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high yield- year 2 > opthomology > Flashcards

opthomology Flashcards

1
Q

what are the 3 layers of the eye?

A
  • outer fibrous layer
  • middle vascular and pigmented layer (uvea)
  • inner nervous layer
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2
Q

structures of outer fibrous layer of eye?

A

-sclera and cornea

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3
Q

what is the outer fibrous layer of the eye responsible for?

A

-refraction (sclera and cornea are part of the outer fibrous layer)

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4
Q

what is the middle vascular and pigmented layer of the eye made up of?

A
  • ciliary body
  • iris
  • choroid
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5
Q

what is the inner layer of the eye made up of?

A

retina

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6
Q

which layer of the eye is most vascular?

A

middle

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7
Q

which layer of the eye is most photosensitive?

A

inner (contains the retina)

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8
Q

what nerve supplies the orbicularis oris?

A

CN VII

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9
Q

what nerve supplies the levator palpabrae superioris?

A

CN III

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10
Q

what type of nerve fibres innervate the superior tarsal muscle

A

sympathetic fibres

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11
Q

what nerve innervates the lacrimal gland?

A

CNVII

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12
Q

what nerve innervates the ciliary muscles?

A

CN III

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13
Q

what nerve innervates the constrictor pupillae?

A

CNIII

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14
Q

what nerve innervates the dilator pupillae?

A

-sympathetic nerves

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15
Q

role of ciliary muscles?

A

change lens shape

-contraction leads to relaxation of suspensory muscles therefore thickening the lens and making it more rounded (allowing you to see close up)

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16
Q

what muscles affect pupil size?

A
  • constrictor pupillae

- dilator pupillae

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17
Q

what are the afferent and efferent blink nerves?

A

blink afferent- V1

blink efferent- CNVII

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18
Q

what nerves control lacrimation?

A 
sympathetic (emotional)
parasympathetic CNVII (cleaning)
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19
Q

role of superior rectus?

A
  • elevation

- adduction and medial rotation

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20
Q

role of inferior rectus?

A
  • depression

- adduction and lateral rotation

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21
Q

role of lateral and medial rectus?

A

lateral- abduction

medial- adduction

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22
Q

role of superior oblique?

A
  • depress

- abduct and medial rotation

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23
Q

role of inferior oblique?

A
  • elevate

- abduct and lateral rotation

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24
Q

presentation of CNIII palsy?

A
  • down and out eye
  • ptosis (drooping eyelid)
  • dilated non reactive pupil
  • unopposed lateral rectus (innervated by abducens) causes exotropia and superior oblique (innervated by trochlear) causes hypotropia
  • CNIII innervates levator palpebrae superioris which is responsible for lifting the eyelid
  • constrictor pupillae is innervated by CNIII
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25
Q

presentation of CN VI palsy?

A
  • medially/ inward
  • Esotropia
  • often have diplopia

This is due to lateral rectus which controls abduction being innervated by CN VI

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26
Q

what can cause a 6th nerve plasy?

A
  • often raised ICP

- acoustic neuroma

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27
Q

how does trochlear nerve palsy present?

A
  • up and in eye
  • esotropia
  • vertical diplopia
  • patients will often present with a head tilt to counter
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28
Q

what does damage to 1 cause?

A

right anopia

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29
Q

what does damage to 2 cause?

+ what can cause damage to 2?

A

bitemporal hemianopia

-pituitary tumour

30
Q

what does damage to 3 cause?

+ what could cause this

A

left homonymous hemianopia

-stroke

31
Q

what does damage to 4 cause?

A

superior left quadrantopia

PITS
Parietal- inferior quadrantopia
Temporal- superior quadrantopia

32
Q

what does damage to 5 cause?

A

-left homonymous hemianopia

33
Q

what does damage to 6 cause?

A

-inferior left quadrantopia

PITS
parietal= inferior
Temporal= superior

34
Q

what is red?

A

retinal vein

35
Q

what is red?

A

retinal artery

36
Q

what is red?

A

optic disc

37
Q

what is red?

A

optic cup

38
Q

what is red?

A

fovea

39
Q

what is red?

A

macula

40
Q

what causes open angle glaucoma?

A
  • increased resistance through trabecular meshwork making passage of aqueous humour more difficult
  • this leads to a slow build up of ICP
41
Q

risk factors for open angle glaucoma?

A
  • afro carribean
  • diabetes
  • hypertension
  • steroid use
  • myopia (near sightedness)
  • increase of age

opeN= Near sighted

42
Q

presentation open angle glaucoma?

A
  • gradual onset vision loss (begins peripherally + often bilateral)
  • fluctuating pain, headaches, blurred vision
  • HALOS around lights (especially at night)

SIGNS:

  • decreased visual acuity
  • increased intraocular pressure
  • optic disc increases in size
43
Q

investigations for open angle glaucoma?

A

visual field assessment and acuity:
-peripheral vision loss and decreased acuity

Fundoscopy:
-optic disc increases in size

Tonametry:
-intraocular pressure increased

44
Q

treatment for open angle glaucoma?

A

First line= latonoprost (prostaglandin analogue)

  • BB (e.g. timolol)- AVOID IS ASTHMATICS
  • Carbonic anhydrase inhibitors (e.g. Dorzolamide)
  • Sympathomimetics (e.g. Brimonidine)

Surgery- trabeculectomy

Latonoprost= Lid= open a lid

45
Q

what causes acute angle closure glaucoma?

A
  • optic nerve damage due to acute raised intracranial pressure
  • the iris bulges forwards, preventing the passage of aqueous fluid from the anterior chamber, increasing intracranial pressure
46
Q

presentation acute angle closure glaucoma?

A
  • rapid onset vision loss (often unilateral)
  • painful, red, teary eye
  • semidilated pupil
  • nausea
  • halos around lights
47
Q

investigations for acute angle closure glaucoma?

A

visual field assessment and acuity:

  • decreased visual acuity
  • dilated fixed pupil

Fundoscopy:
-increase in size of optic disc

Tanometry:
-increase in intraocular pressure

48
Q

management of acute angle closure glaucoma?

A

URGENT REFERRAL

  • Pilocarpine eye drops (Closure- piloCarpine)
  • IV acetazolamide (carbonic anhydrase inhibitor)

Surgery is definitive treatment= laser iridotomy

49
Q

role of pilocarpine?

A

acts on muscarinic receptors causing Pupil Constriction and ciliary muscle contraction

PiloCarpine- Pupil Constriction

50
Q

role of carbonic anhydrase inhibitors?

A

-reduce production of aqueous fluid

51
Q

what is dry age related macular degeneration?

A
  • most common cause of blindness in the UK

- caused by degeneration of the macula

52
Q

risk factors for dry age related macular degeneration?

A
  • advancing age
  • smoking history
  • caucasian/ chinese origin
  • family history
  • ischaemic heart disease
53
Q

more common- dry or wet ARMD?

A

dry (90%)

54
Q

presentation of dry ARMD?

A
  • gradual worsening of central vision
  • reduced visual acuity (usually bilateral)
  • wavy appearance of lines
55
Q

investigations for dry ARMD?

A

snellen chart:
-reduced visual acuity

Amsler Grid test:
-shows distortion of straight lines

Fundoscopy/slit lamp:
-drusen visualised between Bruch’s Membrane and retinal pigment epithelium

Optical Coherence Tomogrophy:
-used to assess progression

56
Q

treatment dry ARMD

A
  • no specific treatment

- avoid smoking, BP control, vitamin supplementation

57
Q

presentation wet ARMD?

A
  • acute onset vision loss
  • reduced visual acuity
  • wavy appearance of lines
  • especially bad at night
  • struggle to see things near

SIGNS:

  • drusen
  • neovascularisation
58
Q

what test is critical in diagnosing wet ARMD?

A

optical coherance tomography

59
Q

treatment of wet ARMD>

A

anti veg F injections

60
Q

presentation of cataracts?

A
  • gradual onset vision loss (unilateral)
  • starbursts around lights
  • loss of red reflex
61
Q

investigations for cataracts?

A
  • snellen chart
  • examination/ fundosopy (shows loss of red reflex)
  • slit lamp (visible cataracts)
  • blood tests are worth while in younger patients
62
Q

risk factors for cataracts?

A
  • smoking
  • alcohol
  • diabetes
  • increase in age
  • LONG TERM STEROID USE + HYPOCALCAEMIA
63
Q

management cataracts?

A
  • monitor and manage conservatively in early stages (stronger glasses)
  • lens replacement surgery (will eventually be required)
64
Q

when is diabetic retinopathy classes as proliferative?

A

when there is neovascularisation

65
Q

what type of diabetes is proliferative retinopathy more common in?

A

Type 1 diabetes

66
Q

what is mild non proliferative retinopathy?

A

1 or more microaneurysms

67
Q

role of latonoprost?

A
  • increases uvescleral outflow

- prostaglandin analogue

68
Q

what is classed as moderate non proliferative diabetic retinopathy?

A
  • microaneurysms
  • blot haemorrhages
  • hard exudates
  • cotton wool spots
69
Q

what is classed as severe diabetic retinopathy?

A

-blot haemorrhages and micro aneurysms in 4 quadrants

OR

-venous beading in 2+ quadrants

OR

-any intraretinal microvascular abnormality

70
Q

what is classed as diabetic maculopathy?

A
  • any visible changes in the macula

- more common in type II DM

71
Q

management of diabetic retinopathy?

A

-optimise glycamemic control, BP and hyperlipidaemia

If severe: panretinal laser photocoagulation

Proliferative disease or maculopathy: intravitreal anti VEGF injections

72
Q

what is papilloedema?

A

-optic disc swelling caused by a raised intracranial hypertension

high yield- year 2 (20 decks)

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