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Conditions Flashcards

1
Q

What is acute angle closure glaucoma

A

when your iris and cornea move closer together, increasing the intraocular pressure because there is no way to drain the fluid

this causes damage to the optic nerve (glaucoma)

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2
Q

What causes acute angle closure glaucoma

A

when the gap between your iris and your cornea closes because e.g.

you:

  • go into a dark room
  • get dilating eye drops
  • are excited or stressed
  • take drugs e.g. antidepressants
  • have cataracts, diabetic retinopathy or tumours
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3
Q

What health conditions are risk factors for acute angle closure glaucoma

A

cataracts

ectopis lens (lens moves from where it should be)

diabetic retinopathy

ocular ischaemia

Uveitis

Tumour

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4
Q

what is the epidemiology of acute angle closure glaucoma

A
  • Women
  • SE Asian
  • Farsighted
  • 55-65
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5
Q

what are the symptoms of acute angle closure glaucoma

A
  • eye pain
  • severe headache
  • nausea/ vomiting
  • blurry vision
  • redness in eye
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6
Q

What tests do you do to diagnose acute angle closure glaucoma

A

Gonioscopy (microscope with slit lamp- checks angle between iris and cornea and sees how well fluid drains)

Tonometry (measures intraocular pressure)

Opthalmoscopy (for damage to optic nerve)

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7
Q

How do you treat acute angle closure glaucoma

A

Initially:

  • eye drops containing beta-blockers to reduce fluid production e.g. Timolol
  • IV acetazolamide (to reduce IOP)

Then Bilateral peripheral iridotomy

Pilocarpine eye drops which constrict pupil (aren’t used much anymore)

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8
Q

What is Orbital Cellulitis

A

infection of soft tissues of the eye socket posterior or deep to the orbital septum (divides eye lid from eye socket

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9
Q

What is the difference between orbital and peri-orbital cellulitis and which one is more severe

A

Orbital is inflammation of the soft tissue posterior/ deep to the orbital septum

Peri-orbital is anterior to the septum (superficial upper eyelid)

orbital is more severe because it actually affects stuff in the orbital cavity

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10
Q

What is the cause of orbital cellulitis

A

when an exisitng infection spreads from its origin

most commonly when a bacterial infection spreads from the paranasal sinuses e.g. ethmoid

or eyelid skin infection spreads

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11
Q

Which bacteria most commonly cause orbital cellulitis

A

Staph. aureus

Streptococci e.g. group A B haemoltyic, pneumoniae,

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12
Q

How do you investigate someone with orbital cellulitis

A

CT scan

Full blood count (leukocytosis (high))

blood culture prior to administration of antibiotics

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13
Q

how does orbital cellulitis present (history and examination)

A

History:
fever, malaise, recent sinusitis/ URT infection

often recent facial trauma/ surgery/ dental work

  • decreased vision
  • eye pain
  • swelling
  • erythema
  • edema of eyelids
  • proptosis (bulging)

OE:

  • elevated IOP
  • RAPD
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14
Q

How do you treat orbital cellulitis

A

prompt hospitalisation

broad spectrum IV antibiotics for 1-2 weeks e.g. Ceftriaxone, ampicillin-sulbactam, moxifloxacin

surgery:

  • canthotomy and cantholysis (incision into canthi) if orbital compartment syndrome is diagnosed (very high IOP)
  • drain if abcess

ENT consultation if recent sinusitis

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15
Q

give 3 examples of antibiotics for orbital cellulitis

A

Ceftriaxone, ampicillin-sulbactam, moxifloxacin

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16
Q

what is the difference between penetrating and perforating eye injuries

A

penetrating= penetrated into eye but no exit wound

perforating= entrance and exit wound

both aka open globe injury

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17
Q

what are the risk factors for a penetrating/ perforating eye injury

A

male gender

occupation

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18
Q

how does a penetrating/ perforating eye injury present

A
  • pain
  • double vision
  • foreign body sensation
  • blurred vision
  • redness
  • light sensitivity
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19
Q

how do you investigate an open globe injury

A

aka penetrating/ perforating eye injury

visual acuity and pupillary exam important

gentle ultrasound and computed tomography

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20
Q

how do you manage a penetrating/ perforating eye injury

A

prophylactic antibiotics e.g. vancomycin, cephalosporin

surgery to close the open globe

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21
Q

what are the two types of chemical injury to the eye and which is worse

A

acid or alkali

alkali is much worse because the acids denature and cant pass the phospholipid bilayer where as alkali burrows down

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22
Q

what are the common causes of chemical eye injuries

A

acid:

  • HCL (cleans swim pools)
  • Sulphuric acid (car batteries)

Alkali:

  • sodium hydroxide (drain cleaner)
  • ammonia (bleach)
  • calcium hydroxide
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23
Q

how do you treat a chemical eye injury

A

irrigation with any noncaustic fluid available until pH of ocular surface is between 7 and 7.2

depending on severity treat with antibiotics, control inflammation, debridement

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24
Q

what are the common causes of conjunctivitis

A

Viral:

  • HSV
  • VZV

Bacterial:

  • Staph. aureus
  • haemophilus influenzae
  • strep. pneumoniae
  • pseudomonas

Allergens:

  • pollen
  • moulds

Think STIs

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25
How does conjunctivitis present
- red sclera - increased tearing - thick yellow discharge that crusts over the eyelashes (bacterial) - itchy eyes (allergic) - blurred vision - photosensitive - swollen eyelids
26
how do you investigate conjunctivitis
slit lamp visual acuity tests eye culture if stays for 2-3 weeks
27
how do you treat conjunctivitis
bacterial= antibiotics e.g. levofloxacin viral= let it run its course- help with cold compress allergic= antihistamines (drops)
28
what are the typical causes of corneal ulcers
Bacterial= - stap. aureus - strep. pnuemoniae - pseudomonas Viral= - HSV - VZV
29
what are the risk factors for corneal ulcers
contact lenses (especially overnight ones) steroid eye drops existing eye conditions e.g. blepharitis, dry eyes
30
how do corneal ulcers present
- pain - redness - foreign object sensation - tearing - photophobia - decreased vision
31
how do you investigate corneal ulcers
slit lamp with fluorescein stain to diagnose cornea culture to rule out infectious cause
32
how do you treat corneal ulcers
- artificial tears - systemic immunosuppressive therapy (methylprednisolone) - corneal transplant if severe
33
What causes giant cell arteritis
actual cause is uncertain associated with autoimmune disease it is an autoimmune disorder
34
how does giant cell arteritis present
bilateral temple pain and scalp tenderness jaw pain vision loss/ diplopia fever fatigue weight loss
35
how do you investigate giant cell arteritis
increased ESR, CRP, thrombocytosis temporal artery biopsy to diagnose
36
how do you treat giant cell arteritis
immediate high dose corticosteroid (e.g. prednisone)
37
what are the 3 causes of retinal detachment
Rhegmatogenous (most common): - hole/ tear in the retina so fluid can pass under it pulling it away from underlying tissue - most commonly caused by ageing which causes posterior vitreous detachment Tractional: - scar tissue on surface - in poorly controlled diabetes Exudative: - fluid accumulation under the retina - caused by age-related macular degeneration, tumour
38
what are the risk factors for retinal detachment
age (posterior vitreous detachment) Previous retinal detachment family history extreme myopia Poorly controlled diabetes (tractional) age-related macular degeneration (exudative) eye injury (exudative) inflammatory disorders (exudative)
39
Symptoms of retinal detachment
painles sudden appearance of floaters flashes of light blurred vision gradually reduced peripheral vision curtain going down/ up
40
investigations of retinal detachment
to diagnose: Visual acuity testing slit-lamp examination, opthalmology
41
treatment of retinal detachment
surgery to repair detachment photocoagulation (welding) or cryopexy (freezing) to weld the retina to the eye wall if tear hasnt progressed to detachment
42
what is amaurosis fugax
transient loss of vision in one or both of the eyes
43
cause of amaurosis fugax
plaque/ blood clot in the carotid artery (at the side of the lesion)
44
what are the risk factors for amaurosis fugax
heart disease hypertension high cholesterol smoking alcohol cocaine MS optic neuritis
45
how does amaurosis fugax present
vision loss in one or both eyes grey curtain that progresses from the periphery towards the centre no pain, lasts 2-30 mins
46
how do you investigate amaurosis fugax
blood pressure (hypotension could be cause) FBC for anaemia ESR and CRP for elderly patients to rule out GCA Imaging of carotid arteries to find blockage
47
how do you treat amaurosis fugax
treat underlying condition e.g. anticoagulant, hypotensives lifestyle changes e.g. stop smoking
48
What is a meibomian cyst
aka chalazion sterile, inflammatory granuloma caused by obstruction of a sebaceous gland these run along the eyelid margin and produce secretion which provides lipid layer of tear film
49
cause of meibomian cyst
obstruction of a sebaceous gland these produce a lipid secretion which makes the lipid layer of tear film
50
what are the risk factors for a meibomian cyst
Chronic blepharitis Rosacea (red face)
51
how does a meibomian cyst present
painless bump in eyelid (usually upper) mild irritation causing watery eyes blurred vision if it is large and pushes on the eyeball
52
how do you treat a meibomian cyst
application of warm compress for 10-15 mins gentle massage 5 times a day
53
what are the common causative organisms of blepharitis
low grade infections staph. epidermidis staph. aureus
54
what causes blepharitis
unclear can spread from person to person can be associated with other conditions e.g. seborrheic dermatitis, infection, rosacea
55
what are risk factors for blepharitis
seborrheic dermatitis rosacea diabetes allergies
56
symptoms of blepharitis
watery eyes red eyes stinging eyes greasy eyelides red eyelids swollen eyelids flaky skin photosensitive blurred vision- improves with blinking
57
how do you investigate blepharitis
if severe: lid biopsy lid margin culture but usually none
58
how do you manage blepharitis
self-care e.g. washing, warm compreßes if doesnt work then antibiotics/ steroid drops
59
what causes corneal abrasions
when your cornea gets scratched by contact with dust, dirt, sand, wood shavings etc
60
how does corneal abrasion present
eye pain tearing photosensitivity foreign body sensation blurry vision blepharospasm
61
how do you treat a corneal abrasion
flush with clean water/ saline lubricating eye drops to keep moist antibiotics if severe
62
how does a corneal foreign body present
eye pain foreign body sensation photophobia tearing red eye decreased visual acuity (blurred vision)
63
how do you treat a corneal foreign body
antibiotic drops prophylactically e.g. Polytrim remove foreign body under topical anaesthetia perhaps topical NSAID for analgesia and anti-inflammatory
64
what causes uveitis
often unknown cause associated with auto-immune diseases e.g. UC, sarcoid, idiopathic juvenile arthritis can be infective e.g. Herpes, syphillis
65
how does uveitis present
acutely with red eye pain blurred vision photosensitivity floaters chronically with floaters and blurred vision
66
how is uveitis treated
if infective antimicrobial if auto-immune with steroid eye drops
67
cause of episcleritis and scleritis
often no apparent cause often underlying stystemic inflammatory condition e.g. rheumatoid arthirtis, lupus, crohn's
68
how does episcleritis present vs scleritis
both have: - red eye Episcleritis: - acute onset - mild pain Scleritis: - subacute onset - severe pain - pain on movement - photophobia
69
how do you treat episcleritis vs scleritis
episcleritis: - usually clears without treatment - often cool compress/ iced arificial tears scleritis: - opthalmology consult - systemic steroids/ NSAIDS
70
causes of vitreous haemorrhage
conditions which cause the formation of new, abnormal blood vessels: diabetic eye disease macular degenration retinal vein occlusion retinal tear causing posterior vitreous detachment
71
how does vitreous haemorrhage present
visual haze painless vision loss floaters cloudy vision photophobia
72
how do you treat a vitreous haemorrhage
laser photocoagulation to stop abnormal vessels from bleeding other treatments e.g. cryotherapy can be used treat underlying condition e.g. diabetes
73
what causes dry eyes
- dysfunction in any of the three tear layers (fatty, mucus, water) reasons e.g. hormone changes, autoimmune disease, inflamed eyelid glands - decreased tear production (keratoconjunctivitis sicca) due to aging, Sjogren's syndrome, RA, meds (e.g. antihistamines, antidepressants), corneal nerve desensitivity through contact lens use - increased tear evaporation due to posterior blepharitis, allergies
74
what are the risk factors for dry eyes
age (over 50) women (oestrogen/ pill) Vit A deficiency Contact lenses
75
how are dry eyes treated
education/ modify environment (e.g. humidifier) topical ocular lubricants (artifical tear drops) topical anti-inflammatory eye drops
76
how do dry eyes present
stinging, burning, itchy stringy mucus in/ around eyes photophobia eye redness foreign body sensation
77
what causes a blocked naso-lacrimal duct
congenital age- related (puncta get narrower) infection/ inflammation e.g. sinusitis tumour chronic eyedrop use
78
what are the risk factors for a blocked naso-lacrimal duct
age chronic eye inflammation previous surgery glaucoma (higher pressure) previous cancer/ treatment
79
how does a blocked naso-lacrimal duct present
excessive tearing scleritis/ conjunctivitis painful swelling near puncta crusting of the eyelids blurred vision
80
how do you treat a blocked naso-lacrimal duct
depends on cause if infective cause treat infection e.g. congenital often gets better by itself dilation with stent/ balloon
81
what causes cataracts
clouding of the lense caused by proteins and fibres in the lenses breaking down and clumping together usually caused by age/ injury
82
what are risk factors for catraracts forming
age diabetes excessive sunlight exposure smoking obesity hypertension
83
how do cataracts present
clouded, blurred vision photophobia halos around lights diplopia in one eye
84
how do you treat cataracts
surgery to remove lens and replace with a new one
85
what causes of open angle glaucoma
blockage of the trabecular meshwork
86
what are the risk factors for open angle glaucoma
- high IOP - age - black, asian, hispanic - family history of glaucoma
87
how does an open angle glaucoma
insidious- asymptomatic in the early stages patchy blind spots in peripheral/ central vision frequently (bilateral) often will be found after visual acuity test
88
how do you investigate open angle glaucoma
tonometry slit lamp- mycrocystic oedema gonioscopy through slit lamp to check angle
89
how do you treat an open angle glaucoma
eye drops to lower IOP: - latanoprost, bimatoprost to improve drainage - timolol, dorzolamide to reduce eye fluid formation trabeculectomy to create a channel in the iris for flow of aqueous humour laser treatment targeting trabecular meshwork
90
what are the causes of macular degeneration
unknown cause macular tissue thins and loses cells
91
what are the risk factors for macular degeneration
``` age!!!! family history race (caucasian) smoking obesity CV disease ```
92
how does macular degeneration present
visual distortion e.g. straight lines seeming bent reduced central vision (mono or bilateral) difficulty in low light levels
93
how do you investigate macular degeneration
Amsler grid tomography angiography to determine if blood vessels are getting adequate blood flow and to investigate the extent of degeneration
94
how do you treat macular degeneration
Dry- no treatment but vision aids can help symptoms Wet: - Bevacizumab, ranibizumab to stop new blood vessel growth (injections) - photodynamic therapy if abnormal blood vessels at fovea (light activates verteporfin injected in arm vein) - photocoagulation to seal abnormal blood vessels (can cause blind spot)
95
what is a 3rd nerve palsy
damage to oculomotor nerve/ branch thereof affects 4/6 extrocular muscles (lateral rectus and superior oblique spared)
96
what is the cause of 3rd nerve palsy
either congenital or acquired acquired can be microvascular, trauma, compression from neoplasm or post-neurosurgery
97
how does 3rd nerve palsy present
- complete ptosis (closed eyelid) - deviation of the eye out and down - enlarged pupil and doesnt react to light
98
what is the most life-threatening type of nerve palsy
third nerve palsy because a subset of them are caused by life-threatening aneurysms
99
how do you treat third nerve palsy
surgery if tumour or aneurysm vision therapy eye patch patching usually recovers in 3 months
100
what causes 4th nerve palsy
congenital trauma microvascular disease
101
how does 4th nerve palsy present
diplopia hypertropia (one eye deviates up) further elevation as it moves medially
102
is 4th nerve palsy dangerous
could be a symptom of a stroke 6 months for spontaenous resolution eye muscle surgery recommended which speeds it up
103
what causes 6th nerve palsy
stroke brain aneurysm diabetic neuropathy trauma infection
104
how does 6th nerve palsy present
dipolpia strabismus (eye might be slightly adducted cos no lateral rectus function)
105
how do you treat 6th nerve palsy
will sometimes disappear without treatment steroids if inlfammation suspected eye patch

Opthalmology (2 decks)

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