UKMLA Ophthalmology Flashcards
Which ethnicity is more prone to developing primary open-angle glaucoma?
Black Africans
What is the characteristic visual defect associated with Primary Open Angle Glaucoma?
Halos and tunnel vision
PAINLESS visual loss of the peripheral field
What is the fundoscopy finding associated with Primary Open Angle Glaucoma?
Cupping of the optic disc with a thin neuroretinal rim
What is the gold-standard investigation indicated to diagnose Primary Open Angle Glaucoma?
Goldmann applanation tonometry - measures intraocular pressure
What is the first line topical drug for the management of Primary Open Angle Glaucoma?
Topical prostaglandin analogue e.g., latanoprost
What is the mechanism of action of prostaglandin analogues
Increases aqueous outflow
Hypertrichosis is an adverse effect associated with which drug implicated in the management of Primary Open Angle Glaucoma?
Prostaglandin analogues
What is the mechanism of action of beta-blockers in the management of Primary Open Angle Glaucoma?
Reduces aqueous production
What is the indication for selective laser trabeculoplasty or surgery for the management of Primary Open Angle Glaucoma?
if IOP >24
What is the clinical difference in visual loss presentation between closed-angle versus open-angle glaucoma?
Closed angle = painful
A fixed mid-dilated pupil is associated with which type of glaucoma?
Closed-angle glaucoma
What is the clinical presentation of closed-angle glaucoma?
- Acute red, painful eye
- Hazy cornea
- Corneal oedema
- Blurred vision
- Decreased visual acuity
- Worse with mydriasis (e.g., watching TV in a dark room)
- Haloes around lights
- Lacrimation
- Firm eyeball
- Fixed mid-dilated pupil
Which investigation is indicated in closed-angle glaucoma to visualise the angle?
- Gonioscopy
What is the first line management of closed-angle glaucoma?
- Emergency (same day) referral to ophthalmologist
+ miotic agent e..g, pilocarpine
How does pilocarpine work?
Causes contraction of the ciliary muscle to open the trabecular meshwork
Which drug reduces the production of aqueous humour and is indicated in the the management of closed-angle glaucoma?
o Oral or IV carbonic anhydrase inhibitor (e.g., acetazolamide)
What is the definitive management of closed-angle glaucoma?
Laser peripheral iridotomy
Which organism is implicated in the contact-lens keratitis?
Pseudomonas aeruginosa.
What is the management of herpes simplex keratitis?
Topical acyclovir 5 times/day, for 2 weeks
What is the management of contact-lens keratitis?
Urgent ophthalmologist referral for ulcer scraping and topical fluoroquinolone (e.g., ofloxacin, levofloxacin, or moxifloxacin). Discontinue contact lens until symptom resolution.
Which stain is used to identify dendritic ulcers in HSV keratitis?
- Fluorescence stain
What is the presentation of keratitis?
- Photophobia
- Lacrimation
- Painful, red-eye
- Foreign body, gritty sensation
- Diminished visual acuity
A foreign body gritty sensation and painful red eye is associated with which eye condition?
Keratitis
What is the management for keratitis?
Urgent referral
Tractional retinal detachment is associated with which pathology?
Proliferative diabetic retinopathy
What is the most common cause of retinal detachment?
Rhegmatogenous (commonest form) – as the vitreous shrinks and partly separates from the retinal surface, a retinal tear may arise, allowing fluid to enter the subretinal space precipitating retinal detachment
Floaters and flashers + shadow curtain involvement of visual loss is associated with what diagnosis?
Retinal detachment
What fundoscopic finding is observed in patients with retinal detachment?
Asymmetrical red reflex
What is the definitive management for retinal detachment?
Laser therapy
Vitrectomy
Which type of glaucoma is associated with a painless loss of the peripheral visual field (tunnel vision)?
Primary Open Angle Glaucoma
What is the presentation of central retinal artery occlusion?
Painless sudden severe unilateral vision loss
RAPD
A cherry red spot on fundoscopy is characteristic of which pathology?
Central Retinal Artery Occlusion
What is the immediate management of Central Retinal Artery Occlusion ?
Emergency referral - ocular massage or anterior paracentesis to dis-logde the clot
What is the aetiology of Central Retinal Artery Occlusion ?
Central retinal artery is blocked by an embolus or inflammation secondary go giant cell arteritis
A stormy sunset appearance on fundoscopy is associated with ophthal pathology?
Central Retinal Vein Occlusion
What is the mainstay management for Central Retinal Vein Occlusion ?
Panretinal photocoagulation
or Anti-VEGF therapy
What are the risk factors for vitreous haemorrhage?
- Proliferative diabetic retinopathy
- Retinal detachment, posterior vitreous detachment
- Coagulation medications
- Trauma (most common in children and young adults).
A red-hue in vision + floaters and dark spots in vision is consistent with what diagnosis?
vitreous haemorrhage
What is the fundoscopic finding associated with vitreous haemorrhage?
Haemorrhage in vitreous gel