Flashcards in Anterior + uveitis (incl posterior uveitis) Deck (343):
What are papillae
hyperplastic conjunctival epithelium
What two main features do papillae have
central vascular core
surrounding infiltrate of inflammatory cells
Papillae commonly occur in
What are follicles
subepithelial hyperplastic lymphoid tissue
What two features do follicles have
central elevated pale lesion
Follices occur in
hypersensitivity to topical medications
Mucoid/watery discharge is generally indicative of what
mucopurulent discharge is generally indicative of what
purulent discharge is generally indicative of what
What kind of reaction is an allergic seasonal/perennial conjunctivitis and what causes it?
hypersensitivity (type 1 IgE-histamine) reaction to airborne antigens
What are the symptoms of seasonal/perennial conjunctivitis (3)
watering +/- mucous strands
What are the signs of seasonal/perennial conjunctivitis (3)
conjunctival injection and oedema
Management of perennial/seasonal conjunctivitis involves a stepwise approach. What are the first three Tx options before drug administration?
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
Name topical mast cell stabiliser and dosage. This is used as Tx mainly for what condition?
lodoxamide (Lomide) qid
nb longer lasting cf antihistamine, longer time to take effect, often used in combination with antihistamine and prophylactic use
Name the two combination topical antihistamine/mast cell stabiliser and dosage
olopatadine (Patanol) 1-2 drops bid
ketotifen (Zaditen) 1 drop bid
NSAIDs can be used as short term Tx of perennial conjunctivitis. Name one with dosage
ketorolac (Acular) 1 drop qid for 2-4 weeks
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
CL-related giant papillary conjunctivitis is what sort of reaction
hypersensitivity reaction to protein build up
What is the typical presentation of someone with GPC
giant papillae on tarsal plate
What is the management of GPC
same as for moderate to severe allergic conjunctivitis
What organisms cause bacterial conjunctivitis (4)
symptoms of bacterial conjunctivitis (3)
red, gritty eyes
sticky discharge, matting of lashes
Would you see follicles or papillae with bacterial conjunctivitis?
Management of bacterial conjunctivitis
usually self limiting 1-2 weeks
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
Symptoms of adenoviral conjunctivitis
red, watery eyes
signs of adenoviral conjunctivitis (5)
purplish/pink conjunctival injection
possible scattered focal subepithelial opacities
Adenoviral conjunctivitis is usually self limiting. What supportive management options are there (2)
artificial tears/lubricants qid+
cool compresses qid+
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)
Chlamydial conjunctivitis symptoms (3)
acute or chronic slight red eye
signs of chlamydial conjunctivitis (3)
follicles (tarsal conj)
possible associated keratitis
Therapeutic Tx of chlamydial conjunctivitis (3)
azithromycin 1g po once weekly
doxycycline 100mg po bid 2-6 weeks
erythromycin 250mg po qid (children)
When is doxycycline contraindicated
Px on blood thinners
children - stains teeth and ceases bone growth
CL-related toxic/allergic keratoconjunctivitis presentation (3)
burning on insertion
Management of CL-related toxic/allergic keratoconjunctivitis (4)
cease CL wear
remove source and lavage
prophylactic Tx of chloramphenicol 0.5% qid
Management of punctate epithelial erosion/SPK
appropriate for etiology
often lubricants and ABs if more serious
Marginal keratitis is associated with what
Management of marginal keratitis
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
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
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
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
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
Symptoms of bacterial keratitis (5)
FB sensation with increasing pain
A contact lens can mask symptoms by acting as a bandage lens. What does the Px feel
discomfort after taking lens out
Signs of bacterial keratitis (5)
white stromal infiltrate
overlying epithelial defect
Suppurative infiltrate is characteristic of which two bacteria which cause keratitis?
well-defined white gray or creamy stromal infiltrate is characteristic of what sort of specific keratitis
Treatment for large >2mm sight threatening lesions (bacterial keratitis)
cephalosporin (cefazolin) 5%
loading dose q5min for 30 min, then q30 min for 24hr tapering to min qid
Management of smaller <1-2mm peripheral lesions in bacterial keratitis
ciprofloxacin (ciloxan) 0.3%
loading dose q5min for 15min, then q30min for 24hr
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
In viral keratitis, if infiltrates are affecting vision and not resolving what do you prescribe?
FML 0.1% qid
Symptoms of HSK
Signs of HSK
terminal end bulbs
reduced corneal sensation
DDx of HSK
healing epithelial abrasion (pseudodendrites)
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
Recurrent HSK Tx (esp with scarring) (2)
topical corticosteroids to control inflam after cornea healed
prophylactic oral acyclovir tabs 400mg bid
Signs/symptoms of fungal keratitis (6)
significant pain, photophobia, lacrimation
marked conj injection
dense corneal infiltration
AC reaction - hypopyon
symptoms of acanthamoeba keratitis (6)
severe pain - disproportionate
signs of acanthamoeba keratitis (9)
epithelial or subepithelial infiltrates (snowstorm)
stromal ring infiltration (Wessely ring) with epith lesion
What investigations do ophthalmologists do for possible acanthamoeba keratitis (4)
light microscopy with calcofluor white stain
culture on non-nutrient agar with E coli
in-vivo confocal microscopy
Tx of acanthamoeba keratitis (5)
propamidine isethionate 1% q1h
PHMB 0.02% OR chlorhexadine 0.02%
What pupil size would you expect to see with someone with anterior uveitis
Management of anterior uveitis
aggressive topical corticosteroid Tx e.g. prednisolone acetate
Management of episcleritis
supportive - advice and artificial tears for FB sensation
NSAIDs e.g. FML 0.1% 1 gtt qid 1 week and stop
Scleritis is associated with which other two conditions
Subconjunctival haemorrhage is characterised by what
What would you expect to see about the pupil in angle closure glaucoma
fixed and mid-dilated
Management of angle closure
-beta-blocker e.g. timolol
-azetazolamide (diamox) 500mg po
age-related sagging or draping upper lid skin tissue due to loss of elastin
Blepharochalasis results from
repeated periorbital swelling and leads to eyelid tissue thinning and redundancy
abnormally low position of upper lid margin relative to globe in primary gaze
Congential aetiologies of ptosis (3)
dystrophy of levator
mis-directed 3rd nerve
Marcus Gun jaw-winking syndome
aquired aetiologies of ptosis (4)
mechanical e.g. trauma, tumour
myogenic e.g. MG
neurogenic e.g. Horner's, III nerve palsy
outward turning of lower lid away from globe
inward turning of the lower lid
Entropion can result in
trichiasis, corneal/conj irritation and possible pannus
posterior misdirection of the eyelashes
Floppy eyelid syndrome is
loose, rubbery eyelids with lax tarsi due to loss of elastin
floppy eyelid syndrome is commonly associated with
high BMI and sleep apnoea
incomplete lid closure with normal blinking or eye closing resulting in exposure keratitis
A VII nerve palsy can cause what
eyelid myokymia is
eyelid twitch due to activity of orbicularis oculi
bilateral, episodic spasm of orbicularis oculi leading to uncontrolled, exaggerated blinking
the loss of eyelashes (and is a sign of something else e.g. skin disease, infection)
partial or complete second row of lashes growing posterior or out of meibomian gland orifices
congenital, bilateral, inner canthal folds resulting in pseudo-strabismus (eso)
acute infection of lash follicle, gland of zeis or moll
Tx of external hordeolum
hot compresses, lid hygiene and sometimes topical antibiotics
acute infection and/or inflammation of meibomian gland
chronic, granulomatous, sterile inflammation of meibomian gland
Tx of chalazion if necessary
hot compresses followed by digital massage, may require intralesional injection of steroid or surgical excision
How do you get preseptal cellulitis
spread from sinusitis, lid infection, trauma
Treatment for preseptal cellulitis
How can you distinguish between orbital and preseptal cellulitis?
With orbital cellulitis:
Slit lamp - conj chemosis, proptosis
ophthalmoscopy ONH swelling
MGD stage 1 symptoms and corneal staining
(minimally altered expressibility and secretion quality)
MGD stage 2 symptoms and corneal staining
minimal to mild symptoms
none to limited corneal staining
(mildly altered expressibility and secretion quality)
MGD stage 3 symptoms and corneal staining
mild to moderate corneal staining (mainly peripheral)
(moderately altered expressibility and secretion quality)
MGD stage 4 symptoms and corneal staining
marked staining (central in addition to peripheral)
severely altered expressibility and secretion quality)
What is the "plus" disease stage of MGD
co-existing or accompanying disorders of ocular surface and/or eyelids
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
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
Treatment of rosacea? (3)
systemic ABs - doxycycline, azithromycin
lid hygiene, warm compresses
possible topical AB ointment
multiple vesicles or ulcerative cold sore lesions on or near lid margins is indicative of what
Tx of HSV infection affecting adnexa (3 Tx + management)
warm saline soaks
drying agents (calamine lotion)
sometimes acyclovir ointment
follow closely for corneal involvement
HZO is a viral infection of the ophthalmic division of which nerve?
Ocular involvement with HZO is common with infection of the
HZO Tx (3)
steroids if cornea involved
analgesics for pain
Is HZO an immediate referral?
Pediculosis oculi is?
infestation of lid cilia with pubic lice (phthirus pubis)
petechial haemorrhages at the lash line may be indicative of what?
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
pinpoint inflammatory lesion with surrounding lid oedema causing symptoms of itch, throbbing, stinging sensation characteristic of what?
signs of malignancy for lumps, bumps and pigment (4)
changing in size over time
changing in coloration
Which condition typically has raised pearly edges, depressed ulcerated center which is slow growing and non-resolving
Which condition looks like a hardened nodule or rough, scaly patch which develops ulcerations or erosions and metastasizes through the lymph system?
Which of these conditions require urgent referral, BCC or SCC?
Which condition tends to be flat and scaly, seen around the eye and face due to dysplasia of keratinocytes?
actinic (solar) keratosis
Which bump/lump can become SCC?
actinic (solar) keratosis
Name an extremely malignant neoplasm arising from Zeiss, Moll or meibomian glands which can mimic a chalazion or internal hordeolum?
sebaceous gland adeno-carcinoma
What characterises a malignant melanoma? (5)
Which condition has pigmented, irregular shaped lesions which increase in size over several months and has a high association with immunocompromised patients?
Signs of non-malignancy (bumps, lumps, pigment)
stable or slow growing
little or no colour changes
Which condition shows asymptomatic, bilateral, symmetrical depigmentation of skin and overlying hair (which requires no Tx)
which conditions shows whitening or loss of pigmentation of lashes or eyebrows which can be due to chronic staph infection, vitiligo or albinism
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)
which condition has aetiology of DNA poxvirus with small, single or multiple, round, waxy nodules with variable cheesy centre
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
small, painless, round, translucent, fluid-filled vesicles?
cyst of moll (hydrocystoma)
DDx for naevi (1)
hyperkeratinised plaques, flat or slightly elevated, dry and scaly, usually light pigmentation, well-circumscribed, typically elderly
basal cell papilloma (seborrhoeic keratosis)
What condition involves benign, embryological tissue growth which contains multiple tissue types
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
Dry eye risk factors
postmenopausal oestrogen therapy
omega 3 and 6 balance
Drug classes that cause dry eye
Schirmer 1 test
- done with or without anaesthesia?
- does it measure basal or reflex tearing?
- normal result is?
basal and reflex
>15mm wetting after 5 minutes
Schirmer 2 test
- done with or without anaesthesia
- does it measure basal or reflex tearing?
- normal result is?
10mm after 5 mins
What indicates tear deficiency in the phenol red thread test
less than 10mm in 15 secs
Levels of what enzyme is elevated in dry eye
DELPHI panel is used to grade what?
Contraindications of punctal plugs (6)
only effective for aqueous deficiency!
infectious conjunctivitis and blepharitis
allergy to plug material
epiphora treatment involves treating
What test involves instillation of NaFl into BE and observing amount of NaFl reaching nasal passages
Jones no.1 test
What test involves expressing saline through a syringe + canula to see if fluid is observed in the nasal passage
Jones no.2 test
dacryocystorhinostomy (DCR) is a surgical intervention to treat what condition?
what is inflammation of the main lacrimal gland called?
acute dacryoadenitis is usually caused by
chronic dacryoadenitis is usually
secondary to inflammatory disorders (sarcoidosis, graves, sjogrens)
What is the characteristic anatomical sign of dacryoadenitis?
S curve of upper lid due to localised swelling and ptosis
Actinomyces israelii is the most common cause of what condition in older patients?
Which condition most commonly causes canaliculitis in younger patients
What is the condition involving infection/inflammation of the lacrimal sac
What symptom would you expect to be different between chronic dacryoadenitis and chronic dacryocystitis?
no tenderness/pain with chronic dacryocystitis
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
congenital, nerves that pass upwards through sclera then retrace their course back down. Name condition
recurrent loop of axenfeld
congenital or acquired pigmentation of the conjunctiva is?
which type of melanosis can convert to malignancy
primary acquired melanosis
areas of increased pigmentation often following distribution of V nerve
naevus of ota (oculodermal melanocytosis)
naevus of ota has risk of becoming what two conditions
heterochromia, iris mammillations and fundus hyperpigmentation are signs of what condition?
naevus of ota
acquired degeneration of conjunctiva due to exposure to environmental factors
Redundant folds of conjunctival tissue assoc with aging, dry eye, CLs, thyroid disease
what is often associated with valsalva maneuvers
pharyngoconjunctival fever is caused by which two types of adenovirus
3 and 7
epidemic keratoconjunctivitis is caused by which two types of adenovirus
8 and 19
caused by enterovirus 70 and looks like many flame haemorrhages in conj
acute haemorrhagic conjunctivitis
Which type of conjunctivitis displays hyperacute onset with severe purulent discharge, papillae and chemosis
Conjunctivitis acquired within one month of birth due to usually Chlamydia or Neisseria gonorrhoeae is called
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
Superior limbic keratoconjunctivitis is associated with what condition?
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
the advancing line of pterygium is called what?
Acne rosacea blepharoconjunctivitis is a problem of?
sebaceous glands involving primarily facial and meibomian glands
Systemic treatment of rosacea blepharoconjunctivitis involves?
oral tetracyclines for long periods with taper as indicated
Which mucous membrane disorder is an auto-immune condition which is progressive, causes chronic blistering of skin and mucous membranes?
Which mucous membrane disorder is an immune-mediated condition with bullous reaction with painful erosions and pseudomembranes?
Reiter's syndrome is a disorder of what kind of tissue?
Which syndrome is a triad of conjunctivitis with iritis, urethritis and arthritis?
Episcleritis is usually self-limiting and management often involves reassurance and ATs, but what topical drugs can be used?
NSAIDs - voltaren, acular
What inflammatory condition is usually associated with underlying systemic condition such as RA, colalgen vascualr disease, metabolic disease, granulomatous disease, or infectious disease?
Necrotising anterior scleritis without inflammation is termed as?
treatment of scleritis consists usually of?
topical and systemic anti-inflammatory agents or immunosuppressive agents
Which conjunctival tumour is a carcinoma in situ and a precursor to SCC?
What are the 5 topical anti-allergy agents?
antihistamines with decongestants
mast cell stabilisers
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
Sodium cromoglycate 2% (opticrom) and lodoxaminde 0.1% (lomide) are examples of what class of drugs?
mast cell stabilisers
Steroids mediate inflammation by inhibiting which enzyme?
loratadine, cetirizine and fexofenadine are examples of what class of drugs?
What class of drugs should be prescribed with care with renal disease, pregnancy, lactation and children
Perennial conjunctivitis symptoms tend to be:
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?
Horner-Trantas dots and Arlt's line are associated with what condition?
what condition is often assoc with atopic dermatitis and other allergic disease? Can also be assoc with keratoconus, cataract.
itching on lens removal with discharge and CL intolerance may be indicative of what kind of conjunctivitis?
giant papillary conjunctivitis
GPC Tx? (3)
mast cell stabilisers
(ie same as allergic conjunctivitis)
Localised area of thinning at limbus is called?
superficial vascularisation/scarring of the peripheral cornea due to inflammation or degeneration with superficial invasion from conjunctival vessel plexus is called?
Hypoxia due to SCL overwear or tight fitting lenses can lead to which condition?
CL-related corneal neovascularisation
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 is usually associated with? (2)
normal aging change
faulty lipid metabolism
what condition is characterised by subepithelial, white, needle-like opacities in the peripheral cornea?
limbal girdle of vogt
what condition is characterised by hypertophied Schwalbe's line with distinct white line paralleling limbus?
What condition is also known as Hassall Henle warts and is characterised by collagen thickening of Descemet's membrane?
elevated, peripheral hyaline nodules (discrete, large greyish-white nodules in peripheral 1/3 of cornea) and of no consequence?
Salzmann's nodular degeneration
name condition which is non-inflammatory and causes peripheral thinning of stroma with pannus?
Terrien's marginal degneration
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?
reddish-brown iron deposits sub-epithelial in older individuals with no Tx necessary?
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?
What condition is characterised by lipid deposition in stroma due to chronic inflammation and vascularisation
Lines in descemet's membrane are also called
What condition is characterised by surface drying due to atmospheric expsoure e.g. improper blink or incomplete closure at night?
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.
What condition would you expect to see in people with cystinosis, multiple myeloma, Waldenstrom's macroglobulinemia, lymphoma, Fyder's dystrophy?
These medications can cause what condition?
(hydroxy)chloroquine - RA, lupus, collagen disease
phenothiazines (e.g. chlorpromazine) - psychiatric disorders
amiodarone - cardiac arrhythmias
Recurrent corneal erosion syndrome occurs due to abnormal...?
basement membrane adherence of basal epithelial cells
Recurrent corneal erosion syndrome has two phases which are?
acute and quiescent phase
The acute phase of recurrent corneal erosion syndrome shows what?
corneal abrasion with FL staining and possibly secondary iritis
the quiescent phase of recurrent corneal erosion syndrome shows what?
subepithelial microcysts and perhaps FL negative staining
Tx of acute episodes of recurrent corneal erosion syndrome? (5)
hyperosmotic ointments and drops
pressure patching with antibiotic ointment
cycloplegia for discomfort
Prevantative therapy for recurrent corneal erosion syndrome (4)
-hyperosmotic ointment atnight and drops during daytime
-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
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
Thygeson's superficial punctate keratitis management (4)
- lubricants especially histamine
- topical antibiotics if significant SPK
- mild topic steroid during acute phase
- bandage CL
Corneal DYSTROPHIES tend to be _____ in location, tend to be ___lateral, and family history is ______
What is the most common anterior dystrophy?
epithelial basement membrane dystrophy
EMBD is also known as? (2)
Cogan's microcystic dystrophy
Which anterior dystrophy is characterised by bilateral, dot-like, cystic, linear or fingerprint like greyish sub- or intra-epithelial opacities
epithelial basement membrane dystrophy
Which one condition has a high association with recurrent corneal erosions?
epithelial basement membrane dystrophy
dot-like, cystic, fingerprint like greyish opacities in EBMD are best seen with which slit-lamp technique?
In severe cases how is EMBD treated?
Which anterior dystrophy is characterised by subepithelial opacification and changes in Bowman's membrane forming a honey comb appearance?
EBMD, Reis-Buckler's dystrophy and lattice dystrophy are associated with what other condition?
recurrent corneal erosion syndrome
There are 3 types of lattice dystrophy. Which type has an early presentation and is more symptomatic and more likely to require keratoplasty?
Which type of lattice dystrophy has a later presentation and is less symptomatic and may have facial palsy
type 3 lattice dystrophy is similar to what other type of lattice dystrophy but has more radial opacities and minimal haze?
Granular dystophy is _____ corneal dystrophy and has what kind of appearance?
snowflake or breadcrumb
Fuch's endothelial dystrophy occurs spontaneously but occasionally hereditary through?
autosomal dominant transmission
Fuch's endothelial dystrophy is characterised by? (3 main points)
progressive increase in central corneal guttata with polymegathism and decreased endothelial cell count
Guttata are best visualised with which techniques?
Fuch's endothelial dystrophy leads to endothelial ________ and leads to ______ _______
If oedema spreads to the epithelium in Fuch's endothelial dystrophy it can lead to?
bullous keratopathy with painful erosions
Tx of Fuch's endothelial dystrophy? (3)
opacities in Descemet's membrane (scalloped bands and geographic, gray hazy areas) are characteristic of which condition?
posterior polymorphous dystrophy
Keratoconus is due to progressive thinning of which area of the cornea?
Central to inferior corneal protrusion is known as?
In keratoconus what name is given to a basal layer of epithelium that demarcates the base of the cone with iron deposits?
In keratoconus what name is given to stress lines in pre-Descemet's membrane in a vertically oblique fashion?
Ruptures in descemet's membrane is called
What are the different cone morphologies in progressing size?
What condition is characterised by bilateral, painless, thinning of inferior peripheral cornea with ectasia?
pellucid marginal degeneration
What condition is characterised by bilateral thinning with protrusion of the entire cornea?
Which four bacteria can penetrate intact epithelium?
What species of bacteria cause oval, 1-2mm, yellow white, dense, opaque opacities
staph and strep
what species of bacteria cause irregular, thick, mucopurulent, necrosis, yellowish-green, large (3-5mm) deeply penetrating opacity?
what species of bacteria cause shallow, ulcerative, gray-white, irregular opacity with surrounding "ring" of infiltrates
Which antibiotic do you not use to treat a gram negative caused bacterial keratitis?
What are the stages of the life cycle of HSV
What should NEVER be used to treat active HSV keratitis?
What are the three variants of HSK?
indolent or neurotrophic ulcer (metaherpetic)
necrotising interstitial keratitis
how is indolent/neurotrophic ulcer (metaherpetic) HSK treated?
discontinuing antiviral meds and instituting prophylactic AB Tx, cycloplegics, lubricants and perhaps bandage CL
Which division of which nerve is involved in reactivation of HSK and HSZ?
ophthalmic division (I) of Trigeminal nerve
Ocular involvement is likely with HZO when which brance is is involved causing Hutchinson's sign?
Herpes Zoster can cause any _______ condition of the eye
inflammatory (ending in -itis)
Treatment of acute phase of HZO?
Treatment of fungal keratitis in hospital?
anti-fungal topical agent (perhaps oral anti-fungal as well) e.g.
Which condition is treated with the following drugs:
Topical: propamidine, neomycin, polyhexamethylene biguanide
Systemic: ketocanazole and itraconazole
Interstitial keratitis is associated with what systemic infections?
Graft rejection lines by the endothelium is also konwn as?
Gaft rejection management before immediate referal to ophthalmology?
intensive anti-inflammatories e.g. Pred Forte
What condition is characterised by epicanthal folds, bilateral ptosis, short horizontal palpebral aperture, risk of ambly, lower eyelid ectropion with dominant family history
Blepharophimosis is associated with what syndrome?
Fetal alcohol syndrome
What is the most common eyelid tumour in infancy and seen in 25% of low birth weight babies
Which syndromes/conditions are related condition to congenital glaucoma? (2)
neurofibromatosis (von Recklinhausen disease)
What condition is characterised by iris strand attached to or near posterior embryotoxon and which can occasionally lead to glaucoma?
Which condition is the same as axenfeld's but more pronounced and attachments may be more anterior
DDx with Axenfled/Reiger
ICE syndrome can lead to secondary what?
What condition is characterised by iris or lens adhesions to the posterior corneal surface
Congenital hereditiary endothelial dystrophy causes
bilateral clouding of cornea
Maternal rubella, deafness, microcephaly, congenital heart defects are common causes for what condition?
What is tunica vasculosa lentis?
persistent pupillary membrane
What is Mittendorf's dot and where is it located
remnant of the hyaloid vessel on the posterior capsule
What is displacement of the lens called?
What conditions can cause ectopia lentis?
What is the order of cataract progressions?
Which condition can show these symptoms?
-altered colored perception
-behavioural changes in children
Which type of cataract has early signs which include the formation of water vacuoles
Which type of cataract tends to progress the fastest?
Cataract risk factors (10)
any intraocular surgery
True diabetic cataract has what appearance?
Which cataract is due to deficiency in galactose pathway enzyme leading to osmotic imbalance?
What cataract is characterised by small white dots that can aggregate into flakes?
Sunfower cataract due to copper deposition is due to what disease?
Steroid induced cataract causes which type?
miotic induced cataract causes which type?
blunt trauma causes what type of cataract?
rosette or stellate
What is the most common congenital cataract?
Which cataract is club shaped, located in the cortex and assoc with Down's syndrome?
What are the early most common post op complications of cataract surgery ?
posterior capsule tear
What are the most common (late) post op complications of cataract surgery?
Post capsular opacity
AC cells and flare
Endophthalmitis is intraocular inflammation excluding what structure?
Granulomatous uveitis is?
non gratulomatous uveitis is?
Active leakage shows the appearance of what in the anterior chamber?
Previous leakage in shows the appearance of what in the anterior chamber?
Symptoms of acute uveitis?
vision near normal
dull ache to deep boring pain
Describe the usual pupil you would expect to see in acute uveitis
Grading of flare
1+ trace, barely detectable
2+ mild, iris details clear
3+ moderate, iris details hazy
4+ severe, exudate (hypopyon)
Grading of cells in AC
+/- <5 cells
1+ 5-10 cells
4+ 50+ cells
Inflammatory cells adherent to corneal endothelium is seen in uveitis and are called
Mutton Fat keratic precipitates are seen in?
granulomatous (chronic) uveitis
Iris nodules are a feature of ?
granulomatous (chronic) uveitis
Koeppe nodules are located at?
Busacca nodules are located?
away from the pupil
What usually happens to IOP in acute uveitis?
IOP may be increased in uveitis. This is especially seen with what kind of uveitis?
Cells in the vitreous is only seen in what type of uveitis?
acute anterior uveitis
DDx of acute anterior uveitis?
all other causes of red eye esp angle closure glaucoma
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
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
tid/qid and taper once AC quiet
If uncomplicated, idiopathic, unilateral acute anterior uveitis is not responding to therapeutic treatment what condition should you suspect?
Fuchs heterochromatic iridocyclitis
Complications of fuchs heterochromatic iridocyclitis?
iris heterochromia and atrophy
cataract and glaucoma
loss of vision
How is Fuchs heterochromatic iridocyclitis usually treated?
topical anti glaucoma medication e.g. Timolol 0.25% bid
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
What are the "later" signs of chronic anterior uveitis? (6)
High or low IOP
What is management for chronic anterior uveitis?
possible co-management of acute phase (Tx as acute)
refer to GP or ophthal
Intermediate uveitis can affect which three structures?
pars plana, peripheral retina, underlying choroid
Intermediate uveitis is associated with what two conditions?
Multiple sclerosis (10-15% develop)
What are symptoms of intermediate uveitis? (2)
decreased vision (CMO)
What are four signs of intermediate uveitis?
peripheral retinal periphlebitis
snowbanking (deposits at inf pars plana)
absence of focal lesions of fundus
What are complications of intermediate uveitis?
cyclitic membrane formation
Like posterior uveitis, intermediate uveitis management involves referral. However how is intermediate uveitis treated by ophthals?
sub-tenon steroid injections
cryotherapy (vitreous base for NV)
pars plana vitrectomy (if haem, RD, opacification)
choroiditis, vitritis, retinitis, vasculitis are all examples of what condition?
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
What is the sign of active retinitis?
white cloudy appearance obscuring retinal vessels
What is the sign of vasculitis?
fluffy white haziness surrounding veins
What are the complications of posterior uveitis? (4)
epiretinal membrane formation
Posterior uveitis is classified into three classes which are?
Toxoplasmosis is the most common cause of posterior uveitis and is caused by the protozoan _______ which is found in the animal _____
Active lesions of toxoplasmosis are urgently referred where they are treated by? (2)
systemic antibiotics (pyrimethamine, sulfadiazine, clindamycin)
Histoplasmosis is a fungal infection caused by ____ and is asymptomatic unless the _____ is involved
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
When histoplasmosis affects vision it is because of ___ ____