Eye Disease Flashcards
(146 cards)
1
Q
what are important aspects of a history involving the eye
A
Visual loss Onset - gradual or sudden Duration? Progressive or non-progressive? Transient, improving? Localisation - central, peripheral, bilateral? Pain - localised or referred Glare Distortion (metamorphopsia) Photophobia Flashing lights / floaters Diplopia (monocular or binocular) Discomfort / dryness / f.b. sensation Abnormal appearance (red/swollen) Itch Discharge / watering / epiphora
2
Q
what should be examined in an ophthalmic examination
A
Facial appearance Lids Conjunctivae - where is the redness? Cornea - corneal reflex / opacity / fluorescein Pupils Red reflex
3
Q
what eye drops can be used to make examination easier
A
Fluorescein
Anaesthetic drops
Mydriatic drops
4
Q
how is visual functioned tested
A
Visual acuity
Visual field
Colour vision
5
Q
what does swollen optic discs mean
A
disc swelling secondary to ANY cause
6
Q
what is papilloedema
A
specific term meaning swollen optic discs secondary to raised intracranial pressure (ICP)
7
Q
what should patients with bilateral optic disc swelling be investigated for
A
having raised ICP due to space occupying lesion (SOL)
8
Q
what is raised ICP considered
A
a medical emergency
9
Q
how can bilateral disc swelling be identified
A
ophthalmoscopy
10
Q
how is CN II examined
A
Ophthalmoscopy visual acuity pupil exam visual field assessment colour vision
11
Q
how does disc swelling appear
A
loss of clarity of edge of disc
disc margins hidden
haemorrhages
prominent vessels
12
Q
papilloedema + few haemorrhages + headache worse in the morning located in the frontal region + young obese woman = ?
A
benign intra-cranial hypertension
13
Q
how does papilloedema occur
A
- Subarachnoid space (SAS) around optic nerve (ON)
- intracranial pressure increases, this is transmitted to the SAS then to the ON
- interruption of axoplasmic flow and venous congestion= swollen discs
14
Q
what is intracranial pressure a sum of
A
Brain
Blood
CSF
15
Q
what does Monro-Kellie hypothesis state in relation to intracranial pressure
A
an increase in one variable will result in a decrease of one/both other variables
16
Q
what happens to the brain in raised ICP
A
brain is squeezed through foramen magnum, brainstem compressed, patient stops breathing and dies
17
Q
what should be checked with disc swelling in a patient
A
blood pressure
18
Q
how is idiopathic intracranial hypertension diagnosed
A
Lumbar puncture showing raised CSF opening pressure
19
Q
what happens if disc swelling becomes chronic
A
Disc swelling subsides, discs become atrophic and pale.
Loss of visual function occurs and blindness may result.
20
Q
causes of sudden visual loss
A
Vascular aetiology
Retinal detachment
Age related macular degeneration (ARMD) -wet type
Closed angle glaucoma
Optic neuritis
Stroke
21
Q
what are vascular causes of sudden visual loss
A
Haemorrhage from
- abnormal blood vessels (eg diabetes, wet ARMD)
- retinal tear
Occlusion of
- retinal artery
- optic nerve head circulation
22
Q
Sx of central retinal artery occlusion
A
Sudden visual loss
Profound - CF or loss
Painless
23
Q
signs of CRAO
A
Pale oedematous retina, thread-like retinal vessels
RAPD (relative afferent pupil defect)
24
Q
what can causes CRAO
A
Stroke
Carotid artery disease
25
what is CRAO classified as
a stroke
| Patient is at risk of another
26
Mx of CRAO if presents within 24 hours
- ocular massage (trying to reintroduce retinal blood flow by reducing intraocular pressure)
- establish source of embolus via carotid doppler
- Assess and manage risk factors => BP, diabetes putting them at risk of further CV events
27
what should be excluded in cases of CRAO
temporal arteritis
28
how else could intra ocular pressure be decreased in CRAO
surgical removal of aqueous from anterior chamber
| antihypertensive treatmetn
29
what are the other types of retinal artery occlusion
Branch retinal artery occlusion
| Amaurosis fugax a.k.a Transient CRAO
30
Sx of Amaurosis fugax a.k.a Transient CRAO
transient painless visual loss
‘like a curtain coming down’
lasts~5mins with full recovery
nothing abnormal seen on examination
31
Mx of Amaurosis fugax a.k.a Transient CRAO and why
Immediate referral TIA clinic
| At risk of full blown stroke
32
Tx of Amaurosis fugax a.k.a Transient CRAO
Aspirin >> to help circulation
33
what are other causes of Amaurosis fugax a.k.a Transient CRAO and why
Migraine >> visual loss followed by headache
34
what are causes of central retinal vein occlusion (CRVO)
Systemic/Ischaemic causes:
Atherosclerosis }
Hypertension } Virchow’s triad
Hyperviscosity }
```
Ocular causes/Not ischaemic:
raised IOP (venous stasis)
```
35
Sx of CRVO
Sudden visual loss
| Moderate to severe visual loss (not as profound as CRAO)
36
signs of CRVO
Retinal haemorrhages
Dilated tortuous veins
Disc swelling and macular swelling
Very red retina (very different from the pale retina in CRAO)
37
Tx of CRVO
based on cause
CRVO: uncomplicated
observation plus management of underlying risk factors
CRVO: with macular oedema
intravitreal therapy plus management of underlying risk factors
CRVO: with neovascularisation
Pan-retinal photocoagulation
(Anti-VEGFs can be used)
plus control intra-ocular pressure
38
how can intra-ocular pressure be controlled
ophthalmic beta-blockers, alpha-2 agonists, or carbonic anhydrase inhibitors
39
what are risk factors CRVO
atherosclerosis
systemic hypertension, diabetes mellitus,
history of smoking, cardiovascular disease
40
how does branch CRVO/CRAO differ
vision loss is only contained to the area of vision that branch supplies
41
Sx of branch occlusion
unilateral vision loss
| fundal appearance confined to an area
42
what is occlusion of optic nerve circulation
a.k.a Ischaemic optic neuropathy
Posterior ciliary arteries (PCA) become occluded by either inflammation or atheroma, resulting in infarction of the optic nerve head
43
what are the causes of ION
Arteritic 50% - inflammation (GCA) just gets so glogged it blocks
Non-arteritic 50% - atherosclerosis
44
Sx of ION
sudden, profound visual loss with pale/swollen disc
| irreversible blindness
45
what is at risk in ION
the other eye is at risk of vision loss until treated
46
Sx of GCA/Temporal Arteritis
```
Headache (usually temporal)
Jaw claudication
Scalp tenderness (painful to comb hair)
Tender/enlarged scalp arteries
Amaurosis fugax
Malaise
```
47
what is seen on Ix of GCA
Very High ESR , PV and CRP
48
what is used to IX GCA
Temporal artery biopsy
49
Tx of ION due to GCA
Prednisolone 80mg/24hr PO promptly
50
what is non-arteritic AION associated with
increased BP
increased lipid
DM
smoking
51
what can lead to the formation of new vessels in the eye
ischaemia caused by >>
- DM retinopathy
- branch or central retinal vein occlusion
52
what can cause a vitreous haemorrhage
bleeding from abnormal vessels >> retinal ischaemia and new vessel formation
bleeding from normal vessels >> retinal tear or retinal detachment or trauma
53
Sx of vitreous haemorrhage
Loss of vision
| ‘Floaters’
54
when there is enough blood in a vitreous haemorrhage to affect vision what are the signs
loss of red reflex
retina may not be seen
haemorrhage seen on fundoscopy
55
Mx of vitreous haemorrhage
Identify cause - B-scan ultrasonography needed
Can fix themselves
Vitrectomy for non-resolving cases or if retinal torn or detached
56
Sx of retinal detachment
```
Painless loss of vision
Flashes of light
Floaters
Field loss
'curtain falling over vision'
```
57
Signs of retinal detachment
May have RAPD
| May see tear on ophthalmoscopy
58
how does the retinal detachment relate to the visual field loss
in superior detachments field loss is inferior
59
Mx of retinal detachment
Surgery
- vitrectomy
- laser coagulation
60
what is the most common cause of blindness in Uk over 65
age related macular degeneration
61
what are the 2 types of ARMD and how do they differ
dry (gradual reduction in vision)
| wet (sudden reduction in vision)
62
what happens in wet ARMD
New blood vessels grow under retina – leakage causes build up of fluid/blood and eventually scarring
63
Sx of Wet ARMD
Rapid central visual loss
| Distortion of
vision (metamorphopsia)
64
Signs of ARMD
haemorrhage/exudate due to leaky
blood vessels
65
Tx of ARMD
Intra-vitreal anti-VEGF treatment
Intra-vitreal steroids can be given as well e.g. Triamcinolone
66
what are features of gradual visual loss
Bilateral – usually
Often asymmetrical
May present early with reduced VA
May present late with decreased field
67
what are causes of gradual vision loss
CARDIGAN
```
Cataract
ARMD (dry type)
Refractive error
Diabetic retinopathy
Inherited diseases e.g. retinitis pigmentosa
Glaucoma
Access (to eye clinic) Non-urgent
```
68
what should be done if cataract is discovered
test fasting plasma glucose to exclude DM
69
what can cause cataracts
```
Age related
Congenital – intrauterine infection (importance of checking red reflex in neonates)
Traumatic
Metabolic – diabetes
Drug-induced (steroids)
```
70
what vitamin deficiency can cause blindness
Vitamin A deficiency
71
what is cataracts in basic terms
cloudiness of the lens
72
what are the different types of cataract
Nuclear cataract Posterior subcapsular cataract
Christmas tree cataract (a.k.a polychromatic cataract)
Congenital cataract
73
Tx of cataract if it is SYMPTOMATIC
surgical removal with intra-ocular lens implant
74
how do cataracts often present
blurred vision
| gradual loss of vision
75
Sx of Dry ARMD
Gradual decline in vision
| Central vision ‘missing’ (scotoma)
76
Signs of Dry ARMD
Drusen – build up of waste
products below RPE
Atrophic patches of retina
77
Tx of dry ARMD
No cure – treatment is supportive with low vision aids eg magnifiers
78
what are the refractive errors
Myopia (‘short-sighted’) light focuses infront of retina
Hypermetropia (‘long- sighted’) light focuses behind retina
Astigmatism (usually irregular corneal curvature) not
allowing light being transmitted to the back
Presbyopia (loss of accommodation with aging)
79
what lenses are given in myopia and hypermetropia
myopia - Concave lens
hypermetropia - convex lens
80
what happens in presbyopia
ciliary muscles reduces tension in the lens, allowing it to get more CONVEX, for close focusing
With age, lens stiffens and presbyopia occurs. Reading glasses needed etc.
81
what is astigmatism
present if cornea or lens don't have the same degree of curvature in horizontal or vertical planes
image of objects is distorted either longitudinally or vertically
82
what is glaucoma and what are the different types
Progressive optic neuropathy resulting in optic nerve damage and visual loss
1 - Chronic simple/Open angle
2 -Acute Closed angle
83
how does Acute Closed angle Glaucoma present
```
Acute Uniocular
headache
nausea + vomiting due to pain
very painful
red eye
visual loss
Halos around light at night
```
84
what causes acute closed angle glaucoma
blocked flow of aqueous from the anterior chamber via the canal of Schlemm
85
Mx of acute closed angle glaucoma
Need to lower IOP with drops/oral medication to prevent patient going blind within a matter of hours
86
how does the pupil appear in acute closed angle glaucoma
fixed dilated pupil
87
Tx of acute closed angle glaucoma
Lower IOP
- carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
>> Pilocarpine (miosis - opens closed channel) + Acetazolamide (carbonic anhydrase inhibitor)
88
Sx of open angle glaucoma
Often none
| Incidental finding or found by optician
89
Signs of open angle glaucoma
```
Enlarged Cupped disc - Cup-to-disc ratios >0.4
Visual field defect
Peripheral visual loss
Scotomas (seen on visual field testing)
May/may not have high IOP
```
90
what is a Scotoma
a partial loss of vision or blind spot in an otherwise normal visual field.
91
Tx of open angle glaucoma
1 - eye drops to lower IOP
- carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
2 - eye drops fail; laser or surgery trabeculoplasty
Patient needs to be monitored by eye clinic
92
in open angle glaucoma, how does the vision deteriorate
nasal and superior fields lost first
| temporal lost last
93
what are causes of red eye
```
Conjunctivitis
Keratitis
Anterior uveitis
Scleritis / Episcleritis
Acute Angle Closure Glaucoma
```
Subconjunctival haemorrhage
Orbital disease e.g. cellulitis
94
what immunoglobulins are present in tears
IgA
| IgG
95
what is blepharitis
inflamed eyelids
96
what are causes of blepharitis
Anterior:
Seborrhoeic (squamous) - scales on the lashes
Staphylococcal – infection involving the lash follicle
Posterior:
Meibomian gland dysfunction
( M.G.D.)
97
Sx of blepharitis
eyes have 'burning' itching red margins
scales on lashes
gritty eyes
mild discharge
98
Tx of blepharitis
Clean crusts off lashes (cotton bud)
Supplementary tear drops - tears Naturale
Oral doxycycline for 2-3 months
99
signs of anterior blepharitis i.e. lid margin
```
Seborrhoeic:
Lid margin red
Scales ++
Dandruff+
(No ulceration, lashes unaffected)
```
Staphylococcal:
lid margin red
Lashes distorted, loss of lashes, ingrowing lashes - trichiasis
Styes, ulcers of lid margin
corneal staining, marginal ulcers (due to exotoxin)
100
what is trichiasis
ingrowing eye lashes
101
what is posterior blepharitis caused by and how does it present
Meibomian gland disease
Lid margin skin and lashes unaffected
M.G. openings pouting & swollen
Inspissated (dried) secretion at gland openings
Meibomian Cysts (chalazia)
102
what is posterior blepharitis associated with
Acne Rosacea (50%)
103
Sx of conjunctivitis
```
red eye
foreign body sensation – gritty eye
discharge – sticky eye; can stick eye together
Itch = allergy
vision unaffected
```
104
signs of conjunctivitis
```
Red eye
Discharge - serous or mucopurulent
Papillae or Follicles
Sub conj. haemorrhage
Chemosis = oedema
Pre-auricular glands (if viral)
```
105
Sx and Tx of acute bacterial conjunctivitis
red sticky eye
papillae
is self limiting - will clear up in about 14 days
without treatment
topical antibiotics clear it faster
106
what organisms commonly cause bacterial conjunctivitis
Staph. aureus
Strep. pneumoniae
H. influenza
107
what causes follicular conjunctivitis
viral (Adeno-, HS, HZ)
molluscum contagiosum
chlamydial
drugs e.g. propine, trusopt
108
what are the layers of the cornea
Epithelium
Stroma
Endothelium
109
what causes CENTRAL corneal ulcers
Viral
Fungal
Bacterial
Acanthamoeba
110
what causes PERIPHERAL (autoimmune) corneal ulcers
rheumatoid arthritis
| hypersensitivity e.g.marginal ulcers
111
Sx of corneal ulcers
```
Pain+ – needle like severe
Photophobia
Profuse lacrimation
Vision may be reduced
Red eye - circumcorneal
```
112
what can affect corneal sensation via corneal ulcers
herpes viruses
113
signs of corneal ulcers
Redness – circumcorneal
Corneal reflex (reflection abnormal)
Corneal opacity
hypopyon
114
Ix of corneal ulcers
Staining with fluorescein
Corneal reflex
Corneal scrape
115
what is a feature of a viral corneal ulcer
dendritic ulcer
116
what is Keratoconjunctivitis Sicca seen in
Sjogrens
117
what is seen in H zoster or V1 corneal ulcers
Neurotrophic keratitis
118
what can cause exposure keratitis
thyroid, VII palsy
119
Tx for corneal ulcer
ID cause via corneal scape
Antimicrobial if bacterial infection
- Eg ofloxacin hourly
Antiviral if herpetic
- Aciclovir ointment 5 x day
Anti-inflammatory if autoimmune
- Oral / topical steroids
120
what are autoimmune causes of anterior uveitis
Reactive arthritis
Ulc colitis
Ank Spondylitis
Sarcoidosis
121
what are infective causes of anterior uveitis
T.B.
Syphylis
Herpes simplex
Herpes zoster
122
Sx of anterior uveitis
```
Acute Pain (+ referred pain)
Vision may be reduced
Photophobia
Red eye (circumcorneal)
Decreased acuity
Watery discharge
```
123
Signs of anterior uveitis
```
Ciliary injection (i.e. circum-corneal )
Cells & Flares in anterior chamber
Keratic precipitates
Hypopyon
Synechiae - Small or irregular pupil
```
124
what are Keratic
| Precipitates
inflammatory cells on the corneal endothelium.
125
Mx of anterior uveitis
Topical Prednisolone to decrease inflammation
Mydriatics - Cyclopentolate to prevent adhesions between lens and iris
investigate for systemic associations if recurrent or chronic
126
what is episcleritis
inflammation below the conjunctiva in the episclera
nodules may occur
often recurrent
127
episcleritis associations
gout
128
Tx of episcleritis
self limiting
129
Tx of episcleritis
self limiting
| Lubricants / topical NSAIDs / mild steroids
130
Sx of scleritis
VERY painful and red
inflamed sclera
oedema of conjunctiva
scleral thinning
131
what is scleritis associated with
RA
Wegener’s
Associated uveitis common
132
what is scleritis associated with
RA
Granulomatosis with polyangiitis (Wegener’s)
SLE
Associated uveitis common
133
Ix of scleritis
FBC
U&Es
ESR
CRP
c-ANCA
Rheumatoid factor
134
Tx of scleritis
Oral NSAIDs
Oral Steroids
Steroid Sparing Agents
135
what is seen in vascular retinopathy
hard exudates
macular oedema
haemorrhages
papilloedema
136
what is seen in Wilson's disease
Kayser-Fleischer rings
137
what is seen in hypo/hyperparathyroidism in relation to the eye
hypo - lens opacities
hyper - conjunctival and corneal calcification
138
what can toxoplasmosis cause
uveitis
139
what eye diseases are seen in SLE
conjunctivitis
| episcleritis
140
what eye diseases are seen in Reiter's syndrome/reactive arthritis
conjunctivitis
| uveitis
141
what is seen in polyarteritis nodosa
episcleritis
142
what is seen in AS
uveitis
143
what is seen in dermatomyositis
orbital oedema
| with retinal haemorrhages
144
what is seen in Behcet's syndrome
uveitis
145
what does temporal arteritis lead to
ischaemic damage to the optic nerve
146
what do people with HIV get
CMV retinitis with retinal spots + flame haemorrhages
