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Passmed Ophthalmology Mushkies Flashcards

1
Q

Amaurosis fugax defn?

A

Painless transient loss of vision in one or both of the eyes

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2
Q

4 most common causes of sudden painless loss of vision?

A
  1. Ischaemic/vascular
  2. Vitreous haemorrhage
  3. Retinal detachment
  4. Retinal migraine
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3
Q

Cause of ischaemic optic neuropathy?

A

Occlusion of the short posterior ciliary arteries, causing damage to the optic nerve

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4
Q

Recognised ischaemic/vascular visual loss syndromes?

A
  1. Central retinal vein occlusion

2. Central retinal artery occlusion

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5
Q

Which is more common, CRVO or CRAO?

A

CRVO

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6
Q

3 causes of central retinal vein occlusion?

A
  1. Glaucoma
  2. Polycythaemia
  3. Hypertension
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7
Q

2 causes of central retinal artery occlusion?

A
  1. Thromboembolism from atherosclerosis

2. Arteritis e.g. temporal arteritis

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8
Q

CRVO on fundoscopy?

A

Severe retinal haemorrhages

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9
Q

2 features of CRAO?

A
  1. Afferent pupillary defect

2. Cherry red spot on pale retina

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10
Q

3 causes of vitreous haemorrhages?

A
  1. Proliferative DM
  2. Posterior vitreous detachment
  3. Ocular trauma
  4. Bleeding diatheses
  5. Anticogualants
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11
Q

How to differentiate between vitreous haemorrhage, posterior vitreous detachment, and retinal detachment?

A
  1. Vitreous haemorrhage = sudden visual loss(L)/numerous dark spots(M)/floaters(S)
  2. Posterior vitreous detachment = Photopsia in peripheral field of vision, floaters
  3. Retinal detachment = dense shadow that starts peripherally and progresses towards the central vision, straight lines appear curved, central visual loss, a veil or curtain over the field of vision
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12
Q

What is the classification for hypertensive retinopathy?

A

Keith-Wagener

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13
Q

Keith-Wagener classification for hypertensive nephropathy stages?

A
  1. Arteriolar narrowing and tortuisotity, and increased light reflex (silver wiring)
  2. AV nipping
  3. Cotton-wool exudates, flame and blot haemorrhage
  4. Papilloedema
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14
Q

Cataracts defn?

A

A common condition of the eyes where the lens gradually opacifies, making it more difficult for light to reach the retina, causing reduced/blurred vision

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15
Q

Leading cause of blindness worldwide?

A

Cataracts

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16
Q

Cataracts sex preference?

A

Women

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17
Q

Causes of cataracts?

A
  1. Normal ageing process (most common)
  2. Smoking
  3. Diabetes
  4. Alcohol
  5. Trauma
  6. Steroids
  7. Radiation
  8. Hypocalcaemia
  9. Myotonic dystrophy
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18
Q

Symptoms of cataracts?

A
  1. Reduced vision
  2. Faded colour vision
  3. Glare (lights appear brighter)
  4. Halos around light
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19
Q

Signs of cataracts?

A

A defect in the red reflex

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20
Q

Ix of cataracts?

A
  1. Ophthalmoscopy = normal fundus and optic nerve

2. Slit-lamp = visible cataract

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21
Q

Classification of cataracts?

A
  1. Nuclear
  2. Polar
  3. Subscapular
  4. Dot opacities
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22
Q

Nuclear cataracts?

A

Changed lens refractive index, common in old age

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23
Q

Polar cataracts?

A

Localised, commonly inherited, lie in the visual axis

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24
Q

Subscapular cataracts?

A

Due to steroid use, just deep to the lens capsule, in the visual axis

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25
Dot opacities cataracts?
Common in normal lenses, also seen in DM and myotonic dystrophy
26
Mx of cataracts?
1. Conservatively = Stronger glasses, encouraging brighter lighting 2. Surgery = lens replacement
27
Post-cataract surgery complications?
1. Retinal detachment 2. Posterior capsule opacification 3. Posterior capsule rupture 4. Endophthalmitis
28
What is endophthalmitis?
Inflammation of the aqueous and/or vitreous humour
29
Features of Horner's syndrome?
1. Miosis 2. Ptosis 3. Anhidrosis 3. Enophthalmos (sunken eyes)
30
How to differentiate between causes of Horner's syndrome?
1. Central lesions 2. Pre-ganglionic lesions 3. Post-ganglionic lesions
31
Horner's syndrome defn?
Horner syndrome is a combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body
32
Feature of central Horner's lesions?
Anhidrosis of face, arm and trunk
33
Feature of pre-ganglionic Horner's lesions?
Anhidrosis of the face
34
Feature of post-ganglionic Horner's lesions?
No anhidrosis
35
Causes of central Horner's?
1. Stroke 2. MS 3. Tumour 4. Encephalitis 5. Syringomyelia
36
Causes of pre-ganglionic Horners?
4 Ts 1. Pancoast's tumour 2. Thyroidectomy 3. Trauma 4. TCervical Rib
37
Causes of post-ganglionic Horners?
4 Cs 1. Carotid artery dissection 2. Carotid aneurysm 3. Cavernous sinus thrombosis 4. Cluster headache
38
Glaucomas defn?
Optic neuropathies associated with raised intraocular pressure
39
Classification of glaucoma is based on?
Based on whether the peripheral iris is covering the trabecular meshwork, which is important in the drainage of aqueous humour from the anterior chamber of the eye.
40
Prevalence of glaucoma?
1. 0.5% > 40y/o | 2. 19% > 80y/o
41
Causes of primary open angle glaucoma?
1. Age | 2. Genetics
42
Symptoms of glaucoma?
1. Visual field defect
43
Ix of glaucoma?
1. Automated perimetry to assess visual field 2. Slit lamp to assess optic nerve (damage/cupping) 3. Applanation tonometry to measure IOP (>24mmHg) 4. Central corneal thickness measurement 5. Gonioscopy to assess peripheral anterior chamber configuration
44
Mx of primary open angle glaucoma?
1. 1st line = Prostaglandin analogue eyedrop 2. Second line = BB, CA inhibitor, Sympathomimetic eyedrop 3. Surgery
45
Prostaglandin analogue for glaucoma and MOA?
1. Latonoprost 2. Increases uveoscleral outflow 3. OD 3. S/e = brown pigmentation of the iris, increased eyelash length
46
BB for glaucoma and MOA?
1. Timolol, betaxolol | 2. Reduced aqueous production
47
C/I of BBs for glaucoma?
Asthmatics and heart block
48
Sympathomimetics for glaucoma and MOA?
1. Brimonidine, a2-agonist 2. Reuced aqueous production and increase outflow 3. S/e = hyperaemia
49
CA inhibitor for glaucoma and MOA?
1. Dorzolamide | 2. Reduces aqueous production
50
Miotics for glaucoma and MOA?
1. Pilocarpine, muscarinic receptor agonist 2. Increases uveoscleral flow 3. S/e = constricted pupil, headache, blurred vision
51
AACG?
Acute angle-closure glaucoma
52
Factors predisposing to AACG?
1. Hypermetropia (long sightedness) 2. Pupillary dilatation 3. Lens growth associated with age
53
Features of AACG?
1. Pain 2. Decreased acuity 3. Hard, red eye 4. Symptoms worse with mydriasis (e.g. dark room) 5. Haloes around lights 6. Semi-dilated non-reacting pupil
54
Mx of AACG?
1. Urgent referral to ophthalmologist 2. Reducing aqueous secretion = acetazolamide 2. Inducing pupillary constriction = topical pilocarpine
55
Classification of infective conjunctivitis?
1. Viral = serous discharge, recurrent URTI, pre-auricular lymph nodes 2. Bacterial = purulent discharge, stuck together eyes in the mornin
56
Mx of infective conjunctivitis?
1. Normally self limiting in 1-2 weeks 2. Topical Abx e.g. chloramphenicol drops 2-3 hourly/ointment QDS 3. Topical fusidic acid for pregnant women
57
Night blindness and tunnel vision?
Retinitis pigmentosa
58
Retinitis pigmentosa defn?
A group of rare, genetic disorders that involve a breakdown and loss of cells in the retina
59
Retinitis pigmentosa on fundoscopy?
1. Black bone spicule-shaped pigmentation in the peripheral retina 2. Mottling of the retinal pigment epithelium
60
Non-painful red eye?
Episcleritis
61
Episcleritis fx?
1. Red eye 2. Classically not painful 3. Watering and mild photophobia may be present
62
Differentiating b/w episcleritis and scleritis?
Phenylephrine drops blanch the conjunctival and episcleral vessels but not the scleral vessels. If the eye redness improves after phenylephrine a diagnosis of episcleritis can be made
63
Mx of episcleritis?
1. Conservative | 2. Artificial tears may sometimes be used
64
POAG?
Primary open angle glaucoma
65
RFs to POAG?
1. Genetics 2. Black 3. Myopia 4. HTN 5. DM 6. Steroids
66
Fx of POAG?
1. Peripheral visual field loss 2. Decreased visual acuity 3. Optic disc cupping
67
Fundoscopy signs of POAG?
1. Optic disc cupping (cup-to-disc ratio >0.7) 2. Optic disc pallor (optic atrophy) 3. Bayonetting of vessels 4. Cup notching
68
S/e of prostaglandin analogues for glaucoma?
1. Increased eyelash length 2. Iris pigmentation 3. Periocular pigmentation
69
Classification of squints?
1. Concomitant (common) | 2. Paralytic (rare)
70
Cause of concomitant squint?
Due to imbalance in extra-ocular muscles, convergent is more common than divergent
71
Cause of paralytic squint?
Paralysis of extraocular muscles
72
Dx of squint?
1. Corneal light reflection test | 2. Cover test
73
Mx of squint?
1. Referral to secondary care | 2. Eye patches may prevent amblyopia
74
Most common cause of blindness in the UK?
Age-related macular degeneration
75
Classification of age related macular degeneration?
1. Dry = 90%, chracterised by Drusen (yellow round spots in Bruch's membrane) 2. Wet = 10%, characterised by choroidal neovascularisation, worst prognosis
76
ARMD sex preference?
2F:1M
77
ARMD RFs?
1. Age 2. Smoking 3. FHx 4. IHD, HTN, DM, dyslipidaemia
78
ARMD symptoms?
1. Reduction in visual acuity esp. for near objects 2. Worse night vision 3. Photopsia (flickering/flashing lights) 4. Glare around objects
79
ARMD on fundoscopy?
1. Dry = Drusen (yellow areas of pigment deposition in macula) 2. Wet = well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage
80
ARMD Mx?
1. Combination of zinc with anti-oxidant vitamins A,C and E 2. anti-VEGF e.g. ranibizumab, bevacizumab and pegaptanib 3. Laser photocoagulation
81
Lines appearing curvy + blurring of small words?
ARMD
82
Eyelid problems?
1. Blepharitis 2. Stye 3. Chalazion 4. Entropion 5. Ectropion
83
Blepharitis defn?
Inflammation of the eyelid margins typically leading to a red eye
84
Stye defn?
Infection of the glands of the eyelid
85
Types of stye?
1. External | 2. Internal
86
External stye aka?
Hordeolum externum
87
External stye features?
Infection of the: 1. Glands of Zeis (sebum producing) 2. Glands of Moll (sweat glands)
88
Internal stye aka?
Hordeolum internum
89
Internal stye features?
Infection of the Meibomian glands, may leave a residual chalazion
90
Mx of stye?
1. Hot compresses 2. Analgesia 3. Only recommend topical Abx if associated conjunctivitis
91
Chalazion aka?
Meibomian cyst
92
Chalazion defn?
A retention cyst of the Meibomian gland, presenting as a firm painless lump in the eyelid
93
Mx of chalazion?
Majority of cases resolve spontaneously but some require surgical drainage
94
Causes of blepharitis?
1. Meibomian gland dysfunction --> posterior blepharitis | 2. Seborrheic dermatitis/staphylococcal infection --> anterior blepharitis
95
Mx of blepharitis?
1. Hot compresses BD = softening of lid margin 2. Mechanical removal of debris w/ cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo 3. Artificial tears
96
AACG hypermetropia or myopia?
Hypermetropia
97
POAG hypermetropia or myopia?
Myopia
98
Most common cause of flashers and floaters?
Posterior vitreous detachment
99
Posterior vitreous detachment (PVD) defn?
Separation of the vitreous membrane from the retina
100
What must you rule out in a pt with PVD?
Important to rule out retinal tears or retinal detachment in anyone with suspected posterior vitreous detachment, as they may result in permanent loss of vision.
101
RFs for PVD?
1. Age = 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. 2. Myopia = myopic eye has a longer axial length than an emmetropic eye
102
Cobweb across vision?
Posterior vitreous detachment
103
Weiss ring on ophthalmoscopy?
PVD = detachment of the vitreous membrane around the optic nerve to form a ring-shaped floater
104
Mx of PVD?
1. Sx gradually improve over a period of around 6 months and therefore no treatment is usually necessary 2. If there is an associated retinal tear or detachment the patient will require surgery to fix this.
105
Ix for neovascular ARMD?
Fluorescein angiography
106
Papilloedema defn?
Optic disc swelling caused by raised ICP
107
Fx of papilloedema?
1. Venous engorgements and loss of venous pulsation 2. Blurring of optic disc margin 3. Paton's lines = radial retinal lines cascading from the optic disc
108
5 causes of papilloedema?
1. SOL 2. Hydrocephalus 3. IIH 4. Malignant HTN 5. Hypercapnia
109
3 medical causes of papilloedema?
1. HypoPT and hypocalcaemia | 2. Vitamin A toxicity
110
3 causes of optic neuritis?
1. MS 2. DM 3. Syphilis
111
Fx of optic neuritis?
1. Unilateral decrease in visual acuity over hrs or days 2. Red desaturation (poor discrimination of colours) 3. Pain worse on eye movement 4. RAPD 5. Central scotoma
112
Mx of optic neuritis?
1. High dose steroids | 2. Recovery usually rakes 4-6 weeks
113
Prognosis of optic neuritis w/ regards to MS?
MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%
114
Most common cause of stye?
S. aureus
115
Mx of anterior uveitis/
Steroid (e.g. prednisolone acetate) + mydriatic eye drops (cyclopentolate)
116
Anterior uveitis defn?
Inflammation of the anterior portion of the uvea, namely the iris and ciliary body, and is HLA-B27 associated
117
Conditions associated with anterior uveitis?
1. Ank Spond 2. Reactive arthritis 3. IBD 4. Behcet's 5. Sarcoidosis
118
Cheese and tomato pizza on retina?
Central retinal vein occlusion
119
Herpes zoster ophthalmicus defn?
Reactivation of VZV in the ophthalmic division of the trigeminal nerve, accounting for 10% of cases of shingles
120
Hutchinson's sign?
Rash on tip/side of nose that is strongly indicative of herpes zoster ophthalmicus
121
Mx of herpes zoster ophthalmicus?
Oral antiviral tx for 7-10 days
122
Drusen?
Dry macular degeneration
123
Differentiating b/w scleritis and episcleritis?
Scleritis is painful, whilst episcleritis is not
124
Classification of diabetic retinopathy?
1. Background retinopathy 2. Pre-proliferative retinopathy 3. Proliferative retinopathy
125
Background diabetic retinopathy fx?
1. Microaneurysms (dots) 2. Haemorrhages (blots) 3. Hard exudates
126
Pre-proliferative diabetic retinopathy fx?
1. Cotton wool spots (soft exudates) 2. Venous beading 3. Cluster haemorrhages
127
Proliferative diabetic retinopathy fx?
1. Neovascularisation | 2. Fibrous tissue forming anterior to retinal disc
128
Flashers and floaters?
Posterior vitreous detachment
129
Most common cause of persistent watery eye in an infant?
Nasolacrimal duct obstruction
130
Cause of nasolacrimal duct obstruction?
Imperforate membrane, usually at the lower end of the lacrimal duct
131
Mx of nasolacrimal duct obstruction?
1. Teach parents to massage lacrimal duct | 2. Unresolved by 1y/o --> ophthalmologist
132
Complication of mydriatic drops?
Precipitant of acute angle closure glaucoma
133
Ptosis + dilated pupil?
Third nerve palsy
134
Ptosis + constricted pupil?
Horner's syndrome
135
Corneal ulcer defn?
Aka microbial keratitis, is an infection of the cornea by a bacteria, fungi, or protists
136
RF for corneal ulcers?
Steroid eye drops
137
Mx of allergic conjunctivitis?
1. 1st line = topical/systemic antihistamines | 2. 2nd line = topical mast cell stabilisers e.g. sodium cromoglicate
138
Argyll-Robertson pupil?
ARP 1. Accomodation Reflex Present (ARP) but 2. Pupillary Reflex Absent (PRA)
139
2 causes of Argyll Robertson pupil?
1. Syphilis | 2. DM
140
Glaucoma screening?
Those with positive FHx should be screened annually from 40 y/o
141
Vitreous haemorrhage presentation?
1. Painless visual loss or haze 2. Red hue in vision 3. Floaters/shadows/dark spots in vision
142
Vitreous haemorrhage Ix?
1. Dilated fundoscopy = may show haemorrhage in vitreous cavity 2. Slit lamp = RBCs in the anterior vitreous
143
Holmes-Adie pupil?
1. Dilated pupil, slowly reactive to light with definite accommodation 2. Damage to parasympathetic innervation of the eye due to viral/bacterial infection
144
Marcus-Gunn pupil?
RAPD
145
Red desaturation?
Optic neuritis
146
Orbital cellulitis fx?
1. Painful, swollen eye 2. Reduced vicual acuity 3. Proptosis and restriction of eye movement
147
Orbital cellulitis defn?
An infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe, usually caused by a spreading URTI from the sinuses
148
Periorbital cellulitis defn?
A less serious superficial infection anterior to the orbital septum
149
Mx of orbital cellulitis?
Admission to hospital for IV Abx
150
Afferent pupillary defect, cherry red spot on pale retina?
Central retinal artery occlusion
151
Entropion?
In turning of the eyelids
152
Ectropion?
Out-turning of the eyelids
153
Causes of tunnel vision?
1. Papilloedema 2. Glaucoma 3. Retinitis pigmentosa 4. Choroidoretinitis 5. Hysteria
154
Bilateral eye grittiness?
Blepharitis
155
RFs for orbital cellulitis?
1. Childhood 2. Previous sinus infection 3. Lack of HiB vaccination 4. Ear/facial infection 5. Recent eyelid infection/insect bite on eyelid
156
Esotropia?
Squint towards nose
157
Exotropia?
Squint temporally
158
Hypertopia?
Squint superiorly
159
Hypotropia?
Squint inferiorly
160
Fluorescein eye stain shows a dendritic ulcer?
Herpes simplex keratitis
161
6 causes of a red eye?
1. Acute angle closure glaucoma 2. Anterior uveitis 3. Scleritis 4. Episcleritis 5. Conjunctivitis 6. Subconjunctival haemorrhage 7. Endophthalmitis
162
Mx of entropion?
Eye lubricants and tape to pull eye outwards whilst awaiting surgery
163
Ix for orbital cellulitis?
Contrast-enhanced CT scan of the orbits, sinuses and brain
164
How to differentiate orbital from preseptal cellulitis?
Reduced visual acuity, proptosis, ophthalmoplegia/pain with eye movements are NOT consistent with preseptal cellulitis
165
2 causes of RAPD?
1. Retina = detachment | 2. Optic nerve = optic neuritis e.g. MS
166
Afferent pupillary reflex path?
Retina --> optic nerve --> lateral geniculate body --> midbrain
167
Efferent pupillary reflex path?
Edinger Westphal nucleus (midbrain) --> oculomotor nerve
168
Holmes Adie Syndrome?
Association of Holmes Adie pupil with absent ankle/knee reflexes
169
Why are antioxidant dietary supplements not recommended for smokers?
Beta carotene has been found to increase the risk of lung cancer

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