Ophthal Flashcards by Arjan Khattar

Leading cause of blindness in developing world + Rx:

TRACHOMA ~Chlamydia:
turned in eyelashes/lids (trichiasis) + chronic conjunctivitis

Rx: PO azithromycin

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Posterior scleritis features and management

PAINFUL loss of vision + proptosis + swollen eye lid + swollen optic disc

Rx: PO NSAID +/- Prednisolone
OR subconjunctival steroid + Methotrexate

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Infective keratitis features

PAINFUL blurred vision, photophobia, epiphora

Circumcorneal injection + conjunctivitis ~infection

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AACG features and management

PAINFUL loss of vision + systemic symptoms + minimally reactive to light + haloes
Semi dilated pupil

(loss of vision tends to be peripheral)

Rx:
Initial:
- miotics eg. pilocarpine (to allow drainage)
- acetazolamide (reduce aqueous production)

Definitive: Laser/surgical iridcectomy once IOP down

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Acute anterior uveitis features and management

Often seen in those with AI Disease
HLAB27 - Ank Spond
HLAB5 - Behcet’s

Features:
acutely painful and red eye, photophobia, reduced visual acuity
Slitlamp: inflammatory cells/hypopyon in anterior chamber
Small pupil
Positive Talbot’s sign: worse pain on convergence and accommodation

Complication: Posterior synechiae (irregular pupil stuck to lens ie. dilates poorly)

Rx: steroid eye drops + anticholinergics eg. cyclopentolate/atropine (relaxes ciliary body to mrdriate and discourage adhesions between iris and lens)

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Vitreous detachment features and management

Caused by bleeding of new vessels

Small haemorrhage: floaters/spots, no loss of acuity

Large haemorrhage: dark streaks, shadow/haze, reduced acuity, absent red reflex, may be unable to see retina

Resolve spontaneously

Rx: Laser photoagulation

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CRVO features

Sudden painless loss of vision in those with CVS RFs

Fundoscopy: “stormy sunset” flame haemorrhages, optic disc oedema

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CRAO features and Rx

Sudden painless loss of vision
Fundoscopy: pale retina, cherry red spot, RAPD
Responds poorly to light but consensual reflex present

Rx: RF control

Permanent visual loss within 1 hour

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Blue-tinged vision secondary to drug

Sildenfail/Viagra - often bought online

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Dendritic ulcer cause and Rx:

HSV

Topical acyclovir
NO STEROIDS as can cause deep-seated infection and permanent vision loss

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CMV retinitis features and Rx

White retinal deposits
Small haemorrhages
“pizza pie”
Often starts in one eye then progresses to other

Rx: antiviral

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Newborn with white pupil + loss of red reflex. DX and RX?

Retinoblastoma

Rx: brachytherapy + chemotherapy (intraarterial)
Cryotherapy an option
Enucleation for large unilateral tumours

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Newborn with cloudy pupil ?Dx

Congenital cataracts
Can be related to rubella

Rx: surgery (lens replacement)

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Hutchinson’s sign

Vesicles on tip of nose ~specific sign for herpes zoster opthalmicus

Suggest nasociliary nerve involvement

Requires urgent antivirals + Ophthal referral

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3rd nerve palsy signs

Down and out, ptosis, DILATED

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Sebaceous cell carcinoma presentation

Often like a chalazion but persists
Associated loss of eyelashes

NB. 3rd most common eyelid malignancy following BCC and SCC

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Pterygium presentation

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Middle Easterns ~wind, dust, UV light

Triangular fibrovascular growth on conjunctiva that can irritate and affect vision

Dacrocystitis definition and presentation and management

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Inflammation of lacrimal sac, often recurrent

Pain, swelling, epiphora of medial eyelids, purulent d/c on palpation

Rx: systemic ABx and Opthal referral ?I+D

NB. Distinct to dacroadentis which is inflammatory of gland and is more lateral

Trichiasis definito and causes

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Eyelashes growing toward eye (usually lower lid)
~irritation, redness, watery eyes

Causes:

entropion
Chlamydia
burns
pemphigoid

Genetic diseases associated with myopia

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Marfans
Ehlers Danlos
Homocystinuria

Treat with concave (cave inward) lenses as light focussing in front of retina

Causes of choroiditis/chorioretinitis

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Immunosuppressed individuals:
CMV
TB
Toxo
Sarcoid
NOT Chlamydia

Gradual visual deterioration with frequent glasses changes
Difficulty driving at night
Haloes and glare
Difficulty reading
BILATERAL symptoms
NO PAIN
Loss/defect of red reflex

Dx and RFs

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Cataracts

RFs:
Smoking
DM
Steroids (prednisolone)
Trauma
Uveitis

Rapidly progressive proptosis in child, what to rule out?

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Rhabdomyosarcoma:

Most common primary orbital malignancy in childhood

River blindness organism and treatment

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Onchocera volvulus (microfilariae)

Rx: Ivermectin

Botulinum is injected into which muscle when treatingblepharospasm?

Orbicularis oculi

Fever and toothache -> swollen, warm red eyelid

Orbital cellulitis Often starts from paranasal sinus infection, dental infection or external ocular infection Needs urgent ENT/Ophtal/MaxFax review and ABX +/- surgery

Seasonal vs perennial allergic conjunctivitis

Seasonal: summer months (pollen) Perennial: year round, often worse in winter (due to dust mites in blankets)

Keratoconjunctivtis sicca Px and Dx test

Unable to cry Manifestation of rheum disease eg. Sarcoid, Sjogrens, RA, amyloid, haemochromatosis Dx: Schirmer's test: place strip of filter paper on lower eyelid

Cataracts: causes signs and symptoms Rx

``` o Causes: Normal ageing Smoking Alcohol Trauma Hypocalcaemia Myotonic dystrophy DM Long term steroids o Sx: Gradual onset reduced vision, glare, haloes, faded colour o Fundoscopy: defect in red reflex o Slit lamp: visible cataract o Rx: Conservative: glasses/lenses Surgical ```

Holmes-Adie pupil features

``` Slowly reactive to accommodation Poorly reactive to light Dilated pupil 80% unilateral Benign ``` If associated with loss of reflexes = Holmes-Adie syndrome

Definitive treatment of AACG

Laser peripheral iridotomy; creates new pathway for aqueous to drain from posterior to anterior chamber, in order to be drained into angle

Argyl Robertson Pupil features and causes

Accommodation Reflex Present, Pupillary Reflex Absent Ax: DM, neurosyphilis

Presentation and causes of lens dislocation

Sudden loss of vision | ``` Associations: - Marfans - Ehlers-Danlos - Homocystinuria - Trauma very similar associations for myopia ```

scleritis vs episcleritis?

Scleritis much more painful

Eye manifestations of RA

Keratoconjunctivitis sicca (most common) Keratitis Episcleritis Corneal ulcer

Opthalmia neonatorum organisms and presentation

Chlamydia: 2-3 weeks old Gonorrhoea: 1-5 days, purulent +++

Toxoplasmosis retinitis

white focal retinitis + overlying vitreous inflammation

CVS RFs + pale, swollen optic disc

anterior ischaemic neuropathy

Post cataracts surgery, redevelop cloudy vision within a few months Dx and Rx

Posterior capsule thickening Rx: capsulotomy + laser surgery (cataract recurrence would take longer)

Allergic conjunctivitis Rx

1st: Topical antihistamine eg. emadastine | Topical steroids if needed

Usual bacteria in bacterial keratitis

pseudomonas

Ophthal Flashcards

(41 cards)