Common Conditions of the Eye Flashcards

1
Q

What is the conjunctiva?

A

Thin vascular membrane that covers inner surface of eyelids and loops back over sclera.

Does not cover the cornea

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2
Q

What is conjunctivitis?

A

Self-limiting bacterial or viral infection of the conjunctiva

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3
Q

What are the symptoms of conjunctivitis?

A

Red, watering eyes, discharge

No loss of vision as long as infection does not spread to cornea

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4
Q

What is the treatment of conjunctivitis?

A

Antibiotic eye drops if it is likely to be bacterial

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5
Q

Name a condition of the conjunctiva

A

Conjunctivitis

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6
Q

Name a condition of the eyelids

A

Style or hordeolum

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7
Q

What is the difference between a style or hordeolum?

A

External – affecting the sebaceous glands of an eyelash

Internal – affecting the meibomian glands

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8
Q

What is the epithelium of the cornea?

A

Stratified squamous nonkeratinsed

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9
Q

What is the nam for the basement membrane of the cornea?

A

Bowman’s membrane

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10
Q

Name the 5 layers of the cornea

A
  1. Epithelium
  2. Bowman’s membrane
  3. Stroma
  4. Descemet’s layer
  5. Endothelium
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11
Q

What is the stroma of the cornea?

A

3rd layer of the cornea: regularly arranged collagen, no blood vessels

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12
Q

What two pathologies can affect the cornea?

A
  1. Inflammatory - i.e. corneal ulcers

2. Non-inflammatory - i.e. dystrophies

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13
Q

What do corneal pathologies often lead to?

A

Opacification of the cornea

Might need to be treated by corneal transplant - Keratoplasty

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14
Q

What are two causes of corneal ulcers?

A
  • Infectious - viral/bacterial/ fungal infection of cornea, needs aggressive management to prevent spread, scarring
  • Non-infectious ulcers due to trauma, corneal degenerations or dystrophy
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15
Q

What are the dystrophies and degenerations of the cornea?

A

They are a group of diseases affecting the
cornea which are:
• Bilateral
• Opacifying
• Non – inflammatory
• Mostly genetically determined
• Sometimes due to accumulation of substances such as lipids within the cornea

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16
Q

What do dystrophies and degenerations present as?

A
  • First to fourth decade
  • Decreased vision
  • Start in one of the layers of the cornea and spread to others
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17
Q

Why do researchers refer to the cornea as the “immune-privileged” site?

A

The avascularity of the cornea means there is a lesser chance of foreign antigens from a corneal graft being recognised by the recipient, so lesser chance of a graft rejection

18
Q

What happens in cataracts?

A

The lens become opacified

19
Q

Why does cataracts develop?

A
  • Older fibres are never shed, compacted in the middle - loss of elasticity and become opaque
  • No blood supply to lens, which depends entirely on diffusion for nutrition
  • Absorbs harmful UV rays preventing them from damaging retina but in the process, get damaged themselves causing opacity
20
Q

What types of fibres causes dilation of pupil?

A

Sympathetic

21
Q

What is used to treat cataracts?

A

Surgery:
(Day case) small incision -> lens capsule opened -> cataracts lens removed by emulsification (phacoemulisification) -> plastic lens placed in capsular bag

Cant use eyedrops

22
Q

What is glaucoma?

A

Raised Intraocular pressure (IOP)

23
Q

How does glaucoma arise?

A

Damage to the AH drainage pathway causing raid intraocular pressure (rare for it to be caused by over-production

24
Q

What is the most common form of primary glaucoma?

A

Primary Open Angle Glaucoma (POAG) - bilateral

25
Q

What is the consequence of raised intraocular pressure?

A

Pressure on nerve fibres on surface of retina -> fibres die -> visual field defects

Pressure on optic nerve head as nerve fibres die out. When seen by ophthalmoscopy – optic disc appears unhealthy, pale and cupped.

This results in altered field of vision as all nerve fibres are lost, which will eventually result in blindness.

26
Q

What is the triad of signs for the diagnosis of glaucoma?

A
  • Raised IOP
  • Visual field defects
  • Optic disc changes on ophthalmoscopy
27
Q

What is the management of glaucoma (POAG)?

A
  • Eye drops to decrease IOP (prostaglandin analogues, beta-blockers, carbonic anhydrase inhibitors)
  • Laser trabeculoplasty (unclog trabecular meshwork)
  • Trabeculectomy surgery
28
Q

What is an angle closure glaucoma?

A

Sudden onset, painful, vision lost/ blurred; headaches (often confused with migraine)

29
Q

What are the symptoms of angle closure glaucoma?

A
  • O/E – Red eye, cornea often opaque as raised IOP drives fluid into cornea
  • AC shallow, and angle is closed.
  • Pupil mid-dilated
  • IOP severely raised
30
Q

Why does the angle close in angle closure glaucoma?

A
  • Functional block in a small eye – large lens
  • Mid-dilated pupil periphery of iris crowds around angle and outflow is obstructed
  • Iris sticks to pupillary border (synechia) which prevents reaching AC. Leads to iris balooning anteriorly and obstructing angle.
31
Q

What are the two management strategies for angle closure glaucoma?

A
  1. Decrease IOP

2. Iridotomy (laser) - drainage in iris to decrease pressure

32
Q

How do you decrease IOP in angle closure glaucoma?

A
  • IV infusion +/- oral therapy - carbonic anhydrase inhibitors (Acetazolamide)
  • Analgesic, antiemetic
  • If no contraindication beta-blocker drops such a timolol
33
Q

Why carry out an iridotomy for angle closure glaucoma?

A

To bypass blockage to prevent another episode, so the AH has short circuit to the trabecular meshwork

Burns a small hole in the iris

34
Q

What is uveitis?

A

Inflammation of the uvea

35
Q

What are the three different types of uveitis?

A
  • Anterior - iris with or without ciliary body inflamed
  • Intermediate uveitis - ciliary body inflamed
  • Posterior - choroid inflamed
36
Q

What are the causes of uveitis?

A
  • Isolated illness
  • Non-infectious autoimmune causes – eg: presence of HLA-B27
  • Infectious causes – chronic diseases such as TB
  • Associated with systemic diseases – eg: ankylosing spondylosis
37
Q

What happens in anterior uveitis?

A

Inflamed anterior uvea (iris) leaks plasma ad white blood cells into the aqueous humor

38
Q

What is the clinical presentation of anterior uveitis?

A
  • Seen in slit lamp examination as a hazy anterior chamber and cells deposited at the back of the cornea
  • The eye is red, painful, with visual loss
  • Cells in the AC may settle inferiorly – “hypopyon”
39
Q

What happens in intermediate uveitis?

A

Ciliary body is inflamed and leaks proteins -> hazy vitreous

40
Q

What happens in posterior uveitis?

A

Choroid is inflamed and because the choroid sits under the retina, the inflammation frequently spread to the retina causing blurred vision

41
Q

What is the uvea?

A

The pigmented layer of the eye, lying beneath the sclera and cornea, and comprising the iris, choroid, and ciliary body