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Flashcards in general ophthalmology Deck (86):
1

A 40-year-old model who enjoys sunbathing is referred to an ophthalmologist with a six month history of vascularisation extending into the nasal aspect of the cornea in her right eye. what does she have?

This lady has a pterygium, which is believed to be related to excessive sun exposure. It is benign but may be removed for cosmesis or if it threatens vision by extending centrally.

2

A 50-year-old man presents to his GP complaining of a foreign body sensation in his left eye. The GP notices that the lower eye lid is inverted. What do you think he has?

entropium.

3

List causes of bilateral cataracts

corticosteroid treatment
Diabetes mellitus
previous radiation
metabolic causes (e.g. hypocalcemia)
congenital
uveitis/inflammation in the eye

4

What is the most important examination to look for optic neuropathy?

RAPD (marcus gunn pupil)

and secondarily
-colour vision
-visual fields

5

ddx of optic neuropathy?

1. GCA (arteritic ischaemic optic neuropathy)
2. AION (non arteritic anterior ischaemic optic neuropathy)
3. tumour (compressive)
4. inflammatory
etc

6

what is non arteritis anterior ischaemic optic neuropathy associated with?

Diabetes, hypertension, hyperlipidemia, sleep apnea; potential increase in use of erectile dysfunction drugs if a crowded disc initially

7

how might we manage wet macular haemorrhoge

intraocular TPA and gas

8

young girl, slightly overweight on the pill comes into ED with blurry vision. What are you worried about?

venous sinus thrombosis
IIH

9

normal IOP range?

12-22 mm Hg

10

what are some symptoms of ectropium?

eyelid is rolls out- and so patients complain that their eyes are watery- incomplete drainage of tear film

11

what is a chalazion?

blocked meibomian glands. Associated with blepharitis

12

which is more common- viral or bacterial conjunctivitis?

viral

13

what are dendritic ulcers on the cornea associated with?

herpes simplex virus conjunctivitis

14

what is hyphaema?

blood in the anterior chamber

15

describe Primary open angle glaucoma and how we treat it

POAG causes a gradual, insidious, painless loss of peripheral visual field. It is initially asymptomatic and the central vision remains good until the end-stage of the disease.

Think TAP:
Timolol
Acetozolamide
Prostaglandin analogues

16

when is acetazolamide contraindicated?

if patient has sulfonamide allergy

17

describe uveitis (encompasses irisitis and posterior uveitis)

Uveitis is inflammation of the uveal tract, which includes the iris, ciliary body and choroid.

The most common symptoms of uveitis are blurred vision, pain, redness, photophobia and floaters. Each symptom is determined by the location of the inflammation such that photophobia and pain are common features of iritis whilst floaters are commonly seen with posterior uveitis.

18

triad of symptoms for irisitis?

The classic presentation entails a triad of eye symptoms: redness, pain and photophobia. Vision can be normal or blurred depending on the degree of inflammation.

19

common symptoms of cataracts?

Symptoms
• Glare with night driving
• Continual repeat changes in prescriptions
• Reduced VA
• Blurry vision
• Washed out colour vision
• Defects in red reflex
Disruption in activities of daily living

20

what type of cataract do diabetic individuals get?

posterior subscapular

21

what sort of cataract is caused by age related degeneration?

nuclear cataracts

22

risk factors for cataracts?

1. Age greater than 65
2. Smoking
3. DM
4. Eye trauma
5. Long term ocular corticosteroid use
6. FHx of congenital cataracts
Uveitis

23

key ix for detecting cataracts?

slit lamp

24

two types of advanced macular degeneration

atrophic/dry

neovascular/wet

25

risk factors for macular degeneration?

smoking
poor diet
increasing age

26

what does 'drusen' mean? what condition do we see drusen?

Drusen are lipofuscian deposits on the retinal pigmented epithelium seen in age related macular degeneration

27

what is the treatment of wet macular degeneration

anti VEGF treatment
macular laser
photodynamic therapy

28

what is the test we use for macular degeneration?

amsler grid

29

treatment protocol for dry macular degeneration

risk factor modulation while watch and wait
specialist referral
antioxidant supplementation

30

what does atropine do to the eye?

dilates it

31

what are some ddx of red eye

chemical injury, conjunctivitis, uveitis, acute closed angle glaucoma, ocular foriegn body, subconjunctival haemorrhage

32

3 types of conjunctivitis?

allergic, viral, bacterial

33

main virus to cause viral conjunctivitis?

adenovirus

34

how is viral conjunctivitis managed?

self limiting. highly infectious though so hand hygeine is extremely important

35

what do we see on slit lamp examination of eyes with iritis?

WCC in anterior chamber, hypopyon, keratic precipitates

36

symptoms of acute closed angle glaucoma?

intense pain, red eye, nausea and vomiting, blurry vision, frontal headache, halos, fixed middilated pupil

37

what are the vision threatening red eye disorders that require immediate referral to opthalmologist and medical attention?

acute glaucoma
orbital cellulitis
chemical injury
hyphaema
scleritis
iritis

38

ddx for sudden PAINFUL loss of vision

Acute angle closure glaucoma
uveitis
corneal ulcer
optic neuritis
giant cell arteritis

39

ddx for sudden PAINLESS loss of vision

embolic retinal artery occlusion
migraine
raised ICP
ischaemic optic neuropathy
Macular degeneration
vitreous haemorrhage

40

what is the pathophys of anterior ischaemic optic neuropathy?

acute decrease in blood supply to the optic nerve head.

41

what do we use to test IOP?

tonometer

42

which is more severe- episcleritis or scleritis?

scleritis

43

A 23-year-old lady presents acutely to her GP with a warm, painful swelling on the nasal aspect of the lower lid. The GP gently presses on the swelling and notes the drainage of pus back through the lacrimal punch. what does she have?

dacryocystitis- inflammation of lacrimal sac

44

List some clinical features of optic neuritis

• Painful uniocular loss of vision
• Afferent pupillary defect
• Swollen optic disc
• Reduced visual acuity- though to varying degrees
Treat with IV methylprednisolone

45

what are cherry red spots on fundoscopy indicate?

central retinal artery occlusion

46

what is a Holmes ardi pupil?

dilated pupil that does not respond to light

47

3 main features of POAG

1. progressive vision loss
2. increased intraocular pressure
3.progressive increase to cup to disc ratio

48

when do you see cotton wool spots on fundoscopy?

retinal vein occlusion

diabetic retinopathy

49

how do you manage ectropium?

ocular lubricants

surgical repair

50

management of blepharitis?

clean eye
good hygiene
topical antibiotics in refractive cases

51

what imaging do we need for orbital cellulitis?

CT orbits

52

what condition do we see punctate erosions on the cornea?

dry eyes

53

what is a condition you have to consider with dry eyes?

sjogren's syndrome

54

what are some common laboratory ix of conjunctivitis?

1. Microscopy (swab)
2. adenovirus PCR
3. herpes simplex PCR
4. varicella zoster PCR
5. RSV PCR

55

what is the main difference between infectious (viral and bacterial) conjunctivitis and allergic conjunctivitis?

allergic conjunctivitis is very itchy

56

what are some causes of subconjunctival haemorrhage?

supra therapeutic warfarin and base of skull fracture

57

do you get visual disturbance with episcleritis?

no

58

what symptoms do you get with scleritis?

ocular pain disturbing sleep
tender globe
vision may be affected

59

should we prescribe topical anaesthetics to someone with a painful eye?

no. as it delays corneal healing.

only used in procedures such as removal of foreign object

60

what is a positive seidel's sign? what does it indicate?

positive sign indicates aqueous humour displacing the dye on the corneal surface

indicates penetrating eye injury and requires urgent ophthalmology review

61

how might you manage chemical injury to the eye?

1. copious irrigation of the affected eye with regular testing of pH
2. admit to hospital
3. topical anaesthetic applied
4. ophthalmologist removes particulate matter

62

what are the common organisms involved in bacterial keratitis

strep pneumonia, staph aureus, pseudomonas

63

what conditions are associated with irisitis?

Spondyloarthropathies
IBD
Vasculitis etc

64

complications of irisitis?

glaucoma, cataract

65

first line treatment of irisitis

topical glucocorticoids
Cycloplegics

66

management of hyphaema?

sleep sitting up
topical steroids and cycloplegics

67

what are some causes of bilateral red eyes?

blepharitis
dry eyes
viral conjunctivitis

68

what usually causes endopthalmititis?

intraocular injury or foreign body
can also be caused by systemic infection

69

how does entropium and ectropium cause blurry vision?

disrupted tear film

70

what causes corneal oedema?

dysfunction of corneal endothelial pump

71

management of corneal oedema?

topical 5% sodium chloride
but definitive management= corneal graft surgery

72

management of keratoconous?

hard contact
corneal transplant

73

which layer of the cornea is affected in keratoconus?

the stroma

74

what is the usual hx for retinal detachment?

flashes of light and floaters in vision

75

some risk factors for central retinal artery occlusion?

atherosclerosis
haematological hyper coagulable states
GCA

76

emergency management of central retinal artery occlusion?

lie patient flat
ocular massage
Azetazolmaide IV stat 500mg

77

what is the difference in pathophysiology for dry and wet macular degeneration?

dry- loss of retinal pigment epithelium and photoreceptors
wet- abnormal growth of leaky vessels in the retinal pigment epithelium

78

what is the most common visual impairment for diabetic retinopathy?

macular oedema

79

what is the ddx for RAPD

optic neuritis
optic nerve compression
CRAO/CRVO
retinal detachment

80

what degenerates in retinosa pigmentosa?

photoreceptor degeneration
rods more so than cones

hence- night vision loss etc

81

what are the two types of diplopia?

monocular vs binocular

82

what type of inflammation is chalazion?

granulomatous inflammation of the melbomium glands

83

describe keratoconus

bulging of the cornea to form a conical shape.
Can be associated with Down's syndrome, atopy or mostly sporadic

84

complications of orbital cellulitis?

cavernous sinus thrombosis
meningitis
brain abscess

85

side effect of timolol

bronchospasm

86

what is a pterygium?

fibrovascular triangular encroachment of epithelial tissue onto the cornea