Questions based on lectures Flashcards
Risk factors for diabetic retionpathy
Young-onset diabetes Duration of diabetes Hypertension Dramatically improved diabetic control Hypercholesterolaemia Pregnancy
What does OCT stand for
Optical coherence tomography
What does IRMA stand for
intra-retinal microvascular abnormality
In summary, why do people with diabetic retinopathy lose their vision?
Retinal haemorrhage affecting the fovea
Vitreous haemorrhage
Scarring/tractional retinal detachment
What are cotton wool spots?
Nerve fibre degeneration
Raised intraocular pressure
Characteristic field defects
Optic disc cupping
Glaucoma
Three things to look for/measure to diagnose and monitor glaucoma
- pressure
- fields
- optic disc
Methods of testing: glaucoma (3)
- pressure (tonometry)
- fields (perimetry)
- optic nerve - clinical exam
Normal eye pressures
Under 20mmHG
20-30 - pretty sure you teach this
Above 30mmHg definitely treat
Classic pattern of visual field loss in glaucoma
Arcuate
Second most common cause of blindness in the UK
Primary open angle glaucoma
How is POAG usually detected
Most detected by optometrist at routine examination
Risk factors for primary open angle glaucoma
- age
- raised IOP
- afro-carribean origin
- family origin
Which disease is more common in afro-carribean people
Primary open angle glaucoma
Treatment for acute glaucoma
1) need to give acetazolamide and mannitol first (to lower pressure and make cornea less cloudy)
2) give all three types of eye drops (beta blockers, prostaglandin analogues and carbonic anhydrase inhibitors)
3) Iridotomy
Sudden painless loss of all or part of visual field
Retinal vessel occlussions
Horizontal and vertical field loss, which is in front and which is behind chiasm?
Horizontal - in front of chiasm
Vertical - behind chiasm
Which condition might colour vision be reduced in first?
Optic neurities
Gradual loss in vision over a couple of weeks, colour vision reduced
Optic neuritis
Over 50 Scalp tenderness Weight loss Proximal myalgia (polymyalgia rheumatica) Jaw claudication Raised PV/ESR/CRP
Giant cell arteritis
How do you treat giant cell arteritis?
Steroids
Causes of retinal vein occlusion
- hypertension
- raised cholesterol
- increased viscosity e.g. myeloma
- inflammation
- Virchows triad (circulatory stress, endothelial injury, hypercoagulable state)
Why is vascular endothelial growth factor bad?
- leaky vessels (oedema)
- new vessels, which could cause vitreous haemorrhage
- new vessels, which could cause neovascular glaucoma
How does dry macular degeneration present
Gradual loss of central vision
Treatment for age-related ARMD
Anti-VEGF intravitreal injections
Cells in the anterior chamber
Synechiae
Keratitic precipitates
Hypopyon if severe
Anterior uveitis
Entropion
Eyelid folds inwards
Ectropion
Eyelid droops outwards
Purulent vs watery discharge
Purulent - think bacterial
Watery - think viral
Mild chemosis
Bacterial conjunctivitis
Moderate chemosis
Viral conjunctivitis
Treatment for bacterial conjunctivitis
Topical antibiotic e.g. chloramphenicol
fusidic acid may also be used
Treatment for viral conjunctivitis
Supportive - cool compress/lubricants
Young patient, unilateral, FOLLICULAR CONJUNCTIVITIS
Chlamydia
do chlamydia PCR swab
Risk factors for bacterial corneal ulcers
Corneal abrasion
Contact lens wearer
Dry eye
Iatrogenic
Treatment for bacterial corneal ulcers
Topical antibiotics e.g. ofloxacin hourly
Which drugs could cause cataract
Steroids
Cataract treatment
Phaco-emuslfication with intra-ocular lens insertion
Most common cause of blindness in western world in the over 65s
Age related macular degeneration
Investigations for wet ARMD
Optic coherence tomography
Fundus fluoroscene angiography
Sudden, profound visual loss (<6/60)
Relative afferent pupillary defect (RAPD)
Pale swollen retina with cherry red spot at macula
Central retinal artery occlusion
CRAO treatment
Ocular massage
Paper bag breathing
IV diamox (acetazolamide)
Anterior chamber paracentesis
Who is most likely to get anterior ischaemic optic neuropathy?
45-65 years
Hypermetropes with small crowded optic discs
Smokers
Treatment for anterior ischaemic optic neuropathy?
No active treatment, assess and treat risk factors
Persisting flashing lights
Burst of new floaters
Dark shadow in peripheral vision, increasing in size
Retinal detachment
Is retinal detachment more common in myopes or hypermetropes?
Myopes (short-sighted)
Symptoms:
Variable loss of vision, usually over few days
Washed out colours
Dull ache on eye movements
Signs: Decreased VA RAPD Decreased colour vision Enlarged blind spot Optic disc swelling (not in retrobulbar neuritis)
Optic / retrobulbar neuritis
Optic/retrobulbar neuritis and steroids?
IV steroids may hasten recovery but not affect final visual acuity
Oral steroids may worsen outcome
When might you see a RAPD?
Anterior ischaemic optic neuropathy
Optic neuritis
CRVO
CRAO
No RAPD in macular disease
Swollen optic disc with hyperaemia - pale disc later
Anterior ischaemic optic neuropathy
What does a RAPD test?
Test of optic nerve function
Lesions anterior to what are associated with a RAPD?
Lesions anterior to the lateral geniculate are associated with optic atrophy and RAPD
Paralysis of sympathetic nerve supply to the eye
Horner’s syndrome
Causes of Horner’s
Pancoast tumour Carotid/aortic aneurysms Lesions of neck Congenital Idiopathic
Really bad side effect of chloramphenicol
Aplastic anaemia
Why would you use Rose Bengal stain?
Will stain devitalised areas
Why would you use fluoroscein?
Shows up de-epithelialised areas
Dilating drops and how long they last for
Tropicamide (shortest duration but least effective)
Cyclopentolate (lasts 1 day)
Atropine (lasts up to 3 weeks)
Phenylephrine - stimulates dilator pupillae
Paediatrics:
Sticky and red eye within first 10 days of birth
Chlamydial conjunctivitis
Paediatrics:
Sticky and white uninflamed eye
Blocked nasolacrimal gland
