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Year 4 > Ophth 2 > Flashcards

Ophth 2 Flashcards

1
Q

Define hypopion

A

Pus in anterior chamber

Due to corneal ulcer

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2
Q

Treatment of hypopion

A

Hourly antibiotic drops in eye
(OFLOXACIN, bacteriocidal)
Avoid contact lenses
Send the contacts off for MC&S

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3
Q

What is the worst case scenario after a hypopion

A

Corneal ulcer perforates
Iris prolapses
Endopthlamitis and loss of eye

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4
Q

What is fluorescin used to diagnose?

A
  • Corneal ulcers
  • Dendritic (herpetic) ulcers
  • Corneal abrasion
  • Dry eye (pin pricks)
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5
Q

3 types of cataract

A

Green/yellow, common: Nuclear sclerosis
Steroid use, diabetes: Posterior subcapsular
Spokes of opacity: Cortical

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6
Q

Symptoms of cataracts

A
  • May improve near sight
  • Decreased contrast
  • Glare
  • Duller colours
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7
Q

Name 3 complications of cataract surgery

A
  • Endophthalmitis
  • Iris prolapse
  • Uveitis
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8
Q

What is used to see whether someone’s vision is distorted?

A

Amsler chart
Grid patter
Close one eye, focus on black central dot

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9
Q

What is an Amsler chart?

A

Diagnoses distortion
Close one eye, focus on black central dot.
Grid pattern.

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10
Q

What does wet AMD look like on fundoscopy?

A

Haemorrhage and exudate (creamy) and fluid are confined to macula
No disc swelling, vessels are not tortuous

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11
Q

Name the bones that make up the orbit

A 
Frontal
Maxilla
Zygomatic
Sphenoid
Palatine
Ethmoid
Lacrimal
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12
Q

Where in the orbit is most at risk from blunt trauma?

A

Medial wall and floor (thinner with sinuses beneath them)

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13
Q

If someone comes in after a tennis ball to the orbit, what do you do?

A

Loss of consciousness? (witness collateral history). Mechanism of injury? Other injuries? Previous ocular/medical/drug history. Tetanus prophylaxis.
• Visual acuity
• Gentle exam of lid, orbit, eye (don’t press due to perforation)
• Eye movements
• Note extent of other injuries (eg max fax)
Xrays and CT scans to identify fractures

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14
Q

What does an eye examination entail?

A
  • Lid
  • Conj
  • Cornea
  • Anterior chamber
  • Iris/pupil
  • Lens
  • Intraocular pressure
  • Vitreous
  • Retina
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15
Q

If blood is seen in anterior chamber, where did it come from? What can it lead to? What is it called?

A

Hyphema
Usually from iris vessels
Can lead to ocular hypertension due to blockage of filtering system

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16
Q

Define iridodialysis

A

Disinsertion of the iris root, iris comes away from ciliary body. Pupil becomes misshapen.

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17
Q

What does a traumatic cataract look like?

A

Traumatic cataracts occur secondary to blunt or penetrating ocular trauma.
Cataracts caused by blunt trauma classically form stellate- or rosette-shaped posterior axial opacities that may be stable or progressive, whereas penetrating trauma with disruption of the lens capsule forms cortical changes that may remain focal if small or may progress rapidly to total cortical opacification.

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18
Q

What can happen to the retina after blunt trauma?

A

Commotio retinae:

Yellowish sheen on retina, sheer effect due to trauma.

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19
Q

Define choroidal rupture

A

Breaks in the choroid, the Bruch membrane, and the retinal pigment epithelium (RPE) that result from blunt ocular trauma
White concentric lines of rupture due to torsion around optic nerve

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20
Q

What will perforation of the eye look like?

A

Tear drop pupil with iris poking out

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21
Q

If there is hx of high velocity injury, what investigation is needed?

A

Xray to pick up metal in back of eye

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22
Q

What happens if metal is not found and stays in back of eye?

A

Siderosis: iris colour changes, pupil becomes sluggish. Due to metal foreign body.

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23
Q

What is seen in diabetic retinopathy

A
  • Microaneurysms
  • Leakage (hard exudates, haemorrhage)
  • Occlusion
  • VEGF-> Angiogenesis-> proliferative retinopathy
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24
Q

Treatment of proliferative diabetic retinopathy?

A

Pan retinal photocoagulation in peripheries
Anti-VEGF intravitreal injections
Steroid injections

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25
Q

Complications of proliferative diabetic retinopathy? (2)

A
  • Ring of fibrous tissue grows with new blood vessels, contracts and can dislodge the retina
  • Blood vessels can grow towards iris, can block drainage of fluid
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26
Q

What is seen in anterior uveitis?

A

Keratitic precipitates

Iris adheres to cornea or lens

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27
Q

Acute uveitis is associated with___

A
  • Can be autoimmune (HLA B27 related, psoriatic arthritis)
  • IBD
  • Collection of inflammatory cells
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28
Q

Chronic uveitis is associated with__

A
  • Mutton fat keratitic precipitates
  • Juvenile idiopathic arthritis
  • TB, syphilis, herpes, sarcoidosis
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29
Q

What can cause retinitis?

A

toxoplasmosis, CMV, candida (in immunosuppression)

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30
Q

Signs and causes of posterior uveitis

A
  • Cells in vitreous: clouding
  • Headlight in the fog
  • Choroidal granuloma/sarcoidosis
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31
Q

What can corticosteroid treatment do to the eye?

A

Posterior subcapsular cataract

2º glaucoma

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32
Q

Which antimalarial drugs can cause eye problems?

A

Chloroquine-> maculopathy

Quinine-> Optic atrophy, arteriolar narrowing

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33
Q

Treatment of giant cell arteritis?

A

Urgent steroids

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34
Q

Which eye muscles adduct?

A

Medial rectus

Inferior and superior recti

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35
Q

Which eye muscles abduct?

A

Lateral rectus

Inferior and superior oblique

36
Q

What is left esotropia?

A

Left pupil too adducted

37
Q

What is right hypertropia?

A

Right pupil too superior

38
Q

What is the difference between a tropia and a phoria?

A

Tropia: misalignment always there, even when both eyes are open and attempting to work together
Phoria: latent squint, misalignment only occurs sometimes, eg in cover test

39
Q

Difference between incomitant and cocomitant

A

Is the deviation the same magnitude regardless of gaze position? Yes: concomitant

40
Q

6 causes of an incomitant strabismus

A 
Mechanical Restrictions
a) Muscle (e.g. contracture)
b) Bone (e.g. fracture)
c) Connective Tissue (e.g inflammation) 
d) Mass (e.g. tumour)
Innervational Abnormalities
a) Underaction (e.g. palsy)
b) Overaction (e.g. inferior oblique)
41
Q

Definition of amblyopia

A

Commonly known as lazy eye, is the eye condition noted by reduced vision not correctable by glasses or contact lenses and is not due to any eye disease. The brain, for some reason, does not fully acknowledge the images seen by the amblyopic eye.

42
Q

Causes of amblyopia

A

Anything that interferes with clear vision in either eye during the critical period (birth to 6 years of age) can result in amblyopia

  • Constant strabismus (constant turn of one eye)
  • Anisometropia (different vision/prescriptions in each eye)
  • Blockage of an eye due to trauma, lid droop
43
Q

Treatment of amblyopia

A 
Correct vision (improve lid drop, correct refractive errors, patch over good eye)
Maximum benefit of amblyopia treatment is up to age 7
44
Q

Define nystagmus

A

Rapid rhythmic repetitious involuntary (uncontrollable) eye movements.
Can be horizontal, vertical or rotary and can effect one or both eyes.

45
Q

5 causes of acquired nystagmus

A

• Inner ear disorders (labyrinthitis or Meniere’s disease)
• Toxic- drugs, medication (such as anti-seizure medications and sedating meds), alcohol intoxication
• Head injury
• Stroke (blood vessel blockage
in the brain)
• Diseases of the brain…multiple sclerosis or brain tumours

46
Q

Signs of Horner’s syndrome

A 
Interruption of sympathetics
Miosis (constricted pupil)
Anhydrosis (decreased sweating)
Ptosis (drooping eyelid)
Enophthalmos (Inset eyeball)
47
Q

If Horner’s syndrome is painful, what needs to be excluded?

A

Carotid dissection

48
Q

Define amaurosis fugax

A
  • Transient monocular visual loss or dimming
  • May last from 2-3 minutes to 30 minutes or more • Due to decrease blood flow to the eye
  • Causes:
  • Carotid atheroma
  • Cardiac valve disease
  • Atrial myxoma
  • Retinal migraine
  • Giant cell arteritis
  • Hyperviscosity syndromes
49
Q

Name the muscles of the eye

A

Levator palpebrae superioris (skeletal)
Muller’s muscle (sympathetic innervation)
Orbicularis oculi

50
Q

Describe sclera

A

Tough white shell starting from the limbus and extends all around the eye
Gets nutrients from episclera and choroid

51
Q

Describe parasympathetic action on iris

A

Sphincter pupillae muscle contracts

Pupil size decreases (miosis)

52
Q

Function of ciliary body

A

Produces aqueous humour in anterior chamber

53
Q

2 treatments of dry eye

A

Lubricating eye drops, punctal plugs

54
Q

Define chalazion

Treatment?

A

Focal swelling of the eyelid as a hard and painless nodule, due to inflammation and blockage of the sebaceous glands. Lid massage with steroid drops if not cleared within a month. Incision and drainage if infected. If sebaceous gland carcinoma is suspected send fluid for screening. If parasitic, nocturnal ointment will smother them.

55
Q

Name the common infectious agents causing conjunctivitis

A

Viral is most common: adenovirus, herpes simplex virus, varicella zoster
Bacterial: Staphylococcus, streptococcus, corynebacterium, haemophilus influenza, pseudomonas

56
Q

Signs and symptoms of allergic eye

A

Erythema, itching, burning, watering of eyes, oedema of eyelids.
Papillary hyperplasia

57
Q

Causes of sticky eye in infant

A

Infant’s nasolacrimal ducts are narrower so it is normal for them to become slightly blocked and cause a watery/sticky eye. Resolves on its own.
Wait 1 year before considering surgical intervention

58
Q

What is a Fresnal prism?

A

Used to correct diplopia (double vision). 1mm thick
Occlusive lens
Patch

59
Q

Symptoms of a corneal ulcer

A

Erythema of eyelid and conjunctiva, mucopurulent discharge,

foreign body sensation, blurred vision, light sensitivity, pain

60
Q

Causes of keratitis

A 
Rheumatoid arthritis (autoimmune), bacterial infection (contact lens use or post-surgery), 
UV light
61
Q

Difference between myopia and presbyopia

A

Myopia (nearsightedness): lens refracts wrongly so can’t see distant objects
Presbyopia (farsightedness): Can’t see up-close, usually age related

62
Q

Difference between phakia and aphakia

A

Aphakia: absence of lens (congenital, surgical removal, perforating wound or ulcer)
Phakia: presence of the natural lens of the eye

63
Q

3 causes of iritis

A

Inflammation of the iris
Injury (blunt force trauma, penetrating injury, burn)
Shingles (herpes zoster) infection, TB, syphilis
Juvenile rheumatoid arthritis

64
Q

Presenting symptoms of diabetic eye disease

A

Blurred vision
Painless gradual reduction in central vision
Sudden onset of dark, painless floaters

65
Q

What does a fluorescein angiogram assess?

A

Highlights retinal blood vessels, looking for Av nipping, haemorrhages, aneurysms, neovascularisation

66
Q

Define drusen

A

Deposits of lipid under the retina

67
Q

Define floaters

A

Grey/black lines/specks/cobwebs seen infront of eyes. They move when the patient moves their eyes and drift when the eyes stop/start moving. Usually fragments of vitreous jelly coming loose

68
Q

Define retinal detachment

Presentation

A

Separation of the neural layer from the underlying pigment epithelial layer
Floaters, flashes, curtain over field of vision

69
Q

Difference between raised intraocular pressure and glaucoma

A

Glaucoma is a multifactorial disease of optic nerve damage and visual field loss.
Raised intraocular pressure is usually seen in glaucoma but raised IOP can be present without glaucoma

70
Q

Normal intraocular pressure?

A

10-21mmHg

71
Q

2 types of visual field assessment

A

Confrontation visual field testing and automated perimetry.

Humphries & Goldmann’s

72
Q

What does asymmetrically cupped discs mean?

A

Suggests early simple glaucoma and optic disk ischaemia, esp if unilateral

73
Q

Define papilloedema

A

Optic disc swelling caused by raised intracranial pressure

74
Q

Give a reason for small and unreactive pupils and a reason for small and reactive pupils

A

Small and unreactive: opiate overdose, posterior synaechiae

Small and reactive: Overactive parasympathetic system/Horner’s syndrome

75
Q

Give a reason for large and unreactive pupils and a reason for large and reactive pupils

A

Large and non reactive: third nerve palsy, dilating drops

Large and reactive: Adie syndrome (slow reaction, damage to dilator pupilae)

76
Q

What are the signs of a direct carotid-cavernous fistula?

A

Ocular pulsations, optic disc swelling, intraretinal haemorrhage +/- tinnitus, bruit over eye

77
Q

Normal cup:disc ratio

A

< 0.5 normal

78
Q

How is vision tested in young children?

A

Most children can cooperate for a vision test by naming or matching pictures from years old. Until that age, assessment of vision is objective e.g. by observing reactions to covering either eye or by comparing the fixation behaviour of either eye when toys or special targets (gratings) are presented to the infant.
Forced choice preferential looking test
Naming/matching pictures/letters

79
Q

When should squints in children be referred?

A

Any constant squint (misalignment of the eyes), convergent or divergent, in a baby or child should be referred to an ophthalmolgist a.s.a.p.
Any intermittent squint after the age of 4 months in a baby should be referred a.s.a.p.

80
Q

R 4th nerve palsy presentation

A

The right eye will tend to be elevated – this could be a manifest or a latent vertical squint. There may be an associated horizontal deviation.
The right eye will demonstrate an under action when looking down to the left.
A head tilt is often present which helps to control the vertical squint.

81
Q

R 6th nerve palsy presentation

A

The right eye will demonstrate an esotropia when looking in the distance and will not move fully into abduction i.e. out to the right.

82
Q

Describe optic neuritis

A
  • Young
  • Rapid vision loss over days (colour washed out first)
  • RAPD
  • Disc swollen and hyperaemic
83
Q

Define en/ex tropion

A

Entropion: eyelid folded in
Lashes rub on eye, very painful

Ectropion: eyelid folded out

84
Q

Define ptergium

A

Conjunctival overgrowth over cornea. Needs surgical excision.
Sun exposure is a risk factor.

85
Q

Describe viral conjunctivitis

A

Redder conjunctiva, subconjunctival haemorrhage. Lubricating eye drops initially. Start steroids if cornea is involved.

86
Q

Signs of chlamydial conjunctivitis

A

Chlamydial: stickier discharge than viral, less than bacterial. Corneal involvement, pale follicles present.

Year 4 (9 decks)

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