teach Flashcards
which wall of the bony orbit is most commonly affected by blow-out fracture? - this on the eye
inferior wall
what extra ocular muscle elevates the eyeball
inferior oblique
which 2 structures form the outer fibrous coat of the eyeball
sclera and cornea
which 3 structures make up the uvea( 2nd layer of the eye)
iris, ciliary body , choroid
3 layers
outer fibrous coat - sclera and cornea
uvea next layer made up of iris, ciliary body and choroid
retina
cones ( distinguish between different colours) are mainly found in the fovea/macula
true
rods are for not vision and low light Vision
in which structure is aqueous humour produced
ciliary body
50yr old lady present with very painful red eye, cause and vomit, halos around Leith and blurry vision. she has hazy cornea and visual acuity
acute glaucoma
temporal arthritis - scalp tenderness and proximal muscle weakness
treatment for acute angle glaucoma
IV acetazolamid and timolol and apraclonidine and predinsiolve
buzz word
fixed mid-dilated pupil
acute angle glaucoma
also blurry vision
red painful eye
N+V and fixed mid-dilated pupil
diagnosed via a slit lamp
in acute angle closure glaucoma do you give treatment to both eyes or the affected
both due to the fact they are high risk
is hypermetropia(long sited) a rf for acute glaucoma
yes
myopia short sited - does not predispose them to it
a man present with 2 weeks of a painless rubbery eyelid lump what is it
stye
chalazion
pterygium
dacrocystitis
chalazion
more likely than a stye
painful Lump would have been a stye
a chalazion is granuloma due to blocked meibomian gland. RF include blepharitis and rosacea what are the symptoms and treatment
painless lump which is rubbery
hot compress, usually self resolves in 6 months , curettage is option
what is a stye
infection of lash follicle glands by staph
RF for stye include acne vulgarisms and DM
what are symptoms and treatment
painful lump in lid margin and swelling
maybe eyelash coming out
hot comrpee, topical antibiotics and eyelid hygiene and eyelash removal
68yr old man with several months of itchy sore eyes in the morning
trichiasis
corneal abrasion
blepharitis
entropion
blepharitis - inflamed lash line or lid margin
blepharitis is chronic inflammation of eyelid margin with infection or not - flakey
RF are atopic eczema dn seborrhaeic dermatitis
clinical features include
treatment
itchy sore eyes in the morning, crusty/scaly/oily lid margin
eyelid hygien and topical doxycycline if infection
is blepharitis is chronic condition
yes
35 woman with kitty eyes tremor on outstretched hands and pulse of 110bpm
parkinsons
thyroid eye diseas e
ectropion
bacterial endophthalmitis
thyroid eye disease
thyroid eye disease can result from people with graves disease with antibodies against TSH causing orbital inflammation
what are the sytmtposm and treatment
need to check TFTs
exophthalmos( immune response not the thyroid hormones causing this) ( kitty eyes) and lid lag accompanied
tremor and pusle
( symptoms same of hyperthryosidim )
antithyroid medications and surgery
TSH levels not raised in grave
6oyr odl man presents following seizure, left parietal mass what visual defect is he most likely to have?
right inferior quadrantopia
damage in cranial nerve get
monocular vision loss
damage to optic chaism
bitemporal hemianopia
damage to optic tract
homonymous hemianopia
optic tract meet maternal geniculate uncles. one goes through temporal and one through parietal lobe.
temporal lobe is inferior to parietal lobe it takes things form the superior optic radiation
and the partial lobe gets it from the inferior optic radiation
visual field defects
pituitary tumour classically cause what visual field defect
bitemporal hemianopia
60yr old patient with diabetes preens with gradual deterioration of vision and dazzling of view in well lit places
cataracts
cataracts is lens opacity, risk facts are age and diabetes and stereo smoking and alto sue and genetics
diagnosis’s via slit lamp
treatment via phaecoemulfificaiton and lens implant
symtposm
bilateral painless blurring of vision over years, glare whilst driving at night
cataracts does not require urgent surgery
RA severe eye pain and dominant blood vessels on either side of eyes
scleritis
scleritis is inflammation of the sclera and RF include ocdntions such as RA, GP And polyarteritis ndoosa
symptoms are
diagnosis are ophthalmology examination and rheumatology review - could be flare
red eye, deep boring pain on the eyes, pain on movement , photophobia and decreased acuity
Treatment with high dose seteriods and DMARDS
sudden loss of vision in right eye. hypertension , hyperlipidemain and diabetes and carotid bruit on examination
central retinal artery occlusions
pale retina with cherry red spot - stroke int eh artery
central retinal artery occlusion is stroke of central retinal artery RF including CVD and stroke and carotid disease
symptoms are
sudden painless monocular severe visual loss and pale retina dn cherry red spot.
treatment is excluded giant cell arteritis ( temporal arteritis - check CRP or ESR) , stroke work up and according to local protocols
easily treateded with steroids
which is typical appearance of a retina with CRAO
pale retina with cherry red spot
CMV retinitis
pizza-pie appearance
retinitis pigmentosa
bone spicule pigmentation
central retinal vein occlusion
stormy sunset appearance
exactly same symptoms as arteries
60 yr old man if refereed to you by opticiity after fundoscopy
shown eye with big bright spot
(chronic) glaucoma
chronic glaucoma is progressive characteristic of optic nerve damage and visual field losss. RF is age , raised intracoular pressure , black African and high myopia
symtposm are
diagnose is slit lamp exam ( CDR>1/3, gonioscopy , perimetry and tonometry
treatment is
none until late
acute scotoma
peripheral VL
spot needs to be bigger than 1/3
topical latanoprost and trabeculoplasty, trabeculectomy
advanced cases tunnel vision only can see through there macula
myopia is a risk factor for chronic glaucoma
yes but not for acute angle closure glaucoma
10 yr old male with right eye difficult to open after sleep, diffuse conjunctival injection and significant mucopuruletn discharge
bacterial conjunctivitis
red/pink eye and itchy if allergic , one purulent if bacterial
treatment for bacterial is chloramphenicol if docent resolve
allergic avoid allergen and antihistamines
viral self resolves
what is visual acuity
Visual acuity (VA) is a measure of the ability of the eye to distinguish shapes and the details of objects at a given distance.
on routine review of diabetic man has this eye
cataract
diabetic retinopathy
age related macular degneraton or glaucoma
diabetic retinopathy
diabetic retinopathy one of the microvasuclar complications- include chronic hyperglycaemia causing cap damage
RF are DM fro over 20 years
clinicla features include painless bilateral VL
exudates and haemorrhage
treatment is
strict glycemic control
panretinal photocoagulation PRP
intravitreal anti-VEGF
3 microvascular complications of diabetes
retinopathy
nephrotpathy
neuropahty
previously healthy 63yr old man left eye pieced by intermitted flashes and curtain like loss of lateral vision that began when he woke up
retinal detachment
retinal detahcenet is neural retina separation from RPE , high myopia, trauma and age and strong sneeze are RF - clinical features
treatment
flashes and floaters
curtain coming down
diagnosed on fundoscopy
time critical surgery - gas tamponade
does myopia increase the risk of retinal detachment
yes
24yr old man acutely with pain in left eye. Temp of 39 and redness and swelling of completely closed left eye
orbital cellulitis
if eyes shut means eyelids are shut
ifnalmmtion of the skin
orbital cellulitis is infection orbital contents and often secondary to sinusitis or ethmoidist as comes in resent with eyelid inflation and pain of eye, proptosis fever and chills. diagnoses via septic screen and CT/MRI
treatment is
IV broad spectrum antibiotics
ENT and ophthalmology
what infection precedes orbital cellulitis
sinusitis
79 yr odl man noticed vision has worsteds over last year
treatment of this
age related macular degeneration
age main risk factors
druse in back of the eye causing loss of central vision ( opposite to glaucoma which is peripheral )
lifestyle changes and Anti-VEGF in wet
drusen are pathogenic of macular degeneration
true - more specifically dry macular degeneration
40yr old man with cilia injection , hypo-yon , photopbia and a small pupil and eye pain when reading
anteriro uveitis
3rd and 6h never palsy cause diplopia
anterior uveitis/ iritis
ifnalmtion or the iris
major risk factors
symtposma re painful red eye with photophobia and hypopyon( pus in cornea) , blurring and perilimbial injection ( redness round the cornea) and cells and flares on slit lamp
treatment is what
ankylosing spondylitis and reactive arthritis and RA
topical corticosteroids and treat underlying cause of rheumatoid condition
which gene is most associated with antihero uveitis
HLA - B27 - the one with ankylosing spondylitis
30yr lady with acute blurring visionamdn eye pain fundoscopy revealed blurred disc marginal and an elevate disc
optic neuritis
optic neuritis is idiopathic and ifnalmmtion of optic nerve - MS too
RF anre MS and NMO and MOG
acute unilateral VL , pain on eye movements, RAPD, central scotoma ,and papillitis
MRI scan
treatment is
steroids and joint ophthalmology and neuroblastoma
50yr old women with painful red eye. Dendritic ulcer is diagnosed after flurosecin stain under blue light
keratitis
infective keratitis is infection of the cornea - viral bacteria fungal or acanthamoeba
rf is people who wear contact lens , cold sores or immunosuppreison
symtpsom
what is the treatment
round ulcer - bacterial
dendritic ulcer if HSV
diagnose if corneal scraping to get organism
treatment is empriaicla topical antimicrobials and modify based on MCS
pain out of proportion to clinic signs what type of keratitis would you suspect
acanthoamoeba
the eye looks normal but a lot of pain
