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Ocular pathology Flashcards

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1
Q

What are the 12 areas that can be affected by pathology?

A 
Superficial
Conjunctiva
Cornea
Sclera
Anterior Chamber
Iris
Lens
Posterior chamber
Retina
Panglobal
Blood vessels
Nerves
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2
Q

What categories of pathology can affect the superficial eye?

A

Cellulitis
Blepharitis
Connective tissue disease

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3
Q

How can orbital cellulitis present?

A

Red eye
Reddening of skin round orbit
Damage to conjunctiva

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4
Q

What is very dangerous about orbital cellulitis?

A

Can travel back towards brain causing abscesses

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5
Q

What is blepharitis?

A

Inflammation of the eyelid

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6
Q

What is a stye?

A

Inflammation of a hair follicle on the eyelid

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7
Q

What can cause blepharitis?

A

Seborrhoeic
Staph
Meibomian gland dysfunction
Acne Rosacea

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8
Q

How does blepharitis present?

A 
Similar to conjunctivitis
Gritty eyes
Mild discharge
Red eye
Ulcers
Scales in eyelids
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9
Q

Where does a feeling of grittiness in the eye suggest the issue is?

A

Superficial

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10
Q

Where does an aching feeling in the eye suggest the issue is?

A

Deep

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11
Q

How do you treat blepharitis?

A

Lid hygiene- Bath it regularly
Tear drops
Oral doxycycline

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12
Q

What connective tissue diseases can affect the eye?

A

SLE- Ocular inflammation
RA- Dry eyes, Scleritis, Corneal melt
Sjogren’s syndrome- Shiney featureless tongue,

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13
Q

What can SLE cause to the eye?

A

Ocular inflammation

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14
Q

What can RA cause in the eye?

A

Dry eyes
Scleritis
Corneal melt

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15
Q

What can Sjogren’s syndrome cause?

A

Keratoconjunctivitis sicca
Xerostomia
Shiney featureless tongue

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16
Q

What is xerostomia?

A

Dry mouth

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17
Q

What does sicca mean?

A

Dry

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18
Q

What pathologies can occur in the conjunctiva?

A

Conjunctivitis

Conjunctival hemorrhage

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19
Q

hat can cause conjunctivitis?

A 
Viral- Bilateral
Bacteria
Chlamydia- Unilateral
Allergic
Drugs
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20
Q

How can conjunctivitis present?

A 
Swelling 
Redness
Pain
Heat
Grittiness
Discharge
Itch
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21
Q

What is the most common cause of conjunctivitis?

A

Bacterial

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22
Q

WHat is a common feature of bacterial conjunctivitis?

A

Papilla

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23
Q

Describe papilla and how they differ from follicles

A

Papillae have blood vessels in center of lump

Follicles have blood vessels round edge (look like grains of rice) and bigger.

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24
Q

How do you treat bacterial conjunctivitis?

A

Self-resolve

Chloramphenicol

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25
How does conjunctival heamorrhage present?
Red eye (basically bruised eye)
26
How do you treat conjunctival heamorrhage?
Resolves on its own
27
What is the main pathology affecting the cornea?
Keratitis
28
What can cause keratitis?
``` Chronic exposure Bacteria Viral Acanthamoeba- associated with contact lenses Fungi RA Hypersensitivity ```
29
What can lead to chronic exposure of the cornea?
In ability to close lids | Inability to produce tears
30
What is acanthamoeba infection of the cornea associated with?
Contact lenses
31
How does keratitis present?
``` Corneal ulcers Needle like pain Photophobia Discharge Red eye Opacity Hypopyon ```
32
How can you test for keratitis?
Fluorescence staining
33
How do you treat keratitis?
ID cause- corneal scrape under LA Antibiotics if bacterial Antivirals if viral Anti Inflammatory if autoimmune
34
What must you not give for corneal damage?
Steroids!!!
35
What two diseases can affect the sclera?
Scleritis and episcleritis
36
What is the difference between Scleritis and episcleritis?
Scleritis affects body of sclera | Episcleritis affects peripheral surface
37
Which is more serious between Scleritis and episcleritis?
Scleritis
38
What can cause scleritis?
Autoimmune
39
How does scleritis present?
Pain on eye movement | Purple looking
40
How do you treat scleritis?
Steroids and NSAIDs
41
What is scleritis often associated with?
Uveitis
42
What is episcleritis associated with?
Gout
43
How do you treat episcleritis?
Self Resolves
44
What systemic disease can affect the anterior chamber of the eye?
Diabetes
45
What does diabetes cause in the anterior chamber of the eye?
Argyll Robertson/Prostitutes pupil
46
What is an Argyll Robertson/Prostitutes pupil?
A pupil that can accommodate (focus light) but not react to light (pupil doesn't constrict)
47
What symptoms can an Argyll Robertson/Prostitutes pupil lead too?
Blurred vision
48
What pathology can affect the anterior chamber of the eye?
Glaucoma | Diabetes
49
What is glaucoma?
Raised pressure in the anterior chamber of the eye
50
What is normal pressure glaucoma?
Glaucoma in the presence of a normal anterior chamber pressure.
51
What are the two types of glaucoma?
Open angle | Closed angle
52
What causes glaucoma?
Too much aqueous humour
53
How can you get too much aqueous humour?
Too much production | Not enough drainage
54
Where does aqueous humour drain through?
Trabecular meshwork | Schlemm canals
55
What causes open angle glaucoma?
Blockage in trabecular meshwork or Schlemm canals
56
How does open angle glaucoma present?
Slow onset and often asymptomatic | Visual loss starting in the periphery
57
What causes closed angle glaucoma?
Iris stuck to lens preventing aqueous humour flow
58
What can predispose you to closed angle glaucoma?
Being long sighted (eyeball too small)
59
How does closed angle glaucoma often present?
``` Acutely (often an emergency) Acute red eye Visual loss Headaches with N+V Pain Dilated pupil Cloudy cornea ```
60
How do you treat closed angle glaucoma?
Burn hole in iris with laser
61
How do you treat open angle glaucoma?
Pharmacology | Trabeculectomy
62
What can cause glaucoma?
Many things | Diabetes important to know
63
How can diabetes cause glaucoma?
Rubeotic glaucoma
64
WHat is rubeotic glaucoma?
Formation of new blood vessels in the iris causing blockage of flow.
65
How can glaucoma damage the eye?
Put pressure on the optic disk thus causing sight loss
66
What pathology can occur in the iris?
Uveitis
67
What can cause uveitis?
Autoimmune Infection Trauma Malignancy
68
What autoimmune diseases can cause uveitis?
UC Ank Spon Sarcoidosis
69
What is the most common autoimmune cause of uveitis?
Ank Spon
70
What part of the eye can sarcoidosis affect?
Whole eye
71
What ket term is associated with sarcoidosis?
Bilateral Hilar Lymphadenopathy
72
What infections can cause uveitis?
``` TB Syphilis Herpes simplex Herpes zoster Toxoplasmosis ```
73
How can uveitis present?
``` Pain Reduced vision Photophobia Red eye Ciliary injection Hypopyon Synechiae- Iris sticks to lens Keratic precipitates- Cells stick to back of cornea ```
74
What is a hypopyon?
Level of dead cells in anterior chamber
75
What is synechiae?
Inflammation causing iris to stick to lens
76
What are Keratic precipitates?
Cells sticking to the back of the cornea
77
How do you treat uveitis?
Topical steroids | Investigate for systemic involvement
78
What pathology can affect the lens?
Cataracts
79
What is a cataract?
Opacity of the lens
80
What can cause cataracts?
``` UVB Trauma Diabetes Age Steroids Glaucoma Hypertension Smoking Genetics ```
81
How can age cause cataracts?
As we age the lens thickens and accumulates damage
82
How can diabetes cause cataracts?
Raised glucose and swelling damages lens
83
What are the symptoms of cataracts?
Loss of vision Blurred vision Glare at night
84
How do you treat cataracts?
Remove and replace
85
What parts of the retina can acquire pathology?
Optic disk Macula Peripheral retina
86
What pathologies can affect the retina in general?
Diabetic retinopathy Retinal detachment Retinal melanoma
87
What happens in retinal detachment?
Retina peels of choroid layer
88
What can cause retinal detachment?
Main one is changes in vitreous humour as we age pulling it off the choroid layer
89
What are some symptoms of retinal detachment?
Painless visual loss Flashes and floaters Relative Afferent Pupil Defect Tear on fundoscapy
90
What is a Relative Afferent Pupil Defect?
When shine light in one eye then the other rapidly the affected eye doesn't pick up as much light so constricts less
91
What is diabetic retinopathy?
Damage to the retina caused by blood leaking out of blood vessels due to chronic hyperglycemia
92
Describe how chronic hyperglycemia causes diabetic retinopathy
Chronic hyperglycemia -> Damage to basement membrane of blood vessels -> Blood leaking -> Ischemia
93
What are some of the symptoms of diabetic retinopathy?
Vision loss- if macula involved very serious
94
What are some of the signs of diabetic retinopathy?
``` Leaky vessels Dot + blot hemorrhage New vessel formation Oedema Hard exudate- Drusens Cotton wool patches Scarring ```
95
What causes cotton wool patches?
Ischemia
96
What is drusens?
Collection of protein/lipid- like atheroma plaques
97
What causes the loss of vision in diabetic retinopathy?
Ischemia caused by blood loss
98
What causes new blood vessel formation in diabetic retinopathy?
VEGF
99
What kinds of new vessels can be developed in diabetic retinopathy?
New vessels on disk (NVD) New vessels in Periphery (NVE) Rubeotic glaucoma
100
Why are new blood vessels in the iris a bad sign?
Serious patho and no reversing from here
101
How do you treat diabetic retinopathy?
Better diabetic control Laser treatment Anti-VEGF
102
What does laser treatment of diabetic retinopathy involve?
Burning away peripheral tissue to decrease O2 demand and seal leaky blood vessels
103
What kind of laser treatment is done in diabetic retinopathy?
PanRetinal Photocoagulation
104
What pathology can affect the macula?
Macula degeneration
105
What is the main form of macula degeneration?
Age related macular degeneration
106
What are the two forms of age related macular degeneration?
Dry | Wet
107
How does wet ARMD differ from dry ARMD?
Wet has blood leakage and new vessel formation while dry is atrophic
108
Describe what happens in dry ARMD
Drusen plaques form under the macular resulting is slow degeneration
109
Is dry ARMD acute or chronic?
Chronic
110
What are are of the symptoms of dry ARMD?
Gradual visual loss Central vision loss Patches of atrophy Drusen plaques
111
How do you treat dry ARMD?
No cure | Magnify to mitigate damage
112
Describe wet ARMD
Formation of new blood vessels results in leaky vessels which results in build up of fluid and scarring.
113
Is wet ARMD acute or chronic in onset?
Acute
114
Can dry ARMD progress to wet?
Yes
115
What mediated wet ARMD?
VEGF
116
What are some of the symptoms of wet ARMD?
Rapid visual loss Disorientation Hemorrhage- looks bruised Exudate
117
How do you treat wet ARMD?
Anti-VEGF
118
What pathologies can affect the optic disk?
Cupping | Swelling
119
What is cupping?
Expansion of the optic disk cup due to loss of nerve fibres.
120
What can cause cupping?
Raised intraocular pressure
121
What can cause swelling of the optic disk?
Papilloedema- just saw swollen as can't be sure | Hypertension
122
What is papilloedema?
Swelling of the optic disk due to raised ICP
123
How do you measure ICP?
LP
124
When should you suspect papilloedema?
Bilateral optic disk swelling
125
What are some symptoms of papilloedema?
``` Loss of cup BLurred contours Blurred vision Headaches N+V ```
126
What are some of the symptoms of hypertension caused optic disk swelling?
``` Copper or silver looking blood vessels Cotton wool spots- areas of ischemia Exudate Heamorrhage Cattle trucking Disk oedema ```
127
What cancers can affect the eye?
SCC BCC Melanoma
128
What can damage or occlusion to any blood vessel supplying the eye lead to?
Visual loss and tissue death
129
What two vessels commonly cause vision loss?
Central Retinal Artery | Central Retinal Vein
130
Which is more common out of central retinal artery occlusion (CRAO) or central retinal vein occlusion (CRVO)?
CRAO
131
How can you differentiate between an artery and vein on fundoscapy?
Artery is smaller
132
What are the symptoms of a CRAO?
Sudden painless vision loss Pale optic disk Relative afferent pupillary defect (RAPD) Swollen nerve fibres
133
Why do you get a pale optic disk in CRAO?
Disk usually pink due to blood therefore no blood = pale
134
What is Relative afferent pupillary defect (RAPD)?
Loss of some light sensing in one eye causes less constriction when light flicked between them
135
What can cause CRAO?
Carotid artery disease | Heart emboli- rare
136
What are some variants of CRAO?
Amaurosis Fugax- TIA | Branch retinal artery occlusion
137
What is Amaurosis Fugax?
TIA of retinal artery | Curtains coming down for ~5min
138
What is Branch retinal artery occlusion?
Occlusion of one branch artery in retina
139
What can cause CRVO?
Virchow's triad: Endothelial damage- Diabetes Abnormal blood flow- Hypertension Hypercoagulability
140
What are the symptoms of CRVO?
Cotton wool spots | Sudden painless vision loss
141
What can hemorrhage of vessels in the eye cause?
Floaters Visual loss Loss of red reflex See on fundoscopy- look like bruising
142
What is Giant Cell Arteritis?
Inflammation of the lumen of medium and large vessels
143
Can Giant Cell Arteritis affect the central retinal vessels?
No
144
What is GCA associated with?
Polymyalgia Rhumatica
145
What can Giant Cell Arteritis cause?
Ischemic optic neuropathy
146
What is ischemic optic neuropathy?
Occlusion of optic nerve heads
147
What are some symptoms of ischemic optic neuropathy?
``` Sudden visual loss Irreversible blindness Swollen optic nerve Headache Jaw claudications Scalp tenderness Enlarged scalp arteries Proptosis- eye protrusion ```
148
What is proptosis?
Abnormal eye protrusion- not normal to see sclera above iris
149
How urgent is it to treat ischemic optic neuropathy?
Very urgent to prevent bilateral blindness
150
What can VI (Abducens) nerve palsy cause?
In ability to abduct eye- can look normal when looking straight on
151
What can cause VI (Abducens) nerve palsy?
Microvascular | Raised ICP
152
What can IV (Trochlea) nerve palsy cause?
Vertical double vision | Head tilt to compensate
153
What can cause IV (Trochlea) nerve palsy?
Congenital | Microvascular
154
What can III (Oculomotor) nerve palsy cause?
``` Diplopia Eye look down and out- due to unopposed IR and SO Ptosis- due to loss of LPS innervation Dilated pupil Eye doesn't move ```
155
What can cause III (Oculomotor) nerve palsy?
Microvascular Tumour Aneurysm- painful Demyelination- MS
156
What causes anterior blepharitis and how does it present?
S. Aureus | Skin flakes
157
What types of conjunctivitis do papillae appear with?
Allergic and bacteria
158
What type of conjunctivitis do nodules appear with?
Viral and chlamydial
159
What can cause corneal ulcers?
HSV
160
What can precipitate angle closure glaucoma?
Pupil dilation
161
What are cherry red spots a sign of?
Arterial occlusion

Ophthalmology (10 decks)

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