opthamology Flashcards
Localised headache, neck pain, and neurological signs (small pupil + droopy eyelid) are indicative of _________
coronary artery dissection
Horner’s sign
The presence of painful eye movements and visual disturbance (‘seeing double’ referring to diplopia) in the context of a red, swollen, tender eye = ? Tx?
orbital cellulitis
Urgent IV cefotaximr
how to differential orbital cellulitis and preseptal cellulitis?
Preseptal: no pain on eye movements, no proptosis, no diplopia, no vision impairment
Contact lens wearers who present with a red painful eye:
should be referred to eye casualty to exclude microbial keratitis
Photophobia, reduced visual acuity and increased lacrimation are all seen in microbial keratitis, as are dilated conjunctival and episcleral vessels and eyelid oedema
how to differentiate:
- microbial keratitis
- bacterial conjunctivitis
- herpetic kertatitis
- allergic conjunctivitis
- episcleritis
- microbial and herpetic keratitis: need slit-lap to differentiate. Unilateral red, painful eye with photophobia, reduced visual acuity, increased lacrimation + dilated conjunctival and episcleral vessels, eyelid oedema.
- bacterial conjunctivitis: more of a gritty foreign body sensation than pain, not associated with photophobia or reduced visual acuity
- allergic conjunctivitis: bilateral, no photophoba or reduced visual acuity
- episcleritis: segmental redness, lacrimation and photophibia present but painless and does not affect visual acuity
blurred vision (caused by turbidity of the aqueous), photophobia and miosis (caused by ciliary muscle spasm) and pain (caused by ciliary muscle spasm and or raised intraocular pressures) –> ?
anterior uveitis
Following panretinal laser photocoagulation up to 50% of patients have________________________
a noticeable reduction in their visual field
Those with a positive family history of glaucoma should be screened annually from age_________________
40 years
Flashes + floaters are most commonly caused by ____________________
a posterior vitreous detachment
retinal detachment would present with
sudden visual loss, often as a ‘veil’ covering the visual field
__________ is a cause of red eye that is classically painful and may be associated with reduced visual acuity and blurred vision
scleritis
how to differentiate scelirits and anterior uveitis?
scleritis: PMHx of SLE, painful, deep red injected eye, vessels immobile and eye tender. Visual acuity can be intact.
AU: pain is worse when using eye, ciliary flush (ring of red spreading outwards), hypopyon (pus in anterior chamber), pupil small and irregular due to irregular sphincter muscle contraction
__________________ - sudden painless loss of vision, severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
RF for acute angle-closure glaucoma?
hypermetropia
tx for acute angle-closure glaucoma
STAMP: supine, timolol (decreases aq production), acetazolamide (reduces aq secretions), pilocarpine (parasympathoimetic, opens trabecular meshwork by causing ciliary muscle contraction)
Tx for age-related macular degeneration
- Zinc, with anti-oxidant vitamins A,C,E
- anti-vascular endothelial growth factors (ranibizumab)
- laster photocoagulation (but risk of acute visual loss after treatment)
risks of cataract surgery
- Posterior capsule opacification: thickening of the lens capsule
- Retinal detachment
- Posterior capsule rupture
- Endophthalmitis: inflammation of aqueous and/or vitreous humour
central retinal vein occlusion vs branch retinal vein occlusion
BRVO results in a more limited area of the fundus being affected
Ix for corneal abrasion
fluorescein staining
what corneal ulcer is specifically associated with contact lens use
Acanthamoeba keratitis
Diabetic retinopathy with severe vitreous haemorrhage - Tx?
vitreoretinal surgery
what can be used to distinguish episcleritis from scleritis?
phenyleprhine
what is Herpes zoster ophthalmicus
reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve
what is Hutchinson’s sign
rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement in herpes zoster opthalmicus
what is holmes adie pupil? what is it associated with?
dilated pupil that remains constricted for a long time, slowly reactive to accommodation but very poorly to light
absent ankle/knee reflexes
Causes and presentations of Horner’s syndrome
stages of Hypertensive retinopathy
1: arteriolar narrowing, tortuosity, increased light reflex (silver wiring)
2: arteriovenous nipping
3: cotton-wool exudates, flames, blot haemorrhages [‘macular star’]
4: papilloedema
bacterial causes of keratitis - most common over all, most common in contact lens wearers
- staph aureus
- pseudomonas aeruginosa
if someone has keratitis Sx on a background of swimming in dirty water suspect
amoebic keratitis, exquisitely painful
hypopyon is seen in
- anterior uveitis
- keratitis
most common cause of a persistent watery eye in an infant
Nasolacrimal duct obstruction
eye pain and swelling + proptosis + ‘rock hard’ eyelids + RAPD esp after trauma =
oribtal compartment syndrome!!
Urgent lateral canthotomy required to decompress orbit
poor discrimination of colours can occur in
- catarcts
- optic neuritis (red desaturation)
pain on eye movement can occur in
- optic neuritis
- scleritis
- orbital cellulitis
gold standard Ix for optic neuritis
MRI of brain and orbits with contrast
who is at risk of developing posterior vitreous haemorrhage earlier in life?
myopic people
HELLP for acute loss of vision
Headache - GCA
Eye movements are painful - optic neuritis
Lights/flashes - retinal detachment
Like a curtain - RAO
Poorly controlled DM - vitreous haemorrhage
abx for suspected orbital cellulitis
IV o-amoxiclav
Ix for orbital cellulitis
CT with contrast
1st line Tx for pts with open-angle galucoma
360 degree selective laser trabeculoplasty
medications used to treat open-angle glaucoma
1st line: prostaglandin analogue like latanoprost (increases uveoscleral outflow) [SE: brown pigmentation of irish]
- bblocker like timolo reduces aq production
- alpha2 adrenoreceptor agonist like briminodine - reduces aq production
- carbonic anhydrase inhibitor like acetozolamide - reduces aq production
- miotics like pilocarpine - increases uveoscleral outflow
small fixed oval pupil with ciliary flush (red eye) =
anterior uveitis
causes of RAPD
retinal detachment, optic neuritis
scleritis Tx
- same day assessment by opthamologist
- oral NSAIDs
what is amblyopia
the brain fails to fully process inputs from one eye and over time favours the other eye - SE of squint
how to detect a squint?
corneal light reflection test - holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils
[primary open angle glaucoma Tx] First-line treatment in a patient with a history of heart block
latanoprost
primary open angle glaucoma Tx
- to increase uveosleral outflow: prostaglandin analogue [lantanoprost], miotics [pilocarpine]
- to reduce aqueous production: bblocker (timolol), carbonic anhydrase inhibitor (acetazolamide), briminodine
avoid briminodine if taking MAOI/TCA
