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YEAR 3 & 5 CORE CONDITIONS > Eye (ENT 3) > Flashcards

Eye (ENT 3) Flashcards

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1
Q

What is the uvea?

A

Pigmented part of the eye:
Iris
Ciliary body
Choroid

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2
Q

What is the anterior and posterior uvea?

A

Iris and ciliary body = anterior uvea
- Inflammation is called anterior uveitis / iritis

Choroid = posterior uvea
- Inflammation is posterior uveitis / choroiditis

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3
Q

What is intermediate uveitis?

A

Affects vitreous = gel like substance that accounts for 80% of the volume of the eye

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4
Q

What are some associations of anterior uveitis?

A 
HLA B27 syndromes: 
Ankylosis spondylitis
Stills (JIA)
IBD
Psoriatic arthritis 
Reactive arthritis 
Behçets
Sarcoid
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5
Q

What is the most common cause of uveitis and most likely to present with a red eye?

A

Anterior uveitis

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6
Q

How does anterior uveitis present?

A

Red eye
Pain
Blurred vision
Photophobia

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7
Q

Describe how the red eye develops in anterior uveitis?

A

Starts with conjunctival infection around the junction of the cornea and slcera and increased lacrimation (but not sticky discharge, unlike conjunctivitis)

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8
Q

How is anterior uveitis diagnosed?

A

Slit lamp with dilated pupil - shows leucocytes in anterior chamber

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9
Q

What is the management of anterior uveitis?

A

Urgent eye clinic

Prednisolone 0.5-1% / 2hr - to reduce pain, redness and exudate

Cyclopentolate 1% / 8hr - to prevent adhesions between lens and iris (synechiae) and to relieve spasm of ciliary body

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10
Q

What can happen if there is prolonged inflammation of the eye following anterior uveitis?

A

Disrupts flow of aqueous leading to glaucoma

+/- adhesions between lens and iris

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11
Q

Why is posterior uveitis not painful (unlike anterior uveitis)?

A

Choroid is not innervated by sensory nerves

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12
Q

What is the conjunctiva?

A

Mucus membrane that lines the inside of the eyelids and the sclera

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13
Q

What are some causes of conjunctivitis?

A

Infective:
Bacterial
Viral

Non-infective:
Allergic

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14
Q

What is it called when there is inflammation of the conjunctiva and the cornea?

A

Keratoconjunctivis

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15
Q

How does conjunctivitis present?

A 
Red eye
Discharge
Burning
FB sensation
Photophobia
Itching
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16
Q

Compare bacterial vs viral conjunctivitis

A

Bacterial

  • Usually unilateral
  • Thick purulent discharge
  • Reduced vision and risk of vision loss

Viral

  • Bilateral (spreads from one to the other within a few days)
  • Clear watery discharge with mucoid component
  • Normal vision
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17
Q

What is the most common cause of viral conjunctivitis?

A

Adenoviruses

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18
Q

What is the management of viral conjunctivitis? Adenovirus vs HSV

A

Adenovirus - supportive eg application of cold moist compresses, artificial tears

Herpes simplex - topical antivirals eg ganciclovir

Topical abx is suspected overlying bacterial infection

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19
Q

Which bacterial conjunctivitis require systemic treatment?

A

Neisseria gonorrhoeae

Chlamydia

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20
Q

When are conjunctival scrapings and culture needed in conjunctivitis?

A

Persistent
Newborn conjunctivitis
Gonococcal / chlamydia suspected

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21
Q

How is conjunctivitis caused by neisseria gonorrhoea managed?

A

IV or IM ceftriaxone plus PO azithroymycin with saline irrigation

+/- topical abx

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22
Q

What is the management of bacterial conjunctivitis?

A

Self limiting in 60%
Should resolve in 1-2 weeks
Topical abx eg chloramphenicol 0.5% drops or 4/6hrs or fusidic acid can reduce duration of symptoms

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23
Q

What is the management of allergic conjunctivitis?

A

Antihistamine drops eg emedastine or olopatadine

Others eg cold compress, artificial tears

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24
Q

What can foreign bodies in the eye cause?

A 
Chemosis - swelling of conjunctivia
Subconjunctival bleeds
Irregular pupils
Iris prolapse
Hyphaemia - haemorrhage into anterior chamber of eye
Vitreous haemorrhage
Retinal tears
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25
What should be done if a high velocity FB is suspected in the eye?
Orbital US Pick up rate is 90% compared to 40% for x rays
26
What is a closed globe contusion?
Occurs in the absence of a full thickness ocular wall laceration Eg blunt trauma
27
What is an open globe injury?
Full thickness perforation or laceration of the ocular globe Eg sharp or high velocity blunt objects
28
What is endophthalmitis?
Inflammation of the tissues or fluid inside the eye Esp occurs following retained intraocular FB
29
What is a a blowout fracture?
Orbital contents are typically forced through a fractured orbital floor eg high velocity blunt trauma to the globe and upper eyelid from punch / tennis ball
30
How may an ocular chemical burn present?
``` Intense pain Visual impairment Blepharospasm - involuntary eyelid closure Erythematous conjunctiva Photophobia ```
31
What is the management of an ocular chemical burn?
Immediate and thorough irigation with copious sterile saline or cold tap water Use plastic scleral lens (Morgan lens) until pH normalises for acidic agents or 2-3 hours for alkaline agents Abx eye drops eg tetracycline Topical steroids eg prednisolone acetate 1%
32
What can cause sudden painless loss of vision?
``` GCA Optic neuritis Central retinal vein occlusion Central retinal artery occlusion Vitreous haemorrhage ```
33
How does GCA present?
``` New onset headache Malaise Jaw claudication Tender scalp and temporal arteries Neck pain Monocular vision loss ```
34
What is GCA associated with?
Polymyalgia rheumatica
35
What tests should be done for GCA?
ESR (>47) CRP (>2.5) - Preferably before steroids Temporal artery biopsy within 1 week of starting prednisolone
36
What is the management of GCA?
Prednisolone 60mg/24hr PO Tailor off steroids as ESR and symptoms settle, may take :1yr 20% left with partial / complete visual loss
37
How does optic neuritis present?
Unilateral loss of acuity over hrs-days Colour vision affected - dyschromatopsia (red appears less red) Eye movements hurt
38
What is optic neuritis associated with?
MS 45-80% will develop in 15yrs
39
What is the management of optic neuritis?
High dose methylprednisolone for 72hrs (1000mg/24hr IV) then prednisolone 1mg/kg/d po for 11 days
40
What is more common - retinal vein occlusion or retinal artery occlusion?
Retinal vein occlusion
41
Structural changes in the eye occur with DM causing what two conditions?
Glaucoma | Cataracts
42
How can DM cause glaucoma?
DM causes ocular ischaemia, which can cause new blood vessel forming on the iris (rubeosis), and if these block the drainage of aqueous fluid, glaucoma can occur
43
What is the structural changes does DM cause in the eye?
Microvascular occlusion causes retinal ischaemia leading to arteriovenous shunts and neovascularisation Leakage results in intraretinal haemorrhages and localised or diffuse oedema.
44
What are the two types of diabetic retinopathy?
Non-proliferative retinopathy | Proliferative retinopathy
45
How is non-proliferative diabetic retinopathy classified?
Mild Moderate Severe = Depending on the degree of ischaemia
46
What signs can be seen in non-proliferative diabetic retinopathy?
``` Microaneurysms = dots Haemorrhages = flames / blots Hard exudates = yellow patches Engorged tortuous veins Ischaemic nerve fibres = cotton wool spots Large blot haemorrhages ```
47
What are signs of significant ischaemia in DR?
Engorged tortuous veins Cotton wool spots Large blot haemorrhages
48
How does non-proliferative diabetic retinopathy progress to proliferative diabetic retinopathy?
Fine new vessels appear on the optic disc and retina | Can cause vitreous haemorrhage
49
What is maculopathy?
Leakage from the vessels close to the macula cause oedema and can significantly threaten vision
50
What is the macula?
Central area of the retina
51
Who needs urgent referral in DR?
Severe NPDR Proliferative retinopathy Maculopathy
52
How is DR screened?
DM type 1 and 2 should have their eyes screened at the time of diagnosis and annually thereafter
53
What is the management of maculopathy and proliferative retinopathy?
Photocoagulation
54
Other than photocoagulation, what can be used to treat macular oedema?
Intravitreal triamcinolone | Anti-VEGF drugs
55
When is a haemorrhage a flame and when is it a blot?
Rupture of microaneurysms at the nerve fibre level = flame shaped haemorrhages When deep in the retina = blot haemorrhages form
56
What is hyperopia vs myopia?
Hyperopia (long sighted) = an image of a distant object becomes focused behind the retina, making objects up close appear out of focus Myopia (short sighted) = an image of a distant object becomes focused in front of the retina, making distant objects appear out of focus
57
In those with DR, what happens to their refractive index? What does this mean in terms of management?
At presentation - the lens may have a higher refractive index producing relative myopia On treatment - the refractive index reduces and vision is more hyperopic Do not correct refractive errors until diabetes is controlled
58
What other nerves are affected in DR?
Typically III and IV
59
Why may the pupil be spared in diabetic third nerve palsy?
Fibres to the pupil run peripherally in the nerve, receiving their blood supply from the pial vessels
60
What are Argyll Robertson pupils?
Bilateral small pupils that reduce in size on a near object (accommodate) but do not constrict when exposed to bright light (unreactive) 'Prostitues pupil' - accommodates but does not react Result of bilateral damage to the pretectal nuclei in the brainstem
61
What causes Argyll Robertson pupils?
Non specific Late stage syphilis Diabetes
62
What happens in arteriopathic retinopathy?
Arteriovenous nipping - arteries nip veins where they cross (they share the same connective tissue sheath)
63
What happens in hypertensive retinopathy?
Damage from arterioslcerotic and HTN related processes Arteriovenous nipping and arteriolar vasconstriction and leakage
64
What are the stages of hypertensive retinopathy?
Grades I - IV Keith-Wagener-Barker system
65
What are grades I-IV of hypertensive retinopathy?
I - mild generalised retinal arteriolar narrowing or sclerosis II - definite focal narrowing, AV nipping III - cotton wool exudates, hard exudates, retinal haemorrhage, retinal oedema, macular star formation IV - papilledema (optic disc swelling), optic atrophy
66
When does hypertensive retinopathy usually become symptomatic?
III and IV
67
Name two types of squint
``` Convergent squint (esotropia) Divergent squint (exotropia) ```
68
Which type of squint is more common? What causes it?
Esotropia - either no cause or can be due to hypermetropia
69
How are squints investigated?
Corneal reflection | Cover test
70
Describe a corneal reflection test
Reflection from a bright light falls centrally and symmetrically if no squint
71
Describe a cover test
Movement of the uncovered eye to take up fixation as the other eye is covered demonstrates a manifest squint A latent squint is revealed by movement of the covered eye as the cover is removed
72
What is a paralytic vs a non paralytic squint?
Paralytic (or concomitant) squint is when the squint occurs in all directions of gaze, double vision does not normally occur Non-paralytic is not constant, occurs when child is tired
73
Describe a 3rd nerve palsy
Down and out Ptosis Proptosis (decreased recti tone) Fixed pupil dilatation
74
Describe a 4th nerve palsy
Up and adducted eye Diplopia Head may hold head tilted Cannot look down and in (superior oblique paralysed)
75
Describe a 6th nerve palsy
Eye is medially deviated and cannot move laterally from midline - LR paralysed Diplopia
76
What is the management of a swuint?
Glasses for refractive errors Eye patches Operation eg resection and recession of rectus muscles to realign Botulinum injections

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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