Eye conditions Flashcards
(97 cards)
1
Q
What is an acute red eye (hint: what segment of eye does it affect)
A
Inflammation of structures in the anterior segment
2
Q
Acute red eye differentials (7)
A
Infective conjunctivitis Allergic conjunctivitis Corneal abrasion Acute anterior uveitis Scleritis Acute angle closure glaucoma Orbital cellulitis
3
Q
Acute red eye general symptoms (5) /signs (2)
A
Symptoms: Eye redness Eye pain Eye discharge - purulent/mucoid/watery Blurred vision
Signs:
Photophobia
Seeing flashing lights
4
Q
Examination of red eye (4)
A
Test best corrected (i.e. with glasses) visual acuity with snellen chart
Fundal examination
- ophthalmoscope OR
- microscope + slit lamp (+volk lens)
Staining with fluoroscein + then viewing with micrscope + slit lamp with a COBALT BLUE light filter
5
Q
What special lens is used in conjunction with a slit lamp to give good view of the posterior segment of the eye
A
Volk lens
6
Q
What does staining with fluorescein allow you to see
A
Outlines epithelial defects
7
Q
Symptoms (2) /signs (2) of infective conjunctivitis
A
Symptoms:
Gritty feeling in eye
Redness
Sign:
Purulent discharge
Eyelids stuck together in morning
8
Q
Treatment of infective conjunctivitis (3)
- if bacterial
- if viral
A
Cleaning with water daily
Topical antibiotics - if bacterial
Topical antihistamines - if viral
9
Q
Symptoms (3) /signs (3) of allergic conjunctivitis
A
Symptoms:
Itchy
Redness
Watering of eye
Signs:
Mucoid discharge
Eyelid swelling
Conjunctival swelling (chemosis - oedema of conjunctiva)
10
Q
Treatment of allergic conjunctivitis (4)
A
Avoid allergen
Artificial tears
Topical antihistamine
Mast cell stabilisers - prophylactic (Treats future episodes, not current)
11
Q
What is corneal abrasion + what causes it
A
Loss of an area of the corneal epithelium - corneal epithelial defect
Foreign body like fingernail or a twig
12
Q
Symptoms (4) /signs (2) of corneal abrasion
A
Symptoms: Eye pain Eye watering Blurred vision Feeling of a foreign body in eye
Signs:
Epithelial defect
Photophobia
13
Q
Treatment of corneal abrasion (3)
A
Remove foreign body
Analgesia - NSAIDs
Topical antibiotics
14
Q
What is acute anterior uveitis
A
Inflammation of anterior part of uvea = iris + ciliary body
15
Q
Symptoms (3) /signs (6) of acute anterior uveitis
A
Symptoms:
Eye pain
Eye watering
Blurred vision
Signs:
Synechiae - iris adhering to cornea
Flare - inflammation and leukocytes floating in AC
Keratic precipitates - lymphocyte aggregates on the corneal endothelium
Photophobia
Redness
Small irregular pupil
16
Q
Treatment of acute anterior uveitis (2)
A
Topical steroids
Dilating eye drops (e.g. cyclopentolate) - to break down adhesion and reduce pain
17
Q
Symptoms (2)/ signs (2) of scleritis
A
Symptoms:
Eye pain
Eye redness
Signs:
Nodules on the sclera
Tender eyeball
18
Q
Treatment of scleritis
A
Systemic steroids - high dose prednisolone IV or oral
19
Q
Symptoms (5)/signs (4) of acute angle closure glaucoma
A
Symptoms: Eye pain Redness Blurry vision Nausea/ vomiting Headache
Signs: Hazy cornea - corneal oedema Fixed mid dilated pupil Hard and tender eyeball Increased IOP >40mmHg
20
Q
Normal intra-ocular pressure range
A
10-21mmHg
21
Q
Treatment of acute angle closure glaucoma (3)
A
1st line - Carbonic anhydrase inhibitors - e.g. acetazolamide
+/- Constrictor pupil eye drops
Laser peripheral iridotomy (when acute attack resolves)
22
Q
Symptoms (4) /signs (4) of orbital cellulitis
A
Symptoms: Pain Redness Blurred vision Malaise
Signs: Diplopia Pyrexia Proptosis - protruding eye Reduced eye movement
23
Q
Orbital cellulitis vs peri-orbital cellulitis
A
Peri-orbital cellulitis is inflammation and infection of the superficial eyelid, usually from a superficial source, e.g. insect bite
Orbital cellulitis is an infection within the orbital soft tissues and is usually due to underlying bacterial sinusitis - far more serious than peri-orbital cellulitis
24
Q
Investigations of orbital cellulitis
A
CT of sinuses
25
Treatment of orbital cellulitis (2)
URGENT TREATMENT
- IV antibiotics
- Drainage of pus if there's abscess
26
What does adnexal refer to
Tissue around the eyeball = eyelids, extrinsic muscles, socket etc
27
Most common type of eyelid tumour + name another type of eyelid tumour
Basal cell carcinoma
squamous cell carcinoma
28
Name 2 major risk factors for basal cell carcinoma eyelid tumours
UV radiation
Frequent sun exposure
29
Possible treatment for basal cell carcinoma/squamous cell carcinoma eyelid tumours (3)
Surgical excision
Radiotherapy
Chemotherapy
30
Clinical features of basal cell carcinoma eyelid tumours (2)
Usually painless
| Flat red mark
31
Symptoms/signs of lacrimal gland tumour (4)
Blurry vision
Double vision
Swelling of eyelid
Pain around the eye
32
Loss is vision is associated with damage of which segment of the eye
Posterior
33
Questions to ask someone presenting with loss of vision (just think socrates with these type of questions)
Is it unilateral/bilateral
Was it sudden or gradual onset
What type of loss - blurry/distorted/black
Any associated symptoms - pain/redness/discharge
34
Examination of someone with loss of vision (5)
Testing best corrected visual acuity with snellen chart
Testing pinhole visual acuity with snellen chart
Fundoscopy
Slit lamp
Ancillary tests (=other supportive tests; not compulsory)
35
2 ways of doing a fundal examination
Direct ophthalmoscope (fundoscope)
Slit lamp + volk lens
36
Name 5 ancillary (accessory) tests that can be done when examining loss of vision
Amsler chart - tests if central vision distorted
Colour vision test
Visual field test
Fluorescein angiography
Optical coherence tomography
37
Differentials of loss of vision (6)
```
Central retinal artery occlusion
Anterior ischaemic optic neuropathy
Cataract
Glaucoma - primary open angle glaucoma, angle closure glaucoma
Age related macular degeneration
Diabetic retinopathy
```
38
Name the 2 conditions causing sudden loss of vision
Central retinal artery occlusion
Anterior ischaemic optic neuropathy
39
Name the 6 conditions causing gradual loss of vision
```
Cataract
Glaucoma
Primary open angle glaucoma (CHRONIC)
Angle closure glaucoma (ACUTE)
Age related macular degeneration
Diabetic retinopathy
```
40
2 causes of central retinal artery occlusion (-->SUDDEN loss of vision)
Embolus often from the carotids or the heart occludes the artery so no blood gets to retina --> retina becomes ischaemic so photoreceptors don't work
Atherosclerosis of the central retinal artery
41
Symptom/sign (2) of central retinal artery occlusion
Sudden PAINLESS vision loss
| Afferent pupillary defect
42
Treatment of central retinal artery occlusion (4)
Treat any risk factors:
- BP control
- Statins
- Antiplatelets
Intravitreal anti Vegf
43
4 Risk factors of central retinal artery occlusion
Atherosclerosis
Hypertension
Hypercholesterolaemia
Diabetes mellitus
44
What does anti Vegf do
Blocks activity of vascular endothelial growth factor (VEGF)
VEGF increases permeability of capillaries in the eye (makes capillaries in eyes more leaky so anti Vegf can dry up the fluid in the retina and improve vision)
45
Definition of anterior ischaemic optic neuropathy
Damage to anterior optic nerve due to ischaemia
Optic nerve supplied by short posterior ciliary arteries, if they’re occluded then optic nerve head infarcts and swells
46
2 types of anterior ischaemic optic neuropathy
Arteritic (giant cell arteritis) and non-arteric type
47
Pathophysiology of arteritic type anterior ischaemic optic neuropathy (2)
Giant cell arteritis (temporal arteritis):
Inflammation of blood vessels supplying blood to optic nerve --> thickens wall of artery and obstructs lumen
Inflammation of arteries of a certain calibre - usually MEDIUM/LARGE SIZED ARTERIES; branches of ECA
48
Symptom (3) /signs (5) of arteritic type anterior ischaemic optic neuropathy
Symptoms:
Sudden painless loss of vision
Headache
Pain on chewing/facial pain
```
Signs:
Scalp tenderness/tenderness of superficial temporal arteries
Claudication of extremities
Loss of appetite
Pale enlarged optic disc
Afferent pupillary defect
```
49
Investigations of arteritic type anterior ischaemic optic neuropathy
Inflammatory markers:
ESR - raised
CRP - raised
Temporal artery biopsy
50
Treatment of arteritic type anterior ischaemic optic neuropathy (i.e. treatment of giant cell arteritis)
High dose IV steroids - prednisolone
51
What is non-arteritic type anterior ischaemic optic neuropathy
Non-inflammatory process of small blood vessels
52
Causes of non-arteritic type anterior ischaemic optic neuropathy
Atheromatous narrowing of short posterior ciliary arteries
Drop in blood pressure to such a degree that blood supply to the optic nerve is decreased;
increased pressure inside the eyeball;
53
Treatment of non-arteritic type anterior ischaemic optic neuropathy
Treat any underlying heart disease and other risk factors
54
Risk factors of non-arteritic type anterior ischaemic optic neuropathy
Hypertension
Diabetes
Hypercholesterolaemia
Heart disease
55
Investigations of of non-arteritic type anterior ischaemic optic neuropathy
Rule out arteritic type with:
- ESR
- CRP
56
What is a cataract
Gradual opacification of the lens from normal ageing process, trauma, metabolic disorders (hereditary or acquired or congenital problems)
57
Pathophysiology of age related cataracts (5)
Undergo a process called nuclear sclerosis -- >nuclear cataract:
As we age, new collagen fibres form around the edges of the lens concentrically which pushes/compresses the older collagen fibres into the middle (into the nucleus of the lens)
This causes the nucleus of the lens to become cloudy, dense and yellow
As we age, the lens absorbs harmful UV rays to prevent these rays from damaging the retina but consequently, the lens gets damaged itself over time
Damaged lens fibres --> OPAQUE --> CATARACT
58
Risk factors of cataract (4)
Smoking
UV rays
Age
Diabetes
59
Symptoms (2) /signs (2) of cataract
Symptoms:
Gradual loss of vision
Blurry vision
Signs:
Glare (difficulty seeing when there's bright lights)
Reduced visual acuity
60
Main examination test of cataract
| + diagnostic criteria of cataract
Testing best corrected visual acuity with snellen chart
Diagnosis - detection of a decrease in visual acuity (can’t focus) that cannot be corrected by refractive correction
61
Treatment of cataract
Surgery: phacoemulsification with intraocular lens implant
-surgical incision into the eye and removal of the opacified crystalline lens by breaking it up into small fragments then sucking it up and replacing with an artificial lens
62
Commonest cause of vision loss + 2nd commonest
Cataract
Glaucoma
63
What is glaucoma
Increased intra-ocular pressure above 23mmHg -due to improper drainage of AH -> increased pressure on optic nerve so damaging it --> VISUAL FIELD DEFECTS
64
2 types of glaucoma
Primary open angle glaucoma - chronic
Angle closure glaucoma - can be acute or chronic
65
Glaucoma - diagnostic triad of signs
1) Raised IOP
2) Visual field defects
3) Optic disc changes on ophthalmoscopy
66
Symptoms/signs (4) of primary open angle glaucoma
Asymptomatic often
```
Signs:
Gradual peripheral field vision loss
Increased IOP
Notching of optic nerve cup
Loss of nerve fibre layer
```
67
Examination (2)
Investigation (1)
of glaucoma
Fundoscopy
Microscope + slit lamp
Visual field test - manual or automated perimetry
68
Pathophysiology of primary open angle glaucoma
Anatomically open angle of the AC but with an obstructed and slowed trabecular drainage system outflow --> gradual build up of IOP
69
Treatment of primary open angle glaucoma
- medical (3)
- surgical (2)
Topical eye drops to decrease IOP by decreasing AH:
- Prostaglandin analogues
- Beta blockers
- Carbonic anhydrase inhibitors
Laser trabeculoplasty - if eye drops fail
Trabeculotomy - creating new pathway for AH to drain
70
2 causes of angle closure glaucoma
The iris may be pushed from behind against the trabecular meshwork - most commonly due to pupillary block (build up of AH in posterior chamber forces peripheral iris anteriorly which narrows/BLOCKS the angle of the AC)
The iris may be pulled up against the trabecular meshwork - e.g. contraction of inflamed membrane in uveitis
71
Symptoms (5) /signs (5) of angle closure glaucoma
```
Symptoms:
PAINFUL aching eye
Headache
Seeing halos around lights
Blurry vision
Nausea/vomiting
```
```
Signs:
Reduced visual acuity
Eye redness
Increased IOP
Fixed dilated pupil
Corneal oedema
```
72
Examination (1)
Investigations (2)
of angle closure glaucoma
Microscope + slit lamp
Automated perimetry - tests visual field
Optical coherence tomography
73
Treatment of acute angle closure glaucoma
- medical (3)
- surgical (1)
Decrease IOP with:
- Topical or oral carbonic anhydrase inhibitors
- AND/OR Topical beta blocker
+Analgesia
+ Laser peripheral iridotomy (after acute attack resolves)
74
What is age related macular degeneration/ pathophysiology
Dystrophy/degeneration of PIGMENT EPITHELIAL LAYER OF THE RETINA which destructs rods and cones as DRUSEN develop between the pigment epithelial layer and the choroid
--> deprive the pigment epithelial layer and photoreceptors of oxygen and nutrients
75
Signs of age related macular degeneration (4)
Gradual loss/DISTORTION of CENTRAL vision
Good peripheral vision
Drusen (fatty deposits) seen on fundal examination
Pigment epithelial changes (atrophy of pigment epithelial layer and subsequently the photoreceptors too )
76
Name the 2 types of advanced ARMD
Dry (90%)
wet (neovascular) (10%)
77
Pathophysiology of wet ARMD
New choroidal blood vessels develop from the choroid, grow up between individual pigment epithelial cells and sit between the pigment epithelial layer and the photoreceptor layer
These blood vessels can start bleeding between these 2 layers --> impairment of the retina --> GRADUAL VISION LOSS
78
Major sign of dry ARMD
Drusen (fatty deposits) in the retina
79
Examination (1)
Investigations (2)
of ARMD
Amsler grid - would show CENTRAL DISTORTION
Optical coherence tomography (OCT)
Fluorescein angiography - confirms wet ARMD
80
Treatment of ARMD (not curative)
- early stage (modify risk factors - 4)
- dry ARMD (1)
- wet ARMD (1)
Low vision aids - hand magnifier
```
Early stages:
=Modify risk factors
-Stop smoking
-Lower cholesterol
-Lower glucose intake
-Control BP
```
Advanced dry ARMD:
-Observe and modify risk factors
Advanced wet ARMD:
-Intravitreal anti Vegf
81
What is diabetic retinopathy/pathophysiology
Complication of chronic progressive diabetic microvascular leakage and occlusion of vessels in the retina
Microvascular damage leads to ISCHAEMIC RETINA which induces retina to produce VEGF --> stimulating growth of abnormal blood vessels (neovascularisation)
These new blood vessels can leak into VH and impair vision
82
Signs of diabetic retinopathy (5)
```
Gradual loss of vision
Microaneurysms
Retinal haemorrhages
Neovascularisation of the optic disc/retina
Macular oedema
```
83
Examination (1)
Investigations (2)
of diabetic retinopathy
Fundus examination
Fluorescein angiography
OCT
84
Treatment of diabetic retinopathy (for non-severe and severe)
- if lots of macular oedema
- if not much macular oedema
Intravitreal anti Vegf - if there's lots of macular oedema
+/-Macular laser therapy
+/- pan-retinal photocoagulation - if not much macular oedema
85
Why is the eye an immune privileged site
Because the avascularity of the cornea plays a good role in corneal transplant - less chance of foreign antigens from a corneal graft being recognised by the recipient so lesser chance of graft rejection
Therefore said to be immune privileged
86
Causes of conjunctivitis (3)
Bacterial
Viral
Allergy
87
What is a stye/hordeolum
Bacterial infection of an oil gland in the EYELID --> abscess formation in eyelid --> red tender bump (stye)
88
2 types of stye + cause of each
```
External stye (hordeolum externum)
-Blocked sebaceous glands of an eyelash
```
```
Internal style (hordeolum internum)
-blocked meibomian glands in tarsal plate
```
89
Symptoms (2) /signs (2) of stye (hordeolum)
Pain/tenderness
Redness
Yellow pus at centre of bump
Swelling of eyelid
90
Treatment of stye (3)
```
Topical antibiotic eye ointment
Warm compress (placing hot water towel on eye 5 times a day)
```
Only need surgical incision + drainage if vision distorted or unresponsive to antibiotics
91
Name an inflammatory and non-inflammatory corneal pathology/disease
Corneal ulcer - inflammatory
Corneal dystrophy - non-inflammatory
92
Sign of corneal dystrophy/degeneration
Impaired vision
93
How high can IOP increase to in acute angle closure glaucoma
70mmHg
94
What part of the uvea is affected in intermediate uveitis
Posterior ciliary body
95
What part of the uvea is affected in posterior uveitis + what other parts of the eye
Choroid
Retina
Optic nerve
96
Pathophysiology of anterior uveitis
Inflamed iris leaks out plasma and WBCs into the AH --> hazy anterior chamber --> hazy vision
97
Causes of uveitis (3)
Idiopathic,
Autoimmune - HLA-B27-related disease (UC)
Infection - viral, bacterial
