PC - Posterior Segment Examination - Week 1 Flashcards

1
Q

What is the purpose of dilation?

A

Allows improved view of the retina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List 13 indications for dilation.

A
  • New patient
  • Routine for all every 2 years
  • Flashes/floaters
  • Unexplained vision reduction/loss
  • Progressive retinal diseases
  • Systemic conditions
  • Hx of head/ocular trauma
  • Hx of chronic uveitis
  • Hx of peripheral retinal degenerations or holes
  • Yearly for hx of ocular sx
  • Biennially for moderate to high myopia, annually for 8D-
  • Limited or no view of the posterior pole (cataracts)
  • Hyperopes, anisometropes,, <6yo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List 13 contraindications for dilation.

A
  • Angle closure glaucoma
  • Pilocarpine use for glaucoma tx
  • Dislocation of crystalline or intraocular lens
  • Iris fixed or anterior chamber intraocular lens
  • Hypaemia
  • Acute corneal diseases
  • Hypersensitivity to mydriatic drops
  • Pregnancy/lactation
  • Narrow anterior chamber angle
  • Recent ocular injury
  • Petite/anorexic individuals
  • Children = liver enzyme activity
  • Sick/febrile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Consider the following types of patients that require dilation:
Petite/anorexic
Children
Sick/febrile
What can be done to minimise systemic absorption, and what percentage reduction in absorption does this result in? What must be monitored?

A

Dont have them open their eyes, and digital occlusion.
Reduces absoprtion by 70%.
Monitor pulse rate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Do drugs targetting the dilator muscles result in more or less dilation? Why?

A

Less, because the dilator muscle is weaker.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Do dilator drugs targetting the dilator muscles result in cycloplegia? Why?

A

No, because the muscles are innervated by the sympathetic nervous system, which only accounts for 1% of accommodation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define sympathomimetics.

A

Drugs that target the dilator muscles to mydriasis (agonists).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name a common sympathomimetic targetting the sympathetic nervous system.

A

Phenylephrine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How long does phenylephrine take to have effect, and how long does it last for?

A

Takes 10 mins, and lasts for 5-7 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What effect does eye colour have on phenylephrine action?

A

Is less effective on higher pigmented eyes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Do drugs targetting the sphincter muscles result in more or less dilation? Why?

A

More, because it is the stronger muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Do dilator drugs targetting the sphincter muscles result in cycloplegia? Why?

A

Yes, because the sphincter muscle is innervated by the parsympathetic nervous system, which also accounts for 99% of accommodation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name 4 dilator drugs that target the parasympathetic nervous system.

A

Tropicamide
Cyclopentolate
Atropine
Homatropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the dilator drug of choice and why? Describe is onset and duration.

A

Tropicamide - highly safe to use, has a quick onset and short duration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What percentage concentrations of tropicamide is used for DFE and cycloplegia?

A

0.5% - DFE

1% - cycloplegia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is cyclopentolate often used for, and what is asked of the px? Why is it typically not the drug of choice?

A

Used for inducing cycloplegia.
Px must attend 1h before the scheduled appointment.
Has more systemic adverse effects.

17
Q

How long does atropine last, and what is it typically used for?

A

Lasts for days to weeks.

Used for amblyopia treatment.

18
Q

What is homatropine typically used for, and what are its side effects like vs atropine?

A

Used to prevent breakdown of posterior synechiae.

Less side effects vs atropine.

19
Q

Which dilator drug has the most systemic side effects?

A

Atropine.

20
Q

Name the four side effects of alcaine.

A

Stings on instillation
Epithelial toxicity with long-term use
Impairs epithelial healing
Increased corneal permeability

21
Q

Why is alcaine somtimes instilled first following another dilator drug?

A

It increases corneal permeability, and so it can be instilled first followed by tropicamide for a faster onset.