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Eye > Part 2 > Flashcards

Part 2 Flashcards

1
Q

Fungal corneal ulcer

A
  • Presents w: hazy cornea, ring shaped dry ulcer with feathery margins
  • Ring called: immunological ring of wiesley
  • Most specific feature: fungal hyphae surrounding the ulcer- satellite lesions
  • Hypopyon- fixed and unsterile
  • MCC- aspergillus
  • DOC- 5% Natamycin drops
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2
Q

Viral keratitis

A

-Viral corneal ulcer. Also called Acute epithelial keratitis.
- Foreign body sensation, Lacrimation, Photophobia, Pain-mild to moderate, Decreased vision, Corneal sensitivity is reduced.
-2% Flouroscien stain will stay green in blue light.
-Dentritic ulcer, club shaped ends
-MCC- HSV type 1 and 2
-DOC- 3% acyclovir ointment

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3
Q

Viral keratitis Rx

A

1- 3% acyclovir ointment
2- triflourothymidine 1% drops
3- debridement
4- topical antibiotics
5- 1% atropine (cycloplegic) for pain relief
6- oral acyclovir in immunocompromised

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4
Q

Herpes zoster ophthalmicus

A

-Follows Hutchinson’s rule- if tip of nose has vesicles, there will be ocular involvement (nasocilliary nerve)
-Ophthalmic dev of trigeminal nerve.
-DOC- oral acyclovir.

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5
Q

Acanthamoeba keratitis

A
  • Acanthamoeba is fresh water protozoan
  • H/O- bathing in dirty pond, contact lens user.
  • most painful ulcer
    •Dendritic ulcer -> ring ulcer
    • Involves the adjoining limbus causing limbitis
    • Radial keratoneuritis.
  • mc organism for contact lens- pseudomonas
  • Dx by biopsy and corneal scraping
  • Rx-
    Debridement
    amoebicides- polyhexamethylene and chlorhexidine
    Antifungal
    Amino glycoside
    Antibiotic and pain relief
    Keratoplasty in unresponsive.6-12 months.
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6
Q

Lagophthalmos

A
  • Inability of the eye to close
  • Due to palsy of CN7
  • orbicularis oculi muscle paralysis

Can lead exposure keratitis

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7
Q

Keratoconus

A
  • conical elevation of cornea anteriorly
  • Common in Young females
  • Mc complain- repeated change of glass numbers
  • can lead to astigmatism
  • Munson sign - notching of lower lid on downward gaze.
  • Fe deposits- fleisher ring
  • vertical stress lines on descemets membrane Vogt’s striae

Rx- C3R
Corneal collagen crosslinkage with riboflavin drops (vit B2)

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8
Q

Esthesiometry

A

Done to check corneal sensations

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9
Q

Keratometry

A

Done to check corneal curvature

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10
Q

Corneal thickness checked by?

A

Pachymetry

Central- 520 micron

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11
Q

Rate of aqueous, humour production

A

2 to 3 microlitre/minute

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12
Q

Most important mechanism for equals humour production?

A

Secretion

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13
Q

Drainage mechanism of aqueous humour

A

Conventional trabecular outflow
Unconventional Uveoscleral outflow

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14
Q

What is gonioscopy used for?

A

To check angle between the cornea and iris
If angle is closed, it can lead to angle-closure glaucoma/ congestive glaucoma

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15
Q

Normal intraocular pressure

A

16 to 21 mmHg

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16
Q

Aqueous humour fluctuation for glaucoma diagnosis

A

8 mmHg

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17
Q

Tonomertry

A

To check IOP

1- Schiotz- indentation tonometer

2- Goldman applanation tonometer (good std)

3- portable- tonopen

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18
Q

Glaucoma signs and symptoms

A

Triad- ROV
Raised intraocular pressure
Visual field defect
Optic nerve defects

IOP can be raised by increased aqueous humour production or decreased aqueous humour drainage.

H1N1 LAB3
Haemorrhagous
Notching
Laminar dot sign
Asymmetry
And Bayoneting of blood vessels: If blood vessels bend or kink sharply when they pass over the edge of the cup.

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19
Q

Glaucoma examination

A

Visible part of retina= fundus
Fundus exam to see retina- by ophthalmoscope.

Optic cup is inside the optic disc
Distance bw that is the cup disc ratio CDR
Normal CDR is 0.3

In glaucoma, there is:
Vertically oval cup
Enlarged CDR- more than 0.7

Tonometry - Raised intraocular pressure
ii. Fundoscopy - Characteristic optic disc head changes
(glaucomatous cupping)
ill. Imaging (OCT) - Retinal nerve fibre layer damage iv. Perimetry - Visual field defects V.
Gonioscopy - An open anterior chamber angle

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20
Q

Visual field examination done by?

A

Perimetry

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21
Q

Visual field defect in glaucoma

A
  • Constriction of visual field
  • Nasal visual field is lost

First change noticed = paracentral, winged shaped scotoma —
Leading to a sickle shaped scotoma —
Arcuate scotoma —
Ring/ annular shaped scotoma
Wo StAR

causing tunnel vision

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22
Q

Acute angle closure glaucoma

A

Sudden rise of interocular pressure— rocky, hard, eyeball

Sudden painful loss of vision

1- Hazy cornea,
2- redness,
3- vertically, oval, fixed, non reactive, mid dilated pupil

Pain, nausea, headache at affected side of face.

First drug- IV MANNITOL
glycerol + tab acetazolamide

DOC- pilocarpine

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23
Q

Open Angle glaucoma DOC

A

Latanoprost

Prostaglandin analog

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24
Q

Only safe drugs for glaucoma in pregnancy

A

Alpha 2 agonists
Apraclinidine

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25
Q

Prostaglandin side-effects

A

-Conjunctival hyperaemia
-Eyelash elongation and darkening
-Peri ocular skin hyperpigmentation
-Iris hyperpigmentation
-Cystoid macular oedema
-Myalgia and skin rash

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26
Q

Mannitol dose for PACG

A

Dose 1g/kg body weight or 5 ml/kg body weight of a 20% solution in water

given intravenously over 30-60 minutes with peak action within 30 minutes.

Use isosorbide in diabetic pts instead

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27
Q

PACG RX

A

IOP > 50mmHg

1- Bright light and supine position
2- mannitol
3- acetazolamide 500mg iv followed by 250 mg 6 hourly orally.
4- Analgesics: For relief of pain.
5- Antiemetics: For control of vomiting.

Peripheral iridotomy
Trabaculotomy

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28
Q

Surgical rx for PACG

A

Angle-closure is due to synechiae formation between the iris and cornea

If synechiae is less than 180° - peripheral irodotomy by Nd YAG laser

If Closure is more than 180° - trabeculectomy

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29
Q

Glaucoma in children

A

If at birth- congenital glaucoma
If between 1 to 3 years, - infantile glaucoma
If after 3 years - juvenile glaucoma

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30
Q

Most common type of glaucoma in children

A

Infantile glaucoma

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31
Q

Congenital glaucoma

A

Due to trabecular dysgenesis

Triad- BPL
B - blepharospasm
P - photophobia
L- lacrimation

  • Buohthalmos - bulls eye appearance
  • horizontal stress lines on the descmets membrane of cornea- Haab’s stria

RXOC- trabeculectomy + trabeculotomy

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32
Q

Which side is optic disc present on?

A

Nasal side

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33
Q

Centre of macula

A

Fovea centralis
1.5mm size

3mm temporal to optic disc

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34
Q

Cones are responsible for?

A

Color and day vision

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35
Q

Rods are responsible for?

A

Night and dim vision

36
Q

Maximum number of cones located at?

A

Fovia centralis

Causing sharpest image formation

37
Q

What is responsible for central vision?

A

Macula lutea

38
Q

Central retinal artery branches of?

A

Ophthalmic artery— internal carotid artery

39
Q

Types of retinal detachment

A

1- Rhegmatogenous retinal detachment
2- Tractional retinal detachment
3- Exudative retinal detachment

40
Q

Rhegmatogenous retinal detachment

A

Due to a tear between the neural and pigment layers of retina
horse shoe shaped tear

Common in myopes, where axial length is increased, so tears occur.

41
Q

Tractional retinal detachment

A

Due to Neovascularisation- (neo angiogenesis) causing traction of the retina
Seen in diabetic retinopathy and Eales disease and CRVO and ROP.

Hazy cornea and neovessels seen

42
Q

Exudative retinal detachment

A

Due to some malignancy or infection, causing collection of pus

shifting fluid sign

43
Q

Hyperoleon

A

After pars plana vitrectomy, (usually done for retinal detachment or haemorrhage) silicon oil is inserted.
If oil comes from the posterior sentiment into the anterior segment, it’s called this sign

44
Q

Vitreous haemorrhage

A

Boat shaped subhyaloid haemorrhage

MCC- trauma

45
Q

Most common cause of sudden painless loss of vision?

A

Vitreous haemorrhage

46
Q

Young adult male presents with hx of recurrent vitreous haemorrhage
Dx?

A

Eale’s disease

Periphlebitis or inflammation of veins

47
Q

FFA

A
  • fundus flourisein angiography
  • dye inserted from the antecubital vein
  • Ischaemic part will appear black
  • Dye will leak out in haemorrhages
48
Q

Rx for VH or eale’s disease

A

Intravitreal steroid injections
Anti VEGF mabs
( beva cizumab and rani bizumab)

Wait for 1 month for blood to be absorbed
If not
PPV- pars plana vitrectomy

49
Q

Diabetic retinopathy

A

Two types
1- nonproliferative diabetic retinopathy
2- Proliferative diabetic retinopathy

1- Most important risk factor- duration of diabetes
2- Poor HbA1c control

50
Q

Nonproliferative, diabetic retinopathy

A

Earliest feature- microaneurysms
Most specific features- dot blot haemorrhage

-Flame shape haemorrhage
-Dot blot haemorrhages
-Hard exudates (yellow)
-Soft exudates (large) cotton wool spot

51
Q

Most common cause of decreased version in diabetic retinopathy

A

Cystoid Macular oedema

52
Q

Most common cause of decreased vision in diabetes

A

Snowflake cataract

53
Q

Beta blocker’s contraindicated in treatment for glaucoma for pts with?

A

Asthma

54
Q

Rx for proliferative diabetic retinopathy

A

Pan retinal photo coagulation

Done by nd yag laser

55
Q

Ischaemic CRVO

A

-Venous occlusion mostly due to compression by the retinal artery
- causes increased pressure leading to flame shaped haemorrhages
- splashed tomato appearance

56
Q

Segmental BRVO

A

-Segmental branch retinal vein occlusion
- only a specific segment affected
- splashed tomato here also

57
Q

CRAO

A
  • due to embolism or plaque
  • retinal whitening due to ischemia
  • Cherry red spot of the choroid
  • segmental blood flow causing tram track/ cattle track appearance
58
Q

Dry ARMD

A

-atrophy of Retinal pig epi, photo receptors, choriocappilary
- MCC of decreased vision in worldwide blindness.
- gradual central vision loss
- Distorted vision difficulty reading
- Bilateral
- Asymmetrical

Hard drussen
Soft drussen
Focal hyperpigmentation

Dx- FFA and fundus exam

Rx-
amsler grid testing to check for wet type conversion
Htn control
Vit c e beta carotene
Vision aid

59
Q

Prolonged use of hydrochloroquines and chloroquine causes?

A

Bullseye maculopathy

60
Q

Retinitis pigmentosa

A
  • Idiopathic degeneration of rods and cones
  • More commonly rods
  • Night vision affected
  • Mc symptom- night blindness nactylopia
  • Mc pattern of inheritance- autosomal recessive
    Signs- BAP
    B- bony specules (pigmentations)
    A- attenuated blood vessels
    P- pale optic disc

Rx- vit A

61
Q

Roth spots

A
  • Haemorrhages with white centres
  • Characteristic of infective endocarditis
    MCC- staph aureus
62
Q

Retinoblastoma

A
  • most common primary intraoccular malignant tumour in children
  • Rb gene mutation located on the 13q14 chromosome
  • autosomal dominant
  • triretinal = bilateral retinoblastoma + pineal gland tumour
  • mc Mets route through optic nerve
  • presenting complain- leukocoria, converging squint
  • Most pathognomic feature- mass + calcification
  • intraoccular calcification
  • Dx: ultrasound B scan
    (B scan for posterior segment pathology
    A scan for axial length)
    Indirect ophthalmoscopy
    Tonometry, slit lamp, CT. MRI
  • flexner winterstiner Roettes on biopsy if done.
63
Q

Retinoblastoma Rx

A
  • Small tumours - <3mm wide x 2mm thick:
    Laser photocoagulation
    Transpupillary thermotherapy
    Cryotherapy

-Medium tumours - 12mm wide × 3mm thick:
Brachytherapy
Primary chemotherapy
External beam radiotherapy

  • Unilateral tumour with advanced disease: Enucleation of the eye
  • Very large tumours: Chemotherapy followed by enucleation of the eye
  • Extraocular extension - Metastasis: Adjuvant chemotherapy
    External beam radiotherapy
    Metastatic disease -chemotherapy
64
Q

Axial prptosis

A
  • protrusion of eye ball forward from the centre
  • MCC in adults- thyroid ophthalmology
  • MCC in children- orbital cellulitis
  • to check degree of proptosis: hertels exophalmometer is used
  • more than 21mm is considered proptosis
65
Q

Thyroid ophthalmopathy

A
  • first muscle affected- inferior rectus
    -signs -
    1 lid retraction causing darilympal sign
    2 Lid lag von graffes sign
    3 Starting look kochers sign
66
Q

Cavernous sinus thrombosis

A
  • Venous sinus that Drains all ophthalmic veins and Al veins of the cranial fossa
  • pooling of blood leads to proptosis
  • Loss of abduction- lateral rectus (LR6)
  • first nerve affected- CN 6
  • 3,4,5 nerve also affected
  • The classic presentation is rapid onset of fever, severe headache 50-90%, malaise, nausea and vomiting.
  • Delirium due to meningitis and septic emboli to various parts of body.

Diagnosis: CBC, ESR, C-reactive protein, Blood cultures, Lumber puncture to rule out meningitis
Imaging:
CT-Scan with contrast
MRI
CT venogram, MRI venogram

Rx. reatment
- Broad spectrum antibiotics iv
- Analgesic and antiinflammatory drugs
Surgical drainage may be required in certain cases.

67
Q

Sympathetic ophthalmitis due to which type of trauma?

A

Penetrating trauma

68
Q

congenital ptosis

A

Present since birth
Third Cranial nerve palsy
Lavator palpebrae superioris muscle palsy

69
Q

Stye/ hordeolum externum

A
  • Acute painful suppurative inflammation of zeis and moll

Small name small glands

-MCC staph aureus

Rx.
Hot compress
Antibiotic drops
Anti inflammatory drugs
Or I/D if v large

70
Q

Chalazion

A
  • Also called tarsal cyst
  • chronic painless, nonsuppurative, inflammation of meibomian gland

CHRONIC IS PAINLESS ALWAYS

RxOC- incision and curettage by chalazion clamp
Steroid injections
Systemic antibiotics
Warm compress and anti inflammatory for conservative

Fate:
- Spontaneous complete resolution
- Liquify to form a thin fibrous sac- chalazion cyst.
- Get fibrosed into a hard nodule.
- Calcify- hard nodule.
- Get infected and suppurate.
- Burst and present as fleshy mass

71
Q

Hordeolum internum

A

Acute painful, suppurative infection of miebomian glands

72
Q

Symblepharon

A

Adhesion of the bulbar conjunctiva, and the palpebral conjunctiva of the same side

Same side- s

73
Q

Ankyloblepharon

A

Adhesion of upper and lower eyelid

Amne samne- Ankylo

74
Q

Ectropion

A

Outward turning of eyelid

75
Q

Entropion

A

Inward turning of eyelid

76
Q

Trichiasis

A

Inward directed eyelashes

77
Q

Districhiasis

A

Extra row of eyelashes

78
Q

Madarosis

A

Loss of eyelashes

79
Q

Most common cancer of eyelid?

A

Basal cell carcinoma/ rodent ulcer
Most common site- lower lid

80
Q

Most common cause of leukocoria?

A

Retinoblastoma

Also, congenital cataract

81
Q

Acute dacryocystitis

A

Inflammation of lacrimal sac

NLD-
18-24mm
Opens into inf meatus
Thru valve of hasner
DOB direction

  • Seen in females commonly
  • MCC staph aureus
  • painful suppurative

Sx- DCR dacryocystorhinostomy into the middle meatus

82
Q

Congenital dacryocystitis Rx

A

Rx-
Topical antibiotics
Till 1 year- crigglers sac massage
1-4 years- probing and syringing and catheter dilation
After 4- external DCR surgery. Thru the skin approach
Types:
With silicon tube
Without tube
(External)
Endolaser (internal)

83
Q

Schirmers test

A

For keratocunjunctivitis sicca

Whatman filter paper used
Side 5x35
Noted after 5 minutes

In normal eye: less than 10 mm is considered dry

W anaesthesia: less than 6mm

84
Q

Dry eye/ keratocunjunctivitis sicca

A

Insufficient tear production to maintain tear film

Types-
- Pure Keratoconjunctivitis sicca: Lacrimal glands alone are involved.
- Primary Sjogren syndrome: autoimmune (dry mouth also)
- Sec. Sjogren (RA SLE)
- Non sjogren (trauma infection tumour)

Dryness irritation burning foreign body sensation photophobia, corneal filaments

Tests:
flouriscein stain, rose Bengal stain, lissamine stain
Tear film break up time: less than 10 secs

Rx.
Artificial tears (methylcellulose)
Autologous serums
Mucolytic agents
Topical retinoids
Anti inflammatory drops
Contact lens to stop evaporation.

Plugs and transplant of limbal system

85
Q

Primary open angle glaucoma

A

bilateral optic neuropathy, often asymmetrical
i. IOP > 21 mm Hg
ii. Glaucomatous optic disc changes ii. Glaucomatous visual field defects iv. Open and normal appearing angle
MC of all glaucoma
Black people
Elderly, myopia, contraceptive pill
Due to loss of trabeculocytes
Symptoms
painless, slowly progressive loss of vision usually bilateral with insidious onset.

a. Night blindness
Sudden loss of vision in one eye with gross visual damage in the other eye.
headache and frequent change of presbyopic glasses.

86
Q

Medicines for glaucoma

A

Increase flow:
Prostaglandins
Alpha 2 agonists
Cholinergics
Adrenergics
Rhokinase inhibitors

Decrease production:
Beta blockers
Alpha 2 agonists
Carbonic anhydrase inhibitors

Eye (3 decks)

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