Ophthalmology Flashcards

Question

Blepharitis

Answer 1

What? Lid inflammation Cause? Staph infection, seborrhoeic dermatitis, rosacea Presentation: Burning, itching red margins of eyes with scales on lashes Clinical Dx Tx: Good eye hygiene w/ baby shampoo. If child with blepharokeratitis, consider adding erythromycin

Answer 2

Presentation: Red eyes, gritting. If unilateral with incomplete closure, think CN VII palsy Tx: Long term ocular lubricant i.e. Viscotears in day, lacrilube at night Risk: Corneal ulcer

Answer 3

aka TAO or Grave's eye disease Who? 25-50% of Grave's patients get it Cause: Glycosaminoglycan and collagen deposition in the extra-ocular muscles in response to inflammation. S/S: - Exophthalmos - Conjunctival oedema "chemosis" - Ophthalmoplegia - Optic disc swelling - Unable to close eyes --> Dry and red eyes --> Risk of exposure keratopathy Progression: NO SPECS Investigations: TFTs, Antibody screen Mangement: Topical lubricants, Radiotherapy, surgery, steroids. Monitor for indication to urgently review e.g. - Disc swelling - Unexplained deterioration in vision, colors - Corneal opacity or exposure

Answer 4

Causative agent: Bacterial- Staph A Viral - Adenovirus Ophthalmia neonatorum - Chlamydia or gonorrhoea. Presentation of bacterial: Sore, red eyes. Purulent discharge, eyes stuck together in morning Viral presentation: Sore, red eyes. Serous discharge, recent URTI, pre-auricular lymph nodes. Ix: History and exam. Swabs rarely required. Tx: 1st line Conservative for 1-2 weeks. No contact lens, do not share towels. No school exclusion required, consider staying off nursery. 2nd line - Topical Abx e.g. Chloramphenicol drops 3rd line: Topical fusidic acid (for preg women)

Answer 5

Associated with atopy, often seen in hayfever context S/S - Red, swollen eyes - Itch! - Eyes stinging > discharge - Swollen eyelids - Seasonal (due to pollen) or perennial (due to allergen exposure e.g. dust mite) Clinical diagnosis Management: 1st line: Allergen avoidance and Topical/systemic antihistamine 2nd line - Topical mast cell stabiliser e.g. Na cromoglicate and nedocromil

Answer 6

What? Infection of the fat and muscle posterior to the orbital septum, but not the globe Cause: Local spread from URTI / sinus/ ear or facial infection. Bacterial agent e.g. Stept, staph, Hib Presentation: - Opthalmoplegia - Red/swollen eye - Reduced visual acuity - Proptosis - Severe ocular pain - Eyelid oedema and ptosis Ix for ALL suspected FBC; WBC, ESR, CRP Ophthalmic assessment - Decreased vision, RAPD, proptosis, oedema, erythma, dysmotility CT with contrast- To negate preseptal cellulitis Culture of blood and eye swabs Management: URGENT admission and senior review. IV Ceftriaxone and oral metronidazole (total duration 7 days) Prognosis: High mortality. Risk of increased IOP and optic nerve damage

Answer 7

What? Inflammation of the cornea Cause: Bacterial - Staph A typically. Viral- HSV Amoebic - Acanthamoebic keratitis from soil or contaminated water Parasitic - Onchocercal keratitis in "river blindness" Chemical in exposure keratitis CL - "Clare" due to pseudomonas aeruginosa- contact lens-induced acute red eye S/S - Pain - Erythema - Photophobia - Foreign body/gritty sensation - Epiphora - xs watering Ix: Opthalmologist performs corneal scrape Management If CL wearer, then same-day referral for slit lamp to exclude microbial cause 1. Stop using CL until resolve. Topical Abx using quinolones. Cyclopegics for analgesia A cycloplegic eye drop is an eye drop that temporarily paralyzes the ciliary body, allowing a doctor to fully measure a patient's vision problem + analgesia Complications: - Corneal scarring - Performation - Endophthalmitis - Visual loss Endophthalmitis is inflammation of the interior cavity of the eye, usually caused by infection. It is a possible complication of all intraocular surgeries, particularly cataract surgery, and can result in loss of vision or loss of the eye itself. Conjunctiva -> cornea > uvea >endophthalmitis

Answer 8

Presentation - Dendritic corneal ulcer - Red, painful eye - Photophobia - Euphoria - Decreased VA Investigation Fluorescein dye show dendritic ulcer Treatment 1st line: Ophthalmic referral for topical aciclovir Risk: Reduced corneal sensation overtime

Answer 9

Cause: - 50 % idiopathic. - Infectious e.g. HSV, VZV, TB, syphilis - Non-infectious e.g. associated with HLA-B27 linked conditions (Ank Spond, MS , IBD, Sarcoid) Symptoms: Acute onset of.... - Unilateral red, painful eye - Pupil smaller on red eye side - Photophobia - Blurred vision - Lacrimation - Hypopyon (inflammatory cells in the anterior chamber of the eye. It is an exudate rich in white blood cells, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera.) suggests Infection Investigation 1st line: Eye exam (slit lamp for cells and flare in ant chamber) - No fluoroescein stain -Normal eyelid closure Treatment 1st line: Urgent review by ophthalmology for... cyclopegics (pupil dilator to releive pain and photopobia. E.g. cyclopentolate, atropine) and steroid eye drops If hypopyon present, immediate Abx injections

Answer 10

Cause: 1/3 associated with systemic autoimmune disease (GPA, SLE, RA). Local causes of Herpes zoster, trauma, surgery Classification: Non-necrotising (75%) and necrotising S/S - Severe ocular pain - Unilateral red eye (can be sectoral) - Decreased VA - ? Iris may be small / photophobia Ix: CRP, ESR, Rheumatoid tests, FBC Mx: Urgent referral (investigate systemic association + anti-inflammatory or immunosuppressive meds) Complications: - Keratitis - Posterior scleritis (seen as choroidal folds on fundoscopy) - Scleromalacia perforans (progressive scleral thinning)

Answer 11

What? Inflammation of the upper layer of sclera. Often bilateral Cause: Idiopathic Presentation: Redness, mild-mod discomfort, grittiness +/- photophobia. VA normal. DDx: - Painful? Think scleritis. Management: - Self-limiting so topical/oral NSAIDs +/- week TOP steroid (FML)

Answer 12

Cause: DM, CRVO, BRVO, spontaneously in healthy people Symptoms: Floaters+++ then steadily increasing misty vision over hrs/days. Signs: No red reflex No RAPD Management: Clears on own over days-months

Answer 13

Symptoms: Vision loss and floaters Signs on fundoscopy: - Micro-aneurysms - Haemorrhages - Exudates - IRMA 9 (intraretinal microvascular abnormalities) - cotton wool spots - Venous beading Classification 1. Non-proliferative diabetic retinopathy (NPDR): Mild, Mod, Severe -Mild NPDR • 1 or more microaneurysm - Moderate NPDR • microaneurysms • blot haemorrhages • hard exudates • cotton wool spots, venous beading/looping and IRMA less severe than in severe NPDR - Severe NPDR • blot haemorrhages and microaneurysms in 4 quadrants • venous beading in at least 2 quadrants • IRMA in at least 1 quadrant 2. Proliferative diabetic retinopathy (PDR) 3. Advanced diabetic eye disease Management No DR--> Review in 12 months Non-proliferative --> Mild and Mod (6 month review), Severe (Review in 1-4 month. Do fundus fluorescein angio to assess ischaemia) Proliferative --> Urgent review in 2 weeks for intravitreal anti-VEGF or PRLP Advanced --> Emergency referral for vitrectomy Diabetic macular oedema --> intravitreal anti-VEGF or laser coagulation Screening: For all diabetics >12 years old with annual appt ``` Complication: Rubeosis iridis (blood vessels growing near iris) is glaucoma risk factors ```

Answer 14

Cause: Often spontaneous. Associated with high myopia and trauma Presentation: 4 F's - Floaters - Flashes - Field loss - Fall in acquity (may be normal in initial stages) Clinical findings - Loss of red reflex - RAPD if the central retina detached Fundoscopy shows grey, opalescent retina ballooning forward Tx: URGENT referral for laser photocoagulation therapy and surgery (vitrectomy, gas tamponade, silicone oil). Rest post-op is key! Prognosis: Re-detachement in 5-10%. Determined by nature of detachment and time to Tx

Answer 15

What? Inherited degeneration of the retina Associated with Alports syndrome etc Presentation: Loss of night vision --> Loss of daytime central and peripheral vision Ix: Fundoscopy shows mottled RPE and blacked peripheral retina Management: Novel treatments with neural prosthetics Prognosis: 25% retain reading, reduced VA and visual acuity

Answer 16

Cause: Secondary to background vasculopathy OR vasculitis Presentation: Sudden, unilateral vision loss with no pain. Vision loss of whole eye = CRAO, partial vision loss = BRAO. Investigation: RAPD present. Fundoscopy shows pale optic disc with "cherry red spot" at the macula in CRAO. Treatment: Immediate/emergency - Ocular massage, aqueous drainage via surgery, intraocular hypotensives Prevention - CV risk factors addressed Risk management - US carotid to screen for stroke.

Answer 17

Cause: Increased age, CVS risk factors Classification: CRVO or BRVO, either ischaemic or non-ischaemic Clinical features: Painless, unilateral vision loss (no loss of vision in macula sparing CRVO) Investigations: RAPD present. Fundoscopy shows haemorrhages and hyperaemic retina. Fundus fluorescein angiogram assesses ischaemia. Management: Refer to opthalmology to manage complication - no vision loss = Closely monitor - Vision loss = Anti-VEGF then Dex - Retinal neovasculisation = Photocoagulation Complications: - Retinal neovascularisation - Chronic macula oedema

Answer 18

What? CN VII palsy Tx: Initial: tape eyes down. Oily ointment to keep eyes lubricated. Should resolve over weeks Monitor for acute deterioration

Answer 19

Cause: MS*****, DM, Syphilis Presentation: Red desaturation (poor colour discrimination), Unilateral gradual vision loss, painful eye movements, OE: - RAPD - Fundoscopy can be normal. Can be telangiectasia, disc swelling then optic atrophy Ix: MRI for dymyelinating plaques Mangement: 1st line: W/W 2nd line: High-dose IV methylprednisolone for 72 hours then ORAL prednisolone for 11 days prognosis: 4-6 weeks recovery

Answer 20

On examination: Subconjunctival haemorrhage: Red eye with edge at cornea Corneal foreign body: Fluorescein stain Hyphaema: Reduced VA, Round pupil, blood in anterior compartment Penetrating eye injury: Reduced VA, stain with Fluorescein Orbital fracture: All normal BUT reduced eye movements VA - visual acuity A hyphema is a pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris). The blood may cover most or all of the iris and the pupil, blocking vision partially or completely. A hyphema is usually painful.

Answer 21

Using swinging flashlight test Positive result: When you swing from one eye to the other , there should be a slight increased constriction then dilation back to previous size. When injury to optic nerve or retina present, when swinging light to injured pupil it dilates.

Answer 22

Indication: Squint or diplopia Tropia = Manifest strabismus = shift in fixation Method: Over one eye and watch other for movement. Results: Horizontal movement = Esotropia (unoccluded eye movement laterally) or exotropia (unoccluded eye movement medially) Vertical movement = = Hypertropia (unoccluded eye movement down) or hypotropia (unoccluded eye movement up) No movement = Patient orthotropic or covered eye fixation

Answer 23

Test of "phoria" that happen in latent stabismus Method: Move occluder quickly from one eye to another, whilst patient focusses on torch 33cm infront of them centrally

Answer 24

No RR - Vitreal haemorrhage, retinoblastoma, cataracts Pale optic disc- Optic neuritis (MS), Retinal artery occlusion Ill-defined margin of optic disease - Papilloedema Cupping - Glaucoma Cotton wool spots / neovascularistion - DM, Retinal vein occlusion AV nipping / Flame haehmorrhages - Hypertension Retinal pallor / cherry red spots - Retinal artery occlusion Macula drusen - AMD

Answer 25

Cause: Idiopathic, warfarin, HTN, trauma, valsava Ix: BP check. If due to trauma or foreign, full ophthalmic assessment Mx: Reassure, will resolve in a few weeks.

Answer 26

Symptoms: Pain Ix: Fluorescein dye - Mx: Antibiotics ointment. Pressure patch? Advise will be sore for 24-48 hours, consider analgesia Risk: Recurrent corneal eroisions.

Answer 27

Mx: NOTHING in primary care, no eating or drinking. Refer to ophthalmology

Answer 28

Mx: 1. IMMEDIATE irrigation with saline (1L at a time), until pH neutralised 2. Slit lamp exam No need to refer if: Minimal discomfort, VA normal, cornea clear with no staining

Answer 29

Cataracts -steroids Corneal opacities - amiodarone - indomethacin Optic neuritis - ethambutol - amiodarone - Metronidazole Retinopathy -Hydroxychloroquine (Plaquenil), quinine

Ophthalmology Flashcards

(53 cards)