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Flashcards in NB topics Deck (49):
1

6 Eye problems in HIV/ AIDS

1. Abnormal conjunctival lesions
2. Abnormal vernal keratoconjunctivitis
3. HZ infection
4. Herpes Simplex Keratitis in periphery
5. Kaposi's Sarcoma
6. Orbital cellulitis

2

What is needed for near vision

1. Convergence
2. Pupillary constriction
3. Accommodation

3

Hypermetropia
Indications for treatment
Treatment

Indications for treatment: < VA, eye exhaustion, strabismus
Treatment:
1. Convex lenses
2. Contact lenses

4

Myopia
treatment

1. Concave lens
2. Contact lenses
3. Refractory surgery

5

Anterior Uveitis: Clinical tests

1. Consensual light reflex--> Pain in contralateral eye
2. Accommodation test
3. Eclipse test

6

Posterior Uveitis
Symptoms
Causes
Signs
Complications

Symptoms: < VA
Causes: Toxoplasmosis from animals
Signs: Dull fundus, yellow/white choroid, retinal vasculitis
Complications: Chorio-retinal scar formation, exudative retinal detachment, rhegmatogenous retinal detachment, papillitis

7

Diagnostic drugs

• Fluorescein: orange liquid, under blue light bright green/yellow
• Midriatics: parasympathetic drugs -> paralysis of iris sphincter:
oAtropine sulphate: 7-14 days (longest) -> therapeutic
oScopolamine: 2-3 days
oTropicamide: 6-8hrs -> shortest
oCyclopentolate: 6-24 hrs
oSide-effects: nausea; vomiting; pallor
oSympathomimetics: Phenylephrine (use in combination with pSympathetic)

8

Side effects: Steroids, Ethambutol, Phenothiazine

• Steroids: cataracts; glaucoma
• Ethambutol: optic neuritis
• Phenothiazine: opacities in lens/corneal epithelium

9

Meibomian Cyst
Definition
Clinical picture
Treatment

• Definition: Lipogranulomatous inflammation secondary to the retention of meibomian due to obstruction
• Clinical Picture: firm round swelling in tarsal plate; often painless; red raised conjunctiva
• Treatment: Incision and curettage

10

Blepharitis treatment

1. Lid hygiene
2. topical antibiotic, post. Blepharitis = systemic tetracyclines
3. warm compress; expression of meibomian glands

11

Ptosis classifications and treatment

Classification: Neurogenic, Aponeuritic, Mechanical, Myogenic
Treatment: refer to ophthalmologist, avoid amblyopia, suspect CN III palsy

12

Causes of mucin & lipid layer deficiency


1. Chemical burns
2. Trachoma
3. Steven-Johnson syndrome
4. Vit A deficiency

13

Lid Abnormalities: Causes of abnormal lid contours & disruption of lid movement

Countour: Trachoma, Trauma, Tumour
Lid Movement: fascial paralysis, Simblephara (trauma, Steven-Johnson, Trachoma)

14

Dacryocystitis: Definition, Signs & Treatment




Definition: obstruction of the tear flow distal to lacrimal sac leading to stasis, secondary infection can occur, filling sac with pus
Symptoms: Epiphora, Pain
Signs: Swelling, Redness, Tenderness over lacrimal sac, can break skin
Treatment: local/systemic antibiotics, drainage of abscess

15

Difference between pre-orbital cellulitis & orbital cellulitis

Orbital: Chemosis, Redness, Pain, Proptosis, Decrease in eye movement
Pre-orbital: opposite of above

16

Pterygium: Treatment & Indications for surgery

Treatment:
1. artificial tears
2. antihistamines
3. vasoconstrictors
4. antibiotics, steroids

Indications:
1. medical treatment failure
2. increasing astigmatism,
3. growth over visual axis,
4. to be able to wear contact lenses,
5. cosmesis
6. suspected malignancy

17

Classify bacterial conjunctivitis, viral conjunctivitis, allergic conjunctivitis

1. Bacterial: Acute, Gonococcal, Chlamydial, Chronic blepharoconjunctivitis
2. Viral: Adeno virus (pharyngo (adeno 3 & 7), epidemic keratoconjunctivitis (8 & 19)) Acute haemorrhagic; Herpes simplex; Molluscum contagiosum keratoconjunctivitis
3. Allergic: Hayfever; Acute allergic blepharoconjunctivitis; Vernal conjunctivitis; Giant papillary conjunctivitis; Steven-Johnson

18

Adenovirus conjunctivitis syndromes: Clinical picture & treatment

Picture: acute follicular conjunctivitis with pre-auricular lymphadenopathy; red eyes; years; itches; photophobia
Treatment: no specific Mx, antibiotic & vasoconstrictor drops (steroids only if vision is affected & herpes simplex excluded)

19

Allergic Conjunctivitis: Treatment

1. Antihistamines
2. Vasoconstrictors
3. Ice packs
4. Topical steroids

20

Bacterial Keratitis: Organisms, treatment & complications

Organisms: Pneumococci, Pseudomonas, Staph. Aureus/epidermidis

Treatment:
1. Cover eye
2. Cycloplegic drugs
3. Local antibiotics

Complication: corneal thinning, corneal opacification, corneal perforation, endophthalmitis

21

Phlyctenulosis: Causes, variance, treatment

Causes: usually TB, reaction against staph.cocc. organism

Variance: conjunctival phlycten (raised pink nodule close the limbus) & corneal phlycten (starts in limbus, may spread centrally, ulcerates)

Treatment: steroids

22

Keratoconus: Munsen’s sign, Clinical picture and treatment

Munsen sign: in keratoconus, the extra bowing of the lower eyelid caused by the misshapen cornea as the eye rotates downward.

Treatment:
1. Corneal transplant
2. Hard contact lenses

23

Optic Neuritis: Classification, Causes, Clinical Picture

Classification: Papillitis, Retrobulbar neuritis

Causes: MS most common in adults, Viral most common in children, idiopathic, autoimmune, systemic infection

Clinical Picture: unilateral loss of vision, retrobulbar pain

24

Optic disk clinical characteristics

1. colour
2. cup
3. contour
4. cardiovascular

25

Strabismus: Consequences


1. Amblyopia (strabismus amblyopia, depravation, refractive)
2. Suppression of image (coping mechanism)
3. Diplopia

26

Strabismus: Commitant (refractive error) vs. Incommitant (eye movement fucked)

Incommitant: deviation will vary with direction of gaze, impairment of movement, angle of deviation maximal in affected muscle test, not present in all directions of gaze, head position is held where affected muscle is least used

Commitant: no impairment of eye movement -> angle of deviation same in all directions

27

CN III Palsy: Consequences & Causes

Causes: space-occupying lesions, vascular causes (ischaemia, thrombosis),

Consequences: horizontal & vertical diplopia, inability to elevate & duct, ptosis of the upper eyelid, pupil may be dilated

28

Horner’s syndrome: Characteristics

1. Miosis
2. ptosis
3. pseudoenophtalmos
4. anhydrosis
5. heterochromia of the iris

29

Differential diagnosis of leucocoria (pupil displays white)

• Cataract
• Retinoblastoma
• Retinal detachment
• Post. Uveitis
• Old virteous haemorrhage
• Retinopathy of prematurity
• Persistant hyperplastic primary vitreous
• Tunica vasculosa lentis

30

Anterior & Posterior Uveitis: Signs, Symptoms, Complication

Anterior:
o Signs: decreased visual acuity, ciliary congestion, anterior chamber opacification, hypopion, miosis
o Symptoms: dull vision, redness, photophobia, deep eye pain
o Complications: anterior/posterior synechiae, cataracts, hypotonia, blocking of trabecular network, glaucoma

Posterior:
o Symptoms: decrease in visual acuity
o Signs: dull fundus, cotton-wool choroid and retina, vasculitis
o Complications: exudative/rhegmatoid retinal detachement, papillitis, scar formation

31

Glaucoma: Diagnosis, Signs & Symptoms, Treatment



Closed angle:
Diagnosis: nature of pain, fixed mid-dilated pupils corneal oedema
Symptoms: acute onset, unilateral pain radiating to ipsilateral hemicranium, can vomit from pain, red eyes, big decrease visual acuity, coloured halos around lights, photophobia
Signs: fixated middilated pupils, ciliary congestion, corneal opacification
Treatment:
1. acetozolamide (diamox)
2. emergency Mx
3. glycerol
4. topical B-blockers
5. pilocarpine
6. systemic analgesia
7. anti-emetic agent

Open Angle:
Diagnosis: optic disk indicative of disease, referral
Symptoms: almost always asymptomatic
Signs: decrease in visual acuity when terminal, loss of visual fields, increased IOP
Optic disk changes: colour pale, cup large (C/D > 0.5), vessels has nasal displacement, border has nerve fibre haemorrhage
Treatment:
1. adrenaline
2. B-blocker

32

Cataracts: Indications & contra-indications for surgery


Indications: impact on daily functioning, diabetic patient, pale fundus, lens-induced disease

Contra-indications: patient don’t want, glasses & other medical treatment works fine, surgery won’t improve

33

Cataracts: Indications & contra-indications for surgery



Indications: impact on daily functioning, diabetic patient, pale fundus, lens-induced disease

Contra-indications: patient don’t want, glasses & other medical treatment works fine, surgery won’t improve

34

Retinoblastoma: Clinical picture & treatment





Clinical picture:
1. Leucocoria
2. strabismus
3. proptosis
4. uveitis,
5. glaucoma

Treatment:
1. radiotherapy
2. chemotherapy
3. cryotherapy
4. enucleation
5. photocoagulation

35

Blow-out fracture: Clinical Picture & Treatment

Clinical:
1. diplopia
2. proptosis
3. enophthalmos
4. periorbital crepitus
5. reduced sensation

Treatment:
1. antibiotics
2. don’t blow nose (eye in maxillary sinus – eye can come out!)

36

Hyphema: Complications & treatment


Complications: raised IOP, discolourisation of corneal stroma, secondary bleeding

Treatment:
1. Topical steroids
2. oral cyclocapron
3. topical cycloplegics
4. B-blockers
5. Diamox

37

Acute central retinal venous occlusion: Associations, Symptoms, Signs, Treatment



Associations: hypertension, glaucoma, diabetes, phlebitis,

Symptoms: sudden unilateral loss of vision in a white eye

Signs: visual acuity & field decrease, RAPD, optic disc swelling, cotton wool spots

Complications: Neovascularisation

Treatment: photocoagulation

38

Differential diagnosis of painful red eyes

• Acute closed angle glaucoma
• Open eye injuries
• Chemical burn
• Corneal abscess

39

Differential diagnosis of painless white eyes

• Acute retinal arterial occlusion
• AION
• Acute retinal tear
• Retinal detachment that threatens macula
• Acute extra-ocular muscle paralysis with headache

40

Rhegmatogenous retinal detachment: Cause/Process & Treatment




Cause/Process:
retinal hole formation is caused by: vitreous traction during post vitreous detachment, vitreous traction during blunt eye trauma, degenerative holes with vitreous traction

Treatment:
1. laser or cryotherapy
2. drainage of fluid

41

Acute central retinal artery occlusion: Causes, Symptoms, Signs, Treatment

Causes: thrombosis, embolism
Symptoms: white eye and sudden unilateral loss of vision, amaurosis fugax (fleeting vision),

Signs: decreased visual acuity, decreased visual field, RAPD, milky-white retina, cherry red spot,

Treatment:
1. massage
2. 95% O2 + Co2
3. vasodilators
4. acetozolamide

42

Eyelid blunt trauma: Treatment


1. Clean thoroughly
2. topical broad spectrum antibiotics, systemic analgesia
3. anti-inflammatory drugs

43

Contusion of eye: Complications


1. Peri/retrobulbar bleeding
2. Proptosis
3. Limitation eye movement

44

Chemical burn: Treatment and complications

Complications: glaucoma, corneal scarring, simblepharon, entropion, dry eyes

Treatment:
1. Rinsing of eye with water
2. Sterile isotonic salt mixture in palpebral
3. Wet cotton bud
4. Local anaesthetic
5. Systemic painkillers

45

Age Related Macular Degeneration: Classification, Symptoms, Treatment


• Classification: Dry and Wet
• Symptoms: painless decrease in visual acuity (wet=fast)(dry=insidious), picture distortion, central scotoma
•Treatment:
1. dry=non-specific
2. wet=laser photocoagulation

46

Diabetic Retinopathy: Microvascularopathy & treatment


Microvascularopathy: vascular leakage, microvascular occlusion

Treatment:
1. Monitor blood glucose
2. Argon laser photocoagulation
3. Regular ophthalmologist visits
4. Blood pressure control
5. Aneamic control
6. Infection control

47

Complications of neovascularisation


• Neovascular glaucoma
• Massive intra-retinal exudates
• Vitreous haemorrhage
• Vitreous traction cords
• Retinal traction detachment

48

Hyperthyroidism


1. Fatty tissue increased inside orbit -> exophthalmos

49

Rheumatoid Arthritis

1. Dry eyes
2. Corneal thinning
3. Episcleritis
4. Scleritis