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opthamology > passmed > Flashcards

passmed Flashcards

1
Q

what is holmes-adie pupil

A

dilated pupil
once the pupil has constricted it remains small for an abnormally long time
slowly reactive to accommodation but very poorly (if at all) to light

Holmes-Adie syndrome
association of Holmes-Adie pupil with absent ankle/knee reflexes

commonly seen in women

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2
Q

what is Herpes zoster ophthalmicus (HZO

A

reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve

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3
Q

features of herpes zoster opthalmicus

A

vesicular rash around the eye, which may or may not involve the actual eye itself

Hutchinson’s sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

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4
Q

management of hZO

A

oral antiviral treatment for 7-10 days
ideally started within 72 hours
intravenous antivirals may be given for very severe infection or if the patient is immunocompromised
topical antiviral treatment is not given in HZO
topical corticosteroids may be used to treat any secondary inflammation of the eye
ocular involvement requires urgent ophthalmology review

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5
Q

Complications of HZO

A

ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
ptosis
post-herpetic neuralgia

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6
Q

entropion?

A

inturning of the eyelids

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7
Q

ectropion?

A

out-turning of the eyelids

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8
Q

types of stye

A

external (hordeolum externum): infection (usually staphylococcal) of the glands of Zeis (sebum producing) or glands of Moll (sweat glands).

internal (hordeolum internum): infection of the Meibomian glands. May leave a residual chalazion (Meibomian cyst)

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9
Q

causes of adie pupil

A

damage to parasympathetic innervation of the eye due to viral or bacterial infection.

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10
Q

marcus-gunn pupil

A

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.

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11
Q

causes for marcus-gunn pupil

A

damage to the optic nerve or severe retinal disease

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12
Q

horners syndrome

A

Miosis (pupillary constriction), ptosis (droopy eyelid), apparent enophthalmos (inset eyeball), with or without anhidrosis (decreased sweating) occurring on one side

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13
Q

cause of horner

A

damage to the sympathetic trunk on the same side as the symptoms, due to trauma, compression, infection, ischaemia or many others.

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14
Q

hutchinson’s pupil?

A

Unilaterally dilated pupil which is unresponsive to light

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15
Q

cause of huthcinsons pupil

A

A result of compression of the occulomotor nerve of the same side, by an intracranial mass (e.g. tumour, haematoma)

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16
Q

argyll-robertson pupil

A

Bilaterally small pupils that accommodate but don’t react to bright light.

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17
Q

causes of argyll-robertson pupil

A

diabetes mellitus

syphillis

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18
Q

contradictions to lumbar puncture

A

papilloedema

focal neurology such as a cranial nerve III or VI palsy can indicate increased intracranial pressure due to a cerebral mass.

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19
Q

CSF findings of a
MS
subarachnoid haemorrhage

A

MS - oligoclonal bands

subarachnoid haemorrhage - RBCs

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20
Q

what is papilloedema

A

optic disc swelling that is caused by increased intracranial pressure. It is almost always bilateral.

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21
Q

features of pailloedema on fundoscopy

A
  • venous engorgement: usually the first sign
  • loss of venous pulsation: although many normal patients do not have normal pulsation
  • blurring of the optic disc margin
  • elevation of optic disc
  • loss of the optic cup
  • Paton’s lines: concentric/radial retinal lines cascading from the optic disc
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22
Q

causes of papilloedema

A
  • space-occupying lesion: neoplastic, vascular
  • malignant hypertension
  • idiopathic intracranial - hypertension
  • hydrocephalus
  • hypercapnia

Rare causes include
hypoparathyroidism and hypocalcaemia
vitamin A toxicity

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23
Q

causes of tonic or Adie’s pupil

A

Caused by damage to parasympathetic fibres innervating the pupil constrictor muscle with cell bodies in the ciliary ganglion
Likely cause an unrecognised viral infection

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24
Q

acetozolamide

A

acute angle glaucoma

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25
Q

chloramphenicol

A

bacterial conjunctivitis

26
Q

causes of mydriasis

A 
third nerve palsy
Holmes-Adie pupil
traumatic iridoplegia
phaeochromocytoma
congenital
27
Q

Drug causes of mydriasis

A

topical mydriatics: tropicamide, atropine
sympathomimetic drugs: amphetamines, cocaine
anticholinergic drugs: tricyclic antidepressants

28
Q

causes of RAPD

A 
optic nerve disorders 
- MS -optic neuritis
- optic nerve tumors
- trauma
-glaucoma
- viral infections
- granulomatosis
before optic chiasm 
retina 
- retinal detachment
29
Q

Tx of RAPD

A

observe

gets better in a few months

30
Q

retinal detachment

A

fluid in RPE and sensiry retina

31
Q

Tx tear in retina but no fluid separating it out

A

laser or cryotherapy

32
Q

types of retinal detachment

A

rhegmatogenous - witha tear U shaped retina, macula on, degenerative changes in neurosensory retina creating a hole allowing to fluid to pass from the virteous to the subretinal space between sensory retina and RPE - trauma

exudative - fluid build up in subretinal space due to breakdown of blood- retinal barrier
HTN, vasculitis, AMD, tumor

tractional retinal detachement - pulling, common miopic

33
Q

presentation of retinal detachment

A

preceded by
Floaters
flashes
peripheral field loss initially -> A veil or curtain over the field of vision
loss of red reflex
loss of central vision at a later stage
detached retina appears grey on fundoscopy

Straight lines appear curved

Central visual loss
Field loss - sudden painless curtain like loss of peripheral visual loss

fall in acuity

34
Q

other causes of retinal detachment

A

proliferative diabetic retinopathy
uveitis
intraocular tumours

35
Q

prognosis of retinal detachment

A

time to give definitive treatment

site and extent of detachment

nature of underlying pathology

36
Q

DD for retinal detachment

A

migraine
retinal artery occlusion

post vitreous detachment

vitreous haemorrhages - diabetes

37
Q

Mx of retinal detachment

A

superior tear - lie them flat

inferior tear - 30 degrees

2) surgery - vitreoctomy -> to remove traction of the vitreous, cryotherapy/laser photocoagulation stick retina back on

38
Q

causes of tunnel vision

A 
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
39
Q

causes of painless loss of vision

A
  • optic neuritis
  • retinal detachment
  • posterior vitreous detachment
  • vitreous haemorrhage
  • retinal migraine
  • CRA occlusion
  • CRV occlusion
40
Q

define transient monocular visual loss

A

sudden, transient loss of vision that lasts less than 24 hours.

41
Q

differentials for amaurosis fugax

A
  • large artery disease (atherothrombosis, embolus, dissection),
  • small artery occlusive disease (anterior ischemic optic neuropathy, vasculitis e.g. temporal arteritis),

venous disease and hypoperfusion

42
Q

causes of central retinal vein occlusion

A

glaucoma, polycythaemia, hypertension

43
Q

fundoscopy finding of CRVO

A

severe retinal haemorrhages

chees pizza appearance

44
Q

causes of vitreous haemorrhage

A

proliferative diabetic retinopathy (over 50%)

posterior vitreous detachment

ocular trauma: the most common cause in children and young adults

, bleeding disorders, anticoagulants

45
Q

features of vitreous haemorrhage

A

sudden visual loss

dark spots

46
Q

features of posterior vitreous detachment

A

Flashes of light (photopsia) - in the peripheral field of vision

Floaters, often on the temporal side of the central vision

47
Q

features of vitreous haemorrhage

A

painless visual loss or haze (commonest)
red hue in the vision
floaters or shadows/dark spots in the vision

Large bleeds cause sudden visual loss

Moderate bleeds may be described as numerous dark spots

Small bleeds may cause floaters

48
Q

signs of vitreous haemorrhage

A

decreased visual acuity: variable depending on the location, size and degree of vitreous haemorrhage
visual field defect if severe haemorrhage

49
Q

Ix for vitreous haemorrhage

A
  • dilated fundoscopy: may show haemorrhage in the vitreous cavity
  • slit-lamp examination: red blood cells in the anterior vitreous
  • ultrasound: useful to rule out retinal tear/detachment and if haemorrhage obscures the retina
  • fluorescein angiography: to identify neovascularization
  • orbital CT: used if open globe injury
50
Q

what is post vitreous detachment

A

separation of the vitreous membrane from the retina

51
Q

risk factors of post vitreous detachment

A

As people age, the vitreous fluid in the eye becomes less viscous, and thus, does not hold its shape as well. Therefore, it pulls the vitreous membrane away from the retina towards the centre of the eye.

Highly myopic (near-sighted) patients are also at increased risk of developing posterior vitreous detachment earlier in life. This is because the myopic eye has a longer axial length than an emmetropic eye.

52
Q

symptoms of post vitreous detachment

A

The sudden appearance of floaters (occasionally a ring of floaters temporal to central vision)

Flashes of light in vision

Blurred vision

Cobweb across vision

The appearance of a dark curtain descending down vision (means that there is also retinal detachment)

53
Q

signs of post vitreous detachment

A

Weiss ring on ophthalmoscopy (the detachment of the vitreous membrane around the optic nerve to form a ring-shaped floater).

54
Q

Ix for post vitreous detachment

A

All patients with suspected vitreous detachment should be examined by an ophthalmologist within 24hours to rule out retinal tears or detachment.

55
Q

Mx for post vitreous detachment

A

Posterior vitreous detachment alone does not cause any permanent loss of vision. Symptoms gradually improve over a period of around 6 months and therefore no treatment is necessary.

If there is an associated retinal tear or detachment the patient will require surgery to fix this.

56
Q

features of horners

A

miosis (small pupil)
ptosis
enophthalmos* (sunken eye)
anhidrosis (loss of sweating one side)

57
Q

what is retinitis pigmentosa

A

affects the peripheral retina resulting in tunnel vision

58
Q

features of retinitis pigmentosa

A

night blindness is often the initial sign

tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)

59
Q

fundoscopy finding of retinitis pigmentosa

A

black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium

60
Q

ass diseases of retinitis pigmentosa

A 
Refsum disease: cerebellar ataxia, peripheral neuropathy, deafness, ichthyosis
Usher syndrome
abetalipoproteinemia
Lawrence-Moon-Biedl syndrome
Kearns-Sayre syndrome
Alport's syndrome
61
Q

define anisocoria

A

different pupil size

62
Q

anisocoria worse in the light

A

parasympahteitc issue

ciliary ganglion

opthamology (16 decks)

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