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Opthalmology > Revision > Flashcards

Revision Flashcards

1
Q

Anterior segment of the eye is in front of the lens
It is divided into the anterior and posterior chamber.

Anterior to iris = anterior chamber
Posterior to iris = posterior chamber

Both contain aqueous humour which is produced by the ciliary body

A

Posterior segment of the eye is posterior to lens and contains vitreous

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2
Q

Remember conjunctivitis can cause a red eye but it is not usually painful. What is the differential?

A

Eyes are red and watery but vision is OK

Viral - adeno, herpes (follicles)
Bacterial - staph/ strep
Trauma - dry eyes
Allergy - seasonal
Toxins - chlorine etc
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3
Q

How would you expect a corneal ulcer to present?

A

Acute, painful red eye
Reduced visual acuity and photophobia
Foreign body sensation
Visible opacity/ hypopyon

Always ask about cold sores and contact lenses

Remember to always stain with fluorescein and never give a steroid without aciclovir and recommendation from ophthalmologist

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4
Q

95% of cases of iritis are idiopathic. What are the other 5% linked to?

A

System disease such as HLAB27 e.g. Ank Spon

Consider further investigation if iritis is severe, bilateral or recurrent

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5
Q

Features of iritis?

A

Painful red eye
Redness is often around iris most

Synechia (iris stick to the cornea or lens and therefore is distorted)

Reduced visual acuity and photophobia

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6
Q

How do you treat iritis?

A

Topical steroid

Dilate pupils to stop iris and lens sticking and reduce pain e.g. cyclopentolate or atropine

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7
Q

How do you differentiate between scleritis and episcleritis

A

Episcleritis:

  • usually localised
  • mild pain
  • can be associated with IBD flare but usually idiopathic
  • usually self limiting but lubricants/ topical steroids may be useful

Scleritis:
- serious condition with risk of necrosis and perforation
- widespread redness, possible blue/ violet hue
- intensely painful, often boring pain
-usually associated with rheumatological/ vascular condition
—> do screen = FBC, CRP, ANCA, Rh
- requires topical steroids + systemic NSAID + systemic steroid

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8
Q

Having a shallow anterior chamber —> be long sighted (a hypermetrope) is a RF for AACG. What are the key features?

A

Painful red eye
Haloes
Mid-dilated pupil
Headache, vomiting —> very unwell

Increased IOP and gonioscopy shows occluded iridocorneal angle

Treatment aims are to lower IOP with topical and systemic treatments

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9
Q

Management of AACG

A
  • refer to ophthalmology as an emergency
  • analgesia + anti-emetic
  • pilocarpine drops to constrict the pupil
  • acetazolamide to reduce production of aqueous humou
  • laser iridotomy (both eyes)
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10
Q

What is the mechanism of acetazolamide?

A

It is a carbonic anhydrase inhibitor - it causes excretion of bicarbonate ions and water —> lowers BP

CI =low Na, low K, hyperchloraemic acidosis etc

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11
Q

What is the cardinal feature of ARMD?

A

Gradual blurring of central vision
Distortion of straight lines (metamorphosia)
Sudden loss of vision due to haemorrhage

Treatment is with anti-VEGF —> prevents new vessel formation

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12
Q

What are the features of background diabetic retinopathy?

A

HOME

H - haemorrhage (dot, blot, and flame)
O - oedema (transudate)
M - micoraneurysms
E - exudate (yellow deposits)

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13
Q

What are the features of pre-proliferative diabetic retinopathy?

A

HOME features maybe be present (haemorrhage, oedema, microaneuysms and exudate)

But CV definitely will be - cotton wool spots and vein abnormalities e.g. looping, beading and engorgement are characteristic

Remember that cotton wool spots are local infarcts

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14
Q

What are the features of proliferative diabetic retinopathy?

A

HOME CV features will usually be present (haemorrhage, oedema, microaneurysms, exudate, cotton wool spots and vein abnormalities)

BUT new vessel growth on retina, optic disc or iris is characteristic

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15
Q

What is the treatment of diabetic retinopathy?

A

1) Optimise glycaemic control
2) regular monitoring - yearly
3) laser photocoagulation

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16
Q

What are the 4 grades of diabetic hypertension?

A

1 - narrowing of arterioles (silver wiring)
2 = AV nipping
3 = flame shaped haemorrhage
4 = papilloedema

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17
Q

Increasing age, DM and steroid therapy are RF for cataract. How does it present?

A

Blurred vision with haloes and glare

Loss of red0refles

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18
Q

The superior oblique does depression, adduction and intortion)

DADI (superior oblique = Depression, ADduction and Intortion_

A

Inferior oblique does elevation, adduction and extortion

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19
Q

Eye is ‘down and out’

A

Third nerve palsy
Will also be ptosis as levator palpabrae superioris is also innervated by 3rd nerve

RF = CV risk factors e.g. HT, DM etc and increased ICP

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20
Q

How does a 4th nerve palsy present?

A

The eye cannot look down and in
In the primary position, the affected eye is elevated to lack of function of superior oblique

Dx = head trauma, congenital IV palsy, CV risk factors

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21
Q

How does a 6th nerve palsy present?

A

Eye deviate medially
Cannot abduct

RF = CV, increased ICP

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22
Q

What are the 3 features which should be examined on the optic disc?

A

Cup - should be a paler disc within the optic disc, about 1/3 of the total disc size. Enlarge cup may suggest glaucoma

Colour - the optic disc should be orange-pink in colour. Pale discus suggest optic atrophy e.g. neuritis, ischaemia, advanced glaucoma, compression etc

Contour - should be clear and well defined —> if not it is papilloedema

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23
Q

Causes of papilloedema

A

Local:

  • optic neuritis/ vasculitis
  • disc infarct

Systemic:

  • increased ICP (SOL)
  • severe HT
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24
Q

Remember optic disc atrophy presents with a pale disc due to loss of fires within the optic nerve

A

Optic neuritis is inflammation of nerves within eye and presents with reduced vision and loss of colour vision —> most common in MS

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25
Q

Entropion = eye-lid turns in

(this requires surgical treatment to prevent a corneal ulcer but lubricants and tape can be used short term

A

Ectropion = eye-lid turn out

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26
Q

A stye presents as a pus filled bump on the eyelid. It is usually cased by staph infection of the sebaceous glands. How is it treated?

A

Apply a warm compress or steam it for several minutes per day

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27
Q

Acute angle-closure glaucoma = mid dilated pupil with hazy cornea

A

Anterior Uveitis = Small, fixed pupil

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28
Q

Remember anterior uveitis is basically the same as iritis

A

It is associated with ank spon, reactive arthritis, UC and Behçet’s disease

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29
Q

Other than blurring of the optic disc margin what are the features of papilloedmea?

A

Venous engorgement
Loss of venous pulsation (can be physiological)
Elevation of disc
Loss of cup

30
Q

Latanoprost

A

Prostaglandin analogue used in the managment of glaucoma

Main SE is brown pigmentation of the iris

31
Q

List a few types of drugs which may be used in open angle glaucoma?

A

Beta-blocker e.g. timplol
Prostaglandin analogue e.g. latanoprost
Alpha agonist e.g. apraclonidine/ brimonidien
Carbonic anhydrase inhibitor e.g. acetazolamide

32
Q

Dilated pupil which does not react to light in a young female?

A

Most likely Holmes-Adie pupil
Often associated with absent ankle/ knee reflexes and excess sweating in Holmes-Adie syndorme

Almost always unilateral

33
Q

What does an Argyl Robertson pupil look like?

A

Small and irregular
Usually bilateral
They accomodate briskly but do not react to light

Usually due to syphillus

34
Q

How do you treat conjunctivitis in pregnant women?

A

Topical fusidic acid

avoid chloramphenicol

35
Q

Give 5 features of optic neuritis

A

1) reduced visual acuity
2) colour desaturation
3) central scotoma
4) RAPD
5) Pain is worse on movement

36
Q

What is the differntial for sudden painless loss of vision?

A

1) CRAO
2) CRVO
3) Retinal detachment (flashes, floaters then curtain)
4) Vitreous haemorrhage (sudden, dark spots)
5) Ischaemic optic neuropathy e.g. temporal arteritis

37
Q

What is the commonest cause of a persistent watery eye in babies?

A

Nasolacrimal duct obstruction

Teach parents how to massage the duct

38
Q

What is normal IOP?

A

10-21mmHg

39
Q

Differential for sudden painless loss of vision?

A
  • Ischaemic optic neuropathy
  • CRVO
  • CRAO
  • Vitreous heamorrhage
  • retinal detachment
40
Q

4 stages of hypertensive retinopathy?

A

1) silver wiring (narrowing of vessels
2) AV nipping
3) cotton wool exudate + flame haemorrhage
4) papilloedema

41
Q

Sudden onset eye pain + seeing haloes =

A

AAGC until proven otherwise

42
Q

Open angle glaucoma causes gradual visual loss which start in the periphery and moves centrally

A

Open angle glaucoma causes gradual visual loss which start in the periphery and moves centrally

43
Q

Classical presentation of blepharitis?

A
  • bilateral eye grittiness and discomfort
  • sticky eyes
  • red eyelid margins
  • soften lid margin using hot compress
  • cotton wool dipped in baby shampoo used to remove debris
  • artificial tear may be given
44
Q

Long sightedness is a risk factor for AACG

A

Treatment options include reducing aqueous secretion and inducing pupillary constriction

45
Q

Give some risk factors for the development of cataracts?

A
  • increasing age
  • DM
  • Steroids
  • conditions such as myotonic dystrophy and DS
  • Trauma
46
Q

What risk factor is associated with sub-capsular cataracts?

A

Steroid use

47
Q

What are the main side effects of latanoprost?

A

It is a prostaglandin analogue which reduces eye pressure by increasing uveoscleral outflow

  • thickens and lengthens eye lashes
  • causes iris pigmentation
48
Q

List some causes of RAPD

A
  • Optic neuritis
  • optic neuropathy
  • large retinal detachment
49
Q

How will a CRVO look on fundoscopy?

A

Stormy sunset with loads of retinal haemorrhages

50
Q

Give some causes of tunnel vision?

A

Papilloedema
Glaucoma
Retinitis pigmentosa

51
Q

How do you manage allergic conjunctivitis?

A
  • 1st line = topical antihistamines (use oral if systemic symptoms)
  • 2nd line = mast cell stabilisers such as sodium cromoglycate
52
Q

Role of pilocarpine in glaucoma?

A

It causes pupil constriction which increases uveoscleral outflow

It is mainly used in closed angle glaucoma due to the side effects of headache and blurred vision

53
Q

Long sighted (hypermetropia) is associated with angle CLOSURE glaucoma

A

Short sightedness (myopia) is associated with angle OPEN glaucoma

54
Q

Features of open angle glaucoma on fundoscopy?

A
  • increased cup to disc ratio >0.7)
  • optic disc pallor
  • bayoneting of vessels
  • cup notching
55
Q

Diabetic patient with sudden visual loss and absence of the red reflex?

A

Vitreous haemorrhage

56
Q

‘Like a curtain coming down’

A

Most likely amarousis fugax - a type of TIA

57
Q

Suggest a treatment option for a patient with dry eyes secondary to Schirmer’s syndrome?

A

Hypromellose - artificial tears

58
Q

What is antazoline?

A

A topical anti-histamine used in the management of allergic conjunctivitis

59
Q

What is tropicamide?

A

A mydriatic eye drop used to dilate pupils ahead of fundoscopy

Effect within 15 minutes and lasts for 2 hours

60
Q

Elderly patient develop acute onset eye pain and reduced visual acuity 1 hour after having tropicamide eye drops. What complication has occurred?

A

Acute closed angle glaucoma (it is very rare)

61
Q

Blue sclera

A

Myotonic dystrophy ot

62
Q

Other than eye tumours, patients with the inherited form of retinoblastoma are at risk of…

A

Pineal and other forms of neuro tumours

Also increased risk of osteosarcoma, melanoma etc

The risk of a second malignancy is about 6%

63
Q

Why is tropicamide preferable to cyclopentolate prior to fundoscopy?

A
  • it is short acting (lasts 4-8 hours) which cyclopentolate lasts much longer
64
Q

What is dacryadenitis?

A

Inflammation of the lacrimal ducts

Causes redness and swelling - may be enough to distort vision

65
Q

CMV retinitis presents with fundoscopy showing a ‘pizza like appearance’ due to areas of yellow/ white exudate. How is it treated?

A

Ganciclovir

associated with myelosupression so needs careful monitoring

66
Q

Which angle is closed in ‘acute angle closed glaucoma’?

A

The iridcorneal

angle between iris and cornea

67
Q

List some drugs which can trigger acute angle closure glaucoma in susceptible individuals?

A
  • ipratropium
  • TCA (anti-muscarinic
    —> pupil dilatation)
68
Q

Child with right eye which moves out on the cover test

A

Esotropia or convergent strabismus

The affected eye is turned in so moves out to focus when other eye is covered

69
Q

Child with eye which turns in when other eye is covered?

A

Exotropia or divergent squint

Eye is turned out so moves in to focus when other eye is covered

70
Q

Which structure is responsible for the blind spot?

A

Optic disc

Opthalmology (1 decks)

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