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Y2 Ophthalmology > Glaucoma/Cataracts/Squint/Refractive errors/Trauma > Flashcards

Glaucoma/Cataracts/Squint/Refractive errors/Trauma Flashcards

1
Q

What is glaucoma

A

Chronic diseases characterised by progressive optic neuropathy

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2
Q

What are the types of glaucoma

A

Closed angle
Open angle
Rubeotic glaucoma

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3
Q

What is open angle glaucoma

A

The trabecular meshwork is open but aqueous humour is not drained properly due to increased resistance

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4
Q

What is closed angle glaucoma

A

The trabecular meshwork is blocked hence aqueous humour cannot be drained

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5
Q

What is rubeotic glaucoma

A

New vessel formation in diabetic eye disease causing obstruction of the trabecular meshwork

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6
Q

Risk factors of open angle glaucoma

A

Increasing age
Raised Intraocular pressure
Genetics
Afro-Carribean descent
Myopia
Hypertension
Diabetes
Steroids use

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7
Q

Risk factors of closed angle glaucoma

A

Increasing age
Asian ethnicity
Hypermetropia - long sightedness

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8
Q

Which risk factor for open angled glaucoma is a key modifiable risk factor

A

Raised intraocular pressure

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9
Q

Difference between open and closed angle glaucoma

A

OAG is more chronic and gradual whereas CAG is more acute

OAG trabecular meshwork is patent whereas CAG it is not

OAG does not cause pain whereas CAG causes severe pain

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10
Q

Symptoms of open angle glaucoma

A

Usually asymptomatic and only detected during eye checks because it occurs gradually

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11
Q

Symptoms of closed angle glaucoma

A

Acute red eye
Painful sudden visual loss
Semi-dilated pupil
Symptoms worse with pupil dilation
Headache
Nausea
Vomiting

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12
Q

Investigations for open angle glaucoma

A

Assess visual field
Fundoscopy
Slit lamp examination
Applanation tonometry
central corneal thickness measurement

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13
Q

Why is slit lamp examination used to examine for open angle glaucoma

A

to assess the optic nerve

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14
Q

What is applanation tonometry used for

A

To measure the intraocular pressure

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15
Q

What may fundoscopy see in open angle glaucoma

A

Optic disc cupping
Pale optic disc
Bayonetting of vessels

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16
Q

What is bayoneting of vessels

A

When vessels have breaks as they disappear into the deep cup then re-appear at the base

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17
Q

What causes enlarging of optic cup

A

Due to loss of optic nerve fibres

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18
Q

Management of open angled glaucoma

A
  1. Prostaglandin analogue eye drop
  2. Beta blockers
    - carbonic anhydrase inhibitors
    - sympathomimetic eyedrops
  3. Surgery
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19
Q

Example of prostaglandin analogue eye drop

A

latanoprost

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20
Q

Function of prostaglandin analogue eye drop

A

Increase uveoscleral outflow (drainage of aqueous humour through the uvea and out of the eye instead of through trabecular meshwork)

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21
Q

Side effects of prostaglandin analogue eye drop

A

Brown pigmentation of iris
Increased eyelash length

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22
Q

Example of beta blockers used for open angle glaucoma

A

timolol
Betaxolol

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23
Q

Function of beta blockers in open angle glaucoma

A

To reduce aqueous humour production

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24
Q

Contraindications of beta blockers for open angle glaucoma

A

Asthamtics
Patients with heart block

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25
Q

Example of sympathomimetics for open angled glaucoma

A

Brimonidine - alpha 2 adrenoceptor agonist

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26
Q

Function of brimonidine (sympathomimetics) for open angled glaucoma

A

Reduce aqueous humour production
increase outflow

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27
Q

Contraindications of sympathomimetics for open angled glaucoma

A

Patients taking tricyclic antidepressants / other antidepressants such as MAOI

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28
Q

Side effect of sympathomimetics

A

Hyperaemia

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29
Q

Example of carbonic anhydrase inhibitors used for open angle glaucoma

A

Dorzolamide

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30
Q

Function of carbonic anhydrase inhibitors used for open angle glaucoma

A

Reduce aqueous humour production

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31
Q

management of closed angle glaucoma

A

Urgent referral
Topical parasympathomimetic / beta blockers / alpha- 2 agonists
IV acetazolamide
Laser surgery

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32
Q

Example of parasympathomimeticc for closed angle glaucoma

A

Pilocarpine

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33
Q

Example of alpha 2 agonist for closed angle glaucoma

A

Apraclonidine

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34
Q

Function of pilocarpine for closed angle glaucoma

A

Causes contraction of ciliary muscles to open the trabecular meshwork

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35
Q

What are cataracts

A

When the lens of the eye gradually opacifies

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36
Q

Cataract is the most common cause of

A

Curable blindness

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37
Q

Risk factors of cataracts

A

Women
Increasing age

38
Q

Causes of cataracts

A

Normal aging process
Smoking
Diabetes
Steroids
UVB radiation damage
Hypocalcaemia

39
Q

Symptoms of cataracts

A

Gradual visual loss
Faded colour vision
Glare - lights appear brighter than usual
Halos around light

40
Q

Clinical sign of cataract

A

Loss of red reflex

41
Q

How does cataract cause defect in red reflex

A

because the cloudiness of lens makes it difficult for light to reach the retina

42
Q

Management of cataracts

A

Surgery to remove the lens and replace with new artificial one

43
Q

Complications of cataract surgery

A

Posterior capsule opacification
Retinal detachment
Posterior capsule rupture
Endopthalmitis

44
Q

What is posterior capsule opacification

A

Opacification of the lens capsule that surrounds the new implanted lens

45
Q

What is endopthalmitis

A

Inflammation of aqueous +/- vitreous humour

46
Q

What does emmetropia mean

A

No refractive error, light focused on retina

47
Q

What does ametrophia mean

A

Light focused in front or behind of retina

48
Q

What does anisometrophia mean

A

Significant difference between right and left ametropia

49
Q

What causes myopia

A

Increased axial length of eye
Light focusd in front of retina

50
Q

management of myopia

A

Glasses with concave lenses

51
Q

Myopia can lead to

A

Open angle glaucoma

52
Q

What causes hyperopia

A

Decrease in axial length of eye
Light focused behind the retina

53
Q

Management of hyperopia

A

Glasses with convex lenses

54
Q

Hyperopia can lead to

A

Closed angle glaucoma

55
Q

What is strabismus (squint)

A

when the eyes do not properly align with each other when focusing to look at an object

56
Q

When does squint usually present

A

During childhood

57
Q

Risk factors of squint

A

Premature birth
Cerebral palsy
Family history of squint

58
Q

Types of squint

A

Concomitant
Paralytic

59
Q

What is concomitant squint

A

Squint due to imbalance in extra ocular muscles

60
Q

What is paralytic squint

A

Squint du to paralysis of extra ocular muscles

61
Q

Causes of squint

A

Idiopathic
Congenital
Cranial nerve palsies
Intracranial infection
Myopathy - myasthenia gravis

62
Q

Symptoms of squint

A
  • Misalignment of the eyes
  • Reduced visual acuity
  • Diplopia
  • Asthenopia (eye strain, fatigue)
63
Q

If uncorrected, what can squint lead to

A

Amblyopia - when the brain fails to process inputs from one eye and over time favours the other eye

64
Q

Investigations for squint

A

Corneal light reflection test - detect squint
Cover test - identify the nature of squint

65
Q

Describe the corneal light reflection test

A

Hold a light source 30cm from the child’s face
See if the light reflects symmetrically on the pupils

66
Q

Describe the cover test

A

ask the child to focus on an object
cover one eye
observe movement of uncovered eye

67
Q

Describe the results of cover test

A

Outward movement of eye -> esotropia
Inward movement of eye -> exotropia
Downward movement of eye -> hypertrophic
Upward movement of eye -> hypotropia

68
Q

Management of squint

A

Referral to secondary care
Cover the unaffected eye using an eye patch to prevent development of amblyopia

69
Q

What is a blowout fracture

A

When there is a fracture of one of the orbital walls but the orbital rim remains intact

70
Q

Which orbital wall is most likely to undergo a blowout fracture

A

Inferior orbital wall

71
Q

Why do blow out fractures occur

A

Because the bone forming the orbital rim is strong but the orbital plates are thinner hence the force can transfer to the thinner orbital plates and cause fracture there

72
Q

What can happen in a blow out fracture

A

Orbital fat can prolapse into maxillary sinus
Can trap infraorbital nerves
Can trap inferior rectus muscle

73
Q

What occurs if infraorbital nerves are trapped in a trapdoor fracture

A

Parasethesia of the face

74
Q

What occurs if inferior rectus muscle is trapped in a trapdoor fracture

A

Unable to look down -> diplopia (since the other side is not affected)

75
Q

What can cause subconjunctival haemorrhage

A

After strenuous activities - heavy coughing / weight lifting / straining when constipiated
Trauma

76
Q

What is hyphema

A

Blood in the anterior chamber of the eye

77
Q

What can hyphema lead to

A

Raised intraocular pressure -> risk of vision loss

78
Q

Management of hyphema

A

Urgent referral to ophthalmologist
Strict bed rest
May require admission

79
Q

Why is strict bed rest required in hyphema

A

Because movements can redisperse blood that had previously settled

80
Q

What must be assessed after an ocular trauma

A

Orbital compartment syndrome

81
Q

What are the features of orbital compartment syndrome

A

Eye pain / swelling
Proptosis
Rock hard eyelids
RAPD

82
Q

Management of orbital compartment syndrome

A

Urgent surgery to decompress the orbit

83
Q

Which parts of the eye are down-regulated immune environment

A

Cornea
Sclera
Retina
Choroid
Vitreous humour

84
Q

Which part of the eye has a lymphatic drainage? What does this imply

A

Conjunctiva
This means that immune cells can regulate around here

85
Q

What does immune privilege mean

A

Sites that are able to tolerate the introduction of antigens without causing an inflammatory cascade

86
Q

What is the benefit of immune privilege

A

It protects these structures in the eye from ocular inflammation

87
Q

What causes immune privilege

A

Lack of lymphatic drainage / blood
Lack of APC
Immunosuppressive molecules
Blood tissue barrier

88
Q

What is an disadvantage of immune privilege of the eye

A

Because the immune system of the eye is separated from the systemic immune system, the eye has a higher chance of developing autoimmune reaction to an antigen that the systemic immune system has already tolerated (= the eye immune system does not know this antigen is not harmful because the systemic immune system cannot communicate with it)

89
Q

Example of disadvantage of immune privilege

A

Sympathetic ophthalmia

90
Q

What is sympathetic ophthalmia

A

Bilateral uveitis after trauma to eye due to the exposure of intra-ocular antigens which were previously immune-privileged, causing autoimmune reaction to both eyes

91
Q

What can be used to see corneal lacerations

A

Fluorescein stain

Y2 Ophthalmology (8 decks)

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