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Ophthalmology > DUMS ophtho > Flashcards

DUMS ophtho Flashcards

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1
Q

What liquid is contained within the anterior and posterior segments of the eye?

A 
Anterior = aqueous humour
Posterior = vitreous humour
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2
Q

What produces aqueous humour and where does it travel?

A

Produced in the ciliary body

Nourishes lens in posterior chamber then nourishes cornea in anterior chamber. Reabsorbed into scleral venous sinus (iridocorneal angle)

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3
Q

Which side of the retina is the optic disk on fundoscopy?

A

Nasal retina

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4
Q

What enters/exits the eye at the optic disk?

A

Optic nerve (CNII)
Artery
Vein

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5
Q

What causes the blind spot in vision?

A

Optic disk

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6
Q

What nerves supply which muscles of eye movement?

A

Lateral Rectus = Abducent (CNVI)
Superior oblique = trochlear (CN CNIV)

Rest = oculomotor (CNIII)

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7
Q

Which nerves control the diameter of the iris and pupil? What muscle does this affect?

A

Ciliary nerves

Sphincter pupillae
Dilator pupillae (sympathetic)
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8
Q

What reflex causes focusing on near and far objects?

A

Accommodation reflex

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9
Q

What reflex causes dilation/constriction?

A

Pupillary light reflex

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10
Q

What is the direct and consensual response of the pupil?

A

When light shone on one eye:
Direct = that pupil constricts
Consensual = other pupil also constricts

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11
Q

What are the innate parts of the immune system in regard to the eye?

A

Innate:
Blinking (tears flush away pathogens)
Chemical properties of tears
Immune cells (macrophages, neutrophils, conjunctival mast cells)

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12
Q

What parts of the adaptive immune system are active in the eye?

A

Langerhans cells (antigen presenting cells - drain to lymph nodes - T/B cell response)

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13
Q

What type of reaction is corneal melting?

A

Type 3 hypersensitivity (immune complex mediated)

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14
Q

What is myopia vs hypermetropia?

A 
Myopia = short sighted
Hypermetropia = long sighted
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15
Q

What are the risks attached to myopia and hypermetropia?

A

Myopia = predisposed to retinal detachment, cataracts, open angle glaucoma (short sighted)

Hypermetropia = predisposed to acute closed angle glaucoma (long sighted)

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16
Q

What are the symptoms of cataracts in one eye or both eyes?

A

One eye: loss of depth perception

Both eyes: gradual visual loss (frequent change of glasses), dazzled by lights

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17
Q

Is open angle or closed angle glaucoma more acute and sight threatening?

A

Closed angle

Open angle = chronic long term

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18
Q

What are the symptoms of open-angle glaucoma?

A

Peripheral field loss (leads to tunnel vision)
Decreased acuity

Due to raised IOP

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19
Q

What signs are seen on fundoscopy of open-angle glaucoma?

A

Cupping,
Pale disc,
Haemorrhages

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20
Q

How is open angle glaucoma managed?

A

First line:
Prostaglandin analogues (travoprost),
Beta-blockers (timolol)

Carbonic anhydrase inhibitors (dorzolamide),
Miotics (pilocarpine)

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21
Q

What are the symptoms of closed angle glaucoma?

A

Severe pain, decreased acuity, haloes around lights

only eye pathology that can make people vomit

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22
Q

What causes closed angle glaucoma?

A

Canal of schlemm completely shut so rapidly raised intra-ocular pressure - leads to axon death and permanent blindness

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23
Q

How does acute closed angle glaucoma appear on examination?

A

Hard red eye with a semi-dilated non reactive pupil

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24
Q

How is closed angle glaucoma managed?

A

Immediate ophtho referral
Pilocarpine (antimuscarinic to constrict pupil - open the closed angle)
Definitive = peripheral iridectomy

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25
What is the most common presentation of macular degeneration and which type has the worse prognosis?
Deteriorating central vision (elderly person) Wet = wears prognosis (leakage of serous fluid + blood)
26
What are the changes on fundoscopy of wet/dry macular degeneration?
Dry: Drusen (fat pads) + degenerative changes Wet: Exudative/neovascular changes
27
How is macular degeneration investigated and what is the treatment?
Ix: Optical coherence tomography (fluorescien angiography if neovascularisation) Dry: non currently available (Stop smoking, high fruit + leafy green veg intake, vitamins) Wet: anti-VEGF (reduce new vessel formation)
28
What sign increases the risk of shingles damaging the eye?
Tip of nose affected (means involvement of nasociliary branch of CNV1)
29
How is ophthalmic shingles managed?
Oral antivirals for 7-10 days
30
Who gets a corneal ulcer and how is it investigated?
Contact lens wearers (bacterial, viral, fungal) Ix: focal fluorescein staining of the eye
31
What is the difference between scleritis and episcleritis?
Both = red eye Scleritis = severe pain, tenderness, photophobia (often have an autoimmune disease) Episcleritis = mild/no pain, sub-conjunctival inflammation (NO CHANGE IN VISUAL ACUITY)
32
How does subconjunctival haemorrhage present?
Frail old ladies Red eye Painless (alarming but harmless)
33
What makes up the uvea?
Iris, ciliary body, choroid (vascular layer)
34
Who gets uveitis?
Those with an autoimmune disease (ie ankylosing spondylitis, IBD, Behcets (vasculitis), reactive arthritis, sarcoidosis, chronic infections - TB, HIV, herpes, syphilis) DON'T REMEMBER ALL THESE; JUST FOR REFERENCE
35
How does uveitis present and what are the examination findings?
Acute, ocular pain, photophobia, blurred vision Decreased visual acuity, red eyes, tears, irregular/small pupil. hypopyon (pus fluid level)
36
How is uveitis managed?
Urgent ophtho referral Cycoplegics (Atropine - dilate pupil) Prednisolone eye drops (prevent damaged from inflammation)
37
What causes scleritis and who gets it?
Vasculitis of the sclera Associated with connective tissue disease: RA, SLE, GPA
38
What is the difference in presentation of viral, bacterial and allergic conjunctivitis?
Allergic: bilateral, itchy, atopic history, seasonal Viral: recurrent URTI Bacterial, unilateral, sticky discharge, eye stuck (due to staph)
39
How is bacterial conjunctivitis treated?
Chloramphenicol
40
What questions should be asked for sudden painless loss of vision?
HELLP Headache (GCA) Eye movements painful (optic neuritis) Lights/flashes/floaters (retinal detachment) Like a descending curtain (temporary amaurosis fugax) Poorly controlled DM (vitreous haemorrhage)
41
What causes ischaemic optic neuropathy and what part of the vision is affected?
Either upper or lower half of vision Arteritis/atherosclerosis of supplying vessels = damage to posterior ciliary nerves + poor flow to optic nerve
42
Which is more common; central retinal vein or artery occlusions?
Vein
43
What is seen on fundoscopy of CRAO?
Cherry red spot on pale macula
44
How quickly is visual loss in CRAO? How is ti managed?
Within seconds, Very dramatic: acuity is counting fingers or worse Surgical removal of aqueous from anterior chamber
45
Who gets vitreous haemorrhage and how does it present?
Diabetes Small = floater, moderate = numerous dark spots, large = obscured vision + loss of red reflex
46
What happens to straight lines in a retinal detachment?
They appear curved
47
How is eye trauma investigated?
Fluorescein (shine blue light and appears green)
48
Which muscle becomes trapped in a blowout fracture?
Inferior rectus (as inferior is weakest part of the orbit)
49
What is the main buzzword for diabetic retinopathy?
Micro-aneurysms (dot/blot haemorrhages)
50
What causes papilloedema and what is the risk?
Swollen optic discs secondary to raised ICP (bilateral) Space occupying lesion in the brain
51
What are the horizontal squints called? Which is more common?
Turned in = esotropia Turned out = exotropia Esotropia more common
52
What is the medical term for a lazy eye and what causes it?
Amblyopia If not corrected in children will not develop normal vision in affected eye as eyes not aligned
53
How is a squint diagnosed?
Corneal reflection | If no squint, light should fall symmetrically on both eyes
54
How is a squint managed?
Optical, orthoptic, operation Optical: refractive lenses Orthoptic: patch the good eye Operation: realign muscles
55
What is astigmatism and how is it corrected?
Defect in the shape of the cornea Correct with glasses
56
What nerve does a swinging light test indicate a defect in?
CNII (optic)
57
What is the gold standard for diagnosis of GCA and how is it managed?
Temporal biopsy | Prednisolone
58
What does no red reflex indicate?
Cataracts (older) | Retinoblastoma (kids)
59
What effect do cataracts have on bright light?
Appears like a halo
60
What conditions are floaters indicative of?
Vitreous haemorrhage | Retinal detachment
61
What is the management of amaurosis fugax?
Refer to stroke clinic (like a TIA of the eyes)
62
What conditions are described as a curtain coming down?
``` Retinal detachment Amaurosis fugax (temporary) ```
63
What is it called if one eye is blind?
Monocular blindness
64
What field of vision do the parietal and temporal lobe interpret?
PITS Parietal = inferior vision Temporal = superior vision
65
What is visual loss in one field of vision called?
Homonymous hemianopia (ie left homonymous hemianopia)
66
What is entropion vs ectropion?
``` Entropion = eyelid inverts (causes eyelashes to rub on eyes - corneal abrasion = infection) Ectropion = eyelid turns out ```
67
What is Trichiasis?
Eyelashes turn in and rub on the eye (cause corneal abrasion + infection)
68
What is the different between a corneal ulcer and a corneal abrasion?
Corneal abrasion = injury to the surface of the eye | Corneal ulcer = inflammation as the result of abrasion
69
What is the vestibulocochlear reflex?
Stabilises images on the retina while the head is moving (activation of vestibular system causes eye movements)

Ophthalmology (5 decks)

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