Ophthal Clinical Flashcards
(122 cards)
1
Q
closure of eyelids
opening of eyelids
A
orbicularis oculi, 7th nerve
levator muscles, 3rd nerve
2
Q
limbus
A
where the cornea meets the slcera
3
Q
scleral and corneal thickness
A
sclera 1mm, cornea 0.5mm
4
Q
tear film components
A
lipid from meibomian glands in eyelid, aqueous from superotemporal lacrimal gland, conjunctiva have goblet cells which secrete mucin
5
Q
ciliary body roles
A
makes aqueous humour for the anterior chamber, anchors the lens via attached zonules and modulates its convexity, also connects the iris to the choriod
6
Q
in between sclera and retina…
A
choriod, provides nutrition to the retina
7
Q
presbyopia
A
loss of accomodation secondary to aging, caused by reduction in lens capsule elasticity and decreased lens deformity
8
Q
anterior chamber/posterior chamber
A
corneairis/irislens
9
Q
vitreous humour gel like consistency
A
99% water but contains collagen fibriles and hyalouron, cushions retina from trauma, as you age it can pull on retina cuasing detachment
10
Q
cones vs rods
A
cones for fine vision and colour in the macula
rods for light and movement in the peripheral retina
11
Q
bones of orbit
A
sphenoid
zygomatic nose/lacrimal bone
maxilla
medial and inferior bones are most vulnerable to #/infection
optic foramen allows entry of the optic nerve and ophthalmic artery
12
Q
rectus muscles arise from..
nerves inervated by…
A
arise from orbital apex
medial - 3rd
lateral - 6th
superior and inferior - oculomotor
13
Q
superior and inferior oblique
A
superior - 4th nerve
inferior oculomotor
14
Q
topical mydriatics
A
antimuscarinics tropicamide, atropine, cyclopentolate - inhibit parasympathetic
phenylephrine - sympathetic (agonist)
15
Q
red eye history
A
glaucoma, hypermetropai
contact lens, trauma
itching (infective), pain, photophobia (iritis)
discharge - watery (viral) or purulent
unilateral or bilateral
ecent disease e.g. herpes, URTI, sarcoidosis,
16
Q
visual loss history
A
sudden and profound - arteriol
recurrent - embolic
?raised ICP
distortion (macular disease), central vision loss (macular)
progression from periphery to centra (retinal detachment, retinal artery embolism, migraine)
17
Q
diplopia history
A
in which direction - side to side (6th)
intermittent - MG, dysthyroid
any trauma
18
Q
stabismus
A
misalignment of the eyes
19
Q
acne rosacea can cause…
A
rosacea keratoconjunctivitis
20
Q
red desaturation in…
A
optic neuritis
21
Q
When is a hess chart used
A
by orthoptists, it is a graphical representation of eye movement
22
Q
visual field testing
A
humfreys visual field, this is called perimetry
23
Q
when is US used
A
for chorioidal tumours, to exclude retinal detachment/viterous haemorrhage when there is a dense cataract or an obscured view
24
Q
what is keratometry
A
measuring the shape of the cornea
25
amsler chart/grid
used for measuring macular degeneration
26
fundus flourescein angiography
hypofluorescence shows ischaemia - dark
| hyperfluorescence shows leakage - bright
27
optical coherence tomography
anatomical detail to macula oedema, macular holes, choroidal neovascular membranes
28
uvea
iris, ciliary body, choriod
29
chalazion
blockage of the meibomian glands causing chronic inflammatory change, warm compresses for 15minutes 4x a day, may need injected steroids or surgical incision
30
investigation of intraocular infection
endophthalmitis, can do a AC tap for testing aqueous humour or a viterous biopsy
31
prostaglandin analogues
treatment of glaucoma, increase aqueous outflow via the uvoscleral route
32
reduce aquous secretion by direct action on the ciliary body
beta blockers (timolol), alpha2 stimulants (brimonide), carbonic anhydrase inhibitors (acetazolamide)
33
muscarinic stimulants
increases aqueous outflow via trabecular meshwork
34
ranbizumab
anti VEGF
35
topical local anaesthetic
oxybuprocaine
36
mebomian gland dysfunction
associated with seborrhoeic dermatitis and acne rosacea. Causes inflammation of the eye and evaporative dry eye disease
37
stye
external hordeolum = bacterial eyelash folliculitis
38
internal hordeolum
acute meibomian gland dysfunction
39
causes of ptosis
ageing, MG (ab to acetylocholine receptors), 3rd nerve palsy (DM, CVA, aneurysm), Horners (disruption to sympathetic chain), enophthalmos secondary to trauma, mitochondrial myopathies, trauma to levator muscle
40
treatment of myasthenia gravis
cholinesterase inhibitors which increase availability of acetylcholine, immunosuppresants
41
cicatricial scarring
scarring of the conjuctiva, can be caused by trachoma, alkali burns, steven johnsons
causes entropion
42
keratoconjunctivitis sicca
deficiency of the aqeous component of the tear film, pure KS due to only lacrimal gland, KS can be a part of sjogrens which involves other glands
43
xerophthalmia
absence of mucin in tear film causing dryness of eye caused by scarring or vit A deficiency
44
dacrocystitis
infection of the lacrimal sac causing swelling at the medial canthus
45
thyroid eye disease treatment
caused by humoural and cell mediated autoimmune reaction to orbital antigens, has a 2-3 acute phase where symptoms can be intermittent followed by a stable chronic phase, manage with prisms, lubrication, radiotherapy, systemic immunosuppression, surgical orbital decompression
46
paediatric tumours
capillary haemangiomas, optic nerve gliomas, retinoblastoma, dermoid cysts
47
chemosis
conjunctival swelling
48
erythema multiforme major
steven johnstons syndrome, causes target like lesions, can affect conjunctiva causing bullae and necrosis leading to scarring
young adults, can be idiopathic, caused by drugs such as sulphonamides, caused by infections
49
ocular cicatricial pemphigoid
chronic relapsing/remitting condition of the conjunctiva causing scarring.
redness, grittiness and watering of the eye, contraction
50
herpes simplex virus
primary: ulcer, blepharoconjunctivitis
secondary: anterior uveitis, virus reactivated along nerve, can cause dendritic ulcer
51
varicella zoster virus (shingles)
herpes zoster ophthalmicus in 10% of shingles, can cause conjunctiitis and rarely an ulcer, can cuase keratitis and anterior uveitis
post herpetic neuralgia
52
adenovirus conjunctivitis
can cause keratitis with white opacities causing blurring of vision
53
hypophyon
suggesting of endophthalmitis, treat with a quinolone such as vancomycin
54
how does rheumatoid arthritis causes corneal melting
secondary sjogrens/keratoconjunctivitis sicca causing decreased aqeous content of tear film which leads to dry eyes and erosion of corneal epithelium
55
keratoconus
disorder of the shape of the cornea leading to a cone like protusion, it has a gradual onset, first noted with visual deterioration and proved with computed corneal topography, can be fixed with riboflavin UVA cross linking or corneal transplant
56
pterygium
can cause astigmatism and encroach visual axis, surgical removal with repair using patch of patients own conjunctiva
57
band keratopathy
corneal deposition in subepithelium in the interpalpebral region
58
glaucoma findings
optic disc cupping, visual field loss, raised intraocular pressure
cup:disc ration of >0.6
Arcuate scotoma
59
primary open angle glaucoma
most common type 1/3, does not present with symptoms until central vision is affected
60
gonioscope
to measure angle of AC
61
treatment of glaucoma
decrease aqueous humour formation: drops such as beta blockers, lasers to ciliary body
increased aqueous outflow: drops such as prostaglandin analogues for uvoscleral or muscarinic antagonists (pilocarpine), can also laser iridiotomy if closed angle or into TM, can use trabeculoplasty
62
side effects of prostaglandin analgues
increased iris pigmentation, increased eyelash length, red eye
63
angle closure glaucoma
present with pain, nausea, loss of vision (due to corneal oedema, also causes loss of red reflex), halos, oval non reactive pupil . more likely in hypermetropic individuals and following mydriatics
64
management of angle closure glaucoma
lie flat
Reverse pupil block with pilocarpine (miotic, cholinergic)
oral acetozolamide
analgesia/antiemetics
laser iriotomy
long term prostaglandin analogues and surveillance
65
causes of secondary glaucoma
```
long term topical steroids
chronic uveitis
inflammation
pseudoexfoliation (deposition of proteins in TM)
lens abnormalities
aphakia
```
66
non pharmacological treatment of glaucoma
trabeculectomy with mitogen c
laser to the ciliary body
tube drainage
67
buphthalmos
enlarged eye in child, can occur in glaucoma in children
68
anterior uveitis
pain, redness, photophobia, watering, blurred vision
| signs: miosis, keratic precipitates, inflammatory cells on slit lamp
69
causes of anterior uveitis/iritis
```
Ocular:
viral HSV/VZV
Trauma
Sympathetic ophthalmitis
Fuchs heterochromic cyclitis
Systemic:
Seronegative spondyloarthropathies
anklyosing spondylitis
reactive arthritis
Psoriatic arthritis
crohns/UC
sarcoidosis
juvenile idiopathic arthritis
Behcets
syphilis
TB
```
70
posterior uveitis
inflammation of the choriod, can cause floaters, decreased vision, inflammatory cells in the vitreous, cotton wool spots, macular oedema, optic disc swelling
Causes of PU: toxoplasmosis, sarcoidosis, syphillis, TB, CMV, candidiasis, behcets, HSV, VZV, sympathetic ophthalmitis
71
CMV retinitis
immunosuppresed individuals, presents with painless visual loss, pizza appearance
72
sarcoidosis in the eye
Intraocular: anterior and posterior uveitis
Extraocular: conjunctivitis, keratitis secondary to keratoconjunctivitis sicca
Chronic: leads to glaucoma, cataract etc
check ACE, CXR and lysozyme levels
treat with topical steroids can use periocular depot steroids and intravitreal injections
vitreous cells, venous sheathing and perivenous exudates
73
systemic causes of cataract vs ocular causes
Systemic:
DM, ageing, corticosteroids, galactosaemia, hypocalcaemia
Ocular:
Trauma, UV light, topical steroids, recurrent uveitis, radiation, high myopia
74
how does diabetes cause retinopathy
poor glycaemic control causes glycosylation of tissues, small vessl occlusion leads to ischaemia and then neovascularisation more like to cause haemorrhage. also increased permiability of blood retinal barrier
75
exudates vs cotton wool spots
exudates are lipid deposits, cotton wool spots are areas of ischaemia
76
background diabetic retinopathy
microaneurysms
blot haemorrhages
exudates
77
preproliferative diabetic retinopathy
cotton wall spots
| venous bleeding
78
proliferative diabetic retinopathy
new vessels at disc and new vessels elsewhere
79
rubeosis
neovascularisation of the iris
80
sudden painless loss of vision
```
retinal detachment
retinal vein occlusion
vitreous haemorrhage
retinal artery occlusion
macular haemorrhage
```
81
causes of retinal vascular occlusion
DM, HTN, IHD, Emboli (vegetations, calcific, cholesterol), clotting disorders (smoking, pregnant, COCP), vessel wall (sarcoidosis, SLE, polarteritis nodosa)
82
hypertensive retinopathy
cotton wool spots, flame haemorrhages, vessel occlusions, macro and microaneurysms, exudates, optic disc swelling
83
retinopathy of prematurity
normal retinal vascularisation is not complete until term, increased risk with high O2 can lead to retinal detachment characteristic purse string, screening is done in babies <31 weeks
84
sickle cell retinopathy
due to occlusion and ischaemia, may have proliferative retinopathy in sea fan distribution, sunbutest scars and salmon patches
85
age related macular degeneration
most common cause of blind registration in western world, deposition of drusen between the retinal pigment epithelium and the photoreceptors, occurs at the macula causing central visual loss
Wet causes profound central visual loss causing haemorrhages, drusen, RPE atrophy and can later develop a large scar
Ix with fundus flourescein angiography
manage with antioxidents, low vision aids, fi wet then antiVEGF
86
cystoid macular oedema
cysts in the macula, due to fluid within retina
87
retinitis pigmentosa
night blindness, decreased peripheral vision, glare, bone spicule pigment, waxy optic disc
take FHx, genetic counselling, low vision aids, optimise cataract if present, known associated genetic metabolic conditions
88
choroideraemia
progressive night blindness then peripheral loss then central loss in young males. it is a x linked recessive retinal disorder
89
rhegmatogenous
when there is a tear or retinal break - leads to retinal detachment rfs: high myopia, FHx, cataract surgery, ocular trauma
90
non rhegmatogenous retinal detachment causes
tractional e.g. advanced DM or exudative e.g. tumout
| posterior vitreous detachment causes flashes and floaters
91
surgical management of retinal detachment
vitrectomy to remove traction
indenting of wall to remove traction
drainage of subretinal fluid
laser to reattach vitreous
92
optic nerve disease causes
eye: uveitis, glaucoma, retinal vein occlusion, retinal ischaemia
nerve: gliomas, neuritis
Tumours: meningiomas, gliomas, pituitary gland compression
93
consequences of papilloedema
true papilloedema is a swollen optic nerve head due to raised intracranial pressure, this can lead to optic disc swellin and optic atrophy causing a central scotoma. raised ICP can also cause a 6th nerve palsy
94
optic neuritis presentation
rapidly progressive loss of vision, worse with eye movement, central scotoma, RAPD
vision often improves within a few weeks, 60% have MS in 5yrs
95
pseudopapilloedema
swollen optic disc not due to raised ICP, can be caused by hypermetropisa
96
retinoblastoma
usually rpesents around 18 months due to loss of red reflex, occurs in approximately 1in20,000. investigate with CT/MRI imaging and staging imagine for ?mets, bloods for tumour markers. large tumours require enucleation, can use radiotherapy as an adjunct, if confined to the orbit has a 90% 3yr survival. 10% develop a second primary tumour often a sarcoma
97
neurofibromatosis
NF1 - peripheral
NF2 - central
axillary freckling, cafe au lait spots, bone dysplasia, fibroma molluscum, lisch nodules in iris, may have proptosis secondary to tumour
AD inheritance
98
von hippel lindau syndrome
haemangiomas, can occur in retinal capillaries, treated with freezing or laser
also liver and kidney cysts
99
stuge weber syndrome
cutaneous facial haemangiomas - port wine stain in the trigeminal nerve distribution can also have haemangiomas in the outer sclera
associated with LD and epilepsy
100
tuberose sclerosis
ocular lesions in 50%, most commonly astrocytomas
| associated with shagreen patches (weird bumpy things), renal cysts
101
causes of childhood cataract
1/3 congenital, downs, rubella, metabolic, toxoplasmosis
102
colobomatous iris
keyhole iris due to abnormal foetal development
103
assessment of ambylopia
```
age of onset
?cause: trauma, maternal history/infection, FHx, neurological disease
acuity
cover test
retinal assessment
orthoptic management/patching
can have surgery to extra ocular muscles
```
104
adult causes of strabismus
trauma, nerve palsy (ischaemic, intracranial, nerve disorders, neoplastic), MG, myopathy
in adults strabismus will cause diplopia
105
vertical upgaze pals
parkinsons progressive supranuclear palsyu
106
internuclear ophthalmoplegia
disruption of medial longitudinal fasciculatus causes failure of convergent gaze due to failure of adduction on affected side and nystagmus of abducting eye
107
pilocarpine
constricts the pupil, it is a cholinergic agent
108
third nerve palsy (oculomotor)
down and out, unable to react to light and accommodation, failure of medial, superior and inferior rectus muscles
causes: DM, trauma, aneurysm
109
orbital wall fractures
thinnest at inferior and medial walls, may see a tear drop sign on facial xray from herniation of soft tissue into the maxillary sinus
110
4th nerve palsy (trochlear)
common with head injury, worse on looking up or down
111
6th nerve palsy (abducens)
inervated lateral rectus, failure of abduction
112
corneal abrasian management
flourescein examination, chloramphenicol drops, can give cyclophenolate for pain if needed, occlusive padding
113
hyphema
bleeding into AC, suggests significant trauma, bed rest to avoid secondary haemorrhage
114
ophthalmia neonatorum
conjunctivitis in first postnatal month, notifiable disease, most commonly chlamydia, herpes, gonorrhoea but can be s aureus, time of onset can give clues to which bug
115
scleritis
very painful (unlike episcleritis which is painless), full thickness of sclera, around anterior chamber, associated with corneal thinning,
causes: herpes, RA, SLE,
treat with topical/systemic steroids, NSAIDs, immunosuppresants if severe
116
astigmatism
imperfection in the curvature of the eyeball causing change in refractive index across different meridians
117
photorefractive keratectomy
laser eye treatment, complications include corneal haze, regression and under/over correction
118
ranges for low vision and blindness
low vision
6/18 - 3/60
blind
<3/60
119
onchocerciasis
parasitic infection transmitted by black flies, has a 1 year incubation period and can cause papular rash with pruritis . in the eyes there can be depigmentation, conjunctivits and keratitis, corneal opacification. treated with ivermectin, eosinophilia will be present, prevention is important
120
leprosy
skin changes, atrophy of peripheries, nerve palsys, can cause corneal exposure, dry eyes, anaesthesia of the eyes, cataract and glaucoma. treated with dapsone and rifampicin, active blinking encouraged
121
driving
as long as you are between 6/9-6/12 and no visual field defect
122
complications of cataracts
perioperative - posterior capsule rupture, expulsive haemorrhage
postoperative - endophaltmitis, opacification of PC (treat with a laser capsulotomy), astigmatism, retinal detachment, macular oedema
