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Opthalmology > Pathology > Flashcards

Pathology Flashcards

1
Q

Which tumours can affect the ventricles and choroid plexus

A

Colloid cyst - often at interventricular foramen
Ependymomas - arise from ependymal cells
Choroid plexus tumours

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2
Q

What is hydrocephalus

A

Accumulation of CSF in the brain
Usually due to some sort of blockage in the system
Can cause the head to enlarge and increases pressure in brain
Treated with a shunt

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3
Q

List the different types of ventricular haemorrhage

A

Epidural hematoma, arterial bleed between skull and dura
Subdural hematoma, venous bleed between dura and arachnoid
Subarachnoid haemorrhage

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4
Q

What is idiopathic intracranial hypertension

A

Increase in CSF pressure but no imaging features of hydrocephalus
No known cause
Causes headache and visual disturbance

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5
Q

What is papilloedema

A

Optic disc swelling due to raised intracranial pressure - puts pressure on the optic nerve
Causes enlarged blind spot, blurred vision and loss of vision
Graded from 1-5

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6
Q

What can cause raised intracranial pressure

A

Head injury
Space occupying lesion, tumour, abscess or haemorrhage
Hydrocephalus
Meningitis - leads to inflammation

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7
Q

What occurs if raised ICP is not relieved

A

Brain damage

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8
Q

What visual changes can occur with raised ICP

A 
Transient blurry vision 
Double vision - diplopia 
Loss of vision 
Papilloedema 
Pupillary changes

Can affect one or both eyes depending on cause

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9
Q

How can raised ICP affect the optic nerve

A

Compresses them
Will also compress the blood supply to the retina
Leading to swelling off the optic disc - papilloedema

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10
Q

What visual symptoms occur with papilloedema

A 
Transient visual obscurations 
Transient flickering 
Blurring 
Constriction of the visual field 
Decreased colour perception
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11
Q

Describe the appearance of the optic disc in papilloedema grade 1-5

A 
Blurry margins in all grades 
1 - C shaped halo 
2 - circular halo 
3 - peripheral vessels disappear from view 
4 - central vessels disappear 
5- no visible vessels
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12
Q

What can damage the oculomotor nerve

A

Compression by raised ICP

Tentorial herniation - pushed through notch by raised ICP

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13
Q

Which fibres tend to be affected first when the oculomotor nerve is compressed

A

Parasympathetic

They usually sit on the outside of the nerve

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14
Q

List symptoms of oculomotor nerve damage

A

Paralysis of extra-ocular muscles
No/slow pupillary reflex (parasympathetic not working)
Dilated pupil - when it becomes fixed it means there has been severe damaged
Ptosis - damage of nerve to LPS
Eye looking down and out - superior oblique still works

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15
Q

Describe symptoms of trochlear nerve damage

A

Paralysis of superior oblique muscle - cannot move inferomedially
Diplopia when looking down

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16
Q

What is diplopia

A

Double vision

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17
Q

What can damage the trochlear nerve

A

Stretching
Compression - ICP
isolated injury is very unusual

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18
Q

What type of damage is the abducent nerve susceptible to

A

Stretch

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19
Q

What are the symptoms of abducent nerve damage

A

Eye can’t move laterally in horizontal plane - lateral rectus is paralysed
Medial deviation of eye

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20
Q

What are cataracts

A

Opacification within the lens

Leads to reduction in vision which affects daily living

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21
Q

What can cause cataracts

A

Degenerative changes in lens fibres - age (most common)
Cumulative UVB damage
May also be caused by hypertension, smoking
Trauma - can be a sudden cataract
Metabolic - diabetes
Congenital
Drug induced - steroids
Intra-uterine infections - rubella, CMV, toxoplasmosis

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22
Q

What is glaucoma

A

A group of diseases characterised by progressive optic nerve damage and visual field loss
Abnormal increase in pressure in the eye
Due to the amount of vitreous fluid and aqueous humour

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23
Q

What areas of the eye does glaucoma have the biggest consequences

A

Optic disc and nerve

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24
Q

What causes 50% of blindness worldwide

A

Cataracts

rarely causes blindness in UK but is the most common cause of gradual visual impairment,

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25
Q

What are the two types of glaucoma

A

Open angled - primary and secondary

Angle closure - primary or secondary

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26
Q

What causes open angled glaucoma

A

Poor drainage through the trabecular network
Fluid builds up
Primary - nothing to see in eye
Secondary - there is something else is blocking the drains – red cells, white cells in uveitis, protein etc.

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27
Q

How does open angled glaucoma present

A

Very slow onset
Usually asymptomatic - picked up by screening
Will see an open anterior chamber angle, raised intra-ocular pressure, “cupping” of the optic disc and progressive loss of visual fields

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28
Q

How do you treat primary open angled glaucoma

A

Pharmacological treatment - prostaglandin then B-blocker or CAI then truspot/alphagan

Then surgery - trabeculectomy
Make a fistula in the eye to allow drainage

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29
Q

What causes angle closure glaucoma

A

Iris becomes opposed to the lens and stops fluid flowing round to the trabecular network
Drainage is patent but fluid cannot get to it
The iris can close over the angle
Fluid builds up and increases pressure

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30
Q

How does angle closure glaucoma present

A 
Unilateral 
Visual loss 
Pain
Red eye 
Cloudy / Hazy cornea
Fixed, mid dilated pupil
Severe headache 
May have nausea and vomiting 
Raised intra-ocular pressure (50-80mmHg)

Can be a medical emergency

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31
Q

How do you treat angle closure glaucoma

A

Laser treatment to the iris - iridotomy
Zap a hole to allow fluid to drain - reduces recurrence

Can also give IV Diamox – carbonic anhydrase inhibitor, topical anti-hypertensives, topical steroids, pilocarpine

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32
Q

What is ‘cupping’ of the optic disc

A

Edges of the optic disc become rolled up and the centre depressed
Caused by pressure damage

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33
Q

Which cancers can affect the eye

A

BCC
SCC
Melanoma

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34
Q

Which part of the body is the only one with no reported incidence of malignancy

A

lens

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35
Q

What is conjunctivitis and how does it present

A

Inflammation of the conjunctiva
Caused swelling, redness, pain and heat
Usually viral

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36
Q

What is scleritis and how does it present

A

Inflammation of the sclera
rarer and more severe
Associated with pain on movement and deep redness

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37
Q

Episcleritis is usually self-limiting - true or false

A

True

It’s a superficial inflammation

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38
Q

What is ARMD

A

Age related macular degeneration

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39
Q

What are the 2 types of macular degeneration

A

Dry - no vascular proliferation
- more common

Wet - vascular proliferation
- eye grows new blood vessels within the macula to ‘repair’ dry ARMD damage but they leak

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40
Q

How do you treat wet macular degeneration

A

Anti-VEGF monoclonal antibodies
Injected into the eye
Stops proliferation of blood vessels

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41
Q

What is Drusen

A

Accumulation of dry product of inflammation (e.g. proteins, lipid etc)
Appear as little yellow plaques on retina

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42
Q

What is an Argyll Robertson pupil

A

Accommodates but doesn’t react

Doesn’t constrict/dilate but you can see near and far

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43
Q

What eye pathologies can be caused by diabetes

A 
Blurred vision - increased osmotic pressure 
Peripheral neuropathy can affect eyes 
Cataracts 
Rubeotic glaucoma 
Retinopathy
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44
Q

How does diabetes cause cataracts

A

Increased sugar in lens, converted to sorbitol which gets stuck in the cells
Alters the osmotic gradients and leads to swelling and fibre disruption

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45
Q

What is retinopathy

A

Poor functioning of vessels in the eye
Leaky and haemorrhages
Leads to vision loss

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46
Q

What vascular diseases can affect the eye

A

Arterial occlusion -thromboembolic disease in carotids

Venous - giant cell arteritis (temporal)

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47
Q

What happens if you have a TIA in the central artery of the eye

A

Sudden visual loss in one eye - like a curtain coming down

Not painful

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48
Q

What is the cardinal feature of an eye movement defect

A

Double vision (diplopia)

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49
Q

What is the cardinal feature of a visual defect

A

Loss of visual acuity

Loss of visual fields

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50
Q

List potential causes of eye disease

A 
Vascular disease 
Tumours - SOL
Trauma 
Demyelination - MS
Inflammation/infection 
Congenital abnormalities
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51
Q

What does a VIth nerve palsy lead to

A

Palsy of the lateral rectus
Will no longer be able to abduct the eye
Causes horizontal double vision

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52
Q

What can cause a VIth nerve palsy

A

Microvascular
Raised Intracranial pressure
Tumour - acoustic neuroma
Congenital

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53
Q

Why is the VIth nerve susceptible to damage by raised ICP

A

The course of the nerve

It runs over a tip in the bone and is easily compressed

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54
Q

What does a IVth nerve palsy lead

A

Palsy of the superior oblique muscle
Eye will sit higher and outwards
Cannot move the eye down and in
Get vertical double vision

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55
Q

How might people compensate for a IVth nerve palsy

A

Tilting their head

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56
Q

What can cause a IVth nerve palsy

A

Congenital defect
Microvascular complication
Tumour
If bilateral it is usually trauma

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57
Q

How does the eye appear in a IIIrd nerve palsy

A

Eye will sit down and out
Dilated pupil
Drooping eyelid

Affects MR, SR, IR, IO, sphincter papillae and LPS

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58
Q

What can cause a IIIrd nerve palsy

A 
Microvascular problems 
Tumour 
Aneurysm (will be painful!) - 3rd nerve passes very close the PCA so aneurysm in this can compress the nerve 
MS 
Congenital
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59
Q

What causes inter-nuclear ophthalmoplegia

A

MS
Vascular issues
etc etc

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60
Q

What is the inter-nuclear pathway involves in

A

Allows the eyes to work together

SO they look the same way, at the same time, at the same speed

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61
Q

What pathologies commonly cause defects in the optic nerve

A

Ischaemic optic neuropathy
Optic neuritis - common in MS
Tumours - rare

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62
Q

How does an optic nerve defect affect the visual fields

A

Either complete loss of vision unilaterally or loss of horizontal field in one eye

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63
Q

How does optic neuritis present

A 
Progressive, unilateral vision loss 
Pain behind the eye, especially on movement 
Colour desaturation 
Central scotoma 
Enlarging blind spot
RAPD 
Optic disc swelling
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64
Q

Which pathologies can affect the optic chiasm

A

Pituitary tumour
Craniopharyngioma
Meningioma

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65
Q

Defect in the optic chiasm leads to what visual defect

A

Bitemporal hemianopia

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66
Q

What pathologies can cause defects in the optic tracts and their radiations

A

Tumours
Demyelination
Vascular anomalies

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67
Q

How does a defect in the optic tracts and their radiations present

A

Homonymous defect - affects the same side of each eye
Macula is not spared
Affects in quadrants or as hemianopia (halves)

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68
Q

What pathologies can cause defects in the occipital cortex

A

Vascular disease

Demyelination - MS

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69
Q

How do defects in the occipital cortex present

A

Homonymous defect - affects same side of both eyes

Macular sparing

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70
Q

List causes of sudden visual loss

A 
Vascular occlusion - central retinal artery or vein 
Ischaemic optic neuropathy 
Vitreous haemorrhage 
Amaurosis Fugax
Retinal detachment 
Retrobulbar neuritis 
ARMD - wet type 
Closed angle glaucoma 
Optic neuritis 
Giant Cell Arteritis
Cerebral infarct involving the optic tract or occipital cortex
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71
Q

Haemorrhage from abnormal blood vessles occurs in which eye pathologies

A

Diabetic retinopathy

Wet ARMD

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72
Q

What are the signs and symptoms of a central retinal artery occlusion

A 
Sudden visual loss - total or subtotal 
No pain 
RAPD 
Pale retina 
Pink spot at fovea as still has some blood supply from choroid - cherry red spot
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73
Q

What can cause a central retinal artery occlusion

A

Carotid artery disease
Emboli from the heart
- may see common CV risk factors

GCA

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74
Q

What can cause a central retinal vein occlusion

A

Endothelial damage - diabetes
Abnormal blood flow - hypertension
Hypercoagulable states - cancer

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75
Q

What are the signs and symptoms of a central retinal vein occlusion

A 
Sudden vision loss - mod to severe
Painless
RAPD
Retinal haemorrhages - flame shaped, stormy sunset
Cotton wool spots 
Dilated, tortuous veins 
Disc swelling
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76
Q

What is ischaemic optic neuropathy

A

Occlusion of the circulation to the optic nerve head

Can be caused by giant cell arteritis (inflammation occludes the vessels) or atherosclerosis (usual risk factors)

Leads to sudden, severe visual loss - irreversible
RAPD
Swollen optic disc with hyperaemia. Pale disc later

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77
Q

List symptoms of giant cell arteritis

A 
Headache - temporal 
Jaw/tongue claudication 
Scalp tenderness 
Tender and enlarged scalp arteries 
Malaise 
Shoulder girdle weakness
Recent weight loss
Sudden visual loss - if progresses to ION
May also have blurred vision, amaurosis fugax and diplopia
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78
Q

What are the symptoms of a vitreous haemorrhage

A

Sudden loss of vision
Floaters in vision
Loss of the red relflex
May see the haemorrhage on fundoscopy

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79
Q

What are the signs and symptoms of retinal detachment

A 
Painless vision loss 
Sudden onset of flashes/floaters 
Dark shadow in peripheral vision, increasing in size
May have RAPD 
May see the tear with ophthalmoscope
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80
Q

Sudden visual loss occurs with dry ARMD - true or false

A

False
It occurs with wet ARMD
Dry leads to progressive loss

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81
Q

What are the signs and symptoms of wet ARMD

A 
Rapid central visual loss 
Distortion - straight lines bend (metamorphopsia)
Haemorrhage and exudate on imaging 
Oedema over macula - slightly paler
Fluid build up on OCT
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82
Q

What are the signs and symptoms of closed angle glaucoma

A 
Painful, red eye 
Sudden visual loss 
Headache 
Nausea and vomiting 
Cloudy cornea 
Circumcorneal injection 
Dilated pupil
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83
Q

List causes of gradual visual loss

A 
Cataract
Dry ARMD 
Refractive error 
Glaucoma - open angle 
Diabetic retinopathy
Age related changes
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84
Q

What are the symptoms of cataracts

A

Gradual visual decline - haziness/blurriness

May get a glare

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85
Q

How do you treat cataracts

A

Surgical removal of the lens - phacoemulsification

Replace with an intra-ocular lens implant

86
Q

What are the signs and symptoms of dry ARMD

A

Gradual visual decline - blurriness
Central vision missing - central scotoma
Drusen - build up of exudate seen as yellow deposits around macula
May also see abnormal pigmentation in this area
Atrophic parts of retina on imaging

87
Q

What is a refractive error

A

Eye cannot clearly focus images

Includes being short or long sighted and stigmatism

88
Q

What are the signs and symptoms of open angled glaucoma

A

Often asymptomatic - picked up by optician
Cupped disc
Visual field defects
High IOP

89
Q

How does raised ICP lead to papilloedema

A

Optic nerve is also surrounded by meninges and therefore CSF
So an increase in pressure in the SAS around the optic nerve affects it

90
Q

What is the major complication of raised ICP

A

Brain ischaemia and swelling

Brain gets pushed through the foramen magnum which compresses the brain stem and the patient will stop breathing

91
Q

Malignant hypertension can lead to papilloedema - true or false

A

True

92
Q

What leads to accumulation of CSF

A

Obstruction to it’s circulation
Overproduction
Inadequate absorption

93
Q

What is idiopathic intercranial hypertension

A

Cause of papilloedema
May be a result of stenosis of cerebral sinuses, increased abdominal pressure (obesity), microemboli
Poorly understood

94
Q

What can happen if disc swelling becomes chronic

A

They become atrophic and pale

There may be a loss of visual function and even blindness

95
Q

What signs might you see in retinopathy

A

Microaneurysms - dot and blot haemorrhages
Hard exudate
Cotton wool patches
Abnormal blood vessels
Venous beading – segmentation of the veins
IRMA – shunt vessels between the arterioles and venules formed by the ischaemic drive, normal vessels, not very leaky

96
Q

What drives new vessel formation

A

VEGF

97
Q

What is the difference between NVD and NVE

A

NVD - new vessels on disc

  • worse prognosis
  • suggests severe ischaemia

NVE - new vessels in periphery
- occurs locally to the ischaemia

98
Q

What is rubeosis iridis

A

Vessel formation on the iris
Due to extreme VEGF production due to severe ischaemia
Irreversible
Very poor prognostic sign – suggests severe ischaemia

99
Q

Why can diabetic patients lose vision

A

Retinal oedema
Vitreous haemorrhage
Scarring and tractional retinal detachment

100
Q

How do you manage diabetic eye disease

A 
Optimise control 
Laser treatment - photocoagulation to stop bleeds 
Vitrectomy - surgical 
Rehabilitation
Anti-VEGF injections
101
Q

List features of hypertensive retinopathy

A 
Attenuated blood vessels 
Cotton wool spots 
Hard exudate 
Retinal haemorrhage 
Optic disc oedema
102
Q

How does an infarcted retina appear

A

Very Pale

103
Q

What are keratic precipitates

A

Deposits of white cells in the eye

Appear as little white dots in the eye

104
Q

List some infective causes of uveitis

A

TB
Herpes zoster
Syphilis

105
Q

List some non-infective causes of uveitis

A

Idiopathic
Sarcoidosis
Ankylosing spondylitis
Juvenile arthritis

106
Q

List features of thyroid eye disease

A 
Proptosis 
Lid retraction and lag 
Lid oedema 
Restrictive myopathy 
Glaucoma 
Injection
107
Q

How can SLE affect the eyes

A

Leads to red, inflamed eyes

Deep tissue involved - scleritis

108
Q

How can RA affect the eyes

A

Dry eyes
Scleritis
Corneal melt

109
Q

How does Marfan’s present in the eyes

A

Displacement of the lens

Will go up the way

110
Q

\what can cause a subconjunctival haemorrhage

A

Can be spontaneous - particularly if on anti-coagulants
Trauma
Hypertension

111
Q

What can lead to orbital cellulitis

A

Insect bite
Eye lid trauma
In kids it’s often caused by sinus infection that travels up to eye

112
Q

What is the major consequence of orbital cellulitis

A

Brain abscesses - this can be life threatening

113
Q

Who is vulnerable to acanthamoeba infections

A

Contact lens wearers

114
Q

Describe how different types of pain suggest pathology in different parts of the eye

A

Grittiness - surface problem

Achy pain - intraocular

115
Q

What is the difference between anterior and posterior blepharitis

A

Anterior - lid margin and lashes affected
- lid margin is redder than deep eye

Posterior - due to Meibomian gland dysfunction
- redness is in deep part of the lid

116
Q

What are the Meibomian glands

A

oil secreting glands in the posterior part of the lid

if they don’t work properly it can lead to blepharitis

117
Q

What are the symptoms of blepharitis

A

Similar to conjunctivitis
Gritty eyes - foreign body sensation
Mild discharge

118
Q

What are the signs of seborrheic anterior blepharitis

A

Red lid margin
Lots of scales
No ulcers
Lashes stuck together

119
Q

What are the signs of staphylococcal anterior blepharitis

A

Red lid margin
Lashes distorted - loss or ingrown
Styes
Marginal ulcers

120
Q

What are the signs of posterior blepharitis

A

lid margin and lashes unaffected
Gland opening swollen
Dry secretions at gland openings
Meibomian cysts

121
Q

What other condition is posterior blepharitis associated with

A

Acne rosacea

122
Q

How do you treat blepharitis

A

Lid hygiene - daily bathing
Supplementary tear drops
Oral doxycycline for 2-3 months

123
Q

List causes of conjunctivitis

A 
Viral - watery, after URTI
Bacterial - purulent, sticky 
Chlamydia - low grade and chronic 
Allergic 
Chemical/drugs 
Associated with skin disease
124
Q

List symptoms of conjunctivitis

A 
Red eye 
Foreign body sensation - gritty eyes 
Discharge - watery or purulent
Pre-auricular lymph nodes - viral causes 
Chemosis 
Itch (in allergic) 
Papillae or follicles 
Vision unaffected
125
Q

In herpes zoster infections, why would you be concerned if the nose was affected

A

If the tip of the nose is affected it means the nasocilliary nerve has been affected and so it is likely the eye will be involved
This is when shingles affects the V1 nerve

126
Q

List signs and symptoms of corneal ulcers

A 
Pain - needle like and severe 
Photophobia 
Profuse lacrimation - watery 
Red eye - around the cornea 
Corneal opacity 
Staining with fluorescein 
Hypopyon
127
Q

How do autoimmune corneal ulcers occur

A

Common in RA

Indicates that the systemic autoimmune condition is poorly controlled

128
Q

Aside from bacteria and viruses, what can cause corneal ulcers

A

Exposure keratitis - seen in those who cannot fully close their eyes (thyroid or nerve palsy)
Dry eyes - Sjorgen’s
Neurotrophic - herpes zoster
Vit A deficiency

129
Q

How do you treat a corneal ulcer

A

Corneal scrape to identify cause
Antimicrobials if bacterial
Antiviral if herpetic - aciclovir for 7-`10 days
Anti-inflammatory if autoimmune

130
Q

List causes of anterior uveitis

A

Idiopathic - 50-60%
Autoimmune - UC, sarcoid, ank spond (associated with HLA-B27)
Infective - TB, syphilis, herpes (uncommon)
Malignancy
Trauma

131
Q

List signs and symptoms of anterior uveitis

A 
Pain - dull ache 
May have reduced vision - blurry
Photophobia 
Red eye - around cornea 
Ciliary injection 
Cells and flare in anterior chamber 
Precipitates 
Hypopyon 
Irregular pupil 
Posterior synechiae – pupil gets stuck down, may not dilate well
132
Q

How do you manage anterior uveitis

A

Topical steroids - 4-8 weeks
Hourly with gradual taper

Mydriatics - paralyses the muscle and reduces photosensitivity and pain from spasm

Investigate systemic causes

133
Q

Which other pathology is episcleritis associated with

A

Gout

134
Q

How do you differentiate between episcleritis and scleritis

A

Adding a vasoconstrictor like topical phenylephrine – in episcleritis the redness would blanche, if deeper inflammation like scleritis it would not

135
Q

How do you manage episcleritis

A

Usually self-limiting
Lubrication
Rarely a topical NSAID

136
Q

Which other pathologies is scleritis associated with

A

RA
Wegener’s granulomatosis
Many connective tissue diseases

137
Q

List symptoms of scleritis

A

VERY painful
Will wake you up from sleep and cannot touch the eye
Injections of the deep vascular plexus - diffuse and deep redness

138
Q

How do you treat scleritis

A

Oral NSAIDs
Oral steroids
Steroid sparing agents

139
Q

A droopy eyelid may be a sign of what extra-ocular pathology

A

Lung cancer

This is a sign of Horner’s syndrome (constricted pupil and reduced ipsilateral sweating)

140
Q

What is RAPD and how would you diagnose it

A

Relevant afferent pupil defect
Do the swinging light test
You would see paradoxical dilation of one pupil when you shine the light in it

141
Q

New vessels form in dry ARMD - true or false

A

False

This occurs in wet ARMD and can lead to visual loss

142
Q

What are the signs of a macular pathology

A

Disturbance of central vision

Straight shapes and faces become distorted

143
Q

How can you treat diabetic retinopathy

A

get diabetes under control
laser treatment - target the new vessels
anti-VEGF injections

144
Q

In the UK, what vision level is considered partially sighted

A

6/60

145
Q

In the UK, what vision level is considered severely visually impaired

A

3/60

146
Q

What is emmetropia

A

normal vision

147
Q

What is presbyopia

A

Loss of accommodation seen in old age

148
Q

What is myopia

A

being short sighted

Eye is too large so focuses light before the retina

149
Q

what is hypertropia

A

being long sighted

eye is small so focuses light behind the retina

150
Q

List causes of a red eye

A 
Infective Conjunctivitis
Foreign Body 
Allergic Conjunctivitis 
Corneal Abrasion 
Blepharitis/ Chalazion 
Dry Eyes 
Subconjunctival Haemorrhage 
Glaucoma 
Anterior Uveitis
151
Q

Pain and photophobia is characteristic of which condition

A

Anterior uveitis

152
Q

Superficial dendritic ulcers are characteristic of what

A

Herpes simplex infection/ulcer

153
Q

Sudden and painful loss of vision is suggestive of what

A

Acute angle closure glaucoma

154
Q

What is amaurosis fugax

A

A transient loss of vision in one eye lasting usually

only a few minutes and at most a few hours - essentially a TIA involving the eye

155
Q

What can cause amaurosis fugax

A

Usually secondary to embolic event from carotid or heart

Must be investigated as a TIA – risk of stroke is high

156
Q

How do you treat wet ARMD

A

Anti-VEGF injections - injected straight into the vitreal body of the eye
This inhibits the growth factors stimulating new vessel growth

157
Q

What are the risk factors for diabetic retinopathy

A

Increased duration of diabetes - 90% of type ones will have it after 20 years
Poor diabetic control

158
Q

Active treatment is available for dry ARMD - true or false

A

False

Only available for wet ARMD in the form of anti-VEGF injections

159
Q

Halo’s forming around lights is a sign of which eye condition

A

Associated with corneal oedema which is seen in acute angle closure glaucoma

160
Q

Giant cell arteritis can lead to irreversible blindness - true or false

A

True
One of the true ophthalmic emergencies
Blindness can be bilateral and irreversible

161
Q

How do you treat giant cell arteritis

A

High dose oral steroids which are tapered down over months

162
Q

What type of discharge is seen in bacterial eye infections

A

Sticky and purulent

163
Q

What type of discharge is seen in viral eye infections

A

Watery

Also seen in surface eye irritation such as foreign bodies

164
Q

What type of eye pain indicates a surface issue

A

Scratchy / gritty / discomfort

E.g. conjunctivitis, foreign body

165
Q

What type of eye pain indicates an intraocular issue

A

Severe / deep / aching pain

E.g. iritis, scleritis, angle closure glaucoma

166
Q

What type of redness indicates an intraocular issue

A

Diffuse injection

If it is greatest around the cornea - circumcorneal

167
Q

What is chemosis

A

Oedema of the conjunctiva Makes the eye look like jelly

Seen in conjunctivitis

168
Q

How do you treat bacterial conjunctivitis

A

Treat with topical antibiotics ie chloramphenicol

169
Q

How do you treat viral conjunctivitis

A

Supportive treatment

Cool compresses, lubricants etc.

170
Q

What features are suggestive of chlamydia conjunctivitis

A

Young patient - sticky + red in first 10 days after birth
Unilateral
Follicular conjunctivitis
Diagnose by PCR swab

171
Q

List risk factors for corneal ulcers

A

Corneal abrasion
Contact lens wearer
Dry eye
Iatrogenic -loose suture or surgery

172
Q

If you apply topical steroids to a herpetic ulcer what can happen

A

It can lead to a geographic ulcer - the infection spreads across the eye

173
Q

How do you treat chlamydial conjunctivitis in an infant

A

Swabs
Erythromycin
contact traces

174
Q

How does a blocked nasolacrimal duct present in infancy

A

Sticky + white uninflamed eye from 2 months

Congenital block in the duct

175
Q

How do you treat a blocked nasolacrimal duct

A

Bathe and massage sac
Most resolve spontaneously by 1 year
Syringe and probing if not resolving

176
Q

What is the leading cause of blindness in people of working age in industrialized countries

A

diabetic retinopathy

177
Q

List risk factors for developing diabetic retinopathy

A 
Increasing duration of diabetes 
Poor blood sugar control 
Hypertension
Dramatically* improved diabetic control - sudden increase in control leads to short term worsening of the retinopathy 
Hypercholesterolaemia
Pregnancy
178
Q

Describe the pathogenesis of diabetic retinopathy

A

Chronic hyperglycaemia
Glucose molecules attaches to the basement membrane of the vasculature of the retina
Causes a loss of pericytes
This leads to vascular dysfunction and increases permeability
Reduced O2 transport leads to tissue hypoxia
Vaso-formative factors produced - VEGF
New vessel formataion occurs to overcome the hypoxia
New vessels do more harm than good – they leak a lot
Get haemorrhage and scarring

179
Q

What is the function of the pericytes in the eye

A

Pericytes help with the tight junctions in the eye vasculature – maintain eye/blood barrier
They are lost in diabetic retinopathy

180
Q

How can diabetic retinopathy lead to retinal detachment

A

DR can cause scarring

Contraction of scarring in the vitreous can lead to retinal detachment

181
Q

What causes visual loss in diabetic retinopathy

A

Retinal oedema affecting the fovea - macular oedema
Vitreous haemorrhage - due to leaking of the new vessels
Scarring/ tractional retinal detachment

182
Q

How is diabetic retinopathy classified

A

By the grade of the retinopahty and the maculopathy

183
Q

List the grades of retinopathy seen in diabetic retinopathy

A 
None 
Mild - micro-aneurysms
Moderate -  microaneurysm, hard exudates, flame shaped haemorrhage 
Severe 
Proliferative - new vessles
184
Q

How do you manage each grade of retinopathy

A

None-severe - observe and re-screen

If proliferative you give laser treatment

185
Q

List the grades of maculopathy seen in diabetic retinopathy

A

No maculopathy

Observable maculopathy - exudates between 1 & 2 disc diameters of the centre of the fovea

Referable maculopathy - any blot haemorrhages or hard exudates – within 1 disc diameter

186
Q

How can you treat the maculopathy seen in diabetic retinopathy

A

You treat if they have reduced vision
Intravitreal anti-VEGF injections are the gold standard now – better outcomes for preserving vision
Focal laser at macula – if they don’t respond to injection

187
Q

Describe the pathogenesis of glaucoma

A

Usually blockage to aqueous outflow - obstruction to drainage
Causes raised intra-ocular pressure
Damage and loss of retinal nerve fibres at optic disc
Visual field loss

188
Q

What is considered normal IOP

A

11.5-21.5 mmHG is considered normal

189
Q

Why is peripheral vision lost first in glaucoma

A

In periphery lots of photoreceptor’s feed into the same ganglion cell, in the macula less photoreceptors per ganglion
Therefore, loss of ganglion cells in periphery is noticed first as it wipes out more photoreceptors

190
Q

List risk factors for primary open angle glaucoma

A 
Age
raised intraocular pressure
Afro-Carribean origin
Family history
Myopia – short sighted is a risk
191
Q

Being highly myopic (very short sighted) increased the risk of which other condition

A

Retinal detachment - have larger eye so retina is thinner and vitreous is more watery so can move about more and separate more easily

Open angled-glaucoma

192
Q

Being highly hypermetropic (very long sighted) increased the risk of which other condition

A

Acute angle closure glaucoma

193
Q

What are the main subtypes of cataract

A

Nuclear Sclerotic – most common type, brown/green appearance
Cortical – spoke like pattern
Posterior Subcapsular - cataract develops at the back of the lens between the lens and the back of the capsule
Mature - appears white

194
Q

A mature cataract has an increased operative risk - true or false

A

True

195
Q

What is the most common cause of blindness in the elderly in the western world

A

ARMD

196
Q

How do you manage dry ARMD

A

No active treatment, just prevent progression to wet ARMD

Low Visual Aids

Dietary / smoking advice

  • Vitamin rich diet can reduce further visual loss and prevent progression to Wet ARMD
  • Macula is very sensitive to smoking damage so promote cessation

Amsler Grid - allows patients to monitor visual distortion – one of the first signs of progression to wet is increased distortion of straight lines

Blind registration

197
Q

What is OCT

A

Ocular Coherance Tomography
Cross sectional map of the retina
Can be used to diagnose and monitor wet ARMD

198
Q

How do you treat a central retinal artery occlusion

A

Only effective if presentation within 12-24 hrs
Treatment aims at dislodging blockage and restoring circulation

Ocular massage - can change the pressure in the eye and force may dislodge the blockage

Paper bag breathing – increases PCO2 which causes reflex vasodilation and may allow the blockage to move

IV Diamox - CAI which drops the intraocular pressure so pressure behind blockage is greater than in front and may push it on

Anterior Chamber Paracentesis – remove some aqueous fluid to reduce IOP and again move blockage down vascular tree

199
Q

What causes a cotton wool spot to appear in the retina

A

It is ischamia of the nerve fibre layer of retina

200
Q

How do you treat a central retinal vein occlusion

A

If no signs of ischaemia - observe (every 3 months initially then less frequently)

If ischaemic but no neovascularition - observe closely (every 4-6 weeks )

If ischaemic with neovascularisation – requires urgent argon laser pan-retinal photocoagulation

also try and find underlying risk factors and modify them

201
Q

How do you treat ischaemic optic anterior neuropathy

A

No active treatment

Assess and treat the risk factors - e.g. smoking

202
Q

How do you treat a retinal detachment

A

If picked up as early retinal tear can be lasered to prevent progression to proper detachment

Vitrectomy – similar to keyhole in the eye, clear away the vitreous gel, laser the initial tear and put a bubble of gas in to hold retina in place while things heal

203
Q

What is retrobulbar neuritis

A

Similar to optic neuritis except the inflammation is behind the optic nerve head so cannot be seen

204
Q

Which eye symptoms and signs can suggest a neurological issue

A

Optic nerve function – acuity, visual field, colour vision, pupil response
Ocular motility – 3rd, 4th, 6th nerve palsies

205
Q

What investigations should be done for bilateral papilloedema

A

Suggests raised ICP
Needs urgent imaging to rule out SOL
If no SOL you may be looking at IIH which can be diagnosed by LP

206
Q

How do you trea optic/retrobulbar neuritis

A

IV steroids may hasten recovery but not affect final VA. Oral steroids may worsen outcome

May be role for B Interferon

207
Q

What can cause Horner’s syndrome

A 
Pancoast tumour
Carotid/Aortic aneurysms
Lesions of neck
Congenital 
Idiopathic

Anything affecting the sympathetic chain

208
Q

Horizontal field defects are seen when which part of the tract is affected

A

Anything in front of the chiasm

209
Q

Vertical field defects are seen when which part of the tract is affected

A

Structures behind the chiasm

210
Q

What is a hyphaema

A

Fluid level of blood in the eye

211
Q

What is a hypopyon

A

Fluid level of white blood cells in the eye

Sign of severe intra-ocular infection

Opthalmology (9 decks)

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