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Opthalmology Flashcards

1
Q

what are the layers of the eye?

A

sclera and cornea
uvea (choroid, ciliary body and iris)
retina

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2
Q

what is the function of the sclera?

A

protection from trauma
maintains intraocular pressure
allows extra ocular muscle attachment

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3
Q

what is the function of the choroid?

A

supplies nutrients and oxygen to the outer retina

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4
Q

what does the refractive error depend on?

A

eyeball length

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5
Q

what is the function of the cornea?

A

most refraction of light occurs here

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6
Q

describe the layers of the cornea

A

epithelium - constantly regenerated by stem cells

endothelium - maintain relative dehydration of the cornea

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7
Q

what is the function of the iris?

A

prevents excess light entering the eye
sphincter pupillae constricts the pupil (parasympathetic system)
dilator pupillae dilates the pupil (sympathetic system)

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8
Q

describe the aqueous humour

A

watery fluid
similar to CSF
constantly produced by the ciliary processes

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9
Q

define glaucoma

A

imbalance between the rate of production and rate of drainage of aqueous causing raised intraocular pressure

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10
Q

what are the functions of the ciliary body?

A

production of aqueous humour

contraction in accommodation

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11
Q

define presbyopia

A

age related reduction in ability to accommodate

mainly due to lens stiffness

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12
Q

what are the functions of the lens?

A

transparency

fine tunes the focussing of the cornea

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13
Q

describe the vitreous humour

A

a hydrated gel; 99% water with hyaluronic acid and some collagen fibrils

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14
Q

what are the layers of the retina?

A

inner neural retina
outer pigmented (RPE)
Bruchs membrane

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15
Q

what are the functions of the retina?

A 
perceive light intensity (rods, found at the peripheries of the retina)
perceive colour (cones, concentrated in the fovea)
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16
Q

describe the optic disc

A

axons from the ganglion cells merge to form the optic nerve
corresponds to the blind spot
no photoreceptors

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17
Q

what pieces of information are given when describing a visual acuity?

A

the acuity itself
how it was achieved (best corrected: glasses, pinhole, unaided)
which eye

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18
Q

what should be done when assessing visual acuity?

A

encourage guessing
discourage cheating
unaided, then aided and/or pinhole

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19
Q

what should be done when VA is less than 6/60?

A 
use a closer distance; 3/60, 1/60
counting finger (CF)
hand movements (HM)
perception of light (PL)
no perception of light (NPL)
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20
Q

what are the features seen in acute angle closure glaucoma?

A 
severe pain; ocular or headache
decreased visual acuity
hard, red eye
dilated, non-reacting pupil
corneal oedema; dull or hazy
nausea
vomiting
abdominal pain
high intraocular pressure
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21
Q

what is the management of acute angle closure glaucoma?

A

emergency referral
eye drops; direct parasympathomimetic, beta blocker, alpha-2 agonist
IV acetazolamide
laser peripheral iridotomy

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22
Q

what are the causes of diplopia?

A

3rd cranial nerve palsy
4th cranial nerve palsy (vertical diplopia)
6th cranial nerve palsy (reduction abduction)
thyroid eye disease
myasthenia gravis
blow out fracture

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23
Q

what are the causes of a fixed dilated pupil?

A

anticholinergic drops
acute glaucoma
3rd nerve palsy

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24
Q

define a medical 3rd nerve palsy

A

stroke of the optic nerve typically seen in older patients with cardiovascular risk factors

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25
what are the features of a surgical 3rd nerve palsy?
``` PCA (posterior communicating artery) aneurysm <40 pain headache pupillary involvment other neurological signs ```
26
what are the signs and symptoms of a 3rd nerve palsy?
ptosis dilated pupil eye looking down and out diplopia
27
what are the symptoms and signs of non-proliferative diabetic retinopathy?
dot and blot haemorrhages microaneurysms cotton wool spots
28
what are the risk factors for progression of diabetic retinopathy?
``` longer duration of diabetes high blood sugars high blood pressure obesity smoking lack of exercise hyperlipidaemia not having an annual eye examination pregnancy ```
29
what are the symptoms and signs of proliferative diabetic retinopathy?
new blood vessels (seaweed frond) | asymptomatic until they bleed; vitreous haemorrhage and floaters
30
what is the management of vitreous haemorrhage?
``` rest laser retinopexy (retinal tear) ```
31
describe advanced diabetic retinopathy
fibrosis under and anterior to the retina | requires surgery
32
what are the symptoms and signs of diabetic macular oedema?
gradual loss of vision exudates cotton wool spots drusen
33
what is the treatment of diabetic macular oedema?
anti-VEGF intravitreal injections | laser treatment in extra-foveal macular
34
what is the treatment of diabetic macular ischaemia?
none
35
what are the risks of intravitreal injections?
infective endopthalmitis
36
what causes a 6th cranial nerve palsy?
raised intracranial pressure
37
what are the signs and symptoms of raised ICP?
diplopia characteristic headache obscurations of vision bilateral swollen optic discs
38
what are the signs and symptoms of thyroid eye disease?
``` diplopia orbital inflammation external eye inflammation dry eyes red eyes optic neuropathy (sight threatening) proptosis ```
39
what are the symptoms and signs of a blowout fracture?
vertical diplopia | greenstick-type fracture in children (inferior rectus necrosis)
40
what are the symptoms and signs of MG?
``` variable diplopia speech slurring swallowing problems breathlessness fatigueable weakness around the head and neck ```
41
define amblyopia
reduced VA in one eye; a clear retinal image was not able to form during childhood due to uncorrected long-sightedness or a squint
42
what is the treatment of amblyopia?
occlusive therapy
43
what are the symptoms and signs of cataracts?
general blur of vision worsening over months and years halos and glare with oncoming light yellow/green/brown/white pupil dull/black opacities in the red reflex
44
what are the causes of a reduced red reflex?
vitreous haemorrhage cataract infective endopthalmitis
45
what are the risk factors for developing cataracts?
``` age diabetes significant trauma significant myopia steroids iritis ```
46
what is the treatment of cataracts?
phacoemulsification and intraocular lens implantation ``` pre-assessment the eye is frozen lying still for 20-30 minutes clear shield over the eye post-operative reviews eye drops new glasses required (6 weeks later) ```
47
what are the complications of cataract surgery?
suprachoroidal haemorrhage posterior capsular thickening/rupture infective endopthalmitis
48
what are the symptoms and signs of infective endopthalmitis?
hypopyon | pain worsening over days
49
what are the symptoms of posterior capsular thickening?
painless | gradual worsening blur of vision
50
what is the treatment of posterior capsular thickening?
YAG laser capsulotomy
51
what are the symptoms of primary open angle glaucoma?
initially asymptomatic patches in the vision tunnel vision (retinitis pigmentosa) blindness
52
what are the risk factors for primary open angle glaucoma?
age | 1st degree relative
53
what are the important signs of primary open angle glaucoma?
raised intraocular pressure optic disc cupping visual field defects
54
what is the management of primary open angle glaucoma?
regular measurement of intraocular pressure and visual fields prostaglandin analogues then beta blockers (IOP) trabeculotomy laser trabeculoplasty
55
what are the signs of dry/atrophic AMD?
retinal pigment epithelium atrophy
56
what are the risk factors for AMD?
age smoking family history
57
what are the symptoms and signs of AMD?
``` central blur gradual onset in dry AMD rapid onset in wet AMD drusen (increased in rapid progression) visual distortion ```
58
what are the signs of wet AMD?
yellow/green neovascular sheet blood exudate fluid on OCT
59
what is the management of dry AMD?
low visual aids | illumination and magnification
60
what is the treatment of wet AMD?
intravitreal injections of anti-VEGFs
61
what are the causes of gradual loss of vision?
cataracts primary open angle glaucoma (dry) AMD diabetic macular oedema
62
what are the causes of a red eye?
``` acute angle closure glaucoma infective endophthalmitis orbital cellulitis trauma (closed and open globe) conjuncitivits keratitis scleritis iritis subconjunctival haemorrhage ```
63
what are the risk factors for acute angle closure glaucoma?
age | hypermetropia
64
what is the treatment of infective endopthalmitis?
a tap of aqueous or vitreous humour for gram stain, microscopy and culture IV antibiotics
65
what are the symptoms and signs of orbital cellulitis?
``` pain blur systemically unwell proptosis rapid onset eyelid swelling unreactive pupils reduced eye movements ```
66
what is the management of orbital cellulitis?
admit patient for observation and bloods IV antibiotics CT to exclude orbital abscess
67
what is the treatment of a corneal abrasion?
``` topical antibiotics chloramphenicol ointment (prevent infection and soothe) cycloplaegic drops (photophobia) ```
68
what causes hyphaema?
blunt trauma causing the iris vessels to bleed
69
what is the management of a hyphaema?
rest children; admit to wards to ensure they are resting vigorous activity can increase the risk of a secondary bleed
70
what is the treatment of an open globe injury?
surgery plastic eye shield analgesia anti-emetics (reduce valsalva)
71
what is the treatment of a chemical eye injury?
irrigation until the pH of ocular fluid is normal
72
what are the complications of eyelid laceration?
ongoing corneal abrasion in-turning eyelashes globe injury
73
what are the symptoms of conjuntivitis?
``` sticky, uncomfortable eye watery discharge (adenoviral) green discharge (bacterial) ```
74
what is the treatment of conjunctivitis?
``` symptomatic cool compresses ocular lubricants avoid close contact with children use own towels topical antibiotics (bacterial) if still remaining after 2 weeks, consider other causes (chlamydia conjunctivitis) ```
75
what are the symptoms of iritis?
pain small/irregular pupil photophobia
76
what diseases are associated with iritis?
IBD psoriasis psoriatic arthritis ankylosing spondylitis
77
what is the treatment of iritis?
exclude keratitis | steroid drops
78
what are the causes, signs and treatment of bacterial keratitis?
contact lens misuse white patch/spot intensely sore and red eye scrape the ulcer to get a sample for microscopy and culture intense topical antibiotics for the first 48hrs
79
what are the causes, signs and treatment of viral keratitis?
herpes simplex virus classic dendritic ulcer seen under blue light and fluorescein staining topical antivirals
80
what are the features of scleritis?
uncommon | severe pain which is worse at night
81
what are the symptoms and signs of vitreous haemorrhage?
sudden onset of new floaters | tomato soup-like retina
82
what are the causes of vitreous haemorrhage?
retinal tear | proliferative diabetic retinopathy
83
what are the causes of sudden loss of vision?
``` vitreous haemorrhage retinal vein occlusion retinal artery occlusion ischaemic optic neuropathy (arteritic and non-arteritic) retinal detachment ```
84
what are the signs of retinal vein occlusion?
scattered blot haemorrhages (central occlusion) arc of haemorrhages (branch occlusion) cotton wool spots exudate similar to diabetic retinopathy but in a patient without diabetes and in one eye
85
what is the cause of retinal vein occlusion?
arteriosclerosis
86
what is the management of retinal vein occlusion?
refer to ophthalmology | OCT
87
what are the risk factors for non-arteritic ischaemic optic neuropathy?
age smoking hypertension
88
what are the signs and symptoms of arteritic ischaemic optic neuropathy (temporal arteritis)?
``` sudden loss of vision temporal headaches and tenderness abnormal tiredness jaw claudication reduced appetite non-pulsatile and tender temporal arteries swollen optic disc ```
89
what is the management of temporal arteritis?
blood tests (ESR, CRP) temporal artery biopsy systemic steroids to protect the uninvolved eye
90
what are the symptoms and signs of retinal artery occlusion?
sudden loss of vision in one eye curtain coming down over their vision cherry-red spot (fovea) pale macula
91
what is the treatment of retinal artery occlusion?
none vigorous ocular massage rebreathe CO2 (dilate the retinal vasculature) AC paracentesis find the embolus source (AF, atherosclerotic carotid arteries, abnormal heart valves)
92
what are the symptoms and signs of retinal detachment?
curtain coming across the vision flashes floaters green, elevated retina
93
what are the risk factors of retinal detachment?
myopia previous eye surgery previous significant eye trauma
94
what is the treatment of retinal detachment?
vitretomy

Clinical Practice (14 decks)

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