Revision Cards Flashcards

Question

Ix/Mx of POAG?

Answer 1

Small non cancerous growth near your brain, which is causing loss of your side vision. We should treat it to prevent further vision loss. NB - MOST pituitary tumours are benign.

Answer 2

Visual Fields Testing Referral to both endocrinology and neurosurgery. Prolactin levels and hormone panel MRI pituitary May be surgically removed or if prolactinoma, the growth can be shrunk with medication (Bromocriptine) Follow up with neuro-ophthalmology

Answer 3

If left untreated, bitemporal hemianopia may worsen as the tumour slowly grows If treated, patients tend to have good recovery of vision, but this depends on how much it has already been affected and for how long.

Answer 4

Stroke of the part of the brain which is responsible for vision. Unfortunately this vision is highly unlikely to be recovered. (depending no how soon they have presented!)

Answer 5

Urgent referral to medical/stroke team in ED CT Head Once bleed excluded, aspirin 300mg +/- thrombolysis/thrombectomy discussion Secondary prevention (risk factor control BP, blood sugar, cholesterol, AF) Follow up from stroke and neuro-ophthalmology teams

Answer 6

Field of vision defects unlikely to recover

Answer 7

Inflammation of the front part of your eye. Serious condition if left untreated. In some cases it can be linked to inflammation in other parts of the body

Answer 8

Examine back of eye Steroid Eye Drops Dilating Eye Drops (advise on blurry vision) (+IOP lowering drops if high pressure either from inflammation or steroids) Sunglasses for photophobia Rheumatology referral (blood tests including HLA-B27) Follow up in uveitis clinic 4-6 weeks (by which time it should have improved)

Answer 9

Initially very frequently and then gradually reducing over 6 weeks. If steroid drops are suddenly stopped, inflammation may return. Steroid drops hourly for first 48hrs (same frequency as Abx in microbial keratitis), then every 2hrly for 5 days. Then week 2 x6/day, week 3 x4/day etc, until x1/day on week 6

Answer 10

Whilst glaucoma and cataracts can be complications of steroid eye drops (more so if used long term), untreated anterior uveitis can cause these complications to develop at a faster rate.

Answer 11

Serious infection of the jelly inside the eye

Answer 12

Deliver antibiotics via injection into the eye. At the same time, take a sample of jelly from inside the eye to see which bugs are growing and to better target antibiotic treatment. Antibiotic tablets (may need IV if unresponsive) Daily review of response File incident report and discuss at clinical governance meeting

Answer 13

Infection of the clear layer in front of the white of the eye

Answer 14

Bacterial - chloramphenicol antibiotic ointment QDS for 7 days (if suspecting STI, take swab for MC&S). Lid hygiene. Viral - lubricating eye drops (does not respond to Abx) Allergic - lubricating eye drops and antihistamine tablets HYGIENE ADVICE - wash hands, avoid sharing towels.

Answer 15

Swab for MC&S Antibiotic eye drops Sexual health clinic referral -> for oral antibiotics vs IM antibiotic injection

Answer 16

Viral lasts longer than bacterial Viral may take 1-2 weeks to resolve Bacterial - antibiotic eye drops are for 1 week, should see improvement after 3 days

Answer 17

Infection of the soft tissue in front of the eye (including eyelids) (does NOT have pain on eye movement or change to vision)

Answer 18

Oral Antibiotics Discuss with paediatrics (sometimes they admit, sometimes not) At the least, follow up in next couple days, might even be daily to monitor response Consent for serial photographs (not sure if patients would be happy for outlining with marker pen lol) Safety-net for orbital cellulitis (pain on eye movement and vision affected)

Answer 19

Most patients do respond well to oral antibiotics. If they don't, can try IV antibiotics. Although progression to orbital cellulitis is rare, that is a significant sight and life-threatening condition if inadequately treated.

Answer 20

Serious infection of the soft tissue behind the eyeball

Answer 21

Admit for IV antibiotics Urgent CT Orbits Discuss with paediatrics and ENT if sinusitis Follow up from oculoplastics

Answer 22

Describe to patient as 'infection of the front clear window of the eye, called the cornea' Technically keratitis refers to inflammation of cornea (may or may not be due to infection), whereas corneal ulcer is a defect in corneal epithelium usually due to infection.

Answer 23

Avoid CL use and educate about CL use CL and case for MC&S Corneal scrape for MC&S If bacterial/CL wearer, antibiotic eye drops hourly for 48hrs, including through the night. Follow up in 48hrs. If viral, ganciclovir ointment for 7-10 days

Answer 24

Small risk of scarring, which can cause long term problems such as blurring of vision. Prompt treatment and follow up helps minimise this risk. HSV Keratitis can recur, inform patients of this.

Answer 25

Ophthalmic shingles. Shingles infection of the top part of your face and your eye.

Answer 26

Clinical diagnosis but can take swab from vesicles. Aciclovir tablets 5 times a day for 1 week and ganciclovir ointment. Lubricating eye drops NOTE - steroid eye drops is a CONSULTANT DECISION, do not mention. Review in 1 week to ensure resolution.

Answer 27

Most patients do make a full recovery in time, however a common complication can be experiencing some pain even after the rash has gone (post-herpetic neuralgia) - incidence varies but increases with age, can be up to 1 in 5 patients. Can treat with nerve pain medication.

Answer 28

Suspicious growth on your eyelid

Answer 29

Urgent referral to oculoplastics or dermatology Maybe biopsy Surgical removal and eyelid reconstruction. The removed tissue is sent to the lab. The reconstruction is usually done a day or two after the removal. Followed up by oculoplastics to exclude recurrence, usually for 3 years.

Answer 30

A painless lump in the eyelid, caused by a blockage in your oil glands.

Answer 31

Warm compress and eyelid massage. If no improvement after 6 months, surgical removal is an option. Note - this does cause bruising for a few days, so not an immediate aesthetic fix for upcoming events. Eyelid hygiene to reduce risk of recurrence.

Answer 32

Chalazion can resolve spontaneously without intervention. Warm compress and massage may help. Daily eyelid hygiene or warm compresses can help reduce chance of recurrence.

Answer 33

Inflammation of the eyelids; like dandruff of the eyelashes.

Answer 34

Examine front surface of eye including cornea. Warm compress and massage Eyelid Hygiene. Lubricating eye drops If evidence of infection, topical antibiotics. If refractory, oral antibiotics.

Answer 35

Chronic condition. Not a complete cure as such but there are ways to control and manage symptoms.

Answer 36

A break in the bones around your eye.

Answer 37

Examine eye, palpate orbital area for crepitus, perform cranial nerves examination including eye movements. Refer to medical team for urgent CT Head. Presence/absence of oculocardiac reflex differentiates immediate versus delayed surgery (allows inflammation to settle). Aim of delayed surgery is to release trapped tissue/muscle, remove bony fragments and reconstruct shape of socket

Answer 38

Overactive thyroid gland When it affects the eyes, it's called thyroid eye disease. This refers to swelling of the normal fat and muscle tissue around the eyes.

Answer 39

Examine back of the eyes (checking nerve) Testing function of the nerve - vision, colour, outer vision, reflexes etc. MRI orbits Thyroid Function Tests Referral to endocrinology, oculoplastics and orthoptics (if double vision) Management (mentally split into conservative, medical and surgical): C: stop smoking programme, prism glasses, lubricating eye drops, tape eyes shut, antithyroid medication. M: Steroids S: after stage of inflammation has passed, can trim down some of the swollen tissue around the eye, correct double vision.

Answer 40

Inflammatory stage lasts around 2 years. Following that, the disease will have passed its worst stage. Any unacceptable changes to the eyes left over (e.g remaining bulging or double vision) can be considered for surgical input at the time. In some cases, the disease can last for several years. Important to signpost patients to the patient support groups available.

Answer 41

High blood sugar damages blood vessels at the back of the eye, affecting vision

Answer 42

Optimise blood sugar and blood pressure control Stop smoking Regular screening as early stages asymptomatic If macular oedema -> anti-VEGF injections PRP (laser procedure) to prevent neovascularisation (whose complications include vitreous haemorrhage and tractional retinal detachment)

Answer 43

Macular oedema -> can be treated with anti-VEGF injections and show improvement Diabetic vitreous haemorrhage secondary to neovascularisation -> VA should improve as blood absorbs itself In general, Sami advised not to go into prognosis details and reasons. Instead state "if we don't get your diabetes under control, this is a condition that can cause you to lose your sight"

Answer 44

A blockage in the vein at the back of your eye (which prevents blood from draining). This can cause swelling and bleeding to the tissue at the back of the eye.

Answer 45

OCT to check for macular oedema FFA to identify blockage location and extent Tests for secondary prevention (BP, blood sugar, blood clotting disorders) Anti-VEGF for macular oedema Laser for neovascularisation

Answer 46

I'm not sure - I think depends on the type? (ischaemic vs non-ischaemic) NB// 50% of patients notice some improvement in vision with anti-VEGF, but some don't

Answer 47

Age-related, slowly progressive thinning to the layer of nerve tissue at the back of the eye responsible for central vision.

Answer 48

Annual monitoring Amsler Grid for home monitoring and in clinic (OCT and FFA if concern of macular oedema and/or choroidal neovascularisation) Stop smoking Vitamin supplementation Low vision aids (similar to cataract e.g. magnifying glass, increase font size) Safety-net for signs of wet

Answer 49

Not curable but can help slow its progression

Answer 50

Age related thinning of the layer of nerve tissue at the back of the eye responsible for central vision. Growth of new delicate blood vessels behind this layer which are prone to bleeding. (idea it causes more sudden change to vision than dry and needs prompt treatment)

Answer 51

Amsler Grid OCT Anti-VEGF (NB// similar to use in DME. Key difference is that laser is not really used in wet AMD like it is in diabetic neovascularisation) Stop smoking More frequent monitoring than dry (every few months rather than annually) Amsler Grid for home

Answer 52

without anti-VEGF treatment = progress quite quickly and cause permanent vision loss through scarring (macular scarring) with anti-VEGF treatment = discuss specifics with consultant, but can stabilise or improve vision

Answer 53

Age-related changes to the jelly inside the eye causing it to pull away from the back of the eye. (Due to jelly becoming more liquid and shrinking. It is common in people over 50. Occasionally however as it pulls away, it can cause the layer of nerve tissue at the back of the eye to peel away, which is a RD)

Answer 54

Examine back of eye to exclude retinal tear or detachment Reassure that it is harmless and that floaters symptoms improve as brain becomes used to them. Safety-net for sudden increase in floaters/new flashes/black curtain coming down (as this indicates tear/ detachment)

Answer 55

Layer of nerve tissue at the back of the eye peels away, causing vision loss. (sudden increase flashes/floaters and painless vision loss - either black curtain or specific part of vision missing)

Answer 56

1. Retinal tear (allows fluid to enter behind the retina) 2. Vitreous stuck tightly to the retina during a PVD. 3. Neovascularisation (vitreous sticks to new vessels through scar tissue) 4. Any build up of fluid/blood behind the retina

Answer 57

Small retinal tears can be fixed with laser Otherwise repair of large tears or RD is urgent surgery within 24-48hrs - refer to vitreoretinal team. Frequently followed up in clinic post-repair to check reattachment and any complications.

Answer 58

If retinal tear left untreated, can cause RD (as fluid enters behind retina through tear) If RD not promptly treated, can cause permanent vision loss. Surgery usually recovers some but not all of the vision. A small proportion (10%) may need a second surgery. If gas is used during surgery, vision may stay blurry for a few weeks until this is reabsorbed by the body.

Answer 59

Bleeding into the jelly that's inside the eye

Answer 60

Most common - neovascularisation in proliferative diabetic retinopathy (ask about diabetes!) Retinal tear or detachment (both of these cause vessels on the retina to break and bleed. Hence why in vitreous haemorrhage, we must always examine the back of eye to exclude these. If view obscured by blood, USS B Scan needed.

Answer 61

Examine back of eye If view obscured, USS B scan to exclude retinal tear/detachment Regarding the bleed itself, small bleeds can be managed conservatively. Large or recurrent bleeds may need vitrectomy

Answer 62

Small bleeds can gradually clear on their own Large bleeds may take longer to resolve and may not clear on their own, requiring surgery (vitrectomy)

Answer 63

Blockage in the artery that supplies the eye, otherwise known as a stroke of the eye. (BBN approach, explain prognosis) (cause is either embolic or arteritic)

Answer 64

Urgent referral to stroke team Urgent bloods including ESR Stroke team will likely give blood thinning medication (aspirin) Secondary prevention - USS Doppler Carotids, ECG, BP and blood sugar control ECLO Inform DVLA

Answer 65

Unlikely to recover the lost vision Approach as breaking bad news

Answer 66

Temporary blockage to the blood supply of the eye, causing a temporary loss of vision. (also known as a mini-stroke of the eye). It is a serious warning sign that you're at risk of a stroke. (NB, stroke = when the blood supply to the brain is disrupted, causing damage to the brain)

Answer 67

ASPIRIN Carotid Doppler ECG Urgent referral to TIA clinic for secondary prevention (aspirin, control BP, control blood sugar, cholesterol)

Answer 68

10% risk of stroke in next 90 days

Answer 69

High blood pressure causes damage to the blood vessels at the back of the eye (NB// if BP >180/120 and papilloedema, this is malignant hypertension, which a medical emergency)

Answer 70

Check BP. If malignant hypertension (>180/120 and papilloedema or signs of end organ damage) -> emergency department, discuss urgently with medics Blood tests to check renal function ECG and possible Echo to check hypertensive damage. Otherwise, letter to GP to optimise control of BP (e.g. with medication), blood sugars, cholesterol. Advise the patient to stop smoking, reduce salt, increase exercise. If vision-threatening retinopathy -> referral to medical retina

Answer 71

Scratch to the front clear window of the eye (acknowledge they are very painful because of the numerous nerve endings making the front of the eye very sensitive)

Answer 72

Examination of eye (with fluorescein staining) and also examining under the eyelids (to check for a trapped foreign body that may have caused it) Lubricating eye drops Cover with antibiotic ointment or if CL-associated or signs of infection or large -> antibiotic eye drops (ofloxacin) Avoid CL use until healed (2 - 4 weeks) Dilating eye drops (cyclopentalate) to help with pain Numbing drops NOT given - these delay corneal healing process Sunglasses for photophobia

Answer 73

Usually heal well by themselves Pain usually improves by 48hrs May have gritty sensation for a few weeks

Answer 74

Likely your symptoms are being caused by the surface of your eyes being too dry. This is usually due to your eyes not producing enough tears or the tears evaporating too quickly from your eye surface

Answer 75

TFBT Examination with fluorescein staining Lubricating eye drops (day) and ointment (night) Use humidifier at home Reduce screen time If refractory, can consider punctual plugs

Answer 76

Eye infection affecting newborns, usually caught during birth NB - 1st week, typically gonorrhoea. 2nd week, typically chlamydia. Chlamydia is more common, gonorrhoea is more severe.

Answer 77

Swab of baby's eye Admit for systemic treatment - oral Abx if chlamydia and IV if gonorrhoea (aim is to treat infection both in eye and if present elsewhere in body such as nose and throat). Advise mum to go to sexual health clinic

Answer 78

Chlamydia is more common and gonorrhoea can be more severe Important to give systemic treatment, because they can cause disseminated infection (e.g. chlamydia can cause pneumonia)

Answer 79

These types of symptoms aren't consistent with any common underlying condition we expect to see, so we're concerned they may represent a non-accidental injury. It's important we follow policies to protect the child and exclude any safeguarding concerns

Answer 80

Admit child to hospital Examine back of eye to check for vitreous haemorrhage, retinal haemorrhage, retinal detachment (the latter requires surgery) CT head to exclude subdural bleed Paediatrics AND safeguarding referral Nb// triad of shaken baby syndrome (retinal bleed, subdural bleed, encephalopathy)

Answer 81

Depends on the injury. First priority is keeping child safe from further injury. Reassure they're in the right place for further Ix and Tx.

Answer 82

Growth at the back of the eye 'in keeping with/suspicious for' a cancer Can be caused by a certain gene (RB1) NB - retinoblastoma can affect 1 or both eyes

Answer 83

Urgent referral to ocular oncology Imaging of the retinoblastoma - USS/MRI Gene testing (RB1) Treatment: laser therapy/cryotherapy, chemotherapy, radiotherapy, if these don't work enucleation.

Answer 84

Treatment aims to get remove the cancer, but unfortunately there is a high chance your child will lose some, or all, of the vision in the affected eye NHS Website - "Treatments are available and it can usually be treated successfully if it's found early" Which therapies it responds to and how it well it responds - probably depends on size and exact location. Ocular oncology best placed to advise on exact prognosis, not an ST1.

Answer 85

Growth at the back of the eye 'in keeping with/suspicious for' a cancer. At some point, need to explain that we suspect it has spread from a different part of the body

Answer 86

Need to find out where the cancer has spread from (most common primary site in women is BREAST and in men LUNGS). Whole body PET-CT Urgent referral to ocular oncology AND medical oncology Treatment of the choroidal met includes chemotherapy or plaque radiotherapy, or enucleation.

Answer 87

Depends on the size, shape, primary site.

Answer 88

When one eye is out of line with the other, so they're not working together to focus on the same object (reasons we care: 1 - causes double vision 2 - affects 3D vision 3 - causes lazy eye (vision in the affected eye does not develop properly)

Answer 89

Examination of eye and eye movements Cover/uncover test Test vision for short or long-sightedness and correct with glasses Cover the stronger eye with a patch Surgery

Answer 90

Children do NOT grow out of a squint. Patching is essential to encourage vision to develop in the affected eye and prevent a lazy eye

Answer 91

Genetic condition which causes gradually progressive deterioration of the layer of nerve tissue at the back of the eye Mention there is NO PROVEN CURE (only experimental therapies)

Answer 92

Referral to medical retina and genetics Examine back of eye Electroretinography - measures how well the retina responds to light, can aid with diagnosis OCT scan Blood testing for gene responsible No cure Key is to offer ECLO, low vision aids etc Medical retina will regularly follow up to monitor progression (just because there is no cure, does not mean we won't support you) Experimental gene therapies and experimental artificial retinal implant

Answer 93

No cure currently available Gradually progressive (affects wide vision in early stages and then central vision in late stages)

Answer 94

Retinitis pigmentosa Diabetic retinopathy with laser treatment Glaucoma Double vision Blepharospasm Night blindness

Answer 95

Glaucoma Retinitis Pigmentosa Retinoblastoma AMD ?Squint