Eye problems and stuff Flashcards

Question

When someone presents with eye pain what 4 diagnoses must be ruled out?

Answer 1

- Acute angle-closure glaucoma - Anterior uveitis - Scleritis - Corneal ulcer

Answer 2

**Medical Emergency** - refer urgently to opthalmology as it is **sight-threatening** **Normal aqueous flow through pupil is disrupted** => increase in pressure gradient causes periphera; iris to bow forward, obstructing the trabecular meshwork - pressure increases abruptly aka a **Blockage or narrowing of the drainage angle formed by the cornea and the iris,** resulting in a sudden increase in intraocular pressure => damage to optic nerve **Risk factors:** - Older Age - Asian or Inuit populations (female??) - Long-sightedness (Hyperopia) **Symptoms:** - Painful eye - Headache - Blurred vision –> sudden vision loss -Haloes – patients will often describe coloured haloes around lights - Nausea and vomiting **Signs:** - Red eye – ciliary flush - Cloudy cornea - Mid-dilated or fixed pupil - Closed iridocorneal angles on gonioscopy - Corneal oedema - Raised IOP (defined as >21 mmHg) – the eye may feel hard on palpation Management: - Lower IOP with drops, oral/IV mediation & laser to prevent irreversible blindness

Answer 3

Classically involves daily episodes of pain around one eye that occur in clusters of 1-3 months. Associated symptoms are red eye, lacrimation and swelling. In some, the pupil is in a fixed constricted position.

Answer 4

- Damage to the corneal epithelium, as opposed to a corneal ulcer which refers to a deeper breach. - - Patients present with pain, photophobia and possibly reduced visual acuity. - Often they mention obvious trauma/injury to the eye, or they may belong to a profession that puts them at risk – such as sheet metal working

Answer 5

A **complication of Grave's disease,** which is an autoimmune hyperthyroidism. An inflammatory process results in swelling of the extraocular muscles and orbital fat, which leads to multiple ocular complications. It manifests with a range of ocular symptoms, including **eyelid retraction, proptosis, double vision, and ocular discomfort**

Answer 6

**Copper coloured rings** around the periphery of the cornea. They are due to copper deposition in the cornea and are associated with a number of conditions e.g. ***Wilsons disease*, cholestasis, primary biliary cirrhosis**

Answer 7

A form of **optic neuropathy** characterized by the **death of optic nerve fibres, either with or without raised intraocular pressure (IOP).** Over time, glaucoma can lead to characteristic changes in the visual field. **Pathophysiology:** - Impaired aqueous humor drainage through the trabecular meshwork, causing elevated intraocular pressure (IOP). - This pressure gradually damages the optic nerve and leads to peripheral visual field loss. - Unlike acute closed-angle glaucoma, where the drainage angle is suddenly blocked, open-angle glaucoma has a slower, insidious onset, allowing for a more gradual increase in IOP. Risk factors: - Raised IOP – key modifiable risk factor - Hypertension - Diabetes mellitus - Corticosteroids Symptoms: - **Often NONE** - Nay be discovered by optician Signs: - May/May not have high IOP - Cupped disc (= loss of retinal ganglion cells aka a large optic cup, the paler part is larger, outside less 'meaty' which is the part with the ganglions) - Visual filed defect (i.e. a thin *inferior* rim corresponds to *superior* field loss) Patient may be asymptomatic because: - Gradual onset - Visual field loss is often peripheral - Disease may be asymmetric: if one eye is badly effected, the other 'better' eye can compensate as our visual fields overlap

Answer 8

Glaucoma = **optic nerve damage due to pressure/fluid build up in the eye** Either open or closed Glaucoma - both sight-threatening Open: Slower progressing Closed: Acute, medical emergency

Answer 9

swelling of the conjunctiva

Answer 10

***A sight- and life-threatening emergency*** **Infection of the structures behind the orbital septum.** The orbital septum is a membranous sheet that forms the anterior border of the orbit, extending from the orbital rims (superior and inferior) and into the eyelids Important findings that suggest preseptal cellulitis, rather than orbital cellulitis, are: - No proptosis - Normal eye movements - No chemosis - Normal optic nerve function

Answer 11

An **infection of tissue anterior to the orbital septum.** It is much more common than orbital cellulitis and 80% of cases occur in children under the age of 10 years. It is less severe than orbital cellulitis, unless it spreads past the septum (which is not fully developed) and becomes orbital cellulitis. Important findings that suggest preseptal cellulitis, rather than orbital cellulitis, are: - No proptosis - Normal eye movements - No chemosis - Normal optic nerve function

Answer 12

**Inflammation of the optic nerve, often resulting in visual impairment and ocular discomfort - typically acute** Pathogenesis - Inflammatory process triggering activation of T-cells, which subsequently transverse the blood-brain barrier leading to a hypersensitivity reaction against neuronal structures - Demyelinating lesions (MS), autoimmune disorders, infections conditions (particularly those affecting the CNS) NOTE: - Predominantly effects adult women - Commonest initial feature of MS **TRIAD:** - Visual loss - from slight to severe - Periocular pain - pain around eye aggrrevated by movement - Dyschromatopsia - colour discrimination - aka suspect this if ocular movement causes pain or there is 'red desaturation'.

Answer 13

- Injuries that occur due to blunt force trauma to the face. Blowout fractures involves the **fracturing of the orbital wall** due to a sudden increase in intraorbital pressure from the impact. - Most commonly involve the **orbital floor and/or medial orbital wall,** as these are the weakest points structurally NOTE: - **Vertical diplopia** and restriction of upgaze - can occur due to entrapment the **inferior rectus muscle**

Answer 14

A viral infection caused by the **reactivation of latent varicella zoster virus (VZV)** in the **trigeminal ganglion,** affecting the ophthalmic division of the trigeminal nerve. The virus can invade the cornea, leading to inflammation, pain, and possible vision loss. NOTE: - A lesion on the nose, known as **Hutchinson's sign,** may suggest ocular involvement - need urgent opthalmic review

Answer 15

Characteristic sign of **optic atrophy.** This condition represents an end stage to numerous disease processes, resulting in damage to the optic nerve cells, a condition known as optic neuropathy.

Answer 16

A **mitochondrially inherited degeneration of retinal ganglion cells and their axons that leads to an acute or subacute loss of central vision;** it predominantly affects young adult males. LHON is transmitted only through the mother

Answer 17

Swelling of the optic disc due to **raised intracranial pressure.** The swelling occurs because the optic nerve sheath is contiguous with the subarachnoid space. NOTE: - Persistent papilloedema leads to optic disc pallor and ultimately loss of optic nerve fibres (optic atrophy). - Commonly seen in conditions such as optic neuritis, nonarteritic ischaemic optic neuropathy, and various intracranial pathologies. - **Frisen scale** used to classify papilloedema severity. 0 = normal optic disc, 5 = severe papilloedema

Answer 18

An abscess at an eyelash follicle, commonly caused by staphylococcus Signs/symptoms: - Painful, red hot lump on the eyelid that points outwards, causing localized inflammation.

Answer 19

An **abscess of the Meibomian gland,** which can lead to a chalazion if the gland becomes blocked - often following an Internal hordeolum aka an inflamed oil gland on the inner edge of your eyelid Signs/symptoms: - Initially painful, but evolves into a non-tender swelling that points inwards.

Answer 20

- Common in kids - White lie blow out fracture - i think?? - Eye cant look up but probs can still look down - Deal w ENT, gonna need to fix surgically

Answer 21

- Deep boggy haemorrhage - If suspicious, handle with caution and get a CT scan

Answer 22

- **Blood in the anterior chamber, forms fluid level due to gravity** - Refer to ophthalmology, emergency, something strange intraoccular is afoot due to a trauma

Answer 23

- Marfans can lead to a spontaneous dislocation

Answer 24

- Can be due to trauma - If there is a tear then lots of fluid can get in and rip away the retina

Answer 25

- “Bruised retina” - Often self-limiting - Due to blunt trauma

Answer 26

- Often caused by a dog attack - Surgical reconstruction, challenging

Answer 27

- Iris try’s to plug gap and gets sucked into cornea - pupil looks deformed

Answer 28

- Seidel Positive = for a leaking cornea, eye??

Answer 29

**Auto-immune reaction in both eyes due to penetrating injury to one eye** May lead to bilateral blindness as body does not differentiate between healthy and injured eye - rare

Answer 30

Foreign body Under upper eyelid - invert eyelid and get out

Answer 31

- Very common - Most typically history: metal work - Rusts very quickly - Local anaesthetic, slit lamp, fixate on something straight ahead, use edge of needle to scrape off foreign body - Chloramphenicol 4x a day for a week

Answer 32

Be sus if: - Irregular pupil - Anteriro chamber shallow - Localised caster act if foreign body touching lens - Gross inflammation Anterior chamber penetration: Between iris and cornea

Answer 33

Fast moving particles: e.g. Hammer and chisel Always X-ray with potential IOFB

Answer 34

History: - Alkali - often the washing pods for laundry and young children = more worrying than acid, eye-lid sticks to eyeball, Limbal Ischaemia, cornea scarring, corneal vascularisation -> end stage scarring - Acid - coagulates proteins = little penetration - Quick history, toxobase if available, measure pH (remember tears are naturally slightly alkali), **early Irrigation**/wash out (min. 2L saline or until pH normal), asses under Slitlamp = neutralise acid or alkali

Answer 35

- Typically a Microvascular, ischaemic cause so less worrying than if pupil is involved (more like an aneurysm, stroke, tumour) - Eye: Down and out

Answer 36

**Occlusion of optic nerve head circulation** (lecturer has put: Posterior ciliary arteries become occluded, resulting on infarction of optic head) Categorised anatomically: anterior and posterior (PION more rare so wont focus on) Anterior ischaemic optic neuropathy (AION) - more common sub-divided: - Arteritic i.e. almost always **giant cell arteritis** = **vision and life-threatening** *treat ASAP with systemic corticosteroids, IV if sight is affected* - Non-arteritic i.e. insuffiecient blood perfusion to optic nerve due to cardio stuff = infarction and vision loss. Makes up 90-95% of AION cases Visual symptoms: - **Sudden vision loss - upper/lower visual filed may be affected** (and colour blindness??) - Usually painless Signs: - **Swelling optic nerve** in acute phases (I think swelling only in AION??) - **Pale optic disc** in chronic phases

Answer 37

**Sudden-onset, profound loss of vision, which is painless,** due to **occlusion of the central retinal artery** *aka an occlusion before the retinal artery branches off into superior/inferior retinal arteries - then it is a 'Branch retinal artery occlusion'* Signs: - **Relative afferent pupil defect (RAPD)!!** - **Pale Oedematous retina,** thread-like retinal vessels Fundoscopy: Pale retina, **'Cherry red spot'** = macula is spared (as it is supplied by the cilioeretinal artery not opthalmic) NOTE: less common than retinal vein occlusion, but faster rate of deterioration Causes (note this is a type of stroke): - Catrotid artery disease - Emboli from the heart (unusual) - Giant cell arteritis

Answer 38

**Central retinal vein or its branches are occluded by a thrombus, respectively** *more common than CRAO)* Assoc. with *(Basically Virchow's triad)*: - Endothelial damage e.g. diabetes - Abnormal blood flow e.g. hypertension - Hypercoaguable state e.g. cancer Symptoms: - Sudden, painless loss of vision or visual field defects (in BRVO Vision loss might only occur if there is involvement of the macula) Signs (CRVO): - Retinal haemorrhages *aka **'stormy sunset'** e.g. numerous **flame haemorrhages**, cotton wool spots* - Dialated tortuous veins - Disc and Macualr swelling Signs (BRVO): - Present only in affected segment of retia but still possibly Macular oedema (I think)

Answer 39

Occular symptoms secondary to severe, chronic arterial hypoperfusionof the eye. Most common cause: Severe ipsilateral or bilateral carotid artery stenosis or occlusion NOTE: may be a warning sign of stroke

Answer 40

**Intravitreal anti-VEGF injections.** If anti-VEGF is contraindicated (e.g., stroke or MI within 3 months, pregnancy), corticosteroids are administered

Answer 41

Various conditions which cause **chronic inflammation of the eyelid margins.** Most common causative: Staphylococcus, Herpes Simplex Virus (HSV) or Varicella-Zoster Virus (VZV) infection, Meibomian gland dysfunction, seborrheic dermatitis, or rosacea. Symptoms: - Painful, gritty, itchy eyes - Eyelids sticking together upon waking - Dry eye symptoms - Symptoms associated with the causative condition (e.g., seborrhoeic dermatitis, acne rosacea) Signs: - Erythema of the eyelid margins - Crusting or scaling at the eyelid margin - Visibly blocked Meibomian gland orifices

Answer 42

Can result from: - Surgical lesions: Compressive (e.g. posterior communicating artery aneurysm) - Medical lesions: Non-compressive (Multiple sclerosis or vascular like DM) Presentation: - **'Down and out'** - at rest - Ptosis, proptosis - Fixed pupil dilatation if lesion is compressive rather than medical aka NEEDS INVESTIGATING

Answer 43

Can result from: - Ocular trauma, DM Presentation: - **'upwards and outwards'* - at rest - head tilt to compensate palsy - double vision in vertical plane, potentially **hypertropia**

Answer 44

Can result from: - Diabetic neuropathy, stroke, infection, MS, trauma * Easily compromised in a state of raised Intra cranial pressure* Presentation: - **Medially** deviated - at rest - Diplopia, aka double vision, worse when patient asked to look horizontally away from midline

Answer 45

Common cause of diplopia in children and occasionally in adults. **Esotropia** – a convergent squint – is the commonest type, where the malaligned eye diverges inwards towards the midline.

Answer 46

**Sight-threatening** complication of DM, resulting from poor glycaemic control = leads to vascular occlusion and leakage from the capillaries that supply the retina, causing **retinal ischaemia, neovascularisation** and, if left untreated, potential **loss of sight.** Symptoms: - Asymptomatic at first - Floaters/dark spots in vision - Blurred or distorted vision - Difficulty seeing at night - sudden vision loss

Answer 47

**Prolonged hypertension leading to damage to the retinal vasculature.** This damage is caused by the **changes in the arteriolar structure, leading to vasoconstriction and leakage.** Signs/symptoms: - **Often asymptomatic** - Blurred vision - Sudden vision loss - Floaters in visual field Management: - Control hypertension; lifestyle modifications, anti-hypertensives - Laser photocoagulation (for neovascularisation or macular oedema) - VEGF inhibitors (for neovascularisation)

Answer 48

**The vitreous gel, a clear substance that fills the space between the lens and the retina in the eye, separates from the retina** **Assoc. w natural aging process (>60s)**, trauma & severe myopia Signs/symptoms *(super similar to retinal detachment)*: - **Photosbia:** sudden flashes of light - **Floaters:** spots or *'cobwebs'* floating in vision, typically caused by vitreous haemorrhage casting a shadow on the retina Management: - Regular fundus checks: looking for complications e.g. retinal tears, retinal detachment = promptly treat

Answer 49

**Separation of the retina from the retinal pigment epithelium (RPE)** Different types of retinal detachment: most common is **rhegmatogenous**, commonly caused by trauma Symptoms: - Painless loss of vision/visual defect - Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal Pigment epithelium) Signs: - RAPD if large area of retina effected - May see tear on opthalmoscopy **NOTE:** If for example there was inferior/nasal retinal detachment in the left eye it would present with superior/temporal field defect

Answer 50

Symptoms: - Sudden, painless loss of vision (severe) - Floaters or shadows in the field of vision (minor) Signs: - Loss of red reflex - May see haemorrhage with opthalmoscope **Find the cause and treat**

Answer 51

- Vascualr aetiology (retinal artery/vein occlusion) - Vitreous Haemorrhage - Retinal detachment - Age-related macular degeneration (ARMD) - wet type - Gluacoma (closed angle) THINK ABC! (A: AMRD, B: Bleed/Blocked blood vessel, C: Closed angle gluacoma)

Answer 52

Symptoms: - Transient painless visual loss - **‘like a curtain coming down’** - Lasts~5mins with full recovery Signs: - Usually nothing abnormal to see on examination **Refer Stroke clinic**

Answer 53

- Giant cell arteritis is an inflammatory condition which can affect the **Posterior ciliary arteries** - wall becomes so inflamed/thickened that the lumen becomes occluded - Patients often have headache/scalp tenderness/ enlarged temporal arteries (= also referred to as 'temporal arteritis') - Vision and life-threatening - Steroids, IV if vision involvement NOTE: strong assoc. with polymyalgia rheumatic

Answer 54

- Cataract - Age-related macular degeneration (dry type) - Refractive error - Glaucoma (open-angle) - Diabetic retinopathy (mainly maculopathy) - Think ABC! (A: AMRD, B: Blur (refractive error), C: Cataract)

Answer 55

**Eye cannot focus image** - Myopia (short-sighted) - Hypermetropia (long-sighted) - Astigmatism (irregular corneal curvature) - Presbyopia (loss of accomodation with aging) - Need glasses!!

Answer 56

**Malignant neoplasm originating from the retina,** and is the most prevalent intraocular tumour in the paediatric population - Hereditary type: Germline mutations in the RB1 gene (a tumour suppressor gene) - Non-hereditary type: somatic mutations in the same gene *Mutations to RB1 are also more associated with increased risk to other cancers, such as **osteosarcoma and soft tissue sarcomas*** Primary clinical sign of retinoblastoma is leukocoria, or a white pupil. Other symptoms include: - Deteriorating vision - Strabismus - Failure to thrive - In developing nations, retinoblastoma often presents with eye enlargement.

Answer 57

**Rapidly growing skin lesion which develops from hair follicles in skin exposed to the sun.** On examination, it appears as a well demarcated, raised papule, surrounded by normal skin. It may be difficult to delineate keratoacanthoma from squamous cell carcinoma so excision is usually recommended.

Answer 58

A developmental defect of cortical visual processing resulting from abnormal visual stimulation during early childhood, which leads to visual impairment - most commonly unilateral, but can affect both eyes. Any cause of reduced visual stimulation in one eye can cause amblyopia. These include: -Squints - Unequal refractive error - Congenital cataracts - Tumours blocking the visual axis Symptoms: - **Reduced visual acuity** - Blurred or cloudy vision - **Double vision (diplopia)** - Poor depth perception - Squinting or closing one eye - Eye fatigue - Strabismus Signs: - **Decreased depth perception** - Suppression - Reduced contrast sensitivity - Anisometropia Treatment: before 8, maybe 10. as early as possible. Cover good eye

Answer 59

CN III, IV, V branches (ophthalmic and maxillary) and CN VII

Answer 60

Deposition of lipids in the periphery of the cornea, resulting in a visible white, blue, or grey opaque ring

Answer 61

**Hypertropia** - upward gaze as superior oblique serves to depress the eye when held in adduction and to intort the eye when the eye is help in primary gaze

Eye problems and stuff Flashcards

(86 cards)