Opthamology Flashcards
What is blepharitis?
inflammation of the eyelid margins. It may due to either meibomian gland dysfunction (common, posterior blepharitis) or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis
What is lantoprost?
Prostaglandin analog used in glaucoma. It works by increasing uveoscleral outflow
Symptoms of carotid artery dissection?
localised headache, neck pain and Horner’s syndrome
When distinguishing between cause of horners what are the different lesions and what relation do they have to anhidrosis?
Central lesion- anhidrosis of the face, arm and trunk
Pre-ganglionic- Anhidrosis of the face
Post-ganglionic- No anhidrosis
What is Adie’s tonic pupil?
cause of ciliary ganglion dysfunction. This would cause a dilated pupil and the anisocoria would be greater in bright light.
Adverse effects of prostaglandin analogues?
brown pigmentation of the iris, increased eyelash length
Risk factors for retinal detachment?
diabetes mellitus- occurs as a result of breaks in the retina due to traction by the vitreous humour. These tears may proceed to detachment if left untreated
myopia
age
previous surgery for cataracts (accelerates posterior vitreous detachment)
eye trauma e.g. boxing
What is tabes dorsalis?
slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain.
What is scleritis?
full-thickness inflammation of the sclera. It generally has a non-infective cause and typically causes a red, painful eye
Features of scleritis?
red eye
classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present
watering and photophobia are common
gradual decrease in vision
Management of infective conjunctivitis
Topical antibiotic therapy- Chlorampenicol
Central retinal vein occlusion vs branch retinal vein occlusion?
Branch- Confined to limited area of retina
Central- Severe retinal haemorrhages throughout
Features of central retinal vein occlusiom?
sudden, painless reduction or loss of visual acuity, usually unilaterally
fundoscopy: widespread hyperaemia and severe retinal haemorrhages - ‘stormy sunset’
What is the mode of action of beta blockers?
Reduces aqueous production
Risk factors for retinal detachment?
diabetes mellitus- occurs as a result of breaks in the retina due to traction by the vitreous humour. These tears may proceed to detachment if left untreated
myopia
age
previous surgery for cataracts (accelerates posterior vitreous detachment)
eye trauma e.g. boxing
What is Argyll-Robertson pupil?
Bilaterally small pupils that accommodate but don’t react to bright light. Causes include neurosyphilis and diabetes mellitus
Mneumonic: Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
The most common causes of a sudden painless loss of vision are as follows:
ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine
Features of optic neuritis?
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma
Presentation of orbital cellulitis?
Redness and swelling around the eye
Severe ocular pain
Visual disturbance
Proptosis
Ophthalmoplegia/pain with eye movements
Eyelid oedema and ptosis
Drowsiness +/- Nausea/vomiting in meningeal involvement (Rare)
In acute angle-closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow. Factors predisposing to AACG include:
hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age
What does intravenous acetazolamide do?
reduces aqueous secretions
What is laser peripheral iridotomy
Creates a tiny hole in the peripheral iris → aqueous humour flowing to the angle
What is central scotoma?
area of depressed vision that corresponds with the point of fixation and interferes with central vision. It suggests a lesion between the optic nerve head and the chiasm
What is Hutchison’s sign?
rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement
What is a memobian cyst?
Retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously but some require surgical drainage
most common cause of bacterial keratitis in contact lens wearers?
Pseudomonas aeruginosa
What are some complications following cataract surgery?
Posterior capsule opacification: thickening of the lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis: inflammation of aqueous and/or vitreous humour
What is Holmes-Adie?
benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.
What is Holmes-Adie syndrome?
association of Holmes-Adie pupil with absent ankle/knee reflexes
What is ambylopia?
Lazy eye
Complications of scleritis?
glaucoma
Cataracts
Raised intraocular pressure
Retinal detachment
Uveitis
Perforation of the globe
What is drusen?
Yellow round spots in Bruch’s membrane
What does a posterior vitrous detachment look like?
Flashes of light (photopsia) - in the peripheral field of vision
Floaters, often on the temporal side of the central vision
What does retinal detachment look like?
Dense shadow that starts peripherally progresses towards the central vision
A veil or curtain over the field of vision
Straight lines appear curved
Central visual loss
What does a vitreous haemorrhage look like?
Large bleeds cause sudden visual loss
Moderate bleeds may be described as numerous dark spots
Small bleeds may cause floaters
What are featues of a central retinal artery occlusion?
sudden, painless unilateral visual loss
relative afferent pupillary defect
‘cherry red’ spot on a pale retina
Signs of acute angle closure glaucoma?
severe pain (may be ocular or headache)
decreased visual acuity, patient sees haloes
semi-dilated pupil
hazy cornea
Signs of anterior uveitis?
acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush
What is scleritis?
severe pain (may be worse on movement) and tenderness
may be underlying autoimmune disease e.g. rheumatoid arthritis
What is conjunctivitis?
purulent discharge if bacterial, clear discharge if viral
What is dry macular degeneration characterised by?
drusen - yellow round spots in Bruch’s membrane
Difference between the vessels in scleritis and episcleritis?
In episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera. In scleritis, vessels are deeper, hence do not move
Causes of papilloedema
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
Investigations for age related macular degeneration?
slit-lamp microscopy is the initial investigation of choice, to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD. This is usually accompanied by colour fundus photography to provide a baseline against which changes can be identified over time.
fluorescein angiography is utilised if neovascular ARMD is suspected, as this can guide intervention with anti-VEGF therapy. This may be complemented with indocyanine green angiography to visualise any changes in the choroidal circulation.
ocular coherence tomography is used to visualise the retina in three dimensions because it can reveal areas of disease which aren’t visible using microscopy alone.
Mangement of anterior uveitits?
urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate
steroid eye drops
Screening for positive FH of glaucoma?
From age 40
treatment of dry ARMD
ombination of zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by around one third. Patients with more extensive drusen seemed to benefit most from the intervention. Treatment is therefore recommended in patients with at least moderate category dry ARMD
Features of acute angle-closure glaucoma?
severe pain: may be ocular or headache
decreased visual acuity
symptoms worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil
corneal oedema results in dull or hazy cornea
systemic upset may be seen, such as nausea and vomiting and even abdominal pain
What do cotton wool spots represent?
Areas of retinal infarction
Optic neuritis symptoms mneumonic?
Central scotoma
Reduced red vision
Acuity (reduced)
Painful eye movement
What is retinitis pigmentosa?
primarily affects the peripheral retina resulting in tunnel vision
Features of retinitis pigmentosa?
night blindness is often the initial sign
tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
Which is more acute wet or dry AMD?
Wet
Signs and symptoms of anterior uveitis?
acute onset
pain
blurred vision and photophobia
small, fixed oval pupil, ciliary flush
What is dorzolamid?
Carbonic anhydrase inhibitor which reduces aqueous production
What is endolamphtisi?
typically red eye, pain and visual loss following intraocular surgery
What is amaurosis fugax
ischaemic optic neuropathy is due to occlusion of the short posterior ciliary arteries, causing damage to the optic nerve
POAG may present insidiously and for this reason is often detected during routine optometry appointments. Features may include
peripheral visual field loss - nasal scotomas progressing to ‘tunnel vision’
decreased visual acuity
optic disc cupping
Diagnostic invesigation for optic neuritis?
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases
Investigations for acute angle closure glaucoma?
tonometry to assess for elevated IOP
gonioscopy (literally looking, oscopy, at the angle, gonio): a special lens for the slit lamp that allows visualisation of the angle
What is gonioscopy?
special lens on the slit lamp which allows visualisation of the anterior chamber angle. This can highlight any blockages that may have resulted in this increasing rise in pressure
Keith Wagner classification of hypertensive retinopathy?
Absolute contraindications to laproscopy?
haemodynamic instability/shock
raised intracranial pressure
acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)
uncorrected coagulopathy
What does a venous duplex US show?
demonstrate retrograde venous flow
Symptoms of posterior vitreous detachment?
The sudden appearance of floaters (occasionally a ring of floaters temporal to central vision)
Flashes of light in vision
Blurred vision
Cobweb across vision
The appearance of a dark curtain descending down vision (means that there is also retinal detachment)
