Flashcards in Eyes And Ears Deck (101):
RFs for cataracts?
Eye trauma, UV exposure, uveitis
3 types of acquired cataracts?
Central (posterior subcapsular)
Infections that can cause congenital cataracts?
Childhood metabolic abnormality associated with cataracts?
Classical symptoms of cataracts?
Painless loss of visual acuity, often initially presenting as reading difficulties
Trouble recognising faces, reading, watching TV etc.
If central - can cause glare and near-vision deterioration
Best sign on examination of eyes of cataracts?
Absent or defective red reflex
Does pinholing improve vision in cataracts?
What cataract is typically associated with DM?
Surgical technique used in repairing cataracts?
Important consideration to be made regarding cataracts and driving?
Does it interfere? Do DVLA need to be informed?
What is glaucoma?
A group of conditions resulting in damage to the optic nerve head and hence loss of the visual field, typically associated with raised intraocular pressure
What is the affected anatomical part of the eye in glaucoma?
Optic nerve head
What is the most common type of glaucoma?
Primary open angle glaucoma
Mechanism behind raised IOP causing glaucoma?
Compression of the microvasculature of the optic nerve head
Progression of primary open angle glaucoma?
Starts peripherally and works inwards - by the time symptoms are manifest the optic nerve may be 90% damaged
RFs generally for glaucoma?
What is the measurement of the irido-corneal angle called?
What 'angle' is affected in glaucoma?
What is tonometry?
Objective measurement of IOP (normally 10-21)
What method is used to measure IOP?
What key pathological changes are observed in the optic disc in glaucoma?
Increasing cup:disc ratio - neuroretinal ring
What is the 'precursor' to glaucoma?
What findings on examination and investigation indicate primary open angle glaucoma?
Tonometry indicating IOP>21 at least once
Open iridocorneal angle
Glaucomatous optic neuropathy indicated on optic disc examination by increasing cup:disc ratio
-> VFD compatible with this damage
Findings in terms of VFDs as POAG progresses?
Arcuate scotoma, thinning of neuroretinal ring (cupping)
Extensive VFDs accompanied by cup:disc ratio 0.9-1
Management options for POAG?
Prostaglandin analogues (latanoprost)
Carbonic anhydrase inhibitors
What side effect can prostaglandin analogue drops have on the eye?
What is primary angle-closure glaucoma?
Intrinsically narrow iridocorneal angle which causes predisposition to angle closure and acutely raised IOP
5 stages of primary angle closure glaucoma?
Latent (anatomical predisposition)
What can secondary angle closure glaucoma be due to?
Hyphaema, DM retinopathy, hypertensive uveitis
Presentation of acute primary angle closure glaucoma?
Pain - orbital/frontal, generalised headache
Blurred vision leading to loss, some Hx of subacute attacks
Systemic signs - nausea, vomiting
What can precipitate the onset of acute angle closure glaucoma?
Dilation of the pupil - pupil gets caught mid-dilated
Examination signs of primary angle closure glaucoma?
Non or minimally reactive pupil, mid-dilated
Red eye, hazy cornea
RFs for normal tension glaucoma?
What is the most common cause of cataracts?
Age-related lens deterioration and opacification
What cataract is typically associated with steroid use?
Central (posterior subcapsular) cataract
What is the 'ageing' cataract?
How is a patient's visual acuity recorded when using a Snellen chart?
Patient distance/lowest line they can read
'Extra' eye tests that you say you'd do?
Near vision testing
Ocular alignment and nystagmus
What does a lesion in the optic chiasm cause?
What does a lesion in the optic tract cause?
A Contralateral homonymous hemianopia
What lesion gives a pie in the sky Contralateral deficit?
A lesion in the lower optical radiations in the temporal lobe
What lesion gives a Contralateral lower quadrant visual field deficit?
Lesion in the upper optic radiations in the parietal lobe
What does an occipital or posterior parietal lobe lesion cause in terms of VFD?
Contralateral homonymous hemianopia with macular sparing
What is the word for one pupil being bigger than the other?
What does a full CN3 lesion cause?
A down and out lesion of the eye
Causes of periorbital swelling?
CCF, nephrotic syndrome
Allergic eye disease
Thyroid eye disease
3 causes of ptosis?
What does eye movement pain with a white eye suggest?
Common cause of 'feeling like there's something in your eye'/dry eyes?
What does ocular pain and a red eye suggest?
What type of chronic visual impairment predisposes to acute angle closure glaucoma?
Hypermetropism (long sightedness)
Common causes of unilateral acute visual loss?
Retinal artery/vein occlusion
What are haloes associated with?
Angle closure glaucoma
What may flashes and floaters precede?
What is cortical blindness?
Often unilateral visual loss with a cortical cause e.g. POCS
Vision absent however pupillary reflexes present in the affected eye +/- macular sparing
What is Riddoch syndrome in the context of cortical blindness?
Ability to perceive light or movement subconsciously but not static objects
What about diabetes particularly are the 2 most important risk factors for developing retinopathy?
What are the two stages of non-proliferative DM retinopathy?
What is the first stage of DM retinopathy?
What 4 peripheral features on fundoscopy are characteristic of background DM retinopathy?
Microaneurysms (bobbly arteries)
Retinal haemorrhage - flame (superficial) or dot/blot (deep)
Hard exudates (oedema and lipid deposition)
Cotton wool spots (soft exudates) - microinfarcts
What feature of background DM retinopathy is suggestive of forthcoming proliferative disease?
Cotton wool spots (microinfarcts)
Signs associated with diabetic maculopathy?
Central damage causing visual blurring
What sign is typically associated with pre-proliferative DM eye disease?
What does venous beading indicate on fundoscopy?
Pre-proliferative DM disease
Characteristics of proliferative DM retinopathy?
VEGF production causing neovasculature, maculopathy and blurring
Two grades that are given on DM eye screening?
R (retina) 0-3
M (macular) 0 or 1
Features of chronic hypertensive retinopathy?
Permanent arterial narrowing
Arteriosclerosis -> copper and silver wiring
What in hypertensive retinopathy is a major RF for branch retinal vein occlusion?
Features of acute severe hypertensive eye disease?
Haemorrhage - flame and dot/blot
Cotton wool spots
Optic disc oedema
What is the most common type of ARMD and how does it present?
Dry - slowly progressive blurring with less central visual loss
Reading problems, blurring, difficulty recognising faces etc.
What investigative findings support a diagnosis of dry AMD?
Atrophic or hyper pigmented retinal pigment epithelium
Flat configuration on OCT
Management of dry AMD?
Low vision aids, dietary advice?
What characterises wet AMD?
More abrupt onset
Signs associated with proliferative retinopathy - VEGF production, haemorrhages, leakage and scarring
What investigative findings support a diagnosis of wet AMD?
Subretinal fluid on OCT and retinal thickening
What is the major management of wet AMD?
Can halt progression and even reverse if done early enough
2 investigations used for AMD?
IVFA (intravenous fluroscein angiography) for differentiation between the two types
OCT (optical coherence tomography) is less invasive and good for looking at layers
4 main symptoms to enquire about in ear history?
Pain and itch (otalgia/pruritis)
Deafness and tinnitus
Vestibular - vertigo and dizziness
Common causes of ear pain and itch?
OM, OE, Ramsey Hunt, trauma, Cancer
Where can pain refer to the ear from?
Purulent otorrhoea causes?
Causes of Mucoid otorrhoea?
Eardrum perf/CSF leak
What does bloodstained otorrhoea suggest?
Trauma - leaking granulation tissue
Common causes of tinnitus?
Is vertigo normally Central or peripheral?
4 common causes of peripheral vertigo?
Acute labyrinthitis/vestibular neuronitis
Drug induced e.g. Gentamycin
Discuss acute labyrinthitis/vestibular neuronitis?
Acute onset vertigo goes on for a few days, may be associated with nausea vomiting malaise and ataxia but no hearing loss or tinnitus
Vertigo attacks triggered by laying on the affected ear, no other focal ear signs
Discuss Ménière's disease?
Recurrent vertigo, persistent tinnitus and progressive SN hearing loss
Central causes of vertigo?
What does otorrhoea with no TM retraction or perforation suggest?
In which direction does the cone of light point on the TM?
Signs of AOM on otoscopy?
Retraction of TM
Perf +/- otorrhoea
What does a bulging TM suggest?
Fluid behind the TM - OME, middle ear effusion
What frequency of tuning fork is used in Rinne's/Webers?
Abnormal results in Weber's test?
Lateralisation towards a conductive loss, away from a SN loss
May be equal if bilateral hearing loss
Which tuning fork test is more sensitive for a conductive hearing loss?
What is a positive Rinne's test?
AC>BC - can be falsely positive in case of SN loss
What is a negative Rinne's and what does it indicate?
BC>AC, indicating a conductive hearing deficit
Common causes of conductive hearing loss?
Middle ear effusion
Middle ear tumours
Potentially inheritable cause of conductive hearing loss?