
Q

cornea

A

the curved transparent anterior portion of the fibrous outer coat of the globe of the eye

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22
Q

cyclodiode laser

A

trans- scleral diode laser photo-coagulation used to lower intra-ocular pressure in advanced glaucoma

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23
Q

cyclodiode laser

A

trans- scleral diode laser photo-coagulation used to lower intra-ocular pressure in advanced glaucoma

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24
Q

cycloplegic

A

a drug that temporarily puts the ciliary muscle at rest, paralyses accomodation and dilates the pupil

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25
Q

dacryocystitis

A

inflammation of the lacrimal sac

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26
Q

dacrocystorhinostomy

A

an operation to produce an alternative drainage route between the lacrimal sac and the nose

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27
Q

diabetic retinopathy

A

microvascular disease of the retina in diabetes

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28
Q

drainage angle

A

the zone in the anterior chamber through which the aqueous must pass to leave the eye
lies at the point of convergence of the iris with the cornea

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29
Q

diplopia

A

the condition in which a single object is seen as two rather than one

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30
Q

divergence

A

movement of the eyes turning outwards away from each other

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31
Q

ectropion

A

turning out of the eyelid

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32
Q

emmetropia

A

state of normal vision

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33
Q

endophthalmitits

A

this is an inflammation of the interior of the eye

  • can be a complication of all intraocular surgeries and or procedures
  • with the potential of loss of vision or even the eye itself
  • eye looks cloudy and inflammed
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34
Q

enopthalmos

A

recession of the eye (globe) into the orbit

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35
Q

enotropion

A

a turning inward of the eyelid

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36
Q

enucleation

A

complete surgical removal of the eyeball

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37
Q

episclera

A

the free connective tissue between the sclera and the conjunctiva

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38
Q

episclera

A

the free connective tissue between the sclera and the conjunctiva

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39
Q

evisceration

A

removal of the eye’s contents leaving the scleral shell and the extraocular muscle intact
-performed to reduce pain or improve aesthetics in a blind eye with endophalmitis

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40
Q

exenteration

A

removal of the entire contents of the orbit, including eyeball, lids and periostium

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41
Q

exopthalmos

A

abnormal protrusion of the eyeball -due to endocrine

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42
Q

fornix

A

the junction of the lid (palpebral) and globe (bulbar) conjunctivas. the pocket into which medication is instilled

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43
Q

fundus, ocular

A

the interior of the eye visible through the pupil with the use of an opthalmoscope
comprises of the retina, pars planna, retinal blood vessels and sometimes choroidal vessels

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44
Q

glaucoma

A

complex group of eye disorders having a common feature of optic nerve damage of a characteristic type affecting the optic nerve head
-assoc. with elevated or unstable intra-ocular pressures

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45
Q

goldman’s applanation tonometer

A

a slit lamp mounted instrument which estimates the intraocular pressure by the force required to flatten a given corneal area

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46
Q

heterochromia

A

difference in colour of the two irises or of different parts of the same iris

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47
Q

hypermetropia

A

long sighted

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48
Q

hyphaema

A

haemorrhage into the anterior chamber

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49
Q

hypopyon

A

collection of white cells in the anterior chamber of the eye forming a fluid level

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50
Q

iris

A

the muscular and vascular diaphragm interposed between the cornea and the crystalline lens

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51
Q

keratic precipitates KP

A

fine cellular deposits at the back of the cornea

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52
Q

keratitis

A

inflammation of the cornea, which may or may not be assoc. with infection

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53
Q

limbus

A

junctional zone where the cornea joins the sclera

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54
Q

macula

A

the cone rich portion of the retina, used for fixation of gaze

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55
Q

meibomian cyst (tarsal cyst, chalazion)

A

a small localised swelling of the eyelid resulting from obstruction and retention of secretions of meibomian glands
-non malignant condition

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56
Q

miotics

A

drugs that constrict the pupil

maybe used to treat glaucoma and accomodative strabismus

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57
Q

miosis

A

constriction of the pupil

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58
Q

mydriatics

A

drugs that dilate the pupil

may be used to facilitate fundal examination, cataract and retinal surgery and to treat ocular inflammations

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59
Q

myopia

A

short sighted
term used to describe the optical status of the eye in which the images of distant objects are focused short (in front) of the retina.
The patient suffers from blurred distance vision

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60
Q

phaco

phacoemulsificaiton

A

a procedure to removal the crystalline lens in cataract surgery that consists of emulsifying and aspirating the contents of the lens with the use of a low frequency ultrasonic needle inserted into the eye at the limbus (cataract surgery)

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61
Q

photophobia

A

abnormal sensitivity and discomfort to light

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62
Q

phthisical eye

A

a shrunken blind eye, which is undergoing severe degenerative changes.
Results in poor cosmetic appearance.
may also become painful and require enuculeation or appearance improved with fitting of a cosmetic shell

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63
Q

photopsia

A

flashing lights associated with migraine headaches, posterior vitreous detachment or retinal detachment

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64
Q

presbyopia (old sight)

A

physiologically blurred near vision, commonly evident soon after the age of 40

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65
Q

punctum

A

a tiny aperture in the margin of each eyelid, at the inner canthus almost level with the caruncle, that opens into the lacrimal duct

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66
Q

retina

A

light sensitive, innermost nervous tissue, layer of the eye which lies between the vitreous body and the choroid

  • extends from the ora serrata to the optic disc and comprises ten layers
  • The retina converts light into nerve impulses for transmission to visual and motor centres in the brain
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67
Q

sclera

A

tough white opaque portion of the fibrous outer coat of the eye

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68
Q

scotoma

A

an area of partial or complete blindness surrounded by a normal or relatively normal visual field

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69
Q

sjorgrens syndrome

A

a chronic connective tissue disease characterised by failure of lacrimal secretion and dryness of all mucous membranes
often assoc. to rheumatoid arthritis

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70
Q

hyperopia

A

long sighted

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71
Q

slit lamp

A

microscope for examining the eye under magnification and providing a slit like beam of light

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72
Q

strabismus squint

A

condition in which the lines of sight of the two eyes are not directed towards the same fixation point

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73
Q

synechia

A

adhesion of the iris to the cornea (anterior synechia)

adhesion of the irirs to the lens (posterior)

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74
Q

temporal arteritis

A

sight threatening condition resulting from a systemic vasculitis
-dx based on CPR and ESR
give steroids!! sight threatening

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75
Q

tonometer

A

an instrument for the objective measurement of intra-ocular pressure

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76
Q

uveal tract

A

the major vascular comparment of the eye comprising iris, ciliary body and choroid

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77
Q

vitreous

A

gel of the eye, lying between the crystalline lens and the retina

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78
Q

keratoconus and rx

A

progressive thinning of the cornea

treated with riboflavin and UVA light to cause new collagen cross linking

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79
Q

RX options for retinal detachment

A

–cryoptherapy with cold probe or
-photocoagulation with laser
-sceral bulking with silicone oil
pneumatic retinopexy with gas injections
vitrectomy - removed and replaced with gas or oil

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80
Q

cornea replacement

A
  • complete= penetrating keratoplasty

- partial= lamellar keratoplasty

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81
Q

macular hole repair Rx

A

vitrectomy- remove some of the vitreous gel to stop it pulling on the retina and a mix of gas/ air is inserted into the space

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82
Q

trichiasis

A

inward growing of eye lashes

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83
Q

red eye causes

A
  1. allergic CJ
  2. infectious conjunctivitis
  3. iritis
  4. scleritis
  5. episcleritis
  6. CN VII palsy
  7. stromal keratitis
  8. epithelial keratitis
  9. acute angle closure glaucoma
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84
Q

Binocular diplopia causes and type of diplopia

A 
Binocular Diplopia (improves when close one eye)
CN 3= vertical diplopia
CN IV= vertical diplopia
CN VI= horizontal diplopia 
internuclear opthalmoplegia= horizontal 
restrictive myopathy= thyroid- tight IR
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85
Q

monocular diplopia causes

A

cataracts does not improve when one eye closed

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86
Q

binocular visual loss causes

A

Chiasm lesion= bitemporal hemianopia

post-chiasm lesion= homonymous hemianopia

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87
Q

monocular visual loss causes

A 
refractive error (improves with pinhole)
retina detachment (RAPD)
optic nerve (RAPD)
vitreous haemorrhage
cataract 
macula
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88
Q

epiphoria causes

A 
red eye
ectropion (eyelid face outwards) 
CN VII palsy
punctal stenosis
nasolacrimal duct stenosis (hard stop)
canalicular stenosis (soft stop)
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89
Q

CN VII palsy presentation

A

red eye

inability to close eye

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90
Q

CNVI palsy

A

horizontal diplopia
loss of lateral rectus so eyes converge
loss of abduction

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91
Q

CN IV PALSY

A

superior oblique
vertical diplopia
eye faces upwards

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92
Q

CN IIII

A 
all the rest
eye looks down and out due to LR and SO
vertical diplopia 
unable to adduct
mydriasis -aniscoria
ptosis
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93
Q

Horner’s syndrome

A 
miosis
ptosis
anihydrosis
enopthalmos- sink 
sympathetic NS
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94
Q

ocular causes of visual field defects

A

glaucoma- most common cause
macula degeneration- central scotoma
retinal detachment
optic neuritis- enlarged blind spot

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95
Q

neurological causes of visual field defects

A

space occupying lesion- pituitary, meningioma
aneurysm
stroke
trauma

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96
Q

orbital causes of visual field defects

A

optic nerve glioma
meningioma
hemangioma

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97
Q

vascular causes of visual field defects

A

branch retinal and central retinal

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98
Q

left optic nerve field defect

A

no light perception of left eye

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99
Q

chiasm field defect

A

bitemporal hemianopia

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100
Q

right optic tract field defect

A

incongrous left homonymous hemianopia

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101
Q

left lateral geniculate nucelus field defect

A

right homonymous quadruple sectoranopia

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102
Q

left temporal lobe field defect

A

right homonymous hemianopia upper quadrant

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103
Q

left parietal lobe field defect

A

right homonymous hemianopia lower quadrant

PITS

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104
Q

left occipital lobe

A

right homonymous hemianopia- macula sparing

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105
Q

retinitis pigmentosa presentation

A 
normal visual acuity
reduced visual field
pigmentation in the retina 
usually initially loss of night vision
tunnel vision
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106
Q

what is retinitis pigmentosa

A

breakdown retina cells
genetic inhertied disorder
affects photoreceptors
peripheral retina loss

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107
Q

assoc. syndromes to retinitis pigmentosa

A

alport
refsum
usher

due to RPDR gene- autosomal dominant or x-linked

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108
Q

management of retinitis pigmentosa

A

no cure
Vit A supplements
complete blindness is rare but visual field loss will continue to be lost

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109
Q

causes of RAPD

A

optic neuropathy

retinal pathology

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110
Q

how is an RAPD identified

A

swinging flashlight test

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111
Q

optic neuropathy fundoscopy

A

normal retinal appearance in optic neuropathy
depends on pathology
if optic papillitis (head of optic nerve) = presents with oedema around the optic disc

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112
Q

retinopathy fundoscopy

A

whitening of the retina- ischaemic

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113
Q

optic neuritis causes

A

MS
diabetes
syphilis

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114
Q

presentation of optic neuritis

A
  • unilateral decrease in Visual acuity over hours
  • poor discrimination- red desaturation
  • pain worse on eye movement (infammation causes traction on inflammed meninges)
  • RAPD
  • central scotoma
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115
Q

treatment of optic neuritis

A

high dose steroids

takes 4-6 weeks to recover

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116
Q

visual loss: macula pathology causes

A
  • macular degeneration

- diabetic maculopathy

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117
Q

macula degeneration fundoscopy features

A 
drusden
RPE atrophy
choroidal neovascularisation 
subretinal or sub RPE haemorrhage
RPE detachment
disciform scar at the macula
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118
Q

diabetic maculopathy signs

A

widespread haemorrhages
wide exudation
cisterna

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119
Q

causes of chiasmic field defect

A

pituitary adenoma

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120
Q

causes of homonymous hemianopia

A

stroke, trauma, tumour, infection

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121
Q

acute visual loss definition

A

rapid onset, <72 hours
usually monocular
may herald binocular disease

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122
Q

acute ocular vascular causes of visual loss

A

Central retinal vein occlusion
central retinal artery occlusion
branch retinal vein occlusion
branch retinal artery occlusion

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123
Q

acute neurologic vascular causes of visual loss

A

Arteritic anterior optic neuropathy- GCA
non-arteritic AION
optic neuritis
papillitis

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124
Q

acute systemic vascular cause of visual loss

A

CVD
Haematological
inflammatory and infection

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125
Q

where are binocular field defects located?

A

either chiasm or posterior visual pathway

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126
Q

acute non vascular causes of visual loss

A

traumatic

non-traumatic causes: retinal detachment and vitreous haemorrhage

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127
Q

chronic causes of visual loss

A
  • lifestyle: tobacco, alcohol
  • macula degeneration ( painless)
  • retinitis pigmentosa
  • cataracts (painless)
  • refractive error (painless)
  • diabetic retinopathy
  • chronic open angle glaucoma (painless)
  • drugs
  • papilloedema (IC HTN)

painful causes

  • systemic eg sarcoidosis
  • IC HTN- headache
  • lesion: glaucoma, optic neuritis
  • mechanical= thyroid eye disease
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128
Q

amaurosis fugax

A
  • painless temporary loss of vision
  • curtain descending
  • vascular/ ischaemic cause
  • can represent a TIA so give aspirin
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129
Q

painless causes of visual loss

A 
CRAO
CRVO
BRVO
BRAO
proliferative diabetic retinopathy
glaucoma
retinal detachment
amaurosis fugax
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130
Q

painful causes of visual loss

A

optic neuritis
scleritis
keratitis
endophalmitis

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131
Q

definition of partial sight registration

A

when either the central vision ie visual acuity in the best eye is around 6/18 to 6/60 or at any level of central vision when a reasonably significant field defect is present

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132
Q

definition of blind sight registration

A

when either the central vision ie visual acuity in either eye is counting fingers or at any level of central vision when a significant field defect is present

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133
Q

investigations for visual loss 4

A
  • confrontation visual fields
  • measurement of visual acuity- snellen and pinhole
  • swinging flashlight test- RAPD CHECK
  • Fundoscopy
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134
Q

cherry red spot on fundoscopy suggests

A

central retinal artery occlusion

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135
Q

complete starry night on fundoscopy suggests

  1. also known as blood and thunder
  2. multiple flame haemorrhages and dialted veins
  3. may or may not have cotton wool spots
  4. chronically may only be small haemorrhages in periphery
A

central retinal vein occlusion

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136
Q

branch retinal artery occlusion fundoscopy signs

A

opaque retina on one half/ section and then normal retina on the other

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137
Q

branch retinal vein occlusion fundoscopy sign

A

areas of starry night sky

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138
Q

hx of abrupt, painless, significant loss of vision and a white eye is…

A

central retinal artery occlusion

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139
Q

hx of abrupt, painless, visual loss suggests

A

branch retinal artery occlusion

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140
Q

hx of painless loss of vision, often noted in am after rising from sleep
>50
gradual onset

A

suggest central retinal vein occlusion

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141
Q

causes of central retinal artery occlusion

A

linked to arteriosclerotic vascular disease, CVD, thrombus, temporal arteritis, hyperocaguable state

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142
Q

cause of branch retinal artery occlusion

A

often an emboli from the carotid artery

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143
Q

RF for branch retinal vein occlusion

A
  1. talc IV drug abuser
  2. fat from long bone #
  3. problems with endocarditis or calcifications
  4. vasculitis
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144
Q

examination findings for central retinal artery occlusion

A

vision: light perception or worse
field: massive visual field loss
pupil: large RAPD
Fundus: opaque retina with a cherry red spot, oedematous

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145
Q

examination findings for branch retinal artery occlusion

A

vision: variable- depends on the size and location
pupil: may have a RAPD depends on defect of the size
field: loss corresponds to occluded artery
Fundus: opaque retina adjacent to occluded artery with an embolus at proximal end of arteriole- often bifurcation

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146
Q

central retinal vein occlusion assoc.

A

assoc. too glaucoma and open angle glaucoma

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147
Q

central retinal vein examination findings

A

vision: variable
pupil: afferent defect
field: general depression
fundus: starry night sky - haemorrhages in all 4 quadrants

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148
Q

branch retinal vein examination findings

A

pupil: variable
afferent defect variable
field variable
haemorrhages in one-two quadrants depending on vein

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149
Q

management of central retinal artery occlusion

A

if seen within 100 mins of onset

  • massage the eyeball to lower the intra-ocular pressure (apply firm pressure with the eyelid closed for 5 seconds to acutely raise the intraocular pressure and then let go) sudden release of pressure can break the occluding material
  • refer to opthalmology
  • consider the source
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150
Q

why does CRAO produce a cherry red spot

A

opaque retina- due to ischaemia to the retina which produces oedema of ganglion cells and axons

cherry red spot since ganglion cells are absent in the macula so there is the normal macular red reflex from the underlying choroidal blood flow is accentuated as a cherry red spot

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151
Q

management of branch retinal artery occlusion

A

determine the source

no specific ocular treatment

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152
Q

management central retinal vein occlusion

A
  • refer the patient to an opthalmologist
  • 40-70% will have open angle glaucoma
  • 60% will develop neovascular glaucoma
  • assess for systemic illness
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153
Q

branch retinal vein occlusion fundoscopy signs

A
  1. flame haemorrhages adjacent to the dilated engorged occluded vein
  2. occlusion site where retinal artery crosses the vein
  3. superior branch veins are occluded more often
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154
Q

management branch retinal vein occlusion

A

opthalmic referral to treat possible

  • macular oedema
  • neovascular proliferation
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155
Q

acute vascular systemic defect causing visual loss presentation

A

again painless and acute visual loss

which is due to vascular occlusion, or leaking vessels

other assoc. symptoms of systemic disease eg arthralgia, fever and malaise

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156
Q

fundoscopy presentation for systemic visual loss 6

A
  1. cotton wool spots (ischaemic micro-infarction of ganglion cells)
  2. flame shaped haemorrhages
  3. lipid exudates (due to serum extravasation through damaged vesels)
  4. embolic plaques- platelet aggregation from damaged endothelium
  5. calcific emboli from damaged cardiac valves
  6. dot and blot haemorrhages- internal retinal elements confine these capillary haemorrhages to their characteristic round shape
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157
Q

cardiovascular causes of visual loss 6

A
  1. hypertensive retinopathy
  2. retinall arteriosclerosis
  3. cardiac vascular disease
  4. carotid atheromatous disease
  5. hypotension leading to anterior ischaemic optic neuropathy
  6. vasculitis
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158
Q

hypetensive retinopathy grading

A

1=arteriolar narrowing
2=focal narrowing and greater arteriole constriction
3=addition of flame haemorrhages, cotton wool spots and lipid exudates
4= grade 3 plus papilloedema, retinal oedema often assoc, with renal, CNS and cardiac involvement

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159
Q

retinal arteriosclerosis pathophysiology

A
  • sclerosis causes widening of the arteriole’s light reflex and causes arterial crossing changes including
  • -> nicking or compressing of the AV
  • -> distortion of the crossing angle from acute towards a right angle called banking
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160
Q

cardiac vascular disease pathophysiology for causing visual loss

A

-heart valve problems that may underlie acute visual loss are
–> endocarditis
–> rheumatic fever
–>mitral valve prolapse
–> calcific valvular disease
opthalmoscopy may show multiple emboli or embolic haemorrhages

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161
Q

cardiac atheromatous disease - pathophysiology visual loss 2

A
  1. occlusive disease: caused by thrombosis which produces ocular ischaemia- retinal haemorrhages and cotton wool spots
  2. eroding atheromatous plaque producing cholesterol and platelet emboli that can lead to retinal artery occlusions
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162
Q

endocrine causes of visual loss

A
  1. diabetes mellitus
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163
Q

haematological causes of visual loss 5

A
  1. leukaemia
  2. anaemia
  3. thrombocytopaenia
  4. hyperviscosity states
  5. hypercoaguable states
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164
Q

haematological pathophysiology

visual loss

A

due to retinal haemorrhages or retinal oedema involving the macular area

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165
Q

inflammatory pathophysiology

visual loss

A
  • collagen vascular and infectious diseases

- produce retinopathy of ischaemic infarcts (cotton wool spots), haemorrhages and exudates

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166
Q

inflammatory causes of visual loss 7

A 
inflammatory
-lupus
-polyarteritis nodosa
-dermatomyositis
infectious
-AIDS
-disseminated HSV 
-disseminated varciella
-cytomegalic viral retinitis
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167
Q

4 acute vascular neurologic causes of visual loss

A
  1. AION arteritic ischaemic optic neuropathy
  2. non-arteritic ischaemic optic neuropathy
  3. papillitis and optic neuritis= inflammatory optic nerve
  4. vascular occlusion in the CNS
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168
Q

GCA pathophysiology

A

hypo-perfusion or sometimes occlusion of the short posterior ciliary arteries causing ischaemia to the optic disc and the anterior optic nerve producing visual loss

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169
Q

GCA cause

A
  • arteritis- (inflammation of artery walls) occlusive

- arteriosclerosis -hypoperfusion and hypoxia

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170
Q

complications GCA

A

risk of binocular and permanent blindness

171
Q

presentation of GCA

A
  • Long prodrome of systemic symptoms before visual symptoms
  • female over 50
  • sudden monocular loss of vision
  • visual loss may stutter- fluctuates for a day or two before permanent
  • jaw claudication
  • headache
  • scalp tenderness
  • malaise, arthralgia, weight loss, fever
  • polymyalgia rheumatica
172
Q

INX for GCA

A
  • ESR!!!- >60- should treat high dose steroids

- DO NOT WAIT FOR TEMPORAL ARTERY BIOPSY

173
Q

temporal artery biopsy signs for GCA 3

A
  • giant cells
  • elastic fragments
  • occlusion
174
Q

examination findings for GCA

A
  • vision: variable to no light perception
  • pupil: afferent pupillary defect
  • field: altitudinal field defect is common (usually loss of upper or lower half of field of vision)
    fundus: pale, swollen optic disc, small splinter haemorrhages
175
Q

non arteritic AION exam findings

A

normal ESR

no arteritis on temporal artery biopsy

176
Q

assoc, to non-AION

A

high BP
high lipids
smoking

177
Q

ambylopia

A

lazy eye

caused by strabismus

178
Q

exotropia

A

In exotropia, when the fixating eye is covered, the outwardly deviated eye will move inward to fixate the viewed object..

179
Q

esotropia

A

When the fixating eye is covered, the other eye will move outward from its inwardly deviated position to fixate the viewed object.

180
Q

hypertopia

A

In hypertropia, when the fixating eye is covered, the upwardly deviated eye will move downward to fixate the viewed object.

181
Q

presentation of non AION

A

painless
often noticed upon awakening
>50 years

182
Q

examination findings for non AION

A

no difference to arteritic except the swollen nerve is usually NOT pale in non arteritis cases

183
Q

visual field defect for vascular occlusion in the CNS

A

homonymous hemianopia or quadrantanopia as ischaemic or haemorrhage infarcts of the visual pathways and cortex

184
Q

presentation of vascular occlusion in the CNS visual loss

A
  • normal visual acuity

- homonymous hemianopia or quadrant

185
Q

optic neuritis main causes- inflammatory optic nerve disease

A 
multiple sclerosis
diabetes
syphilis 
vitamin deficiency
leber's
ischaemic due to thrombosis
186
Q

presentation of optic neuritis

A 
monocular visual loss
acute onset over hours or days
unilateral loss
affects colour vision
poor descrimination especially red
RAPD
central scotoma 
dull retrobulbar eye ache which is aggravated with eye movement
187
Q

examination findings for optic neuritis

A

vision: decreased in most cases- no light perception
pupil: RAPD, unless previous episode in other eye to balance it
Field: central scotoma and altitudinal field loss are common- ie often top half
Fundus: normal disc in many cases- can be some swelling or pale
raised ESR

188
Q

management optic neuritis

A

high dose steroids

takes 4-6 weeks to recover

189
Q

location of optic neuritis

A
  • retrobulbar neuritis= means in the posterior part of the optic nerve so wont see disc changes
  • papillitis= means anterior so get papilloedema
190
Q

what should not be given in optic neuritis

A

oral steroids as may lead to more reccurrences

use IV??

191
Q

papillitis vs papilledema

  • vision
  • pupil response
  • optic disc
  • haemorrhages
  • cells in vitreous
  • cause
A

papillitis

  • reduced vision
  • afferent defect
  • swollen disc
  • haemorrhages
  • cells in vitreous
  • inflammation

papilloedema

  • normal vision
  • normal pupil response
  • swollen disc
  • haemorrhages
  • no cells in the vitreous
  • caused by raised ICP
192
Q

assoc. conditions to papillitis

A
  • lupus
  • sarcoidosis
  • syphilis
193
Q

retinal detachment presentation

A

4f’s

  • floating spots (floaters)
  • flashing lights
  • may detect a curtain or shade obscuring any part of field of vision
  • fall in acuity
  • central vision loss
  • straight lines appear curved
  • painless
  • gradual over days
  • fhx of myopia
  • can be gradual over days
194
Q

types of retinal detachment

A
  1. rhegmatogenous retinal detachment

2. tractional retinal detachments

195
Q

rhegmatogenous retinal detachment

A
  • tear in the retina causes fluid to pass from the vitreous space into the subretinal space
  • trauma
196
Q

tractional retinal detachments

A
  • pulling on the retina
  • more common in myopic eyes
  • cataracts for myopic eyes increases the risk
197
Q

RF/ causes of retinal detachments 6

A
  • age
  • previous surgery for cataracts
  • myopia
  • eye trauma
  • fhx
  • phx of retinal break
198
Q

examination findings for retinal detachment

A
  • vision: normal to hand motions, if macular detached
    -pupil: RAPD
    loss of red reflex
    decreased visual acuity
    -field: any areas of visual field may be obscured, depending on which area of the retina is detached
    -fundus: dilated exam show elevated waxy, gray appeararing retina, ballooning forward
199
Q

management of patient presenting with flashing lights and floaters

A

refer to opthalmology immediately

200
Q

retinal detachment management

A
  • refer to opthalmology
  • rest
  • if detachment is superior then nurse flat
  • if detachment is inferior then lie 30 degrees head up
  • laser photocoagulation therapy
  • surgery
201
Q

surgery options for retinal detachment

A
  • vitrectomy and gas tamponade scleral silicone implants

- cryotherapy to secure retina

202
Q

vitreous haemorrhage cause

A

vitreous haemorrhage is a separation of the posterior vitreous from the retina

  • normal ageing degeneration
  • retinal blood vessels may also tear in separation
203
Q
  • sudden visual loss
  • dark spots
  • painless
    is. ..
A

vitreous haemorrhage

204
Q
  • acute visual loss
  • painless
  • flashing lights and floaters
  • straight lines appeared curve
  • central vision loss
  • curtain over field of vision
A

retinal detachment

205
Q 
flashing light and floaters 
painless
blurred vision
cobweb across vision 
is..
A

posterior vitreous detachment

206
Q

vitreous haemorrhage causes 6

A
  1. diabetic retinopathy
  2. retinal break
  3. retinal detachment
  4. posterior vitreous detachment
  5. neovascularisation from retinal vein occlusions
  6. anticoagulants
207
Q

management vitreous haemorrhage

A

urgent referral to opthalmology

208
Q

rf for vitreous detachment

A
  • ageing

- myopic eye

209
Q

sign for vitreous detachment

A

weiss ring= floater on opthalmoscopy

210
Q

management for vitreous detachment

A

wait 6 months

211
Q

management for vitreous and retinal detachment

A

need surgery

212
Q

red flags for visual loss 6

A 
sudden onset
headache--? GCA
pain- glaucoma, keratitis, scleritis
pain on eye movement, optic neuritis, scleritis
distorition- macular
worse in morning- RVO, macular oedema
213
Q

optic neuropathy meaning

A

damage to optic nerve of any cause

214
Q

causes of optic neuropathy

A
  • Ischaemic optic neuropathy= AION, PION, radiation
  • optic neuritis
  • compression from lesions thyroid
  • infiltrative eg infection
  • toxic
  • trauma
  • hereditary
215
Q

drugs that cause Bull’s eye maculopathy 2

A
  • chloroquine

- hydroxychloroquine

216
Q

drugs that damage the RPE 3

A
  • mellaril
  • chloroquine
  • plaquenil
217
Q

drugs that damage optic nerve 3

A

ethambutol
chloramphenicol
quinine

218
Q

what dose of chloroquine- aralen is toxic

A

> 300 daily dose

219
Q

monitoring on chloroquine for
<250
>250 daily

A 
<250= annually
>250= 2-4 times yearly
220
Q

hydroxychloroquine- plaquenil dose that is toxic and monitoring

A

> 400 can be tolerated but check eye every 4 month

<400check annually

221
Q

ethambutol what damage does it cause 5

A 
optic nerve
optic disc oedema
visual loss
colour defect
central field visual loss
222
Q

toxic dose of ethambutol

A

> 25

223
Q

thyroid

-2 eye signs specific to grave’s

A

lid lag and lid retraction

224
Q

eye disease in thyroid

A
  • lid lag and retraction
  • proptosis or exopthalmos
  • secondary corneal exposure
  • ocular motility restriction
  • optic nerve compression
225
Q

what is the big complication from thyroid eye disease

A

optic nerve compression

226
Q

inx for thyroid eye disease

A
  • examine thyroid, visual field, pupil, acuity, exopthalmometry
  • thyroid levels
  • CT and USS- check eye muscles
227
Q

management during active phase for thyroid eye

A
  • dry= artifical tears
  • dark glasses
  • corneal exposure-treat with tarsorrhaphy-suture lid close
  • optic nerve compression: steroids, irradiation, surgical orbital decompression
228
Q

management during inactive phase for thyroid eye disease

A
  • eyelid lengthening to reduce lid retraction
  • ocular muscle surgery to relieve diplopia
  • orbital decompression to reduce proptosis
229
Q

mechanisms of diabetes and poor vision 4

A
  1. macrovascular- facial palsy and cornea exposure, occipital stroke - homonymous hemianopia
    2.microvascular-temporary squint, retinopathy
    maculopathy
  2. premature lens opacities- cataracts
    4.osmotic lens changes–> refractive errors with hypoglycaemic episodes
230
Q

pathology of diabetic retinopathy 5 stages

A
  1. no diabetic eye changes
  2. background diabetic retinopathy
  3. pre-proliferative dr
  4. proliferative dr
  5. vitrous haemorrhage or fraction retinal detachment
231
Q

pathogenesis of retinopathy

A
  1. leaky vessels- hard exudates, oedema

2. occlusion- ischaemia- cotton wool spots and neovascularisation

232
Q

earliest detectable sign of DM retinopathy

A

loss of pericytes from retinal capillaries and breakdown of blood retinal barrier

233
Q

diabetic maculopathy presenation

A

macular oedema

234
Q

mild NDPR or background diabetic retinopathy

A
  1. micro-aneurysms- dot haemorrhages- greater than or equal to 1
  2. +/-blot haemorrhages- deeper haemorrhages
  3. +/-hard exudates = protein leaks
235
Q

moderate NDPR 4

A
  1. cotton wool spots
  2. venous beading
  3. IRMA= dilated tortuous capillaries in retina
  4. +mild changes
236
Q

severe NDPR

A
  1. blot haemorrhage and/or microaneurysms in all 4 quadrants
  2. venous beading in greater than or equal to two quadrants
    IRMA in greater than or equal to 1 quadrants
237
Q

what are cotton wool spots

A

nerve fibre layer infarct

238
Q

what are venous beading

A

congested veins

239
Q

proliferative diabetic retinopathy

A

-neovascularisation
-fibrous tissue = NVD neovascularisation of the disc, neovascularisation elsewhere NVE
proliferation of extra retinal fibrovascular tissue occurs

240
Q

management of proliferative DR

A

-urgent referral to opthamology

241
Q

when would an emergency referral for diabetic retinopathy be needed 4
and what is the risk of this

A 
1. rubeosis iridis= new vessels on iris
risk of glaucoma secondary 
2. retinal traction and detachment 
3.vitreous haemorrhage
4. pre-retinal haemorrhage
242
Q

signs of diabetic maculopathy 3

A
  1. macular oedema
  2. hard exudates
  3. microaneurysms or dot haemorrhages
243
Q

presentation of diabetic maculopathy

A
  1. loss of visual acuity
  2. unlike PDR can be asymptomatic initially
  3. affects central more than peripheral vision
244
Q

INX for diabetic maculopathy

A

ocular coherence tomography OCT

  1. OCT helps to identify cystoid macular oedema
  2. funudus fluorescein angiography for ischaemia
245
Q

treatment for diabetic maculopathy

A

-intravitreal anti VEGF injections

246
Q

what is ranibiziumab, aflibercept, bevacizumab

A

Anti VEGF injections

247
Q

what is clinically significant macular oedema CSMO

A

presence of retinal thickening with or without hard exudates within a radius of <1 disc diameter of the centre of the foeva
- sight threatening

248
Q

eye screening for diabetic eye by age

A

0-30 years onset= first exam 5 years after onset, minimum follow up is annually

31+ years onset= first exam at time of dx, review annually

pregnancy onset= first exam during first trimester, and then every 3 months

249
Q

eye screening for diabetic eye by severity and treatment

A

mild and mod= review every 4 months

severe= fundus fluorscein check - treat with pan retinal laser coagulation

250
Q

management for diabetic eye

A
  1. eye follow up
  2. laser photocoagulation for
    - macular oedema
    - proliferative DR- remove new vessels
  3. diabetic control
  4. vitrectomy
  5. maculopathy give VEGF injections
    - focal for hard exudates
    - grid for CSMO
251
Q

vitrectomy indications for diabetes

A
  1. if pan retinal laser is not possible (vitreous haemorrhage blocks retinal view)
  2. traction retinal detachment
  3. no space left for laser
  4. repeated PRLP fails to control neovascularisation
  5. persistent vitreous haemorrhage after 3 months
252
Q

macular degeneration vs glaucoma

A

macular degeneration= loss of central vision

glaucoma= loss of peripheral vision

253
Q

what is the leading cause of blindness in the >65 in the UK

A

age related macular degeneration

254
Q

pathogenesis of ARMD

A

there is degeneration of retinal photoreceptors causing pigment, drusen in the macula
over time it progresses to retinal atrophy and central retinal degeneration causing central loss of vision

255
Q

most common type of ARMD

A

dry atrophic type 80-90%

256
Q

features of dry ARMD

A 
slower progressive loss
cause is unknown
drusen and changes at macula
prevention best treatment
vitamins
no other treatment
257
Q

features of wet/ exudative/ proliferative ARMD

A

10-20%
-pathological choroidal neovascular membranes CNVM develop under the retina
-choroidal neovascularisation
-the CNVM can leak fluid and blood causing a central disciform scar
-vision deteriorates rapidly and distortion is a key feature
-opthalmoscopy
fluid exudation, localised detachment of pigment

258
Q 
which of these are a feature of ARMD
- loss of night vision
-reduction in visual acuity
-peripheral vision loss
-central vision loss
-acute loss
-gradual loss
-blurry small words
-reduction of visual acuity- long sight
-fluctuating vision loss
-photopsia
-glare 
straight lines appear curvy
A
  1. older age
  2. central vision loss
  3. loss of night vision
  4. gradual loss
  5. blurry small words
  6. reduction of visual acuity- especially short sight-fine detail
  7. fluctuating
  8. photopsia
  9. glare
  10. straight lines appear curvy -metamorphosia
259
Q

elderly female presents with reduced visual acuity complaining of blurred vision, glare
on examination there is a central scotoma

A

macular degeneration

260
Q

risk factors for macular degeneration 5

A
  • increasing age
  • smoking
  • CVD
  • FHX
  • cataract surgery
261
Q

what is used to monitor macular degeneration

A

Amsler grid

262
Q

fundus presentation of atrophic macular degeneration

A
  • drusen: small round deposits under the retina- in the macula bilaterally
  • atrophy of the RPE
263
Q

fundus presentation of wet macular degeneration

A
  • all features of atrophic degeneration plus
  • neovascular membrane under the retina which causes- neovascular proliferations leak
  • subretinal haemorrhages
  • serous detachments of macula and eventual
264
Q

investigations for macular degeneration

A
  • Fundoscopy
  • slit lamp
  • fluoroscein angiography for wet type if signs of neovascular- as can guide anti VEGF
  • occular CT coherence tomography for monitoring
265
Q

where are drusen found

A

in macular degeneration around the macula small yellow deposits
-lipoporteinaceous deposits

266
Q

what can laser proliferation be used for in ARMD

A

if wet ARMD is detected early and caused by neovascular membrane outside the centre of the macula then new blood vessels can be destroyed by laser photocoagulation

267
Q

wet ARMD management options 9

A
  • needs prompt treatment to avoid visual loss
  • arrange a fluoroscein angiogram at the outset and then 4-6 weekly reviews with a photograph and OCT
  • anti-VEGF- intravitreal vascular endothelial growth factor inhibitors- monthly Bevacizumab, and ranibizumab
  • laser photocoagulation
  • photodynamic therapy PDT IV verteporfin
  • intravitreal steroids triamcinolone
  • visual aids
  • diet rich in fruit and green veg
  • vitamins and antioxidants
268
Q

Dry ARMD management

A
  • stop smoking
  • antioxidant supplements
  • no other treatment options
269
Q

what do cones do

A

colour vision

central vision

270
Q

what do rods do

A

night vision

peripheral vision

271
Q

fhx cause of macular degeneraiton

A

complement factor H mutation

272
Q

what is the most common cause of damage to the optic nerve

A

glaucoma

273
Q

what is normal eye pressure

A

11 to 21

274
Q

what is glaucoma

A
  • increased eye pressure as meshwork is narrowed and get damage to optic nerve
  • glaucoma is optic neuropathy with death of retinal ganglion cells and their optic nerve axons
275
Q

two types of glaucoma

A

chronic open angle glaucoma

acute angle closure glaucoma

276
Q

risk factors for chronic open glaucoma

A
  • increased IOP
  • black
  • FHX
  • increased age
  • HTN
  • DM
  • myopia
  • steroids
277
Q

diagnosis of COAG

A

-intraocular pressure measure using tonometry
>21 but not needed
-central corneal thickness measurements
-gonioscopy- peripheral anterior chamber depths
-visual field: central field is intact as forms an arcuate defect with central intact so presentation often delayed
-slit lamp and fundoscopy

278
Q

symptoms of chronic open angle glaucoma

A

often asymptomatic until visual fields are impaired
peripheral visual field loss- nasal scotomas
-tunnel vision
-decreased visual acuity

279
Q

fundoscopy presentation for COAG

A
  1. optic disc cupping >0.7
  2. optic disc pallor- atrophy
  3. bayonetting of vessels
  4. cup notching
  5. disc haemorrhages
280
Q

screen for COAG IF

A

> 35 yrs and ?

  • positive fhx
  • african carribean
  • myopic
  • diabetic
  • thyroid eye disease
281
Q

follow up for COAG is

A

4-6 monthly

282
Q

management for COAG

A
  1. Prostaglandin analogues- lantoprost or travoprost- increase uveoscleral outflow
  2. beta blockers eg timolol- decrease production of aqueous
  3. alpha adrenergic agonists - brimonidine, apraclonidine
  4. carbonic anhydrase inhibitors- acetazolamide, dorzolamide
  5. miotics- pilocarpine
  6. sympathomimetic- dipivefrine
  7. fixed dose combination treatment
  8. laser therapy trabeculoplasty
  9. trabeculectomy
283
Q

pathogenesis COAG

A
  • cause unknown- but increased IOP- retinal ganglion cell death

In open-angle glaucoma, the angle in your eye where the iris meets the cornea is as wide and open as it should be, but the eye’s drainage canals become clogged over time, causing an increase in internal eye pressure and subsequent damage to the optic nerve. It is the most common type of glaucoma

284
Q

optic disc cupping means

and glaucoma changes

A

loss of disc substances making the disc look larger

  • asymmetric cupping suggests glaucoma
  • as damage progresses disc pales and cup widens and deepens so vessels appear to have breaks as disappear into cup -bayonetting
  • disc vessels are also displaced nasally
  • nasal and superior fields are lost first and temporal fields last
285
Q

optic cup ratio definition for glaucoma

A

glaucoma is present when on field testing, 3 or more locations are outside normal limits and the cup to disc ratio is >0.7 (optic disc cupping)

286
Q

pathogenesis acute angle closure glaucoma

A

blockage of the trabeculae meshwork duct occurs at the anterior chamber angle- therefore aqueous fluid cant drain so the pressure increases
-displacement of the lens and the iris obstructs the fluid outflow across the trabecular meshwork

Mechanisms that push the iris from behind including, most commonly, relative pupillary block (where accumulation of aqueous in the posterior chamber forces the peripheral iris anteriorly, causing anterior iris bowing, narrowing of the angle

Mechanisms that pull the iris into contact with the TM (e.g., contraction of inflammatory membrane as in uveitis, fibrovascular tissue as in iris neovascularisation

also with time friction can cause scar tissue between TM and iris

287
Q

factors predisposing to AACG are

A

hypermetropia= long sightedness
pupillary dilatation
lens growth assoc. to age

288
Q

A 64-year-old woman presents to the emergency department with severe pain around her right eye of 4-hour duration, accompanied by blurred vision in that eye. She is also nauseated. Examination shows a red right eye with oedematous cornea and a wide pupil that is unresponsive to light. Intra-ocular pressure is extremely elevated (60 mmHg), only in the right eye.

A

acute angle closure glaucoma

289
Q

A 50-year-old man presents for a routine eye examination with no symptoms. He has elevated intra-ocular pressure of 25 mmHg in the right eye and 30 mmHg in the left eye. On dilated examination, the cup-to-disc ratio is 0.5 in the right eye and 0.8 in the left eye. Corneal thickness and gonioscopy are normal. Subsequent automated testing of visual fields demonstrates peripheral visual field loss greater in the left eye than in the right. Repeated automated visual field testing shows that the visual field defects are reproducible.

A

open angle glaucoma

290
Q

A 75-year-old woman presents with new-onset distortion in one eye. Vision is 20/80 in the involved eye. has smoked 20 cigarettes a day for most of her life. blurred vision and difficult reading small print

A

AMD

291
Q

A 65-year-old man presents with generally decreased vision and difficulty driving at night due to glare from oncoming headlights. He describes having trouble reading the small print on his television screen. He is healthy and has no history of any other eye problems. His best corrected visual acuity is noted to be 20/50 in the right eye and 20/40 in the left eye. On examination, a yellowish opacification of the lens in the left eye is noted.

A

cataracts

292
Q

A 67-year-old man presents with a 2-day history of sudden visual loss in his right eye. He is slightly myopic and had successful cataract extraction with intraocular lens implantation 3 years earlier. He does not remember this eye ever having been injured. No pain was associated with the vision loss, and his blood pressure is normal with medication. The patient describes the loss of vision as a veil covering the visual field.

A

retinal detachment

293
Q

A 65-year-old man with a history of hypertension and hypercholesterolaemia notices sudden, painless vision loss in his right eye. The vision loss is limited to the superonasal quadrant of his visual field. He first noticed the visual field loss approximately 6 weeks ago. For the past 2 weeks, however, he has started to have blurred vision centrally, making reading difficult.

A

CRVO

294
Q

A 40-year-old man presents to the emergency department complaining of red eye without purulent discharge. He also has pain, photophobia, blurred vision, and tearing. On slit-lamp examination, the attending ophthalmologist notices a small irregular pupil, conjunctival injection around the corneal limbus, and WBCs in the anterior chamber.

A

uveitis

295
Q

primary vs secondary glaucoma

A 
primary= in a patient with anatomical predisposition- ie no known cause
secondary= due to a cause eg haemorrhage
296
Q

presentaation of acute angle closure glaucoma

A
  • mid dilated pupil
  • n and v
  • ciliary injection
  • corneal oedema- rise in IOP
  • steamy vision
  • see halos and rainbows around light
  • pain severe and achy
  • cloudy eyes
  • headache
  • blurred vision
297
Q

signs of acute angle closure glaucoma

A
  • whole cornea is cloudy
    -fixed mid dilated pupil
    -not reacting to light
    -red eye
    -sore
    IOP
    visual field defect
    optic disc cupping
298
Q

when is AAC glaucoma worse

A
  • dim light so in winter as the pupil dilates so pushes iris up
  • anatomical= in small eyes -hypermetropia- increase risk as lens capsule keeps growing in life so lens gets bigger
299
Q

management of AACG

A 
refer to opathalmoloy
emergency
give
-beta blockers eg timolol
-carbonic anhydrase eg acetazolamide
-mitotic eye drops- pilocarpine
-prostaglandin analogues eg latanoprost
-sympathomimetics eg brimonidine- alpha 2 receptor agonist
  • laser iridotomy-creation of opening in iris to allow aqueous humor to flow from posterior to anterior
  • iridectomy surgical
300
Q

complications of AACG

A

visual loss
CRVO CRAO
repeat episodes

301
Q

lantoprost SE

A

-increased eyelash length
iris pigmentation
periocular pigmentation

302
Q

pathology cataracts

A
  • any opacity of the crystalline lens may be considered cataracts
  • light scattering opacity in the lens
303
Q

commonest cause of blindness in the world

A

cataracts

304
Q

risk factors for cataracts

A
  • usually ageing assoc.
  • DM
  • genetics in children
  • smoking
  • alcohol
  • sunlight
  • trauma
  • radiotherapy
  • HIV
  • drugs eg steroids
  • intraocular tumors
  • trauma
  • long term UV exposure
305
Q

inx cataracts

A
  • blood glucose
  • hx and exam
  • opthalmoscopy
  • slit lamp exam
306
Q

four types of cataracts

A
  1. mature
  2. nuclear sclerotic NS
  3. posterior subcapsular
  4. cortical spokes
307
Q

most common type of cataracts

A

nuclear sclerotic

308
Q

nuclear sclerotic cataracts

A
  • usually characterised by darkening and hardening of the lens
  • nucleus- central part of lens
  • slow and insidious dimming of distance vision while good reading vision preserved
  • hardening of nucleus increases refractive index - myopic refractive error shift
  • common in old age
309
Q

mature cataracts

A

when the entire lens is opacified nucleus and cortex

- most dont reach this stage due to surgery

310
Q

posterior subcapsular cataracts

A
  • this type of cataract shows with aggregations of degenerated epithelial fibers beneath the posterior lens capsule commonly in the visual axis
  • symptoms are glare especially in the sunlight and from ongoing headlights
  • also reduced reading vision
  • can be caused by high dose steroids
  • recently created lens fibres break down eg after x-ray ,trauma, steroids
311
Q

cortical spokes cataracts

A
  • looks like bike spoke
  • peripheral spokes against the red fundus reflex are commonly seen in this type of cataracts
  • opacified cortical lens fibers
  • otherwise few visual problems until spokes involve visual axis
312
Q

ocular causes of cataracts

A
  • trauma
  • uveitis
  • high myopia
  • steroid eye drops
  • intraocular trauma
313
Q

systemic causes of cataracts

A
  • diabetes and other metabolic
  • systemic steroids, chlorpromazine
  • x-radiation
  • congenital rubella
  • atopic dermatitis
  • myotonic dystrophy
  • down syndrome
314
Q

symptoms and signs of cataracts

A

-painless loss of vision
-glare and halos-dazzle in sunlight
-can get monocular diplopia
-change in refraction
-altered colour perception
-decreased visual acuity- especially in bright lights
-difficulty driving at night
-dark silhouette against red reflex
loss of stereopsis affects distance judgements

315
Q

management cataracts

A
  • mydriatic drops
  • shades
  • stronger glasses/ light improvement
  • if symptoms are restricting or unable to read number plate at 20m then offer surgery
  • phacoemulsion and intraocular lens implant
  • patient choice not based on visual acuity
316
Q

complications of phacoemulsion

A
  • posterior capsule opacification
  • retinal detachment
  • endophalmitis
  • posterior capsule rupture
  • iris prolapse
  • cystoid macular oedema
  • vitreous loss
317
Q

prevention of cataracts

A
  1. use sunglasses
  2. oxidative stress decrease with antioxidants and caffeine
  3. stop smoking
318
Q

inx for cataracts

A
  • examination- red reflex
  • look for systemic cause in <60or if unilateral cataract
  • biometry to enable accurate intraocular lens power calculation
319
Q

red eye causes

A

bilateral

  • allergic conjunctivitis- mostly itchy
  • infective conjunctivitis- discharge
  • keratoconjunctivitis sicca

unilateral

  • CN VII palsy
  • entropion
  • trichiasis
  • stromal keratitis
  • epithelial keratitis
  • episcleritis
  • scleritis
  • iritis
  • acute angle closure glaucoma
320
Q

5p’s of red eye

A 
pain
pus
pink
pupil
pressure
321
Q

red eye bilateral
bilateral watery discharge
follicles

A

viral conjunctivitis

322
Q

red eye bilateral
purulent discharge
gritty or burning

A

bacterial conjunctivitis

323
Q

red eye bilateral

predominantly itchy

A

allergic conjunctivitis

324
Q

causes of a red eye

A 
conjunctivitis
dry eyes
CN VII palsy
entropion or trichiasis
stromal keratitis 
epithelial keratitis
acute angle closure glaucoma
iritis
scleritis
episcleritis
325
Q

watery eye infant

cause treatment

A

nasolacrimal duct obstruction

rx: lacrimal duct massage

326
Q

ciliary injection meaning

A

inflammation within the anterior segment of the eye

injection most intense adjacent to the edge of the cornea-limbal area

327
Q

diffuse injection meaning

A

denotes an inflammed surface conjunctiva- conjunctivitis - more around the outside of the eye

328
Q

scletoral injection

A

episcleritis

329
Q

ciliary injection with purulent discharge

A

indicates a corneal ulcer

330
Q

> 30
diffuse injection
mucoid crusting
reduced schrimer tear test

A

dry eyes

331
Q

management of allergic conjunctivitis

A 
avoid allergen
shower and was hair
sodium p.
opatanol-mast celll stabiliser
anti-histamine eg antazoline
-antihistamine drops eg emedastine 
NSAID eg Ketorolac 
avoid steroids
332
Q

management of viral conjunctivitis

A

symptomatic relief

artificial tears, decongestants

333
Q

bacterial conjunctivitis rx

A

most settle no treatment
topical chloromycetin drops or chloramphenicol
ointment at night
-if fails take swabs for STI

topical fusidic acid for pregnant women

334
Q

newborn baby purulent eye discharge

A

need to to consider chlamydia/ gonorrhoea

335
Q

chlamydia eye presentation

A

bleeding
bacterial that doesnt go away
treat systemically

336
Q

gonorrhoea eye presentation

A

purulent discharge
vision threatening
treat systemically IV

337
Q

SE of topical steroids

A

secondary infections
delayed corneal epithelial wound healing
cataract formation
permanent rise in intraocular pressure- glaucoma

338
Q

dry eyes

A

-diffuse inflammation
severe RA
crusting on eyelids
superficial punctate keratopathy SPK

339
Q

inx dry eyes

A

schrimer tear test

<10mm after 5 minutes

340
Q

treatment dry eyes

A

artifical tears
long term ocular lubricants
viscotears and lacrilube
punctal occlusion

341
Q

sub-conjunctival haemorrhage cause

A

spontaneous

secondary to trauma

342
Q

epithelial keratitis presentation

A 
ciliary injection 
no pus
aching pain
foreign body sensation
gritty sensation
smaller pupil
red eye
photophobia
343
Q

risk factors keratitis

A

dry eyes
corneal graft
contact lens wearers
corneal ectasian

344
Q

causes of keratitis

A 
chronic HSV
infection
-HSV
actahamoeba
gram positive
gram negative rods 
pseudomonas most common contact wearers
345
Q

contact wearers keratitis pathology

A

-pseudomonas
-acathamoeba
inflammatory keratitis
-white dot in ulcer
pain

trauma
contact lens wearer abuse
severe dry eyes
complication from topical steroidal
exposure keratitis
346
Q

inx keratitis

A

fluoroscein

347
Q

management of keratitis by pathology

A

refer to opthalmology
-bacterial= antibiotics -topical quinolones
viral= topical oral antivirals
fungal= antimyoctics

also can give cyclopentolate to relieve

348
Q

complications of ulcers

A

-hypophyon= pus in the ant chamber

visual loss
scarring
perforation

349
Q

stromal keratitis

A

abscess
infection in stroma
urgen attention

350
Q

uveitis presentation

A 
-throbbing pain 
ciliary injection
photophobia
smaller pupil 
red eye
distorted pupil
no pus
severe and aching pain
351
Q

anterior uveitis

A

irits

anterior cyclitis

352
Q

intermediate uveitis

A

vitreous

353
Q

posterior uveitis

A

retina/ choroid

354
Q

panuveitis

A

all of the uvea

355
Q

anterior uveitis presentation

A 
red eye
pain
kerato precipitates
photophobia
assoc. seronegative
356
Q

intermediate/ posterior uveitis

A

painless
floaters
blurred vision
less common

357
Q

management uveitis

A

refer to opthalmology
steroid eye drops
cyclopentolate to dilate

358
Q

complications of uveitis

A

cataract
macular oedema
secondary glaucoma

359
Q

scleritis presentation

A 
often assoc. with ocular tenderness 
deep boring pain 
can be segmental or whole
scleral swelling
produces more injection 
can be sight threatening
smaller pupil
360
Q

risk factors scleritis

A

RA

361
Q

inx scleritis

A

fluoroscein

epinephrine- wont blanch vessels

362
Q

management scleritis

A

urgent referral

topical or oral steroids

363
Q

scleromalacia perforans necrotising

A

severe form of sscleritis
blue black patches where sclera has thinned out
needs IV steroids

364
Q

episcleritis presentation

A 
inflammation more superficial episceleral tissue
self-limiting
segment in the red eye
no usually assoc. to pain
mild foreign body sensation
sector of engorged episcleral and assoc. conjunctival vessels- diffuse injection
no pus
itchy and burning sometimes
small pupil
high pressure
365
Q

inx episcleritis

A

fluoroscein

will blanch under epinephrine

366
Q

management episcleritis

A

self limiting

symptomatic treatment

367
Q

blepharitis

A

inflammation of eyelid margins
bilateral grittiness

cause
-sebhorreic dermatitis
meibomian gland dysfunction

features

  • bilatera
  • gritty
  • sticky
  • red
  • swollen- staph. bleph
  • styes are more common

rx
hygiene
hot compress

368
Q

herpes zoster opthalmicus is

A

describes the reactivation of the varicella zoster virus in the opthalmic division of the trigeminal nerve

369
Q

features hzo

A

vesicular rash around the eye which may or may not involve the actual eye itself
photophobia
red eye
watery eye
Hutchinson’s sign is rash on the tip or side of the nose- inidcates nasocilirary involvement and strong Rf

370
Q

management hzo

A

refer to opthalmology
oral anti-viral aciclovir for 7 to 10 days
IV antivirials if severe
topical steroids may be used

371
Q

complications of HZO

A

ocular- conjunctivitis, keratitis, ant uveitis
ptosis
post herpatic neuralgia

372
Q

herpes simplex keratitis

A 
most common cause of corneal blindness
also get conjunctivitis, keratitis
red eye
vesicles on kips
pain
epiphoira
ulceration
373
Q

papilloedema causes

A 
increased ICP
hydrocephalus
malignant HTN
hypercapnia
idiopathic intracranial hypertention
tumour trauma
374
Q

signs of papilloedema

A 
swollen optic disc
decreased blurring optic disc margin
cork screw blood vessels
blood vessel obscuration- blurry
disc haemorrhage
venous engorgment
elevated
loss optic cup
paton's line
375
Q

myopic eye

A

short sighted
eye is bigger
so things from a distance dont meet behind the retina

376
Q

causes myopia

A 
simple myopia
degenerative myopia
-malignant or pathological
-gets worse over time
often with peri disc atrophy and RPE
377
Q

hypermetropia

A

long sighted
eye is smaller
rays of light from a close object focus behind

378
Q

presbyopia

A

impaired power of accomodation

379
Q

astigmatism

A

where cornea is irregularly curved prevent light rays from being brought into common focus on the retina

380
Q

eye trauma

A 
foreign body
UV burns
hyphemia
perforating injury
blow out fractures
381
Q

chemosis

A

swollen conjunctiva

can be due to foreign material or ruptured globe

382
Q

limitation on upper gaze suggests a

A

blow out fracture

383
Q

subconjunctival haemorrhage

A 
usually benign
can be due to HTN
normal va, clear cornea
round pupil
normal fundus and eye movements
384
Q

corneal foreign body

A

normal visual acuity
stain with fluoroscein
normal fundus, eye movements

385
Q

hyphema

A 
reduced visual acuity
clear cornea
no stain
round pupil
abnormal RR-loss of red reflex 
cant visualise fundus
full eye movements
blood in anterior chamber
386
Q

penetrating injuries

A 
reduced visual acuity
clear cornea
stains
peaked pupil
cant visualise fundus 
full eye movements
387
Q

orbital fracture

A 
normal va
clear cornea
no stain
round pupil
abnormal eye movements 
diplopia
388
Q

corneal laceration

A

peaked pupil
penetrating corneal laceration into pupil
entire thickness

389
Q

traumatic iridodialysis

A

sign of blunt trauma

separation or tearing of the iris

390
Q

canaliculus lid laceration

A

chronic tearing

391
Q

orbital floor fracture

A

blunt trauma
orbital contents can herniate down
inferior rectus becomes trapped so trapped in upgaze
diplopia

392
Q

acute alkali chemical keratoconjunctivitis

A

irrigate eye immediately

393
Q

uv eye burn treatment

A

cyclopentolate
topical antibiotics
patching

394
Q

complications hyphaema

A

lens dislocates
glaucoma
retinal detachment

395
Q

peaked distorted pupil suggests

A

corneal laceration

refer

396
Q

styes are

A

swelling on the lids
infection in the oil gland in the eyelid
often staph aureus

397
Q

horodeolum externum

A

outward

lash follicles or sweat gland of moll and seis

398
Q

horodeolum internum

A

abscess of meibomian glands and point inwards opening into the conjunctiva
less local reaction
leave a residual swelling called a chalazion

399
Q

pinguecula

A

degenerative yellow vascular grey nodules on the conjuctiva either side of corneum

if inflammed can use ttopical steroids

400
Q

entropion

A 
lid inturning
irritates cornea
taping lower eyelids to cheek
or botox injections
surgery
401
Q

ectropion

A

assoc.
old age
facial palsy
out turning eyelids

402
Q

horner

A

miosis
ptosis
annihydrosis

403
Q

third nerve

A

down and out
mydriasis
ptosis

404
Q

causes of third nerve palsy

A

cavernous sinus lesions
superior orbital fissures
diabetes and HTN
PCA aneurusm

but vascular lesions spare the pupil eg diabetes and HTN in the nerve

405
Q

other causes of a fixed dilated pupil

A

mydriatics
trauma
acute glaucoma

406
Q

holmes adie pupil

A

tonically dilated pupil
accompanied by absent knee and ankle jerks
slow response to accomodation and light

idiopathic
loss of parasympathetic to the eye
benign-often women
slowly refractive to light with more definite accomodation

407
Q

Horner causes

A

central lesions (anihydrosis face arms and trunk)
stroke
MS
tumour

pre-ganglionic anihydrosis only face
tumour- pancoast
thyroidectomy
trauma

post-ganglionic no anihydrosis
carotid artery aneurysm
cavervous sius thrombosis
carotid artery dissection

408
Q

hutchinson’s

A

unilateral dilated pupil unresponsive to light

compression to occulomor nerve on same side by intracranial mass

409
Q

argyll robertson

A

bilateral small pupils that accomodate but dont react to bright lights
neurosyphilis and DM

410
Q

tropia and phoria

A

tropia- always present- cover test

phoria- only seen on alternate cover test

411
Q

conmitant strabismus

A

due to imbalance of extraocular muscles
inherited CNS problem
constant upon direction of gaze

412
Q

non comitant strabismus

A

due to paralysis of nerve
depends upon direction of gaze
acquired nerve palsy
therefore may only be evident when patient attempts to use the weak muscle

413
Q

ambylopia

A

lazy eye
failure to achieve normal visual acuity
reduction of corrected central visual acuity even though the eye appears structually normal
can be unilateral or bilateral

414
Q

pathology ambylopia

A

50%
due to if one eye sees significantly worse (diplopia) - due to a refractive error= then the brain suppresses the image from the poorer seeing eye so a squint develops

the brain also begins to rely on the good eye
so vision of the bad eye is suppressed and neural connections diminish and fail to develop

415
Q

ambloypia need to treat by

A

age 8

416
Q

causes ambylopia

A 
poor alignement
irregular shape eye
hypermetropia and myopia
opacifications of ocular media in one eye
signifcant asymmetric refractive index 
retinoblastoma
417
Q

management of strabismus and ambloypia

A

-refer children with squints to opthalmology
corneal light reflection test and other testsing
E game
eye patch the good eye so suppressed eye has to be used

418
Q

binocular diplopia means

A

diplopia will go when each eye is covered separately

419
Q

monocular diplopia means

A

diplopia will be present when each eye is covered separately

  • cataracts
  • cortical abnormality
420
Q

horizontal diplopia

A

lateral rectus palsy

421
Q

vertical diplopia causes

A

3rd nerve palsy - aniscoria, dilated pupil, down and out, ptosis

thyroid orbiopathy

cranial nerve 4

422
Q

3rd nerve palsy causes

A

space occupying lesion- dilated pupil

ischaemic cause- normal pupil as no effect on parasympathetic supply

423
Q

signs of thyroid orbitopathy present

A

tightness of eye muscles

lid and conjunctiva

424
Q

causes 4th nerve palsy

A

trauma- blow out
diabetes
tumour
idiopathic

year 5 (9 decks)

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