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YR6 Rotations > Medicine - Ophthalmology > Flashcards

Medicine - Ophthalmology Flashcards

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1
Q

Esotropia

A

Form of strabismus
1 eye deviates towards the nose

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2
Q

Strabismus

A

eye misalignment caused by imbalance in muscles holding the eye

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3
Q

Myopia

A

Near-sightedness
Light focuses in front of retina
Eye too long

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4
Q

Hyperopia/ Hypermetropia

A

Far-sightedness
Light focuses (theoretically) beyond retina
Eye too short

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5
Q

Presybopia

A

Age related loss of reading vision
Diminishing flexibility of lens

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6
Q

Emmetropia

A

No refractive error or visual defects

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7
Q

Amblyopia

A

“Lazy eye”
vision development disorder in which an eye fails to achieve normal visual acuity, even with prescription glasses or contact lenses

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8
Q

Metamorphopsia

A

Straight lines appear wavy

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9
Q

Astigmatism

A

Cornea or crystalline lens of the eye (or both) are not the ideal spherical ‘football’ shape, but more like the pointed end of a rugby ball.
Eye focuses light at 2 separate points on the retina, which blurs + distorts vision.

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10
Q

Where is the macula? What is it responsible for?

A

Central part of retina
Sharp, detailed vision
Depression/ pit = Fovea: greatest VA

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11
Q

Give differentials for sudden painless visual loss

A

Vitreous haemorrhage
Retinal detachment
Retinal migraine
Central retinal vein occlusion
Central retinal artery occlusion
Non-arteritic ischaemic optic neuropathy

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12
Q

Give differentials for painful visual loss

A
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13
Q

How can you tell which eye is being examined on fundoscopy pictures?

A

Optic disc usually on nasal side of patient

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14
Q

Give the 4 features of Horner’s syndrome

A

Miosis (constricted)
Ptosis
Enopthalmos (sunken eye/ narrow palpebral aperture)
Anhidrosis (loss of sweating 1 side)

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15
Q

What feature distinguishes congenital Horner’s syndrome from other causes?

A

Heterochromia: difference in iris colour

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16
Q

Which causes of Horner’s syndrome cause anhidrosis of the face, arm and trunk?

A

Central lesions
Stroke
Syringomyelia
MS
Tumour
Encephalitis

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17
Q

Which causes of Horner’s syndrome cause anhidrosis of the face?

A

Pre-ganglionic lesions
Pancoast’s Tumour
Thyroidectomy
Trauma
Cervical rib

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18
Q

Which causes of Horner’s syndrome DONT cause anhidrosis?

A

Post-ganglionic lesions
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache

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19
Q

Give signs and symptoms caused by Pancoast tumours

A

Ipsilateral invasion of sympathetic cervical plexus causes:
Horner’s syndrome
Shoulder + arm pain (brachial plexus invasion)
Hoarseness (pressing on recurrent laryngeal nerve)

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20
Q

3 features of an Adie pupil

A

Tonically dilated pupil
Slowly reactive to light with more definite accommodation response

Commonly seen in females accompanied by absent knee/ ankle jerks

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21
Q

What causes an Adie pupil?

A

Damage to parasympathetic innervation of eye due to viral/ bacterial infection

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22
Q

What is characteristic of a Marcus-Gunn pupil?

A

RAPD seen in swinging light test
Pupils constrict less + therefore appear to dilate when light is swung from unaffected to affected side

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23
Q

What are the most common causes of a Marcus-Gunn pupil?

A

Damage to optic nerve
Severe retinal disease

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24
Q

What is Hutchinson’s pupil?

A

Unilaterally dilated pupil, unresponsive to light

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25
What does Hutchinson's pupil result from?
Compression of occulomotor nerve of same side by intracranial mass e.g. tumour, haematoma
26
What are Argyll-Robertson pupils?
Bilaterally small irregular pupils that accommodate but don't react to bright light
27
Give 2 causes of Argyll-Robertson pupils
Neurosyphilis Diabetes mellitus
28
What mneumonic can be used to remember the features of Argyll-Robertson pupils?
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
29
Recall the features of optic atrophy
Mnemonic: Optic Atrophy Can Reduce Sight Optic disc pale Acuity reduced Colour vision reduced (especially red) RAPD (relative afferent pupil defect) Scomata centrally
30
What are the 2 most common causes of optic atrophy?
MS Glaucoma
31
Recall 4 red flags when assessing red eyes
Photophobia Poor vision Fluorescein staining reveals foreign material Abnormal pupil
32
Give 5 signs/ symptoms of corneal foreign body
Eye pain FB sensation Photophobia Watering eye Red eye
33
Give 6 indications for referral to ophthalmology with corneal FB
Penetrating eye injury due to high velocity/ sharp objects Significant orbital/ peri-ocular trauma Chemical injury (irrigate for 20-30 mins before referring) FB composed of organic material e.g. soil, seeds (higher infection risk) FB in or near centre of cornea Any red flags e.g. severe pain, irregular, dilated or non reactive pupils, significant reduction in visual acuity
34
List 7 causes of blurred vision
Refractive error: most common Cataracts Retinal detachment ARMD AACG Optic neuritis Amaurosis fugax
35
What can be used to determine whether blurred vision is due to refractive error?
Pinhole occluder If blurring improves with pinhole occluder then likely cause is a refractive error Refer to optician
36
Is photophobia more likely to be present in acute glaucoma or anterior uveitis?
Anterior uveitis
37
What are the typical signs and symptoms of acute closed angle glaucoma?
Reduced acuity N+V Haloes around lights Severe pain
38
What may be seen on examination in acute closed angle glaucoma?
Cloudy/ red cornea Fixed + mid-dilated pupil
39
What are some risk factors for acute closed angle glaucoma?
Hypermetropia (key one) Female FH Old age
40
What sort of examination can examine fluid drainage from the eye?
Gonioscopy with slit lamp
41
What are the general principles of management of acute closed angle glaucoma?
Refer Medicate Laser peripheral iridiotomy Lens extraction
42
What drugs can be used to treat acute closed angle glaucoma?
IV: Carobonic anhydrase inhibitor (reduces aqueous formation) Top: Carobonic anhydrase inhibitor Beta blocker (also reduces aqueous formation) Alpha-2 agonist (miosis opens blockage)
43
How does anterior uveitis usually present?
Acute pain Photophobia Reduced acuity Hypopyon
44
How does the eye appear in anterior uveitis?
Irregular, small pupil Hypopyon
45
What is episcleritis?
Inflammation below the conjuctiva in the episcleral layer
46
How does episcleritis usually present?
Asymptomatic
47
What is scleritis?
Full-thickness inflammation of sclera usually non-infective cause
48
What conditions is scleritis associated with?
Rheumatoid arthritis (most commonly) Systemic Lupus Erythematous Granulomatosis polyangiitis Sarcoidosis
49
Give 5 signs and symptoms of scleritis
Red eye Painful + worse on eye movement Watering Photophobia Gradual decrease in vision
50
What can be seen on examination in scleritis and how can it be differentiated from episcleritis?
Conjunctival oedema Scleritis much more diffuse than episcleritis If you add phenylephrine drops the sclera goes white in episcleritis but stays red in scleritis
51
Describe management of scleritis
``` Urgent referral + assessment by opthalmologist(\<24 h) NSAIDs PO Cortisosteroids PO for severe presentations Immunosuppressants for resistant cases ```
52
How can viral vs bacterial vs allergic conjunctivitis be differentiated by appearance?
Viral: waterey and unilateral Bacterial: sticky and unilateral Allergic: pruritic, bilateral
53
Why do contact-lens wearers need urgent referral if they get conjunctivitis?
Difficult to distinguish between cojunctivitis and microbial keratitis which requires prompt treatment
54
Which cause of keratitis is associated with contact lens use in the sea/ swimming pools?
Acathamoeba keratitis
55
How does the management of viral vs bacterial vs allergic conjunctivitis differ?
Viral: nil Bacterial: chloramphenicol drops Allergic: antihistamine drops
56
What classifies as a "corneal abrasion"?
Epithelial breech without keratitis
57
How can corneal abrasion be investigated?
Fluorescein stains the defect green
58
How can corneal abrasion be managed?
You just use antibiotic infection prophylaxis (chloramphenicol ointment)
59
How does a corneal ulcer/keratitis appear?
visible defect + white corneal opacity
60
Why is corneal ulcer/keratitis an emergency?
It can cause scarring and vision loss
61
What is the cause of ophthalmic shingles?
CN VI reactivation of shingles
62
What is Huntchinson's sign?
Herpes zoster opthalmicus vesicles extending to tip of nose Indicates nasociliary involvement Strongly a/w ocular involvement in shingles (anterior uveitis)
63
How should ophthalmic shingles be managed?
Aciclovir/ Famciclovir PO 7-10d +/- topical corticosteroids for inflammation Urgent opthalmology review if ocular involvement
64
Recall 2 possible complications of ophthalmic shingles?
Post-herpetic neuralgia Ptosis Ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
65
Which artery is involved in anterior ischaemic optic neuropathy?
Posterior ciliary artery
66
What is the cause of arteritic anterior ischaemic optic neuropathy?
Giant cell arteritis
67
What are the 4 main symptoms of optic neuritis?
CRAP DR Central scomata RAPD Acuity loss (unilateral over hours-days) Pain worse on movement DR (RD: red desaturation- poor discrimination of colours)
68
List 3 causes of optic neuritis
Multiple sclerosis (most common) Diabetes Syphilis
69
What investigation should be performed for suspected optic neuritis?
MRI brain + orbits with gadolinium contrast
70
How should optic neuritis be managed (immediately and ongoing)?
72h Methylprednisolone IV 11d Prednisolone PO Recovery 4-6w
71
What is the prognosis for optic neuritis?
MRI: if > 3 white-matter lesions, 5y risk of developing MS is ~50%
72
Recall the signs and symptoms of vitreous haemorrhage
Small bleeds --\> small black dots in vision and ring floaters Large bleeds --\> loss of red reflex, retina not visualised Fundal photo source: https://www.glycosmedia.com/education/diabetic-retinopathy/diabetic-retinopathy-features-of-diabetes-vitreous-haemorrhage/
73
What are 5 risk factors for vitreous haemorrhage?
Diabetes - causes angiogenesis (most common) Trauma Anticoagulants e.g. Warfarin Coagulation disorders Severe short sightedness
74
What is the best investigation for vitreous haemorrhage?
Brightness scan ultrasonography
75
How should small vitreous haemorrhages be managed?
They should resorb spontaneously
76
How should large vitreous haemorrhages be managed?
Vitrectomy
77
What is the aetiology of retinal detachment?
Holes in retina allow fluid to separate retina from the pigmented epithelium
78
What is the most common cause of retinal detachment?
Diabetes due to breaks in the retina due to traction by the vitreous humour tears may proceed to detachment if left untreated
79
List 5 RFs for retinal detachment
DM Myopia Age Previous surgery for cataracts (accelerates posterior vitreous detachment) Eye trauma e.g. boxing
80
Recall 5 signs and symptoms of retinal detachment
FLOATERS: pigment cells entering vitreous space FLASHES: traction on retina FIELD LOSS: curtain/ shadow progressing to centre from periphery FALL in ACUITY: if macula involved RAPD: if optic nerve involved
81
Describe the appearance of the retina on fundoscopy in retinal detachment
Loss of red reflex Retinal folds: pale, opaque, wrinkled May appear normal if break is small Photo: retinal detatchment secondary to horseshoe retinal tear
82
On the other side of the card is a fundal photo of a central retinal vein occlusion for reference
83
On the other side of this card is a fundal photo of branch retinal vein occlusion for reference
84
How should retinal detachment be managed?
Uregent referal to opthalmologist assessment with slit lamp + indirect opthalmoscopy for pigment cells + vitreous haemorrhage Urgent vitrectomy + gas tamponade with laser coagulation
85
Differentiate the symptoms of central retinal vs branch retinal vs cilioretinal artery occlusion
Central RAO: sudden painless total loss of vision + RAPD Branch RAO: sudden painless partial loss of vision with NO RAPD Ciliretinal AO: painless central vision loss
86
Recall 3 things that must be done to investigate possible retinal artery occlusion
1. CVS RF history 2. Temporal artery biopsy 3. ESR
87
Recall some ways of managing retinal artery occlusion
First thing to do is an eyeball massage Then options include: - Carbogen therapy (inhalation of 95% O2 and 5% CO2) - Haemodilution - Vasodilators - Measures to decrease IOP
88
Recall 5 RFs for central retinal vein occlusion
Age HTN Cardiovascular disease Glaucoma Polycythaemia
89
What happens in central retinal vein occlusion?
As vein becomes blocked excess fluid + blood leak into retina + appear as severe haemorrhages ("cheese + tomato pizza appearance")
90
What is the main feature of central retinal vein occlusion? Give 2 signs seen on fundoscopy
Sudden, painless reduction/ loss of visual acuity, usually unilaterally Fundoscopy: Widespread hyperaemia Severe retinal haemorrhages- 'stormy sunset'
91
Name a differential to central retinal vein occlusion
Branch retinal vein occlusion (BRVO) Occurs when a vein in distal retinal venous system is occluded + is thought to occur due to blockage of retinal veins at arteriovenous crossings. Results in a more limited area of fundus being affected.
92
Describe management of central retinal vein occlusion
Majority managed conservatively
93
Give 2 indications for treatment in central retinal vein occlusion. What treatment is used?
Macula oedema: intravitreal anti-VEGF agents Retinal neovascularisation: Laser photocoagulation
94
How does the nature of vision loss in retinal vein occlusion indicate whether it is ischaemic or non-ischaemic in nature?
If it is sudden total vision loss = ischaemic If it is subacute partial vision loss = non-ischaemic If RAPD = ischaemic
95
What is the best investigation for imaging retinal vein occlusion?
Fluorescin angiography
96
How can retinal vein occlusion be managed?
Can only be managed actively if ischaemic cause Mx = panretinal photocoagulation
97
What is the phrase 'cherry red macula' usually associated with?
Central retinal artery occlusion
98
What causes Central retinal artery occlusion?
Thromboembolism (from atherosclerosis) Arteritis (GCA)
99
Give 2 S/S Central retinal artery occlusion
Sudden painless unilateral visual loss RAPD
100
What is the management for Central retinal artery occlusion?
Mx difficult + prognosis poor Identify + treat underlying conditions e.g. IV steroids for GCA If patient presents acutely intraarterial thrombolysis may be attempted (mixed evidence)
101
What is the most common cause of blindness in \>60yo?
Age-related macular degeneration (ARMD)
102
What is age related macula degeneration characterised by?
Degeneration of retinal photoreceptors that results in formation of Drusen
103
Give 3 key risk factors for age related macular degeneration
Age (greatest RF) Smoking FH
104
What are the 2 types of age-related macular degeneration?
Wet and dry Dry = geographic atrophy Wet = subretinal neovascularisation
105
What characterises dry macular degeneration?
DRUSEN Yellow round spots in Bruch's membrane
106
What are drusen?
White fluffy spots around macula caused by fat deposits under retina Seen in dry ARMD
107
What characterises wet macular degeneration?
Choroidal neovascularisation Leakage of serous fluid + blood can subsequently result in rapid loss of vision Carries worst prognosis
108
What is the timeline of decline of vision in wet vs dry ARMD?
Dry: 1-2y Wet: days to weeks
109
What is the relative prevalence of wet vs dry ARMD?
``` Wet = 10% of ARMD Dry = 90% of ARMD ```
110
What is each form of macular degeneration also known as?
Dry: Atrophic Wet: Exudative/ neovascular
111
What is the aetiology of wet ARMD?
Aberrant vascular growth into the retina from the choroid that leads to haemorrhage
112
What test is used during eye examiation to identify macular degeneration?
Amsler grid
113
How can wet ARMD be managed?
Photodynamic therapy VEGF inhibitors
114
How should ARMD be investigated?
Urgent referral to ophthalmology 1st = slit lamp microscopy to identify pigmentory, haemorrhage, exudative changes If wet ARMD --\> fluorescin angiography as this detects abnormal neovascularisation All pts should get a high-res image of retina = Optical Coherence Tomography
115
What lifestyle measure is most useful for slowing the progression of ARMD?
Smoking cessation
116
How can dry ARMD be managed?
Antioxidant vitamins (ACE) and zinc
117
What is tobacco-alcohol ambylopia?
Toxic effects of cyanide radicals combined with thiamine deficiency
118
Recall 3 signs and symptoms of tobacco-alcohol ambylopia
Optic atrophy Loss of red/green discrimination Scomata
119
Recall 5 drugs used to manage chronic glaucoma
Those that reduce aqueous production = ABC Alpha 2 antagonists Beta blockers Carbonic anhydrase inhibitors Those that Increase uveoscleral outflow: Prostaglandin analogues Pilocarpine (2nd line)
120
What IOP counts as 'increased'?
\>21mmHg
121
Describe 2 features of the optic disc in chronic OA glaucoma?
Atrophy Cupping
122
Recall 7 RFs for primary open angle glaucoma
Myopia FH Age Afro-Carribean HTN DM Steroids
123
What is the main symptom of chronic open angle glaucoma? Give 2 other features
Peripheral visual field loss: nasal scotomas progressing to 'tunnel vision' Decreased visual acuity Optic disc cupping
124
Does IOP need to be raised to diagnose glaucoma?
No Can have normal tension glaucoma
125
List 4 signs on fundoscopy in primary open angle glaucoma
Optic disc CUPPING: cup-to-disc ratio >0.7 (normal = 0.4-0.7), occurs as loss of disc substance makes optic cup widen + deepen Optic disc PALLOR: indicating optic atrophy BAYONETTING of vessels: vessels have breaks as they disappear into the deep cup + re-appear at the base Additional features: Cup notching (usually inferior where vessels enter disc), Disc haemorrhages
126
How is primary open angle glaucoma diagnosed?
Case finding + provisional dx done by an optometrist Referral to ophthalmologist via GP Final dx confirmed with Ix
127
What investigations are performed for primary open angle glaucoma?
Automated perimetry to assess visual field Slit lamp exam with pupil dilatation: assess optic nerve + fundus for baseline Applanation tonometry to measure IOP Central corneal thickness measurement Gonioscopy: assess peripheral anterior chamber configuration + depth Assess risk of future visual impairment, using RFs such as IOP, central corneal thickness (CCT), FH, life expectancy
128
When does glaucoma screening begin for people with a strong family history of glaucoma? How frequently?
40y Annual screening Early stages asymptomatic
129
What are the first and second line medical options for treating chronic open angle glaucoma?
1st line: one, then the other, then both: - Prostaglandin analogue: Latanoprost - B-blockers: Timolol/ Betaxolol 2nd line: - Sympathomimetic: Brimonidine tartrate (alpha-2 antagonist) - Carbonic anhydrase inhibitor: Acetazolamide, Dorzolamide - Miotic: Pilocarpine (TOP)
130
What is the MOA of Latanoprost in POAG? How is it prescribed? Name 2 side effects
Prostaglandin analogue Increases outflow of aqueous humour OD SE: Brown pigmentation of iris + increased eyelash length
131
What is the MOA of B-blockers in POAG? In which patients should these be avoided?
Reduces aqueous humour production Avoid in asthmatics + heart block
132
What is the MOA of sympathomimetics in POAG? In which patients should these be avoided? Name 1 adverse effect
Reduces aqueous production + increases outflow Avoid if taking MAOI or TCAs SE: hyperaemia
133
What is the MOA of carbonic anhydrase inhibitors in POAG? In which patients should these be avoided?
Reduces aqueous production Systemic absorption causes sulphonamide-like reactions
134
What is the MOA of miotics in POAG? Name 3 side effects?
Increase uveoscleral outflow SE: constricted pupil, headache + blurred vision
135
What is the surgical option for managing chronic open angle glaucoma?
Laser trabeculoplasty
136
What does annual eye screening involve for diabetic patients?
Fundus photography Fluorescin staining
137
Recall the stages of diabetic retinopathy and their features on fundoscopy
Background: hard Exudates, Microaneurysms + blot Haemorrhages (it's the lowkey one so it's MEH) Pre-proliferative: cotton wool spots + soft exudate Proliferative: angiogenesis Diabetic maculopathy: hard changes + background changes on macula
138
What do cotton wool spots in diabetic retinopathy represent?
areas of retinal infarction
139
How should diabetic proliferative retinopathy be managed?
Pan-retinal photocoagulation
140
What is diabetic maculopathy?
Progressive vision loss (most common cause of vision loss in diabetics) Any structural abnormality due to diabetes affecting macula Often preceded by diabetic retinopathy
141
How should diabetic maculopathy be managed?
Focal retinal photocoagulation
142
Recall the types of hypertensive retinopathy and their features on fundoscopy
Grade 1: silver wiring + arteriole tortuosity Grade 2: AV-nipping Grade 3: flame haemorrhages + cotton wool exudates Grade 4: papilloedema
143
Describe the features of hypertensive retinopathy seen here
Cotton-wool spots (widespread white-ish areas resulting from ischaemia) Retinal haemorrhages (red blotches around the centre of image) A 'macular star' composed of intraretinal lipid exudates (the radial, sunburst pattern of white streaks around the macular) Optic nerve head is swollen, which is the feature that separates grade 3 + grade 4 hypertensive retinopathy
144
List 6 features of papilloedema on fundoscopy
Venous engorgement (usually 1st sign) Loss of/ abnormal venous pulsation Blurring of optic disc margin Elevation of optic disc Loss of optic cup Paton's lines: concentric/ radial lines cascading from optic disc
145
List 5 causes of papilloedema
Space occupying lesion: neoplastic, vascular Malignant HTN Idiopathic intracranial hypertension Hydrocephalus Hypercapnia
146
Describe the classification of cataracts
Nuclear Cortical Subcapsular Dot opacities
147
Describe Nuclear cataracts
Primarily involves nucleus of lens Central opacification + discolouration interferes with visual function Common in old age
148
Describe cortical cataracts
primarily opacification of cortex of lens. Can be central or peripheral, + spoke-like or nummular in appearance.
149
Describe sub-capsular cataracts
develops in subcapsular cortex. Anterior or posterior.
150
What are posterior sub-capsular cataracts associated with?
Drug related e.g. topical corticosteroids Metabolic cataracts
151
What are anterior sub-capsular cataracts associated with?
Blunt trauma injuries
152
Describe the typical symptoms of cataracts
Glare + sensitivity to light Haloes Reduced acuity Faded colour vision esp. blue Night vision loss
153
Recall some risk factors for cataracts
Age Steroids Diabetes Smoking Hypocalcaemia
154
How is the red reflex affected by cataracts?
It is darkened
155
How can cataracts be medically managed?
Mydriatic eye drops (tropicamide)
156
What is the most common complication of cataract surgery?
Posterior capsular opacification
157
Name a serious but rare complication of cataract surgery. What is it caused by? List 5 S/S
Endopthalmitis Inflammation of aqueous +/ or vitreous humour Caused by peri-operative introduciton of organisms S/S: Retinal periphlebitis, pain, red eye, discharge + worsening vision
158
What are the most common, best prognostic and worst prognostic inheritance pattern of retinitis pigmentosa (it has variable inheritance)?
Most common: AR Best prognosis: AD Worst prognosis: X-linked
159
What are the signs and symptoms of retinitis pigmentosa?
Night-blindness Tunnel-vision Blindness by mid-30s
160
Recall some fundoscopic findings in retinitis pigmentosa
Pale optic disc Macula-sparing peripheral retinal pigmentation
161
What mutation is responsible for hereditary retinoblastoma?
RbP gene mutation (a TSG)
162
Recall 2 signs of retinoblastoma
Strabismus Leukocoria
163
Recall the 2 causes of inflammatory eyelid swelling
Stye (hordeolum externum/internum) Chalazion
164
What is a stye?
Abscess in lash follicle
165
What is a chalazion?
Abscess in Meibomian gland after a hordeolum internum
166
What is blepharitis?
Chronic eyelid inflammation
167
Recall 2 causes of blepharitis
Seborrhoeic dermatitis Staphylococcus
168
What are the signs and symptoms of blepharitis?
Red gritty/ itchy eyes with scales on the lashes Eyes sticky in morning Usually bilateral
169
How should blepharitis be managed?
Hot compresses BD "Lid hygiene": mechanical removal of debris from lid margins with cotton bud diffed in cooled boiled water + baby shampoo Artificial tears for Sx relief if dry eyes
170
What is lagophthalmos?
Difficulty closing the eyelid over the globe leading to exposure keratitis
171
Recall 7 signs and symptoms of orbital cellulitis
Redness + swelling around eye Severe ocular pain Visual disturbance Proptosis Opthalmoplegia or pain on movement Eyelid oedema + ptosis Drowsiness, N+V if meningeal involvement (rare)
172
What is preseptal cellulitis aka?
Periorbital cellulitis
173
How do the symptoms of periorbital cellulitis differ from orbital cellulitis?
Periorbital cellulitis does NOT have: Reduced visual acuity Proptosis Opthalmoplegia or pain on eye movement Systemic Sx
174
How should you investigate suspected orbital cellulitis?
CT w/ contrast: orbits, sinuses + brain to assess for posterior spread FBC: raised WCC + inflammatory markers Blood culture + swab to determine organism
175
How should orbital cellulitis be managed?
IV cefuroxime Urgent ophthalmology referral
176
What would cause the following eye symptoms?: - engorgement of eye vessels - lid and conjunctival oedema - pulsatile exophthalmos - eye bruit
Carotid cavernous fistula
177
What is the layterm for strabismus? What is this?
Squint misalignment of the visual axes
178
How can squint be classified?
to nose: esotropia temporally: exotropia superiorly: hypertropia inferiorly: hypotropia
179
What are the 2 forms of strabismus, and what is the difference between them?
Concomitant: imbalance of extraocular muscles (common) Paralytic: paralysis of extraocular muscles (rare)
180
What tests can be used to detect strabismus?
Corneal light reflection test: hold light 30cm from child's face to see if light reflects symmetrically on the pupils Cover test: cover 1 eye, observe movement of uncovered eye. Repeat with other eye.
181
How is strabismus managed? What does uncorrected strabismus lead to?
Refer to secondary care: Eye patches Amblyopia
182
Describe the appearance of the eyes in CNIII vs IV vs VI palsy
CNIII: ptosis, fixed/dilated pupil, 'down and out' CNIV: diplopia going downwards CNVI: diplopia in horizontal plane
183
What are the 2 most common causes of CN III/IV/VI palsies?
DM Trauma
184
Recall 2 vascular causes of CNIII palsy
Cavernous sinus thrombosis PCA aneurysm
185
Recall 3 central causes of CNIV/VI palsy
MS SOL Vascular
186
What is the most common type of strabismus in children?
Esotropia (towards the nose)
187
Recall the '4 Os' of strabismus management
Ophthalmological review Optical (correct refractive errors) Orthoptic (eye patch to the GOOD eye to prevent ambylopia) Operations (rectus muscle resections)
188
What is the possible serious complication of intra-ocular haemorrhage?
Acute closed angle glaucoma | (Large blood volume may restrict outflow)
189
What is the aetiology of orbital blowout fracture?
Trauma --\> increase in IOP --\> orbital contents herniate into sinuses
190
Recall 5 causes of floaters
Retinal detachment (one of the 4 Fs) Vitrous haemorrhage Diabetes Old retinal branch occlusion Syneresis (degenerative opacities in vitreous)
191
Recall 3 causes of haloes in the vision
Cataracts Corneal oedema Acute glaucoma
192
Which pathology typically caues jaggered haloes in the vision?
Migraine
193
What pathology causes haloes with eye pain?
Acute glaucoma
194
What are the 1st and 2nd line options for managing seasonal allergic conjunctivitis
1st line: topical antihistamine 2nd line: mast cell stabiliser eg cromoglycate
195
What tropical eye diseases are spread by flies?
Trachoma (Chlamydia trachomitis) Onchocerciasis (onchocerca volvulus)
196
How is trachoma managed?
Tetracycyline
197
How is onchocerciasis managed?
Ivermectin
198
What is a sudden, painful loss of vision likely to be due to in a patient with a background of MS?
Optic neuritis - treat with methylprednisolone
199
How should acute closed angle glaucoma be treated initially?
Refer to ophthalmologist * Pilocarpine eye drops stat * Timolol topical * Acetazolamide 500mg **IV** stat * Analgseia and anti-emetics
200
What is the subsequent management of acute closed angle glaucoma once the immediate presentation has been managed?
Bilateral laser peripheral iridotomy once IOP has decreased
201
What is the uvea?
Pigmented part of the eye inc. iris, ciliary body + choroid Iris + ciliary body = anterior uvea
202
How should anterior uveitis be managed?
Prednisolone and cyclopentolate drops
203
How can episcleritis be managed?
Topical or systemic NSAIDs
204
What is the main complication of scleritis to be aware of?
Scleromalacia (scleral thinning) leading to **globe perforation**
205
List 6 complications of scleritis
Perforation of the globe Glaucoma Cataracts Raised IOP Retinal detachment Uveitis
206
What is the most likely viral cause of conjunctivitis?
Adenovirus
207
What anti-histamine drops can be used to treat allergic conunctivitis?
Emedastine
208
How should corneal abrasions be managed?
Chloramphenicol ointment for infection prophylaxis
209
Recall some differentials for sudden vision loss and how to differentiate between them
HELLP: Headache-associated = GCA Eye movements painful = optic neuritis Lights/ flashes prceding = detatched retina Like a curtain descending = TIA/GCA Poorly-controlled DM = vitreous bleed from new vessels
210
What is the cause of *non*-arteritis anterior ischaemic optic neuropathy?
HTN DM Hyperlipidaemia Smoking
211
In which field does vision loss begin in chronic open angle glacuoma?
Nasal superior
212
How should a stye be treated?
Topical fusidic acid
213
How should orbital cellulitis be managed?
IV cefuroxime
214
What is the most likely pathogen in contact-lens associated conjunctivitis?
Pseudomonas
215
Which type of glaucoma is associated with: a) hypermetropia? b) myopia?
Hypermetropia - acute closed angle glaucoma Myopia - primary open angle glaucoma
216
How is Herpes zoster ophthalmicus treated?
Urgent ophthalmological review 7-10 days of **oral** antivirals IV aciclovir reserved for severe infection and immunocompromised
217
How does herpes simplex keratitis most commonly present?
Dendritic corneal ulcer
218
Give 5 signs/ symptoms of herpes simplex keratitis
Red painful eye Photophobia Epiphora Decreased visual acuity Fluorescein staining shows epithelial ulcer
219
Describe management of herpes simplex keratitis
Urgent referral to opthalmologist Aciclovir TOP
220
What are the 2 possible mechanisms of sight loss in proliferative diabetic retinopathy?
* Vitreous haemorrhage * Retinal detachment
221
What would be seen on fundoscopy on central retinal vein occlusion?
Severe retinal haemorrhages
222
What is the most common cause of abnormal tearing in infants and children?
Nasolacrimal duct obstruction Causes intermittent tearing, occasional redness of conjunctiva
223
Give 2 characteristics of posterior vitreous detachment
Flashes of light (photopsia) in peripheral field of vision Floaters often on temporal side of central vision

YR6 Rotations (22 decks)

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