Neuro & Opthal - Ophthalmology Flashcards by Jasmine Sappor

Role of blinking

Spreads a thick film of tears across the eyes and replenishes moisture

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Disorders of tear film

Low quantity of tears
Poor quality tears
Disturbance of blink reflex
Increased evaporation through exposure

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Causes of low quantity of tears

Age
Eye surgery
Damage to tear gland

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Cause of poor quality tears

Blepharitis

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When might you see disturbance of blink reflex

After surgery

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Causes of increased tear evaporation through exposure

Post-surgery
VII palsy
Thyroid eye disease
Poor obicularis tone (ageing/ VII palsy)

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What does exposure in the eye cause

Drying of ocular surface

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Sx of exposure

Irritation
Stinging
Burning
Red, sticky eye in morning

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Complications of exposure

Microbial keratitis
Loss of vision

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Lagophtalmos

Incomplete eye lid closure

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What is chalaza often associated w/

Blepharitis

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How may chalzion px initially

Diffuse, swelling ‘stye’

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Mx of chalazioon

Often resolves spontaneously
Hot lid massage and incision & curettage
Lid hygiene for underying blepharitis

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Main cause of lid malposition

Lid laxity/ ageing
Other causes incl congenital, spastic, cicatricial

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Entropion

Eyelid rolls inward

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Sx of eyelid malposition - entropion

Irritation
Watering
Grittiness
Stickiness
Recurrent infections

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Entropion mx

Usually conservative
Lubricants
Taping lower eyelid
Botox
Surgery - definitive

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Why would botox be given as mx of entropion

Combat blepharism - lasts 3/12

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Possible surgery for entropion

Everting sutures
Lid tightening

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Ectropion

Eyelid rolls outwards from ocular surface

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Causes of ectropion

Lid laxity/ ageing
Paralytic - VII nerve palsy
Cicatricial

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Sx of ectropion

Watering
Red appearance to eyes
Discharge
Blurred vision
If exposure - stinging and pain

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Tx of ectropion

Lubrication
Surgery

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What is ptosis

Malposition of upper eyelid
Sign and NOT a dx

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Hx for ptosis

Recent or gradual onset (sudden onset requires referral) Associated sx - diplopia, variability (day to day), visual loss Eye hx Fhx Systemic disease - neurology, myasthenia

Examination and ix for ptosis

Lid heights and variability Lid movements Ocular surface dryness Obicularis tone and function Risk of exposure? Extraocular motility Pupil reactions VA

Why is VA important to test for in children w/ ptosis

Amblyopia is a risk

Congenital causes of ptosis

Dystrophic muscle

Acquired causes of ptosis

Aponeurotic/ senile Traumatic Neurogenic Myogenic Mechanical

Treating aponeurotic ptosis

Levator advancement

Dermatochalasis

Excess skin in upper eyelid, causing eyelid to be pushed down

Features of malignant lid lesions

Recent onset Rapid growth Bleeding Pigmented

Examination findings of malignant lid lesions

Ill-defined borders Loss of lashes Destruction of lid architecture Bleeding Ulceration Diplopia

Examples of benign lid lesions

Chalazion Cyst of Moll Cyst of Zeiss Papilloma Xanthelasma

Examples of pre-malignant lid lesions

Keratoacanthoma Solar keratosis Lentigo maligna

Examples of malignant lid lesions

BCC- nodular, infiltrative SCC Merkel cell Ca

Risk factors for orbital extension from neglected BCC

Previous RT Previous surgery for BCC Elderly Mental health problem e.g. dementia

Disorders of lacrimal system

Dacrocystitis Dacryoadenitis Nasolacrimal duct obstruction

Dacryoadenitis

Infl of lacrimal gland Settles on conservative mx w/ anti-infl

Sx of lacrimal gland swelling

Dry eyes Reduced vision Swollen upper lids S shaped deformity in upper lid

Mx of lacrimal gland swelling

Conservative mx If not, lacrimal gland debulking

Dacrocystitis

Abscess in lacrimal sac

Hx of dacrocystitis

Watery eye Recent onset Painful swelling in medial canthal area

Ddx of dacryocystitis

Lacrimal sac mass/ tumour - will have blood-stained tears

Mx of dacryocystitis

Oral abx Drain DCR surgery Bypass nasolacrimal duct obstruction

Sx of orbital disease

Diplopia Swelling around the eye Bulging, prominent eye Ache behind the eye Pain on eye movements Awareness of a 'lump'

Signs of orbital disease

Restricted eye movement Swelling around the eye Proptosis Lid retraction Reduced vision Reduced colour vision Pupil abnormalities

What is proptosis

Eye swelling within orbit Bulging eyes, pushed forward May be bilateral

Causes of proptosis

Usually, thyroid eye disease Primary orbital tumour - lymphoma, glioma Metastasis - breast, prostate

Sx of proptosis

Double vision Reduced vision if compressing optic nerve Exposure can result if eye cannot close

Swelling of which muscles can lead to esotropia

Medial & inferior rectus

Signs requiring urgent opthal referral

Exposure of the eye - refer urgently Double vision and ptosis Reduced vision Rapidly suspicious eye lid lesion Proptosis Swelling in lacrimal gland or sac area Entropion

What does the orbit contain

Eyeball and associated structures Extrinsic and intrinsic muscles of the eye Fat and periorbital fascia

Which CNs pass through or supply structures in the orbit

II, III, IV, V and VI

Is the optic nerve found anteriorly or posteriorly

Posteriorly

How many layers in the eye surrounded by

3 concentric layers

Compartments of the eye

Anterior Posterior

Features of anterior compartment of eye

Transparent ~1/6th of eyeball Anterior and posterior chamber Makes aq humour

Features of posterior compartment

Opaque ~5/6th of eyeball Makes vitreous humour

Which layers of the eye make up its structure

Fibrous outer layer Vascular middle layer Neural inner layer

Fibrous outer layer of eye

Anterior cornea - transparent Posterior sclera - opaque

What does the vascular middle layer of the eye consist of

Choroid Ciliary body and iris

What is the neural layer pf the eye

Retina - optic and non-visual parts

What is the cornea

Transparent, anterior continuation of sclera

Since the cornea is avascular, how does it receive nourishment?

Peripheral capillary beds Lacrimal gland Aq humour

What is the sclera

'White of the eye' Tough, opaque fibrous membrane, relatively avascular Visible anteriorly through the transparent bulbar conjunctiva

Function of sclera

Maintenance of the eyeball shape Attachment for extrinsic muscles

Anatomical relationship between sclera and optic nerve

Optic nerve pierces sclera anteriorly - continuous w/ Dural sheath

Neuro & Opthal - Ophthalmology Flashcards

(69 cards)