List I - Core Conditions Flashcards

Question

What is the appearance on slit lamp of an acanthoma (parasite) corneal ulcer?

Answer 1

* Stromal infiltrates with ring shaped configuration and hypopyon

Answer 2

``` 1. Eyelid assessment for Blepharitis, meibomian glands dysfunction, ectropian/ entropian, lagophthalmos. 2. Eyelashes assessment for trichiasis/ distichiasis 3. Lacrimal apparatus system assessment for punctal abnormalities, dacryocystitis 4. Conjunctiva assessment for discharge, inflammation, foreign body, papillae, follicle, cicatrization, symblepharon, pseudomembrane, filtering bleb, tube errosion 5. Sclera assessment for any nodule, thinning 6. Cornea assessment for epithelial defects, punctate keratopathy, stromal edema, ulceration, thinning, perforation, infiltrate characteristics (size, shape, location, depth), foreign body, sign of previous corneal surgeries. Fluorescein or rose Bengal staining allow clinicians to identify some organism or underlying cause. For example in cases of viral infections dendritic ulcers are stained with fluorescein and rose Bengal stain. 7. Anterior chamber assessment for presence of any inflammation, look for cells and flare, hypopyon, hyphema ```

Answer 3

* Antibiotic, anti-fungal or antiviral eye drops | * Anti-fungal and Acanthamoeba therapy started only after microbiological evidence in most cases

Answer 4

* Levofloxacin 1.5%

Answer 5

* Natamycin (topical) | * Voriconalzole (intrastromal adjunct)

Answer 6

* Usually 50% heal spontaneously without treatment * Topical examples include - Acyclovir 3% - Ganciclovir 0.15% - Trifluorothymidine 1% * Systemic examples include - Oral acyclovir 400 mg - Famciclovir 500 mg - Valacyclovir 1 gm - Valganciclovir 900 mg

Answer 7

* Combination of - Propamidine Isethionate (Brolene) 0.1% and Polyhexamethylene biguanide 0.02% can be prescribed at an initial stage * Combination of brolene and neomycin or monotherapy with chlorhexidine also gives good results

Answer 8

* Also known as a hordeolum is an acute localised infection or inflammation of the eyelid margin * It describes a bacterial infection of a cilium and adjacent gland with local abscess formation, usually caused by staphylococcal infection

Answer 9

* An external stye (also known as a hordeolum or common stye: - Appears on the eyelid margin - Is caused by infection of an eyelash follicle and its associated sebaceous or apocrine gland * An internal stye (also known as an internal hordeolum or Meibomian stye) - Occurs on the conjunctival surface of the eyelid - Is caused by infection of a Meibomian gland (situated within the tarsal plate)

Answer 10

* Chronic blepharitis - May present with eyelid margin inflammation and teleangiectasia, with possible eyelash crusting - May be itch, irritation and typically soft, oily, yellow scaling around the eyelashes * Acne rosacea - May present with acneiform eruptions of the eyelids as well as oedema, erythema and telangiectasia of the lid margin - Eyes may appear thickened and irregular

Answer 11

* Usually transient and self limiting * Symptoms typically resolve within 5-7 days, once the stye has spontaneously ruptured or been drained * Recurrence is common if there is underlying blepharitis

Answer 12

* Infective conjunctivitis - Infection of the eyelid margin can spread * Periorbital or orbital cellulitis - Infection may spread to other ocular glands or neigbouring tissues (rare), presenting with acute onset unilateral eyelid erythema and oedema which may feel firm, warm and tender - Orbital cellulitis may present with severe pain, blurred vision, double vision, limited and painful eye movements and proptosis (protrusion of the eyeball) * Meibomian cyst (chalazion) - Persistent internal stye may develop into a meibomian cyst which is a chronic inflammatory granuloma due to retained Meibomian gland secretions from a blocked duct situated on the posterior aspect of the eyelid, typically it presents as a painless nodule

Answer 13

* Acute onset of painful, localised swelling (papule or furuncle) near the eyelid margin that develops over several days - Symptoms are usually unilateral but may be bilateral - Eye may water excessively (ephora)

Answer 14

* Swelling is located at the eyelid margin (upper or lower) * Swelling is usually localised around an eyelash follicle * It points anteriorly through the skin * Small, yellow, puss filled spot may be visible * Occasionally, multiple styes involve the entire eyelid

Answer 15

* Swelling is tender and localised on the internal eyelid (although the whole eyelid can be affected) * It is usually further away from the lid margin compared with an external stye * On everting the eyelid, there is localised swelling within the tarsal plate * It may point through the skin or posteriorly through the conjunctiva

Answer 16

* Ask about unilateral or bilateral * Timing * Any previous episodes - is it recurrent in the same location * Any associated symptoms such as changes in visual acuity, double vision, limited or painful eye movements or red eye which may suggest an alternative diagnosis * Triggers for symptoms such as application of cosmetics, fragrances, haircare products, or contact lens use which may suggest a diagnosis on contact dermatitis * Any known co-morbidities or risk factors for the development of a stye such as bleparitis of acne rosacea

Answer 17

* Clinical features of an external (swelling at the eyelid margin) or internal (swelling on the internal eyelid) stye * It is important to evert the lower and upper eyelid during a full examination * Clinical features suggesting a complication such as orbital or periorbital cellulitis, infective conjunctivitis, or a meibomian cyst (chalazion) * Signs of chronic inflammation of surrounding skin (dryness and scaling, lichenification and fissuring) which may suggest an alternative diagnosis such as eczema or blepharitis * Any atypical clinical features such as distortion of the eyelid margin, loss of eyelashes, ulceration or bleeding which may suggest an alternative diagnosis such as malignant eyelid tumour

Answer 18

* Benign eyelid cysts * Contact dermatitis * Atopic eczema * Blepharitis * Dacrocystitis * Acne rosacea * Herpes zoster infection * Herpes simplex infection * Periorbital and orbital cellulitis * Malignant eyelid tumours

Answer 19

* Emergency - if signs of significant periorbital or orbital cellulitis * Urgent (to see an ophthalmologist within 2 weeks) if a malignant eyelid tumour is suspected

Answer 20

* Offer reassurance and self care advice * Advise that a stye is usually self limiting and rarely causes serious complications * Apply a warm compress (for example, using a clean flannel that has been rinsed with hot water) to the closed eyelid of the affected eye for 5-10 minutes 2-4 times per day until the stye drains * Advise the person do not attempt to puncture the stye * Advise to avoid using eye make up or contact lenses until the area has healed

Answer 21

* Consider treatment for symptom relief by: - Plucking the eyelash from the infected follicle, to facilitate drainage - Incision and drainage of the stye using a fine needle if appropriate performed by a professional with suitable experience - Do not routinely prescribe a topical anti-biotic - only if there are clinical features of spreading infection causing conjunctivitis such as copious muco-purulent discharge - Manage any co-exisiting conditions such as blepharitis or acne rosacea to reduce the risk of recurrence - Refer the person to an ophthalmologist for possible specialist incision and drainage if: - Stye does not improve or resolve with management in primary care - An internal stye is particularly large and painful

Answer 22

* Inflammation of the conjunctiva due to allergic or immunological reactions, infection (viral, bacterial or parasitic), mechanical irritation, neoplasia, or contact with toxic substances

Answer 23

* A thin transparent mucous membrane lining the anterior part of the sclera (bulbar conjunctiva) and the under-surface of the eyelids (palpebral conjunctiva) * Inflammation or infection of the conjunctiva causes dilation of conjunctival vessels leading to hyperaemia and oedema of the conjunctiva which may be associated with discharge

Answer 24

* Term used to describe a group of ocular conditions associated with an immunoglobulin E (IgE) hypersensitivity reaction including: - Seasonal allergic conjunctivitis (hay fever conjunctivitis) occurring periodically and is associated with seasonal allergens (such as tree pollen in spring and grass pollen in early summer) - Perennial allergic conjunctivitis - associated with non- seasonal environmental allergens often found in the home (such as house dust mites, mould spores or animal dander) - Vernal keratoconjunctivitis - commonest and most severe in hot arid environments (such as Mediterranean, West Africa and India) - Atopic keratoconjunctivitis - more severe and usually associated with atopic dermatitis of the eyelids - Giant papillary conjunctivitis - often grouped with ocular allergic conditions

Answer 25

* Estimated to affect 15-40% of the population

Answer 26

* IgE response to an allergen * Allergens bind to mast cells in the conjunctiva causing them to degranulate which initiates an inflammatory cascade * Histamine and other inflammatory mediators are then released - Activation of histamine H1 receptors in the conjunctiva leads to ocular itching (the predominant feature of ocular allergy) - Other allergic symptoms (such as redness and swelling [chemosis] of the conjunctiva and eyelid swelling) have been attributed to stimulation of H1 and H2 receptors on blood vessels

Answer 27

* Irritability, decreased concentration and daytime fatigue * Impaired performance at school, at work and in social interactions * Reduced quality of life

Answer 28

* These are more sever forms which can be sight threatening * They can cause: - Thickening to the eyelids, ptosis, conjunctival scarring, corneal neovascularisation, thinning, ulceration and infection and loss of vision and cataract

Answer 29

* Contact lens wear can lead to keratoconjunctivitis or giant cell papillary conjunctivitis * Giant papillary conjunctivitis can lead to intolerance of contact lenses and other ocular foreign bodies such as protheses and sutures

Answer 30

* Most people with allergic conjunctivitis respond well to treatment although seasonal exacerbations occur * Vernal conjunctivitis generally resolves spontaneously after puberty * Atopic keratoconjunctivitis is a chronic disease which persists for year - Corneal complications which can be sight threatening have been reported in 60-70% of people

Answer 31

* Onset and duration of symptoms * Variation of symptoms with location, season and exposure to specific triggers and whether symptoms are unilateral or bilateral * Amount and type of discharge and when it is worst for example on waking from sleep * Itching - severity and whether intermittent or persistent * Changes in vision such as blurring * Eyelid changes such as swelling and flaking * Recent exposure to a person with similar symptoms * Red flags indicating the need for urgent ophthalmology assessment such as: - Reduced visual acuity - Marked eye pain, headache or photophobia - always consider serious systemic conditions such as meningitis in a person presenting with photophobia - Inability to open the eye or keep it open - Red sticky eye in a neonate (within 30 days of birth) - History of trauma (mechanical, chemical or ultraviolet) or possible foreign body - Copious rapidly progressive discharge - may indicate gonococcal infection - Possible infection with a herpes virus - HSV or HZV - assume ocular involvement if lesions are present on the tip of the nose (Hutchinson's sign) - Soft contact lens use with corneal symptoms * Associated symptoms such as: - Nasal congestion, nasal itch, rhinorrhoea and sneezing. - Upper respiratory tract infection. - Enlarged tender lymph nodes. * Past medical history - Atopy - Immunocompromise - Systemic conditions such as RA, sjogrens syndrome, SLE and reactive arthritis - Opthalmic surgery * Drug history - mydriatics, anticholinergis and anticoagulants * Social history including smoking, occupation, hobbies, sexual activities and travel

Answer 32

* Examine all of the following, looking for: - Conunctiva - look for injection, chemosis, follicles, papillae and membranes - Cornea - look for ulceration and opacities - Sclera - look for localised or widespread oedema and erythema which indicates a serious cause such as sleritis - Pupil - assess shape, size and pupillary reaction (with a pen torch) - Visual acuity - Snellen chart and visual fields - Eyelids - look for discharge - Periorbital area - look for swelling and erythema which may indicate orbital or periorbital cellulitis - Blue discolouration below the eye sometimes called the allergic shiner from venous congestion may be present in some people with allergies - Lymph nodes - look for periauricular, submandibular and cervical areas

Answer 33

* Clinical presentation can be non-specific but the hall mark symptom of allergic conjunctivitis is ocular itching (usually bilateral) * Other clinical features may include: - Watery mucoid discharge - Conjunctival redness (hyperaemia injection) - Conjunctival swelling (chemosis) - Conjunctival papillary reaction - Eyelid oedema (swelling) - periorbital oedema can occur in severe cases * Allergic conjunctivitis can coexist with other atopic conditions including: - Rhinitis and rhinosinusitis - Asthma - Urticaria - Eczema

Answer 34

* Vernal keratoconjunctivitis - more common and more severe in hot arid areas - Severe itching and copious fibrinous discharge - Giant papillae on the superior tarsal conjunctiva (due to inflammation of the palpebral conjunctiva), yellow-white points on the limbus (Horner's points) or conjunctiva (Trantas dots), lower eyelid creasing (Dennie's lines) and pseudomembrane formation on the upper lid - Cornea can become involved leading to significant visual impairment * Atopic keratoconjunctivitis - chronic condition - Severe itching, tearing, and swelling - Cornea can become involved leading to significant visual impairment * Giant papillary conjunctivitis - Moderate or severe itching, blurring or vision, intolerance of contact lenses, conjunctival injection and discharge which is typically white, stringy and worst in the morning

Answer 35

* Acute glaucoma * Episcleritis and scleritis * Keratitis * Iritis/uveitis * Corneal ulcer, abrasion or foreign body * Prespetal or preorbital cellulitis * Infective conjunctivitis and other subtypes * Dry eye * Blepharitis * Thyroid eye disease * Subconjunctival haematoma

Answer 36

Arrange urgent assessment by ophthalmology if the person: * Has any clinical features suggestive of a serious cause of red eye. * Has suspected periorbital or orbital cellulitis. * Has severe disease for example corneal ulceration, significant keratitis or presence of pseudomembrane. * Has had recent intraocular surgery. * Has conjunctivitis associated with a severe systemic condition such as rheumatoid arthritis or other reasons for immunocompromise * Has corneal involvement associated with soft contact lens use * Is a neonate with red sticky eye (suggesting ophthalmia neonatorum) - Do not give anti-biotics in the interim, it may interfere with corneal culture - Advise the person to take their contact lenses with them to eye casualty as special diagnostic tests may be required

Answer 37

* Advise the person to avoid allergens for example through dust mite, mould and animal dander control, avoidance of pets and proper ventilation of home and office environments * Washing the hair before going to bed may help reduce allergen exposure * Avoidance of eye rubbing * Application of cold compress to the eyes (for 5-10 minutes once or twice daily) to relieve symptoms * Application of ocular surface lubricants such as saline solution or artificial tears - certain products cannot be used with contact lenses and the manufacturers literature on product characteristics should always be consulted prior to application * Advise the person that after using eye drops or eye ointment, they should not drive or perform other skilled tasks until vision is clear

Answer 38

* If non-pharmacological measures do not provide adequate relief: - Consider prescribing anti-histamine topical or dual action mast cell stabiliser and topical anti-histamine - Advise the person that after using eye drops or eye ointments they should not drive or perform other skilled tasks until vision is clear - If the person is a contact lens wearer advise them that contact lens use should be avoided for the duration of topical treatment - Arrange review in one week to assess therapeutic response, in the interim ensure that the patient is aware of red flag symptoms - Provide patient information for example: - Allergy UK - allergic eye disease

Answer 39

* Eye drops containing anti-histamines that can be used for allergic conjunctivitis include: - Emedastine - licenced for use in seasonal allergic conjunctivitis in adults and children over 3 year apply twice daily

Answer 40

* Azelastine - for use in seasonal allergic conjunctivitis in adults and children over 4 years, apply twice daily, increased if necessary to 4 times daily; licenced for use in perennial conjunctivitis in adults and children over 12 years, apply twice daily, increased if necessary to 4 times daily; maximum duration of treatment 6 weeks * Epinastine - for use in seasonal allergic conjunctivitis in adults and children over 12 years, apply twice daily; maximum duration of treatment 8 weeks * Ketotifen - for use in seasonal allergic conjunctivitis in adults and children over 3 years, apply twice daily * Olopatadine - for use in seasonal allergic conjunctivitis in adults and children over 3 years, apply twice daily; maximum duration of treatment 4 months

Answer 41

* Sodium cromoglicate - for us in allergic conjunctivitis and seasonal keratoconjunctivitis in adults and children apply eye drops 4 times daily * Nedocromil sodium - for use in seasonal and perennial conjunctivitis in adults and children over 6 years — apply twice daily increased if necessary to 4 times daily; maximum 12 weeks treatment for seasonal allergic conjunctivitis

Answer 42

* Acute (persisting for less than 4 weeks) * Chronic (persisting for more than 4 weeks) * Recurrent * Inflammation or infection of the conjunctiva causes dilation of conjunctival vessels leading to hyperaemia and oedema of the conjunctiva which may be associated with discharge

Answer 43

* Rapidly developing severe conjunctivitis, is typically caused by infection with Neisseria gonorrhoea

Answer 44

* Conjunctivitis occurring within the first four weeks of life - it can be infectious or non-infectious * Infectious ON can be caused by Neisseria gonorrhoea or Chlamydia trachomatis and is associated with serious complications if not treated promptly and appropriately

Answer 45

* Acute infective conjunctivitis accounts for approximately 1% of all GP consultations in the UK

Answer 46

* The most common infectious conjunctivitis - up to 80% of infective is viral

Answer 47

* Second most common cause of infectious conjunctivitis - 50-75% of cases

Answer 48

* Chlamydia trachomatis was 6.9/100, 000 live births | * Neisseria gonorrhoea was 3.7/100, 000 live births

Answer 49

* Most common is adenovirus | * Others include herpes simplex, VZV, molluscum contagiosum, EBV, coxsackie and enteroviruses

Answer 50

* Most common bacterial causes are streptococcus pneumoniae, staphylococcus aureus and haemophilus influenzae

Answer 51

* Chlamydia trachomatis (serotypes D-K) * Neisseria gonorrhoea * Haemophilus species * Streptococcus species * Staphylococcs species etc

Answer 52

* Viral - can cause epidemic keratoconjunctivitis develop subepithelial infiltrates, which can cause persistent visual loss and light sensitivity * Bacterial - can cause keratitis in people who wear contact lenses or those who are immunocompromised - caused by Neisseria gonorrhoeae is associated with a high risk of corneal perforation * Ophthalmia neonatorum - Chlamydial ON include superficial corneal vascularization, conjunctival scarring and pneumonia - Gonorrheal ON include corneal scarring, ulceration, panophthalmitis, perforation of the globe and permanent visual impairment * Trachoma - chronic keratoconjunctivitis found mostly in sub-Saharan Africa - Due to recurrent infection with Chlamydia trachomatis in childhood and can cause scarring of the eyelid, conjunctiva and cornea - It is the most common cause of infectious blindness worldwide

Answer 53

* Most cases resolve in about 7 days * Incubation and communicable intervals of conjunctivitis associated with adenoviruses are 5–12 days and 10–14 days respectively

Answer 54

* Most cases resolve within 5 to 10 days | * Contact lens wearers and immunocompromised people have the greatest risk of complications

Answer 55

* Most cases are mild, however, untreated infection (such as gonococcus, chlamydia, pseudomonas or herpes) can lead to serious complications including sight loss and mortality

Answer 56

* Purulent or mucopurulent discharge with crusting of the lids which may be stuck together on waking. * If discharge is mucopurulent and copious, infection with Neisseria gonorrhoeae should be considered. * Mild or no pruritus. * Pre-auricular lymphadenopathy — often seen with hyperacute bacterial conjunctivitis (such as Neisseria gonorrhoea)

Answer 57

* Mild to moderate erythema of the palpebral or bulbar conjunctiva, follicles on eyelid eversion and lid oedema. * Petechial (pin-point) subconjunctival haemorrhages. * Pseudomembranes — may form on tarsal conjunctival surfaces in severe cases. * Epidemic keratoconjunctivitis (due to adenovirus) can lead to pseudomembrane formation along with severe pain, subconjunctival haemorrhage, visual changes and photophobia. * Less discharge (usually watery) than bacterial conjunctivitis. * Mild to moderate pruritus. * Upper respiratory tract infection and pre-auricular lymphadenopathy. * Pharyngoconjunctival fever (due to adenovirus) can lead to fever, pharyngitis, periauricular lymphadenopathy, and bilateral conjunctivitis occasionally with corneal involvement

Answer 58

* Herpes simplex typically presents as unilateral red eye with vesicular lesions visible on the eyelid and watery discharge * Ocular involvement in Herpes zoster infection should be assumed if lesions are present at the tip of the nose (Hutchinson's sign)

Answer 59

* Inflammation may be seen in the superior conjunctiva especially under the upper lid — topical fluorescein may identify corneal staining (epithelial defect)

Answer 60

* Often presents with a chronic (longer than 2 weeks) low-grade irritation and mucous discharge in a sexually active person. Pre-auricular lymphadenopathy may be present * Most cases are unilateral but may be bilateral

Answer 61

* Symptoms usually develop rapidly (over 12–24 hours) with copious mucopurulent discharge, eyelid swelling, and tender preauricular lymphadenopathy * GC conjunctivitis has a high risk of complications including uveitis, severe keratitis and corneal perforation

Answer 62

* Chlamydial ON — typically presents with a watery or mucopurulent discharge about 5–14 days after birth * Gonococcal ON — typically presents within the first 5 days of life but can also present up to 3 weeks after delivery. It is characterised by copious purulent discharge and eyelid swelling which may be severe * Viral ON — most commonly due to adenovirus or Herpes simplex virus. May present with petechial or occasionally large subconjunctival haemorrhages and lymphadenopathy

Answer 63

* If the person does not respond to initial treatment * For severe purulent discharge (which may indicate gonococcal infection) or conjunctivitis in neonates, should be carried out urgently in secondary care

Answer 64

* Serious conditions such as: - Acute glaucoma - Scleritis - Episcleritis - Keratitis - Uvitis - Iritis - Corneal ulcer, abrasion or foreign body * Non-infectious conjunctivitis - Atopic or allergic - Toxic conjunctivitis - Irritative conjunctivitis - Immune mediated inflammation * Other conditions affecting the eye - Naso-lacrimal duct obstruction - Subconjunctival haematoma - Dry eye - Blepharitis - Blepharokeratoconjunctivitis - chronic inflammation of the surface of the eye and eyelids which can lead to corneal scarring, vascularisation and opacity - Thyroid disease

Answer 65

* Reassure that most are self limiting and do not require anti-microbial treatment * Advise that the symptoms may be eased with self care measures such as: - Bathing eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge - Cool compresses applied gently around the eye area - Use of lubricating drops or artificial tears

Answer 66

* Advise the person that most cases of bacterial conjunctivitis are self limiting and resolve within 5-7 days without treatment * Treat with topical antibiotics if required, the options for this include: - Chloramphenicol 0.5% drops - apply 1 drop 2 hourly for 2 days and then 4 times daily for 5 days - Chloramphenicol 1% ointment — apply four times daily for 2 days, then twice daily for 5 days - Fusidic acid 1% eye drops — can be used second line. Apply twice daily for 7 days

Answer 67

* Use topical fluoresein - if it does not identify any corneal staining and the person does not require referral to ophthalmology advise them to: * Advise them to stop contact use immediately * Advise regular eye bathing * Refer to ophthalmology if there is any suspicion of corneal involvement - this is a sight threatening condition

Answer 68

* Foreign body sensation * Watering * Pain * Ask about power tools and consider the possibility of intra-ocular foreign body

Answer 69

* Visible corneal foreign body * Fluorescein stains the cornea around the foreign body * Red eye

Answer 70

* Observe conunctiva and cornea with white light * Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25% * Observe for corneal staining preferably using a blue light * If the presence of a corneal foreign body is confirmed, moisten a cotton bud with a few drops of sodium chloride 0.9% and gently remove the foreign body with the cotton bud, sweeping it away from the corneal surface; only use a needle to remove if you have been trained and have appropriate magnification * Re-examine the eye to ensure that they

Answer 71

* Give patient foreign body information sheet * Give chloramphenicol ointment QDS 5 days * Consider padding and oral analgesia as for corneal abrasion * Offer advice e.g. on the wearing of safety glasses, to prevent another injury

Answer 72

* Hyphema (blood in the anterior chamber of the eye) - in the context of trauma, this presentation warrants urgent referral to an ophthalmic specialist for assessment and management

Answer 73

* Raised intracranial pressure which can develop due to blockage of the angle and trabecular meshwork with erythrocytes

Answer 74

* Strict bed rest is required - excessive movement can re-disperse blood that had previously settle; therefore high risk cases are often admitted * Even isolated hyphema will require daily ophthalmic review and pressure checks initially as an outpatient

Answer 75

* Hyperglycaemia is thought to cause increased retinal blood flow and abnormal metabolism in the retinal vessel walls, this precipitates damage to endothelial cells and pericytes * Endothelial dysfunction leads to increased vascular permeability which causes the characteristic exudates seen on fundoscopy * Pericyte dysfunction predisposes to the formation of microaneurysms * Neovascularisation is thought to be caused by production of growth factors in response to retinal ischaemia

Answer 76

* Background retinopathy - Microaneurysms (dots) - Blot haemorrhages (<=3) - Hard exudates * Pre-proliferative retinopathy - Cotton wool spots (soft exudates; ischaemic nerve fibres) - > 3 blot haemorrhages - Venous beading/looping - Deep/dark cluster haemorrhages - More common in type I DM, treat with laser photocoagulation

Answer 77

* Mild NPDR - 1 or more microaneurysm * Moderate NPDR - Microaneurysms - Blot haemorrhages - Hard exudates - Cotton wool spots, venous beading/looping and intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR * Severe NPDR - Blot haemorrhages and microaneurysms in 4 quadrants - Venous beading in at least 2 quadrants - IRMA in at least 1 quadrant

Answer 78

* Type I DBM - 50% are blind in 5 years - Fibrous tissue forming anterior to retinal disc - Retinal neovascularisation - may lead to vitrous haemorrhage

Answer 79

* Type II DBM - Based on location rather than severity - Hard exudates and other 'background' changes on the macula - Check for visual acuity

Answer 80

* Keith-Wagener classification Stage 1. Arteriolar narrowing and tortuosity, increased light reflex - silver wiring 2. Arteriovenous nipping 3. Cotton-wool exudates, flame and blot haemorrhages 4. Papilloedema

List I - Core Conditions Flashcards

(104 cards)