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Pass Medicine > Opthalmology > Flashcards

Opthalmology Flashcards

1
Q

What is amaurosis fugax?

A

Transient monocular vision loss (TMVL). Usually ischaemic/vascular cause

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2
Q

How do we typically treat amaurosis fugax?

A

As it usually has a thrombotic cause, we give 300mg aspirin as with TIAs/strokes

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3
Q

Which of central retinal vein and central retinal artery occlusion is more common?

A

Central retinal vein occlusions are more common

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4
Q

What would you see on fundoscopy for central retinal vein occlusion?

A

Retinal haemorrhages

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5
Q

Causes of central retinal vein occlusion?

A

Glaucoma
Hypertension
Polycythaemia

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6
Q

What would you see on fundoscopy for central retinal artery occlusion?

A

Pink cherry spot

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7
Q

Causes of central retinal artery occlusion?

A

Arteritis

Thromboembolism

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8
Q

Does TIA cause monocular vision loss?

A

No. It causes a hemianopia

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9
Q

What causes vitreous haemorrhage?

A

Diabetes
Bleeding disorders
Anticoagulants

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10
Q

Vitreous haemorrhage features

A

Sudden vision loss
Dark spots
Small bleeds cause floaters

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11
Q

Retinal detachment features

A

Dense shadow that starts peripherally and progresses toward the central vision
Straight lines appear curved
Central vision loss
Veil/curtain over field of vision

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12
Q

Posterior vitreous detachment features

A

Flashes of light (photpsia) in peripheral fields of vision

Floaters (often on temporal side)

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13
Q

How can we stage hypertensive retinopathy

A

Keith-Wagener classification

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14
Q

Hypertensive retinopathy stages

A

Stage 1
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring

Stage II
AV nickiing
Stage III
Cotton-wool exudates
Flame and blot haemorrhages

Stage IV
Papilloedema

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15
Q

Features of cataracts

A

Gradual onset of reduced vision
Faded colour vision
Glare (lights appear brighter)
Halos around lights

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16
Q

What signs might you see in cataracts

A

A defect in the red reflex

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17
Q

Management of cataracts

A

Non-surgical: stronger contacts/glasses

Surgical: Removal of the lens and replacing it with an artificial one

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18
Q

Causes of cataracts

A 
Normal aging (most common)
Smoking
DM
High alcohol consumption
Long-term corticosteroids
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19
Q

What are cataracts?

A

Opacification of the lens of the eye making it more difficult for light to reach the back of the eye (retina)

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20
Q

What is argyll-robertson pupil?

A

Bilaterally small pupils that accommodate but don’t react to bright light

Mneumonic
ARP = Accomodation reflex present
PRA = Pupillary reflex absent

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21
Q

What causes argyll-robertson pupil?

A

Neurosyphilis and diabetes mellitus

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22
Q

What is the pathology of Horner’s syndrome?

A

Damage to the sympathetic trunk on the same side as symptoms

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23
Q

Horner’s syndrome symptoms?

A

Miosis (pupil constriction)
Ptosis (droopy eyelid)
Enopthalmos (inset eyeball)
Anhidrosis (decreased sweating)

All on one side

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24
Q

Adie pupil symptoms

A

Tonically dilated pupil
Slowly reactive to light with a more definite accommodation response
Holmes-Adie pupil often associated with absent knee/ankle reflexes

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25
Q

What is the pathology of adie pupil syndrome?

A

Damage to the parasympathetic innervation of the eye

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26
Q

What is Hutchinson’s pupil?

A

Unilaterally dilated pupil unresponsive to light

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27
Q

What causes Hutchinson’s pupil?

A 
Compression of the occulomotor nerve of the same side
Intracranial mass (e.g. tumour, haematoma)
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28
Q

Marcus-gunn pupil symptoms?

A

Relative afferent pupillary defect seen during the swinging light examination of pupil response - the pupils constrict less and therefore appear to dilate when light is swung from unaffected to affected eye

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29
Q

What causes Marcus-gunn pupil?

A

Damage to the optic nerve or severe retinal disease

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30
Q

What is associated with anterior uveitis?

A

HLA-B27

So conditions linked to it include:
Ankylosing spondylitis
Reactive arthritis
UC
Crohn's
Behcet's disease
Sarcoidosis
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31
Q

What are the features of anterior uveitis?

A 
Acute onset
Occular discomfort/pain
Pupil may be irregular (oval shaped) and small
Photophobia
Blurred vision
Red eye
Lacrimation
Visual acuity impaired
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32
Q

How do you manage anterior uveitis?

A

Urgent referral to opthalmology
Cycloplegics (dilates the pupil to relieve pain/photophobia) - examples include atropine and cyclopentolate
Steroid eye drops

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33
Q

What is herpes zoster ophthalmicus?

A

Reactivation of varicella-zoster virus in division of trigeminal nerve

34
Q

How do you treat HZO?

A

Oral antiviral treatment for 7-10 days

Topical corticosteroids can be used to treat secondary inflammation

35
Q

What characterises ARMD?

A

Degeneration of retinal photoreceptors

36
Q

What would you see on fundoscopy in dry ARMD?

A

Drusen (yellow round spots in Bruch’s membrane)

37
Q

What might you see on fundoscopy in wet ARMD?

A

Well demarcated red patches representing sub-retinal fluid leakage or haemorrhage
Neovascularisation

38
Q

What is the treatment for dry ARMD?

A

Anti-oxidants
Zinc
Vitamins A, C and E
Stop smoking

39
Q

What is the treatment for wet ARMD?

A

Anti-VEGF (vascular endothelial growth factor) - e.g. ranibizumab. 4 weekly injection

40
Q

What causes primary open angle glaucoma?

A

Increased resistance to aqueous outflow through the trabecular meshwork caused by slow blockage of the drainage canals

41
Q

What causes closed angle glaucoma?

A

The iris blocks the drainage angle which the eye would usually use to decrease fluid buildup

42
Q

What are the symptoms/signs of primary open-angle glaucoma?

A

Symptomless for a long period
Typically presents with an increased ocular pressure on routine measurement

Increased intraocular pressure
Visual field defect
Pathological cupping of the optic disc

43
Q

What IOP indicates glaucoma?

A

> 24mmHg on Goldmann-type applanation tonometry

44
Q

Treatment for primary open angle glaucoma?

A

First line:
Prostaglandin analogues (latanoprost)
Beta-blockers (timolol)

Can give pilocarpine as well (this can cause blurry vision, headache and a constricted pupil)

45
Q

What is blepharitis?

A

Inflammation of the eyelid margins

46
Q

What are the features of blepharitis?

A 
Bilateral
Grittiness and discomfort
Eyes may be sticky iin the morning
Eyelid margins may be red
Styes/chalazions common
47
Q

How do we manage blepharitis?

A

Hot compresses twice a day
Lid hygiene - cotton wool buds dipped in cooled boiled water to remove debris
Artificial tears

48
Q

How do we treat nasolacrimal duct obstruction?

A

Teach parents to massage the lacrimal duct

49
Q

What causes a dendritic ulcer?

A

Herpes simplex keratitis

50
Q

What are the features of herpes simplex keratitis?

A 
Red, painful eye
Photophobia
Epiphora
Decrease in visual acuity
Fluorescein staining may show an epithelial ulcer
51
Q

How do we manage herpes simplex keratitis?

A

Immediate referral to ophthalmologist

Topical aciclovir

52
Q

What increases the risk of corneal ulcers?

A

Contact lens use

Steroid eye drops

53
Q

What are the features of a corneal ulcer?

A

Eye pain
Photophobia
Watering of the eye

54
Q

How do we treat styes?

A

Warm steaming or soaking with a warm flannel

55
Q

What causes styes?

A

Generally a staphylococci infection of the glands of the eyelids

56
Q

What are the features of a chalazion (meibomian cyst)?

A

Firm painless lump on the eyelid
Often follows an internal stye
Usually a prolonged history

57
Q

How do we treat a chalazion?

A

Often resolves spontaenously

Surgical drainage in some cases

58
Q

What is an ectropion?

A

An out-turning of the eyelids

59
Q

What is an entropion?

A

An in-turning of the eyelids

60
Q

What are risk factors for primary open angle glaucoma?

A 
Genetics
Black patients
Myopia
HTN
DM
Corticosteroids
61
Q

How do we manage entropion?

A

If left untreated it can cause corneal ulcer, so:
We definitely manage using surgery
In the meantime we can use eye lubricants and tape to pull the eyelid outwards

62
Q

Features of bacterial conjunctivitis (as opposed to in viral)?

A

Purulent discharge

Eyes may be stuck together in the morning

63
Q

Features of viral conjunctivitis (as opposed to in bacterial)?

A

Watery discharge
Recent URTI
Preauricular lymph nodes

64
Q

Management of infective conjunctivitis?

A 
Self-limiting - resolves in 1-2 weeks
Topical abx commonly offered (chloramphenicol)
Topical fusidic acid if pregnant
Contact lenses should NOT be used
Do NOT share towels
School exclusion not necessary
65
Q

What are factors that predispose individuals to acute angle-closure glaucoma?

A

Hypermetropia (long-sightedness)
Pupillary dilation
Lens growth with age

66
Q

Features of acute angle-closure glaucoma?

A

Severe pain (ocular, headache)
Decreased visual acuity
Symptoms worse with mydriasis (e.g. watching tv in a dark room)
Hard, red eye
Haloes around lights
Corneal oedema results in dull/hazy cornea
Systemic upset (nausea/vomiting/abdo pain)

67
Q

Treatment for acute closed-angle glaucoma?

A

Urgent ophthalmology referral
Acetazolamide
Topical pilocarpine

68
Q

What causes optic neuritis?

A

MS
Diabetes
Syphilis

69
Q

Features of optic neuritis?

A 
Unilateral decrease in vis. acuity over hours/days
Poor discrimination of colours
Pain worse on eye movement
Central scotoma
RAPD
70
Q

How do we treat optic neuritis?

A

High dose steroids

Recovery takes 4-6 weeks

71
Q

What condition is both scleritis and episcleritis associated with?

A

Rheumatoid arthritis?

72
Q

How can you differentiate between scleritis and episcleritis?

A

Scleritis is painful, episcleritis is not

73
Q

What features are there of scleritis/episcleritis?

A 
Red eye
Watery eye
Photophobia
Gradual decrease in vision
Pain (scleritis only)
74
Q

What is Hutchinson’s sign?

A

Rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement in HZO

75
Q

What might you observe on fundoscopy in papilloedema?

A 
Venous engorgement
Loss of venous pulsation (???)
Blurring of the optic disc margin
Elevation of optic disc
Loss of the optiic cup
Paton's lines (retinal lines that cascade away from the optic disc)
76
Q

Causes of papilloedema?

A 
Space occupying lesion
Malignant hypertension
Raised ICP
Hydrocephalus
Hypercapnia
77
Q

Pre-septal vs orbital cellulits

A 
Orbital cellulitis has:
Restricted eye movement
Proptosis
Increased IOP
Signs of optic neuropathy
78
Q

Subconjunctival haemorrhage

A

Looks awful, red sclera but usually just conservative management
If significant trauma, think about base of skull fracture

79
Q

Pre-septal vs orbital cellulits

A 
Orbital cellulitis has:
Restricted eye movement
Proptosis
Increased IOP
Signs of optic neuropathy
80
Q

Subconjunctival haemorrhage

A

Looks awful, red sclera but usually just conservative management
If significant trauma, think about base of skull fracture

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