Opthalmology Flashcards
blepharoptosis (ptosis)
drooping or abnormal relaxation of upper eyelid
hypopyon
inflammatory cells in the anterior chamber. It is an exudate rich in WBC that settles due to gravity. It can be sterile (in case of bacterial corneal ulcer) or not sterile (in case of fungal corneal ulcer)
endopthalmitis
inflammation of anterior eye. Is a common complication of cataract surgery. Infectious causes are most common.
epiphora
overflow of tears onto face not due to crying
cycloplegia
paralysis of ciliary muscle resulting in loss of accomodation
accomodative exotropy
crossed eyes when trying to focus
keratitis sicca
inadequate tear production leading to corneal or conjunctival inflammation. is due to secondary sjogren syndrome and VA deficiency
atonic pupil
no damage to ciliary ganglion or short ciliary nerves. Is a responsive pupil
exotropia
is a form of strabismus where the eyes are deviated outward. (lack of tone of medial rectus seen in neurogenic ptosis)
eyelid xanthelasma
yellow spots due to lipid (cholesterol) deposition
blepharitis
inflammation of eyelids
quinsy
peritonsillar abscess
xeropthalmia
dry eye- eye doesn’t produce enough tears. Due to severe VA deficiency
order of operation for red eye diagnosis
- inspection
- Pain/pressure test (if pain is gone with eye drops its conjunctivitis/keratitis, if not then glaucoma/uveitis/scleritis)
- pupil reflex
- corneal appearance (window reflex/infiltrates)
what pathology makes the eye red and rock hard
glaucoma
WIDE UNREACTIVE PUPIL (MYDRIATIC )AND RED EYE MEANS ? NARROW PUPIL (MIOTIC)+PHOTOPHOBIA MEANS?
acute glaucoma attack/
UVeitis (pain goes away when you dilate the pupil)
would you give miosis inducing drops in acute glaucoma attack
yes
symptoms of conjunctivitis
pain burning itching eyelids stuck together redness/secretion/follicles (nodular hyperplasia in allergies)/membranes
identify secretion types in conjunctivitis
- serous/foamy means viral
- catarrhal/yellow means bacterial
follicles appear in what conjunctivitis
acute viral
list the tests and their purposes for the eye
- fluorescein dye:
- shirmer: tear production in ml (should be > 20ml)
- break up time:see dry patches on conjunctiva. Should be >20s
- bengala: to see conjunctival erosion
- water into nasolacrimal duct to check patency of passage
- GAG test
- dacryocystography
- lysozyme test
dacriocystitis
acute inflammation of lacrimal sac due to blockage of lacrimal duct
pachymetry measures
measures the thickness of the cornea
define refractive errors
when shape of eye prevents light from focusing directly on the retina
in hyperopia you want to make the lens more/less steep
more
LASIK is not recommened for
severe hyperopia
in phakic IOL the eye’s natural lens is
kept in the eye, we only add another lens infront/behind the iris
what color is a nuclear cataract
yellow/brown
cataract that appears as spoke like opacities towards the centre is called
cortical cataract, Later becomes a white cataract
morgagnian cataract
total liquifaction of the cortex allows nucleus to sink inferiorly
intumescent cataract
During the immature phase of the cataract, it starts to absorb aqueous humor and becomes swollen. It can result in secondary glaucoma. NOTE THAT IT EXPLODES WHEN CUTTING
operative complications of cataract
vitreous loss, posterior loss of lens fragment, suprachroidal hemorrhage (expulsive)
early post op complications of cataract
iris prolapse (sutures dont hold up), striate keratopathy, acute bacterial endophalmitis
late post op complications of cataract
capsule opacifications (secondary cataract), implant displacement, retinal detachemtns, chronic bacterial endopthalmitis
are artifical lenses flexible
no so they cant accomodate
list ocular anomalies that lead to congenital cataract
aniridia, coloboma
micropthalmos
buphthalmos
what is a round central shell like opacity surrounding a clear nucleus called
a lamellar cataract
where is a sutural cataract
it is a congenital cataract where the opacity follows the shape of the Y sutur
phimosis
anterior capsular phimosis is the centripetal fibrosis and contraction of the capsulorhexis after cataract extraction
striate keratopathy is
corneal edema and folds in descemets membrane due to damage to endothelium during surgery
diabetic retinopathy progression to vision loss
(1) retinal capillary leakage leading to macular edema
(2) retinal capillary occlusion leading to proliferative DR leading to vitreous hemorrhage/retinal detachment/neovascular glaucoma
hard exudates are present in
diabetic retinopathy they are waxy yellow
cotton wool spots are found in
diabetic retinopathy
why is there retinal vessel occlusion in DR
Thickening of capillary basement membranes
Abnormal proliferation of capillary endothelium
Increased platelet adhesion
Increased blood viscosity
Defective fibrinolysis
what causes blindness in DR
diabetic macular edema
treatment of DR causing vision loss
if controlling glycemia doesnt work, then use laser to stop vessel leakage, and anti-VEGF antibodies
differentiate AMD early and late
early has focal drusens in between bruchs membrane and RPE.
late has drusens in subretinal space, and RPE atrophy, If even later then vessels grow in bruchs membrane
drusen vs exudates
Drusen occur beneath the retina and are usually, but not always, a sign of age-related macular degeneration (breakdown of tissues in the back of the eye). Exudates typically are within, or immediately under, the retina and typically associated with problems in the retinal blood vessels. Both are fatty deposits
metamorphopsia
objects appear distorted
amsler test
the Amsler grid is used to check whether lines look wavy or distorted, or whether areas of the visual field are missing
treatment of AMD
antioxidant tablets, or anti VEGF tablets (-mab) (NOTE YOU CANNOT REVERSE THIS CONDITION)
which vessels does indocyanin green dye show? which does FAG show?
IGD: choroidal vessels
FAG: retinal vessels
FA has hyperfluorescence characterised by leakage/pooling/staining what do these words mean
Leakage: Hyperfluorescence progressively enlarges with fuzzy borders. The dye permeates out of leaky, incompetent blood vessels in the setting of neovascularization, retinal vasculitis, vascular malformations, tumors, or disc edema (dye leaks from prepapillary capillaries).
Pooling: Hyperfluorescence progressively enlarges to fill the fluid cavity and then becomes fixed in size. Usually the dye fills a cavity like the subretinal space or sub-RPE space (in a PED).
Staining: Late hyperfluorescence due to accumulation of fluorescein dye. The hyperfluorescence gradually gets brighter, but the size stays the same. Usually a mild amount of fluorescence is seen, but it is never very bright. The optic disc always stains. Additionally, drusen and fibrosis will stain.
FA hypofluorescence is
blocking (due to preretinal or vitreous hemorrhage) or filling defect (retinal artery occlusion)
RF for AMD
mainly age >50.
white race and low antioxidant levels
HTN retinopathy signs:
- siegrist streaks
- elsching sign
- exudative detachment
- linear pigmented streaks
- focal ischemia
- damage to RPE pump
arterial/venous retinal vessel occlusion has worse prognosis?
arterial. It is comparable to stroke, somehow an embolus has entered the eye instead of going to the brain
a cilio retinal artery is beneficial in what scenarios
for arterial vessel occlusion
amblyopia
lazy eye
blepharochalsis
loss of elasticity of the skin of the upper eyelid
mullers muscle is
the inferior tarsal muscle
proptosis
buldging eye
most common ocular tumor
Is basal cell carcinoma
meibomian glands produce
oil for tears
ziess glands produce
oil for eyelashes
moll glands
sweat glands
a chalazion is a
meibomian gland cyst
whats a hordeolum
A hordeolum (ie, stye) is a localized infection or inflammation of the eyelid margin involving hair follicles of the eyelashes (ie, external hordeolum) or meibomian glands (ie, internal hordeolum).. A hordeolum usually is painful, erythematous, and localized
chemosis
swelling/edema of the conjunctiva
sjogren syndrome is associated with
dry eye and chronic darcyoadenitis
what do you need for retinal detachment?
- liquid vitreous
- tractional forces
- retinal break
what retinal detahment is for diabetes?
tractional RD, is a non rhegmatogenous RD
treatment for RD is
- scleral buckle
- retinopexy
- intra vitreal gas insertion
- vitrectomy
types of retinal tears
flap/horseshoe giant operculated hole dialysis macular hole atrophic retinal hole
retinoschisis is
separation of the layers of the layer of the retina but still attached to RPE
RF for retinal detachment
- cataract surgery
- lattice degeneration
- pseudophakia/aphakia
types of retinal detachment
rhegmatogenous
tractional
exudative
explain anatomy of vitreous
the vitreous humor is encapsulated by an anterior hyaloid membrane (separating humor from lens) and a posterior hyaloid membrane (separating humor from retina). This attachement is strongest anteriorly at the ora serrata
OCT is based on
interferometry which is superimposing 2 or more waves to detect the differences
FAG dye is
Sodium fluorescein which is 80% bound to proteins
list dye characteristics in FAG
- autofluorescence
- hypofluorescence (due to blockage/filling defect)
- hyperfluorescence (staining/pooling/filling)
name the accessory lacrimal glands
krause and wolfring
discharges in corneal/conjunctival infections
- watery: acute virl or acute allergic
- mucoid: chronic allergic C or dry eye
- mucopurulent: chlamydia/acute bacterial
- severly purlent: Gonococcal
- moderately purulent: acute Bacterial
multiple small hemorrhages mean
viral conjunctivitis
large diffuse hemorrhages mean
bacterial conjunctitivits
signs of acute bacterial conjunctivitis
mucopurulent discharge, superficial corneal puncta epithelial erosions, redness, grittiness, burning
define corneal dystrophy
is when material deposits in the layers of the cornea and reduces transparency and presents irregular astigmatism (high order aberration)
deposits in corneal dystrophy can be in the periphery or in the center, what are the repercussions on corneal shape with these new depositions
at periphery: corneal flattening
at center: corneal steepening
reiss bucklers CD affects what layer
bowmans layer
fuch corneal dystrophy affects what layer
descements/endothelial membrane
keratoconus is
progressive thinning of the cornea
penetrating keratoplasty has less risk of x than lasik because y
x: ectasia (the expansion of a hollow or tubular organ)
Y: it doesnt involve the endothelium like lasik does
types of corneal dystrophy
granular and macular CD
therapy for ocular migraines
- triptans/NSAID
- preventative: BB/triptans/antidepressants/antiepileptics
explain the morphological classification of uveitis
- anterior: of the iris. Is most common (also with sarcoidosis)
- intermediate: of the vitreous and ciliary body
- posterior: of the retina and choroid
- panuveitis: of the entire uvea
anterior vs posterior synechiae
anterior: iris adheres to cornea
posterior: iris adheres to lens
aniskoria is
unequal pupil size
symptoms of acute anterior uveitis?
Of chronic anterior uveitis?
- photophobia/pain/watery discharge/blurry vision
- if none of the acute symptoms are present then the first sign of uveitis you’ll see are complications like cataracts, glaucoma, and keratopathy
signs of anterior UVeitis slit lamp
Koeppe nodules (inflammatory cell precipitates which lie at the pupillary margin and could be found in non-granulomaous as well as granulomatous uveitis) Bussaca nodules (lie on the iris surface) which are pathognomonic for granulomatous uveitis. Keratitic percipitates (mutton)
treatment of anterior uveitis
corticosteroids, cyclopleigics, mydriatics, anti rheumatoids for long term
juvenile idiopathic artritis can cause
anterior uveitis in children. treat with steroids, methotrexate, adalimumab
components of the trabecular meshwork are
- uveal (innermost)
- corneoscleral (thickest)
- juxtacanalicular
where does the trabecular network drain
schlemm canal
aqueous humor is made by
the ciliary body pars plicata
why is there optic nerve damage in glaucoma
1) due to pressure at lamina cribosa
2) ischemic atrophy
congential glaucoma is due to
misformed angle
- iris touching cornea
- mesoderm is still present
- no canal of schlemm
acquired open angle glaucoma is due to
sclerosis of meshwork and lining of schlemm (THIS IS THE MOST COMMON TYPE OF GLAUCOMA)
types of secondary glaucoma are
- pigmentary
- pseudoexfoliative sydrome
BOTH ARE OPEN ANGLE
Drugs given to treat glaucoma
- diuretics
- alpha 2 agonists to decrease aqueous humor production
- BB
phempigoid
autoimmune disease causing blisters on skin and mucous membranes that may be present in dye eye
