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Opthalmology > Revision > Flashcards

Revision Flashcards

1
Q

in the retina what do the rods do

A

are sensitive to low levels of light- night vision/ peripheral vision

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2
Q

in the retina what do the cones do

A

detailed vision (acuity), coloured vision

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3
Q

what are the ocular adnexae

A

extra oricular tissues- lids, lacrimal gland, lacrimal sac, naso-lacrimal duct

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4
Q

what is cranial nerve II

A

optic

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5
Q

what is cranial nerve III

A

oculomotor

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6
Q

what is cranial nerve IV

A

trochlear

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7
Q

what is cranial nerve V

A

trigeminal

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8
Q

what is cranial nerve VI

A

abducens

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9
Q

what is cranial nerve VII

A

facial

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10
Q

what is emmetropia

A

no refractive error in vision

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11
Q

what is hypermetropia

A

long sightedness- caused by eye being smaller than average

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12
Q

what is myopia

A

short sightedness- eye is bigger than normal

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13
Q

what is Astigmatism

A

blurred vision caused by the eye being shaped more like a rugby ball than a football

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14
Q

what is amaurosis

A

partial or total blindness without visible change in the eye

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15
Q

what is oscillopsia

A

when objects in the visual field appear to oscillate

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16
Q

what is diplopia

A

double vision

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17
Q

what condition causes the peripheral vision to deteriorate whilst central vision is maintained

A

glaucoma

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18
Q

what condition can headlight glare be a symptoms

A

cataracts

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19
Q

what condition cause central vision to deteriorate

A

macular degeneration

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20
Q

what is epiphora

A

excessive watering of the eye

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21
Q

how do you test visual function

A

visual acuity (clarity of vision), visual field, colour vision

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22
Q

what are the roles of the eyelids

A

tear film distribution, protects eyes, have glands that add to tear film

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23
Q

what is sclera show

A

when eyelids not covering iris, can see sclera above or below

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24
Q

what is ptosis

A

drooping or falling of the upper eyelid

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25
Q

what is the pupil sign that suggests horners

A

abnormally constricted pupil in eye with droopy eyelid

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26
Q

what controls the muscle LPS

A

CN III

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27
Q

what is the mullers muscle - action and innervation

A

fibres within LPS, holds open eye in F/F

sympathetically controlled

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28
Q

what is the role of the different parts of the orbicularis occuli

A

orbital part- squeezing of the eye, forced blink

palpebral part- normal blinking, reflex blink

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29
Q

what innervates the obicularis occuli

A

CN VII

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30
Q

what palsy affects obicularis occuli meaning you lose your reflex blink

A

bells palsy- presents with dryness and irritation

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31
Q

where are tears formed (three places)

A

fluid from lacrimal gland, oil from eyelid glands, mucosa from conjunctiva

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32
Q

what covers the inner surface of the eyelid

A

palpebral conjuncitva

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33
Q

what lines the eyeball

A

bulbar conjunctiva

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34
Q

what do the palpebral and bulbar conjunctiva create

A

a mucosal surface which allows tears to stick to eye

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35
Q

what makes up the cornea

A 
epithelium 
bowmans membrane 
stroma 
descents membrane 
endothelium
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36
Q

what is the major refracting surface of the eye

A

cornea - bends the light onto the lens

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37
Q

why do you need glasses

A

misshapen cornea

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38
Q

what is a condition that clouds the lens

A

cataracts

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39
Q

what is the middle of the lens called

A

lens nucleus

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40
Q

what keeps the lens in place

A

zonules

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41
Q

does the cornea change shape in the accommodation reflex

A

no

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42
Q

describe the accommodation reflex

A

If looking at something in the distance cornea does enough light bending to focus light on the retina. If then go to close up cornea needs help from the lens to bend the light into focus. Spherical lens had more refractive power than a flat lens
To pull zonules ciliary muscles need to relax- this makes lens flat to see in distance. To see something close need spherical lens so need ciliary muscles to contract to relax the zonules

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43
Q

what is the natural shape of the lense

A

spherical

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44
Q

how does the lens shape change

A

contraction or relaxation of the cilliary muscle then relaxes or tightens the zonules

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45
Q

why do you need glasses as you get older to see close up

A

ciliary muscles doesn’t contract and zonules don’t relax aswell

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46
Q

what is the uvea

A

middle layer of eyeball, inbetween sclera and retina, formed from embryo uvea tissues, made up of choroid cilliary body and iris

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47
Q

what does the ciliary body do

A

makes aqueous

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48
Q

where is the choroid

A

underneath the retina - turns in to cilliary body and then iris

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49
Q

what is the role of the choroid

A

is extremely vascular- acts as a way to get blood to the avascular retina

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50
Q

what is the afferent pathway of the pupillary light reflex

A

optic nerve- chiasm- optic tract- BOTH pretectal nucleus- BOTH pretectal nucleus go to BOTH EWNucleii (each goes to two)

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51
Q

what is the efferent pathway of the pupillary light reflex

A

CN III (oculomotor) from EWN- synapses halfway at cilliary ganglion

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52
Q

what is the direct pupillary reflex

A

light in right makes right constrict

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53
Q

what is the consensual pupillary reflex

A

light in right makes left constrict

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54
Q

what will shining a light in the right eye tell you about the afferent pathway of the left

A

nothing

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55
Q

what is the RAPD pupillary reflex

A

(relative afferent pupillary defect)

subtle change in the afferent of one eye (optic nerve not working aswell)

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56
Q

how is RAPD tetsed

A

Swinging light test- by making maximal constriction in one eye and they switching to eye not working before has time to dilate properly will dilate a little bit as nerve not working at full capacity. If go back to other eye will go back to pin prick

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57
Q

do parasympathetics synapse close to or far from organs

A

close to

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58
Q

what is the path of the nerves from the eyeball to the brain

A 
optic nerve 
chiasm 
optic tract 
lateral geniculate nuclei 
optic radiation 
occipital cortex
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59
Q

what side of occipital cortex will right visual field go to

A

left

same for left to right
lower to upper
upper to lower

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60
Q

what crosses at the chiasm

A

nasal visual field fibres (peripheral vision)

temporal remains on outside

61
Q

what vision loss in a problem with the optic nerve

A

unilateral vision impairment (one side)

62
Q

what vision loss in a problem with the chiasm (pituitary tumour)

A

bilateral hemianopia (loss of peripheral/ temporal fields)

63
Q

what causes a homonomous vision loss (same side lost on both eyes)

A

problem after the chiasm

64
Q

what causes a quadrantoanopia

A

problem with lobes after geniculate nuclei (e.g. parietal lobe)

65
Q

what is the path of the lower visual field

A

hits upper retina, stay in upper fibres in nerves, chiams and optic tract, to nucleus, as high able to go in straight line to the occipital cortes to the parietal lobe

66
Q

what is the path of the upper visual field

A

goes to lower retina, stay in lower part of nerve, chiasm and tract but are obstructed by the ventricles so to get to occipital cortex need to go around the front of the ventricle (in temporal lobe) (round the temporal ventricle)

67
Q

what makes up the fibrous outer layer of the eye

A

sclera and cornea

68
Q

what are the three coponents of the uvea

A

retina, choroid and iris

69
Q

what makes up the iris

A

pigment cells and smooth muscle

70
Q

what controls pupil size

A

sphincter pupillae constricts under parasympathetic stimulus

dilator pupilae dilates under sympathetic stimulus

71
Q

what is the role of the ciliary body

A

secretes aqueous humor
(cilliary epithelium)
controls the shape of the lens

72
Q

what is the path of light into the eye

A

tear film, cornea, aqueous humour of anterior chamber, pupil, aqueous humor of posterior chamber, lens, vitrous body (containing vitrous humour), retinal artery/ vein branches, ganglion cells axon, photoreceptors

73
Q

why dont you blow your nose in blow out fractures

A

as might introduce nasal commensal- cause orbital cellulitis

74
Q

what is the efferent limb of the pupillary reflex

A

oculomotor nerve and iris

75
Q

what is the afferent limb of the pupillary reflex

A

retina, optic nerve, chiasm

76
Q

how does a perforated blind fold test visual acuity

A

blocks divergent rays that need focusing, leaving only parallel rays that are focused already to strike retina- shows if vision bad cos need glasses if vision improved with this blindfold

77
Q

what is the blind spot

A

the optic disc- part of retina with no photoreceptors, only axons joining to make optic nerve

78
Q

what is the innervation of the lacrimal gland

A

parasympathetic CN 7

79
Q

what are the components of CN III

A

somatic motor and parasympathetics

80
Q

what nerve supplies sensation to the ala of the nose

A

ophthalamic division of the trigeminal nerve

81
Q

what is the fovea

A

area of macula with greatest concentration of cones

82
Q

where is optic disc always

A

nasal side of those pictures

83
Q

what is the macula

A

area of greatest acuity- found in the centre of all four quadrants (centre of the retina)

84
Q

when do you get vision changes in an eye pathology

A

when it affects the macula

85
Q

what are the red dots in macular degeneration

A

haemorrhages (mild type only has haemorrhages)

86
Q

when do you look at the macula in an osce

A

at the end as can be sore to look at the light

87
Q

what do you look for in an osce in opthalmoscopy

A

cup, contour, vascular arcades, macula

(right eye use your right eye and stand on the right side)
red light, look into distance, dial to green 10= anterior chamber. dial down to 0 to into at the retina

mannequin heads commonly have CRAO or CRVO

88
Q

list all the bones in the orbit

A

frontal, ethmoid, lacrimal, sphenoid, maxilla, zygomatic, palatine

89
Q

list the key findingd in a 3rd nerve palsy

A 
eyeball looks down and out
droopy eyelid 
cant move eye medially or up 
pupil dilated, will struggle to constrict 
can also get headache
90
Q

what pathology are you most concerned about

A

posterior communicating artery aneurysm

91
Q

what is cupping and what causes it

A

loss of axons in the optic nerve, progressive thinning of the neuro-retinal rim (increasing the cup size)
found in glaucoma

92
Q

what vision loss in cupping

A

tunnelling (brain fills in missing bits)

93
Q

what is the treatment for a herpes simplex keratitis

A

aciclovir ointment or ganciclovir

94
Q

what is a dendritic ulcer

A

herpes simplex keratitis

95
Q

what do you never give to treat a dendritic ulcer

A

steroids- can cause corneal melt

96
Q

what is ocular coherence tomography used for

A

wet macular degeneration
shows zones of fluid leakage
can be used for diabetic macular oedema

97
Q

what does a CRVO look like

A

pale retina with a cherry spot macula- can see underlying arteries from choroid in macula

98
Q

what causes sudden painless loss of vision with a number of CV risk factors

A

CRAO or CRVO

99
Q

what is a hypopyon

A

pus fluid level in the eye

100
Q

what are the signs of GCA

A

thickened wall of temporal artery, swollen disc

101
Q

what is a hyphaema

A

fluid level of red blood cells in the anterior chamber- seen in blunt trauma

102
Q

what type of hypersentivity is a corneal graft rejection

A

type 4

103
Q

which cranial nerves are involved in afferent and efferent blink reflex

A

afferent: trigeminal V1 (nasocillary branch)- corneal sensation

efferent- facial nerve the orbicularis oculi

104
Q

what is blepharitis

A

inflammation of the eyelids (v common, often chronic)

105
Q

what are the types of blepharitis

A

anterior (seborric- flakey white scales, drandruff on eyelashes) (s. aureus- more erythematic, oedematous)

posterior (Meibomian (tarsal) gland dysfunction- too much secretion, associated with acne rosacea)

106
Q

what are the symptoms of anterior blephritis

A

affects outer eyelid

  • red lid margin
  • scales, dandruff
  • seborrheic dermatitis
  • styes, ulcers, inflammation, distorted eyelashes, stains, keratitis

itchy red sore eyes, burning sensation, photophobia

107
Q

what are the symptoms of posterior blepharitis

A

affects inner eyelid

  • red, deep lid
  • swelling
  • dried secretions
  • gritty eyes
  • chalazia (eyelid cyst)
  • acne rosacea

itchy red sore eyes, burning sensation, photophobia

108
Q

what is the treatment for blephritis

A 
lid hygiene (bathing, warm massage)
topical chloramphenicol (short course) 
if acne rosacea- doxycycline 
incision/ currettage of chalazion 
furisidic acid
109
Q

what is ectopion

A

lid margin rolls outward
caused by age, VII palsy
get watery eye
Tx= surgery

110
Q

what is entopion

A

lid margin rolls inward- lashes against globe
caused by age
get irritation, red eye, abrasion
Tx= surgery

111
Q

what is conjunctivitis - what can cause it

A

infammation of the conjunctiva

viral, bacterial, allergic

112
Q

buzzwords: papillae and follicles

A

conjunctivitis
papillae- bacterial and allergic
follicles- viral and chlamydial

113
Q

does conjunctivitis affect vision

A

not usually

114
Q

what are the features of bacterial conjunctivitis

A

begins in one eye then spreads to other
acute onset
gritty eyes with purulent discharge (stuck together when wake up)
minimal pain
clear cornea
chemosis (conjunctival oedema) and lid oedema
papillae

115
Q

what is the treatment for bacterial conjunctivitis

A 
self limiting (14 days) 
to speed up:
-chloramphenicol 
-penicillin if gonococcal 
-fusidic acid 
(can swab but dont usually need to)
116
Q

who gets chlamydial conjunctivitis

A

adolescents and YA

beware the red eye in the neonate

117
Q

what are the features of chlamydial conjunctivitis

A 
slow onset red eye 
discomfort 
purulent discharge 
palpable pre auricular node 
corneal vascularisation 
follicles
118
Q

what is the treatment for chlamydial conjunctivitis

A

topical erthyromycin

referal to GU/paediatrics

119
Q

what viruses can cause viral conjunctivitis

A

adenovirus, herpes simplex + zoster, molluscum contagiosum

120
Q

what are the features of adenovirus conjuctivitis

A 
highly contagious 
follows URTI
watery discharge 
chemosis 
lid oedema 
pseudomembrane 
follicles
121
Q

what is the treatment for adenovirus conjunctivitis

A

self limiting
lubricants, hygiene
if corneal involvement/intense inflammation then can use topical steroid

122
Q

what are the features of herpes simplex conjunctivitis

A

unilateral
affects eyelids + surrounding skin
dendritic corneal ulcer
palpable pre auricular node

123
Q

what is the treatment for herpes simplex conjunctivitis

A 
can be self limiting 
topical aciclovir (never steroids!!!)
124
Q

what are the features of molluscum contagiosum conjunctivitis

A

unilateral
red eye that fails to improve
pearly umbilicated nodules

125
Q

what is the treatment for molluscum contagiosum conjunctivitis

A

currettaging central lesion

short course topical prednisolone

126
Q

is viral conjunctivitis water or dischargy

A

watery

127
Q

what are the symptoms of corneal abrasion

A 
severe needle like pain
profuse watering 
decreased acuity
photophobia 
circumcorneal redness 
hypopyon
128
Q

what investigations into a corneal abrasion

A

fluoroscein drops + blue light

orange dye drops + blue light

129
Q

what is the treatment for a corneal abrasion

A

topical anasthetic (oxybuprocaine)
chloramphenicol drops
steroids
(heals better without)

130
Q

what is keratitis

A

corneal inflammation

131
Q

what can cause keratitis

A 
trauma, foreign body 
viral (adeno, herpes simplex)
bacterial (staph, strep, pseudomonas, acanthamoeba (contact lenses)
blephartitis 
fungal (trauma from vegetation)
132
Q

what are the symptoms of keratitis

A 
diffuse injection, red eye
photophobia
gritty eye 
decreased vision 
needle like pain 
epiphora (excess lacrimation)
opacity 
bacterial= hypopyon 
herpetic= v. painful 
fungal= slow growing
133
Q

what investigations in keratitis

A

flouroscein, corneal scrape, gram stain

134
Q

what is the treatment for keratitis

A

topical anaesthetic
ofloxacin if bacterial
aciclovir if herpetic

135
Q

what is uveitis

A 
inflammation of the uvea
can be:
anterior: iris and ciliary body 
-intermediate: ciliary body and choroid 
-posterior: back of eye, retina and choroid
136
Q

what condition is common mistaken for conjunctivitis

A

uveitis

137
Q

what is chorioretinitis

A

form of posterior uveitis

associated with cytomegalovirus and toxoplasmosis

138
Q

what can cause uveitis

A

HLA-B27 gene: ankylosing spondylitis, reiters (reactive arthritis), UC, sarcoidosis)
infective (TB, syphilis, herpes zoster and simplex)
malignancy (leukaemia)
idiopathic
trauma

139
Q

what are the symptoms of uveitis

A 
unilateral 
pain
decreased acuity 
photophobia 
red eye 
ciliary injection
hypopyon (anterior)
synchechiae (small irregular pupil)
flashes and floaters
140
Q

what is the treatment for uveitis

A

corticosteroid eye drops/ injections
cycloplegic mydriatic drops (dilate the eye)
rarely surgery/ immunosuppression

141
Q

what is iritis

A

anterior uveitis

142
Q

what are the features of anterior uveitis

A 
red, painful eye 
photophobia 
injection
normal/blurred vision 
cells, keratic precipitates
hypopyon
143
Q

what is the treatment for anterior uveitis

A

topical dexamethasone

mydriatics (pupil dilator)

144
Q

what is episcleritis

A

inflammation below the sclera, usually idiopathic, sometimes associated with gout

145
Q

what are the symptoms of episcleritis

A 
acute onset
mild pain/ discomfort 
tender globe, achy eye 
blue sclera
normal acuity 
usually associated with a nodule
146
Q

what is the treatment for episcleritis

A

self limiting

topical/systemic NSAIDs

147
Q

what is scleritis and what is it associated with

A

severe inflammation throughout entire thickness of sclera
V rare, more common in women
associated with RA

148
Q

what are the symptoms of scleritis

A 
sub acute 
severe boring eye pain that radiates to forehead, brow and jaw 
local/ diffuse red eye 
violoceous hue (purple due to deep injected vascular plexus) 
tender globe 
watering 
photophobia 
gradual decrease in vision
149
Q

what is the treatment for scleritis

A

oral NSAIDs/steroids

Opthalmology (16 decks)

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