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OPTOM 450 > Anterior + uveitis (incl posterior uveitis) > Flashcards

Anterior + uveitis (incl posterior uveitis) Flashcards

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1
Q

What are papillae

A

hyperplastic conjunctival epithelium

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2
Q

What two main features do papillae have

A

central vascular core

surrounding infiltrate of inflammatory cells

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3
Q

Papillae commonly occur in

A

allergic conditions
bacterial infections
CL wear

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4
Q

What are follicles

A

subepithelial hyperplastic lymphoid tissue

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5
Q

What two features do follicles have

A

central elevated pale lesion

surrounding vascularisation

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6
Q

Follices occur in

A

viral infections
chlamydial infections
hypersensitivity to topical medications

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7
Q

Mucoid/watery discharge is generally indicative of what

A

allergic reaction

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8
Q

mucopurulent discharge is generally indicative of what

A

chlamydial infection

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9
Q

purulent discharge is generally indicative of what

A

bacterial infection

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10
Q

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

A

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

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11
Q

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

A

pink eye
watering +/- mucous strands
itchiness

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12
Q

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

A

lid oedema
conjunctival injection and oedema
small papillae

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13
Q

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

A

avoid allergen
lavage
cold compresses

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14
Q

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

A

levocabastine (Livostin) bid to qid up to 2 months

allergic conjunctivitis and adenoviral conjunctivitis

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15
Q

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

A

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

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16
Q

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

A

olopatadine (Patanol) 1-2 drops bid

ketotifen (Zaditen) 1 drop bid

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17
Q

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

A

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

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18
Q

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

A

FML 0.1% (Flucon) 1-2 drops bid to qid

nb side effects increased IOP, increased risk SCC, HSK reactivation

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19
Q

CL-related giant papillary conjunctivitis is what sort of reaction

A

hypersensitivity reaction to protein build up

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20
Q

What is the typical presentation of someone with GPC

A

itching
mucous discharge
lens awareness
giant papillae on tarsal plate

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21
Q

What is the management of GPC

A

same as for moderate to severe allergic conjunctivitis

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22
Q

What organisms cause bacterial conjunctivitis (4)

A

staph aureus
staph epidermis
strep pneumoniae
haemophilus influenza

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23
Q

symptoms of bacterial conjunctivitis (3)

A

red, gritty eyes

sticky discharge, matting of lashes

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24
Q

Would you see follicles or papillae with bacterial conjunctivitis?

A

papillae

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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

OPTOM 450 (2 decks)

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