Flashcards in Clinical (5 + 6) Deck (81):
What is the most common cause of red eye?
What do eyelid secrete for defence?
What is contained in tears?
IgA and IgG
What can ocular pain be presenting as?
What are the following features of:
- Seborrhoeic (squamous) scales on lashes
- Staphylococcal infection of lash follicle
- Lid margin redder than deeper part of lid
What are the following features of:
- Meibomian gland dysfunction
- Redness in deeper lid
- Lid margin often appears normal
Which of the following is not a symptom of blepharitis:
- Gritty eyes
- Foreign body sensation
- Mild discharge
- Vascular injection into sclera
Vascular injection into sclera
What conditions is blepharitis associated with?
Keratitis (Marginal and SPK)
What are styes and what condition are they indicative of?
Ulcers of lid margins
Staphylococcal anterior blephatitis
What is trichiasis and what can it be a sign of?
Staphylococcal anterior blepharitis
What causes corneal staining and marginal ulcers in Staphylococcal anterior blepharitis?
How do the meibomian glands appear in posterior blepharitis?
What are chalazia?
What is posterior blepharitis associated with?
How is blepharitis treated?
- Daily bathing
- Warm compresses
Supplementary tears drops
Oral doxycycline for 2-3 months
What are common infective causes of conjunctivitis?
Apart from infective causes of conjunctivitis, what else can cause it?
Skin disease -> Eczema
Which of the following is not a symptoms of infective conjuncitivitis:
- Red eye
- Gritty eye
- Discharge (sticky eye)
- Unaffected vision
- This suggests allergy
What sign of conjunctivitis is specific to viral causes?
How long does bacterial conjunctivitis take to clear without treatment?
How can we treat bacterial conjunctivitis?
What bacteria most commonly cause conjunctivitis?
Which of the following does not cause follicular conjunctivitis?
- Herpes zoster
- Drugs (Propine and Trusopt)
Which of the following is not a cause of chronic conjunctivitis:
- Chlamydial conjunctivitis
- Keratoconjunctivits sicca
- Chronic dacrocystitis
- Topical glaucoma medication
- Subtarsal foreign body
What are the three layers of the cornea from external to internal?
What causes central corneal ulcers?
What causes peripheral corneal ulcers?
- Hypersensitivity (eg. Marginal ulcers)
- Rarely GPA and Polyarteritis
What are the characteristics of the pain in corneal ulcers?
Corneal sensation affected by Herpes
What is the pattern of red eye in corneal ulcers?
What are three other symptoms of corneal ulcers (apart from pain and red eye)?
Possible reduced vision
Which of the following is not a sign of corneal ulcers:
- Circumcorneal redness
- Abnormal reflection on corneal reflex
- Corneal opacity
- Vascular injections into sclera and cornea
- Fluorescein staining
Vascular injections into sclera and cornea
Corneal dryness due to inadequate lid closure in thyroid disease or CN VII palsy
This condition is due to either:
- Reduced tear production
- Increased tear evaporation
It is commonly seen in Sjogren's
What type of keratitis is causes by herpes zoster in CN V1?
What vitamin deficiency can cause corneal ulcers?
Vitamin A deficiency
How do we identify the cause of a corneal ulcer?
- Gram stain
How do we treat bacterial corneal ulcers?
How do we treat herpetic corneal ulcers?
Aciclovir ointment 5 times daily
How do we treat autoimmune corneal ulcers?
Which of the following autoimmune conditions is not associated with anterior uveitis:
- Reiter's syndrome
- Ankylosing spondylitis
- Sjogren's syndrome
What malignancy can cause anterior uveitis?
Which of the following infections is not associated with anterior uveitis:
- Herpes simplex
- Herpes zoster
Which of the following is not a symptoms of anterior uveitis:
- Pain (and referred pain)
- Reduced vision
- Circumcorneal red eye
What is a synechiae and what is it a sign of?
What are the potential treatments of anterior uveitis?
- Prednisolone Forte 1% hourly
-> Tapering over 4-8 weeks
- Cyclopentolate 1% twice daily
How do we manage chronic or recurrent anterior uveitis?
Investigate for systemic causes
What joint condition is episcleritis associated with?
What systemic vasculidities is scleritis associated with?
How does scleritis present?
Injection of deep vascular plexus -> Violaceous line
How do we manage episcleritis?
How do we manage scleritis?
Steroid sparing agents (Immunosuppressants)
What is the pathophysiology of acute angle-closure glaucoma?
IOP raised acutely due to drainage angle closure (ie Trabecular meshwork and Schlemm's canals)
What precipitates acute angle-closure glaucoma?
What predisposes people to acute angle-closure glaucoma?
Elderly people with hypermetropia
Which of the following is not a sign/symptom of acute angle-closure glaucoma:
- Severe pain and nausea
- Circumcorneal injection
- Cornea cloudy
- Mid-dilated pupil
- Eye stony hard
Put the following steps in the pathogenesis of diabetic retinopathy in order:
- Loss of pericytes
- Chronic hyperglycaemia
- Leakage and ischaemia
- Glycosylation of protein and basement membrane (thickens)
1. Chronic hyperglycaemia
2. Glycosylation of protein and basement membrane (thickens)
3. Loss of pericytes
5. Leakage and ischaemia
Which of the following is not a feature of non-proliferative retinopathy:
- Microaneurysms/Dot and blot haemorrhages
- Hard exudate
- Cotton wool patches
- Abnormalities of venous calibre
- Intraretinal microvascular abnormalities (IRMA)
Neovascularisation (this is a sign of proliferative retinopathy)
What are cotton wool spots?
What do cotton wool spots trigger the release of what what does this cause?
- Compensatory neovascularisation
Where can new vessels grow in proliferative retinopathy?
Optic disc -> NVD
Peripheries -> NVE
Iris (if severe) -> Rubeosis iridis
What can happen to the new vessels in proliferative retinopathy? How does this present?
They can haemorrhage:
- Cloud vision
- Retinal ischaemia
What results when neovessels haemorrhage?
What can result due to the fibrous tissue in proliferative retinopathy?
It can retract:
- Increased risk of tractional retinal detachment
Why do diabetics lose their vision?
Retinal oedema affects fovea
Scarring/Tractional retinal haemorrhage
What are the three classes of non-proliferative retinopathy?
What are the three stages of maculopathy?
What is the main way of managing diabetic retinopathy?
Optimise medical treatment of DM
How does Pan-Retinal Photocoagulation (PRP) help in diabetic retinopathy?
1. Reduces hypoxic drive -> Reduces ischaemia
2. Reduces production of VEGF
3. Reduces neovascularisation
True or false; Elderly patients with atherosclerosis often have minimal hypertensive changes on fundoscopy?
Which of the following is not a feature of hypertensive retinopathy:
- Attenuated blood vessels (Copper/Silver wiring)
- Cotton wool spots
- Hard exudates
- Vitreal haemorrhage
- Retinal haemorrhage
- Optic disc oedema
What is a cherry red spot a sign of?
In CRAO, what does the degree of ischaemia correlate to?
Degree of vision reduction
What infective causes are there of uveitis?
What non-infective causes are there of uveitis?
HLA-B27 -> Reiter's, Anterior uveitis
Behcets disease (Small vessel vasculitis)
Which of the following lid changes is not seen in thyroid eye disease:
Which of the following is a posterior segment sign (instead of anterior segment sign) of thyroid eye disease:
- Choroidal folds
What structures swell in thyroid eye disease?
Extraocular muscles (restrictive myopathy)
What eye features can present in RA?
What is the pathogenesis behind Sjogren's Syndrome?
Lymphocytic infiltration of lacrimal (and salivary) glands
What is symblepharon and what dermatological condition is it seen in?
Partial/Complete adhesion of the palpebral conjunctiva to the bulbar conjunctiva:
- Seen in Stevens-Johnson syndrome