Pathology Flashcards
1
Q
What are the cells of the epithelial surface of the lens?
A
they are anucleate
2
Q
What is cupping?
A
raised intraocular pressure which degenerated the optic disc and nerve
3
Q
What does cupping look like?
A
- rolled edges of the optic disc
- depressed centre
- therefore, the optic disc appears larger
4
Q
What is the main test for diplopia?
A
- cover test: tests the squint and gives more information
- corneal reflections
5
Q
What are the names for a squint with outward or inward movement?
A
- outward = esotropia/convergent
- inward = exotropia/divergent
6
Q
What are the names for a squint with upward or downward movement?
A
- downward = hypertropia
- upward = hypotropia
7
Q
What are the features and causes of horizontal double vision?
A
- Esotropia or exotropia on cover test
- LR or MR problem
8
Q
What are the features and causes of vertical double vision?
A
- Hypertropia or hypotropia on cover test
- SR, SR, IR, IO problem
9
Q
What causes a global haemorrhage?
A
vein occlusion
10
Q
What causes a pale retina with a cherry red spot?
A
artery occlusion
11
Q
What is normal pressure in the eye?
A
16-21
12
Q
What are the two sight-threatening conditions?
A
GCA
Closed-angle glaucoma
13
Q
What is the most common cause and age group for eye trauma?
A
- 25-34y (younger men and older women)
- in men, machinery and assault
- in women, home-related falls
14
Q
What is used to identify epithelial loss in the eye?
A
fluorescein drops
15
Q
What are the main forms of blunt trauma to the eye?
A
- Blow out fracture
- Subconjunctival haemorrhage
- Traumatic uveitis
- Hyphaema
- Tearing of intra-ocular structures eg lens detachment
- Retinal detachment
- Choroidal tear
- Commotio retinae/bruised retina
- Optic nerve avulsion
16
Q
What herniates down into the sinuses in a blowout fracture?
A
inferior rectus or fat
17
Q
What is hyphaema?
A
blood in the anterior chamber of the eye which pools and forms a meniscus
18
Q
What does a retinal detachment look like?
A
crinkly appearance of the retina
19
Q
What are the most common forms of penetrating trauma from large objects?
A
- Lid laceration
- Corneal laceration
- Scleral lacerations
- Sympathetic ophthalmia
20
Q
What does a corneal laceration present with?
A
- beam-shaped pupil
- flat anterior chamber
- seen with Seidel test with fluorescein
- iris can leak
21
Q
What are the main types of trauma from small objects?
A
- Sub-tarsal
- Conjunctival
- Corneal: metallic foreign bodies
- Intra-ocular: beware of fast moving particles and ALWAYS XR
- Intra-orbital
22
Q
How do you remove small foreign objects?
A
- slit lamp
- LA
- edge of needle
- cover with chloramphenicol ointment
23
Q
What can a foreign body cause?
A
a traumatic cataract
24
Q
What does alkali do to the eye?
A
- changes to the conjunctiva and cornea
- penetrate intraocular structures
- look for ischemia around the limbus (china-white eye with no veins)
25
What do acids do to the eye?
coagulate proteins but don't penetrate
26
What is the treatment for chemical burns in the eye?
- irrigate thoroughly immediately
- check toxbase for pH and half-life etc
- assess with slit lamp
(solution to pollution is dilution)
27
What are the golden rules for ocular trauma?
- history is key
- always record visual acuity
- don't forget fluorescein
- handle suspected globe rupture with care
- XR obits if suspicion of intra-ocular foreign body
- immediate irrigation of chemical injuries (solution to pollution is dilution)
28
What does hypertension do to the eye?
the fundus reflects the severity
- attenuated blood vessels
- cotton wool spots
- hard exudates
- retinal haemorrhage
- optic disc oedema
29
What is a central retinal artery occlusion?
sudden painless loss of vision and the retinal nerve fibre layers becomes swollen except at fovea (cherry red spot)
30
What happens in a central retinal vein occlusion?
- sudden painless visual loss
- degree of ischemia correlates to the degree of reduced vision and fundal appearances
- way more common than the artery ones
31
What is a branch vein occlusion?
painless disturbance in vision which can be asymptomatic
32
What are the causes of uveitis in inflammatory disease?
- HLA-B27
- sarcoidosis
- TB
- syphilus
- juvenile and psoriatic arthritis
- herpes zoster
- toxoplasmosis
- candidiasis
33
What are the main features of GCA?
- can cause blindness
- multinucleated giant cells
- inflammation of middle sized arteries
- associated with polymyalgia rheumatica
34
What are the features of thyroid eye disease?
- proptosis, lid retraction, lid lag, lig oedema, there can be glaucoma, injection, chemosis
- smoking worsens this
- control thyroid function, surgical decompress
35
What are the connective tissue disorders that can cause eye diseases?
```
SLE = ocular inflammation
RA = dry eyes, scleritis and corneal melt
Sjogren's = dry eyes + infiltration of lacrimal glands
Marfan's = lens can dislocate superiorly
```
36
What is the dermatology disease associated with the eye?
Stevens-Johnson syndrome causes occlusion of the lacrimal glands, corneal ulcers and symblepharon
37
What is the main blood supply to the eye?
- internal carotid artery gives rise to the ophthalmic artery which is the major blood supply to the eye
- the central retinal artery is a branch of this
38
What are the layers of the retina supplied by?
- inner 2/3rds retina = central retinal artery
| - outer 1/3rd retina (mostly photoreceptors here) = choroid
39
What causes a pale or a dark retina?
- pale = artery occlusion
| - dark = vein occlusion
40
What is the normal pathway of aqueous humour?
- made in ciliary body
- travels between lens and iris
- through pupil
- into trabecular meshwork
41
What does most of the refracting in the eye?
the cornea does the majority and the lens does the rest
42
What is myopia?
- short-sightedness
- image focussed in front of the retina
- needs a concave lens
43
What is hypermetropia?
- long-sightedness
- image focussed behind the retina
- needs a convex lens
44
What is astigmatism?
irregular corneal curvature
45
What is presbyopia?
loss of accommodation with ageing
46
What are the main causes of sudden visual loss?
- A RMD
- B leed/Blocked vessel
- C losed angle glaucoma
- D etached retina
47
What are the main causes of gradual visual loss?
- A RMD
- B lur (refractive error)
- C ataract
- D iabetes
- G laucoma
48
What is involved in the second cranial nerve exam?
- visual acuity
- optic discs
- colour vision
- pupils
- visual field assessment
49
What are the functions of CSF?
- maintains stable extracellular environment
- buoyancy
- provides mechanical protection
- waste removal
- nutrition
50
What is the production of CSF?
- made in the lateral ventricles by the choroid plexuses
- travels through the 3rd and 4th ventricles
- into the subarachnoid space
51
What are the CSF-related causes of increased ICP?
- obstruction to CSF circulation
- CSF overproduction
- inadequate absorption
52
What are the causes of an optic nerve problem resulting in a visual field defect?
- Common cause is ischaemic optic neuropathy (GCA)
- Optic neuritis (if you have MS this is common)- scan with MRI
- Tumours are rare
53
How do altitiudinal visual field defects arise?
- vessel supplying the retina splits into upper and lower
| - if one of these is taken out there there is a loss of top or bottom vision
54
What is optic neuritis?
- progressive visual loss
- pain behind eye on movement
- colour desaturation
- central scotoma
- recovery is over weeks to months
- optic atrophy following this
55
What can the optic chasm be affected by?
pituitary tumour, craniopharyngioma or meningioma
56
What are the optic tracts and radiations affected by?
tumours, demyelination and vascular anomalies
57
What does injury to the optic tracts and radiations cause?
homonymous defects, macula not spared, quadrantanopia
58
What is the occipital cortex affected by?
vascular disease or demyelination
59
Is the macula spared in occiptal cortex pathology?
macula is spared because it is such a huge area of the occipital cortex so a problem is unlikely to take out the whole of this area so the macular will be ok
60
What are the features of optic neuritis?
- loss of vision in one eye
- 24-48 hours
- demyelination
- colours affected
- central structure in field tests
