opthamology Flashcards
How do you differentiate posterior vitreous detachment, retinal detachement and vitreous haemorrhage?
Posterior vitreous detachment:
Flashes of light/ floaters in peripheral vision. no visual loss
Fundoscopy- Weiss ring
visualacuity normal
No emergency mx - will settle by self
Retinal detachment:
flashers and floaters –> visual loss
A veil over the field of vision
Straight lines appear curved.
Shadow in peripheray, progressing towards middle (as retina peels off orbit)
visual field loss.
Fundoscopy - retinal tear/ retina billowing forwards, ‘tobacco dust’ in anterior chamber
Vitreous haemorrhage:
Large bleeds cause sudden visual loss + loss of red reflex
Moderate bleeds may be described as numerous dark spots.
Small bleeds may cause floaters.
Occurs when blood leaks into the vitreous humour from damaged blood vessels in conditions such as diabetic retinopathy or retinal tears or from anti-cogulants/ bleeding disorders.
Mx with photocoagulation to make new blood vessels
How do you differentiate central retinal vein occlusion from central retinal arterial occlusion?
Both cause painless visual loss
Retinal vein: more common, with age, can be caused by glaucoma, hypertension, CVD RF, polycythaemia.
Starts subtle then progresses to full loss
in non-ischaemic get optic disc swelling, and multiple flame-shaped and blot haemorrhages may be seen. “stormy sunset” appearance
in ischaemic get afferent pupilary defect, cotton wool spots, severe oedema, scattered haemorrhages
occurs when there is a blockage in the central retinal vein, leading to impaired venous drainage from the retina. This results in increased pressure within the blood vessels, causing them to leak blood and fluid into the surrounding tissues.
Retinal arterial: SUDDEN blindness. Cherry spot on pale retina on fundoscopy, afferent pupillary defect, will have CVD RF - which will need addressing as will be at risk of stroke
When blood vessel is affected in ischaemic optic neuropathy?
due to occlusion of the short posterior ciliary arteries, causing damage to the optic nerve
Anterior uveitis vs acute closed angle glacuoma signs and sx?
Acute closed-angle glaucoma:
sudden unilateral eye pain and visual loss.
Haloes around lights.
Poor vision in dark.
headache.
erythematous globe with a fixed and DILATED pupil with a hazy cornea.
Can be brought on my mydriatic activity eg drops/ watching TV
Anterior uveitis (AKA iritis):
painful red eye with photophobia.
hypopyon
ciliary flush
posterior synechiae - pupil sticks to lens (irregular and dilates poorly)
+ve talbot test (pain on accomdation)
Vairable visual loss.
CONSTRICTED pupil.
HLA-B27/ autoimmune association
Mx with steroid eye drops and topical cycloplegics (for pain relief)
What is keratitis?
microbial invasion of the cornea causing eye redness, gritty foreign sensation, pain, photophobia, increased lacrimation, corenal haziness, and eyelid oedema.
signs of infection - conjunctivitis and infection
can get hypopyon if severe
Can lead to corneal ulcer
most commonly caused by pseudomonas aeruginosa
RF: trauma and contact lens
Emergency - topical antibiotic eye drop/ PO abx if bad
What is retinitis pigmentosa? What do u see on fundoscopy?
inherited retinal disorders
Cause progressive degeneration of the retina, leading to night blindness and peripheral vision loss (tunnel vision)
fundoscopy shows black bone spicule-shaped pigmentation in the peripheral retina and mottling of the retinal pigment epithelium
What does fundoscopy for diabetic retinopathy show?
Usually slow onset visual loss.
Fundoscopy shows microaneurysms, dot and blot haemorrhages, hard exudates, and cotton wool spots (retinal arterial obstrution causing ischaemia)
What is Argyll-Robertson pupil
small, irregular pupils
no response to light but there is a response to accommodate
Associated with neurosyphilis but most common cause in UK is DM
What is a stye vs chalazion vs blepharitis?
stye (hordeolum externum): infection of the glands of the eyelids. PAINFUL
A chalazion (Meibomian cyst) is a retention cyst of the Meibomian gland. PAINL\ESS lump normally the internal eyelid.
blepharitis: inflammation of the eyelid margins typically leading to a red eye, causing dry + irritated + watery eye
How do you manage a stye?
management includes hot compresses and analgesia. CKS only recommend topical antibiotics if there is an associated conjunctivitis
What is a holmes- adie pupil?
Tonically dilated pupil, slowly reactive to light with more definite accommodation response. Caused by damage to parasympathetic innervation of the eye due to viral or bacterial infection. Commonly seen in females, accompanied by absent knee or ankle jerks.
80& time is unilateral
What is a marcus-gunn pupil?
AKA Relative afferent pupillary defect, seen during the swinging light examination of pupil response. The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye. Most commonly caused by damage to the optic nerve or severe retinal disease.
What is horners syndrome?
Miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating) occurring on one side. Caused by damage to the sympathetic trunk on the same side as the symptoms, due to trauma, compression, infection, ischaemia or many others.
What is hutchinsons sign?
Unilaterally dilated pupil which is unresponsive to light. A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)
What is open-angle glaucoma ? How does it present? RF? findings on exam?
Glaucoma = raised intraocular pressure (>21 mmhg)
Open angle = peripheral iris is NOT covering trabecular meshwork –> aqueous humor can drain
RF: age, fhx, myopia, HTN, DM, steroids
Presentation: insidious, peripoheral visual field loss (nasal scotoma), decreased acuity
Fundoscopy:
1. Optic disc cupping - cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen and deepen
2. Optic disc pallor - indicating optic atrophy
3. Bayonetting of vessels - vessels have breaks as they disappear into the deep cup and re-appear at the base
4. Additional features - Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
How does dry vs wet age related macular degeneration present?
BOTH: blurred central vision and poor vision at night. Patients often complain that straight lines become curved. Can get charles-bonnet syndrome
Dry: Drusen (small accumulations of extracellular material between Bruch’s membrane and the retinal pigment epithelium of the eye,) on opthalmoscopy, comes on gradual
Nothing can be done for this
wet: faster, choroidal neovascularisation on opthalmoscopy
anti-VGEF injections for wet ARMD - urgent referral to opthamology needed
How does hypertensive retinopathy present sx + signs with diff stages?
Hypertensive retinopathy is often asymptomatic but can present with reduced acuity.
Stage 1: Mild narrowing of the arterioles + silver wiring
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema
First they start to twist and turn [silver wiring], then they nip about the place [AV nipping], afterwards they play with cotton wool and fire [cotton wool spots, flame and blot haemorrhages], finally they swell up [papilloedema].
How do cataracts present?
Cataracts are often asymptomatic if they aren’t in the visual axis. If they do present with symptoms it is generally a loss of vision with problems such as haloes due to light scattering. A peripheral cataract can easily be visualised on slit lamp examination, and there would be no optic disc involvement. red reflex lost
better vision with pinhole test
Describe chorioretinitis and its fundoscopy appearance
Infection/ autoimmune disease leads to inflammation of chroid and retina
COMMONLY caused by CMV so need to check for underlying HIV
Causes blurred vision, loss and floaters.
Pizza pie appearance on fundoscope - retinal spots (superficial retinal infarction + flame-shaped haemorrhages
Describe endophthalmitis?
inflammation of the intraocular fluids (vitreous and aqueous) usually post op
Sx: Red eye, pain and visual loss following intraocular surgery are red flags for endophthalmitis - need urgent ophthalmic review
entropion vs ectropion?
entropion: in-turning of the eyelids
ectropion: out-turning of the eyelids
Mx of acute glaucoma
Administer pilocarpine, timolol, and brimonidine eye drops
definitive mx = laser peripheral iridotomy
What anaesthetic eye drops should you give for a corneal ulcer?
Prescribing anaesthetic eye drops for patients with corneal ulcer is not advisable as it may cause more harm- delays healing of the ulcer
Mx of anterior uveitis?
steroid + cycloplegic (mydriatic) drops
What is the most common long term complication of cataract surgery?
Posterior capsule opacification often happens years after cataract surgery and is often the most common cause of blurring of vision years after cataract surgery. Once a cataract surgery is done, it is impossible to get a recurrence of cataract because the lens has already been replaced with an artificial lens.
What are the stages of diabetic retinopathy?
Background – microaneurysms, retinal haemorrhages, hard exudates and cotton wool spots
Pre-proliferative – venous beading, multiple blot haemorrhages and intraretinal microvascular abnormality (IMRA)
Proliferative – neovascularisation (most important - is why is proliferative) and vitreous haemorrhage, Rubeosis iridis → secondary glaucoma
What is first line for primary open angle glaucoma?
Latanoprost (PG analogue)
How do you treat herpes zoster opthamalicus vs herpes zoster opticus vs herpes simplex keratitis? What are they associated with/ also known as?
Herpes zoster Ophthalmicus-Oral aciclovir + topical steroid, caused by VZV affecting trigeminal nerve
herpes zoster opticus is ramsay hunt –> give PO aciclovir AND PO steroids
Herpes simplex keraTiTis- Topical aciclovir
This is also called a dendritic ulcer
what is Diabetic maculopathy
Diabetic maculopathy describes any structural abnormality due to diabetes affecting the macula
Mx of proliferative diabetic retinopathy?
laser photcoagulation
mydiriaosis vs miosis
mydriatic - dilated
miotic - constriction
esotropia (covergent) vs exotropia (divergent)
esophoria vs exophoria
exo = out
eso = in
tropia = deviation present all the time
phoria =deviation present from time to time
