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Y4 Special senses > Opthalmology workbook > Flashcards

Opthalmology workbook Flashcards

1
Q

Initial management of blepharitis

A
  • Warm compresses
  • Cotton wool buds dipped in dilated baby shampoo
  • Artificial tears
  • Avoidance of contact lens use during flare-ups
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2
Q

Further medical treatment for blepharitis

A
  • Chloramphenicol
  • Fusidic acid gel
  • Oral doxycycline, erythromycin for rosacea
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3
Q

What is the immediate management of a chemical eye injury

A
  • Immediate and copious irrigation with sterile water for 15-30 minutes
  • Evert the eyelids
  • Analgesia drops (proxymetacaine)
  • Urgent ophthalmology review
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4
Q

Which type of chemical injuries are more severe and why?

A

Alkali base injury
Liquefactive necrosis
- penetrates cell membranes and enters deeper tissues

Acids is coagulative necrosis- protein denaturation but creating a protective coagulated layer- limits deeper tissue penetration

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5
Q

A patient has a chemical injury to the eye.

On examination you see the following:
- Red eye, except for pallor of vessels close to the limbus in the interpalpebral fissure
- Cloudy cornea
- Hazy view of iris detail

What is the cause of the unusual conjunctival injection?

A
  • Pallor near limbus means ischaemia. Part of the eye that has stem cells essential for corneal healing.
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6
Q

How do you manage severe chemical eye injury with signs of limbal ischaemia?

A
  • Intensive irrigation and topical therapy (antibiotics, steroids, vitamin c and tetracyclines)
  • Temporarily suturing the eyelids closed
  • Careful monitoring to prevent glaucoma, vision loss
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7
Q

What are complications of severe chemical burns to the eye?

A
  • Secondary glaucoma
  • Corneal ulceration and melting- can lead to perforation and loss of the eye
  • Cataracts
  • Anterior uveitis
  • Corneal scarring and vision loss
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8
Q

A 71 year old man is referred by his optometrist with reduced visual acuity associated with a substantial change in his spectacle prescription over the last six months. He tells you he is having problems driving at night and often gets glare when looking at oncoming vehicles.

What are the most likely causes for his symptoms?

A

Cataracts

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9
Q

Why would cataracts lead to refractive changes?

A
  • Clouding of the lens changes the way it is refracted
  • Lens may become more convex
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10
Q

What are the different approaches with regards to cataract surgery?

A
  • Phacoemulsification
  • Manual small incision cataract surgery
  • Extracapsular cataract extraction (larger incision to remove the lens in one piece along with capsule)
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11
Q

At roughly what level of vision do most people undergo surgery in the UK?

A

6/12

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12
Q

Explain cataract surgery to a patient (PHACO)

A
  • Before the surgery we will give you eye drops to dilate the eye and numb it
  • You will be awake for the procedure but it should only take about 30 minutes
  • We will make a cut in the corner of your eye and use a special tool to break up the cataract
  • The same tool will then gently suck it out
  • Put the new lens in
  • This will help give you better vision after
  • We’ll give you an eye guard after and give you eye drops to take care of your eye
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13
Q

What complications of cataract surgery do you warn the patient of?

A
  • Endopthalmitis
  • Retinal detachment
  • Glare and halos
  • IOL dislocation
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14
Q

What percentage of world blindness do cataracts account for?

A

51%

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15
Q

Common causes of blindness worldwide

A
  • Cataracts
  • Glaucoma
  • Age-related macular degeneration
  • Diabetic retinopathy
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16
Q

Treatment and public health measures for cataracts

A

Surgery- phacoemulsification with intraocular lens

  • Awareness campaigns for cataracts
  • Education about preventing cataracts- stopping smoking, quitting alcohol
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17
Q

Treatment and public health measures for glaucoma

A

Treatment

Medications
- Prostaglandin analogues, beta blockers, carbonic anhydrase inhibitors
Surgery
- Trabeculectomy
- Laser surgery

Public health measures
- Routine screening
- Patient education
- Awareness campaign

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18
Q

Treatment for AMD

A
  • Anti-VEGF injections
  • Photodynamic therapy- light-activated medication is used to destroy abnormal blood vessels
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19
Q

Treatment for diabetic retinopathy

A
  • Laser photocoagulation (seal leaking blood vessels)
  • Anti-VEGF therapy
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20
Q

What is the commonest cause of registration as blind in the UK?

A

Age related macular degeneration

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21
Q

What two investigations can be used to investigate the diagnosis (suspecting AMD)

A
  • Fundoscopy
  • OCT
22
Q

How do you differentiate between dry and wet AMD?

A

Dry AMD
- Drusen
- No abnormal blood vessels
- Gradual vision loss
- Gradual central vision loss
- RPE atrophy, drusen
- Drusen, pigment changes

Wet AMD
- Rare or not typically present
- Abnormal new blood vessel growth
- Rapid and severe
- Distortion, dark spots, sudden loss
- Fluid, choiroidal neovascularisation
- Haemorrhages, fluid, CNV

23
Q

Management of dry AMD

A
  • AREDs vitamin C, E, beta-carotene, zinc and copper
  • smoking cessation
  • regular eye examination
24
Q

How to manage wet AMD

A
  • Anti VEGF injections monthly
  • Photodynamic therapy (seal leaky vessels)
  • Laser photocoagulation (destroy abnormal blood vessels)
25
Q

A 70 year-old woman presented in A&E with a one day history of sudden, unilateral, painful loss of vision, headaches and nausea developing over the course of 24 hours.

Name a likely diagnosis?

A

Acute angle-closure glaucoma

26
Q

What examination findings would you look for with acute angle-closure glaucoma?

A
  • Mid-dilated, non reactive pupil
  • Red eye
  • Cloudy cornea
  • Hard and tender eyeball
27
Q

What medical treatment needs to be immediately initiated with acute angle-closure glaucoma?

A

Timolol drops and IV Acetazolamide

28
Q

What systemic medications can induce acute angle-closure glaucoma?

A

Trihexyphendiyl (used in parkinson’s) pupil dilation which can narrow the angle

Adrenergic medications (pseudoephedrine) dilate the pupil

29
Q

A 45 year-old person who is asymptomatic, is referred to you by their optician with probable chronic simple (open angle) glaucoma

What is the definition of Glaucoma?

A

A condition in which there is a build-up of fluid in the eye, which presses on the retina and the optic nerve.

30
Q

What laser treatment can help with open angle glaucoma?

A

Selective laser trabeculoplasty
Targets specific cells in the trabecular meshwork promoting drainage

31
Q

If laser therapy is not successful in open angle glaucoma, what surgical options are there?

A

Trabeculectomy
Cyclophotocoagulation- laser that targets the ciliary body to stop production of aqueous
Tube shunt surgery

32
Q

What are the principles of glaucoma surgery?

A
  • Reduction of aqueous humor production
  • Enhancement of aqueous humor outflow
  • Maintaining anterior chamber integrity
33
Q

A 70 year old man comes in complaining recent onset of painless loss of vision in his left eye.
His past medical history includes type 2 diabetes (diet controlled) and hypertension.
He has had one myocardial infarction three years ago. On examination you find that he has a left relative afferent pupillary defect (RAPD).

Name 3 conditions in which you would see a RAPD.

A
  • Optic neuritis
  • Transection of the optic nerve
  • Central retinal artery occlusion
  • Retinal detachment
  • Severe glaucoma
34
Q

What are the possible outcomes for a patient with central retinal vein occlusion without treatment?

A
  • Visual acuity loss
  • Macular edema
  • Retinal ischaemia
35
Q

Why would you get an area of pallor within scleritis?

A

Localised ischaemia due to vasculitis of the scleral blood vessels.

36
Q

Common underlying non-infectious diseases of scleritis

A
  • Granulomatosis with polyangitis
  • Systemic lupus erythamatosus
  • Polyarteritis nodosa
37
Q

What investigations would you like to request to exclude underlying pathologies in scleritis?

A

FBC- anaemia, leucocytosis or thrombocytosis.

ESR and CRP

RF and anti-CCP- rhematoid arthritis

ANCA- granulomatosis with polyangitis and microscopic polyangitis

C3 and C4- low complement levels can be seen in active autoimmune conditions like SLE

CXR- GPA or sarcoidosis

Urinalysis and renal function testes- renal involvement if GPA or polyarteritis nodosa

Ophthalmology assessment- extent of scleritis and to monitor therapy

Temporal artery biopsy- rule out GCA

38
Q

How do you treat her presenting condition?

A

Oral NSAIDs are typically first line

Oral glucocorticoids may be used for more severe presentations

Immunosuppressive drugs to resistant cases- methotrexate, azathioprine, cyclophosphamide.

39
Q

What are the three layers of the tear film and their sources?

A

Surface lipid layer- secreted by meibomian glands

Middle aqueous layer- secreted by lacrimal glands and accessory lacrimal glands

Inner mucus layer- secreted by goblet cells of the conjunctiva

40
Q

What are the three layers of the eyeball and their functions?

A

Outer fibrous layer: Sclera and cornea, providing protection and muscle attachment.

Middle vascular layer: Choroid, ciliary body, and iris, supplying blood and controlling light entry.

Inner neural layer: Retina, responsible for light reception and signal transmission.

41
Q

What is the normal range for intraocular pressure?

A

11–21 mmHg.

42
Q

Name two routes of aqueous humour drainage

A

Trabecular meshwork → Canal of Schlemm → Episcleral vessels → Systemic venous circulation.
Uveoscleral route: Drains into the root of the iris or ciliary muscle.

43
Q

Example of a beta-blocker used in glaucoma

A

Timolol- reduces aqueous production

44
Q

Example of an alpha agonist and it’s function in glaucoma

A

Brimonidine- reduce production and increase uveoscleral outflow

45
Q

Example of an prostaglandin analogue and it’s function in glaucoma

A

Latanoprost- increase uveoscleral outflow

46
Q

Example of a parasympathomimetic and it’s function in glaucoma

A

Pilocarpine- increase aqueous outflow by ciliary muscle contraction

47
Q

Example of an carbonic anhydrase inhibitor and it’s function in glaucoma

A

Dorzolamide- reduce aqueous production

48
Q

What is the function of the choroid in the eye?

A

Supplies nutrients to the outer retina via the choriocapillaris

Removes waste products from the outer retina

Absorbs light that passes through the retina to prevent reflection

Acts as a bridge for nerves and vessels to reach the anterior eye

49
Q

What is a common finding in a patient with anterior uveitis?

A

Circum-corneal injection (redness around the cornea)

Presence of keratic precipitates on the corneal endothelium

Cells and flare in the anterior chamber (protein from leaky blood vessels)

Possible posterior synechiae (adhesions between iris and lens)

50
Q

What anatomical feature connects the retina to the choroid?

A

The retina is attached to the choroid via Bruch’s membrane, a basement membrane.

51
Q

What is the role of the vitreous humour in the eye?

A

The vitreous humour fills 2/3 of the eye’s volume, maintaining the eye’s shape.

It supports the retina and holds the lens in place.

It is 99% water and more viscous than water, but it degenerates with age, leading to floaters.

Y4 Special senses (8 decks)

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