Opthalmology Flashcards
A 30-year-old man has presented to the eye emergency department after being hit across the face with a baseball bat. On examination, the right eye has blood in the anterior chamber.
What is he at increased risk of?
Glaucoma = due to increased IOP as the blood blocks the drainage of the aqueous humour.
What is hyphema?
Pooling of blood in the anterior chamber
Rf and associations with types of cataracts
Myotonic dystrophy
Myopia
Ocular trauma
Allopurinol
Myotonic dystrophy is associated with dot cataracts
Myopia is associated with nuclear cataracts
Ocular trauma is usually associated with nuclear cataracts with a ‘stellate’ morphology but depend on the trauma mechanism
Allopurinol use has been linked with the formation of sub capsular cataracts, but not as strongly as for steroid use
Describe the two types of macular degeneration?
dry (90% of cases, geographic atrophy) macular degeneration: characterised by drusen - yellow round spots in Bruch’s membrane
wet (10% of cases, exudative, neovascular) macular degeneration: characterised by choroidal neovascularisation. Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. Carries worst prognosis
Name some risk factors for ARMD?
- advancing age
- smoking
- Fhx
- rf for CVD e.g. HTN, dyslipidaemia, DM
What do patients present with in ARMD?
Reduction in VA particularly for near field objects
difficulties in dark adaptation
fluctuations in visual disturbance
Straight lines appearing curvy
Photopsia - perception of flickering or flashing lights
What investigations would you do for someone with ARMD?
Slit lamp is initial exam
If neovascular ARMD is suspected do fluorescin angiography
Ocular coherence tomography is used to visualise the retina in 3D
Describe the treatment of ARMD?
Dry
- zinc anti-oxidant and vitamins A,C and E
Wet
- VEGF
- Laser photocoagulation as a last resort
What can mydriatic drops cause?
Acute angle closure glaucoma
What is an entropian?
Where the eyelid turns inwards
Which one of the following features is not present in diabetic pre-proliferative retinopathy?
Microaneurysms Blot haemorrhages Cotton wool spots Venous Bleeding Neovascularisation
Neovascularisation
How is anterior uveitis treated?
Steroid + mydriatic drops
What sign is strongly associated with ocular involvement in shingles?
Hutchinson’s sign = vesicles extending to the tip of the nose
What are flashes and floaters a symptom of?
Vitreous detachment
Where does glaucoma mainly affect?
peripheral visual fields
