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Ophthalmology > Random > Flashcards

Random Flashcards

1
Q

What is Argyll Robertson pupil?

A

Small irregular pupils with no response to light but there is a response to accommodation

Can be caused by DM or syphilis
(Sometimes referred to as prostitutes pupil)

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2
Q

When would you see a dendritic ulcer on fluorescein eye stain?

A

In herpes simplex keratitis

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3
Q

What are the features of herpes simplex keratitis?

A 
Red painful eye
Photophobia
Excessive watering of eyes
May have decreased visual acuity
Fluorescein stain may show an epithelial ulcer (dendritic ulcer)
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4
Q

What is the treatment for herpes simplex keratitis?

A

Immediate ophthalmology referral

Topical aciclovir

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5
Q

How are squints classified?

A 
Classified as to where the eye deviates towards:
Nose- esotropia
Temporally- exotropia
Superiorly- hypertropia 
Inferiorly- hypotropia
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6
Q

True or false
When you are testing for a squint you do the cover test and when you cover the unaffected eye the affected eye will move in the opposite direction to the classified squint
i.e. if it’s an Esotropic squint that would usually move towards the nose, it would move laterally when the other eye is covered

A

True

And well done for reading all that waffle!

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7
Q

What’s another word for squint?

A

Strabismus

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8
Q

What are the two types of squint?

A

Concomitant (common)

Paralytic (rare)

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9
Q

What causes a concomitant squint?

A

Imbalance in extraocular muscles

Convergent is more common than divergent

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10
Q

What causes paralytic squint?

A

Paralysis of the extraocular muscles

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11
Q

How can you treat squints?

A

Eye patches to prevent amblyopia (lazy eye that fails to reach full acuity)
Referral to secondary care

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12
Q

What condition do you think of when you hear grittiness in the eyes?

A

Blepharitis

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13
Q

What is blepharitis?

A

Inflammation of the eyelid margins
It may be due to meibomian gland dysfunction or seborrhoeic dermatitis/ staph infection

It is also more common in patients with rosacea

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14
Q

How may blepharitis present?

A 
Bilateral
Grittiness and discomfort
Sticky eyes in the morning
Eyelid margins may be red
Styes and chalazions 
Secondary conjunctivitis May occur
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15
Q

How do you treat blepharitis?

A

Softening of the lid margin using hot compresses 2x a day
Mechanical removal of debris from lid margins using cotton wool buds dipped in cooled boiling water and baby shampoo
Artificial tears for symptom relief

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16
Q

What are the features of anterior uveitis?

A 
Acute onset ocular discomfort and pain
Pupil may be irregular and small
Photophobia
Blurred vision
Red eye
Lacrimation
Ciliary flush
Hypopyon- pus and inflammatory cells in the anterior chamber often resulting in visible fluid level
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17
Q

What conditions are associated with anterior uveitis?

A 
Ankylosing spondylitis
Reactive arthritis
UC, Crohn 
Behçet’s disease 
Sarcoidosis
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18
Q

True or false

Anterior uveitis is associated with HLA-B27

A

True

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19
Q

How do you manage anterior uveitis?

A

Urgent review by ophthalmology
Cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. atropine, cyclopentolate
Steroid eye drops

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20
Q

How would you differentiate between peri orbital and orbital cellulitis?

A

Absence of painful movements, Diplopoda and visual impairments indicate periorbital

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21
Q

What is the other name for periorbital cellulitis?

A

Preseptal cellulitis

22
Q

How would you manage periorbital cellulitis?

A

Refer to secondary care
Oral abz usually coamoxiclav
Children may require admission

NB bacterial infection can spread into the orbit and evolve into orbital cellulitis

23
Q

Name some differentials for sudden loss of vision

A 
Retinal detachment
Vitreous haemorrhage
Retinal migraine
Amaurosis fugax (ischaemic event)
Central retinal vein occlusion
Central retinal artery occlusion
24
Q

What are some causes of central retinal vein occlusion?

A

Glaucoma
Polycythaemia
HTN

25
Q

What causes central retinal artery occlusion?

A

Thromboembolism from atherosclerosis

Arteritis e.g. temporal arteritis

26
Q

What would you see on fundoscopy in central retinal vein occlusion?

A

Severe retinal haemorrhages

27
Q

Cherry red spot on a pale retina is most likely due to what?

A

Central retinal artery occlusion

28
Q

What is Holmes-Adie pupil?

A

A benign condition seen commonly in women and is a main differential for a dilated pupil

It is unilateral in 80%
Dilated pupil
Once the pupil is constructed it remains small for an abnormally long time
Slowly reactive to accommodation but very poorly to light

29
Q

What is Holmes-Adie pupil associated with?

A

Loss of ankle and knee reflexes

30
Q

Steroid eye drops can lead to fungal infections which in turn cause corneal ulcers

True or false

A

True

31
Q

What is the most common cause of persistent watery eye in an infant?

A

Nasolacrimal duct obstruction

32
Q

What is the management for nasolacrimal duct obstruction?

A

Teach parents to massage the lacrimal duct
Symptoms resolve in 95% of cases by 1yr
It persists longer refer to ophthalmology for consideration of probing the imperforate membrane in the lacrimal duct under a light GA

33
Q

How is Marcus Gunn pupil diagnosed?

A

Swinging light test

34
Q

What is Marcus Gunn pupil?

A

A relative afferent pupillary defect
Caused by a lesion anterior to the optic chains ie the optic nerve or retina
It can be seen in patients with MS

35
Q

What would you expect on a swinging light test in Marcus Gunn pupil?

A

The affected and Normal eye appear to dilate when light is shone in the affected eye

36
Q

Describe the afferent pupillary light reflex pathway

A

Retina—>optic nerve—>lateral geniculate body—>midbrain

37
Q

Describe the efferent pupillary light reflex pathway

A

Edinger-Westphal nucleus (midbrain)—> oculomotor nerve

38
Q

What is a stye ?

A

Infection if the glands of the eyelids

39
Q

What is a chalazion? (Does it have another name?)

A

Other name is meibomian cyst

It is a retention cyst of the meibomian gland presenting as a firm painless lump in the eyelid

40
Q

What is an entropion?

A

In-turning of the eyelids

41
Q

What is an ectropion?

A

Out-turning of the eyelids

42
Q

How do you manage styes?

A

Hot compresses and analgesia

Only give topical abx if there is associated conjunctivitis

43
Q

You are asked to prescribe a patient a topical antibiotic for their infective conjunctivitis- what will you prescribe?

A

Topical chloramphenicol drops given 2-3hrly initially

NB chloramphenicol ointment is given QDS initially

If pregnant prescribe topical fusidic acid BD

Bonus mark advise not to wear contact lenses and do not share towels. Exclusion from school not necessary

44
Q

What is amaurosis fugax?

A

Painless transient monocular blindness
Can be described as a curtain coming down

It’s is essentially a TIA of the eye

45
Q

What do you prescribe a patient if they have had amaurosis fugax?

A

300mg aspirin

46
Q

What features make up Horners syndrome ?

A

Miosis
Ptosis
Enophthalmos +/- anhydrosis

47
Q

True or false

Episcleritis is painful

A

False

Scleritis is painful but episcleritis is painless

48
Q

What eye drops can you use to differentiate between episcleritis and scleritis?

A

Phenylephrine

If redness improves with it- it is episcleritis

49
Q

How do you manage episcleritis?

A

Conservative

Artificial tears may be used

50
Q

What imaging should be done to confirm a diagnosis and evaluate the complications of orbital cellulitis?

A

Contrast enhance CT scan of the orbits, sinuses and brain

Assessed for posterior spread

51
Q

Ptosis and dilated pupil think:

A

3rd nerve palsy

52
Q

Ptosis and constricted pupil think:

A

Horner’s syndrome

Ophthalmology (10 decks)

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