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Opthalmology > Masters in Surgery > Flashcards

Masters in Surgery Flashcards

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1
Q

Peripheral flashing lights and ‘floaters’

Patient may also complain of ‘black curtain’ or ‘shadow’

A

Rhegmatogenous retinal detachment

  • may have reduced visual acuity
  • may have field defect
  • may have RAPD
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2
Q

What might the retina look like if it has been detached?

A

Anteriorly placed, slightly pale retina may be seen ballooning forwards
-treatment is surgical

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3
Q

Posterior vitreous detachment

A

Floaters and peripheral floating

Symptoms normally settle after a few months

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4
Q

Opthalmoscopy shows pigmentary mottling in the macular region around areas of pale atrophic-looking retina
Well demarcated yellow deposits may be seen in association with these deposits

A

Dry ARMD

-in wet ARMD, haemorrhage or grey subretinal neovascular membrane may be seen

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5
Q

Patients complain of disortion

A

(wet) ARMD

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6
Q

Treatment for ARMD

A

Magnifiers
Photodynamic therapy
anti-VEGF

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7
Q

Amaurosis Fugax

A

Visual disturbance/loss but lasts less than 24 hours

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8
Q

Swollen pale retina with a ‘cherry red spot’

A

Retinal artery occlusion

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9
Q

CRVO treatment

A

Based on treatment of systemic or ocular causes (eg hypertension, diabetes, glaucoma)

Monitor : may develop complications due to development of new vessels (laser treatment may be required to avoid complications from these vessels eg vitreous haemorrhage)

More recently, anti- VEGFs used (VEGF = vascular endothelial growth factor)

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10
Q

Ischaemic optic neuropathy?

A

Sudden, profound visual loss with swollen disc

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11
Q

Sudden, profound visual loss with swollen disc

A

Ischaemic optic neuropathy

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12
Q

Arteritic ION?

A

Medium to large size vessels

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13
Q

Vitrous haemorrhage

A 
Symptoms
Loss of vision
‘Floaters’ 
Signs 
Loss of red reflex
No RAPD – unless associated with other pathology
Management
Identify cause
Vitrectomy for non-resolving cases
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14
Q

Red reflex and RAPD in vitreous haemorrhage?

A

Loss of red reflex but no RAPD (unless associated with other pathology)

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15
Q

Vitreous haemorrhage and bleeding? Where does the bleeding come from?

A

Bleeding occurs from abnormal vessels
Associated with retinal ischaemia and new vessel formation eg after retinal vein occlusion or diabetic retinopathy

Bleeding occurs from retinal vessels
Usually associated with a retinal tear

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16
Q

Retinal detachment

A

Symptoms
Painless loss of vision
Sudden onset of flashes/floaters (mechanical separation of sensory retina from retinal pigment epithelium)

Signs
May have RAPD
May see tear on ophthalmoscopy

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17
Q

Signs and symptoms of wet ARMD

A

Symptoms
Rapid central visual loss
Distortion (metamorphopsia)

Signs
haemorrhage/exudate

TREATMENT = anti-VEGF

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18
Q

Causes of gradual visual loss? (CARDIGAN)

A

Cataract
Age related macular degeneration (dry type)
Refractive error
Diabetic retinopathy (covered in other lecture)
Inherited diseases e.g. retinitis pigmentosa
Glaucoma
Access (to eye clinic) Non-urgent

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19
Q

Management for cataract

A

Management is surgical removal with intra-ocular lens implant if patient is symptomatic

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20
Q

Symptoms and signs of dry ARMD

A

Symptoms
Gradual decline in vision
Central vision ‘missing’

Signs 
Drusen – build up of waste 
	products below RPE
RPE changes – atrophy/
	hyperplasia
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21
Q

Refractive error

A

Myopia (‘short-sighted’)
Hypermetropia (‘long- sighted’)
Astigmatism (usually irregular corneal curvature)
Presbyopia (loss of accommodation with aging)

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22
Q

Open angle glaucoma

A

Symptoms
Often NONE
Optician screening important

Signs
Increased intraocular pressure
Cupped disc
Visual field defect

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23
Q

Arcuate field defect

A

Glaucoma

Increased cup

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24
Q

Open angle glaucoma treatment

A

Treatment - pressure-lowering eye drops or occasionally surgery

Patients need regular monitoring in eye clinic

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25
Chronic inflammation of the lid margins and associated meibomian glands
Blepharitis -eyes are persistently gritty and sore Lid hygiene – daily bathing / warm compresses Supplementary tear drops Oral doxycycline for 2-3 months Very difficult to eradicate
26
Ptosis causes
``` Neurogenic -third nerve cranial palsy -horners syndrome Myogenic -weakness of levator muscle (e.g. senile ptosis) Neuromyogenic -myasthenia gravis Mechanical -cysts or swelling of upper eyelid ```
27
Acute-onset, red, gritty eyes with a purulent discharge that characteristically causes eyelids to be stuck together on wakening
Bacterial conjunctivits | -Most common causative pathogens are staph, strep and haemophilus influenzae
28
Treatment for bacterial conjunctivits
Chloramphenicol topical drops
29
Difference between anterior and posterior blepharitis
Anterior Seborrhoeic (squamous) scales on the lashes Staphylococcal – infection involving the lash follicle Lid margin redder than deeper part of lid Posterior Meibomian gland dysfunction ( M.G.D.) redness is in deeper part of lid lid margin often quite normal looking
30
Staphylococcal blepharitis
lid margin red Lashes distorted, loss of lashes, ingrowing lashes - trichiasis Styes, ulcers of lid margin corneal staining, marginal ulcers (due to exotoxin)
31
Seborrhoeic blepharitis?
Lid margin red Scales ++ Dandruff+ (No ulceration, lashes unaffected)
32
Posterior blepharitis?
``` Lid margin skin and lashes unaffected M.G. openings pouting & swollen Inspissated (dried) secretion at gland openings Meibomian Cysts (chalazia) Associated with Acne Rosacea (50%) ```
33
What is posterior blepharitis associated with?
Associated with Acne Rosacea (50%) | Acne rosacea also associated with corneal ulcer
34
Chalazion?
Opening of meibomian gland blocked and the gland swells to create a chalazion
35
Treatment for blepharitis?
Lid hygiene – daily bathing / warm compresses Supplementary tear drops Oral doxycycline for 2-3 months Very difficult to eradicate
36
Skin condition associated with conjunctivits?
Eczema
37
Acute bacterial conjunctivitis
red sticky eye papillae is self limiting - will clear up in about 14 days without treatment topical antibiotics clear it faster Most common organisms: Staph. aureus, Str. pneumoniae, H. infuenzae
38
Causes of anterior uveitis
Autoimmune Reiter's, Ulc colitis, Ank Spondylitis, Sarcoidosis Infective T.B. Syphylis, Herpes simplex, Herpes zoster Malignancy Eg. leukemia Other idiopathic, traumatic, secondary to other eye disorders etc
39
Anterior uveitis symptoms and signs
``` Symptoms Pain (+ referred pain) Vision may be reduced Photophobia Red eye (circumcorneal) Signs Ciliary injection (i.e. circum-corneal ) Cells & flare in anterior chamber Keratic precipitates Hypopyon Synechiae Small or irregular pupil ```
40
What is episcleritis associated with?
Episcleritis is associated with gout
41
Acute closed angle glaucoma
Circumcorneal injection Cornea cloudy (oedematous) Pupil mid dilated Eye stony hard
42
Scleritis
Scleritis is a chronic, painful, and potentially blinding inflammatory disease that is characterized by edema and cellular infiltration of the scleral and episcleral tissues.
43
What is scleritis commonly associated with
Scleritis is commonly associated with systemic autoimmune disorders, including rheumatoid arthritis, systemic lupus erythematosus, relapsing polychondritis, spondyloarthropathies, Wegener granulomatosis, polyarteritis nodosa, and giant cell arteritis.
44
Conjunctivitis
the most common cause of red eye, is characterized by vascular dilation of the superficial conjunctival blood vessels, cellular infiltration, and exudation. Patients with conjunctivitis usually do not experience visual changes or ocular pain
45
What is blepharitis often associated with?
Conjunctivitis
46
Patients may have decreased visual acuity and photophobia and often complain of severe eye pain. An epithelial defect may be evident on slit-lamp examination or may require fluorescein staining for visualization. Corneal inflammation or infection may be accompanied by anterior chamber reaction.
Keratitis | bacterial keratitis associated with contact lens wearing
47
What is episcleritis associated with?
Gout
48
Cluster headache
Severe one sided headache | Typically around the eye
49
Headache differentials
``` Posterior scleritis Paranasla or paraorbital sinusitis Cluster headache Temporo-mandible joint dysfunction Otitis Giant cell, cranial or temporal arteritis Carotid artery dissection Opthalmic neuralgia ```
50
Autoimmune conditions associated with scleritis?
SLE | Rheumatoid arthritis
51
The importance of tears
``` tear flow / blinking mucous trapping lysozyme immunoglobulin : IgA, IgG complement ```
52
Follicular conjunctivitis
viral (Adeno-, HS, HZ) chlamydial drugs e.g. propine, trusopt
53
Mucosum contagiosum could cause what?
Follicular conjunctivitis
54
Central corneal ulcers
Central (infective) Viral Fungal Bacterial Acanthamoeba
55
Peripheral corneal ulcers
rheumatoid arthritis hypersensitivity e.g. marginal ulcers (+ rarely Wegener’s granulomatosis, polyarteritis etc)
56
Corneal ulcer symptoms and signs
``` Symptoms Pain+ – needle like severe – i.e. if corneal nerves intact _ note corneal sensation is affected by herpes viruses Photophobia Profuse lacrimation Vision may be reduced Red eye - circumcorneal ``` ``` Signs Redness – circumcorneal Corneal reflex (reflection abnormal) Corneal opacity Staining with fluorescein hypopyon ```
57
Dendritic corneal ulcer?
Herpes simplex
58
Exposure keratitis (corneal ulcer)
e.g. thyroid, VII palsy
59
Neurotrophic keratitis? (corneal ulcer)
e.g. herpes zoster | V1
60
Vitamin deficiency which could cause corneal ulcers?
Vitamin A
61
Corneal ulcer treatment
``` Identify cause – ‘corneal scrape’ for gram stain and culture Antimicrobial if bacterial infection Eg ofloxacin hourly Antiviral if herpetic Aciclovir ointment 5 x day Anti-inflammatory if autoimmune Oral / topical steroids ```
62
Anterior uveitis treatment | topical steroids and mydriatics
topical steroids Pred Forte 1% Hourly tapering over 4-8 weeks Mydriatics eg Cyclopentolate 1% BD investigate for systemic associations if recurrent or chronic
63
What is cyclopentolate?
Mydriatic
64
What is episcleritis associated with?
Gout
65
Choroidal folds may be a feature of what?
``` Thyroid eye disease EXTRAOCULAR Proptosis Lid signs retraction oedema lag pigmentation Restrictive myopathy OCULAR Anterior Segment chemosis injection exposure glaucoma Posterior Segment choroidal folds optic nerve swelling ```
66
Most common cause of unilateral and bilateral proptosis?
Thyroid eye disease
67
Stevens-Johnson syndrome
``` Reaction to infection/drugs Very serious Starts as a maculopapular rash and spreads and blisters Stomatitis Conjunctivits Symblepharon Occlusion of lacrimal glands Corneal ulcers ```
68
Posterior blepharitis is associated with what skin condition?
Acne rosacea | -acne rosacea is also associated with corneal ulcers
69
Blepharitis treatment
Lid hygiene – daily bathing / warm compresses Supplementary tear drops Oral doxycycline for 2-3 months Very difficult to eradicate
70
Drugs which could cause follicular conjunctivitis?
Propine | Trusopt
71
Examination of the cornea
``` Use of anaesthetics if photophobic Corneal reflex (reflection) Use of fluorescein Vascularisation Opacity Oedema ```
72
When might hypopyn be present? | hypopyn = inflammatory cells in the anterior chamber of the eye
You can see this with corneal ulcers
73
Corneal ulcer treatment
``` Identify cause – ‘corneal scrape’ for gram stain and culture Antimicrobial if bacterial infection Eg ofloxacin hourly Antiviral if herpetic Aciclovir ointment 5 x day Anti-inflammatory if autoimmune Oral / topical steroids ```
74
Malignancy which could cause anterior uveitis?
Leukaemia
75
``` Ciliary injection (i.e. circum-corneal ) Cells & flare in anterior chamber Keratic precipitates Hypopyon Synechiae Small or irregular pupil ```
Anterior uveitis
76
Neuroendocrine tumour of the adrenal medulla that originates in the chromaffin cells
Phaeochromocytoma

Opthalmology (10 decks)

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