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05- Ophthalmology > Presentations > Flashcards

Presentations Flashcards

1
Q

what is amblyopia?

A

reduction is visual acuity due to problem with focussing in early childhood

most commn cause = ‘lazy eye’ (strabismus)

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2
Q

when is surgery for cataracts considered?

A

visual acuity <6/18 in one or both eyes

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3
Q

pathophysiology of cataracts?

A

opacification- proteins in lens of the eye degrade over time

Age is main risk factor

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4
Q

a 75 yr old presents with painless loss of vision, and blurring of vision. Whats the likely diagnosis?

A

Cataracts

On exam: reduced visual acuity on snellen, black against red reflex with slit lamp/ opthalmascope

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5
Q

what is the surgical procedure for cataracts?

A

phaecoemulsification

lens is dissolved with US and replaced with plastic/ silicone lens

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6
Q

A 63yr old presents with painless loss of vision and blurring. He has a background of DM and has been diagnosed with diabetic retinopathy. Given the likely diagnosis how would you treat?

A

NOT surgery- diabetic retinopathy contradicts

lifestyle modifications only e.g. not driving at night, help around house to avoid falls

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7
Q

what is Schrimers test?

A

used to investigate complaints of dry eyes

Strip of filter paper in fornix, measures advancing edge of tears

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8
Q

Occular lubricants for dry eyes?

A

hypromellose, carbomers

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9
Q

which structure in the eye produces aqueous humour?

A

ciliary body

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10
Q

open/ closed (acute) angle closure galucoma is most common?

A

open angle closure glaucoma

slow deterioration of vision

closed (acute) angle closure is medical emergency

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11
Q

glaucoma occurs due to a build up of?

A

aqueous humour

usually issue with drainage through trabecular meshwork and canal of schlem, rarely can be issue woth production of aqeous humour

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12
Q

is routine screening indicated in glaucoma?

A

yes- every 2 yrs if strong FHx

every 5 yrs if >40, every 2 yrs if >60

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13
Q

triad of findings in open angle glaucoma?

A

elevated pressure

optic disc changes

visual loss

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14
Q

medical and surgical mamagament options in open angle glaucoma?

A

medical: B Blockers, prostaglandin analogues, carbonic anhydrase inhibitors
surgical: trabeculectomy, plastic tube, laser

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15
Q

a 65 yr olf man presents with an extremely red and painful eye. He complains of feeling sick and seeing blurry lines around lights. given the likely diagnosis whst is the treatment?

A

B blocker (timolol)

Carbonic anhydrase inhibitor (acetazolamide)

Osmotics (glycerin and IV mannitol)

Mitoic (pilocarpine)

Surgical treatment definitively

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16
Q

a 57 yr old lady presents with headaches, malaise and finds it painful to rest her head on her pillo wat night.. She also mentions havign trouble with her vision. Given th elikely diagnosis what is the treatment?

A

GCA with visual loss- treat with methylprednisolone, then prednisolone + low dose aspirin

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17
Q

a woman presents with suspected giant cell arteritis. Which investigations should you do?

A

Bloods: ESR + CRP, FBC, LFTs

Temporal artery biopsy –> before/ within 7 days of steroid treatment

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18
Q

how long will a pt with GCA expect to be on steroids i.e. prednisolone for?

A

12-36 months of steroids (need to reduce dose slowly)

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19
Q

what other drugs are important to co-prescribe with prednislone when treating GCA?

A

calcium and vit D supplements

consider PPI if increased risk of GI bleeding

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20
Q

what is keratoconus?

A

progressive thinning of the cornea causing visual disturbances i.e.blurry vision, double vision and photosensitivity

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21
Q

signs and symtpoms of blepharitis?

A

sore, gritty eyes and sore eyelids

chalazion (granuloma of meibomian glands) and styes (infection of lash follice) more common

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22
Q

red flags for macular degeneration?

A

decrease in central vision (macula)

distortion of vision

previous vision loss in other eye for macular degeneration

23
Q

biggest risk factor for ARMD?

A

smoking- 3-4x inc risk

FHx- 50% chance if 1st degree relative affected

24
Q

which is more common wet or dry ARMD?

A

Dry - 75%cases, very gradual change, can progress to wet, hard to treat

wet - vasucalr proliferation under retina causes more sudden change in vision, treatable

25
Q

62yr old presents with vision changes. He struggles watching the TV and finds it harder to recognise peoples faces. Visual fields are normal. fundoscopy reveals drusen and pale spots on the retina. whats the liekly diagnosis?

A

Dry macular degeneration

wet would show new vessel formation. scarrign and haemorrhages may also be present

26
Q

treatment for dry ARMD

A

high dose vitamin supplements

stop smoking

annual eye exam

27
Q

treatment for wet ARMD

A

injections og anti-VEGF

laser therapy targetting new vessels

28
Q

how do you manage preseptal celliulitis?

A

oral co-amoxiclav for 10 days + drain lid abscess

29
Q

hwo do you manage orbital cellulitis?

A

IV Ceftriaxone + Flucloxacillin + metronidazole for 7-10 days

monitor optic nerve function every 4 hrs

30
Q

damage to which cranial nerve causes ptosis?

A

CN III (oculomotor)- lifts upper lid of eye

lid is closed by orbicularis oculi CN VII- facial nerve palsy will not cause ptosis

31
Q

what is the afferent nerve in the pupillary response?

A

optic nerve (CNII)

detects lights and sends signal to brain

HOWEVER, defect can be anywhere along afferent pathway i.e. optic chiasm not just within optic nerve itself

32
Q

what is the efferent nerve in the pupillary response?

A

Oculomotor nerve (CNIII)

brain recieves signal from EITHER eye and sends signal back down both oculomotor nerves telling pupil to constrict/ dilate

33
Q

describe the afferent pathway and the efferent pathway?

A

Afferent: AP in optic nerve, AP travels through L & R lateral geniculate nucleus, axons synapse at L&R pre-tectal nuclei

Efferent: AP passes to L&R Edinger-westpha nuclei, then to L&R ciliary ganglions, constriction of pupil (either direct/ consesual)

34
Q

a RAPD in the left eye will result in what?

A

shining light in left eye will result in no constriction of either pupils

shining light in right eye will result in constriction of both pupils

Damage to the left afferent pathway

35
Q

how will CN III (oculomotor) palsy present?

A

‘down and out’ pupil on affected side. A dilated pupil that does not respond to light in either eye

However, as afferent is still functioning the contralateral eye will respond to light in both the affect eye and its own light

36
Q

what is the most common cause of inherited blindness?

A

Retinitis pigmentosa

>50 causitive genes and variable inheritance patterns

37
Q

describe the view of the retina in retinitis pigmentosa

A

pigmentation of periphery

optic atrophy

38
Q

Investigations for someone with a squint

A

Visual acuity

cover/uncover test

alternate cover test

assess ocular movements

fundoscopy

determien refractive error

39
Q

a patient complains of painful loss of vision they described as flashes and then a black curtain. What is the likely diagnosis?

A

Retinal detachment

painful visual loss(central -> macula), floaters/ flashes, ‘curtain coming down’, common in myopic individuals and diabetics

40
Q

how do you manage retinal detachment?

A

small = laser to retinal tears

large = retinal surgery +/- vitrectomy

41
Q

which complicaiton in Giant cell arteritis can cause painful visual loss?

A

Temporal Arteritis- central scotoma due to occlusion of the ciliary arteries supplying the optic nerve

treat with prednisolone

42
Q

a pt presents with painless loss of vision that came on suddenly with black spots. Red reflex in decreased. RBC can be seen in the anterior vitreous. Given the likley diagnosis what is the treatment?

A

Vitreous Haemorrhage- refer to ophthalmology to confirm rule out retinal detahcment, manage complications i.e glaucoma

usually resolves spontanesouly (surgical vitrectomy rarely required to stop bleeding)

43
Q

A 75yr old presents with a sudden painless loss of vision particularly in the centre. Opthalmoscopy reveals a hyperaemi retina with engorged veins multiple haemorrhages and cotton wool spots. What is the likely diagnosis?

A

Central Retinal Vein Occlusion‘stormy sunset’ appearance

44
Q

what is amaurosis fugax?

A

TIA of the retina causing transient loss of vision from occlusion of retinal artery

pts need full work up as with any other TIA pt

45
Q

how do amaurosis fugax and central retinal artery occlusion differ?

A

CRAO is not transient- needs refered urgently, unlikely to resolve itself if not treated within 30 mintues

Amaurosis fugax will self resolve

46
Q

patient with IBD has a deep burnign pain in their eye, photophobia and decerased vision. Talbots test is positive (pain increases as tehir eyes converge and constrict) Whats the diagnosis?

A

Anterior uveitis (iritis)

associated w systemic disease

47
Q

you’ve diagnosed a pt with anterior uveitis (iritis) you decide to prescribe steroid drops. this is fine right?

A

NO- need consent from ophthalmologist as if diagnosis wrong could worsen glaucoma, cause cataracts or infeciton

48
Q

how to differentiate between scleritis and episcleritis?

A

episcleritis- self limiting, mild pain

scleritis- severe, deep burning pain, photophobia

49
Q

what can cause a worrying looking really red eye but is actually nothing to worry about?

A

subconjuctival haemorrhage- will resolve spontaneously in 10-14 days

50
Q

where would a lesion cause a left sided homonymous hemianopia?

A

lesion at right optic tract

51
Q

where would a lesion cause a left sided upper homonymous quadrantopia?

A

right temporal radiation (meyers loop)

52
Q

where would a lesion causing a lower qaudrantopia be?

A

parietal radiation

53
Q

a pale retina is seen in central vein/ artery occlusion?

A

Artery occlusion

05- Ophthalmology (6 decks)

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