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HYMS Y4 > KEY OPHTHALMOLOGY > Flashcards

KEY OPHTHALMOLOGY Flashcards

1
Q

What is glaucoma?

A

Optic nerve damage caused by a significant rise in IOP.

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2
Q

Pathophysiology in open angle glaucoma?

A

Gradual increase in resistance through trabecular meshwork
More difficult for aqueous humour to pass through
Pressure slowly builds

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3
Q

Pathophysiology in acute angle closure glaucoma?

A

Iris bulges forwards and seals off trabecular meshwork
Prevents aqueous humour from being able to drain away
Leads to continual build up of pressure

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4
Q

Effect of increased IOP on optic disc?

A

Cupping of optic disc.

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5
Q

Presentation of open angle glaucoma?

A 
Asymptomatic for a long time. 
Affects peripheral vision (leads to tunnel vision)
Fluctuating pain + headaches
Blurred vision
Haloes around lights
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6
Q

Gold standard way to measure IOP?

A

Goldmann application tonometry

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7
Q

Management of open angle glaucoma?

A

1st line = prostaglandin eye drops (Latanoprost).
2nd line = timolol, carbonic anhydrase inhibitors, sympathomimetics.
3rd line = trabeculectomy.

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8
Q

When is treatment of open angle glaucoma usually started?

A

At an IOP of 24mmHg or above.

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9
Q

MoA of Latanoprost (prostaglandins eye drops)?

A

Increase uveoslceral outflow.

SEs: eyelash growth, eyelid pigmentation, iris pigmentation (browning).

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10
Q

MoA of Timolol?

A

Reduce production of aqueous humour.

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11
Q

MoA of Carbonic anhydrase inhibitors?

A

Reduce production of aqueous humour.

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12
Q

MoA of sympathomimetics?

For example, Brimonidine.

A

Reduce production of aqueous fluid + increase uveoscleral outflow.

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13
Q

Surgical option for open angle glaucoma?

A

Trabeculectomy if eyedrops options are ineffective.

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14
Q

Medications which can precipitate acute angle closure glaucoma?

A 
Adrenergic medications (noradrenaline)
Anticholinergic medications (Oxybutynin)
TCAs
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15
Q

Acute angle closure glaucoma presentation?

A

Severely painful red eye
Blurred vision
Haloes around lights
Headache, nausea + vomiting

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16
Q

Signs of angle closure glaucoma?

A 
Red, teary eye
Hazy cornea
Decreased visual acuity
Dilatation of affected pupil
Fixed pupil size
Firm eyeball on palpation
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17
Q

Initial management of acute angle closure glaucoma?

A

Pilocarpine (2% for blue eyes, 4% for brown)
Acetazolomide
Analgesia + antiemetic if required.

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18
Q

Secondary care management of acute angle closure glaucoma?

A 
Pilocarpine
Acetazolomide
Hyperosmotic agents (glycerol/ mannitol)
Timolol
Dorzolamide
Brimonidine
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19
Q

MoA of hyper osmotic agents (glycerol/ mannitol)?

A

Increase osmotic gradient between blood and fluid in the eye.

20
Q

MoA of pilocarpine?

A

Acts on muscarinic receptors to cause constriction of the pupil.

21
Q

MoA of acetazolamide?

A

Carbonic anhydrase inhibitor which reduces production of aqueous humour.

22
Q

Surgical management option for definitive management of acute angle closure glaucoma?

A

Laser iridotomy

23
Q

Management dry age related macular degeneration?

A

Lifestyle measures

24
Q

Management in wet age related macular degeneration?

A

Anti-VEGF medications (Ranibizumab/ bevacizumab/ pegaptanib).

**These are injected directly into the vitreous chamber.

25
Q

Two categories of diabetic retinopathy?

A

Proliferative and non-proliferative.

26
Q

Findings in non-proliferative diabetic retinopathy?

A

Mild - micro aneurysms
Moderate - micro aneurysms, blot haemorrhages, hard exudates, cotton wool spots
Severe - blot haemorrhages + micro aneurysms in 4 quadrants.

27
Q

Findings in proliferative retinopathy?

A

Neovascularisation

Vitreous haemorrhage

28
Q

Findings in diabetic maculopathy?

A

Macular oedema

Ischaemic maculopathy

29
Q

Management of diabetic retinopathy?

A

Photocoagulation
Anti-VEGF
Vitreoretinal surgery

30
Q

Stage 1 hypertensive retinopathy?

A

Mild narrowing of arterioles

31
Q

Stage 2 hypertensive retinopathy?

A

Focal constriction of blood vessels

AV nipping

32
Q

Stage 3 hypertensive retinopathy?

A

Cotton wool patches
Hard exudates
Flame haemorrhages

33
Q

Stage 4 hypertensive retinopathy?

A

Papilloedema

34
Q

Presentation of cataracts?

A

Very slow reduction in vision
Progressive blurring
Change in colour vision (colours more yellow/ brown)
Starbursts appearing around lights, particularly at night time

35
Q

Rare but serious complication of cataract surgery?

A

Endophthalmitis

36
Q

Cause of blepharitis?

A

Dysfunctional meibomian glands.

37
Q

Blepharitis presentation?

A

Inflammation of eyelid margins.

Gritty, itchy and dry sensation in the eyes.

38
Q

Management of blepharitis?

A

Hot compresses + gentle cleansing of the eyelid margins to remove debris.

39
Q

What is entropion?

A

Eyelashes turn inwards.

40
Q

What is ectropion?

A

Outwards turning of the eyelid.

41
Q

What is periorbital cellulitis?

A

Infection of eyelid and skin in front of orbital septum.

42
Q

What is orbital cellulitis?

A

Infection around eyeball involving tissues behind orbital septum.

43
Q

Features that differentiates orbital cellulitis from periorbital cellulitis?

A

Orbital cellulitis = pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball.

44
Q

3 causes of painless red eye?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

45
Q

Pathognomonic findings of anterior uveitis?

A

ciliary flush (red spreading from cornea outwards)
photophobia
abnormally shaped pupil

HYMS Y4 (8 decks)

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