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4th year everything > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Simply conjunctivitis does not usually require a specialist referral unless one or more of what three features occur?

A
  1. Symptoms do not abate for more than two weeks
  2. The eye becomes painful
  3. Vision decreases
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2
Q

How is bacterial conjunctivitis usually treated?

A

Topical broad-spectrum antibiotics e.g. chloramphenicol

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3
Q

What are some features of gonnococcal conjunctivitis?

A

Rapid onset
Copious amounts of discharge
Chemosis (conjunctival oedema)
Lid oedema

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4
Q

Describe the clinical course of viral conjunctivitis?

A

Self-limiting

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5
Q

What precautions should be taken to prevent the spread of conjunctivitis? Why is so much care required?

A

Conjunctivitis is very contagious

Strict hygiene and separate towel use from other family members while the eye is still red.

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6
Q

What is the function of the sclera?

A

Thick, protective membrane forming the outer coat of the eyeball (white of the eye)

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7
Q

What is the function of the cornea?

A

Transparent dome-shaped anterior portion of the outer covering of the eye. Provides the eye with its refractive power

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8
Q

What is the function of the conjunctiva?

A

Richly vascular mucous membrane covering the anterior surface of the sclera and reflected onto the undersurface of the eyelids

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9
Q

What is the function of the anterior chamber of the eye?

A

Contains aqueous humour (produced by the ciliary body and drained via the canal of Schlemm) providing nutrients and oxygen to the cornea

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10
Q

What is the function of the iris?

A

Coloured part of the eye, muscles regulate the size of the pupil and thus the amount of light entering the eye.

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11
Q

What is the function of the lens?

A

Transparent biconvex disc which changes shape in order to alter the refractive power of the eye

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12
Q

What is the function of the retina?

A

Contains two types of photoreceptors:

  • Cones (provide colour vision and are confined mainly to the central macula)
  • Rods (providing night/low-light vision)
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13
Q

What is the area in the centre of the macula called? What is its function?

A

Fovea

Highest density of cone photoreceptors - meaning the central vision is the most acute

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14
Q

What types of visual field anomaly is present during a migraine?

A

Temporary blurring or “zig-zag” lines

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15
Q

What is amaurosis fugax?

A

Severe temporary visual loss due to a transient lack of blood supply to the retina or visual cortex - commonly occuring due to TIA

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16
Q

What is the occurence of amaurosis fugax considered a “warning sign” of?

A

Impending blindness of stroke

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17
Q

What feautes of a history would indicate conjunctival infection?

A 
Often bilateral diffuse redness 
Itchy
Gritty 
Purulent discharge 
No pain 
Normal acuity
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18
Q

What feautes of a history would indicate subconjunctival haemorrhage?

A

May occur after rubbing eye, severe coughing or hypertension

Unilateral bright red area

Normal acuity

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19
Q

What is subconjunctival haemorrhage?

A

Bleeding between the sclera and conjunctiva

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20
Q

What is episcleritis?

A

Inflammation of the episclera causing mild irritation and redness of the eye

No change in acuity

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21
Q

What feautes of a history would indicate keratitis?

A

History - paini, foreign body sensation, blurred vision, photophobia

Reduced acuity

Maximal redness around the cornea

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22
Q

What complication of keratitis could occur that may be difficult to identify? How would you go about observing it?

A

Corneal ulceration

More easily visible with fluouriscien drops and blue light

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23
Q

What is acute glaucoma?

A

Sudden and severe rise in intraocular pressure due to reduced aqueous fluid drainage

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24
Q

What features of a history would indicate acute (closed-angle) glaucoma?

A
  • Sudden onset of severe pain with diffuse redness
  • Blurred vision
  • “Halos around lights”
  • Nausea and vomiting
  • Fixed and dilated pupils
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25
Q

What is endopthalmitis?

A

Infection of the eyeball following eye surgery, injury of spread via the blood

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26
Q

List some conditions characterised by a gradual loss of vision

(6)

A 
Optic Atrophy 
Chronic glaucoma
Cataracts 
Diabetic retinopathy 
Macular degeneration
Chronic retinal detachment
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27
Q

What two infections seen in developing countries can cause visual loss?

A

Chlamydia trachomatis

Onchocerciasis (river blindness)

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28
Q

List some conditions can cause sudden/rapid visual loss

6

A 
Acute retinal detachment 
Retinal vein occlusion
Retinal artery occlusion
Acute optic neuropathy
Vitreous haemorrhage
"Wet" Age-related macular degeneration
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29
Q

What examination findings would support a diagnosis of acute retinal detachment?

A

Pupil in affected eye dilates in response to light (relative afferent pupillary defect, RAPD)

Abnormal red-reflex: Retina looks grey and wrinkled

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30
Q

What examination findings would support a diagnosis of retinal vein occlusion?

A

Retinal haemorrhages
Tortuous dilated veins
Macular oedema
Cotton wool spots (infarct)

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31
Q

What examination findings would support a diagnosis of retinal artery detachment?

A

Pale retina with central macular “cherry red spot”

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32
Q

What progressive neurological condition is most strongly associated with acute optic neuropathy?

A

Multiple sclerosis

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33
Q

What features of the history/examination indicate age-related macular degeneration?

A

History - sudden distortion or blurring of vision with central scotoma (central loss of vision)

Examination - macular oedema and/or subretinal haemorrhages

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34
Q

What patients groups are most at risk of developing chronic (open-angle) glaucoma?

A 
Those with a positive family history
Elderly
Diabetes mellitus
Myopic patients
Black race
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35
Q

What medical treatment options are available to patients with glaucoma?

A

Beta-blocker eye drops (decrease aqueous humour production)
Alpha-adrenergic agonists (decrease aqueous humour production)
Prostaglandin analogues (improve humour drainage)

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36
Q

What surgical options are available to treat glaucoma?

A

Laser surgery - induces changes in trabecular networks allowing better drainage of aqueous humour

Trabeculectomy - creates an opening in the anterior chamber

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37
Q

What is accommodation?

A

Changing of the lens shape to focus near objects using the ciliary muscles

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38
Q

What is acuity?

A

A measure of how well the eye can see a small object

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39
Q

What is amblyopia?

A

Decreased acuity uncorrectable by lenses with no anatomical defect

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40
Q

What is an Amsler grid?

A

Test chart of intersecting lines useful in the diagnosis of Age-Related Macular Degeneration (ARMD) - line distortion in the middle (central scotoma) is the key feature

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41
Q

What is anisocoria?

A

Unequal pupil size

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42
Q

What is anisometropia?

A

The state of having different refractive defects in each eye

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43
Q

What is aphakia?

A

The state of having no lens (i.e. after removal in cataract surgery)

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44
Q

What is blepharitis?

A

Inflammed eyelids

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45
Q

What are the canthi?

A

Singular canthus. The medial or lateral angles made by open eyelids

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46
Q

What is chemosis?

A

Oedema of the conjunctiva

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47
Q

What is the choroid?

A

The vascular coat between the retina and the sclera

48
Q

What is the ciliary body?

A

Portion fo the uvea between the iris and the choroid. Containing the ciliary processes and muscle

49
Q

What is the conjunctiva?

A

mucous membrane on the anterior sclera and posterior lid aspect

50
Q

What is cycloplegia?

A

Ciliary muscle paralysis preventing accomodation

51
Q

What is dacryocystitis?

A

Inflammation of the lacrimal sac

52
Q

What is a dioptre?

A

Unit for measuring refractive power of lenses

53
Q

What is ectropion?

A

The lids evert (especailly the lower lid)

54
Q

What is entropion?

A

The lids invert (so that lashes irritate the eye)

55
Q

What is epiphora?

A

Passive overflow of tears onto the cheek

56
Q

What is the fornix?

A

Where the bulbar (scleral) and palpebral (lid) conjunctivae meet

57
Q

What is the fovea?

A

Cone-rich part of the central macula

58
Q

What is the fundus of the eye?

A

That part of the retina normally visible through the fundoscope

59
Q

What is keratoconus?

A

Cone shaped cornea

60
Q

What is keratomalacia?

A

Corena is softened

61
Q

What is the limbus?

A

The annular border between the sclera and the cornea

62
Q

What is the macula?

A

Retinal area approx. 5mm across lateral to the optic disc

63
Q

What is a miotic agent?

A

An agent that serves to pupil constriction (e.g. pilocarpine)

64
Q

What is a mydriatic agent?

A

An agent causing pupillary dilation (e.g. tropicamide)

65
Q

What is the near point?

A

Where the eye is looking when maximally accomodated

66
Q

What is the optic disc?

A

The part of the optic nerve seen in the fundus

67
Q

What is the optic cup?

A

The cup-like depression in the centre of the optic disc

68
Q

What is papillitis?

A

Inflammation fo the head of the optic nerves

69
Q

What is presbyopia?

A

Age-related reduced near acuity from failing accomodation

70
Q

What is ptosis?

A

Drooping lids

71
Q

What is refraction?

A

Light ray deviation on passing through media of different density

72
Q

What is retinal detachment?

A

The sensory retina separates from the pigmented epithelial layer of the retina

73
Q

What is the sclera?

A

The whites of the eyes starting from the corneal perimeter

74
Q

What is scotoma?

A

A defect causing a part of the visual field to be lost

75
Q

What is strabismus?

A

Commonly called a squint. Eyes deviate and dont look in the same direction

76
Q

What is a tonometer?

A

A device for measuring intraocular pressure

77
Q

What is the uvea?

A

Collective term for iris, ciliary body and choroid

78
Q

What is a vitrectomy?

A

Surgical prcedure to remove the vitreous of the globe

79
Q

What is the vitreous?

A

Jelly-like substance filling the globe behind the lens

80
Q

What is a stye?

A

A colloquial terms for inflammatory lid swellings

81
Q

What are the different types of styes?

A

Hordeolum externum (most common) - infection of a lash follicle

Hordeolum internum (less common) - abscess of Meibomiam glands - as they heal they form calazions (granuloma) before resolving

82
Q

What is the common presentation fo retinoblastoma?

A

Absence of red reflex
Strabismus
Leukoria (white pupil)

83
Q

Retinoblastoma shows a hereditary component. What inheritance pattern is shown? What gene is implicated?

A

Autosomal dominant

RB gene at 13q14

84
Q

What treatment options are available for retinoblastoma?

A 
Chemotherapy
Enucleation (removal of the eye) 
External beam radiotherapy
Ophthalmic plaque bradytherapy 
Cryotherapy and transpupillary thermotherapy
85
Q

What is orbital cellulitis?

A

A severe and life/sight threatening emergency caused by infection of the soft tissues posterior to the orbital septum

86
Q

What is the typical presentation of orbital cellulitis?

A

Inflammation of the orbit, fever, lide swelling and decreased eye motility

Potential double vision, visual impairment and proptosis

87
Q

What are the most common complications of orbital cellulitis?

A

Subperiosteal and orbital abscess

88
Q

How is orbtial cellulitis distinguished from pre-septal/periorbital cellulitis?

A

The absence of painful eye movements, diplopia and visual impairment distinguish preorbital cellulitis

89
Q

What are the features of a third cranial nerve palsy?

A

Ptosis, proptosis with the pupil looking down and out

90
Q

What are the features of a fourth cranial nerve palsy?

A

The eye looks upwards and in adduction and is unable to look down and in due to superior oblique paralysis

91
Q

What are the features of a sixth cranial nerve palsy?

A

Diplopia in the horizontal plane

92
Q

What nerve is responsible for the afferent pathway in the pupillary response?

A

Optic nerve

93
Q

What nerve is responsible for the efferent (constriction) pathway in the pupillary response?

A

Oculomotor nerve

94
Q

What is scleritis?

A

Generalised inflammation fo the sclera with oedema of the conjunctiva

Types include anterior (90%), posteiror and necrotising (most severe)

95
Q

How does scelritis present?

A

Deep, boring ocular pain and pain on eye movements (due to recti inserting on the sclera)

Bright red injection of the white of the eye.

96
Q

What is episcleritis? How does this differ from scleritis?

A

Inflammation below the conjunctiva (episcleritis)

Hyperaemic vessles are mobile when prodded with a cotton bud and blanching on application of phenylephrine

97
Q

What is the treatment for scleritis/episcleritis?

A

Topical/systmeic NSAIDs

More commonly prednisolone in scleritis

98
Q

What are the most common causes of anterior uveitis?

A

Underlying autoimmune conditons

99
Q

How does anterior uveitis calssically present?

A

Pain, blurred vision and photophobia

100
Q

What signs may be seen in the case of anterior uveitis?

A

Corneal precipitates (seen on slit lamp)

Posterior synechiea (iris adhesion to the lens causing irregular pupillary border)

101
Q

What is the most common vascular occlusion in the eye?

A

Central retinal artery occlusion

102
Q

What are the symptoms of retinal artery occlusion?

A

Dramatic visual loss within seconds of occlusion

103
Q

What is the characteristic examination finding of retinal artery occlusion?

A

Retinal pallor with ‘cherry red’ spot macula

104
Q

What are the characteristic examination findings of retinal vein occlusion?

A

Optic nerve sweling, tortousous veins and cotton wool spots around vessles (areas of infarct)

105
Q

How is retinal vein occlusion related sight loss managed?

A

Intravitreal anti-VEGF followed by dexamethasome implants

Photocoagulation (if there is retinal neovascularisation)

106
Q

Bleeding into the vitreous is called what?

A

Vitreous haemorrhage

107
Q

What are the causes of vitreous haemorrhage?

A

Retinal neovasculariisation
Retinal tears/detachement
Trauma

108
Q

Outline the symptoms of small and large vitreal haemorrhages

A

Small extravasations - vitreous floaters

Large extravasations - potential blindness

109
Q

What is the chief cause of registerable blindness in the UK?

A

Age-related macular degeneration

110
Q

What is the pathogenesis of age-related macular degeneration?

A

There is pigment, drusen and sometimes bleeding into the macula

111
Q

What are the typical symptoms of age-related macular degeneration?

A

Decreased acuity (difficulty reading, recognising faces, poor night vision, visual fluctuation)

Metamorphopsia - distortion of central vision

112
Q

What are the different types of age-related macular degeneration?

A

Wet (exudative) - pathological choroidal neovascularisation under the retina

Dry (non-exudative) - progressive visual loss

113
Q

What are cataracts?

A

Lens opacification causing gradual and painless visual loss

114
Q

What is the management plan of cataracts in a neonate?

A

Intervention needs to be done within the latent period of visual development (first six weeks of life) to avoid significant deprivation amblyopia

115
Q

What is retinal detachment?

A

Separation of the sensory retina from the retinal pigment epithelial layer (RPE)

116
Q

What are the four F’s of retinal detachament symptoms?

A

Floaters
Field loss
Fall in acuity
Flashes

117
Q

How are retinal detachments treated?

A

Urgent referral for surgery either by vitriectomy and gas tamponade followed laser coagulation to secure the retina

4th year everything (43 decks)

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