(PM3A) Ocular Conditions Flashcards
What is uveitis?
Inflammation or swelling of the middle layer of the eye
Of uvea/ uveal tract
Where is the uvea?
Middle layer of the eye
(1) Anterior: Ciliary body + iris
(2) Posterior: Choroid
What are some of the symptoms of uveitis?
(1) Ache/ pain
(2) Red eye
(3) Small pupil, irregular outline
(4) Blurred vision
(5) Cloudiness
(6) Headaches/ light sensitivity
What are some of the causes of uveitis?
Unclear
(1) Inflammation of the uvea/ iris
(2) Mainly affects children + young adults
(3) Association with trauma or autoimmune
What is the treatment for uveitis?
Depends on which areas of the eye are affected
(1) Corticosteroid eye drops
dexamethasone
(2) Corticosteroid injections
(3) Mydriatic eye drops, e.g. atropine sulfate
What is blepharitis?
Chronic inflammation of the eye lid
What are some of the symptoms of blepharitis?
(1) Itchy/ red + sore eye lids
(2) Eye lids stick together
(3) Problems opening eyes upon waking
(4) Crusty eyelashes
(5) Burning/ gritty sensation
(6) Photophobia
(7) Abnormal eyelashe growth + loss
What are the potential causes of blepharitis?
Sebaceous gland dysfunction
Can be caused by:
(1) Staphylococci infection
(2) Infestation of lice/ demodex lice
(3) Allergic reactions
(4) Fungal infection
(5) Viral infection
What is the typical treatment for blepharitis?
(1) Daily eye lid cleaning
(2) ABx for more severe cases - topical/ oral
Describe the usual onset of blepharitis symptoms.
Repeated episodes
Separated by periods without symptoms
What is a stye?
External hordeolum
Small + painful lump on inside/ outside of eyelid
What is an external hordeolum?
Stye
What are some of the common symptoms of a stye?
(1) Swollen/ lumpy
(2) Redness
(3) Swelling/ tenderness lasting several days
(4) Often a white head in the centre of the swelling
What are some of the potential causes of a stye?
(1) Acute staphylococcal infection of the sebaceous glands
(2) In-growing eyelash
(3) Can be associated with blepharitis
(4) Recurrent in diabetics
(5) Positive correlation with stress
What is the typical treatment for a stye?
Usually self-limiting (days-weeks)
Topical ABx if severe
What is conjunctivitis?
Inflammation of the conjunctiva
What are some of the different types of conjunctivitis?
(1) Bacterial conjunctivitis
(2) Allergic conjunctivitis
(3) Chlamydial conjunctivitis
What are some of the common symptoms of conjunctivitis?
(1) Uni/bilateral
(2) Sudden onset - seasonal
(3) Reddening of eyes
(4) Itchy + sore
(5) Watery eyes
(6) Swollen eyelids
What are some of the potential causes of conjunctivitis?
(1) Pollen - hay fever
(2) Dust mites
(3) Makeup
(4) Animal fur
(5) Eye drops
(6) Unclean contact lens
(7) Bacterial/ viral
What is the typical treatment for conjunctivitis?
Usually self-limiting within 2 weeks
(1) Allergic conjunctivitis: azelastine hydrochloride eye drops
(2) Infective conjunctivitis: chloramphenicol 1% tds-qds/ fusidic acid
What is keratitis?
Inflammation of the cornea
What are some of the symptoms of keratitis?
(1) Eyelid oedema
(2) Conjunctival inflammation
(3) Dicharge
(4) Corneal ulceration
(5) Pink eye
What are some of the potential causes of keratitis?
(1) Bacterial - contact lenses/ trauma
(2) Viral - herpes simplex
(3) Fungal - Candida
(4) Parasitic - pools/ hot tubs/ contact lens solution
What is the most common cause of blindness?
Keratitis
What is the typical treatment for keratitis?
(1) Depends on severity of infection
eye drops ABx
cefazolin, vancomycin
IF bacterial:Oral ABx
doxycycline
(2) Antiseptic drops - chlorhexidine/ brolene/ hexamidine
- Anti-amoebic effect
Why may antiseptic eye drops be given for treatment of keratitis?
Anti-amoebic effect
microbial keratitis
What is ectropion?
Condition where eyelids turn outwards
What are some of the common symptoms of ectropion?
(1) Permanently watery eye
(2) Eyelid sag
(3) Exposure of conjunctival surface
(4) Exposure of corneal surface
(5) Decreased vision
(6) Ocular surface pain
What are some of the potential causes of ectropion?
(1) Weak muscles around the eye - old age
(2) Injury to the skin around the eyes
(3) Bell’s (facial) palsy
(4) Congenital (genetic) defect
What is the typical treatment for ectropion?
(1) Mild cases may not require treatment
(2) Operation (surgery) to correct is recommended
What is exophthalmos? (Proptosis)
Abnormal protrusion of the eye ball
What is proptosis?
Exophthalmos
Abnormal protrusion of the eye ball
What are some of the common symptoms of exophthalmos?
(1) Forced eyelid widening
(2) Staring expression
(3) Impaired eye movement
(4) Double/ blurred vision
(5) Dry + itchy eyes
What are some of the potential causes of exophthalmos?
(1) Increase in volume of tissue behind the eyes
(2) Associated with hyperthyroidism
(3) Hereditary disease - Grave’s
(4) Infection of the sinuses - in children only
(5) Protrusion of one eye - cyst/ brain tumour/ blood clot
What is the treatment for exophthalmos?
When caused by thyroid eye disease:
(1) Medication to correct thyroid hormone levels
i.e. carbimazole/propylthiouracil
(2) IV corticosteroid therapy
(3) Corrective surgery - following reduction of inflammation
What are cataracts?
Clouding of the lens in the eye
What are some of the common symptoms of cataracts?
(1) Blurred/ cloudy/ misty vision
(2) Gradual visual deterioration
(3) Age/ environment related
(4) Discomfort in bright light
(5) Colour fading
(6) Reading/ watching TV more difficult
(7) Glasses becoming less effective
What are some of the potential causes for cataracts?
(1) Protein aggregation in lens
(2) Eye injury
(3) Diabetes
(4) Uveitis
What are some of the risk factors for cataracts?
(1) Smoking
(2) Overexposure to light
(3) Prolonged steroid use
What is the typical treatment for cataracts?
Cataract surgery
No other proven treatment
What is keratoconjunctivitis sicca?
Dry eye syndrome
Decreased tear production/ increased tear film evaporation
What are some of the common symptoms of keratoconjunctivitis sicca?
(1) Ocular irritation - dryness/ soreness
(2) Usually bilateral
(3) Worsens throughout the day
(4) Redness of eyes
What are some of the potential complications of keratoconjunctivitis sicca?
(1) Scarring
(2) Conjunctivitis
(3) Photosensitivity
(4) Corneal thinning
What are some of the potential causes of keratoconjunctivitis sicca?
(1) Environmental factors
(2) Concomitant illness
(3) Hormonal changes
(4) Ageing
(5) Loss of tear fluid
- Lacrimal gland defect
- Meibomian gland defect
- Eyelid defect
- Cornea defect
- Tear duct/s defect
What biological factors can cause loss of tear fluid?
(1) Lacrimal gland defect
(2) Meibomian gland defect
(3) Eyelid defect
(4) Cornea defect
(5) Tear duct/s defect
What is glaucoma?
Group of eye diseases
Result in damage to the optic nerve
Causes vision loss
What are some of the common symptoms of glaucoma?
(1) Largely asymptomatic - slow onset
(2) Impairment of peripheral vision
(3) Hazy/ blurred vision
(4) Rainbow-coloured circles around bright lights
(5) Severe eye/ head pain
(6) Nausea/ vomiting - associated with eye pain
(7) Sudden sight loss
What are some of the potential causes of glaucoma?
Triggers are unknown
Usually associated with excessive pressure within the eye damaging the optic nerve
Caused by misbalance of production and drainage in the aqueous humour
Trabecular meshwork progressively blocked/ impaired
What is the trabecular meshwork?
the spongy tissue located near the cornea
Drainage point of the aqueous humour in the eye
What are the main types of glaucoma?
(1) Open-angle glaucoma (~90%)
(2) Angle-closure glaucoma
What is open-angle glaucoma?
Most common type of glaucoma (~90%)
Slow clogging of drainage canals
Slow development
Lifelong condition
What is angle-closure glaucoma?
Least common main type of glaucoma (~10%)
Blocked drainage canals
Sudden rise in intraocular pressure
Develops very quickly
What are some of the risk factors for glaucoma?
(1) Age - more common >40yrs old
(2) Blood pressure - low BP increased risk
(3) Race
- african/ afro-caribbean increased risk of chronic open-angle glaucoma
- asian increased risk of acute angle-closure glaucoma
(4) Family history - increased risk
(5) Short/ long sight
(6) Medical history - diabetes increases risk
What is myopia?
Short-sightedness
What effect does myopia have on glaucoma risk factor?
Increased risk of chronic open-angle glaucoma
What effect does short-sight have on glaucoma risk factor?
Increased risk of chronic open-angle glaucoma
What effect does diabetes have on glaucoma risk factor?
Increased risk of glaucoma
What are some treatment options for glaucoma?
(1) Prostaglandin analogues
(2) Beta-blockers
(3) Carbonic anhydrase inhibitors
(4) Sympathomimetics
(5) Miotics
Why are prostaglandin inhibitors used for treatment of glaucoma? I R
Increase the flow of aqueous humour fluid out of the eye
Reduces the intraocular pressure
e.g. latanoprost
Why are beta-blockers used for treatment of glaucoma? R R
Reduce intraocular pressure
Reduce production of aqueous humour in the eye
e.g. timolol maleate
Why are carbonic anhydrase inhibitors used for treatment of glaucoma? R R
Reduce production of aqueous humour
Reduces intraocular pressure
e.g. brinzolamide
Why are sympathomimetics used for treatment of glaucoma? R I
Reduces production of aqueous humour
Increases flow of aqueous humour out of the eye
e.g. brimonidine tartrate
Why are miotics used for the treatment of glaucoma?
O Imp
Open up blocked trabecular meshwork
Improves drainage of aqueous humour out of eye
e.g. pilocarpine hydrochloride
What is acute injury of the eye?
(1) Foreign body in eye
(2) Corneal scratch
What are some of the common symptoms of acute eye injury?
(1) Dry eye sensation
(2) Sensation of a foreign body
(3) Normal appearance with some redness
(4) Excessive tear production
What are some of the potential causes of acute eye injury?
(1) Superficial eye injury/ trauma (scratch)
(2) Fingernails
(3) Working with power tools
(4) Dirt/ grit
What is diabetic retinopathy?
Damage to the retina
Resulting from diabetes
What are some of the common symptoms of diabetic retinopathy?
(1) Few early warning signs
(2) Black spots in the vision
(3) Early stages detectable by fundus photography
(4) Early stages: non-proliferative
(5) Late stages: proliferative
What are some of the potential causes of diabetic retinopathy?
(1) Microvascular changes - due to poor glycaemic control degenerating vascular walls
(2) 80% of diabetic patients >10 years
What percentage of diabetic retinopathy cases are preventable if monitored and treated correctly?
90%
What percentage of patients with diabetes for longer than 10 years will develop diabetic retinopathy?
80%
What are the typical treatments for diabetic retinopathy?
(1) Laser treatmetn
(2) Management of diabetes
(3) Intravitreal injections/ implant with fluocinolone acetonide
(4) Operation to remove blood/ scar tissue
What is fluocinolone acetonide?
Corticosteroid
What is a sub conjunctival haemorrhage?
Bleeding underneath the conjunctiva
What are some common symptoms of subconjunctival haemorrhage?
(1) Blood form burst blood vessel cover surface of eyeball - not in eyeball itself
(2) Initial pain disappears quickly
(3) No change in vision
What is a potential cause of subconjunctival haemorrhage?
Mild physical trauma
What is the typical treatment for subconjunctival haemorrage?
No treatment required if infection not present
Check for significant trauma
What is age related macular degeneration (AMD)?
Painful eye condition
Causes loss of central vision
Usually bilateral
What are some of the common symptoms of age related macular degeneration (AMD)?
(1) Difficulty reading
(2) Less vibrant colours/ dulling
(3) Difficult recognising faces
(4) Does not affect peripheral vision
What are the types of age related macular degeneration (AMD)?
(1) Dry age related macular degeneration
(2) Wet age related macular degeneration
What is dry age related macular degeneration (AMD)?
Cells of macula become damaged
Due to build up of deposits called drusen
Most common type of AMD
Least severe type of AMD
~90% of all AMD cases
What is wet age related macular degeneration?
Also known as neovascular AMD
Develops when abnormal blood vessels form under macula
Damage macula cells
Where is the macula?
At the back of the eye
What does damage to the macula do?
Distorts the macula + bleeds
Affects central vision
What are some of the risk factors for age related macular degeneration (AMD)?
(1) Smoking
(2) Obesity
(3) Cardiovascular disease
(4) Family history
What is the treatment for age-related macular degeneration?
No cure for either type of AMD
Wet AMD: Treated monthly with intraocular injections with anti-vascular endothelial growth factor (anti-VEGF) medication
- e.g. ranibizumab
What are some symptoms of myopia?
(1) Distant objects appear blurred
(2) Close objects are clear
(3) Manifests from childhood to 25 years old
What percentage of the UK population have myopia?
30%
What causes myopia?
(1) Rays of light are focused short of the retina in the eye
(2) Eye is too long from front to back
(3) Cornea too steeply curved
What is hyperopia?
Long-sightedness
How can myopia or hyperopia be corrected?
(1) Contact lenses
(2) Glasses
(3) Myopia - concave lens (minus)
(4) Hyperopia - convex lens (plus)
How are contact lenses held in the eye?
Thin transparent discs
Sit on the cornea
Held in place by eyelid pressure + tear film surface tension
What types of contact lenses are there?
(1) Rigid - hard/ gas permeable
(2) Soft - hydrogel/ silicone hydrogel
What care advice must be given for contact lens wearers?
(1) Worn for a limited number of hours per day
(2) Require strict cleaning
(3) Daily disposables are best option
What are some complications of wearing contact lenses?
(1) Papillary conjunctivitis
(2) Ulcerative keratitis
(3) Acanthamoeba keratitis - sight threatening parasite
What is papillary conjunctivitis?
Allergic reaction of the eye
What is ulcerative keratitis?
Inflammation + ulceration of the cornea
What is acanthamoeba keratitis?
Sight threatening parasite
Name some rarer conditions of the eye, besides those known in more detail.
(1) Cancer
(2) Keratoconus - corneal degeneration
(3) Limbal stem cell deficiency
(4) Corneal dystrophies
(5) Cicatrical pemphigoid - autoimmune blistering
