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Clinical Practice > Opthalmology > Flashcards

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
Q

what are the features of a surgical 3rd nerve palsy?

A 
PCA (posterior communicating artery) aneurysm
<40
pain
headache
pupillary involvment
other neurological signs
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26
Q

what are the signs and symptoms of a 3rd nerve palsy?

A

ptosis
dilated pupil
eye looking down and out
diplopia

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27
Q

what are the symptoms and signs of non-proliferative diabetic retinopathy?

A

dot and blot haemorrhages
microaneurysms
cotton wool spots

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28
Q

what are the risk factors for progression of diabetic retinopathy?

A 
longer duration of diabetes
high blood sugars
high blood pressure
obesity
smoking
lack of exercise
hyperlipidaemia
not having an annual eye examination
pregnancy
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29
Q

what are the symptoms and signs of proliferative diabetic retinopathy?

A

new blood vessels (seaweed frond)

asymptomatic until they bleed; vitreous haemorrhage and floaters

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30
Q

what is the management of vitreous haemorrhage?

A 
rest
laser retinopexy (retinal tear)
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31
Q

describe advanced diabetic retinopathy

A

fibrosis under and anterior to the retina

requires surgery

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32
Q

what are the symptoms and signs of diabetic macular oedema?

A

gradual loss of vision
exudates
cotton wool spots
drusen

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33
Q

what is the treatment of diabetic macular oedema?

A

anti-VEGF intravitreal injections

laser treatment in extra-foveal macular

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34
Q

what is the treatment of diabetic macular ischaemia?

A

none

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35
Q

what are the risks of intravitreal injections?

A

infective endopthalmitis

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36
Q

what causes a 6th cranial nerve palsy?

A

raised intracranial pressure

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37
Q

what are the signs and symptoms of raised ICP?

A

diplopia
characteristic headache
obscurations of vision
bilateral swollen optic discs

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38
Q

what are the signs and symptoms of thyroid eye disease?

A 
diplopia
orbital inflammation
external eye inflammation
dry eyes
red eyes
optic neuropathy (sight threatening)
proptosis
39
Q

what are the symptoms and signs of a blowout fracture?

A

vertical diplopia

greenstick-type fracture in children (inferior rectus necrosis)

40
Q

what are the symptoms and signs of MG?

A 
variable diplopia
speech slurring
swallowing problems
breathlessness
fatigueable weakness around the head and neck
41
Q

define amblyopia

A

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
Q

what is the treatment of amblyopia?

A

occlusive therapy

43
Q

what are the symptoms and signs of cataracts?

A

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
Q

what are the causes of a reduced red reflex?

A

vitreous haemorrhage
cataract
infective endopthalmitis

45
Q

what are the risk factors for developing cataracts?

A 
age
diabetes
significant trauma
significant myopia
steroids
iritis
46
Q

what is the treatment of cataracts?

A

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
Q

what are the complications of cataract surgery?

A

suprachoroidal haemorrhage
posterior capsular thickening/rupture
infective endopthalmitis

48
Q

what are the symptoms and signs of infective endopthalmitis?

A

hypopyon

pain worsening over days

49
Q

what are the symptoms of posterior capsular thickening?

A

painless

gradual worsening blur of vision

50
Q

what is the treatment of posterior capsular thickening?

A

YAG laser capsulotomy

51
Q

what are the symptoms of primary open angle glaucoma?

A

initially asymptomatic
patches in the vision
tunnel vision (retinitis pigmentosa)
blindness

52
Q

what are the risk factors for primary open angle glaucoma?

A

age

1st degree relative

53
Q

what are the important signs of primary open angle glaucoma?

A

raised intraocular pressure
optic disc cupping
visual field defects

54
Q

what is the management of primary open angle glaucoma?

A

regular measurement of intraocular pressure and visual fields
prostaglandin analogues then beta blockers (IOP)
trabeculotomy
laser trabeculoplasty

55
Q

what are the signs of dry/atrophic AMD?

A

retinal pigment epithelium atrophy

56
Q

what are the risk factors for AMD?

A

age
smoking
family history

57
Q

what are the symptoms and signs of AMD?

A 
central blur
gradual onset in dry AMD
rapid onset in wet AMD
drusen (increased in rapid progression)
visual distortion
58
Q

what are the signs of wet AMD?

A

yellow/green neovascular sheet
blood
exudate
fluid on OCT

59
Q

what is the management of dry AMD?

A

low visual aids

illumination and magnification

60
Q

what is the treatment of wet AMD?

A

intravitreal injections of anti-VEGFs

61
Q

what are the causes of gradual loss of vision?

A

cataracts
primary open angle glaucoma
(dry) AMD
diabetic macular oedema

62
Q

what are the causes of a red eye?

A 
acute angle closure glaucoma
infective endophthalmitis
orbital cellulitis
trauma (closed and open globe)
conjuncitivits
keratitis
scleritis
iritis
subconjunctival haemorrhage
63
Q

what are the risk factors for acute angle closure glaucoma?

A

age

hypermetropia

64
Q

what is the treatment of infective endopthalmitis?

A

a tap of aqueous or vitreous humour for gram stain, microscopy and culture
IV antibiotics

65
Q

what are the symptoms and signs of orbital cellulitis?

A 
pain
blur
systemically unwell
proptosis
rapid onset eyelid swelling
unreactive pupils
reduced eye movements
66
Q

what is the management of orbital cellulitis?

A

admit patient for observation and bloods
IV antibiotics
CT to exclude orbital abscess

67
Q

what is the treatment of a corneal abrasion?

A 
topical antibiotics
chloramphenicol ointment (prevent infection and soothe)
cycloplaegic drops (photophobia)
68
Q

what causes hyphaema?

A

blunt trauma causing the iris vessels to bleed

69
Q

what is the management of a hyphaema?

A

rest
children; admit to wards to ensure they are resting
vigorous activity can increase the risk of a secondary bleed

70
Q

what is the treatment of an open globe injury?

A

surgery
plastic eye shield
analgesia
anti-emetics (reduce valsalva)

71
Q

what is the treatment of a chemical eye injury?

A

irrigation until the pH of ocular fluid is normal

72
Q

what are the complications of eyelid laceration?

A

ongoing corneal abrasion
in-turning eyelashes
globe injury

73
Q

what are the symptoms of conjuntivitis?

A 
sticky, uncomfortable eye
watery discharge (adenoviral)
green discharge (bacterial)
74
Q

what is the treatment of conjunctivitis?

A 
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
Q

what are the symptoms of iritis?

A

pain
small/irregular pupil
photophobia

76
Q

what diseases are associated with iritis?

A

IBD
psoriasis
psoriatic arthritis
ankylosing spondylitis

77
Q

what is the treatment of iritis?

A

exclude keratitis

steroid drops

78
Q

what are the causes, signs and treatment of bacterial keratitis?

A

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
Q

what are the causes, signs and treatment of viral keratitis?

A

herpes simplex virus

classic dendritic ulcer seen under blue light and fluorescein staining

topical antivirals

80
Q

what are the features of scleritis?

A

uncommon

severe pain which is worse at night

81
Q

what are the symptoms and signs of vitreous haemorrhage?

A

sudden onset of new floaters

tomato soup-like retina

82
Q

what are the causes of vitreous haemorrhage?

A

retinal tear

proliferative diabetic retinopathy

83
Q

what are the causes of sudden loss of vision?

A 
vitreous haemorrhage
retinal vein occlusion
retinal artery occlusion
ischaemic optic neuropathy (arteritic and non-arteritic)
retinal detachment
84
Q

what are the signs of retinal vein occlusion?

A

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
Q

what is the cause of retinal vein occlusion?

A

arteriosclerosis

86
Q

what is the management of retinal vein occlusion?

A

refer to ophthalmology

OCT

87
Q

what are the risk factors for non-arteritic ischaemic optic neuropathy?

A

age
smoking
hypertension

88
Q

what are the signs and symptoms of arteritic ischaemic optic neuropathy (temporal arteritis)?

A 
sudden loss of vision
temporal headaches and tenderness
abnormal tiredness
jaw claudication
reduced appetite
non-pulsatile and tender temporal arteries
swollen optic disc
89
Q

what is the management of temporal arteritis?

A

blood tests (ESR, CRP)
temporal artery biopsy
systemic steroids to protect the uninvolved eye

90
Q

what are the symptoms and signs of retinal artery occlusion?

A

sudden loss of vision in one eye
curtain coming down over their vision
cherry-red spot (fovea)
pale macula

91
Q

what is the treatment of retinal artery occlusion?

A

none
vigorous ocular massage
rebreathe CO2 (dilate the retinal vasculature)
AC paracentesis
find the embolus source (AF, atherosclerotic carotid arteries, abnormal heart valves)

92
Q

what are the symptoms and signs of retinal detachment?

A

curtain coming across the vision
flashes
floaters
green, elevated retina

93
Q

what are the risk factors of retinal detachment?

A

myopia
previous eye surgery
previous significant eye trauma

94
Q

what is the treatment of retinal detachment?

A

vitretomy

Clinical Practice (14 decks)

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