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1
Q

What is glaucoma?

A

Where the intra occular pressure in the eye is raised due to the aqueous humour not being able to leave the eye

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2
Q

What is open angle vs closed angle glaucoma?

A

In acute angle-closure glaucoma: iris bulges forward and seals off the trabecular meshwork from the anterior chamber preventing aqueous humour from draining –> Raised intraocular pressure –> oedema cornea –> blurred vision –> iris sphincter ischaemic so pupil is fixed and dilated

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3
Q

What are the RF for open angle glaucoma?

A

Afro carribean
near sighted (myopia)
fhx
age

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4
Q

What are the sx of open angle glaucoma?

A 
Reduction in peripheral visual fields - tunnel vision
Halos around light at night
Headache
fluctuating pain
blurred vision
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5
Q

How do you diagnose open angle glaucoma?

A

Measure the intra occular pressure via Goldmann applanation tonometry
Differentiate between open and closed using Gonioscopy to measure the iridocorneal angle.
Visual field testing
Fundoscopy to look at optic disc for cupping

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6
Q

What is the mx of open angle glaucoma?

A

In GP give pilocarpine (miotic) and acetazolamide (carbonic anyhydrase inhibitors)
FIRST LINE: Prostaglandins to increase aqueous humor leaving the eye - e.g. latanoprost
Topical beta blockers to decrease aqeous humour production e.g. timolol

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7
Q

What are the RF for closed angle glaucoma?

A 
Asian ethnicity
Female
Age
hypermetropia - long-sighted 
Drugs: anticholinergics, adrenergics
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8
Q

What is the presentation of closed angle glaucoma?

A 
Sx:
V PAINFUL RED EYE!!
Reduced acuity
Halos at night around lights
headache, N+V
Worse at night due to pupil dilating, but may resolve when sleep as that causes it to constrict 
O/E:
Red eye
Firm, hardened eye when palpate
Hazy cornea
fixed and dilated pupil
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9
Q

What is the mx of closed angle glaucoma?

A

Call 999
Get pt to lie back
Adminster pilocarpine and acetazolamide if have it
Opthamologists have more drugs and can do surgery to relieve the eye pressure - iridectomy

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10
Q

How does pilocarpine work?

A

Acts on andrenergic receptors and constricts the eye (miosis)

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11
Q

What is age related macular degeneration?

A

Degeneration of the macular portion of the eye which includes: the choriod (blood supply) and photoreceptors.
Most common cause of blindness in UK

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12
Q

What are the two different types of macular degeneration. Explain difference?

A

Dry (90%): macular degeration

Wet (10%): Dry + new vessels grow which leak blood + fluid. Worse prognosis. Presents more acutely.

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13
Q

What are the RF for AMD?

A

Age
Smoking
CVD
Fhx

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14
Q

What is the presentation of AMD?

A

Sx:
Reduced acuity from the CENTRE of vision
straight lines become wiggly

O/E:
Dresen (lipid deposits) on optic disc with fundoscopy
Scotoma (central visual field loss)
Amsler grid test to see distorted lines
Optical coherence tomography used by specialist

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15
Q

What is the mx of AMD?

A

Dry: Manage RF
Wet: Can get anti- VEGF injections into eye

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16
Q

What is diabetic retinopathy?

A

Diabetes causes damage to the walls of blood vessels —> the vessels then leak their contents (e.g. lipids forming hard exudates or haemorraging) or form microaneurysms (bulging)
Neoproliferation occurs as eye releases growth factors to deal with damage
Nerve damage causes cotton wool spots to form

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17
Q

What are the complications of diabetic retinopathy?

A

Retinal detachment
Cataracts
Vitreous haemorrhage

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18
Q

What is the mx of diabetic retinopathy?

A

Manage the DM!
Laser photocoagulation
Anti-VEGF injections
Surgery if v bad

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19
Q

Explain the pathophysiology of a cataract

A

The lens focuses light onto our retina. In a cataract is where the lens becomes cloudy.

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20
Q

What are the RF for a cataract?

A 
Congential (screened for in NIPE)
AGE!
Diabetes
Smoking
Steroids
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21
Q

How do cataracts present?

A 
A general decreased visual acuity 
Asymmetrical 
Starbursts form around lights at night
Colours become brown/ yellow
Loss of red reflex
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22
Q

What is the mx of cataracts?

A

If symptomatic then can operate - break down lens and replace with an artifical one

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23
Q

What is the pupil?

A

A hole in the iris

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24
Q

How does the pupil constrict vs dilate?

A

Constrict (miosis): Parasympathetic nerve fibres contstrict which travel along the occulomotor (3rd nerve)

Dilate (mydriosis): Sympathetic innervation

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25
What are the causes of abnormal mydriasis?
``` 3rd nerve palsy Raised ICP Drugs e.g. cocaine Trauma Congenital Anticholinergics ```
26
What are the causes of abnormal miosis?
Horner's syndrome Cluster headaches Opioids
27
What is the pathophysiology of a third nerve palsy?
3rd Nerve supplies: all eye muscles apart from superior oblique and abductor so is down and out has parasympathetic nerve fibres so palsy results in mydriasis supplies levator palpebrae superioris so without there is a ptosis
28
What is a possible cause of a 3rd nerve palsy?
3rd nerve travels through the carvenous sinus and along posterior communicating artery so an aneurysm/ thrombosis involving these
29
What is the pathophysiology of Horner's syndrome?
Sympathetic nerve fibres arise from the spinal cord and travel alongside the carotid artery Damage to them results in anhidrosis (no sweating), miosis and ptosis
30
What is a test for Horner's syndrome?
Cocaine eye drops not dilating pupil as noradrenalin is not being released so cocaine does not have usual effect
31
What is blepharitis?
Eye lid inflammation
32
How does blepharitis present?
Gritty, itchy, dry bilateral, red eyelid, may lead to style/ chelazia
33
Mx of blepharitis?
Clean eyelid using baby shampoo. Can use lubricating eye drops
34
What is a stye vs a chalazion?
``` Stye = infection of glands in eye Chalazion = gland blocked so become a cyst ```
35
How do styes vs chalazion present?
``` Stye = Red, inflammed, painful, lump Chalazia = uncomfortable, red, nodule ```
36
How are styes and chalazion mx?
Hot compress, analgesia, topical abx (only if obvious signs of infection like mucopurulent discharge and conjunctivitis)
37
What is entropion vs ectropion?
``` entropion = eyelid turns in ectropion = eyelids turns outwards ```
38
What is periorbital vs orbital cellulitis?
Periorbital = skin and eyelid infection in front of eye Orbital = medical emergency as it is an infection around that involves tissues behind orbital septum - so will cause painful eye movement, visual changes, proptosis, abnormal pupil reactions etc.
39
How does conjunctivitis present?
``` Discharge Red eye bilateral Itchy/ gritty feeling Will effect inner and outer eyelid (so will see red when pull eyelid foward) - unlike blepharitis ```
40
How do you differentiate between viral and bacterial and allergic conjunctivits?
Viral: clear discharge, systemic sx Bacterial: purulent discharge Allergic: itchy, mucus discharge, swelling
41
What is the mx of conjunctivitis?
Clean eye and careful not to spread If bacterial - fuscidic acid or chloramphenicol drops If allergic - antihistamines
42
What is the uvea?
Iris, ciliary body and choroid (layer between retina and sclera)
43
What is anterior uveitis? What is the cause?
Inflammation and infiltration of immune cells in the uvea | Usually autoimmune
44
Causes of acute and chronic uveitis?
Acute: HLA B27 conditions e.g. Ank Spond; IBD; reactive arthirits Chronic: Sarcoidosis, syphilis, lymes, TB, HSV
45
How does anterior uveitis present?
``` Unilateral sx Painful red eye Ciliary flush (Ring of red spreading out from the cornea) Reduced acuity Floaters Miosis Photophobia Lacrimation Abnormally shapred pupil Hypopyon (Collection WBC in anterior chamber so can see yellow fluid in lower iris) ```
46
Mx of anterior uveitis?
Steroids atropine drops - antimuscarinic so will block action of iris sphincter muscles Immunosuppressants
47
Differentials for a red eye
Painless: conjunctivits, episcelritis, subconjunctival haemorrhage (conjunctiva vessel reuptures releasing bld after trauma/ strenuous activity) ``` Painful: glaucoma, anterior uveitis, corneal ulcer/ abrasion, keratitis, foreign body, trauma ```
48
What is episcleritis?
Inflammation of episclera (located between sclera and conjunctiva)
49
How does episcleritis present?
``` Young Segmental (small patch redness) Feels like foreign body but NO pain watering but NO discharge dilated vessels May have IBD/ RA ```
50
How do you mx episcleritis?
Self-limiting | Safety net - if pain could be scleritis so then they need to go hospital
51
What is scleritis?
Inflammation of the whole sclera - much more serious than episcleritis as can perforate
52
What are some associated conditions with scleritis?
``` IBD RA SLE Sarcoidosis GPA - previously wegeners ```
53
How does scleritis present?
``` SEVERE pain Photophobia blue/ violet hue to sclera Eye watering Decresed acuity abnormal pupil reaction to light tender to palpation ```
54
Mx of scleritis?
Any red eye that is potentially slight threatening needs same day opthamologist referral and assessment where they will use NSAIDs/ steroids. immunosuppression
55
How do you diagnose a corneal abrasion?
Use fluorescein stain which will show ulcer/ abrasion in yellow-orange colour
56
What is herpes keratits?
Corneal inflammation specifically caused by herpes but keratitis can be caused by any infection
57
How does herpes keratitis present?
``` Painful red eye Photophobia Vesicles around the eye Foreign body sensation Watering eye Reduced visual acuity Dendritic ulcer seen on fluorescein staining ```
58
What is the mx of herpes keratits?
Refer to opthamology who can give aciclovir and steroids
59
What is retinal detachment?
Retina detaches from choriod - this is a sight threatening emergency as retina needs choriod for blood supply
60
What are the RF for retinal detachement?
``` Age Fhx Diabetic retinopathy Posterior vitreous detachment (where the gel in the eye that pushes the retina up against the choriod becomes less firm with age) Retinal malignancy eye trauma ```
61
How does retinal detachement present?
Sudden peripheral visual loss Blurred vision PAINLESS floaters and flashes
62
Mx of retinal detachement?
Immediately refer to opthamology who will try to reconnect retina and choriod with lazer/ cryotherapy or with surgery eg vitrectomy
63
What is central retinal vein occlusion?
Clot in central retinal vein causing blood to pool in the retina --> macular oedema; haemorrhage and neovascularisation Presents with sudden painless loss of vision and needs immediate opthamology assessment
64
What is central retinal artery occlusion?
Occlusion of the artery via atherosclerosis/ GCA which presents with sudden painless loss of vision AND RAPD; fundoscopy shows pale retina and cherry red spot Need immediate opthamology input
65
What is a RAPD?
a relative afferent pupillary defect. This is where the pupil in the affected eye constricts more when light is shone in the other eye compared when it is shone in the affected eye. This occurs because the input is not being sensed by the ischaemic retina when testing the direct light reflex but is being sensed by the normal retina during the consensual light reflex.
66
What is retinosa pigmentosa?
Congenital degenerations of rods and cones which presents with night blindness!
67
What is vitreous haemorrhage?
Vitreous haemorrhage is bleeding into the vitreous humour. It is one of the most common causes of sudden painless loss of vision. BIG LINK WITH DM! Can't see retina upon fundoscopy unlike retinal vein/ artery occlusion
68
Findings on fundoscopy for diabetic retinopathy
Microaneurysms, flame-shaped haemorrhages, hard exudates, engorged tortuous veins.
69
Findings on fundosocpy for hypertensive retinopathy
Arteriolar constriction (silver/copper wiring), arteries nipping veins where they cross (AV nipping), cotton wool spots or exudates, flame-shaped haemorrhages, papillloedema.
70
What are you worried about with shingles and the eye?
Involvement of nasociliary branch --> Hutchinsons sign --> may involve cornea and lead to lack of corneal sensation i.e. when you touch it it doesnt blink --> risk of corneal ulcer

Opthamology (1 decks)

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