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Phase 4 Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Give 3 causes of a painful red eye

A

Acute glaucoma

Anterior uveitis

Conjunctivitis

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2
Q

Define conjunctivitis and give 3 possible causes

A

Inflammation of the conjunctiva

Causes;

Viral - Adenovirus

Bacterial - Staph, chlamydia, gonococcus

Allergic

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3
Q

Give 4 clinical features of conjunctivitis

A

Often bilateral

Purulent discharge (sticky = bacterial, watery = viral)

Red, bloodshot eyes

Itchy, gritty sensation

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4
Q

How is conjunctivitis managed? (3)

A

Resolves without treatment in 1-2 weeks

Bacterial = Chloramphernicol/ fusidic acid eye drops

Allergic = Antihistmaines (oral/topical)

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5
Q

What causes a corneal abrasion and how may it present? (3)

A

Cause = Trauma

Presentation;

Pain, foreign body sensaiton

Photophobia

Blurred vision, watering eye

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6
Q

How is corneal abrasion investigated? (1)

A

Slit lamp, fluorescein stains defect yellow/orange

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7
Q

How is corneal abrasion managed? (1)

A

Cyclopentolate to dilate pupil

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8
Q

Define episcleritis and give 2 causes

A

Inflammation of the episclera (outermost layer of the sclera, just below the conjunctiva)

Causes;

Idiopathic

Associated with; RA, IBD, SLE

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9
Q

How may episcleritis present? (4)

A

Painless/mild pain

Mild photophobia

Localised redness

Dilated episcleral vessels

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10
Q

How is episcleritis managed? (3)

A

Self-limiting in 1-4 weeks

Analgesia, cold compress, safety net

Severe = Systemic NSAIDs (naproxen) or topical steroid eye drops (phenylephrine)

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11
Q

Define scleritis and give 3 causes

A

Inflammation of the full thickness of the sclera

Causes;

RA, SLE, Polymyalgia rheumatica

IBD (Ulcerative colitis)

Sarcoidosis, Granulomatosis with polyangitis

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12
Q

How may scleritis present? (4)

A

Severe pain, worse on movement

Blue sclera

Photophobia

Reduced visual acuity

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13
Q

How is scleritis managed? (3)

A

NSAIDs - Topical/systemic

Steroids

Immunosuppression for underlying condition

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14
Q

Define simple open angle glaucoma

A

Describes optic nerve damage due to raised IOP due to blockage from aqueous humour >24mmHg.

Nerve damage and decreased blood flow results in disc atrophy and cupping

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14
Q

Give 4 risk factors for chronic simple open angle glaucoma

A

Increasing age

Black ethnic origin

FHx

Steroids

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15
Q

Define Glaucoma

A

Describes optic neuropathy that occurs due to raised intraocular pressure

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16
Q

How may chronic simple open angle glaucoma present? (2)

A

Peripheral vision loss causing tunnel vision

Gradual onset of fluctuating pain, headaches, blurred vision and halos around lights

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17
Q

How is chronic simple open angle glaucoma investigated? (3)

A

Tonometry = non contact (puff of air on cornea) and Goldman applanation >24mmHg

Fundoscopy = Optic disc cupping

Visual field = Peripheral vision loss

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18
Q

How is chronic simple open angle glaucoma managed? (3)

A

Eye drops to decrease intraocular pressure

1st - Prostaglandin analogue eye drops (latanoprost)

Others;

BB - Timolol

Carbonic anhydrase inhibitor - Dorzolamide

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19
Q

Define acute angle-closure glaucoma

A

Describes a rise in intra-ocular pressure that impairs aqueous outflow.

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20
Q

Name 3 factors that predispose someone to acute angle closure glaucoma

A

Hypermetropia (long-sightedness)

Pupillary dilatation

Lens growth associated with age

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21
Q

Give 5 clinical features of acute angle-closure glaucoma

A

Severe pain (ocular or headache)

Decreased visual acuity

Hard, red eye

Semi-dilated non-reacting pupil

Corneal oedema > Dull/Hazy cornea

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22
Q

What investigations are performed to diagnose acute angle closure glaucoma? (2)

A

Tonometry - To assess for elevated intraocular pressure

Gonioscopy - Allows visualisation of the angle

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23
Q

How is acute angle closure glaucoma initially managed? (3)

A

Urgent referral to ophthalmologist

Combination of eye drops;
Pilocarpine, Timolol or Apraclonidine

IV acetazolamide

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24
Q

What is the definitive management for acute angle closure glaucoma?

A

Laser peripheral iridotomy

(Creates tiny hole in peripheral iris > Aqueous humour flowing to the angle)

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25
Q

How does pilocarpine treat relieve symptoms of acute angle closure glaucoma?

A

Direct parasympathomimetic (Muscarinic Receptor Agonist)

Causes contraction of ciliary muscle > opening the trabecular meshwork > increased outflow of the aqueous humour

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26
Q

How do beta blockers, like timolol, relieve symptoms of acute angle closure glaucoma?

A

Decrease aqueous humour production

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27
Q

How do alpha-2 agonists, like apraclonidine, help relieve symptoms of acute angle closure glaucoma?

A

Dual mechanism;

Decrease aqueous humour production and increase uveoscleral outflow

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28
Q

Define Blepharitis

A

Describes inflammation of the eyelid margins

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29
Q

Name 2 types of Blephraritis

A

Posterior Blepharitis - meibomian gland dysfunction (most common)

Anterior Blephraritis - Seborrhoeic dermatitis/staphylococcal infection

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30
Q

Blepharitis is more common in patients with what?

A

Rosacea

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31
Q

What is the function of the meibomian glands?

A

Secrete oil onto the surface of the eye to prevent rapid evaporation of the tear film.

Hence any problem with these glands can lead to irritation.

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32
Q

Give 5 clinical features of Blepharitis

A

Bilateral symptoms

Grittiness and discomfort around eye margins

Eyes may be sticky in the morning

Eyelid margins may be red

Styes and chalazions

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33
Q

What is the difference between a Chalazion and a Stye? (3)

A

Styes occur along the eyelash line

Chalazions occur further away from the eye on the top eyelid or under the bottom eyelash.

Styes are also more painful than chalazions

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34
Q

How is Blepharitis managed? (4)

A

Hot compress 2x per day

Lid hygiene - Mechanical removal of debris from lid margins (cotton wool bud dipped in cooled boiled water and baby shampoo)

Topical antibiotics (when bacterial infection is suspected)

Artificial tears

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35
Q

Give 2 risk factors for cataracts

A

Women > Men

Increasing age

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36
Q

Define cataracts

A

A common eye condition where the lens of the eye gradually opacifies (becomes cloudy).

Cloudiness makes it difficult for light to reach the retina, causing reduced/blurred vision.

37
Q

Give 5 clinical features of cataracts

A

Gradual onset of;

Reduced vision

Faded colour vision

Glare (lights appear brighter than usual)

Halos around lights

38
Q

Give 4 classifications of cataracts

A

Nuclear - Common in old age

Polar - Localised and inherited

Subcapsular - Occurs due to steroid use

Dot opacities - Diabetes and myotonic dystrophy

38
Q

Give 1 clinical sign of cataracts observed using an opthalmoscope

A

Defective red reflex

(Red reflex = Light reflecting from retina. Cataracts prevents light reaching the retina, causing a defect in the red reflex.

38
Q

How is cataracts managed non-surgically? (2)

A

Stronger glasses/contact lenses

Encourage using brighter light

39
Q

Give 2 investigations performed to investigate cataracts

A

Opthalmoscopy (done after pupil dilation) (normal fundus and optic nerve)

Slit lamp examination (showing visible cataract)

40
Q

How is cataracts managed surgically?

A

Removal of cloudy lens and replacement with artificial lens

41
Q

Give 4 complications of cataracts surgery

A

Posterior capsule opacification (thickening of lens capsule)

Retinal detachment

Posterior capsule rupture

Endophthalmitis (inflammation of aqueous and/or vitreous humour)

42
Q

Describe central retinal artery occulsion

A

Describes a sudden unilateral visual loss due to thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)

43
Q

Give 3 clinical features of central retinal artery occlusion

A

Sudden, painless unilateral visual loss

Relative afferent pupillary defect

“Cherry red” spot on pale retina

44
Q

How is central retinal artery occlusion managed?

A

Treat underlying cause (i.e IV methylprednisolone for temporal arteritis)

45
Q

Give 3 classifications of diabetic retinopathy

A

Non Proliferative Diabetic Retinopathy (NPDR) (mild, moderate and severe)

Proliferative retinopathy (PDR)

Maculopathy

46
Q

How is mild NPDR defined?

A

1 or more microaneurysm

47
Q

How is moderate NPDR defined? (4)

A

Microaneurysms

Blot haemorrhages

Hard exudates

Cotton wool spots (represents retinal infarction)

48
Q

How is severe NPDR defined? (3)

A

Blot haemorrhages and microaneurysms in 4 quadrants

Venous beading in at least 2 quadrants

Intraretinal microvascular abnormalities in at least 1 quadrant

49
Q

How many proliferative diabetic retinopathy present? (3)

A

Retinal neovascularisiation - may lead to vitrous haemorrhage

Fibrous tissue forming anterior to retinal disc

More common in type 1 DM

50
Q

How is maculopathy defined? (4)

A

Based on location rather than severity

Hard exudates and other changes on macula

Check visual acuity

More common in Type II DM

51
Q

How are all patients with diabetic retinopathy managed? (2)

A

Optimise glycaemic control, blood pressure and hyperlipidaemia.

Regular review by ophthalmology

52
Q

How is maculopathy managed?

A

If there is change in visual acuity - Give Intravitreal vascular endothelial growth factors (VEGF inhibitor) (Ranibizumab)

53
Q

How is proliferative retinopathy managed?

A

Panretinal laser photocoagulation

Intravitreal VEGF inhibitor - Ranibizumab

54
Q

Give 2 complications of panretinal laser photocoagulation

A

Reduction in visual fields (due to scarring of peripheral tissue)

Decreased night vision (due to reduction in rod cells)

55
Q

Define keratitis

A

Describes inflammation of the cornea

56
Q

Give 2 bacterial causes of Keratitis

A

Staphylococcus Aureus (most common)

Pseudomonas aeruginosa (in contact lens wearers)

57
Q

Give 1 amoebic cause of keratitis

A

Acanthamoebic keratitis (5% of cases)

58
Q

Give 4 clinical features of keratitis

A

Red eye (pain and erythema)

Photophobia

Foreign body, gritty sensation

Hypopyon (milky fluid in inferior part of anterior chamber)

59
Q

How is keratitis diagnosed?

A

Slit-lamp + Same day referral to eye specialist to rule out microbial keratitis

60
Q

How is keratitis managed? (3)

A

Stop using contact lenses until Sx have resolved

Topical antibiotics (quinolones)

Cyclopentolate (for pain relief)

61
Q

Give 4 complications of keratitis

A

Corneal scarring

Perforation

Endophthalmitis

Visual loss

62
Q

Define anterior uveitis

A

Describes inflammation of the anterior portion of the uvea (iris and ciliary body)

63
Q

What gene is associated with anterior uveitis?

A

HLA-B27

64
Q

Give 5 clinical features of anterior uveitis

A

Acute onset red eye

Ocular discomfort and pain

Small pupil/Irregular

Blurred vision

Lacrimation

65
Q

Give 4 conditions associated with anterior uveitis

A

Ankylosing Spondylitis

Reactive arthritis

Ulcerative colitis and Crohn’s disease

Bechet’s disease

66
Q

How is anterior uveitis managed? (3)

A

Urgent review by Ophthalmology

Cycloplegics (dilate pupil to relieve pain and photophobia) (Atropine, cyclopentolate)

Steroid eye drops

67
Q

Describe macular degeneration

A

The most common cause of blindness in the UK.

Characterised by degeneration of retinal photoreceptors, leading to degeneration of the central retina (macula)

Changes are usually bilateral

68
Q

Give 3 risk factors for macular degeneration

A

Increasing age (greatest risk factor)

Smoking

Positive Family History

69
Q

Name and describe 2 forms of macular degeneration

A

Dry macular degeneration;
- 90% of cases
- Characterised by drusen - Yellow round spots in Bruch’s membrane

Wet macular degeneration
- 10% of cases
- Characterised by choroidal neovascularisation
- Aka exudative or neovascular macular degeneration

70
Q

Give 4 clinical features of macular degeneration

A

Subacute vision loss with;

  • A reduction in visual acuity (gradual in dry, subacute in wet
  • Poor night vision
  • Fluctuations in visual disturbance from day to day
  • Visual hallucinations (Charles-Bonnet syndrome)
71
Q

Give 3 examination findings for macular degeneration

A

Distortion of line perception on Amsler grid testing

Presence of drysen on fundoscopy

Demarcated red patches representing haemorrhage (in wet)

72
Q

How is macular degeneration diagnosed? (3)

A

Slit lamp microscopy + Colour fundus photography (initial investigation of choice)

Fluorescein angiography (if neovascular ARMD is susected)

Optical coherence tomography

73
Q

How is macular degeneration managed? (3)

A

Prevention (dry) - Zinc with antioxidant vitamins A, C and E can reduce progression

Anti-VEGR agents - Ranibizumab

Laser photocoagulation - slows progression but carries risk of acute visual loss after treatment

74
Q

What is the commonest disease associated with optic neuritis?

A

Multiple Sclerosis

75
Q

Give 5 clinical features of optic neuritis

A

Unilateral decrease in visual acuity over hours/days

Poor discrimination of colours (red desaturation)

Pain worse on eye movement

Central scotoma

Relative afferent pupillary defect

76
Q

What investigation is used to diagnose optic neuritis?

A

MRI of brain and orbits with gadolinium contrast

77
Q

How is optic neuritis managed? (2)

A

High dose steroids

Recovery usually takes 4-6 weeks

78
Q

Describe orbital cellulitis

A

Describes infection affecting the fat and muscles posterior to the orbital septum.

Usually caused by URTI spreading from sinuses.

Medical emergency requiring hospital admission and urgent senior review.

79
Q

Give 4 risk factors for orbital cellulitis

A

Childhood

Previous sinus infection

Lack of Hib Vaccination

Recent eyelid infection/insect bite on eyelid (periorbital cellulitis)

80
Q

Give 5 presenting features for orbital cellulitis

A

Redness and swelling around eye

Severe ocular pain

Visual disturbance

Proptosis

Pain with eye movements

81
Q

How is orbital cellulitis differentiated from preseptal cellulitis?

A

Reduced visual acuity, proptosis, eye ophthalmoplegia/pain with eye movements are NOT features of preseptal cellulitis

81
Q

Give 4 investigations for orbital cellulitis

A

FBC - Raised WBC and CRP/ESR

Clinical examination (Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema)

CT with contrast

Blood culture - to determine organism

82
Q

What are the most common bacterial causes of orbital cellulitis? (3)

A

Streptococcus

Staphylococcus aureus

Haemophilus influenzae B

83
Q

Describe retinal detachment

A

Describes when neurosensory tissue that lines the back of the eye comes away from it’s underlying pigment epithelium

Reversible form of vision loss if recognised and treated before the macula is affected.

84
Q

Give 5 risk factors for retinal detachment

A

Diabetes mellitus

Myopia

Age

Previous surgery for cataracts

Eye trauma (boxing)

85
Q

How can diabetes mellitus cause retinal detachment

A

Occurs as a result of breaks in the retina due to traction by the vitreous humour.

86
Q

Give 4 clinical features of retinal detachment

A

Now onset floaters/flashes

Sudden onset, painless and progressive visual field loss

Relative afferent pupillary defect (if optic nerve is affected)

Fundoscopy (loss of red reflex)

Phase 4 Medicine (15 decks)

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