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3B > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Eyelid problems

A

Blepharitis

  • Inflammation of eyelid margins
  • Red eye

Stye - Infection of eyelid glands

Chalazion

  • Meibomian cyst
  • Firm painless lump in eyelid
  • Resolves spontaneously

Entropion - In-turning of eyelids
Ectropion - Out-turning of eyelids

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2
Q

Blepharitis aetiology

A

Inflammation of eyelid margins

Meibomian gland dysfunction

Seborrhoeic dermatitis - Staph infection
More common in patients with rosacea

Meibomian glands

  • Secrete oil onto eye surface
  • Prevent rapid evaporation of tear film
  • Meibomian gland disorders cause dry eyes
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3
Q

Blepharitis clinical features

A

Bilateral - RED EYE

Grittiness and discomfort - Around eyelid margins
Sticky eyes in morning
Swollen if Staph
Styes and chalazions
Secondary conjunctivitis
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4
Q

Blepharitis management

A

Hot compress - Soften lid margin

Lid hygiene - Mechanical removal of debris - Cotton wool buds

  • Baby shampoo in cooled boiled water
  • Sodium bicarb in cooled boiled water

Artificial tears

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5
Q

Stye

A

Infection of eyelid glands

External

  • Glands of Zeis - Sebum producing
  • Glands of Moll - Sweat producing

Internal

  • Meibomian glands
  • May leave residual chalazion

Management

  • Hot compress
  • Analgesia
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6
Q

Conjunctivitis aetiology and management

A

Bacterial

  • Purulent discharge
  • Sticky eyes in morning

Viral

  • Serous discharge
  • Recent URTI
  • Periauricular lymph nodes

Management - Self-limiting - 1-2 weeks

  • Topical abx - Chloramphenicol
  • Pregnant women - Topical fusidic acid
  • Avoid contact lenses
  • Prophylaxis - Don’t share towels
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7
Q

Anterior uveitis aetiology

A

Iritis
Inflammation of uvea - Iris and ciliary body

Associated conditions - HLA-B27
CRABS
- Crohn's/UC
- Reactive arthritis
- Ankylosing spondylitis
- Bechet's disease 
- Sarcoidosis - BL
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8
Q

Anterior uveitis management

A

Urgent ophthalmology review

Steroid eye drops - Prednisolone acetate

Cycloplegics
Dilate the pupil  
Relieve pain and photophobia
- Atropine
- Cyclopentolate
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9
Q

Episcleritis

A

Red eye

  • Bilateral 50%
  • Not painful
  • Watering
  • Photophobia
  • Injected vessels mobile when gentle pressure applied to sclera

Diagnosis - Phenylephrine drops
- Blanches conjunctival and episcleral vessels
NOT scleral vessels
- If redness improves after phenylephrine - Diagnosis is episcleritis

Management - Conservative
- Artificial tears

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10
Q

Corneal ulcer

A

More common in contact lens users

Eye pain
Photophobia
Eye watering

Focal fluoruescein staining of cornea

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11
Q

Acute angle closure glaucoma aetiology

A

Impaired aqueous outflow due to mispositioned iris

Predisposing factors

  • Hypermetropia - Long-sightedness
  • Pupillary dilatation
  • Lens growth associated with age
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12
Q

AACG clinical features

A

Severe pain - Ocular or headache
Systemic upset - N/V + Abdo pain

Symptoms worsen with mydriasis - E.g. watching TV in a dark room

Decreased visual acuity
Hard red eye
Haloes around lights
Semi-dilated non-reactive pupil
Corneal oedema - Dull/hazy cornea
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13
Q

AACG management

A

Emergency - Urgent ophthalmology referral

Combination of eye drops

Direct parasympathetic - Pilocarpine

  • Contraction of ciliary muscle
  • Opening of trabecular meshwork
  • Increased outflow of aqueous humour

BB - Timolol - Decreases aqueous humour production

A2 agonist - Apraclonidine

  • Decreased aqueous humour production
  • Increases uveoscleral outflow

Acetazolamide IV - Reduces aqueous secretions

Definitive management - Laser peripheral iridotomy

  • Hole in peripheral iris
  • Increased aqueous outflow
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14
Q

Primary open-angle glaucoma aetiology and clinical features

A

Trabecular meshwork not draining properly

Family history
Black
Myopia

HTN
DM
Corticosteroids

Clinical features - Insidious onset…

  • Peripheral visual field loss - Nasal scotomas > Tunnel vision
  • Decreased visual acuity
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15
Q

Primary open-angle glaucoma investigations

A

Fundoscopy

  • Optic disc cupping
  • Optic disc pallor
  • Bayonetting of vessels
  • Cup notching
  • Disc haemorrhages

Automated perimetry - Assess visual field
Slit lamp examination with pupil dilatation - Assess optic nerve and fundus
Applanation tonometry - Measure IOP
Central corneal thickness measurement
Gonioscopy - Assess peripheral anterior chamber configuration and depth

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16
Q

Primary open-angle glaucoma management and prognosis

A
  1. Prostaglandin analogue eyedrop
  2. BB, carbonic anhydrase inhibitor, sympathomimetic eyedrop

Advanced disease - Surgery or laser treatment

Reassessment - Exclude progression and visual field loss

Risk factors for future visual impairment

  • IOP
  • Central corneal thickness
  • Family history
  • Life expectancy
17
Q

Latanoprost

A

Prostaglandin analogue

Increases uveoscleral outflow

Adverse effects

  • Brown iris pigmentation
  • Increased eyelash length
18
Q

Timolol / Betaxolol

A

BB

Reduces aqueous production

CI in asthma

19
Q

Brimonidine

A

Sympathomimetic

Reduces aqueous production
Increases outflow

20
Q

Dorzolamide

A

Carbonic anhydrase inhibitor

Reduces aqueous production

21
Q

Pilocarpine

A

Miotic

Increases uveoscleral outflow

Adverse effects

  • Constricted pupil
  • Headache
  • Blurred vision
22
Q

Cataracts aetiology

A

Lens gradually opacifies
Blocks light from reaching retina
Reduced / blurred vision
Leading cause of curable blindness

Normal ageing process
Smoking / Alcohol
Trauma
DM

Long-term corticosteroids
Radiation exposure
Myotonic dystrophy
Metabolic disorders - Hypocalcaemia

23
Q

Cataracts clinical features and investigations

A

Insidious onset

  • Reduced vision
  • Faded colour vision
  • Glare - Lights appear brighter than usual
  • Halos around lights
  • Red reflex defects

Ophthalmoscopy - After pupil dilatation

  • Normal fundus
  • Normal optic nerve

Slit-lamp examination - Visible cataract

24
Q

Cataracts classification and management

A

Nuclear - Change in lens refractive index
Polar - Localised, inherited, lie in visual axis
Subcapsular - Steroid use, deep to lens capsule, lie in visual axis
Dot opacities - Common in normal lenses, DM and myotonic dystrophy

Non-surgical management

  • Stronger glasses / contacts
  • Encourage use of brighter lighting

Surgical management - Artificial lens replacement

25
Q

Complications following cataract surgery

A

Posterior capsule opacification - Thickening of lens capsule
Retinal detachment
Posterior capsule rupture
Endophthalmitis - Inflammation of aqueous and/or vitreous humour

26
Q

Central retinal vein occlusion

A

Sudden painless loss of vision

Risk factors

  • Increasing age
  • Glaucoma
  • Polycythaemia

Clinical features

  • Sudden painless loss of vision/acuity - Unilateral
  • Fundoscopy - Several retinal haemorrhages
27
Q

Central retinal artery occlusion

A

Sudden painless loss of vision

Aetiology

  • Thromboembolism - Atherosclerosis
  • Arteritis - Temporal arteritis

Clinical features

  • Afferent pupillary defect
  • Cherry red spot on pale retina
28
Q

Retinal detachment aetiology and clinical features

A

Preceded by retinal tear

Holes/tears in retina
Fluid separates sensory retina from retinal pigment epithelium

4 Fs

  • Floaters
  • Flashes
  • Fall in acuity
  • Field loss
29
Q

Retinal detachment investigations and management

A

Ophthalmoscopy

Superior - Lie flat
Inferior - Lie 30 degrees head up

Urgent referral for surgery

30
Q

Vitreous haemorrhage aetiology and presentation

A

Retinal neovascularisation

  • DM
  • CRVO

Retinal tears
Retinal detachment
Trauma

Sudden onset - Vitreous floaters

  • Small black dots
  • Tiny rings with clear centres
31
Q

Vitreous haemorrhage diagnosis and ?management

A

Ophthalmoscopy

Refer to ophthalmology

Should resolve spontaneously

May require surgery if severe

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3B (23 decks)

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