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Finals HH > Opthamology > Flashcards

Opthamology Flashcards

1
Q

What is glaucoma?

A

Glaucoma is optic nerve damage due to rise in intraocular pressure due to block of aqueous

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2
Q

What is the normal intra-ocular pressure?

A

Normal IOP is 10-21mmHg

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3
Q

What happens in acute angle-closure glaucoma?

A

Iris bulges forward and seals off trabecular meshwork

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4
Q

What happens in chronic open-angle glaucoma?

A

There is increased resistance of trabecular meshwork

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5
Q

What is the Px of acute angle closure glaucoma?

A

Acute painful red eye

  • Blurred vision
  • Headaches, N&V
  • Seeing halos around lights
    o Hazy oedematous cornea
  • Evening symptoms
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6
Q

What is the Px and Ix of chronic open-angle glaucoma?

A

Is often asymptomatic

Ix:
- Visual field defects
Peripheral vision closes until tunnel vision

  • Fundoscopy -> Cupped optic disc
    Optic cup > 0.5 x optic disc
  • Measure IOP (> 24mmHg)
    o Non-contact tonometry = puff of air at cornea
    o Goldmann applanation tonometry
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7
Q

Mx of acute angle-closure glaucoma?

A

->Refer to ophthalmologist

Emergency mx:
- Patient lie flat with head not supported to relieve pressure
- Pilocarpine eye drops
o 2% in blue eyes
o 4% in brown eyes
- Acetazolamide 500mg orally
- Analgesia + anti-emetic

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8
Q

Mx of chronic open-angle glaucoma?

A

If >24 mmHg:
- Laser trabeculoplasty (SLT)

  • Not suitable for SLT ->
    1. Prostaglandin analogue
    2. B-blocker
    3. Carbonic anhydrase inhibitor
  • Advanced COAG -> glaucoma surgery + mitomycin-C (MMC)
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9
Q

What is blepharitis?

A

Inflamed eyelids

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10
Q

What are the different types of blepharitis?

A

Anterior - staphylococcal or seborrheic

Posterior - meibomian

Can also be mixed

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11
Q

Mx of blepharitis?

A

Mx – no cure, chronic intermittent condition:
1. Self-care (eyelid hygiene and warm press), no eye make-up

  1. Eyelid measures are ineffective:
    o Anterior blepharitis -> Topical antibiotic – Chloramphenicol
    o Posterior blepharitis + meibomian gland dysfunction & rosacea -> oral antibiotics
  2. Refer to ophthalmology if severe
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12
Q

What is a chalazion?

A

Meibomian gland blockage -> non-tender eyelid swelling

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13
Q

What is an entropion and mx?

A

Eyelids turn inwards with the lashes against the eyeball
-> corneal damage + ulceration

Mx:
Tape eyelid down + lubricating drops

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14
Q

What is an ectropion?

A

Eyelid turns outwards with inner aspect of eyelid exposed
-> exposure keratopathy

Mx:
Lubricating drops

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15
Q

What is trichiasis and mx?

A

Inward growth of eyelashes -> corneal damage + ulceration

Mx - Epilation, laser mx

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16
Q

Who gets cataracts?

A

Rx – elderly, smoking, alcohol, diabetes, steroids, hypocalcaemia
- Can also occur in children (congenital)

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17
Q

Px of cataracts?

A
  • Reduced acuity, progressive blurring, change of colour vision
  • Loss of red reflex
  • ‘Halos’ around lights
  • Gradual visual loss
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18
Q

Px of central retinal artery and vein occlusion?

A

Both - Sudden, painless unilateral loss of vision, RAPD

Amaurosis fugax – branch retinal artery occlusion
o “Black curtains coming down” – lasts a few minutes

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19
Q

What would be seen on fundoscopy of central retinal artery occlusion and central retinal vein occlusion?

A

Artery occlusion (light) - pale retina (due to lack of blood flow & oedema) with a cherry-red spot

Vein occlusion (dark) - Flame and blot haemorrhages, optic disc oedema, macular oedema

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20
Q

Mx of central retinal artery occlusion?

A

Refer to ophthalmology - immediate mx:
o Ocular massage
o Increase blood oxygen content and dilate renal arteries -> Sublingual isosorbide dinitrate and inhaled carbogen
o Reduce ocular pressure ->IV acetazolamide and mannitol

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21
Q

Mx of central retinal vein occlusion?

A

Mx – treat macular oedema + prevent neovascularisation
- Laser photocoagulation
- Intravitreal steroids
- Anti-VEGF

22
Q

Difference in px between peri-orbital and orbital cellulitis?

A

Painful eye movements, blurred vision and altered colour vision in orbital cellulitis

Peri-orbital cellulitis - Eyelid and skin infection in front of the orbital septum
Orbital cellulitis - Infection around the eyeball that involves tissues behind the orbital septum

23
Q

Chlamydia and gonorrhoea conjunctivitis px:

A

Chlamydia conjunctivitis:
- Chronic low-grade irritation and mucous discharge, often unilateral
- Follicles “grains of rice” on lower eyelid

Gonorrhoea conjunctivitis:
- Rapid with copious discharge, eyelid swelling & tender lymphadenopathy

24
Q

Rx of different conjunctivitis?

A

Bacterial -> Keratitis

Viral -> Keratoconjunctivitis

Gonorrhoea -> Corneal ulceration

25
Q

Mx of bacterial conjunctivitis?

A

Self-limiting

If severe -> chloramphenicol drops or fusidic acid

26
Q

Mx of contact lens conjunctivitis?

A

Contact lens conjunctivitis -> stop contacts + antibiotics against gm -ve (gentamicin or levofloxacin)

27
Q

Px of allergic conjunctivitis?

A

Bilateral ocular itching +/- watery discharge, conjunctival redness & swelling

  • Hx of rhinitis, asthma urticaria, eczema
28
Q

Mx of allergic conjunctivitis?

A

Mx:
1. Avoidance of allergens, eye care
2. Topical antihistamine or mast cell stabiliser / topical antihistamine
3. Adjuvant – Topical ocular diclofenac

29
Q

What is uveitis?

A

Inflammation of the uveal tract (iris, ciliary body and choroid)

30
Q

Uveitis px:

A

Red painful eye, blurred vision, eye watering, photophobia
- Deep aching pain
- 20-50 years
- Can be acute or chronic
- Hypopyon – exudate in front of iris

31
Q

Types of uveitis?

A

Anterior uveitis – anterior segment of eye (iris & ciliary body) inflammation (90% of cases)

Intermediate uveitis – vitreous inflammation

Posterior uveitis – retina and choroid inflammation

Panuveitis – inflammation in the anterior chamber, vitreous and retina or choroid

32
Q

Causes of uveitis?

A

Autoimmune (HLA-B27) [ankylosing spondylitis]

Infective – herpes simplex, hzv, cytomegalovirus, toxoplasmosis

Traumatic, neoplasia (rare)

33
Q

Non-infectious uveitis mx:

A

Corticosteroids to reduce inflammation

Mydriatic to paralyse ciliary body (cyclopentolate or atropine)

34
Q

Difference in px between episcleritis and scleritis?

A

Episcleritis - normal vision, 50% are bilateral

Scleritis - reduced visual acuity + severe pain

35
Q

Mx of episcleritis?

A

Lubricant + NSAIDs

36
Q

Mx of scleritis?

A

Emergency as life threatening

Oral NSAIDs + steroids

37
Q

Ix for keratitis?

A

Fluorescein
Viral -> dendritic corneal ulcer
Bacterial - > corneal ulcer + hypopyon

38
Q

Mx for keratitis?

A

Viral -> refer to ophthalmology, acyclovir
Bacterial -> topical antibiotics (oxaflocin)

39
Q

Px of keratitis?

A

Inflammation of the cornea
Px - Painful red eye, photophobia, vesicles around eye, foreign body sensation, watery eye, acute visual loss

40
Q

Px of optic neuritis?

A
  • Partial or total unilateral visual loss over a few days
  • Pain behind eye, worse on movement
  • Poor colour discrimination
  • Pale and swollen optic disc on fundoscopy
  • RAPD, central scotoma
41
Q

Mx of optic neuritis?

A

High dose oral steroids (IV methylprednisolone)

42
Q

Px of age-related macular degeneration?

A
  • Gradual worsening central visual field loss (scotoma)
  • Reduced visual acuity
  • Distortion of vision where straight lines appear wavy (metamorphopsia)
43
Q

Fundoscopy of age-related macular degeneration?

A

Drusen - Yellow deposits under the retina made of lipids

44
Q

Types of age-related macular degeneration?

A
  • Dry (90% – gradual) – drusen + macular atrophy
  • Wet (10% – subacute) – new vessels growing -> leakage of fluid and blood -> oedema
45
Q

Mx of wet age-related macular degeneration?

A

Intra-vitreal anti-VEGF (ranibizumab)

46
Q

Fundoscopy of diabetic retinopathy?

A
  • Microaneurysms -> Blot haemorrhages
  • Exudate (cotton wool spots)
  • New blood vessel growth
  • Oedema
47
Q

How is diabetic retinopathy classed?

A

Is it proliferative? (is there new vessel growth?)

Is there maculopathy? (is the macula thickened?)

48
Q

Complications of diabetic retinopathy?

A
  • Retinal detachment
  • Vitreous haemorrhage
  • Optic neuropathy
  • Glaucoma
  • Cataracts
49
Q

Px of retinal detachment?

A

Sudden onset, painless progressive visual field loss, floaters, recurrent flashes, and progressive visual loss

50
Q

Mx of diabetic retinopathy?

A

Laser photocoagulation
Anti-VEGF (ranibizumab)
Vitreoretinal surgery

51
Q

Keith Wagner classification of hypertensive retinopathy?

A

Stage:
I Arteriolar narrowing
II Arteriovenous nipping
III Retinal haemorrhages, exudates, cotton wool spots
IV Papilloedema

52
Q

Visual field loss types:

A

Optic nerve defect – Monocular vision loss

Optic chiasm defect – bitemporal hemianopia

Optic tract defect or occipital cortex (macula spared) – Homonymous hemianopia

Finals HH (21 decks)

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