Anterior + uveitis (incl posterior uveitis) Flashcards Preview

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Flashcards in Anterior + uveitis (incl posterior uveitis) Deck (343):
1

What are papillae

hyperplastic conjunctival epithelium

2

What two main features do papillae have

central vascular core
surrounding infiltrate of inflammatory cells

3

Papillae commonly occur in

allergic conditions
bacterial infections
CL wear

4

What are follicles

subepithelial hyperplastic lymphoid tissue

5

What two features do follicles have

central elevated pale lesion
surrounding vascularisation

6

Follices occur in

viral infections
chlamydial infections
hypersensitivity to topical medications

7

Mucoid/watery discharge is generally indicative of what

allergic reaction

8

mucopurulent discharge is generally indicative of what

chlamydial infection

9

purulent discharge is generally indicative of what

bacterial infection

10

What kind of reaction is an allergic seasonal/perennial conjunctivitis and what causes it?

hypersensitivity (type 1 IgE-histamine) reaction to airborne antigens

11

What are the symptoms of seasonal/perennial conjunctivitis (3)

pink eye
watering +/- mucous strands
itchiness

12

What are the signs of seasonal/perennial conjunctivitis (3)

lid oedema
conjunctival injection and oedema
small papillae

13

Management of perennial/seasonal conjunctivitis involves a stepwise approach. What are the first three Tx options before drug administration?

avoid allergen
lavage
cold compresses

14

Name topical antihistamine and dosage. This is used as Tx for what 2 conditions?

levocabastine (Livostin) bid to qid up to 2 months
allergic conjunctivitis and adenoviral conjunctivitis

15

Name topical mast cell stabiliser and dosage. This is used as Tx mainly for what condition?

lodoxamide (Lomide) qid
allergic conjunctivitis
nb longer lasting cf antihistamine, longer time to take effect, often used in combination with antihistamine and prophylactic use

16

Name the two combination topical antihistamine/mast cell stabiliser and dosage

olopatadine (Patanol) 1-2 drops bid
ketotifen (Zaditen) 1 drop bid

17

NSAIDs can be used as short term Tx of perennial conjunctivitis. Name one with dosage

ketorolac (Acular) 1 drop qid for 2-4 weeks

18

Non-penetrating topical corticosteroids can be used as short term Tx of perennial conjunctivitis. Name one and dosage

FML 0.1% (Flucon) 1-2 drops bid to qid
nb side effects increased IOP, increased risk SCC, HSK reactivation

19

CL-related giant papillary conjunctivitis is what sort of reaction

hypersensitivity reaction to protein build up

20

What is the typical presentation of someone with GPC

itching
mucous discharge
lens awareness
giant papillae on tarsal plate

21

What is the management of GPC

same as for moderate to severe allergic conjunctivitis

22

What organisms cause bacterial conjunctivitis (4)

staph aureus
staph epidermis
strep pneumoniae
haemophilus influenza

23

symptoms of bacterial conjunctivitis (3)

red, gritty eyes
sticky discharge, matting of lashes

24

Would you see follicles or papillae with bacterial conjunctivitis?

papillae

25

Management of bacterial conjunctivitis

usually self limiting 1-2 weeks
artificial tears/lubricants

26

In more serious cases of bacterial conjunctivitis, broad spectrum topical antibiotics can be used. Name 3

fusidic acid (Fucithalmic) bid
chloramphenicol (chlorofast and chlorsig) qid
ciprofloxacin (ciloxin) q2h-qid

27

Symptoms of adenoviral conjunctivitis

red, watery eyes
burning irritation
possible photophobia

28

signs of adenoviral conjunctivitis (5)

watery discharge
follicles
purplish/pink conjunctival injection
preauricular adenopathy
possible scattered focal subepithelial opacities

29

Adenoviral conjunctivitis is usually self limiting. What supportive management options are there (2)

artificial tears/lubricants qid+
cool compresses qid+

30

what topical therapeutics are used to treat adenoviral conjunctivitis (3)

levocabastine (Livostin) qid for itch
FML 0.1% qid with long, slow taper for subepithelial infiltrates and decreased vision (refer severe cases with pseudomembranes)
Povidone (iodine) 0.8-2.0% in clinic Tx (Px must not have epithelial defect)

31

Chlamydial conjunctivitis symptoms (3)

acute or chronic slight red eye
irritation
mucopurulent discharge

32

signs of chlamydial conjunctivitis (3)

follicles (tarsal conj)
preauricular adenopathy
possible associated keratitis

33

Therapeutic Tx of chlamydial conjunctivitis (3)

azithromycin 1g po once weekly
doxycycline 100mg po bid 2-6 weeks
erythromycin 250mg po qid (children)

34

When is doxycycline contraindicated

Px on blood thinners
pregnancy
children - stains teeth and ceases bone growth

35

CL-related toxic/allergic keratoconjunctivitis presentation (3)

burning on insertion
injection
PEE

36

Management of CL-related toxic/allergic keratoconjunctivitis (4)

cease CL wear
remove source and lavage
lubricants
prophylactic Tx of chloramphenicol 0.5% qid

37

Management of punctate epithelial erosion/SPK

appropriate for etiology
often lubricants and ABs if more serious

38

Marginal keratitis is associated with what

blepharitis

39

Management of marginal keratitis

Treat bleph
-lid hygiene
-antibiotic ointment
Chloramphenicol 0.5% drops qid and ointment 1% nocte lid margin OR
Fucithalmic 1% drops/gel bid
Continue Tx for 48 hours after signs resolve

40

CL-related marginal keratitis presentation (3)

asymptomatic to acute red eye presentation
conj and limbal injection
single or multiple small (1mm) round greyish superficial peripheral corneal infiltrates

41

Management for mild CL-related marginal keratitis

tobramycin 0.3% (Tobrex) q1h initially (review next day)
treat min 1 week until epith healed (qid min.)
consider FML 0.1% qid to manage infiltrate once epith healed and clear signs of improvement

42

Management for more severe CL-related marginal keratitis

ciprofloxacin 0.3% (ciloxan) q15 then q1h, review next day, reduce dosage according to response (q1d), continue for min 1 week until epith healed.
Consider FML 0.1% qid to manage infiltrate once epith healed and clear signs of improvement

43

For CL-related marginal keratitis once the epithelium is healed and there are clear signs of improvement, what do you use to manage infiltrates

FML 0.1% qid

44

Symptoms of bacterial keratitis (5)

FB sensation with increasing pain
injection
photophobia
blur
tearing/discharge
CL intolerance

45

A contact lens can mask symptoms by acting as a bandage lens. What does the Px feel

discomfort after taking lens out

46

Signs of bacterial keratitis (5)

white stromal infiltrate
overlying epithelial defect
possible ulceration
stromal oedema
AC reaction

47

Suppurative infiltrate is characteristic of which two bacteria which cause keratitis?

pseudomonas
strep pneumoniae

48

well-defined white gray or creamy stromal infiltrate is characteristic of what sort of specific keratitis

staphylococcal keratitis

49

Treatment for large >2mm sight threatening lesions (bacterial keratitis)

duotherapy
cephalosporin (cefazolin) 5%
tobramycin 1.5%
loading dose q5min for 30 min, then q30 min for 24hr tapering to min qid

50

Management of smaller <1-2mm peripheral lesions in bacterial keratitis

monotherapy
ciprofloxacin (ciloxan) 0.3%
loading dose q5min for 15min, then q30min for 24hr

51

CL-related bacterial keratitis involves duotherapy, monotherapy and two other treatment options which are?

cyclopentolate 1% tid
FML 0.1% qid 1-2 weeks to treat infiltrates after cornea has healed

52

In viral keratitis, if infiltrates are affecting vision and not resolving what do you prescribe?

FML 0.1% qid

53

Symptoms of HSK

blurred vision
lacrimation
photophobia
discomfort

54

Signs of HSK

dendritic ulcers
terminal end bulbs
reduced corneal sensation
AC reaction
increased IOP

55

DDx of HSK

acanthamoeba keratitis
healing epithelial abrasion (pseudodendrites)
HZO

56

Management of non-sight threatening dendritic ulcer (HSK)

topical acyclovir 3% ointment (Virupos) 10mm ribbon in fornix, 5 times a day for 10-14 days, continue for 3 days after resolution

57

Recurrent HSK Tx (esp with scarring) (2)

topical corticosteroids to control inflam after cornea healed
prophylactic oral acyclovir tabs 400mg bid

58

Signs/symptoms of fungal keratitis (6)

slow onset
significant pain, photophobia, lacrimation
marked conj injection
dense corneal infiltration
corneal oedema
AC reaction - hypopyon

59

symptoms of acanthamoeba keratitis (6)

severe pain - disproportionate
photophobia
injection
blurred vision
tearing
swollen lids

60

signs of acanthamoeba keratitis (9)

epithelial or subepithelial infiltrates (snowstorm)
pseudodendrites
limbitis
perineural infiltrates
stromal ring infiltration (Wessely ring) with epith lesion
hypopyon
episcleritis
scleritis
corneal thinning

61

What investigations do ophthalmologists do for possible acanthamoeba keratitis (4)

corneal scrape
light microscopy with calcofluor white stain
culture on non-nutrient agar with E coli
in-vivo confocal microscopy

62

Tx of acanthamoeba keratitis (5)

propamidine isethionate 1% q1h
PHMB 0.02% OR chlorhexadine 0.02%
cycloplegia
oral NSAIDs
penetrating keratoplasty

63

What pupil size would you expect to see with someone with anterior uveitis

miotic

64

Management of anterior uveitis

aggressive topical corticosteroid Tx e.g. prednisolone acetate

65

Management of episcleritis

supportive - advice and artificial tears for FB sensation
NSAIDs e.g. FML 0.1% 1 gtt qid 1 week and stop

66

Scleritis is associated with which other two conditions

HZO
RA

67

Subconjunctival haemorrhage is characterised by what

ecchymosis

68

What would you expect to see about the pupil in angle closure glaucoma

fixed and mid-dilated

69

Management of angle closure

Topical
-pilocarpine (<45mmHg)
-beta-blocker e.g. timolol
-apraclonidine
-dorzolamide
Systemic
-azetazolamide (diamox) 500mg po
-mannitol

70

Dermatochalasis is

age-related sagging or draping upper lid skin tissue due to loss of elastin

71

Blepharochalasis results from

repeated periorbital swelling and leads to eyelid tissue thinning and redundancy

72

Ptosis is

abnormally low position of upper lid margin relative to globe in primary gaze

73

Congential aetiologies of ptosis (3)

dystrophy of levator
mis-directed 3rd nerve
Marcus Gun jaw-winking syndome

74

aquired aetiologies of ptosis (4)

aponeurotic
mechanical e.g. trauma, tumour
myogenic e.g. MG
neurogenic e.g. Horner's, III nerve palsy

75

ectropion

outward turning of lower lid away from globe

76

entropion is

inward turning of the lower lid

77

Entropion can result in

trichiasis, corneal/conj irritation and possible pannus

78

trichiasis is

posterior misdirection of the eyelashes

79

Floppy eyelid syndrome is

loose, rubbery eyelids with lax tarsi due to loss of elastin

80

floppy eyelid syndrome is commonly associated with

high BMI and sleep apnoea

81

lagophthalmos is

incomplete lid closure with normal blinking or eye closing resulting in exposure keratitis

82

A VII nerve palsy can cause what

ectropion
lagophthalmos

83

eyelid myokymia is

eyelid twitch due to activity of orbicularis oculi

84

blepharospasm is

bilateral, episodic spasm of orbicularis oculi leading to uncontrolled, exaggerated blinking

85

madarosis is

the loss of eyelashes (and is a sign of something else e.g. skin disease, infection)

86

distichiasis is

partial or complete second row of lashes growing posterior or out of meibomian gland orifices

87

epicanthus is

congenital, bilateral, inner canthal folds resulting in pseudo-strabismus (eso)

88

external hordeolum

acute infection of lash follicle, gland of zeis or moll

89

Tx of external hordeolum

hot compresses, lid hygiene and sometimes topical antibiotics

90

internal hordeolum

acute infection and/or inflammation of meibomian gland

91

chalazion

chronic, granulomatous, sterile inflammation of meibomian gland

92

Tx of chalazion if necessary

hot compresses followed by digital massage, may require intralesional injection of steroid or surgical excision

93

How do you get preseptal cellulitis

spread from sinusitis, lid infection, trauma

94

Treatment for preseptal cellulitis

oral antibiotics

95

How can you distinguish between orbital and preseptal cellulitis?

With orbital cellulitis:
VA decreased
pupils (RAPD)
Slit lamp - conj chemosis, proptosis
EOMs restricticted
IOP elevated
ophthalmoscopy ONH swelling

96

MGD stage 1 symptoms and corneal staining

none
none
(minimally altered expressibility and secretion quality)

97

MGD stage 2 symptoms and corneal staining

minimal to mild symptoms
none to limited corneal staining
(mildly altered expressibility and secretion quality)

98

MGD stage 3 symptoms and corneal staining

moderate symptoms
mild to moderate corneal staining (mainly peripheral)
(moderately altered expressibility and secretion quality)

99

MGD stage 4 symptoms and corneal staining

marked symptoms
marked staining (central in addition to peripheral)
severely altered expressibility and secretion quality)

100

What is the "plus" disease stage of MGD

co-existing or accompanying disorders of ocular surface and/or eyelids

101

Therapeutic intervention for MGD occurs at which stage? What drugs are used?

doxycycline 50mg nocte x 6 wks
azithromycin 500mg stat, then 250mg x 3 days

102

Which condition describes this: midline facial inflammatory disorder affecting adults showing signs/symptoms of:
- erythema, pustules, papules, telangectasia of nose, forehead, cheeks
- bulbous nose
- bleph, chalazia, injection, KCS

rosacea

103

Treatment of rosacea? (3)

systemic ABs - doxycycline, azithromycin
lid hygiene, warm compresses
possible topical AB ointment

104

multiple vesicles or ulcerative cold sore lesions on or near lid margins is indicative of what

HSV infection

105

Tx of HSV infection affecting adnexa (3 Tx + management)

warm saline soaks
drying agents (calamine lotion)
sometimes acyclovir ointment
follow closely for corneal involvement

106

HZO is a viral infection of the ophthalmic division of which nerve?

trigeminal

107

Ocular involvement with HZO is common with infection of the

nasociliary branch

108

HZO Tx (3)

oral acyclovir
steroids if cornea involved
analgesics for pain

109

Is HZO an immediate referral?

yes

110

Pediculosis oculi is?

infestation of lid cilia with pubic lice (phthirus pubis)

111

petechial haemorrhages at the lash line may be indicative of what?

pediculosis oculi

112

Tx of pediculosis oculi (2)

any type of ointment applied thickly to lids qid for 10-14 days
pediculocidal agent on scalp, pubic region and body

113

pinpoint inflammatory lesion with surrounding lid oedema causing symptoms of itch, throbbing, stinging sensation characteristic of what?

insect bite/sting

114

signs of malignancy for lumps, bumps and pigment (4)

changing in size over time
changing in coloration
vascularisation
non-healing lesion

115

Which condition typically has raised pearly edges, depressed ulcerated center which is slow growing and non-resolving

BCC

116

Which condition looks like a hardened nodule or rough, scaly patch which develops ulcerations or erosions and metastasizes through the lymph system?

SCC

117

Which of these conditions require urgent referral, BCC or SCC?

SCC

118

Which condition tends to be flat and scaly, seen around the eye and face due to dysplasia of keratinocytes?

actinic (solar) keratosis

119

Which bump/lump can become SCC?

actinic (solar) keratosis

120

Name an extremely malignant neoplasm arising from Zeiss, Moll or meibomian glands which can mimic a chalazion or internal hordeolum?

sebaceous gland adeno-carcinoma

121

What characterises a malignant melanoma? (5)

irregular borders
fast growing
colour changes
vascularised
sudden onset

122

Which condition has pigmented, irregular shaped lesions which increase in size over several months and has a high association with immunocompromised patients?

kaposi's sarcoma

123

Signs of non-malignancy (bumps, lumps, pigment)

stable or slow growing
little or no colour changes
regular borders
avascular

124

Which condition shows asymptomatic, bilateral, symmetrical depigmentation of skin and overlying hair (which requires no Tx)

vitiligo

125

which conditions shows whitening or loss of pigmentation of lashes or eyebrows which can be due to chronic staph infection, vitiligo or albinism

poliosis

126

congenital purplish hemangioma of skin from underlying telangectactic capillaries sometimes assoc with Sturge-Weber syndrome and a risk factor for glaucoma

naevus flammus (port wine stain)

127

which condition has aetiology of DNA poxvirus with small, single or multiple, round, waxy nodules with variable cheesy centre

molluscum contagiosum

128

Which condition can be infectious or UV related, variable in size and pigmentation characterised by hyperplastic squamous epithelium that can cause chronic conjunctivitis?

viral wart/squamous papilloma, verrucae

129

small, painless, round, translucent, fluid-filled vesicles?

cyst of moll (hydrocystoma)

130

DDx for naevi (1)

squamous papilloma

131

hyperkeratinised plaques, flat or slightly elevated, dry and scaly, usually light pigmentation, well-circumscribed, typically elderly

basal cell papilloma (seborrhoeic keratosis)

132

What condition involves benign, embryological tissue growth which contains multiple tissue types

dermoid cyst

133

DEWS II definition of dry eye

Multifactorial disease of the ocular surface characterised by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play an etiological role

134

Dry eye risk factors

older age
female
postmenopausal oestrogen therapy
omega 3 and 6 balance
antihistamines

135

Drug classes that cause dry eye

anti-histamines
anti-anxiety
roaccutane

136

Schirmer 1 test
- done with or without anaesthesia?
- does it measure basal or reflex tearing?
- normal result is?

without
basal and reflex
>15mm wetting after 5 minutes

137

Schirmer 2 test
- done with or without anaesthesia
- does it measure basal or reflex tearing?
- normal result is?

with
basal
10mm after 5 mins

138

What indicates tear deficiency in the phenol red thread test

less than 10mm in 15 secs

139

Levels of what enzyme is elevated in dry eye

MMP-9

140

DELPHI panel is used to grade what?

dry eye

141

Contraindications of punctal plugs (6)
only effective for aqueous deficiency!

infectious conjunctivitis and blepharitis
MGD
dacryocystitis
inflammation
epiphora
allergy to plug material

142

epiphora treatment involves treating

underlying cause

143

What test involves instillation of NaFl into BE and observing amount of NaFl reaching nasal passages

Jones no.1 test

144

What test involves expressing saline through a syringe + canula to see if fluid is observed in the nasal passage

Jones no.2 test

145

dacryocystorhinostomy (DCR) is a surgical intervention to treat what condition?

acquired epiphora

146

what is inflammation of the main lacrimal gland called?

dacryoadenitis

147

acute dacryoadenitis is usually caused by

infection

148

chronic dacryoadenitis is usually

secondary to inflammatory disorders (sarcoidosis, graves, sjogrens)

149

What is the characteristic anatomical sign of dacryoadenitis?

S curve of upper lid due to localised swelling and ptosis

150

Actinomyces israelii is the most common cause of what condition in older patients?

canaliculitis

151

Which condition most commonly causes canaliculitis in younger patients

HSV/HZO

152

What is the condition involving infection/inflammation of the lacrimal sac

dacryocystitis

153

What symptom would you expect to be different between chronic dacryoadenitis and chronic dacryocystitis?

no tenderness/pain with chronic dacryocystitis

154

This condition occurs congenitally around the blood vessels that penetrate the sclera to anastamose with iridial circle and looks dark purplish/green

episcleral uveal pigmentation

155

congenital, nerves that pass upwards through sclera then retrace their course back down. Name condition

recurrent loop of axenfeld

156

congenital or acquired pigmentation of the conjunctiva is?

melanosis

157

which type of melanosis can convert to malignancy

primary acquired melanosis

158

areas of increased pigmentation often following distribution of V nerve

naevus of ota (oculodermal melanocytosis)

159

naevus of ota has risk of becoming what two conditions

glaucoma
choroidal melanoma

160

heterochromia, iris mammillations and fundus hyperpigmentation are signs of what condition?

naevus of ota

161

acquired degeneration of conjunctiva due to exposure to environmental factors

pinguecula

162

Redundant folds of conjunctival tissue assoc with aging, dry eye, CLs, thyroid disease

conjunctivochalasis

163

what is often associated with valsalva maneuvers

subconjunctival haemorrhage

164

pharyngoconjunctival fever is caused by which two types of adenovirus

3 and 7

165

epidemic keratoconjunctivitis is caused by which two types of adenovirus

8 and 19

166

caused by enterovirus 70 and looks like many flame haemorrhages in conj

acute haemorrhagic conjunctivitis

167

Which type of conjunctivitis displays hyperacute onset with severe purulent discharge, papillae and chemosis

gonococcal conjunctivitis

168

Conjunctivitis acquired within one month of birth due to usually Chlamydia or Neisseria gonorrhoeae is called

neonatal conjunctivitis

169

What is the first step of action with toxic or chemical conjunctivitis

immediate copious irrigation with water/saline for at least 15 mins in case of acid or alkali

170

Superior limbic keratoconjunctivitis is associated with what condition?

thyroid dysfunction

171

What conjunctivitis is an allergic hypersensitivity response to some antigen and are characterised by small, localised, raised, pinkish-white nodular lesions with assoc sectoral injection

phlyctenular conjunctivitis

172

the advancing line of pterygium is called what?

Stocker's line

173

Acne rosacea blepharoconjunctivitis is a problem of?

sebaceous glands involving primarily facial and meibomian glands

174

Systemic treatment of rosacea blepharoconjunctivitis involves?

oral tetracyclines for long periods with taper as indicated

175

Which mucous membrane disorder is an auto-immune condition which is progressive, causes chronic blistering of skin and mucous membranes?

cicatricial pemphigoid

176

Which mucous membrane disorder is an immune-mediated condition with bullous reaction with painful erosions and pseudomembranes?

Stevens-Johnson syndrome

177

Reiter's syndrome is a disorder of what kind of tissue?

connective tissue

178

Which syndrome is a triad of conjunctivitis with iritis, urethritis and arthritis?

Reiter's syndrome

179

Episcleritis is usually self-limiting and management often involves reassurance and ATs, but what topical drugs can be used?

NSAIDs - voltaren, acular

180

What inflammatory condition is usually associated with underlying systemic condition such as RA, colalgen vascualr disease, metabolic disease, granulomatous disease, or infectious disease?

scleritis

181

Necrotising anterior scleritis without inflammation is termed as?

scleromalacia perforans

182

treatment of scleritis consists usually of?

topical and systemic anti-inflammatory agents or immunosuppressive agents

183

Which conjunctival tumour is a carcinoma in situ and a precursor to SCC?

intraepithelial neoplasia

184

What are the 5 topical anti-allergy agents?

antihistamines with decongestants
antihistamines
mast cell stabilisers
steroids
cyclosporin

185

Naphazoline 0.1% (Albalon), tetrahydrozoline 0.05% (Visine) and Xylometazoline 0.05% (otrivine-antistin) are examples of what class of drugs?

topical decongestant - a1 agonists

186

Sodium cromoglycate 2% (opticrom) and lodoxaminde 0.1% (lomide) are examples of what class of drugs?

mast cell stabilisers

187

Steroids mediate inflammation by inhibiting which enzyme?

phospholipase A2

188

loratadine, cetirizine and fexofenadine are examples of what class of drugs?

ORAL anti-histamines

189

What class of drugs should be prescribed with care with renal disease, pregnancy, lactation and children

oral anti-histamines

190

Perennial conjunctivitis symptoms tend to be:
chronic?
acute?

chronic

191

Which keratoconjunctivitis tends to be worse in spring, warm dry climates and can be assoc with asthma and eczema with symptoms of itching, injection, oedema, photophobia, FB sensation, lacrimation, stringy discharge, large papilae (typically upper lids) and exacerbated by exposure to wind, dust, heat, physical exertion?

vernal keratoconjunctivitis

192

Horner-Trantas dots and Arlt's line are associated with what condition?

vernal keratoconjunctivitis

193

what condition is often assoc with atopic dermatitis and other allergic disease? Can also be assoc with keratoconus, cataract.

atopic keratoconjunctivitis

194

itching on lens removal with discharge and CL intolerance may be indicative of what kind of conjunctivitis?

giant papillary conjunctivitis

195

GPC Tx? (3)

remove cause
lubrication
mast cell stabilisers
(ie same as allergic conjunctivitis)

196

Localised area of thinning at limbus is called?

dellen

197

superficial vascularisation/scarring of the peripheral cornea due to inflammation or degeneration with superficial invasion from conjunctival vessel plexus is called?

pannus

198

Hypoxia due to SCL overwear or tight fitting lenses can lead to which condition?

CL-related corneal neovascularisation

199

what condition is characterised by a 0.5-1mm wide, greyish, white band in peripheral cornea with a limbal clear zone and sharp edge?

Arcus senilis

200

Arcus senilis is usually associated with? (2)

normal aging change
faulty lipid metabolism

201

what condition is characterised by subepithelial, white, needle-like opacities in the peripheral cornea?

limbal girdle of vogt

202

what condition is characterised by hypertophied Schwalbe's line with distinct white line paralleling limbus?

posterior embryotoxon

203

What condition is also known as Hassall Henle warts and is characterised by collagen thickening of Descemet's membrane?

endothelial guttata

204

elevated, peripheral hyaline nodules (discrete, large greyish-white nodules in peripheral 1/3 of cornea) and of no consequence?

Salzmann's nodular degeneration

205

name condition which is non-inflammatory and causes peripheral thinning of stroma with pannus?

Terrien's marginal degneration

206

What condition has two types (benign and progressive) often painful with photophobia with greyish infiltration, stromal thinning, peripheral vascularisation and healing with opacification thought to be an autoimmune reaction?

Mooren's ulcer

207

reddish-brown iron deposits sub-epithelial in older individuals with no Tx necessary?

Hudson-Stahli line

208

what condition is assoc with chronic iridocyclitis, phthisis bulbi, high blood levels of calcium or phosphorous presenting with calcium deposition at the level of Bowman's layer?

band keratopathy

209

What condition is characterised by lipid deposition in stroma due to chronic inflammation and vascularisation

lipid keratopathy

210

Lines in descemet's membrane are also called

endothelial striae

211

What condition is characterised by surface drying due to atmospheric expsoure e.g. improper blink or incomplete closure at night?

exposure keratopathy

212

What condition is characterised by anaesthesia/hypoesthesia of cornea due to loss of 5th nerve function which then causes exposure keratopathy. The most common cause of this condition is herpes infections.

neurotrophic keratopathy

213

What condition would you expect to see in people with cystinosis, multiple myeloma, Waldenstrom's macroglobulinemia, lymphoma, Fyder's dystrophy?

crystalline keratopathy

214

These medications can cause what condition?
(hydroxy)chloroquine - RA, lupus, collagen disease
phenothiazines (e.g. chlorpromazine) - psychiatric disorders
amiodarone - cardiac arrhythmias
tamoxifen

vortex keratopathy

215

Recurrent corneal erosion syndrome occurs due to abnormal...?

basement membrane adherence of basal epithelial cells

216

Recurrent corneal erosion syndrome has two phases which are?

acute and quiescent phase

217

The acute phase of recurrent corneal erosion syndrome shows what?

corneal abrasion with FL staining and possibly secondary iritis

218

the quiescent phase of recurrent corneal erosion syndrome shows what?

subepithelial microcysts and perhaps FL negative staining

219

Tx of acute episodes of recurrent corneal erosion syndrome? (5)

hyperosmotic ointments and drops
hair-dryer use
bandage CL
pressure patching with antibiotic ointment
cycloplegia for discomfort

220

Prevantative therapy for recurrent corneal erosion syndrome (4)

-hyperosmotic ointment atnight and drops during daytime
-bandage CL
-improvement of tear film e.g. PO doxycycline, azithromycin, dexamethazone ointment nocte/drops qid 2 weeks
- more radical therapy - epithelial scraping, anterior st romal puncture, laser PTK

221

What condition is characterised by "bread crumbs" on the cornea which is bilateral, recurrent and can look like subepithelial infiltrates from adenoviral keratitis.

Thygeson's superficial punctate keratitis

222

Thygeson's superficial punctate keratitis management (4)

symptom relief
- lubricants especially histamine
- topical antibiotics if significant SPK
- mild topic steroid during acute phase
- bandage CL

223

Corneal DYSTROPHIES tend to be _____ in location, tend to be ___lateral, and family history is ______

central
bilateral
common

224

What is the most common anterior dystrophy?

epithelial basement membrane dystrophy

225

EMBD is also known as? (2)

map-dot-fingerprint
Cogan's microcystic dystrophy

226

Which anterior dystrophy is characterised by bilateral, dot-like, cystic, linear or fingerprint like greyish sub- or intra-epithelial opacities

epithelial basement membrane dystrophy

227

Which one condition has a high association with recurrent corneal erosions?

epithelial basement membrane dystrophy

228

dot-like, cystic, fingerprint like greyish opacities in EBMD are best seen with which slit-lamp technique?

retroillumination

229

In severe cases how is EMBD treated?

scraping
PTK

230

Which anterior dystrophy is characterised by subepithelial opacification and changes in Bowman's membrane forming a honey comb appearance?

Reis-Buckler's dystrophy

231

EBMD, Reis-Buckler's dystrophy and lattice dystrophy are associated with what other condition?

recurrent corneal erosion syndrome

232

There are 3 types of lattice dystrophy. Which type has an early presentation and is more symptomatic and more likely to require keratoplasty?

type 1

233

Which type of lattice dystrophy has a later presentation and is less symptomatic and may have facial palsy

type 2

234

type 3 lattice dystrophy is similar to what other type of lattice dystrophy but has more radial opacities and minimal haze?

type 2

235

Granular dystophy is _____ corneal dystrophy and has what kind of appearance?

stromal
snowflake or breadcrumb

236

Fuch's endothelial dystrophy occurs spontaneously but occasionally hereditary through?

autosomal dominant transmission

237

Fuch's endothelial dystrophy is characterised by? (3 main points)

progressive increase in central corneal guttata with polymegathism and decreased endothelial cell count

238

Guttata are best visualised with which techniques?

specular reflection
indirect retro-illumination

239

Fuch's endothelial dystrophy leads to endothelial ________ and leads to ______ _______

dysfunction
corneal oedema

240

If oedema spreads to the epithelium in Fuch's endothelial dystrophy it can lead to?

bullous keratopathy with painful erosions

241

Tx of Fuch's endothelial dystrophy? (3)

hyperosmotic agents
bandage CL
keratoplasty

242

opacities in Descemet's membrane (scalloped bands and geographic, gray hazy areas) are characteristic of which condition?

posterior polymorphous dystrophy

243

Keratoconus is due to progressive thinning of which area of the cornea?

paracentral

244

Central to inferior corneal protrusion is known as?

Munson's sign

245

In keratoconus what name is given to a basal layer of epithelium that demarcates the base of the cone with iron deposits?

Fleischer's ring

246

In keratoconus what name is given to stress lines in pre-Descemet's membrane in a vertically oblique fashion?

Vogt's striae

247

Ruptures in descemet's membrane is called

hydrops

248

What are the different cone morphologies in progressing size?

nipple
oval
globus

249

What condition is characterised by bilateral, painless, thinning of inferior peripheral cornea with ectasia?

pellucid marginal degeneration

250

What condition is characterised by bilateral thinning with protrusion of the entire cornea?

keratoglobus

251

Which four bacteria can penetrate intact epithelium?

Neisseria
corynebacterium
listeria
haemophilus

252

What species of bacteria cause oval, 1-2mm, yellow white, dense, opaque opacities

staph and strep

253

what species of bacteria cause irregular, thick, mucopurulent, necrosis, yellowish-green, large (3-5mm) deeply penetrating opacity?

pseudomonas

254

what species of bacteria cause shallow, ulcerative, gray-white, irregular opacity with surrounding "ring" of infiltrates

enterobacteriae

255

Which antibiotic do you not use to treat a gram negative caused bacterial keratitis?

Fucithalmic

256

What are the stages of the life cycle of HSV

primary infection
latent stage
recurrent infection

257

What should NEVER be used to treat active HSV keratitis?

steroids

258

What are the three variants of HSK?

indolent or neurotrophic ulcer (metaherpetic)
necrotising interstitial keratitis
disciform keratitis

259

how is indolent/neurotrophic ulcer (metaherpetic) HSK treated?

discontinuing antiviral meds and instituting prophylactic AB Tx, cycloplegics, lubricants and perhaps bandage CL

260

Which division of which nerve is involved in reactivation of HSK and HSZ?

ophthalmic division (I) of Trigeminal nerve

261

Ocular involvement is likely with HZO when which brance is is involved causing Hutchinson's sign?

nasociliary branch

262

Herpes Zoster can cause any _______ condition of the eye

inflammatory (ending in -itis)

263

Treatment of acute phase of HZO?

oral acyclovir

264

Treatment of fungal keratitis in hospital?

anti-fungal topical agent (perhaps oral anti-fungal as well) e.g.
econazole
natamycin
amphotericin B
imidazole

265

Which condition is treated with the following drugs:
Topical: propamidine, neomycin, polyhexamethylene biguanide
Systemic: ketocanazole and itraconazole

acanthamoeba keratitis

266

Interstitial keratitis is associated with what systemic infections?

congenital syphillis
TB
Cogan's syndrome

267

Graft rejection lines by the endothelium is also konwn as?

Khodadoust line

268

Gaft rejection management before immediate referal to ophthalmology?

intensive anti-inflammatories e.g. Pred Forte

269

What condition is characterised by epicanthal folds, bilateral ptosis, short horizontal palpebral aperture, risk of ambly, lower eyelid ectropion with dominant family history

blepharophimosis

270

Blepharophimosis is associated with what syndrome?

Fetal alcohol syndrome

271

What is the most common eyelid tumour in infancy and seen in 25% of low birth weight babies

haemangiomas

272

Which syndromes/conditions are related condition to congenital glaucoma? (2)

Sturge-Weber syndrome
neurofibromatosis (von Recklinhausen disease)

273

What condition is characterised by iris strand attached to or near posterior embryotoxon and which can occasionally lead to glaucoma?

axenfeld's anomaly

274

Which condition is the same as axenfeld's but more pronounced and attachments may be more anterior

Reiger's anomaly

275

DDx with Axenfled/Reiger

ICE syndrome

276

ICE syndrome can lead to secondary what?

glaucoma

277

What condition is characterised by iris or lens adhesions to the posterior corneal surface

Peter's anomaly

278

Congenital hereditiary endothelial dystrophy causes

bilateral clouding of cornea

279

Maternal rubella, deafness, microcephaly, congenital heart defects are common causes for what condition?

congenital cataract

280

What is tunica vasculosa lentis?

persistent pupillary membrane

281

What is Mittendorf's dot and where is it located

remnant of the hyaloid vessel on the posterior capsule

282

What is displacement of the lens called?

ectopia lentis

283

What conditions can cause ectopia lentis?

marfans syndrome
homocystinuria
trauma
tumours

284

What is the order of cataract progressions?

immature
mature
intumescent
hypermature
morgagnian

285

Which condition can show these symptoms?
-colored halos
-monocular diplopia/polyopia
-altered colored perception
-behavioural changes in children

cataract

286

Which type of cataract has early signs which include the formation of water vacuoles

cortical cataract

287

Which type of cataract tends to progress the fastest?

posterior subcapsular

288

Cataract risk factors (10)

age
smoking
uveitis
RD
RP
any intraocular surgery
intraocular tumour
high myopia
trauma
acute glaucoma

289

True diabetic cataract has what appearance?

snowflake

290

Which cataract is due to deficiency in galactose pathway enzyme leading to osmotic imbalance?

galactosemia

291

What cataract is characterised by small white dots that can aggregate into flakes?

hypoparathyroidism/hypocalcemia

292

Sunfower cataract due to copper deposition is due to what disease?

Wilson's disease

293

Steroid induced cataract causes which type?

PSC

294

miotic induced cataract causes which type?

ASC

295

blunt trauma causes what type of cataract?

rosette or stellate

296

What is the most common congenital cataract?

zonular/lamellar

297

Which cataract is club shaped, located in the cortex and assoc with Down's syndrome?

coronary

298

What are the early most common post op complications of cataract surgery ?

iris prolapse
posterior capsule tear
corneal oedema
increased IOP

299

What are the most common (late) post op complications of cataract surgery?

CMO
Post capsular opacity
AC cells and flare

300

Endophthalmitis is intraocular inflammation excluding what structure?

sclera

301

Granulomatous uveitis is?
a. chronic
b. acute

chronic

302

non gratulomatous uveitis is?
a. chronic
b. acute

acute

303

Active leakage shows the appearance of what in the anterior chamber?

cells

304

Previous leakage in shows the appearance of what in the anterior chamber?

flare only

305

Symptoms of acute uveitis?

usually unilateral
red eye
photophobia
vision near normal
dull ache to deep boring pain

306

Describe the usual pupil you would expect to see in acute uveitis

miotic pupil

307

Grading of flare

1+ trace, barely detectable
2+ mild, iris details clear
3+ moderate, iris details hazy
4+ severe, exudate (hypopyon)

308

Grading of cells in AC

+/- <5 cells
1+ 5-10 cells
2+ 11-20
3+ 21-50
4+ 50+ cells
hypopyon

309

Inflammatory cells adherent to corneal endothelium is seen in uveitis and are called

keratic precipitates

310

Mutton Fat keratic precipitates are seen in?

granulomatous (chronic) uveitis

311

Iris nodules are a feature of ?

granulomatous (chronic) uveitis

312

Koeppe nodules are located at?

pupillary border

313

Busacca nodules are located?

away from the pupil

314

What usually happens to IOP in acute uveitis?

decreases

315

IOP may be increased in uveitis. This is especially seen with what kind of uveitis?

herpetic uveitis

316

Cells in the vitreous is only seen in what type of uveitis?

acute anterior uveitis

317

DDx of acute anterior uveitis?

all other causes of red eye esp angle closure glaucoma
other uveitis'
RD

318

HLA-B27+ is a _____ part of the ___ and associated with conditions such as ankylosing spondylitis, reiter's syndrome, psoriatic arthritis, IBD

nucleated cell surface antigen
MHC

319

Therapeutic Tx of acute anterior uveitis

-prednisolone acetate 1.0% (Prednisolone-AFT)
loading dose q5min - q1h for 1-2 days
mainteneance: q2h-qid until quiet
taper to qd for weeks to months

-cycloplegia
tid/qid and taper once AC quiet

320

If uncomplicated, idiopathic, unilateral acute anterior uveitis is not responding to therapeutic treatment what condition should you suspect?

Fuchs heterochromatic iridocyclitis

321

Complications of fuchs heterochromatic iridocyclitis?

iris heterochromia and atrophy
cataract and glaucoma
loss of vision

322

How is Fuchs heterochromatic iridocyclitis usually treated?

topical anti glaucoma medication e.g. Timolol 0.25% bid
NOT LATANOPROST

323

Chronic anterior uveitis patients show minimal redness and discomfort. What signs might you be able to see on a routine check up?

Mutton fat or pigmented KPs
iris nodules

324

What are the "later" signs of chronic anterior uveitis? (6)

iris atrophy
band keratopathy
secondary cataract
High or low IOP
CMO
Rubeosis

325

What is management for chronic anterior uveitis?

possible co-management of acute phase (Tx as acute)
refer to GP or ophthal

326

Intermediate uveitis can affect which three structures?

pars plana, peripheral retina, underlying choroid

327

Intermediate uveitis is associated with what two conditions?

Multiple sclerosis (10-15% develop)
genotype HLA-DR15

328

What are symptoms of intermediate uveitis? (2)

increasing floaters
decreased vision (CMO)

329

What are four signs of intermediate uveitis?

vitritis
peripheral retinal periphlebitis
snowbanking (deposits at inf pars plana)
absence of focal lesions of fundus

330

What are complications of intermediate uveitis?

CMO
cataract
tractional RD
cyclitic membrane formation

331

Like posterior uveitis, intermediate uveitis management involves referral. However how is intermediate uveitis treated by ophthals?

sub-tenon steroid injections
systemic steroids
cryotherapy (vitreous base for NV)
pars plana vitrectomy (if haem, RD, opacification)

332

choroiditis, vitritis, retinitis, vasculitis are all examples of what condition?

posterior uveitis

333

What are the active and inactive signs of choroiditis

active: deep, yellow or greyish patches with fairly well demarcated borders
inactive: white defined atrophic lesions with pigment

334

What is the sign of active retinitis?

white cloudy appearance obscuring retinal vessels

335

What is the sign of vasculitis?

fluffy white haziness surrounding veins

336

What are the complications of posterior uveitis? (4)

CMO
maculopathy
epiretinal membrane formation
RD

337

Posterior uveitis is classified into three classes which are?

focal
multifocal
geographical

338

Toxoplasmosis is the most common cause of posterior uveitis and is caused by the protozoan _______ which is found in the animal _____

toxoplasma gondii
cats

339

Active lesions of toxoplasmosis are urgently referred where they are treated by? (2)

systemic antibiotics (pyrimethamine, sulfadiazine, clindamycin)
systemic corticosteroids

340

Histoplasmosis is a fungal infection caused by ____ and is asymptomatic unless the _____ is involved

histoplasma capsulatum
macula

341

Histoplasmosis is characterised by asymptomatic lesions such as PPA, linear perpheral streaks and histo spots, the latter which has what appearance?

scattered small round yellow-white lesions

342

When histoplasmosis affects vision it is because of ___ ____

exudative maculopathy

343

The clinical features of a slowly progressive retinitis or fulminating retinitis with:
dense, white geographic retinal opacification
haemorhage
involvment of ONH
RD
loss of vision
are signs of what condition seen commonly in patients with AIDS?

CMV retinitis