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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
Example of sympathomimetics for open angled glaucoma
Brimonidine - alpha 2 adrenoceptor agonist
26
Function of brimonidine (sympathomimetics) for open angled glaucoma
Reduce aqueous humour production increase outflow
27
Contraindications of sympathomimetics for open angled glaucoma
Patients taking tricyclic antidepressants / other antidepressants such as MAOI
28
Side effect of sympathomimetics
Hyperaemia
29
Example of carbonic anhydrase inhibitors used for open angle glaucoma
Dorzolamide
30
Function of carbonic anhydrase inhibitors used for open angle glaucoma
Reduce aqueous humour production
31
management of closed angle glaucoma
Urgent referral Topical parasympathomimetic / beta blockers / alpha- 2 agonists IV acetazolamide Laser surgery
32
Example of parasympathomimeticc for closed angle glaucoma
Pilocarpine
33
Example of alpha 2 agonist for closed angle glaucoma
Apraclonidine
34
Function of pilocarpine for closed angle glaucoma
Causes contraction of ciliary muscles to open the trabecular meshwork
35
What are cataracts
When the lens of the eye gradually opacifies
36
Cataract is the most common cause of
Curable blindness
37
Risk factors of cataracts
Women Increasing age
38
Causes of cataracts
Normal aging process Smoking Diabetes Steroids UVB radiation damage Hypocalcaemia
39
Symptoms of cataracts
Gradual visual loss Faded colour vision Glare - lights appear brighter than usual Halos around light
40
Clinical sign of cataract
Loss of red reflex
41
How does cataract cause defect in red reflex
because the cloudiness of lens makes it difficult for light to reach the retina
42
Management of cataracts
Surgery to remove the lens and replace with new artificial one
43
Complications of cataract surgery
Posterior capsule opacification Retinal detachment Posterior capsule rupture Endopthalmitis
44
What is posterior capsule opacification
Opacification of the lens capsule that surrounds the new implanted lens
45
What is endopthalmitis
Inflammation of aqueous +/- vitreous humour
46
What does emmetropia mean
No refractive error, light focused on retina
47
What does ametrophia mean
Light focused in front or behind of retina
48
What does anisometrophia mean
Significant difference between right and left ametropia
49
What causes myopia
Increased axial length of eye Light focusd in front of retina
50
management of myopia
Glasses with concave lenses
51
Myopia can lead to
Open angle glaucoma
52
What causes hyperopia
Decrease in axial length of eye Light focused behind the retina
53
Management of hyperopia
Glasses with convex lenses
54
Hyperopia can lead to
Closed angle glaucoma
55
What is strabismus (squint)
when the eyes do not properly align with each other when focusing to look at an object
56
When does squint usually present
During childhood
57
Risk factors of squint
Premature birth Cerebral palsy Family history of squint
58
Types of squint
Concomitant Paralytic
59
What is concomitant squint
Squint due to imbalance in extra ocular muscles
60
What is paralytic squint
Squint du to paralysis of extra ocular muscles
61
Causes of squint
Idiopathic Congenital Cranial nerve palsies Intracranial infection Myopathy - myasthenia gravis
62
Symptoms of squint
- Misalignment of the eyes - Reduced visual acuity - Diplopia - Asthenopia (eye strain, fatigue)
63
If uncorrected, what can squint lead to
Amblyopia - when the brain fails to process inputs from one eye and over time favours the other eye
64
Investigations for squint
Corneal light reflection test - detect squint Cover test - identify the nature of squint
65
Describe the corneal light reflection test
Hold a light source 30cm from the child's face See if the light reflects symmetrically on the pupils
66
Describe the cover test
ask the child to focus on an object cover one eye observe movement of uncovered eye
67
Describe the results of cover test
Outward movement of eye -> esotropia Inward movement of eye -> exotropia Downward movement of eye -> hypertrophic Upward movement of eye -> hypotropia
68
Management of squint
Referral to secondary care Cover the unaffected eye using an eye patch to prevent development of amblyopia
69
What is a blowout fracture
When there is a fracture of one of the orbital walls but the orbital rim remains intact
70
Which orbital wall is most likely to undergo a blowout fracture
Inferior orbital wall
71
Why do blow out fractures occur
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
What can happen in a blow out fracture
Orbital fat can prolapse into maxillary sinus Can trap infraorbital nerves Can trap inferior rectus muscle
73
What occurs if infraorbital nerves are trapped in a trapdoor fracture
Parasethesia of the face
74
What occurs if inferior rectus muscle is trapped in a trapdoor fracture
Unable to look down -> diplopia (since the other side is not affected)
75
What can cause subconjunctival haemorrhage
After strenuous activities - heavy coughing / weight lifting / straining when constipiated Trauma
76
What is hyphema
Blood in the anterior chamber of the eye
77
What can hyphema lead to
Raised intraocular pressure -> risk of vision loss
78
Management of hyphema
Urgent referral to ophthalmologist Strict bed rest May require admission
79
Why is strict bed rest required in hyphema
Because movements can redisperse blood that had previously settled
80
What must be assessed after an ocular trauma
Orbital compartment syndrome
81
What are the features of orbital compartment syndrome
Eye pain / swelling Proptosis Rock hard eyelids RAPD
82
Management of orbital compartment syndrome
Urgent surgery to decompress the orbit
83
Which parts of the eye are down-regulated immune environment
Cornea Sclera Retina Choroid Vitreous humour
84
Which part of the eye has a lymphatic drainage? What does this imply
Conjunctiva This means that immune cells can regulate around here
85
What does immune privilege mean
Sites that are able to tolerate the introduction of antigens without causing an inflammatory cascade
86
What is the benefit of immune privilege
It protects these structures in the eye from ocular inflammation
87
What causes immune privilege
Lack of lymphatic drainage / blood Lack of APC Immunosuppressive molecules Blood tissue barrier
88
What is an disadvantage of immune privilege of the eye
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
Example of disadvantage of immune privilege
Sympathetic ophthalmia
90
What is sympathetic ophthalmia
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
What can be used to see corneal lacerations
Fluorescein stain

Y2 Ophthalmology (8 decks)

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