Corrections Flashcards
(117 cards)
1
Q
What can be given to help slow deterioration of vision loss in ARMD?
A
High dose of beta-carotene, vitamins C and E, and zinc
2
Q
What 2 investigations should be performed in patients with AACG?
A
1) Tonometry (measures IOP)
2) Gonioscopy (measures angle of eye)
3
Q
What is lupus retinopathy?
A
Typically features in chronically uncontrolled disease.
Can cause decreased visual acuity.
Fundoscopy:
- cotton wool spots
- microaneurysms
- hard exudates
4
Q
Is peripheral iridotomy usually performed unilaterally or bilaterally in AACG?
A
Bilaterally due to the likelihood of occurence in the contralateral eye.
5
Q
Is proliferative retinopathy more common in T1D or T2D?
A
T1D
6
Q
Give 4 risk factors for scleritis
A
1) RA (most common)
2) SLE
3) sarcoidosis
4) granulomatosis with polyangiitis
7
Q
Where are drusen located in ARMD?
A
Betwen Bruch’s membrane and the retinal pigment epithelium of the eye.
8
Q
Are drusen seen in wet or dry ARMD?
A
Dry
9
Q
Give 3 conditions associated with optic neuritis
A
1) MS
2) Diabetes
3) Syphilis
10
Q
Give 3 factors that predispose to AACG
A
1) Hypermetropia (long-sightedness)
2) Pupillary dilatation
3) Lens growth associated with age
11
Q
What is a vitreous haemorrhage?
A
Bleeding into the vitreous humour.
It is one of the most common causes of sudden PAINLESS loss of vision.
12
Q
Is loss of vision in vitreous haemorrhage painful or painless?
A
Painless
13
Q
Give 3 causes of vitreous haemorrhage?
A
1) proliferative diabetic retinopathy (over 50%)
2) posterior vitreous detachment
3) ocular trauma
14
Q
What is the most common cause of vitreous haemorrhage in children & young adults?
A
Ocular trauma
15
Q
Presentation of vitreous haemorrhage?
A
1) painless visual loss or haze (commonest)
2) red hue in the vision
3) floaters or shadows/dark spots in the vision
16
Q
When should those with a +ve family history of glaucoma receive screening?
A
From 40 y/o
Annual screening
17
Q
Define +ve FH in glaucoma
A
Have a first-degree relative (parent, sibling, or child) with open angle glaucoma
18
Q
Purpose of Amsler grid test?
A
To check for distortion of line perception - may be useful in ARMD
19
Q
Main action of latanoprost?
A
Increases uveoscleral outflow
20
Q
Myopia vs hypermetropia in glaucoma?
A
Myopia –> higher risk of 1ary open angle glaucoma
Hypermetropia –> higher risk of AACG
21
Q
Action of dorzolamide eye drops?
A
Carbonic anhydrase inhibitor
22
Q
Mx of AACG?
A
1) Combination of eye drops
- pilocarpine (parasympathomimetic)
- timolol (beta blocker)
- apraclonidine (alpha-2 agonist)
2) IV acetazolamide
3) laser peripheral iridotomy
23
Q
Can glaucoma occur in patients with normal IOP?
A
Yes
24
Q
How can calcium affect the eyes?
A
Hypocalcaemia is a risk factor for cataracts
25
Key complication of cataract surgery?
Endophthalmitis --> intravitreal abx
26
Most common cause of CRAO?
Carotid artery atherosclerosis
27
Most common cause of CRAO in <40y/o?
Cardiac emboli
28
What is normally the cause of CRAO in older diabetic or hypertensive patients with a normal carotid doppler?
Small artery disease i.e. local atheroma within the central retinal artery itself
29
Is myopia or hypermetropia a risk factor for retinal detachment?
Myopia
30
What is seen on fundoscopy in CRVO?
- widespread hyperaemia
- severe retinal haemorrhages - 'stormy sunset'
31
Who is CMV retinitis common in?
HIV patients with low CD4 count (<50)
32
How does CMV retinitis present?
Blurred vision
33
What does fundoscopy show in CMV retinitis?
retinal haemorrhages and necrosis, often called 'pizza' retina
34
Treatment of choice for CMV retinitis?
IV ganciclovir
35
Investigations in suspected microbial keratitis?
An accurate diagnosis can only usually be made with a slit-lamp, meaning SAME DAY referral to an eye specialist is usually required to rule out microbial keratitis
36
In what condition does fundoscopy reveal a 'bull's eye' appearance?
Hydroxychloroquine retinopathy
37
What would a red, painful eye with loss of vision post cataract surgery indicate?
Endophthalmitis
38
1st line treatment for blepharitis?
Hot compresses
39
Flashes + floaters are most commonly caused by what?
Posterior vitreous detachment
40
What are the 2 mechanisms of sight loss in proliferative diabetic retinopathy?
1) retinal detachment
2) vitreous haemorrhage
41
Is vision loss in retinal detachment progressive or sudden?
Progressive
42
Mx of any patient who presents with new-onset flashes or floaters?
Urgent referral to ophthalmology (24h)
43
1st line treatment for a stye?
Regular warm steaming
44
What is the most common complication of thyroid eye disease?
Exposure keratopathy
This complication arises primarily due to the proptosis of the eyeballs and eyelid retraction associated with the condition, which can lead to difficulty in completely closing the eyes.
45
Pupil shape in anterior uveitis?
Oval
46
What is entropion?
Inward turning of eyelids
47
What is ectropion?
Outward turning of eyelids
48
What is a potential complication of panretinal photocoagulation?
Decrease in night vision
49
Role of pan-retinal laser photocoagulation in proliferative diabetic retinopathy?
Utilises a laser to create numerous micro-burns across the peripheral retina.
These burns serve to eradicate the newly formed blood vessels that arise due to neovascularisation.
50
Mx of temporal arteritis with vision involvement?
IV methylprednisolone
51
In diabetic retinopathy, what do cotton wool spots represent?
areas of retinal infarction
52
What is acanthamoeba keratitis commonly associated with?
Contact lens use in bodies of water such as the sea or swimming pools.
Also soil & ponds.
53
Pupil size in anterior uveitis?
Miosis (constricted pupil)
54
What are posterior synachiae?
Adhesions between lens & iris
55
What should immediately be done in babies with purulent eye discharge?
Take urgent swabs of the discharge for microbiological investigation, using methods that can detect chlamydia and gonococcus.
While the guidance is to start systemic antibiotic treatment for possible gonococcal infection while awaiting the swab microbiology results, swabs must be TAKEN FIRST.
56
1st line abx therapy of bacterial conjunctivitis?
Chloramphenicol drops
57
1st line abx therapy of bacterial conjunctivitis in pregnant women?
Topical fusidic acid
58
Features of optic neuritis?
- unilateral decrease in visual acuity over hours or days
- poor discrimination of colours, 'red desaturation'
- pain worse on eye movement
- RAPD
- central scotoma
59
What visual defect may be seen in optic neuritis?
RAPD
60
What medication are a risk factor for a corneal ulcer?
Steroid eye drops - can lead to fungal infections (and then a corneal ulcer)
61
CT head or IV abx first in suspected orbital cellulitis?
IV abx
62
1st line investigation in suspected orbital cellulitis?
CT scan of orbits, sinuses & brain with contrast to assess the posterior spread of infection.
63
What imaging is recommended in suspected optic neuritis?
MRI brain and orbits with gadolinium contrast
64
1st line mx of allergic conjunctivitis?
Topical antihistamines
65
What is Hutchinson's sign? What does it indicate?
Vesicles extending to the tip of the nose.
This is strongly associated with ocular involvement in shingles --> urgent ophthalmological assessment
66
What are risk factors for subcapsular cataracts?
- steroids
- hypermetropia
- diabetes
67
What is a corneal abrasion?
Refer to any defect of the corneal epithelium and most commonly come about from a recent history of local trauma (e.g. fingernails, branches).
68
Features of a corneal abrasion?
- eye pain
- lacrimation
- photophobia
- foreign body sensation and conjunctival injection
- decreased visual acuity in the affected eye
69
1st line investigation in corneal abrasion?
fluorescein staining
70
What will fluorescein staining typically show in a corneal abrasion?
Yellow-stained abrasion (representative of the de-epithelialised surface) which is usually visible to the naked eye
71
1st line mx of a corneal abrasion?
Topic abx is recommended to prevent 2ary bacterial infection.
72
What grade hypertensive retinopathy does papilloedema indicate?
IV
73
Mx of acute optic neuritis?
High dose steroids
74
Classic triad of symptoms of Horner's?
1) miosis
2) ptosis
3) enophthalmos
+/- anhydrosis
75
What is an Argyll-Robertson pupil?
Bilaterally small pupils that accommodate but don't react to bright light.
76
Give 2 causes of Argyll-Robertson pupil
1) neurosyphilis
2) diabetes
77
What is Hutchinson's pupil?
Unilaterally dilated pupil which is unresponsive to light
78
Cause of Hutchinson's pupil?
Compression of the occulomotor nerve of the SAME side by an intracranial mass e.g. tumour, haematoma
79
what is a Marcus-Gunn pupil?
RAPD, seen during the swinging light examination of pupil response.
The pupils constrict less and therefore appear to dilate when a light is swung from unaffected to affected eye.
80
What is a common complication following panretinal laser photocoagulation?
Reduction in visual field
81
Mx of a patient with an organic foreign body in their eye e.g. grass seed?
Immediate referral to ophthalmology for same-day assessment due to increased infection risk.
82
1st line mx of orbital compartment syndrome?
Immediate canthotomy (decompression)
83
1st line mx of Herpes zoster ophthalmicus requires?
1) urgent ophthalmological review
2) 7-10 days of oral antivirals e.g. famciclovir, aciclovir
84
What is the best definitive treatment for proliferative retinopathy?
panretinal laser photocoagulation
85
Risk factors for vitreous haemorrhage?
- Diabetes
- Trauma
- Anticoagulants
- Coagulation disorders
- Severe short sightedness
86
Mx of optic neuritis?
IM steroids
87
Mx of contact lens wearers who present with a red painful eye?
referred urgently to eye casualty to exclude microbial keratitis
88
What is most likely cause of contact lens associated keratitis?
Pseudomonas aeruginosa
89
Mx of herpes zoster ophthalmicus?
Oral aciclovir
90
What is the definitive treatment for wet ARMD?
Anti-VEGF e.g. bevacizumab
91
What is involved in the mx of acute glaucoma?
1) reducing aqueous secretion
2) constricting the pupil (this helps to open up the drainage angle and promote outflow)
92
Mx of contact lens wearers who present with a red painful eye?
Refer for same day ophthalmology assessment to exclude microbial keratitis
93
What is the 1st line mx of 1ary open angle glaucoma if the IOP ≥24mmHg?
Laser trabeculoplasty --> targets trabecular meshwork and improves outflow.
94
What are some potential complications of panretinal photocoagulation?
1) decrease in night vision
2) peripheral vision loss
3) increased sensitivity to light
95
Mx of a stye (i.e. hordeolum externum)?
Analgesia & warm compress
96
What organism typically causes a stye?
Staph. aureus
97
Where can a pancoast tumour cause pain?
Shoulder & upper limb pain due to local extension of tumour
98
Describe vision loss in retinal detachment
Dense shadow that starts peripherally and progresses towards the centrl vision
99
Mx of anterior uveitis?
Topical steroid + cycloplegic/mydriatic drops e.g. atropine
100
Role of beta blockers in 1ary open angle glaucoma e.g. timolol?
Reduce aqueous production --> reduce IOP
101
What is Hutchinson's sign?
A rash on tip of nose in herpes zoster --> strongly predictive for ocular involvement
102
RAPD indicates a lesion where?
Optic nerve lesion or severe retinal disease
103
In diabetic retinopathy, what do cotton wool spots represent?
Areas of retinal infartion
104
How can a vitreous haemorrhage affect vision?
- presents with dark spots obscuring vision/complete loss of vision if bleed is large enough
- can cause a red hue
105
Mx of a vitreous haemorrhage?
Will resolve with time
106
Is metronidazole an enzyme inhibitor or inducer?
Inhibitor e.g. increases the anticoagulant effect of warfarin
107
Typical presenting of an oculomotor nerve palsy?
'Down and out' eye with a fixed (non-reactive to light), dilated pupil.
Palsy of the oculomotor nerve will affect the ipsilateral eye, meaning that a R oculomotor nerve palsy will affect the R eye.
108
What nerve is involved in a patient unable to abduct the left eye and worsening double vision when looking to the left?
CN VI palsy
109
mx of acute angle closure glaucoma?
1) combination eye drops:
- pilocarpine
- beta blocker e.g. timolol
- alpha agonist e.g. apraclonidine
2) IV acetazolamide
110
role of pilocarpine in AACG?
A direct parasympathomimetic
Causes contraction of ciliary muscle --> opens trabecular meshwork --> increases outflow of aqueous humour
111
Role of beta blockers in AACg?
Decrease aqueous humour production
112
Role of alpha agonists in AACG?
1) decreases aqueous humour production
2) increases uveoscleral outflow
113
Role of IV acetazolamide in AACG?
Reduces aqueous secretions
114
Definitive mx of AACG?
Laser peripheral iridotomy --> creates a tiny hole in the peripheral iris
115
Topical ivermectin vs topical brimonidine in rosacea?
Topical ivermectin --> mild to moderate papules and/or pustules
Topical brimonidine --> predominant flushing but limited telangiectasia
116
Myopia vs hypermetropia in AACG vs POAG?
AACG --> associated with hypermetropia
Primary open angle glaucoma --> associated with myopia
117
