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Surgery finals > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Describe the classic features of cataracts

A

Symptoms occur gradually over long period of time:

  • Myopia (short-sightedness)
  • Blurry vision -> visual loss
  • Dazzling in sunshine/bright lights
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2
Q

Describe the causes/risk factors for cataracts

A
  • Older age
  • DM
  • Steroids
  • Congenital causes: rubella, Wilson’s
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3
Q

Describe the management of cataracts

A

Conservative:

  • Glasses
  • Mydriatic eyedrops

Surgical: if significant impact on life/driving

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4
Q

Describe the types of ophthalmologic investigations and their uses

A
  • Visual acuity: Snellen chart
  • Fundoscopy: visualise the retina eg. Dx/Ix papilloedema, retinopathy, retinal A/V occlusion
  • Slit-lamp: Dx macular degeneration, retinal detachment, cataracts, corneal injury
  • Tonometry: measures pressures in the eye eg. Dx glaucoma
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5
Q

Describe some conditions of the outer eye

A
  • Stye/hordeolum: acute, tender, red swelling. Occurs in eyelash follicle.
  • Chalazion: abscess of Meibomian glands. Not located on eyelash line. Deeper + larger.
  • Blepharitis: swelling of the eyelid + conjunctival injection.
  • Peri-orbital cellulitis: swelling of area surrounding eye without eye involvement
  • Orbital cellulitis: swelling of deeper orbit w eye signs
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6
Q

List some causes of a red eye

A

Lid: chalazion, blepharitis, cellulitis
Conjunctiva: conjunctivitis, subconjunctival haemorrhage
Sclera: scleritis and episcleritis
Cornea: corneal abrasion, keratitis
Anterior chamber: uveitis, iritis, acute glaucoma

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7
Q

Describe some conditions affecting the conjunctiva

A

Conjunctivitis: bacterial, viral, allergic

Subconjunctival haemorrhage

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8
Q

Describe the classic presentation of conjunctivitis and relevant negative findings

A

Unilateral/bilateral eye discomfort, discharge, redness

  • Sticky/purulent: bacterial eg. Staph, Strep, Haemophilus
  • Watery: viral

NO change in acuity or pupil response, NO ciliary flush

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9
Q

Describe the management of conjunctivitis

A

Conservative:
-Hygiene

Medical:

  • Bacterial: chloramphenicol eyedrops
  • Allergic: antihistamines (PO or drops)
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10
Q

Describe some conditions affecting the sclera

A

Episcleritis: acute red eye without pain. Idiopathic, gout. Resolves spontaneously, can use topical NSAIDs

Scleritis: acute red eye VERY painful. Scleral oedema. Assoc with autoimmune disease. Needs systemic management eg steroids + NSAIDs

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11
Q

Describe some conditions affecting the cornea. How are they identified?

A
  • Corneal abrasion: epithelial breach caused by trauma. Causes pain, photophobia, blurry vision. Give chloramphenical drops for prophylaxis.
  • Corneal ulcer eg. HSV. Topical/PO aciclovir
  • Keratitis: inflammation of cornea. Causes pain, photophobia, conjunctival injection + ciliary flush.

Slit-lamp with fluoroscein stain shows defects

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12
Q

What is the uvea?

A

Part of the eye including iris, ciliary body and choroid

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13
Q

Describe the presentation of uveitis/iritis

A 
Acutely red eye: ciliary flush 
-Pain
-Photophobia
-Blurry vision
-Pain on convergence (Talbot's test)
\+ may be assoc with systemic diseases eg. IBD, RA
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14
Q

Describe the management of uveitis/iritis

A

Refer to ophthal

  • Steroid eyedrops
  • Cyclopentolate drops
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15
Q

Name the types of glaucoma and describe the pathophysiology

A

Two main types:

  • Acute closed angle glaucoma: blocked flow of aqueous humour thru canal of Schlemm -> ^^ pressure
  • Chronic open angle glaucoma: defect in trabecular meshwork gradually -> ^ pressures over time
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16
Q

Describe the presentation of glaucoma

A

Acute:
-Prodrome: rainbow halo around lights at night
-Severe pain +/- N+V
-Blurry vision, red eye
O/E: cloudy cornea, ciliary flush, irregular fixed pupil, ‘hard eye’. IOP >40
-Assoc with female,

Chronic:

  • Peripheral visual field defect (1st is superior nasal field)
  • Slowly progressive
  • IOP >21
  • Assoc with DM, Afro-Caribbean, FHx, steroids, HTN
17
Q

Describe the management of glaucoma

A

Acute:

  • Refer to ophthal
  • Pilocarpine drops (miosis to open blockage)
  • Topical beta-blocker (decrease aqueous formation)
  • Acetazolamide IV (decrease aqueous)
  • > surgical Mx

Chronic:

  • Topical beta-blockers (timolol)
  • Prostaglandin analogues (latanoprost)
  • Alpha agonists
  • Acetazolamide
  • Surgical: trabeculoplasty
18
Q

Describe some causes of visual loss

A

Chronic:

  • Worldwide: trachoma (chlamydia)
  • Glaucoma
  • Cataracts
  • DM retinopathy
  • Age-related macular degeneration

Sudden:

  • Inflammation: optic neuritis, GCA
  • Vascular: TIA, retinal artery or vein occlusion, vitreous haemorrhage
  • Retinal detachment
  • Acute glaucoma
19
Q

Describe the presentation of age-related macular degeneration

A

Slowly progressive central visual loss

20
Q

Describe the presentation of retinal detachment and the cause

A 
Sudden onset painless visual loss
Remember the 4 Fs:
-Floaters: acute onset, many
-Flashes
-Field loss
-Fall in acuity

Separation of retinal layers. RFs: DM, surgery, trauma

21
Q

Describe the management of retinal detachment

A

Refer to ophthal for urgent surgery

22
Q

Describe the presentation of central retinal artery occlusion

A

Sudden onset unilateral visual loss

  • Afferent pupillary defect
  • Pale retina with cherry red macula
23
Q

Describe the presentation of retinal vein occlusion

A

Sudden onset unilateral visual loss

  • RAPD
  • ‘Stormy sunset appearance’ on fundoscopy
24
Q

Describe the causes and presentation of vitreous haemorrhage

A

Causes: trauma, surgery, DM (new vessels)
Small bleeds -> small black dots in vision, floaters
Large bleeds -> visual loss, loss of red reflex

25
Q

Describe the presentation of optic neuritis

A

Acute loss of visual acuity and colour vision

  • Pain
  • Enlarged blind spot
  • Afferent defect
  • Optic disc swollen, blurred
26
Q

Describe some important questions to ask patients with visual loss

A

Headache: GCA
Floaters/flashing lights: detachment
Pain with eye movements: optic neuritis

27
Q

Describe some red flags for eye conditions that warrant referral and conditions they may indicate

A
  • Change in acuity: may things
  • Painful loss of vision: glaucoma, optic neuritis,
  • Abnormal pupils: optic neuritis, retinal artery/vein occlusion, glaucoma, uveitis
  • Photophobia: uveitis, keratitis
28
Q

What is strabismus? Describe the types

A

Aka Squint
Non-paralytic:
-Esotropia vs exotropia: eye points in or outward

Paralytic: due ot CN palsies, usually have diplopia
III: down and out pupil (+ ptosis, mydriasis)
IV: vertical diplopia
VI: horizontal diplopia

29
Q

Describe some basic tests for non-paralytic squint

A

Pupillary reflection: shine light directed at patient, should reflect at same point in both pupils. asymmetry = squint

Cover test: focus on one point. Cover each eye in turn. Covering good eye will cause squint eye to move to focus

Surgery finals (16 decks)

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