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Ophthalmology Year 2 > Pathology Part 1 > Flashcards

Pathology Part 1 Flashcards

1
Q

Amaurosis fugax

A

Transient, painless loss of vision
o “Like a curtain coming down”
o Lasts ~5min with full recovery
o Examination usually normal

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2
Q

Anterior uveitis

A

Describes inflammation of the anterior portion of the uvea - iris and ciliary body. It is associated with HLA-B27 and may be seen in association with other HLA-B27 linked conditions.

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3
Q

Features of Anterior uveitis

A 
>   acute onset
>   ocular discomfort & pain
>   pupil may be small +/- irregular 
>   photophobia (often intense)
>   blurred vision
>   red eye
>   lacrimation
>   ciliary flush: a ring of red spreading outwards
>   hypopyon
>   visual acuity initially normal → impaired
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4
Q

Hypopyon

A

describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level

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5
Q

Disorders associated with Anterior uveitis

A
  1. ankylosing spondylitis
  2. reactive arthritis
  3. ulcerative colitis, Crohn’s disease
  4. Behcet’s disease
  5. sarcoidosis: bilateral disease may be seen
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6
Q

Chorioretinitis

A

Is a form of posterior uveitis and is associated with cytomegalovirus and toxoplasmosis (cats).

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7
Q

Management of Anterior uveitis

A
  1. Urgent review by ophthalmology
  2. Cycloplegics (mydriatic) eye drops
  3. Steroid eye drops
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8
Q

Investigations of Anterior uveitis

A

Slit lamp

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9
Q

Conjunctivitis

A

Inflammation of the conjunctivae. It is very common

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10
Q

Bacterial Conjunctivitis

A 
Acute onset red, gritty eyes with purulent discharge that causes the eyes to be stuck together on wakening
▪      Minimal pain & Red eye 
▪	Will spread from one eye to the other
▪	Clear cornea 
▪	Normal pupillary light response
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11
Q

Causes of Bacterial Conjunctivitis

A

▪ Staph aureus, strep. pneumonia, h. influenzae
▪ Pseudomonas
▪ In babies: chlamydia trachomatis, Neisseria gonorrhoea
▪ Chlamydia in sexually active adults

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12
Q

Management of Bacterial Conjunctivitis

A
  1. Chloramphenicol
  2. If neonate, refer to ophthalmology
  3. Fusidic acid
  4. Pseudomonas – gentamicin
  5. Chlamydia – oxytetracycline, azithromycin
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13
Q

Causes of viral Conjunctivitis

A
  1. Adenovirus
  2. Herpes simplex
  3. Herpes zoster
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14
Q

Symptoms of viral conjunctivitis

A

▪ Swollen and tender pre-auricular lymph nodes
▪ Watery eye (sticky in bacterial conjuncitivits)
▪ Red eye
▪ Extreme eye movements can cause pain
▪ Tends to occur with a URTI

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15
Q

Keratitis

A

Inflammation of the cornea. Often caused by corneal abrasion

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16
Q

Causes of Keratitis

A

> bacterial
fungal
amoebic
parasitic: onchocercal keratitis (‘river blindness’)

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17
Q

Types of bacteria in bacterial Keratitis

A

> Staphylococcus aureus

> Pseudomonas aeruginosa - contact lens wearers

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18
Q

What bacteria causes keratitis in contact kens wearers?

A

Pseudomonas aeruginosa

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19
Q

Features of Keratitis

A
  1. red eye: pain and erythema
  2. photophobia
  3. foreign body, gritty sensation
  4. hypopyon may be seen
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20
Q

Diagnosis of Keratitis

A

o Fluorescein

o Corneal scrape

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21
Q

Management of suspected keratitis in contact wearers

A

Same-day referral to an eye specialist is usually required to rule out microbial keratitis

Stop using contact lens until the symptoms have fully resolved

Topical antibiotics - typically quinolones

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22
Q

Complications of Keratitis

A

> corneal scarring
perforation
endophthalmitis
visual loss

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23
Q

Endophthalmitis

A

Inflammation of the intraocular space occupied by the vitreous. If it involves all layers and the peri-ocular tissues, it is known as panopthalmitis. Potentially devastating infection

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24
Q

Causes of Endophthalmitis

A

> 

Staph epidermidis
Most cases are after cataract procedures
Injury 
Contact lenses
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25
Q

Symptoms of Endophthalmitis

A
  1. Red eye
  2. Decreased vision
  3. Extreme pain
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26
Q

Investigations for Endophthalmitis

A

o Slit lamp

o Ultrasound

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27
Q

Management of Endophthalmitis

A

> 

Immediate referral

> Intravitreal vancomycin

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28
Q

Blepharitis

A

Inflammation of the eyelid margins

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29
Q

Anterior blepharitis

A

Inflammation of the eyelid margins

caused by seborrhoeic dermatitis/staphylococcal infection

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30
Q

Posterior blepharitis

A

Inflammation of the eyelid margins. caused by either meibomian gland dysfunction or acne rosacea

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31
Q

Symptoms of Blepharitis

A 
o	Itchy, sore, red eyelids
o	Burning sensation in the eyes
o	Photophobia
o	Swollen eyelid margins
o	Cysts
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32
Q

Management of Blepharitis

A
  1. Hot compresses twice a day
  2. Mechanical removal of the debris
  3. artificial tears
  4. Chloramphenicol, Fusidic acid, Doxycycline
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33
Q

Episcleritis

A

Common and usually benign condition characteristed by inflammation of the epislcera . Usually idiopathic

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34
Q

Features of Episcleritis

A
  1. red eye
  2. classically not painful (in comparison to scleritis),
  3. watering and mild photophobia
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35
Q

Episcleritis management

A

Self-limiting

Artificial tears

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36
Q

Difference between scleritis and episcleritis

A

Severe pain in scleritis, mild/none in Episcleritis

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37
Q

Scleritis features

A
  1. red eye
  2. classically painful (in comparison to episcleritis),
  3. watering and photophobia are common
  4. gradual decrease in vision
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38
Q

Difference between scleritis and episcleritis

A

Episcleritis is inflammation of the superficial, episcleral layer of the eye. It is relatively common, benign and self-limiting. Scleritis is inflammation involving the sclera. It is a severe ocular inflammation, often with ocular complications.

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39
Q

What condition is associated with scleritis?

A

Associated with rheumatoid arthritis

40
Q

Scleritis

A

Severe infection throughout the entire thickness of the sclera. It is very rare and more common in women

41
Q

Scleritis management

A
  1. Oral NSAIDs

2. Oral steroids

42
Q

Ocular manifestations of Rheumatoid arthritis

A 
keratoconjunctivitis sicca (most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis
43
Q

Orbital cellulitis

A

The result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe. It is usually caused by a spreading upper respiratory tract infection from the sinuses and carries a high mortality rate. Orbital cellulitis is a medical emergency.

44
Q

Risk factors for Orbital cellulitis

A
  1. Childhood
  2. Previous sinus infection
  3. Lack of Haemophilus influenzae vaccination
  4. Recent eyelid infection/ insect bite on eyelid (Peri-orbital cellulitis)
  5. Ear or facial infection
45
Q

Features of Orbital cellulitis

A 
o	Sudden onset of unilateral swelling of conjunctiva and lids
o	Proptosis 
o	Pain on movement
o	Relative afferent pupillary defect 
o	Fever
o	Severe malaise
46
Q

Investigation of Orbital cellulitis

A

CT which may shows Inflammation of the orbital tissues deep to the septum, sinusitis.

47
Q

Management of Orbital cellulitis

A

Admission to hospital for IV antibiotics

48
Q

Preseptal cellulitis

A

It is an infection of the soft tissues anterior to the orbital septum - this includes the eyelids, skin and subcutaneous tissue of the face, but not the contents of the orbit.

49
Q

Preseptal cellulitis causes

A

Staph. aureus
Staph. epidermidis
Streptococci and anaerobic bacteria.

50
Q

Investigations of Preseptal cellulitis

A

> Bloods - raised inflammatory markers
Swab of any discharge present
Contrast CT of the orbit may help to differentiate between preseptal and orbital cellulitis.

51
Q

Management of Preseptal cellulitis

A
  1. All cases should be referred to secondary care for assessment
  2. Oral antibiotics are frequently sufficient - usually co-amoxiclav
52
Q

Complications of Preseptal cellulitis

A

Bacterial infection may spread into the orbit and evolve into orbital cellulitis

53
Q

Features of Argyll-Robertson pupil

A
  1. small, irregular pupils

2. no response to light but there is a response to accommodate

54
Q

Causes of Argyll-Robertson pupil

A

> diabetes mellitus

> syphilis

55
Q

A chalazion (Meibomian cyst)

A

A retention cyst of the Meibomian gland. It presents as a firm painless lump in the eyelid. The majority of cases resolve spontaneously but some require surgical drainage

56
Q

Stye

A

infection of the glands of the eyelids

57
Q

Entropion

A

In-turning of the eyelids

58
Q

Ectropion

A

Out-turning of the eyelids

59
Q

Dendritic ulcer

A

Herpes simplex keratitis causes this ulcer

60
Q

Herpes zoster ophthalmicus (HZO)

A

Describes the reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve. It accounts for around 10% of case of shingles.

61
Q

Herpes zoster ophthalmicus (HZO) features

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

62
Q

Management of Herpes zoster ophthalmicus (HZO)

A
  1. Oral antiviral treatment for 7-10 days
  2. intravenous antivirals may be given for very severe infection or if the patient is immunocompromised
  3. ocular involvement requires urgent ophthalmology review
63
Q

Curtain coming down < 5 minutes

A

amaurosis fugax

64
Q

Holmes-Adie pupil

A

> unilateral in 80% of cases
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

65
Q

Stage 1 hypertensive retinopathy

A

Arteriolar narrowing and tortuosity

Increased light reflex - silver wiring

66
Q

Stage 2 hypertensive retinopathy

A

Arteriovenous nipping

67
Q

Stage 3 hypertensive retinopathy

A

Cotton-wool exudates

Flame and blot haemorrhages

68
Q

Stage 4 hypertensive retinopathy

A

Papilloedema

69
Q

Papilloedema

A

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

70
Q

Features of Papilloedema

A

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

71
Q

Causes of Papilloedema

A 
space-occupying lesion: neoplastic, vascular
malignant hypertension
idiopathic intracranial hypertension
hydrocephalus
hypercapnia
72
Q

Vitreous haemorrhage

A

Bleeding into the vitreous humour. It is one of the most common causes of sudden painless loss of vision. It causes disruption to vision to a variable degree, ranging from floaters to complete visual loss.

73
Q

Causes of Vitreous haemorrhage

A
  1. proliferative diabetic retinopathy (over 50%)
  2. posterior vitreous detachment
  3. ocular trauma
74
Q

Most common cause of vitreous haemorrhage in young adults and children

A

Ocular trauma

75
Q

Features of Vitreous haemorrhage

A
  1. painless visual loss or haze (commonest)
  2. red hue in the vision
  3. floaters or shadows/dark spots in the vision
76
Q

Causes of tunnel vision

A 
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
77
Q

Tunnel vision

A

Tunnel vision gives the appearance of looking through a narrow tube. Peripheral vision is obscured, causing a constricted field of view.

78
Q

Retinitis pigmentosa

A

Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision. Retinitis pigmentosa (RP) is a group of rare, genetic disorders that involve a breakdown and loss of cells in the retina

79
Q

Features of Posterior vitreous detachment

A

> The sudden appearance of floaters
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)

80
Q

Investigations for Posterior vitreous detachment

A

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

81
Q

Pain on eye movement

A

Optic neuritis

82
Q

Curtain coming down >5 minutes

A

Retinal detachment

83
Q

Dacrocystitis

A

Inflammation of lacrimal sac which occurs secondary to blockage of the lacrimal system and is treated with broad spectrum antibiotics.

84
Q

What is worse; alkali or acid burns in the eyes?

A

Alkali burns to the eye are worse than acid burns, because alkali penetrates the eye, whereas acid is relatively self-limiting by caused the proteins to coagulate and prevent further damage.

85
Q

Hyphaema

A

Blood in the anterior chamber that may occur following blunt trauma

86
Q

Sympathetic ophthalmia

A

A dangerous complication of penetrating injury. Injury causes intra-ocular antigens to be released into the immune system. This causes an autoimmune response by the body to be launched against both eyes. Requires immediate treatment with immunosuppression or vision in both eyes will be lost.

87
Q

Most common cancer of the eyelid

A

Basal cell carcinoma

88
Q

Schirmer’s test

A

Measures ocular dryness - tear production

89
Q

Damage to the optic chiasm

A

Bitemporal hemianopia

90
Q

Damage to the optic tracts/radiations

A

May cause homonymous defects

91
Q

Damage to the occipital cortex

A

Homonymous defects with macular sparing

92
Q

Eye changes in Wilson’s disease

A

kayser Fleischer rings

93
Q

Eye changes in Down Syndrome

A

brushfield’s spots

94
Q

Eye changes in Ehlers-Danlos syndrome

A

Blue sclera

95
Q

Meibomian glands

A

Are oil glands along the edge of the eyelids where the eyelashes are found. These glands make oil that is an important part of the eye’s tears. The oily layer is the outside of the tear film that keeps tears from drying up too quickly.

Ophthalmology Year 2 (2 decks)

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