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Ophthalmology 1 Flashcards

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1
Q

Acute angle closure glaucoma
Name three factors predisposing patient to AACG

A
  1. Hypermetropia (long sightedness)
  2. Pupillary dilatation
  3. Lens growth associated with increasing age
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2
Q

Name five features of acute angle closure glaucoma

A

Red, painful eye
Haloes around light
Semi dilated non reacting pupil
Dull/ hazy cornea
Worse in a dark room

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3
Q

Mx acute angle closure glaucoma
Acute: (5)

A
  1. Urgent referral to ophthalmologist
  2. Direct parasympathomimetic (e.g pilocarpine)
  3. BB
  4. Alpha 2 agonist e.g apraclonidine
  5. IV acetazolamide
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4
Q

Mx acute angle closure glaucoma
Definitive management

A

Laser peripheral iridotomy

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5
Q

Most common cause of blindness in the UK

A

Age related macular degeneration

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6
Q

ARMD
Degeneration of what?
Through the formation of what?
Unilat or bilat?

A

Central retina/ macula
Drusen
Bilateral

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7
Q

ARMD
RF (4)

A

Age
Smoking
FH
CVD

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8
Q

Which is more common? Dry or wet macular degeneration?

A

Dry - 90%

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9
Q

What is the difference between dry and wet macular degeneration?

A

Dry - drusen
Wet - exudative, choroidal neovascularisation, rapid loss of vision

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10
Q

ARMD
Features
Onset
Near or far field objects loss of vision
Worse when?
Another feature

A

Subacute onset of visual loss
Near field objects
Worse at night
Flashing lights/ glare

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11
Q

ARMD signs (3)

A

Distortion of line perception on Amsler grid testing
Drusen
Wet ARMD - demarcated red patches

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12
Q

ARMD Ix (3)

A

Slit lamp microscopy
Fluorescein angiography (if wet)
Ocular coherence tomography

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13
Q

ARMD Rx (3)

A
  1. Zinc, vitamins A,C,E
  2. anti-VEGF (wet)
  3. Laser photocoagulation
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14
Q

Mx allergic conjunctivitis (2)

A
  1. Topical/ systemic anti-histamines
  2. Topical mast cell stabilisers e.g sodium cromoglicate and nedocromil
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15
Q

Anterior uveitis
Onset
Pain or no pain
Red or not red
Pupil size
x3 other symptoms
Acuity

A

Acute
Painful and red
Small pupil and irregular
Photophobia
Lacrimation
Ciliary flush (ring of red spreading outwards)
Acuity - initially normal, then impaired

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16
Q

Anterior uveitis
Name five conditions associated with this

A

Ank spond
Reactive arthritis
Behcet’s
IBD
Sarcoidosis

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17
Q

Mx anterior uveitis (3)

A

Urgent ophthalmology review
Cyclplegics e.g atropine
Steroid eye drops

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18
Q

Small irregular pupils
No response to light
Response to accommodate

A

Argyll Robertson pupil

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19
Q

Argyll Robertson pupil associated with which conditions? (2)

A

Syphillis
DM

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20
Q

Argyll Robertson pupil
Features (3)

A

Small irregular pupils
No response to light
Response to accommodate

AID:
Accommodation Reflex Present
Pupillary Reflex Absent

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21
Q

What is blepharitis?
What is it due to?
Common in patients which which condition?

A

Inflammation of the eyelid margins
Meibomian gland dysfunction
Rosacea

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22
Q

Blepharitis
Unilat or bilat?
Sx (4)

A

Bilat
Grittiness and discomfort
Sticky eyes
Red + dry eyes

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23
Q

Blepharitis Mx (3)

A

Hot compress BD
Lid hygiene - cotton wool buds dipped in cooled boiled water + baby shampoo
Artificial tears

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24
Q

Most common cause of blurred vision?

A

Refractive error

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25
What is amaurosis fugax?
Sudden loss of vision in an eye due to lack of blood flow to the retina
26
Features of cataracts (4)
Gradual onset of: Reduced vision Faded colour vision Glare Halos
27
Cataract sign
Defect in the red reflex
28
Complications following cataract surgery (4)
Posterior capsule opacification/ thickening of the lens capsule Retinal detachment Posterior capsule rupture Endophthalmitis
29
Sudden painless unilateral visual loss Cherry red spot Pale retina RAPD
Central retinal artery occlusion
30
Sudden painless unilateral reduction in visual acuity Retinal haemorrhages - stormy sunset
Central retinal vein occlusion
31
Central retinal artery occlusion Features (4) Secondary to what? (2)
Pale retina Cherry red spot Sudden painless visual loss RAPD VTE or temporal arteritis
32
Central retinal vein occlusion Features (3)
Sudden, painless loss of vision Stormy sunset Retinal haemorrhages
33
Mx central retinal vein occlusion (2)
Anti VEGF Laser photocoagulation
34
Local trauma, eye pain, photophobia, reduced visual acuity =
Corneal abrasion
35
Corneal abrasion fluorescein examination typically reveals what?
Yellow stained abrasion
36
Corneal abrasion rx
Topical abx
37
Corneal foreign body When would you refer to ophthalmology? (7)
High velocity penetrating eye injury e.g hammering or drilling Sharp objects Significant orbital/ periorbital trauma Chemical injury Injury to the centre of the cornea Organic materials foreign bodies Or if any red flags
38
What eye condition is more common in contact lens wearers?
Corneal ulcers
39
Classification of diabetic retinopathy (1)
Non proliferative Proliferative Maculopathy
40
What is mild non proliferative diabetic retinopathy? (1)
1 or more microaneurysm
41
What is moderate NPDR? (5)
Microaneurysms Blot haemorrhages Hard exudates Cotton wool spots (soft exudates) Venous beading/ looping
42
What is severe NPDR? (3)
Blot haemorrhages and microaneurysms in x4 quadrants Venous beading in 2 quadrants Intraretinal microvascular abnormalities (IRMA) in 1 quadrant
43
What is proliferative diabetic retinopathy? (3) Common in which type of diabetes?
Retinal neovascularisation Vitrous haemorrhage Fibrous tissue More common in T1DM
44
Maculopathy Feature (1) Common in which diabetes?
Hard exudates on macula More common in T2DM
45
Mx for Maculopathy NPDR Proliferative
anti-VEGF Observe +/- laser photocoagulation Laser photocoagulation + anti-VEGF
46
Example of anti-VEGF medication?
Ranibizumab
47
Episcleritis is associated with which two conditions?
IBD and RA
48
Episcleritis versus scleritis - pain
Episcleritis - not painful Scleritis - painful
49
Features of episcleritis (4) Unilateral or bilateral
Painless Red eye Watery eye Photophobia 50% bilateral
50
What investigation can be done to differentiate between episcleritis and scleritis?
Phenylephrine drops - if eye redness improves then more likely episcleritis
51
Mx episcleritis (1)
Artifical tears
52
Scleritis features (4)
Red eye Painful Watering Photophobia
53
Dilated pupil Slow reactive to accommodation No/ poor reaction to light Absent ankle/knee reflexes
Holmes Adie syndrome
54
Horner's syndrome features (4)
Miosis (small pupil) Anhidrosis (loss of sweating) Ptosis Enopthalmos (sunken eye)
55
What is Horner's syndrome?
Lesion/ problem with the sympathetic pathway to the face
55
Horner's anhidrosis Central lesion Pre-ganglionic Post-ganglionic
Anhidrosis of face, arm and trunk Face No anhidrosis
56
Causes of central lesions Horners (5)
Stroke Syringomyelia MS Tumour Enceph
57
Causes of pre-ganglionic lesions Horners (4)
Tumour - pancoasts Thyroidectomy Trauma Cervical rib
58
Causes of post-ganglionic lesions Horners (4)
Carotid aneurysm Carotid dissection Cavernous sinus thrombosis Cluster headache
59
Sudden loss of vision (4)
Central retinal vein occlusion Central retinal artery occlusion Retinal detachment Vitreous haemorrhage
60
Dark spots, haze, sudden visual loss =
Vitreous haemorrhage
61
How to differentiate between posterior vitreous detachment, retinal detachment, vitreous haemorrhage
Posterior vitreous detachment - flashes of light, floaters often on temporal side Retinal detachment - veil/ curtain, straight lines appear curvy Vitreous haemorrhage - dark spots and floaters, haze
62
Floaters worse on temporal side Flashes of light =
Posterior vitreous detachment
63
Curtains/ veil Straight lines become curvy =
Retinal detachment
64
Name four causes of tunnel vision
Papilloedema Glaucoma Retinitis pigmentosa Choroidoretinitis

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