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IPE > Opthamology > Flashcards

Opthamology Flashcards

1
Q

How are Snellen charts interpreted?

A
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2
Q

Name some causes of papilloedema

A
  • Intracranial Space-Occupying Lesion
  • Encephalitis
  • Optic neuritis
  • Benign intracranial hypertension
  • Malignant hypertension
  • Ischaemic optic neuropathy
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3
Q

Label this retina

A
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4
Q

Label this eye

A
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5
Q

Name some causes of ptosis

A

Neurological:

  • Oculomotor nerve palsy (dilated pupil)
  • Horner’s syndrome (constricted pupil)

Muscular/mechanical:

  • Old age (changes in levator muscle)
  • Myasthenia gravis
  • Muscular dystrophy
  • Myopathy (Grave’s)
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6
Q

What is a stye?

A
  • External stye = infection of lash follicle or associated sweat/sebum gland
    • Points outwards
    • Staph aureus
  • Internal stye = abscess of a meibomian gland
    • Points inwards

Both treated with oral or topical antibiotics

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7
Q

What is a Meibomian cyst/Chalazion?

A

Blockage of the Meibomian gland, which can become infected

Treat with topical antibiotics or refer to opthalmology if recurrent (incision/curettage)

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8
Q

What is blepharitis? How does it present?

A

Chronic, low-grade inflammation of the Meibomian glands and lid margins

  • Red eyelid margins
  • Irritable, burning, dry, red eyes
  • Scales on eyelashes
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9
Q

How is blepharitis managed?

A
  • Warmth - apply hot, moist flannel to open up glands
  • Massage - press on the eyelids with a cotton bud to release the Meibomian gland secretions
  • Clean
  • Treat dry eyes with tear supplements
  • Topical antibiotics
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10
Q

What are the red flag signs of red eye?

A
  • Decrease in visual acuity
  • Pain deep in the eye (not surface)
  • Absent or sluggish pupil response
  • Corneal damage on fluorescin staining
  • History of trauma
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11
Q

How does conjunctivitis present?

A
  • Uni/bilateral red eye
  • Surface irritation
  • Eye discharge
  • Sticking of the eyelids
    • Especially on waking up
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12
Q

How is conjunctivitis managed?

A
  • Conservative
    • Bath eye with boiled, cooled water BD
    • Avoid contact lens use
    • Simple hygiene measures (hand washing)
  • If symptoms not improved in 3-5d = topical chloramphenicol qds for 5 days
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13
Q

What is keratitis? How does it present?

A

Inflammation of the cornea

  • Very painful eye
  • Blurred vision
  • Photophobia
  • Profuse watering
  • Decrease visual acuity
  • Conjunctivitis
  • Creamy-white, disc-shaped lesion
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14
Q

What is epicleritis and scleritis? What’s the difference?

A

Episcleritis = inflammation of the thin layer of vascular tissue overlying the sclera

  • Minimal tenderness
  • Usually unilateral
  • No discharge

Scleritis = inflammation of the sclera

  • Painful, red eye
  • Uni or bilateral
  • May blur vision and decrease acuity
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15
Q

How is epicleritis and scleritis treated?

A

Episcleritis:

  • NSAID
  • Opthalmology - steroids

Scleritis:

  • Steroids
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16
Q

How does iritis/anterior uveitis present?

A
  • Acute pain
    • Increases as eyes converge/pupils constrict
  • photophobia
  • Blurred vision
  • Decreased visual acuity
  • Circumcorneal redness
  • Small or irregular pupil
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17
Q

What are the major causes of blindness in the UK?

A

Elderly:

  • Macular degeneration
  • Glaucoma
  • Cataracts

Younger:

  • Diabetic retinopathy
  • Uveitis
  • Inherited retinal disease
  • Retinovascular disease
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18
Q

What are the different types of glaucoma?

A
  • Open angle/chronic (majority) = drainage of the aqueous fluid is slowed by a clogging causing increased intra-ocular pressure over a long period of time
    • Angle between iris and cornea is ‘open’ and wide
  • Closed angle/acute (emergency) = drainage becomes suddenly blocked causing a sudden rise in intra-ocular pressure which leads to loss of vision
    • Angle between iris and cornea is ‘closed’
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19
Q

Describe how to assess the eye

A
  • Visual acuity records macular (central) vision
    • Snellen chart at 6m
  • Colour vision assessment - ishihara chart
  • Examination
    • Eyelids - symmetrical, position, skin changes
    • Eye surface - use fluorescin stain if indication of corneal damage
    • Note redness
  • Opthalmoscopy
  • Visual fields (peripheral vision)
  • Eye movements (9 positions of gaze)
  • Pupils
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20
Q

Describe how to carry out fundoscopy

A
  • Darken the room
  • Check red reflex
  • Examine disc
    • Place hand on patients forehead
    • Use your right eye for patients right eye
    • Shape, colour and size of cup
  • Follow vessels to periphery
  • Examine macula by asking patient to look directly into the light
  • Examine peripheral retina by asking patient to look up and down
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21
Q

How is a squint managed? (eso/exotropia)

A

3 O’s:

  • Optical - assess refractive state
    • Exclude abnormality
    • Glasses to correct refractive error
  • Orthoptic - patching good eye
  • Operations - resection and recession of rectus muscles
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22
Q

What is refraction? Different types?

A

Disorders of size and shape of eye

  • Myopia (short sight) = eyeball too long → focus on close objects
    • Need concave spectacles or LASIK
  • Hypermetropia (long sight) = eyeball too short → focus on distant objects
    • Need convex spectacles
  • Astigmatism = cornea or lens don’t have the same degree of curvature in horizontal and vertical planes → distorted image longitudinally/vertically
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23
Q

What is acute/closed angle glaucoma?

A

Blocked flow of aqueous from anterior chamber via canal of Schlemm (imbalance between drainage and production of aqueous)

  • Intraocular pressure >/= 30mmHg (normal 15-20)
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24
Q

Symptoms of acute glaucoma

A
  • Reduced vision
    • Preceded by blurred vision or halos around lights
  • Painful, red eye
  • Corneal oedema
  • Fixed mid-dilated and oval-shaped pupil
  • Associated headache and nausea
  • Worse at night (pupil dilatation)
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25
Q

How is acute glaucoma managed?

A
  • Send to eye unit immediately for gonioscopy (view iridocorneal angle)
  • Pilocarpine 2-4% drops/2 hours
    • Miosis opens blocked channels
  • Acetazolamide 500mg IV stat
    • Decreases aqueous formation
  • Mannitol 2% IV infusion
  • Topical steroids + beta blockers
  • Peripheral iridectomy
26
Q

How is corneal abrasion identified and managed?

A
  • Identify - fluorescin drops + blue light = green lesions
  • Manage = chloramphenicol drops
27
Q

How are corneal ulcers managed?

A
  • Take appropriate smears and cultures
  • Chloramphenicol (G +ve) alternated with ofloxacin (G -ve)
    • Adapt after cultures
  • Admit if diabetes or immunosuppression
  • Add steroid drops after recovery starts
28
Q

What questions to ask with sudden painless loss of vision? What differentials do they suggest?

A

HELLP

  • Headache associated? If > 50 years do ESR → giant cell arteritis
  • Eye movements hurt? → optic neuritis
  • Lights/flashes preceding → Detached retina
  • Like a curtain descending → amaurosis fugax (emboli/GCA)
  • Poorly controlled diabetes?

Check acuity, pupil reaction anf fundi

29
Q

What is optic neuropathy? Name some causes

A

Optic nerve damaged if posterior ciliary arteries are blocked by inflammation or atheroma

  • Arteritic = giant cell arteritis
  • Non-arteritic
    • Hypertension
    • Hyperlipidaemia
    • Diabetes
    • Smoking
30
Q

What is vitreous haemorrhage

A

Haemorrhage from new retinal vessels (diabetes, central retinal vein occlusion) retinal tears, retinal detachment or trauma

  • Vitreous floaters = black dots/ring-like forms
  • Large bleed obscures red reflex and retina
  • B-scan ultrasound to identify cause
31
Q

Name some symptoms of optic neuritis?

A
  • Unilateral loss of acuity over hours or days
  • Colour vision affected
  • Eye movements hurt
  • Afferent defect in pupil (no direct constriction)
  • May have swollen optic disc
32
Q

Name some causes of optic neuritis?

A

Disc swelling due to inflammation of the myelin sheath of the optic nerve

  • Multiple sclerosis
  • Syphilis
  • Diabetes
  • Vit deficiency (B12, D)
33
Q

How is optic neuritis managed?

A
  • Methylprednisolone for 72 hours
  • Then prednisolone for 11 days
34
Q

Name some causes of transient visual loss

A
  • TIA
  • MS
  • Subacute glaucoma
  • Papilloedema
  • Migraine
  • Vascular
35
Q

Name some symptoms of central retinal artery occlusion

A
  • Unilateral visual loss in seconds
  • Acuity reduced to finger counting
  • Afferent pupil defect (no direct contraction)
  • Retina = white with cherry red spot at macula
36
Q

Name some causes of central retinal artery occlusion

A

Mainly thromboembolic

  • Hypertension
  • Smoking
  • Diabetes
  • Hyperlipidaemia
37
Q

How is central retinal artery occlusion managed?

A

If < 6 hours

  • Ocular massage
  • Surgical removal of aqueous
  • Antihypertensives
38
Q

Name some causes of central retinal vein occlusion

A
  • Arteriosclerosis
  • Hypertension
  • Diabetes
  • Polycythaemia
  • Glaucoma
39
Q

Name some causes of gradual loss of vision

A
  • Cataracts
  • Macular degeneration
  • Glaucoma
  • Diabetic retinopathy
  • Hypertension
  • Optic atrophy
40
Q

Name some risk factors for age-related macular degenerations (AMD)

A
  • Genetics
  • Smoking
  • Age
  • White
  • CVS disease
  • Hypertension
  • Hyperopia
41
Q

How does AMD present?

A
  • Elderly patients with deteriorating central vision
    • Can’t see clock face
    • Can’t see faces
  • Problems seeing straight lines - blurry or curved
  • Dimming of vision
  • Fundoscopy
    • Drusen = undigested cellular debris from degeneration of RPE (retinal pigmented epithelium) - small amounts normal
    • Pigment
    • +/- macular bleeding
42
Q

How is AMD investigated?

A
  • Visual acuity test
  • Fundoscopy/slit lamp exam
  • Amsler grid (straight lines appear wavy)
  • Fluorescin angiography - view leaking vessels
  • Optical coherence tomography
43
Q

How is AMD managed?

A
  • Antioxidants/vitamins (green leaf veg etc)
  • Intravitrael VEGF inhibitor
  • Laser photocoagulation
  • Intravitreal steroids (traimcinolone)
44
Q

How can cataracts present?

A
  • Blurred vision
  • Reduced colour sensitivty
  • Loss of stereoptosis - affects distance judgement
  • Gradual loss of vision
  • Changing refraction
  • Dazzle in sunlight
  • Monocular diplopia
45
Q

How is cataracts managed?

A
  • Convervative
    • Sunglasses
    • Mydriatic drops
  • Surgery = lens extraction via phacoemulsion (US energy) and insertion of intraocular lens
    • Antibiotic and anti-inflammatory drops for 3-6 weeks post-op
    • Change glasses
46
Q

Name some complications of cataracts surgery

A
  • Posterior capsule thickening + opacification
    • Treat with YAG laser
  • Astigmatism more noticeable
  • Endopthalmitis
  • Eye irritation
  • Vitreous haemorrhage
  • Anterior uveitis
  • Retinal detachment
47
Q

What are the risk factors for cataracts?

A
  • Genetics
  • DM
  • Steroid use
  • High myopia
  • Trauma
  • Down’s syndrome
48
Q

What pathology can the optic disc show?

A

3 Cs:

  • Colour (normally pale pink) - pale in optic atrophy
  • Contour
    • Oval in astigmatism
    • Large in myopia
    • Blurred margins in papilloedema and optic neuritis
  • Cup *normamly 1/3 of disc diamter) - wider/deeper in glaucoma
49
Q

What is retinal detachment? How does it present?

A

Fluid separates the sensory retina from the retinal pigment epithelium. 4 Fs:

  • Floaters
  • Flashes
  • Field loss
  • Fall in acuity
  • Curtain falling over vision
50
Q

Name some causes of retinal detachment

A
  • Retinal tear
    • Melanoma
    • Diabetes
  • Surgery
  • Trauma
  • Myopia
51
Q

Name risk factors for developing diabetic retinopathy

A
  • Duration of DM
  • Hyperglycaemia
  • Hypertension
  • Hyperlipidaemia
  • Nephropathy
  • Pregnancy
52
Q

Describe the fundoscopy of diabetic retinopathy

A
  • Microangiopathy → occlusion → ischaemia and new vessel formation
  • New vessels bleed → vitreous haemorrhage
  • Ischaemic nerve fibres → cotton wool spots
  • Microaneuryms → flame haemorrhages
  • Hard exudate (lipid-filled macrophages)
53
Q

How is diabetic retinopathy managed?

A
  • Primary prevention
    • Glycaemic control
    • BP control
    • Lipid lowering
  • Medical
    • Anti-VEGF injections
    • Intravitreal steroids (triamcinolone)
  • Surgical
    • Photocoagulation by laser
    • Vitreo-retinal surgery
54
Q

Signs of hypertensive retinopathy

A
  • AV nipping and crossover
  • Hard exudate
  • Macula oedema
  • Cotton wool spots
  • Flame haemorrhages
55
Q

What is chronic/open angle glaucoma? Criteria for diagnosis

A

Optic neuropathy → death of retinal ganglion cells and optic nerve axons

  • 3 or more field locations are outside noraml limits
    • Nasal and superior 1st
  • Large cup-to-disc ration (> 1/3)
  • Intra-ocular pressure may be > 21
  • Central field intact (good acuity)
56
Q

How is chronic glaucoma screened for? Who?

A

Humphrey visual fields

  • >35 with positive family history
  • Afro-Caribbean
  • Myopia
  • Diabetic/thyroid eye disease
57
Q

How is chronic glaucoma investigated?

A
  • Intra-ocular pressure
  • Cup/disc ratio on fundoscopy
  • Visual fields (humphrey)
  • Gonioscopy (view iridocorneal angle)
  • Optical coherence tomography
  • Central corneal thickness (normal 555 micrometers)
58
Q

Describe the drug management of chronic glaucoma

A
  • Prostaglandin analogues (latanoprost)
    • Inc uveosacral outflow
  • Beta blockers (timolol)
    • Dec production of aqueous
  • Carbonic anydrase inhibitors (dorzolamide)
  • Alpha-adrenergic agonists (brimonidine)
  • Miotics (pilocarpine)
59
Q

Describe the surgical management of chronic glaucoma

A
  • Trabeculectomy
    • Early failure, hypotony (low IOP) infection, bleb leakage
  • Selective laser trabeculoplasty
  • Glaucoma tube surgery
  • Laser peripheral iridotomy
60
Q

Name some symptoms of chronic glaucoma

A

Late stage

  • Blurred vision
    • Parts of page missing
  • Tunnel vision
  • Loss of central fixation
  • Haloes (rainbow) around lights
  • Headache
61
Q

What is amaurosis fugax?

A

Temporary loss of vision in 1 eye with complete recovery after seconds to minutes

  • Thrombotic embolus in retinal, opthalmic or ciliary artery from carotid atheromatous plaque

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