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D3 > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

Afferent Defect of Pupils

A

 No direct response but intact consensual response
 Cannot initiate consensual response in contralateral eye.
 Dilatation on moving light from normal to abnormal eye

Total CN2 Lesion

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2
Q

Relative Afferent Pupillary Defect

A

Features

  • minor constriction to direct light
  • dilated on moving light from normal to abn eye
  • marcus gunn pupil

Causes

  • optic neuritis
  • optic atrophy
  • retinal disease
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3
Q

Efferent Defect

A

Dilated Pupil does not react to light

  • initial consensual response in contralateral pupil
  • opthalmoplegia + ptosis

Cause

3rd nerve palsy
 The pupil is often spared in a vascular lesion (e.g.
DM) as pupillary fibres run in the periphery.

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4
Q

DDx of fixed dilated pupil

A

Mydriatics (tropicamide etc)
Iris trauma
Acute glaucoma
CN3 compression (tumour, coning)

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5
Q

Holmes-Adie Pupil

A

Features
 Young woman sudden blurring of near vision
 Initially unilateral and then bilateral pupil dilatation
 Dilated pupil has no response to light + sluggish
response to accommodation.
 A “tonic” pupil

Ix
 Iris shows spontaneous wormy movements on slit-lamp
examination (Iris streaming)

Cause - damage to postganglionic parasympathetic fibres
idiopathic - may have viral origin

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6
Q

Holmes Adie syndrome

A

Tonic Pupil
absent knee/ankle jerks
low blood pressure

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7
Q

Horner Syndrome

A 
PEAS
Ptosis
Enopthalmos
Anhydrosis
Small pupil

Causes
- Central - MS, Wallenberg’s Lateral Medullary Syndrome

  • Pre-ganglionic (neck)
     Pancoast’s tumour: T1 nerve root lesion
     Trauma: CVA insertion or CEA

Post-ganglionic
Cavernous sinus thrombosis
 Usually 2ndary to spreading facial infection via the ophthalmic veins
 CN 3, 4, 5, 6 palsies

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8
Q

Argyll Robertson Pupil

A

Features

  • small, irregular pupils
  • accommodate but doesn’t react to light
  • atrophied + depigmented iris

Cause

  • DM
  • Quaternary syphilis
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9
Q

Optic atrophy/neuropathy

Features

A 
 ↓ acuity
 ↓colour vision (esp. red)
 Central scotoma
 Pale optic disc
 RAPD
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10
Q

Optic Atrophy/neuropathy

Causes

A

CAC VISION
- commonest MS + glaucoma

Congenital 
 Leber’s hereditary optic neuropathy 
 HMSN / CMT
 Friedrich’s ataxia
 DIDMOAD
 Retinitis pigmentosa

Alcohol + other toxins
 Ethambutol
 Lead
 B12 deficiency

Compression
 Neoplasia: optic glioma, pituitary adenoma
 Glaucoma
 Paget’s

Vascular: DM, GCA or thromboembolic

Inflammatory: optic neuritis –MS, Devic’s, DM

Sarcoid / other granulomatous

Infection: herpes zoster, TB, syphilis

Oedema: papilloedema

Neoplastic infiltration: lymphoma, leukaemia

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11
Q

Red eye History

A

Vision

  • blurred
  • distorted
  • diplopia
  • field defect/scotoma
  • floaters, flashes

Sensation

  • irritation
  • pain
  • itching
  • photophobia
  • FB

Appearance

  • red ?distribution
  • lump
  • puffy lids
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12
Q

Red eye key examination questions

A

Inspect from anterior to posterior

is acuity affected?

is the globe painful?

Pupil size + reactivity

Cornea - intact, cloudy? Use fluorescein

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13
Q

Sign of serious disease

A

Photophobia
Poor vision
Corneal fluorescein staining
Abnormal pupil

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14
Q

Acute closed angle glaucoma

A

Blocked drainage of aqueous from anterior chamber via canal of schlemm

Pupil dilatation worsens with blockage)

IOP rises from 15-20 to over 60mmHg

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15
Q

Acute closed angle glaucoma

RF

A 
Hypermetropia - long sitedness
Shallow ant. chamber
Female
FH
↑age
Drugs
 Anti-cholinergics
 Sympathomimetics
 TCAs
 Anti-histamines
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16
Q

Acute closed angle glaucoma

Sx
O/E
Ix

A

Sx

  • prodrome - rainbow haloes around lights at night
  • severe pain w n/v
  • decrease acuity + blurred vision

O/E

  • Cloudy cornea w circumcorneal infection
  • Fixed dilated irregular pupils
  • ^IOP - eye feels hard

Ix
- Tonometry (^^IOP - usually 40+)

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17
Q

Acute closed angle glaucoma

Acute Mx

subsequent Mx

A

Acute Mx - refer to cardiologist
 Pilocarpine 2-4% drops stat: miosis opens blockage
 Topical β-B (e.g. timolol): ↓ aqueous formation
 Acetazolamide 500mg IV stat: ↓ aqueous formation
 Analgesia and antiemetics

Subsequent Mx
- Bilateral YAG peripheral iridotomy once IOP decreses medically

YAG is Yttrium-Aluminum Garnet

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18
Q

Anterior Uveitis/Acute Iritis

A

 Uvea is pigmented part of eye and included: iris, ciliary
body and choroid.
 Iris + ciliary body = anterior uvea
 Iris inflammation involves ciliary body too.

Sx

  • acute pain + photophobia
  • blurred vision
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19
Q

Anterior Uveitis/Acute Iritis

O/E

A 
 Small pupil initially, irregular later
 Circumcorneal injection
 Hypopyon: pus in anterior chamber
 White (keratic) precipitates on back of cornea
 Talbots test: ↑pain on convergence
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20
Q

Anterior uveitis/acute iritis Associations

A

 Seronegative arthritis: AS, psoriatic, Reiter’s
 Still’s / JIA
 IBD
 Sarcoidosis
 Behcet’s
 Infections: TB, leprosy, syphilis, HSV, CMV, toxo

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21
Q

Anterior uveitis/acute iritis

Mx

A

 Refer to ophthalmologist
 Prednisolone drops
 Cyclopentolate drops: dilates pupil and prevents
adhesions between iris and lens (synechiae)

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22
Q

Episcleritis

A

inflammation below conjunctiva in episclera

Presents
 Localised reddening: can be moved over sclera
 Painless / mild discomfort
 Acuity preserved

Causes
 Usually idiopathic
 May complicate RA or SLE

Rx: Topical or systemic NSAIDs

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23
Q

Scleritis

A

vasculitis of sclera

Presents

  • severe pain, worse on eye movement
  • generalised scleral inflammation (vessels won’t move over sclera)
  • conjunctival oedema (chemosis

Causes

  • Wegener’s
  • RA
  • SLE
  • Vasculitis

Mx

  • refer to specialist
  • most need corticosteroids or immunosuppressants

Complications - scleromalacia (thinning) > globe perforation

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24
Q

Conjunctivitis Presents

A
  • Often bilateral ¯c purulent discharge
     Bacterial: sticky (staph, strep, Haemophilus)
    Viral: watery

Discomfort
Conjunctival injection
 Vessels may be moved over the sclera

Acuity, pupil responses and cornea are unaffected.

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25
Q

Conjunctivitis Causes/Rx

A

Causes
 Viral: adenovirus
 Bacterial: staphs, chlamydia, gonococcus
 Allergic

Rx
 Bacterial: chloramphenicol 0.5% ointment
 Allergic: anti-histamine drops: e.g. emedastine

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26
Q

Corneal Abrasion

A

 Epithelial breech w/o keratitis
 Cause: trauma

Symptoms
 Pain
 Photophobia
 Blurred vision

Ix
 Slit lamp: fluorescein stains defect green

Rx
 Chloramphenicol ointment for infection prophylaxis

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27
Q

Corneal Ulcer + Keratitis (Causes)

A

Causes: bacterial, herpetic, fungal, protozoa, vasculitic (RA)
 Dendritic ulcer = Herpes simplex
 Acanthamoeba: protazoal infection affecting contact
lens wearers swimming in pools.

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28
Q

Corneal Ulcer + Keratitis (Presentation + RF)

A

Pain photophobia
Conjunctival hyperaemia (XS blood vessels)
decreased acuity
white corneal opacity

RF - contact lense wearers

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29
Q

Corneal Ulcer + Keratitis (Ix + Rx + complications)

A

Ix - green w fluorescin on slit lamp

Rx - refer immediately to specialist
 Take smears and cultures
 Abx drops, oral/topical aciclovir
 Cycloplegics/mydriatics ease photophobia
 Steroids may worsen symptoms: professionals only

Complications
- scarring + visual loss

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30
Q

Opthalmic Shingles

A

Pain in CNV1 dermatome precedes blistering rash
40% → keratitis, iritis

Hutchinson’s sign
 Nose-tip zoster due to involvement of nasociliary
branch.
 ↑ chance of globe involvement as nasociliarry
nerve also supplies globe

Opthalmic involvement

  • Keratitis + corneal ulceration (fluorescin stains)
  • +/- iritis
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31
Q

Sudden Loss of vision

Key Questions

A

 Headache associated: GCA
 Eye movements hurt: optic neuritis
 Lights / flashes preceding visual loss: detached retina
 Like curtain descending: TIA, GCA
 Poorly controlled DM: vitreous bleed from new vessels

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32
Q

Anterior Ischaemic Optic Neuropathy (AION)

A

optic nerve damaged if posterior cilliary arteries blocked (inflammation or atheroma)

Pale swollen optic disc

Causes

  • Arteritic AION - giant cell arteritis
  • Non-arteritic AION - HTN, DM, hyperlipidaemia, smoking
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33
Q

Optic neuritis

Sx + Signs

A

Sx - unilateral loss of acuity over hrs - days

  • ↓ colour discrimination (dyschromatopsia)
  • eye movements may hurt
Signs 
 ↓ acuity
 ↓ colour vision
 Enlarged blind-spot
 Optic disc may be: normal, swollen, blurred
 Afferent defect
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34
Q

Optic neuritis

Causes + Rx

A 
Causes
 Multiple sclerosis (45-80% over 15yrs)
 DM
 Drugs: ethambutol, chloamphenicol
 Vitamin deficiency
 Infection: zoster, Lyme disease

Rx
 High-dose methyl-pred IV for 72h
 Then oral pred for 11/7

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35
Q

Vitreous Haemorrhage

A

Source
 New vessels: DM
 Retinal tears / detachment / trauma

Presentation
 Small bleeds → small black dots / ring floaters
 Large bleed can obscure vision → no red reflex, retina
can’t be visualised

Ix
 May use B scan US to identify cause

Mx
 VH undergoes spontaneous absorption
 Vitrectomy may be performed in dense VH

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36
Q

Central Retinal Artery Occlusion

A

Presents

  • Dramatic unilateral vision loss in seconds
  • Afferent pupil defect (may precede retinal changes)
  • Pale retina w cherry-red macula

Causes

  • GCA
  • Thromboembolism: clot, infective, tumour
Rx 
- if seen w/i 6h aim is to ^retinal blood flow by decreasing IOP
>occular massage
> Surgical removal of aqueous 
> antihypertensives (local + systemic)
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37
Q

Central Retinal Vein Occlusion

A

Commoner than arterial occlusion

Causes: arteriosclerosis, ↑BP, DM, polycythaemia

Pres: sudden unilat visual loss w RAPD (relative afferent pupillary defect)

Fundus: Stormy Sunset Appearance
 Tortuous dilated vessels
 Haemorrhages
 Cotton wool spots

Complications
 Glaucoma
 Neovascularisation

Prognosis: possible improvement for 6mo-1yr

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38
Q

Branch Retinal Vein Occlusion

A

Presents - unilateral visual loss

Fundus - segmental fundal changes

Comps - retinal ischaemia > VEGF release + neovascularisation

Rx - laser photocoagulation

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39
Q

Retinal Detachment

A

Holes/tears in retina allow fluid to separate sensory retina from retinal pigmented epithelium

May be 2ndary to cataract surgery, trauma, DM

Presentation  4 Fs
- Floaters - numerous acute onset spider web
- Flashes
- Field loss
- Fall in acuity
painless

Fundus - grey, opalescent retina, ballooning forwards

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40
Q

Retinal detachment Rx

A

Urgent surgery

Vitrectomy + gas tamponade w laser coagulation to secure retina

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41
Q

Causes of transient visual loss

A

 Vascular: TIA, migraine
 MS
 Subacute glaucoma
 Papilloedema

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42
Q

Gradual Visual Loss

Causes

A 
Common
 Diabetic retinopathy
 ARMD
 Cataracts
 Open-angle Glaucoma

Rarer
 Genetic retinal disease: retinitis pigmentosa
 Hypertension
 Optic atrophy

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43
Q

Age Related Macular Degeneration

A

Commonest cause of blindness 60+

RF - smoking, age, genetics

Presentation - elderly, central visual loss

Dry and Wet

Ix Optical Coherence Tomography
- high resolution images of retina

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44
Q

Dry AMD

A

Geographic Atrophy

Drusen - fluffy white spots around macula
Degeneration of macula
Slow visual decline over 1-2 years

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45
Q

Wet AMD

A

Subretinal Neovascularisation

Abberrant vessels grow into retina from choroid + haemorrhage

Rapid visual decline (sudden/days/weeks) w distortion

Fundoscopy - macular haemorrhage > scarring

Amsler grid detects distortion

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46
Q

Mx of Wet AMD

A

Photodynamic therapy

Intravitreal VEGF inhibitor

  • Bevacizumab (Avastin)
  • Ranibizumab (Lucentis)

Antioxidant vitamins (C,E) + zinc may help early AMD

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47
Q

Tobacco-Alcohol Amblyopia

A

Due to toxic effects of cyanide radicals when combined
with thiamine deficiency.

Pres: Optic atrophy, loss of red/green discrimination,
scotomata

Rx: vitamins may help

48
Q

Chronic Simple (open-angle) Glaucoma

Pathogenesis

A

Pathogenesis depends on susceptibility of pt retina + optic nerve to ^IOP damage

IOP >21mmHg > decreased bloow flor + damage to optic nerve > optic disc atrophy (pale) + cupping

49
Q

Chronic Simple (open-angle) Glaucoma

Presentation

A

Peripheral Visual field defect (superior nasal first)

Central field intact - acuity maintained until late
> presentation delayed until optic N damage is irreversible

50
Q

Chronic Simple (open-angle) Glaucoma

Screen if high risk (RF)

A 
>35y
Afrocaribbean
FH
Drugs - steroids
Co-morbidities - DM, HTN, Migraines
Myopia
51
Q

Chronic Simple (open-angle) Glaucoma

Ix Mx

A

Ix

  • Tonometry - IOP 21+ mmHg
  • Fundoscopy - cupping of optic disc
  • visual field assessment - peripheral loss
52
Q

Chronic Simple (open-angle) Glaucoma

Mx

A

Lifelong follow/up

Eye-drops to lower IOP to baseline

1st line: β-blockers
 Timolol, betaxolol
 ↓ aqueous production
 Caution in asthma, heart failure

Prostaglandin analogues
 Latanoprost, travoprost
 ↑ uveoscleral outflow

α-agonists
 Brimonidine, apraclonidine
 ↓ aqueous production and ↑ uveoscleral outflow

Carbonic anhydrase inhibitors
 Dorzolamide drops, acetazolamide PO

Miotics
 Pilocarpine

Non-medical options

  • laster trabeculoplasty
  • Surgery (trabeculectomy) if drugs fail > new channel allows aqueous to flow into conjunctival bleb
53
Q

Commonest Causes of Blindness Worldwide

A 
 Trachoma
 Cataracts
 Glaucoma
 Keratomalacia: vitamin A deficiency
 Onchocerciasis
 Diabetic Retinopathy
54
Q

The eye in DM

A

DM is leading cause of blindness up to 60yrs
 30% have ocular problems @ presentation
 BP < 130/80 and normoglycaemia → ↓ diabetic retinopathy

55
Q

Eye in DM pathogenesis

A

Cataract

  • DM accelerates formation of cataract
  • Lens absorbs glucose, converted to sorbitol by aldose reductase

Retinopathy
- Microangiopathy > occlusion
- Occlusoin > ischaemia > new vessel formation in retina
 Bleed → vitreous haemorrhage
 Carry fibrous tissue w them → retinal detachment
- occlusoin also > cotton wool spots (ischaemia)
- vascular leakage > oedema + lipid exudates
- rupture of microaneurysms > blot haemorrhages

56
Q

Eye in DM fundoscopy findings

A

Background Retinopathy: Leakage
 Dots: microaneurysms
 Blot haemorrhages
 Hard exudates: yellow lipid patches

Pre-proliferative Retinopathy: Ischaemia
 Cotton-wool spots (infarcts)
 Venous beading
 Dark Haemorrhages
 Intra-retinal microvascular abnormalities

Proliferative Retinopathy
 New vessels
 Pre-retinal or vitreous haemorrhage
 Retinal detachment

Maculopathy
 Caused by macular oedema
 ↓ acuity may be only sign
 Hard exudates w/i one disc width of macula

57
Q

Eye in DM Ix Mx

A

Ix - fluorescein angiography

Mx
- good BP and glycaemic control
- Rx concurrent disease (HTN, dyslipidaemia, renal disease, smoking, anaemia
- Laser photocoagulation
 Maculopathy: focal or grid
 Proliferative disease: pan-retinal (macula spared)

58
Q

CN palsies in DM (eye)

A

CNIII and CNVI palsies may occur

in diabetic CNIII palsy, pupil may be spared as nerve fibres run peripherally + receive blood from pial vessels

59
Q

Cataracts Presentation

A

 Increasing myopia
 Blurred vision → gradual visual loss
 Dazzling in sunshine / bright lights
 Monocular diplopia

60
Q

Cataracts causes

A 
↑Age: 75% of >65s
DM
Steroids
Congenital
Idiopathic
 Infection: rubella
 Metabolic: Wilson’s, galactosaemia
 Myotonic dystrophy
61
Q

Cataracts Ix

A

Visual acuity
dilated fundoscopy
tonometry
blood glucose to exclude dM

62
Q

Cataracts Mx

A

Conservative

  • glasses
  • mydriatic drops + sunglasses may give relief

Surgery
- consider if Sx affect lifestyle or driving
- day case under local - phacoemulsion + lens implants
-1% risk serious complications
 Anterior uveitis / iritis
 VH
 Retinal detachment
 Secondary glaucoma
 Endophthalmitis (→ blindness in 0.1%)
- post-op capsule thickening common
- post-op eye irritation common + requires drops

63
Q

Retina

A

outer pigmented layer in contact w choroid
inner sensory layer in contact w vitreous
at centre - fovea

64
Q

Optic disc

A

Colour - pale pink, paler optic atrophy

Contour - margins blurred in papilloedema + optic neuritis

Cup

  • physiological cup lies centrally + should occupy 1/3 of disc diameter
  • Cup widening + deepening in glaucoma
65
Q

Retinitis Pigmentosa

A

Most prevalent inherited degeneration of macula

Presentation
 Night blindness
 ↓↓ visual fields → tunnel vision
 Most are registrable blind (<3/60) by mid 30s

Fundoscopy

  • Pale optic disc - optic atrophy
  • peripheral retina pigmentation - spares macula
assw
Friedrich's ataxia
Refsum's disease
Kearns-Sayre Syndrome 
Usher's syndrome
66
Q

Retinoblastoma

A

commonest intraocular tumour in children

  • AD mutation in RB gene
  • can be non-hereditary
  • pt typically have 1 mutant allele in every retinal cell, if other allele mutates > TB

Assw osteosarcoma, rhabdomyosarcoma

Signs - stabismus (eyes not aligned properly
- leukocoria (white pupil) - no red reflex

Rx - depends on size
- chemo, radio, enuclreation

67
Q

Stye or hordeolum externum

A

abscess/infection in lash follicle which points outwards

Rx - local abx - fusidic acid

68
Q

Chalazion or hordeolum internum

A

abscess of meibomian glands which point inwards onto conjunctiva
- sebacious glands of eyelid

69
Q

Blepharitis

A

common inflammation of eyelid

Causes - seborrhoeic dematitis, staph

Features

  • red eyes
  • gritty/itchy sensation
  • scales on lashes
  • oft assw rosacea

Rx

  • clean cursts w warm soaks
  • may need fusidic acid drops
70
Q

Entropion

A

lid inversion > corneal irritation

degeneration of lower lif fascia

71
Q

Ectropion

A

lower lid eversion > watering + exposure keratitis

assw ageing + facial nerve palsy

72
Q

Ptosis

A

True ptosis is intrinsic Levator Palpebrae Superioris msucle weakness

Bilateral
- congen, senile, MG, Myotonic dystrophy

Unilateral

  • 3rd nerve palsy
  • Horner’s syndrome
  • Mechanical - xanthelasma , trauma
73
Q

Lagopthalmos

A

difficulty in lid closure over globe may > exposure keratitis

Causes - exopthalmos, facial palsy, injury

Rx - lubricate eyes w liquid paraffin ointment
- Temporary tarsorrhaphy may be needed if cornreal ulcer develops

74
Q

Pinguecula

A

yellow vascular nodules either side of cornea

75
Q

Pterygium

A

 Similar to pinguecula but grows over the cornea → ↓
vision.
 Benign growth of conjunctiva
 Assoc. c¯ dusty, wind-blown life-styles, sun exposure

76
Q

Orbital Cellulitis

A

infection spreads locally (from paranasal sinuses, eyelid or external eye)
- staph, pneumococcus, GAS

Presentation

  • usually child w inflammation of orbit + lif swelling
  • pain and decreased ROM of eye movement
  • exopthalmos
  • systemic signs - fever
  • +/- tenderness over sinuses

Rx - IV Abx - cefuroxime (20mg/kg/8h IV)

Complication

  • local extension > meningitis and cavernous sinus thrombosis
  • blindness due to opitc N pressure
77
Q

Carotico-Cavernous fistula

A

May follow carotid aneurysm rupture w reflux of blood
into cavernous sinus.

Causes: spontaneous, trauma

Presentation
 Engorgement of eye vessels
 Lid and conjunctival oedema,
 Pulsatile exophthalmos
 Eye bruit

Rx - oral antivirals - famciclovir, aciclovir

78
Q

Exopthalmos/Proptosis

A

protrusion of one or both eyes

Common cause

  • Grave’s (retroorbital inflam + lymphocyte inflammation > swelling)
  • orbital cellulitis
  • trauma
Other causes
- idiopathic (orbital inflammatory disease)
- vasculitis - wegener's
- carotico-cavernous fistula
- Neoplasm
 Lymphoma
 Optic glioma: assoc. c¯ NF-1
 Capillary haemangioma
 Mets
79
Q

Myopia

A

short sightedness

  • eye too long
  • distant objects focused too far forward

Causes

  • genetic
  • XS close work in early decades

Solution
- concave lenses

80
Q

Astigmatism

A

cornea or lens not same degree of curvature in horizontal + vertical planes
- image of object is distorted longitudinally or vertically

Solution - correcting lenses

81
Q

Hypermetropia: long-sightedness

A

eye too short

  • when eye relaxed + not accommodating, objects focussed behind retina
  • contraction of ciliary muscles to focus image > tiredness of gaze + possibly convergent squint in children

Solution - convex lenses
- convex lenses

82
Q

Presbyopia

A

w age lens becomes stiff + less easy to deform

start 40 completed by 60

use convex lenses

83
Q

Esotropia

A

convergent squint
 Commonest type in children
 May be idiopathic or due to hypermetropia

84
Q

Exotorpia

A

divergent squint
 Older children
 Often intermittent

85
Q

Non-paralytic Squint

A

Diagnosis

  • Corneal reflection - should fall centrally + symmetrically on each cornea
  • Cover test - movement of uncovered eye to take up fixation demonstrates manifest squint

Management of 3Os

  • optical - correct refractive errors
  • orthoptic - patching good eye encourages use of squinting eye
  • Operations - resection and recession of rectus muscles - help alignment + cosmesis
86
Q

Paralytic Squint

A

Diplopia most on looking in direction of pull of paralysed muscle

eye won’t fixate on covering

cover each eye in turn
- whichever sees outer image is malfunctioning

87
Q

CNIII Paralytic Squint

A

Ptosis (Levator palpebrae superioris)

Fixed dilated pupil (no parasympathetic)

Eye looking down and out

Causes

  • Medical - DM, MS, infarction
  • Surgical - ^ICP, cavernous sinus thrombosis, posterior communicating artery aneurysm
88
Q

CNIV Paralytic Squint

A

Diplopia esp on going downstairs
- head tilt

Test - can’t depress in adduction

Causes

  • peripheral - DM, trauma, compression
  • Central - MS, vascular, SOL
89
Q

CNVI

A

eye medially deviated and cannot abduct
- diplopia in horizontal plane

Cause

  • peripheral - DM, compression, trauma
  • Central - MS, vascular, SOL

Rx- botulinum toxin - can eliminate need for surgery

90
Q

Eye trauma if unable to open injured eye -

A

instill LA

91
Q

Foreign Bodies

A

XR orbit if metal FB suspected
- fluorescein may show cornreal abrasions

Mx
- Chloramphenicol drop 0.5% prevent infection 
> usually coagulase negative staph 
- eye patch
- cycloplegic drops may decrease pain
92
Q

Intra-ocular haemorrhage

A

blood in anterior chamber = hyphaemia

small amounts clear spontaneously - some may need evacuation

complicated by corneal staining + glaucoma (pain)

keep IOP low + monitor

93
Q

Orbital Blowout Fracture

A

Blunt injury > sudden ^ IOP w herniation of orbital contents into maxillary sinus

Presents

  • Opthalmoplegia + Diplopia - tethering of inferior rectur + inferior oblique
  • Loss of sensation to lower lid skin - infraorbital nerve injury
  • Ipsilateral epistaxis - damage to anterior ethmoidal artery
  • decreased acuity
  • irregular pupil reacting slowly to light

Mx - Reduction and muscle relesae necessary

94
Q

Chemical Injury to eye

A

Alkaline solutions are particularly damaging

Mx
 Copious irrigation
 Specialist referral

95
Q

Floaters (eye)

A

small dark spots in visual field

Sudden showers of floaters can be due to blood or retinal detachment

Causes

  • Retinal detachment
  • VH
  • diabetic retinopathy/HTN
  • Old retinal branch vein occlusion
  • snresis (degenerative opacities in vitreous)
96
Q

Flashes (Photopsia)

A

either intraocular or intracerebral pathology

Headache N/V migraine

Flashes and floaters - retinal detachment

97
Q

Haloes (eye)

A

usually diffractive phenomena
may be caused by hazy ocular media - cataract, corneal oedema, acute glaucoma

Haloes + eye pain - acute glaucoma

jagged haloes which change shape - usually migraine

98
Q

Seasonal Allergic Conjunctivitis

A

50% allergic eye disease
small papillae on tarsal conjunctivae

Rx

  • antzoline - antihistamine drops
  • cromoglycate - inhibits mast cell degranulation
99
Q

Perennial allergic conjunctivitis

A

Sx all year w seasonal exacerbations
small papillae on tarsal conjunctivae

Rx - olopatadine (antihistamine + mast cell stabiliser)

100
Q

Giant Papillary Conjunctivitis

A

Iatroenic FBs - contact lenses, prostheses sutures

giant papillae on tarsal conjunctivae

101
Q

Mx or Allergic eye disorders

A

1 Remove allergen responsible where possible

2 General measures

  • cold compress
  • artificial tears
  • oral antihistamines - loratadine 10mg/d PO

3 eye drops

  • antihistamines - antazoline , azelastine
  • mast cell stabilisers - cromoglycate, lodoxamide
  • steroids - dexamethasone (beware inducing glaucoma)
  • NSAIDs - diclofenac
102
Q

Trachoma

A

Caused by Chlamydia trachomatis

spread by flies

inflammatory reaction under lids > scarring > lid distortion > entropion > eyelashes scratch cornea > ulceration > blindness

Rx - tetracycline 1% ointment +/- PO

Prevention - good sanitation, face washing

103
Q

Onchocerciasis (river blindness)

A

Caused by microfilariae of nematode Onchocerca volvulus

  • spread by flies
  • fly biets > microfillariae infection > invade eye > inflammation > fibrosis > corneal opacities + synechiae

Rx - Ivermectin

104
Q

Xeropthalmia + Keratomalacia

A

Vit A deficiency

Presents

  • night blindness + dry conjunctivae (xerosis)
  • corneal ulceration + perforation

Rx - vit A/palmitate reverses early corneal changes

105
Q

hypertensive retinopathy

A

Keith-Wagener Classification

  1. Tortuosity and silver wiring
  2. AV nipping
  3. Flame haemorrhages and soft / cotton wool spots
  4. Papilloedema

 Grades 3 and 4 = malignant hypertension

106
Q

Granulomatous Disorders (eye signs)

A

TB, sarcoid, toxo, leprosy, brucella

Uveitis (ant/post) and choroidoretinitis

107
Q

Systemic inflammatory disease (eye signs)

A

Conjunctivitis: SLE, reactive arthritis, IBD

Scleritis / episcleritis: RA, vasculitis, SLE, IBD

Iritis : ank spond, IBD, sarcoid

Retinopathy: dermatomyositis

108
Q

Keratoconjunctivitis Sicca/Sjogren’s

A

↓ tear production (Schirmer’s: <5mm in 5min)

Dry eyes and dry mouth

1O or 2O: SLE, RA, sarcoid

Rx: artificial tears or saliva

109
Q

Vascular occlusion of eye

A

Emboli - amaurosis fugax : GCA, carotid atheroemboli

Microemboli > roth spots - infective endocarditis
> boat shaped haemorrhage w pale centres

110
Q

Metabolic eye signs

wilson’s
grave’s
hpt

A

 Kayser-Fleischer Rings: Wilson’s
 Exophthalmos: Graves’
 Corneal calcification: HPT

111
Q

HIV/AIDs eye signs

A

CMV retinitis (pizza pie fundus + flames)

HIV retinopathy - cotton wool spots

112
Q

Mydriatics

A

Indication - eye examination, prevention of synechiae in ant uveitis/iritis

Caution - may > acute glaucoma if shallow anterior chamber

Anti-Muscarinics
-Tropicamide
 Duration: 3h
-Cyclopentolate
 Duration: 24h
 Preferred for paediatric use
-Pupil dilatation + loss of light reflex
-Cycloplegia (ciliary paralysis) → blurred vision

Sympathomimetics
 Para-hydroxyamphetamine, phenylephrine
 May be used w tropicamide
 Don’t affect the light reflex or accommodation

113
Q

Miotics

A

constrict pupils

Use - acute closed angle glaucoma

Muscarinic agonist - Pilocarpine

114
Q

Chronic Open-Angle Glaucoma Rx

A

1st line: β-blockers
 Timolol, betaxolol
 ↓ aqueous production
 Caution in asthma, heart failure

Prostaglandin Analogues
 Latanoprost, travoprost
 ↑ uveoscleral outflow

α-agonists
 Brimonidine, apraclonidine
 ↓ aqueous production and ↑ uveoscleral outflow

Carbonic anhydrase inhibitors
 Dorzolamide drops, acetazolamide PO

Miotics
 Pilocarpine

115
Q

eye lubricants

A

hypomellose

antazoline

116
Q

Anaesthetic used to permit examination of painful eye

A

Tetracaine

 Anaesthetic used to permit examination of a painful eye

117
Q

Topical Anti-histamine

A

Emedastine

Antazoline

D3 (14 decks)

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