Opthamology Flashcards
What is the management of bacterial conjunctivitis?
Topical Abx. (Chloramphenicol)
Give 3 common bacteria associated with bacterial conjunctivitis?
Staph. Epidermidis
Staph. Aureus
Strep. Pneumoniae
Haem. Influenzae
Give 3 pieces of advice you would give a patient with bacterial conjunctivitis?
Follow up if condition worsens/persists Frequent hand washing Min. touching of eyes Don't share towels Avoid shaking hands
What is the management of allergic conjunctivitis?
1) Artificial tears
2) Mast cell stabiliser (sodium cromoglicate)
3) Mild topical steroid
What are the layers of the cornea?
Epithelium Basement membrane Bowmans layer Stroma Dua layer Descemet membrane Endothelium
Give 5 possible presentations of cataract?
Reduced visual acuity Glare in bright light Distortion of lines Altered colours Monocular diplopia
State 2 ways you can manage cataracts?
Glasses prescription
Surgery (phacoemulsification)
Describe the path of aqueous humor in the eyeball?
Cilliary body -> Pupil -> Trabecular meshwork -> Canal of schlemm
State 4 types of drugs that can be used in glaucoma and say what their mechanism of action is?
Prostaglandin analogues - increase uveoscleral drainage of aqueos humor
Beta blockers - decrease humor production
Alpha adrenergic agonists - reduce production and increase outflow
Carbonic anhydrase inhibitors - decrease production
Which 4 parameters/symptoms are used in the screening of open angle glaucoma?
Increased Intraocular pressure (IOP)
Visual field loss
Optic disc appearance (disc cupping)
Open anterior chamber
Name 3 sight threatening causes of red eye?
Acute angle closure glaucoma
Corneal ulcer/abscess
Penetrating eye injury
Name 4 high risk factors for open angle glaucoma?
> 35yrs with +ve family history
African-Caribbean
Myopia
Diabetic/Thyroid eye disease
What are the pathological changes seen in diabetic retinopathy? 5 things
Microaneurysms Exudates Haemorrhages Ischaemia (cotton wool spots) New vessel growth (proliferative)
What 3 systemic conditions can scleritis be associated with?
Wegener’s granulomatosis
Rheumatoid arthritis
SLE
Describe the diff. types of diabetic retinopathy severities?
Background - microaneurysms and exudates
Pre-proliferative - ischaemic changes (cotton wool)
Maculopathy - damage to the macula (oedema at macula, haemorrhages)
Proliferative - new fragile vessel growth
Advanced proliferative - retinal detachment/glaucoma
Name 3 methods of treatment for diabetic retinopathy and describe them?
Medical - Glycaemic control, BP control, Control associated conditions
Laser - Photocoagulation
Surgery - Vitrectomy (removal of vitreous)
Give 4 possible presentations of retinal detachment?
Fall in visual acuity
Flashes (flashing lights = photpsia)
Floaters (small haemorrhages)
Field loss
Give 3 risk factors for developing age related macula degeneration?
Genetic predisposition
Cigarette smoking
Associated with vascular disease, hypertension and light exposure
In fundoscopy, what is dry ARMD characterised by? 3 things
Soft drusen (small yellow deposits)
Pigment clumping
Macular atrophy
How might you clinically differentiate between wet and dry ARMD?
Wet = Sudden loss/distortion of vision Dry = Gradual loss of vision over years
Describe 2 surgical options for managing open angle glaucoma?
Laser surgery - target trabecular network hence lowering IOP
Trabeculectomy - creates opening in anterior angle for drainage
Give 6 clinical features suggestive of acute angle closure glaucoma?
Ocular pain
Nausea/vomiting
Intermittent blurring of vision
IOP greater than 30 mm Hg
Mid-dilated non-reactive pupil
Loss of red reflex
Which group of patients are likely to suffer from acute angle closure glaucoma?
Hypermetropic patients
Suggest 4 visual problems that diabetes can cause?
Diabetic retinopathy
Cataract
Retinal vascular occlusions
Extraocular muscle palsy
Name 2 conditions that might cause retinopathy?
Hypertension
Diabetes
What is a dendtritic ulcer and how is it treated?
Ulcer caused by herpes simplex virus
Treat with topical acyclovir ointment
Aside from trauma identify 3 other types of retinal detachment and explain pathology for each?
Tractional - retina pulled off by membranes growing across its surface
Exudative - break down of blood retinal barrier allowing fluid to accumulate in subretinal space
Rhegmatogenous - degenerative changes in neurosensory retina creating a hole allowing vitreous fluid to pass in subretinal space
What is the clinical difference between episcleritis and scleritis?
Scleritis is associated with pain
Give 4 main symptoms of retinitis pigmentosa?
Night blindness (nyctalopia)
Decreased peripheral vision
Decreased central vision
Glare (from cataract)
Give 4 ways of managing ARMD?
High dose antioxidant vitamins
Possible registration of visually impaired
Laser therapy for wet ARMD
Anti VEGF drugs for wet ARMD
What two tests can you perfom to diagnose squints?
Corneal reflection
Cover test
How can you tell the difference between manifest squint and latent squint?
Latent squint: Remove covered eye and it will move to fixate
Manifest: Cover normal eye and squint eye will move to take up fixation
What 3 ways can you manage a squint?
Optical: Assess refractive state and provide glasses
Orthoptic: Patching good eye
Operation: Resection of rectus muscles
Give 3 ways you can manage acute closed angle glaucoma?
Pilocarpine + Acetazolamide
Analgesia
Antiemetic
Peripheral iridectomy
State 4 clinical features seen in anterior uveitis?
Pain Photophobia Low acuity Lacrimation Small pupil
What 2 tests/investigations can you perform to diagnose anterior uveitis?
Talbot test (pain increases on convergence of eyes) Slit lamp (pus in anterior chamber)
How might you treat anterior uveitis?
Prednisolone drops
Keep pupil dilated with cyclopentolate
State 3 causes of sudden painless loss of vision?
Vitreous haemorrhage Optic neuritis Central retinal artery occlusion Retinal vein occlusion Anterior ischaemic optic neuropathy
Give 3 ways retinal artery occlusion can be treated?
Ocular massage
Surgical removal of aqueous
Antihypertensives
How does the appearance of the retina differ in arterial and venous occlusions?
Artery: Pale with cherry red (macula) spot
Vein: Hyperaemia and haemorrhages (stormy sunset appearance)
