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Neurology and Special Senses > Ophthalm Presentations > Flashcards

Ophthalm Presentations Flashcards

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1
Q

What could cause a red eye? What are the key buzzwords for each

A

Conjunctivitis - Dicharge can be purulent or serous
Blepharitis - Crusts
Subconjunctival haemorrhage
Uveitis - small fixed oval pupil, perilibical injection
Epicleritis - blanch with phenylephrine
Scleritis
Corneal abrasion - visible with fluoroscein
Corneal ulcer (infectious keratitis) - ulcer (dendritic = herpes)
Acute closed angle glaucoma - semi dilated pupil, hazy cornea
Entropion - visible lash involvement

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2
Q

What can cause gradual vision loss?

A 
Macular Degeneration
Diabetic retinopathy
Open angle glaucoma
Cataract
Refractive error
Optic nerve pathology
Drugs
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3
Q

What can cause sudden vision loss?

A 
Retinal vessel occlusion
Closed angle glaucoma
Retinal detachment
Vitreous haemorrhage
Ischaemia
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4
Q

What does painful loss of vision indicate?

A

Serious pathology - malignancy or inflammatory process

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5
Q

What does loss of red reflex mean?

A

Problem with cornea, lens or vitreous

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6
Q

Where is the lesion likely to be if a patient has monocular blindness?

A

Ipsilateral optic nerve

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7
Q

Where is the lesion likely to be if a patient has a homonymous hemianopia?

A

Contralateral optic tract

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8
Q

Where is the lesion likely to be if a patient has a bitemporal hemianopia?

A

Optic chiasm

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9
Q

Where is the lesion likely to be if a patient has a superior quadrantanopia?

A

Contralateral temporal lobe or inferior optic radiation

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10
Q

Where is the lesion likely to be if a patient has a inferior quadrantanopia?

A

Contralateral parietal lobe or superior optic radiation

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11
Q

What does a homonymous hemianopia with macula sparing suggest?

A

Occipital love damage due to posterior cerebral artery infarct

Occipital pole supplied by middle cerebral artery

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12
Q

What can cause double vision?

A 
Microvascular problems
Squint
Trauma
Myasthenia gravis
Thyroid eye disease
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13
Q

What is the difference between monocular and binocular diplopia?

A

Monocular - double vision remain on occlusion of uninvolved eye

Binocular - double vision corrected when either eye is occluded

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14
Q

What causes monocular diplopia?

A

Refractive error
Cataracts
Dislocated lens
Retinal detachment

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15
Q

What causes binocular diplopia?

A

Intermittent - myasthenia gravis

Constant - CN palsy, orbital disease (thyroid), post surgery or trauma

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16
Q

What does a unilateral large pupil indicate?

A

Pupil is poorly constricted in well lit room

Trauma
3rd nerve palsy
Rubeosis Iridis
Holmes-adie
Pharmacological dilation
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17
Q

What causes a unilateral small pupil?

A

Poorly dilated in low lit room

Uveitis
Horner’s
Argyll Robertson
Pharmacological constriction

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18
Q

What is a Holmes Adie pupil?

A

Benign condition due to damage to ciliary ganglion or post ganglionic parasympathetics

Once pupil constricted, remain for long time
Pupil accommodate but slow to react to light

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19
Q

What is an Argyll Robertson pupil?

A

Bilateral sign of neurosyphilis
Damage to midbrain nuclei
Accommodate but slow to react to light

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20
Q

What can cause a relative afferent pupillary defect?

A

Defect in pupillary response - issue with optic nerve/retina

Optic neuritis
Giant cell arteritis
Retinal detachment
Unilateral glaucoma
Retinal artery disease
Optic nerve tumour/infections
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21
Q

What can a fixed dilated pupil be indicative of?

A 
Post traumatic iridocyclitis
Intracranial pathology
CNIII injury
Brainstem injury
Post. communicating artery aneurysm
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22
Q

What drugs cause dilation of a pupil?

A

Topical -
Sympathomimetics (adrenaline)
Antimuscarinics

Systemic - 
Adrenaline
Atropine
TCA's
Amphetamines and ecstasy
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23
Q

What drugs cause pupillary constriction?

A 
Muscarinic agonists (pilocarpine)
Opiates
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24
Q

What can cause ptosis?

A 
CN3 palsy
Bells palsy
Horners syndrome
Myasthenia gravis
Thyroid eye disease
MS
Trauma, infection or lesion
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25
What is optic atrophy?
Loss of some or all of the nerve fibres within the optic nerve
26
How does optic atrophy present?
Loss of vision - type depend on cause
27
How does optic atrophy appear on Fundoscopy?
Pale retina Well demarcated disc Fewer small vessels crossing surface
28
What is the aim of management of optic atrophy?
Stop progression - optic nerve can't regenerate
29
What can bilateral optic atrophy commonly be caused by?
Intracranial neoplasm >40 - vascular
30
What are the causes for optic atrophy?
Primary - MS, Raised IOP, Trauma Secondary - papilloedema, giant cell arteritis, non arteritis ischaemia Retinal - artery occlusion Toxins - quinine, methanol, arsenic Vitamin B1,2,6,12 deficiency
31
What is myopia/hypermetropia?
Myopia = short sightedness Hypermetropia = long sightedness
32
What are the risks of myopia?
Retinal detachment | Macular degeneration
33
What are the risks of hypermetropia?
Acute closed angle glaucoma | Convergent squint
34
Why may hypermetropia be picked up late?
Accommodation can compensate Can lead to headaches
35
What is presbyopia?
Reduction in accommodative ability with age Lens and capsule less elastic - less able to accommodate
36
How is presbyopia corrected?
Give convex lens | Bifocals if pre-existing refractive error
37
What is astigmatism?
Abnormal curvature of the eye - rugby ball Can cause blurred vision and headaches
38
What is amblyopia?
Eye functioning normally but dysfunction processing of visual information
39
How is amblyopia treated?
Correct any causative issues Patch over good eye Atropine drops in good eye Aim to blur good eye so the bad eye has to work
40
How is amblyopia diagnosed?
Unilateral decrease in visual acuity >2 lines on snellen chart
41
What are the ocular manifestations of diabetes?
Retinopathy Rubeosis iridis Ocular nerve palsies Maculopathy - complication of retinopathy
42
How does diabetic retinopathy appear on Fundoscopy?
Mild non proliferative - microaneurysms Moderate non proliferative - microaneurysms, cotton wool spots, flame haemorrhages, hard exudates, venous beading Severe non proliferative - as above in more quadrants of eye Severe proliferative - + neovascularisation and vitreous haemorrhage
43
What are flame haemorrhages?
Haemorrhages due to weak vessels that track along nerve fibre bundles
44
What are cotton wool spots?
Build up of axonal debris - poor axonal metabolism in infarcted areas
45
How is diabetic retinopathy diagnosed?
Dilated retinal photography and ophthalmoscopy
46
How often are diabetic patients screened for retinopathy?
At diagnosis and annually for patients >12yo
47
How does diabetic retinopathy present?
Painless reduction in central vision Dark painless floaters
48
How is diabetic retinopathy managed?
Prevent Laser treatment of new vessels Intravitreal steroids Vitrectomy
49
What is diabetic maculopathy?
Macula oedema occurring with retinopathy Breakdown of blood retinal barrier allow fluid to accumulate Reduction in central vision Treat with anti VEGF injections
50
What are the ocular manifestations of neurofibromatosis?
Lisch nodules
51
What are the ocular manifestations of shaken baby syndrome?
Intra retinal haemorrhages
52
What are the ocular manifestations of TIA?
Amaurosis Fugax
53
What are the ocular manifestations of hyper viscosity syndromes?
Amaurosis fugax, visual loss, retinal vein dilation, haemorrhage, disc oedema
54
What are the ocular manifestations of sickle cell?
Retinal artery occlusion - peripheral neovascularisation and haemorrhage
55
What cancers metastasise to the eye and how do they manifest?
Breast and Lung Creamy white lesion in choroid Irregular pupil shape Hyphema
56
How does papilloedema look on Fundoscopy?
Cupping of optic disc Blurring of optic disc margin Venous engorgement Loss of venous pulsation
57
What are the types of uveitis?
Granulomatous - blurred vision, mild pain, watering, sarcoid, TB Non granulomatous - acute pain and photophobia - herpes, ank spond, IBD
58
What causes retinal vasculitis?
``` Behcet Sarcoid MS RA SLE Temporal arteritis ```
59
How does retinal vasculitis present?
Painless loss of vision - esp. colours Floaters Scotomas
60
How does optic neuritis present?
Reduced vision - exaggerated by heat Pain on eye movement Impaired colour vision Can have socotoma, photopsia, RAPD
61
How is optic neuritis managed?
V high dose steroids
62
How does amaurosis fugax present?
Curtain drawing from above | Temporary loss of vision - between seconds to hours
63
What causes amaurosis fugax?
Emboli or atherosclerosis Temporary vasospasm Giant cell arteritis
64
What can cause hornets syndrome?
Pancoast tumour Thyroid tumour Carotid dissection Cavernous sinus thrombosis
65
What are the phases of thyroid eye disease?
Active inflammatory - expansion of extra ocular muscles and orbital fat Inactive fibrotic - lead to sight loss if active phase not treated
66
How does thyroid eye disease present?
``` Proptosis Lid retraction Orbital fat prolapse Diplopia Optic neuropathy Exposure keratopathy Decreased ocular mobility ```
67
How would you investigate thyroid eye disease?
TSH, free t4, thyroid autoantibodies | MRI
68
How is thyroid eye disease managed?
Achieve euthyroid state Smoking cessation Lubricants, steroids, prisms and surgery can be done/used
69
What is herpes zoster opthalmicus?
Reactivation of varicella zoster in area supplied by ophthalmic division of trigeminal nerve
70
How does herpes zoster ophthalmicus present?
Vesicular rash around eye | Hutchinson's sign - rash on tip or side of nose
71
How is herpes zoster ophthalmicus managed?
Urgent ophthalmology review Oral antiviral treatment for 7-10 days (systemic) Topical corticosteroids can be used
72
What are the complications associated with herpes zoster ophthalmicus?
``` Conjunctivitis Keratitis Episcleritis Anterior uveitis Ptosis Post herpetic neuralgia ```

Neurology and Special Senses (28 decks)

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