Flashcards in general ophthalmology Deck (86):
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.
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?
List causes of bilateral cataracts
metabolic causes (e.g. hypocalcemia)
uveitis/inflammation in the eye
What is the most important examination to look for optic neuropathy?
RAPD (marcus gunn pupil)
ddx of optic neuropathy?
1. GCA (arteritic ischaemic optic neuropathy)
2. AION (non arteritic anterior ischaemic optic neuropathy)
3. tumour (compressive)
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
how might we manage wet macular haemorrhoge
intraocular TPA and gas
young girl, slightly overweight on the pill comes into ED with blurry vision. What are you worried about?
venous sinus thrombosis
normal IOP range?
12-22 mm Hg
what are some symptoms of ectropium?
eyelid is rolls out- and so patients complain that their eyes are watery- incomplete drainage of tear film
what is a chalazion?
blocked meibomian glands. Associated with blepharitis
which is more common- viral or bacterial conjunctivitis?
what are dendritic ulcers on the cornea associated with?
herpes simplex virus conjunctivitis
what is hyphaema?
blood in the anterior chamber
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.
when is acetazolamide contraindicated?
if patient has sulfonamide allergy
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.
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.
common symptoms of cataracts?
• 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
what type of cataract do diabetic individuals get?
what sort of cataract is caused by age related degeneration?
risk factors for cataracts?
1. Age greater than 65
4. Eye trauma
5. Long term ocular corticosteroid use
6. FHx of congenital cataracts
key ix for detecting cataracts?
two types of advanced macular degeneration
risk factors for macular degeneration?
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
what is the treatment of wet macular degeneration
anti VEGF treatment
what is the test we use for macular degeneration?
treatment protocol for dry macular degeneration
risk factor modulation while watch and wait
what does atropine do to the eye?
what are some ddx of red eye
chemical injury, conjunctivitis, uveitis, acute closed angle glaucoma, ocular foriegn body, subconjunctival haemorrhage
3 types of conjunctivitis?
allergic, viral, bacterial
main virus to cause viral conjunctivitis?
how is viral conjunctivitis managed?
self limiting. highly infectious though so hand hygeine is extremely important
what do we see on slit lamp examination of eyes with iritis?
WCC in anterior chamber, hypopyon, keratic precipitates
symptoms of acute closed angle glaucoma?
intense pain, red eye, nausea and vomiting, blurry vision, frontal headache, halos, fixed middilated pupil
what are the vision threatening red eye disorders that require immediate referral to opthalmologist and medical attention?
ddx for sudden PAINFUL loss of vision
Acute angle closure glaucoma
giant cell arteritis
ddx for sudden PAINLESS loss of vision
embolic retinal artery occlusion
ischaemic optic neuropathy
what is the pathophys of anterior ischaemic optic neuropathy?
acute decrease in blood supply to the optic nerve head.
what do we use to test IOP?
which is more severe- episcleritis or scleritis?
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
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
what are cherry red spots on fundoscopy indicate?
central retinal artery occlusion
what is a Holmes ardi pupil?
dilated pupil that does not respond to light
3 main features of POAG
1. progressive vision loss
2. increased intraocular pressure
3.progressive increase to cup to disc ratio
when do you see cotton wool spots on fundoscopy?
retinal vein occlusion
how do you manage ectropium?
management of blepharitis?
topical antibiotics in refractive cases
what imaging do we need for orbital cellulitis?
what condition do we see punctate erosions on the cornea?
what is a condition you have to consider with dry eyes?
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
what is the main difference between infectious (viral and bacterial) conjunctivitis and allergic conjunctivitis?
allergic conjunctivitis is very itchy
what are some causes of subconjunctival haemorrhage?
supra therapeutic warfarin and base of skull fracture
do you get visual disturbance with episcleritis?
what symptoms do you get with scleritis?
ocular pain disturbing sleep
vision may be affected
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
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
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
what are the common organisms involved in bacterial keratitis
strep pneumonia, staph aureus, pseudomonas
what conditions are associated with irisitis?
complications of irisitis?
first line treatment of irisitis
management of hyphaema?
sleep sitting up
topical steroids and cycloplegics
what are some causes of bilateral red eyes?
what usually causes endopthalmititis?
intraocular injury or foreign body
can also be caused by systemic infection
how does entropium and ectropium cause blurry vision?
disrupted tear film
what causes corneal oedema?
dysfunction of corneal endothelial pump
management of corneal oedema?
topical 5% sodium chloride
but definitive management= corneal graft surgery
management of keratoconous?
which layer of the cornea is affected in keratoconus?
what is the usual hx for retinal detachment?
flashes of light and floaters in vision
some risk factors for central retinal artery occlusion?
haematological hyper coagulable states
emergency management of central retinal artery occlusion?
lie patient flat
Azetazolmaide IV stat 500mg
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
what is the most common visual impairment for diabetic retinopathy?
what is the ddx for RAPD
optic nerve compression
what degenerates in retinosa pigmentosa?
rods more so than cones
hence- night vision loss etc
what are the two types of diplopia?
monocular vs binocular
what type of inflammation is chalazion?
granulomatous inflammation of the melbomium glands
bulging of the cornea to form a conical shape.
Can be associated with Down's syndrome, atopy or mostly sporadic
complications of orbital cellulitis?
cavernous sinus thrombosis
side effect of timolol