Opthalmology Flashcards
1
Q
Papillodema indicates…
A
Raised ICP
2
Q
First line management of suspected meningitis (photophobia, headache, neck stiffness)
A
Ceftriaxone
3
Q
Horner’s syndrome features
A
Miosis
Anhydrosis
Ptosis
4
Q
Sudden visual loss in diabetics, what test should you do? And what are you thinking of?
A
Slit lamp to try and visualise any RBC in the vitreous
Worried about vitreos haemorrhage due to the extra vessels (proliferative diabetic retinopathy)
5
Q
Features of vitreous haemorrhage
A
Painless visual loss
Red hue
Hx of diabetes
6
Q
What is the most common cause of blindness in the UK?
A
Age related macular degeneration
7
Q
2 forms of macular degneration
A
Wet
Dry
8
Q
What is age related macular degeneration
A
Degeneration of retinal photoreceptors resulting in the formation of DRUSEN (yellow round spots)
9
Q
What are drusen?
A
Yellow round spots in the eye
10
Q
What is the difference between wet and dry ARMD?
A
Wet is more aggressive and can detatch the retina
11
Q
Signs of ARMD
A
Distortion of vision (e.g. blurred)
Examination shows drusen (yellow areas)
Wet may show red patches of intra-retinal leakage
12
Q
Pt feels like something stuck in eye, pain, photophobia, dendritic ulcer. Cause?
A
Herpes simplex keratitis
13
Q
Management of herpes simplex keratitis
A
Topical aciclovir
Referral to opthalmologist
14
Q
Diagnosis of ARMD
A
Slit lamp to identify any pigment (Druser)and or exudate or haemorrhagic changes
Fluorescein angiography can be used if neovascular ARMD is suspected, which can guid antii-VEG-F therapy
15
Q
Ptosis and DILATED pupil
A
Third nerve palsy
16
Q
Ptosis and miosis
A
Horner’s
17
Q
Treatment of acute optic neuritis
A
High dose steroids
18
Q
Investigation of choice for MS
A
MRI brain
Then can do lumbar puncture if necessary (oligoclonal bands)
19
Q
Signs of optic neuritis
A
Blurred vision
Headache
20
Q
Causes of tunnel vision (narrow visual field)
A
Papilloedema
Glaucoma
Retinitis pigmentosa (genetic loss of vision, often trouble seeing at night)
Choroidoretinitis (inflammation of choroid, the coating of the eye). It’s a form of posterior uveitis.
21
Q
Causes of sudden loss of vision
A
Vitreous haemorrhage
Retinal detachment
Retinal igrane
Ischaemic/vascular. I.e. occlusion of central retinal vein or artery
22
Q
Eye stuck together and red Dx?
A
Conjunctivitis
23
Q
Treatment of conjunctivitis
A
Can watch and wait and see if it improves OR topical chloramphenicol
24
Q
What is blepharitis?
A
Inflammation of the eyelids (swollen, irritated and red)
25
Treatment of acute closed angle glaucoma
```
Pilocarpine drops (constricts the pupil and releases the aqueous humour)
Admit them to hospital
```
26
Definitive treatment of acute closed angle glaucoma
Laser peripheral iridotomy
27
Sudden, painless loss of vision.
| Severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
28
Acute visual loss, pale retina with a cherry red spot
Central retinal artery occlusion
29
Red eye NOT painful, slight watering and mild photophobia
Episcleritis
| Vessels move with gentle pressure as they are very superficial
30
Scleritis is?
Inflammation of deep vessels in the eye, often painful, with blurred vision.
The vessels DO NOT move when gentle pressure is applied
31
Management of episcleritis
Conservative, maybe artifial tears
32
Differentiating between scleritis and episcleritis
Phenylephrine drops
| If eye redness improves = episcleritis
33
Key aspects of ophthalmology history
```
Onset
1 eye vs 2 eyes
Activities they were doing at the time
Do they wear glasses
Any pain
Any associated symptoms
```
34
Aspects of ophthalmologic examination
Visualise anterior segment
Slit lamp
Posterior eye examination
35
Questions to ask in ophthalmology
```
Redness
Discharge
Itching
Burning
Oedema
Floaters
```
36
Causes of discharge from eye
```
Corneal trauma
Blepharitis
Conjunctivitis
Stye
Chemical = emergency, what chemical was it?
```
37
Features of subconjunctival haemorrhage
Fragile vessels rupture
Often from straining, check if they have high blood pressure
The cornea is NOT INVOLVED
This will resolve spontaneously
38
Symptoms of iritis
Blurring of vision
Photophobia
Eye pain
Red eye
39
What is ectropion re eye?
The eyelid is turned away from the eyeball
40
Causes of ectropion
```
Muscle weakness
Facial paralysis (Bell’s palsy)
Scars and damaged skin
Previous surgery
Growths (pushing the eyelid out of place)
```
41
Signs and symptoms of ectropion
```
Watery eyes (can’t drain properly)
Excessive dryness
Grittiness
Irritation because they aren’t being irrigated properly
Sensitivity to light
```
42
Mx of ectropion
Eye drops
| Surgery is the definitive treatment
43
Name of oil secreting glands in eyelash’s
Glands of Zeis
44
What causes a stye?
Infection of a gland of Zeis in the eye
| Causes a swelling like a piece of barley
45
Symptoms of a stye
Swelling above the eye
Redness and oedema around the eye
It’s basically an infection
46
Treatment of stye
Pluck eyelash to improve drainage
Hot compresses for comfort
Oral antibiotics because get to internal structures better
47
What is the structural support of the eyelid, that also helps with irrigation of the eye?
Tarsal plates
48
Gradual onset, swelling of the eyelid
Chalazian
49
Symptoms of chalazion
Small, almost fatty swelling in the eyelid
| Caused by mebomium gland obstruction
50
Mx of chalazion
Conservative if not too bad
Hot compresses
Oral antibiotics if significant infection
Steroid injection
Surgery for persistent lesions
51
What is ptosis?
From the Greek “to fall”
| Drooping of the upper eyelid
52
Acquired causes of ptosis
Neurogenic
Myogenic (e.g. myasthenia gravis)
Myopathies
Tumour pulling the eyelid down
Anything affecting nerve -> muscle
53
Mx of ptosis
Surgery
Brow suspension
Treat the underlying cause.
54
Myopia is
Short sightedness
55
What drains aqueous humour from the anterior chamber?
Trabecular meshwork
56
What secretes aqueous humour?
Ciliary epithelium
57
What causes glaucoma?
Drainage system blocked for aqueous humour
| Increases pressure
58
What can the increased pressure in glaucoma lead to?
Damage to optic nerve -> vision loss!
59
Pathophysiology of open angle glaucoma
The angle between the lens is open
The blockage is from a slow clogging of the trabecular meshwork
Causes a gradual pressure increase
60
Symptoms of open angle glaucoma
Gradual loss of peripheral vision because of outer rim atrophy
Continued damage leads to loss of central vision as well
61
Pathophysiology of closed angle glaucoma
Angle above lens is too small
Lens is pushed against the iris
Rapid build up of pressure
62
Symptoms of closed angle glaucoma
```
Eye pain
Redness
Blurry vision
Headaches and nausea
Visual haloes
```
63
Diagnosis of glaucoma
Tonometry to assess intraocular pressure
Visual field testing
Imaging looking for optic nerve damage (cupping of optic nerve)
64
Mx glaucoma
Medications to lower pressure = production or outflow
Production reducers = beta blockers and carbonic anhydrase inhibitors
Increase outflow = prostaglandin analogues
Also alpha adrenergic agonists and surgery (lasers)
Trabeculoplasty to open up trabecular meshwork in open angle
Iridotomy to put a hole in the iris = closed angle glaucoma
65
What is under the optic disc?
The head of the optic nerve
66
How do you find the optic disc?
Trace the blood vessels to the point of coalescence
67
Pathophysiology of diabetic retinopathy
Micro angiopathy causing damage to the small blood vessels of the retina as a result of hyperglycaemia
68
RF of diabetic retinopathy
Poor diabetic control
| Duration of diabetes
69
What is the spectrum of diabetic retinopathy?
Background
Pre proliferative
Proliferative
Advanced
70
Components of background diabetic retinopathy
Microaneurysms (appear as little red dots on the retina)
| Dot and blot haemorrhages (like bigger dots on the retina)
71
Components of pre-proliferative diabetic retinopathy
Any signs of retinal ischaemia
| Cotton wool spots (white, fluffy areas of necrotic tissue)
72
Components of proliferative diabetic retinopathy
New vessels at the optic disc
| New vessels elsewhere
73
Signs of advanced diabetic retinopathy
Recurrent vitreous haemorrhage from bleeding areas of neovascularisation (bleeding from new vessels)
Retinal detachment
74
What is the primary treatment for proliferative diabetic retinopathy?
Pan retinal coagulation
75
What is the method behind pan retinal photocoagulation?
Burn the retina with a laser
Reduce VEGF by reducing oxygen demand of the retina
Stops proliferation of new vessels (which are going to cause you to go blind)
76
Steps of hypertensive retinopathy
Grade 1 = very subtle, narrowing of arterioles
Grade 2 = AV nipping
Grade 3 = similar features to diabetic retinopathy, cotton wool spots, hard exudates, retinal haemorrhages
77
Optic disc of malignant hypertension
All the features of grade 3 hypertensive retinopathy + optic disc swelling
78
Symptoms of malignant hypertension
Headaches
Eye pain
Reduced visual acuity
Focal neurological deficits
79
Mx of malignant hypertension
Antihypertensives
| Admission to hospital
80
What might you see on fundoscopy for glaucoma?
Increased ratio of cup to disc
81
Is optic disc swelling the same as papilloedema?
No, papilloedema is specifically due to raised ICP
| Optic disc swelling is after any pathology causing it, e.g. malignant hypertension
82
When might you see a pale disc on fundoscopy?
Optic nerve atrophy
| Caused by optic neuritis, glaucoma or general retinal ischaemia
83
What causes secondary optic nerve atrophy
Long-standing papilloedema
84
What should you do if you detect papilloedema?
Imaging
85
When might you see a cherry red spot on fundoscopy?
Central retinal artery occlusion
86
How might central retinal artery occlusion present?
Sudden, profound loss of vision
87
What actually is the cherry red spot seen in central retinal artery occlusion?
The fovea against a backdrop of a very pale retina
88
What causes central retinal vein occlusion?
Atherosclerotic thickening, compressing and blocking the vein
89
What are you seeing on central retinal vein occlusion?
Retinal hypoxia leads to endothelial cell damage which leads to extravasation of blood
90
What does vein occlusion look like on fundoscopy?
Like someone has brushed with a purple paint brush
91
Most common cause of irreversible blindness in the uk?
Age related macular degeneration
92
1st line treatment of open angle glaucoma
Latanoprost (prostoglandin analogue)
93
Eye changes colour when on glaucoma treatment, which drug has this side effect?
Latanoprost
94
Treatment of central retinal artery occlusion
IV acetazolamide
95
Cupping and high pressure on fundoscopy, with some visual field defects indicates...
Glaucoma
96
What does the fourth cranial nerve do in terms of eye movement?
Down and in (look towards nose)
| Damage e.g. trauma -> can't do that movement with one side/both
97
Double vision and when asked to look down and in, can't do it with right eye, which nerve has been affected?
4th nerve palsy
98
How does Leber's optic atrophy usually present?
Young patient
| Loss of vision in one eye, followed by the other
99
Optic disc pallor indicates...
Optic atrophy
100
Causes of optic atrophy
Glaucoma due to raised intraocular pressure
Retinitis pigmentosa
Choroiditis
Central retinal artery occlusion
Multiple sclerosis
Leber’s optic atrophy (or Leber’s hereditary optic neuropathy)
Syphilis
101
What does 6/9 (-2) indicate in opthalmogy notation?
From 6m, can get to the 9th line, where they made 2 mistakes reading it
102
Most common cause of elderly 'clouding' of vision
Cataracts
103
Features distinguishing Ramsey-Hunt syndrome from Bell's palsy
Prominent otalgia
| Vesicular rash in the external auditory meatus, palate or tongue.
104
A 51 year old female patient attends A&E complaining of a red right eye. She reports that her red eye started suddenly, and she can her a 'whooshing noise'. She also reports diplopia, a headache and loss of vision.
On examination her visual acuity is 1/60 in her right eye. Her conjunctiva is injected, and she has a restriction in her right eye movements in all direction. The eye is severely proptosed and pulsatile.
What is the most likely diagnosis?
Carotid-cavernous fistula
