Year 5 passmed Flashcards
Histopathologically where is the inflammation in GCA and what are things are deposited in the walls on the arteries causing inflammation and later on ischaemia.
Histopathologically, GCA is marked by transmural inflammation of the intima, media, and adventitia of affected arteries, as well as patchy infiltration by lymphocytes, macrophages, and multinucleated giant cells. Mural hyperplasia can narrow the arterial lumen, resulting in distal ischemia
4 most common causes of sudden vision loss
ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine
fundoscopy features of papilloedema
Swollen optic disc: The optic disc, or optic nerve head, appears swollen and elevated above the retina.
Indistinct margins: The margins of the optic disc appear fluffy and indistinct.
Tortuous retinal veins: The retinal veins appear congested, dilated, and twisted.
why cant topical steriods be used in herpes simplex keratitis
corticosteroids are contraindicated in active herpes simplex keratitis.
Using corticosteroids in this condition can exacerbate the viral infection and lead to more severe complications, such as corneal perforation.
what is a scotoma
a medical term for a blind spot or visual field abnormality that can appear in one or both eyes
seen in glaucoma or macular, optic neuritis, degeneration or stroke or tumours
if yoi see RAPD
optic neuritis
hyphema or blood in the anterior chamber of the eye
needs urgent referral to opthal
Peripheral curtain over vision + spider webs + flashing lights in vision
retinal detachement
contact lens associted keratitis - what causative organism
pseudomonas aeruginosa
blurring of the optic disc edges and enlargement of the surrounding veins. There are small haemorrhages (patches of red) surrounding the optic disc which are also seen in
in papilloedema.
something like an optic nerve tumour
positive family history of glaucoma - screening starts when
Those with a positive family history of glaucoma should be screened annually from aged 40 years
what steriod eye drops can cause corneal ulcers
Steroid eye drops can lead to fungal infections, which in turn can cause corneal ulcers
panretinal photo procedure for Diabetic retinopathy can do what
reduce night vision post procedure
flashes and floaters new onset in eyes
Any patient who presents with new-onset flashes or floaters should be referred urgently for assessment by an ophthalmologist within 24 hours
difference between macular degeneration and chronic glaucoma field loss findings
Macular degeneration is associated with central field loss
Primary open-angle glaucoma is associated with peripheral field loss
can you wear contact lenses in conjunctivitis
Contact lens may be worn once topical antibiotic treatment has been started
what is retinitis pigmentose and what are the main signs
Retinitis pigmentosa primarily affects the peripheral retina resulting in tunnel vision
night blindness is often the initial sign
tunnel vision due to loss of the peripheral retina (occasionally referred to as funnel vision)
fundoscopy: black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
what abx increase the risk of idiopathic intracranila hypetnsion
Fundoscopy reveals bilateral optic disc swelling.
whoosing sound in head
dull headaches
tetracylcines like lymecycline
A 34-year-old man with a history of ankylosing spondylitis presents with a painful right eye associated with mild photophobia:
given cyclopeptic drops
ant uveitis
in ant uveitis why are cyclopeptic drugs given
to dilate the eye reducing pain s pupil is normally small due to constrcition
three features of behcets disease
Oral ulcers + genital ulcers + anterior uveitis = Behcet’s
how do you treat diabetic retinopathy
Intravitreal VEGF inhibitors + pan-retinal photocoagulation laser
rod cells are located in the peripheral retina - what cell are predominately repsonsible for vision in low light or night
rod cells
which is why you loose night vision and this gets worse
Subacute unilateral visual loss, eye pain worse on movements
optic neuritis
Central scotoma
Painful eye movements
Affected colour vision
Relative afferent pupillary defect (RAPD)
decreased visual acuity over days or hours
optic neuritis
mx of optic neutiris
`MRI - gandolinium
high dose steriod
4-6 w recovery
optic neuritis what happens with white matter lesions with prognosis for MS
MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%
Vitreous haemorrhage occurs as a result of
thus what are the risk factors
bleeding into the vitreous humour, most often from unstable retinal neo-vasculature. Therefore, any condition which risks the formation of retinal neo-vasculature is a risk factor for vitreous haemorrhage, including diabetic retinopathy and hypertensive retinopathy.
Other risk factors include anti-coagulant use and trauma
CRAO caused by
CRAO can be caused by atherosclerosis, and therefore is also linked to diabetes and can result in sudden onset unilateral loss of vision in the absence of pain
Corneal abrasions refer to any defect of the corneal epithelium and most commonly come about from a recent history of local trauma
how do we treat
topical abx are given to prevent secondary bacterial infection
. Amsler grid testing shows the distortion of line perception.
dry macular degeneration
indicating potential issues with the macula in the eye, where a person might see straight lines on the grid appearing wavy, curved, or even missing in certain areas, signifying a potential problem like macular degeneration.
Proliferative retinopathy is more common in what type of diabetes
1
wet compared to dry macular degenration
more acute vision loss and distortion
funoscopy - neovasularisation
RAPD indicates what
A 32-year-old woman presents with visual disturbance. On examination, you swing the penlight from eye to eye quickly and note that the right and left pupils dilate when light is shone into the right eye.
Relative afferent pupillary defect indicates an optic nerve lesion or severe retinal disease
Right retina or optic nerve
what are the three tx for macular degeneraion
zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by around one third - dry
vascular endothelial growth factor (VEGF) - wet
laser photocoagulation does slow progression of ARMD where there is new vessel formation
Laser photocoagulation is a treatment option for wet age-related macular degeneration but there is a risk of acute visual loss after treatment, which may be increased in patients with sub-foveal ARMD. For this reason, anti-VEGF therapies are usually preferred.
Definitive treatment for wet AMD is
Anti-vascular endothelial growth factor (VEGF)
Primary open-angle glaucoma: 360° selective laser trabeculoplasty (SLT) is first-line if the IOP is ≥ 24 mmHg
if stable
features of CRAO
relative afferent pupillary defect (RAPD), also known as Marcus Gunn pupil, which is an abnormal response to light in the affected eye due to a severe decrease in the number of functioning retinal ganglion cells. Fundoscopy typically reveals a pale retina with a cherry-red spot at the fovea due to obstruction of blood flow in the central retinal artery.
Ocular migraines are more prevalent in children and young adults, which aligns with the age of this patient. Scintillating phenomena are common and patients may describe distortions as shimmering, kaleidoscope or swimming in appearance. In other cases they may have a scotoma or even total monocular visual loss. Crucially these changes develop gradually over
5mins lasting less than an hour
difference between pre and central hroners and post
Pre-ganglionic lesions of the sympathetic trunk, such as that seen in an apical lung tumour, cause anhidrosis (loss of sweating) of just the face, and therefore, no sweating on the face is correct.
central cause of Horner’s syndrome, such as a stroke, syringomyelia or multiple sclerosis - sweating face and neck
post no anhidrosis - cs - carotid artery anuerysm , cluster headache, cavernous sinus throbmosis , carotid artery dissetion
difference between brand and central retinal vein occlusion
Fundoscopy will shows severe retinal haemorrhages (red patches) confined to a limited area of the retina, making the diagnosis branch retinal vein occlusion.
central - This would have severe retinal haemorrhages throughout, rather than confined to a limited area
Patients with orbital cellulitis require admission to hospital for IV antibiotics due to the risk of
cavernous sinus thrombosis and intracranial spread
why do you get optic disc cupping
Optic disc cupping occurs when the central depression within the optic nerve head becomes larger, usually due to damage to the optic nerve fibers caused by increased pressure within the eye (glaucoma), leading to a “cup-like” appearance on the optic disc;
difference between vision loss in macular degeneration and primary open-angle glaucoma
macular - central vision loss
primary open-angle - peripheral field loss
Contact lens wearers who present with a red painful eye should be referred to eye casualty to exclude
keratitis - pseduomonas in contact lens otherwise staph
get photphobia and hypopyon - white cells infront of eye
quinolones used frist line
decreasing vision over months with metamorphopsia and central scotoma
wet age-related macular degeneration
rf smoking and HTN
what is the most common cause of vitreous harmorrhage
diabetic retinopathy
what is vitreous haemorrhage
sudden painless loss of vision
floaters to vision loss
bleeding comes from any vessel through the retina - bleeding into jelly like at back of eye
sx of vitreosu haemorrhage
painless loss of vision or haze
red hue
floaters or shadows
reduced visual acuity
