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4th Year Neuro > Ophthalmology > Flashcards

Ophthalmology Flashcards

(55 cards)

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1
Q

Painful visual loss affecting the cornea

A

Keratitis

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2
Q

Painful visual loss affecting the iris

A

Anterior uveitis

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3
Q

Painful visual loss affecting the drainage angle

A

Acute angle-closure glaucoma

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4
Q

Painful visual loss affecting the optic nerve

A

Optic neuritis

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5
Q

Painful visual loss affecting the orbit

A
  • Orbital cellulitis
  • Endophthalmitis
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6
Q

Painless visual loss affecting the drainage angle

A

Primary open angle glaucoma

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7
Q

Painless visual loss affecting the lens

A

Cataract

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8
Q

Painless visual loss affecting the retina/macula

A
  • Retinal detachment
  • Central retinal vein occlusion
  • Central retinal artery occlusion
  • Macualar oedema
  • Wet age related macular degeneration
  • Vitreous haemorrhage
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9
Q

Definition of keratitis

A

Inflamation of the cornea

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10
Q

Microbial keratitis cause

A

Commonly infective

  • Bacterial: staphylococcus, pseudomonas
  • Viral: herpes
  • Fungal: candida
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11
Q

Risk factors for microbial keratitis

A
  • Contact lens
  • A breech in the corneal epithelium eg trauma
  • Dry eye
  • Prolonged use of steroid drops
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12
Q

Which bacteria is the most common culprit in microbial keratitis in a contact lens wearer?

A

Pseudomonas aeruginosa

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13
Q

Clinical features of microbial keratitis

A
  • Painful eye
  • Red eye
  • Purulent discharge
  • Blurred vision
  • Hypopyon (collection of WBCs)
  • White corneal opacity = corneal ulcer
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14
Q

Investigations in microbial keratitis

A
  • Stain with flourescein in to see epithelial defect
  • Corneal scrape: gram stain and culture
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15
Q

Management of microbial keratitis

A
  • Stop wearing contact lenses until healed
  • Topical antibiotic drops eg ciprofloxacin, ofloxacin
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16
Q

Which structures make up the uvea?

A

Iris, ciliary muscle and choroid

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17
Q

Definition of anterior uveitis

A

Inflammation of the iris

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18
Q

Risk factors for anterior uveitis

A
  • HLA-B27 allele
    • Ankylosing spondylitis
    • Psoriatic arthritis
    • Reiter’s syndrome
    • Inflammatory bowel disease
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19
Q

Clinical features of anterior uveitis

A

Symptoms

  • Photophobia
  • Red eye
  • Watering

Signs

  • Anterior chamber cells: WBCs floating in the anterior chamber
  • Hypopyon
  • Disorted pupil: due to posterior synechiae (adhesions from the iris to the lens)
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20
Q

Management of anterior uveitis

A
  • Topical steroids: dexamethasone 0.1%
  • If there is posterior synechiae: dilating drops (to try and break them)
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21
Q

Definition/pathophysiology of glaucoma

A
  • Optic nerve damage
  • With visual field defect
  • Related to raised IOP (intraocular pressure)
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22
Q

What are the two main types of glaucoma?

A
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23
Q

Describe the normal aqueous pathway within the eye

Study These Flashcards
A
  • Aqueous humour is made by the ciliary body and secreted into the posterior chamber
  • Aqueous passes through the pupil into anterior chamber
  • Most of the aqueous leaves the eye via the trabecular meshwork → Schlemm’s canal → bloodstream
24
Q

Pathogenesis of acute angle closure glaucoma

Study These Flashcards
A
  • Pupil dilation eg in dark conditions → peripheral iris “bunches up” → increased resistance to aqueous flow
  • Build up of aqueous in posterior chamber → bows iris forward → closes drainage angle
25
Risk factors for acute angle glaucoma
* Female * Small eyes * Asian ethnicity * Age
26
Clinical features of acute angle closure glaucoma
* IOP \> 40mmHg * Red eye * Cloudy cornea * Fixed, oval, irregularly dilated pupil * Pain * Watering * Reduced vision
27
Management of acute angle closure glaucoma
* Immediate management: lower eye pressure * Topical drops * alpha 2 agonist * beta blockers * steroids * Systemic * Acetazolamide PO * Definitive treatment * Laser peripheral iridotomy (bilateral)
28
Pathogenesis of primary open-angle glaucoma
Outflow of aqueous is impaired due to disruption of the trabecular mashwork channels eg extacellular material blocking RM spaces.
29
Risk factors for chronic open-angle glaucoma
* Age \>60 * African * Family history * Myopia * Diabetic * Long tern steroid drops
30
Clinical features of primary open-angle glaucoma
* Patient asymptomatic as the disease is slowly progressive * Raised IOP (\>22mmHg) * Optic nerve cup:disc ratio \>0.4 * Loss of peripheral visual fields
31
Treatment of primary open-angle glaucoma
* Topical therapy * Prostaglandin analogues: lantanoprost * Beta-blockers: timolol * Laser * Surgery * Trabeculectomy
32
Definition of retinal detachment
The potential space between the neuroretina and the retinal pigment epithelium (loosely attached in the eye) become separated.
33
Risk factors for retinal detachment
* Recent eye trauma * Retinal detachment in the other eye * High myope (large eye, so at risk of tears)
34
Clinical features of retinal detachment
* Flashing lights * \> 100 new floaters * Shadow/curtain over vision
35
Treatment for retinal detachment
Urgent referral to ophthalmology for surgery (pars plana vitrectomy)
36
Pathophysiology of central retinal vein occlusion
* Usually related to Virchow's triad of thrombogenesis * Stasis * Vessel wall damage * Hypercoagulability
37
Risk factors for central retinal vein occlusion
* Age * Hypertension * Hyperlipidaemia * Diabetes mellitus * Smoker
38
Clinical features of central retinal vein occlusion
* Sudden, unilateral blurred vision * Fundus findings * Dilated tortuous veins * Haemorrhages in all 4 quadrants of the retina * Cotton wool spots
39
Management of central retinal vein occlusion
* No specific treatment for uncomplicated CRVO * Allow time to settle (should settle in 3 to 6 months) * Closely monitor
40
Complications of central retinal vein occlusion and their management
* Macular oedema * Cysts of fluid form at macula * Managment: intravitreal anti-VEGF injections * Retinal neovascularisation * New vessels in response to VEGF released from ischaemia retina * New vessels are fragile and can bleed * Managment: laser photocoagulation
41
Clinical features of central retinal artery occlusion
42
Managment of central retinal artery occlusion
* **Transfer to stroke unit** * **​**Carotid Doppler US * CT head angiogram
43
Definition of cataract
Opacification of the intraocular lens
44
Aetiology of cataract
Chemical and structural alteration of lens proteins (clear → opaque)
45
Risk factors for cataracts
* Old age * Diabetes * Steroid use (drops, PO) * UV light exposure
46
Clinical features of cataracts
* Gradual (over years - decades) progressive loss of vision * Glare at night
47
Treatment of cataracts
Phacoemulsification
48
Orbital cellulitis clinical features
* Lid: induration, warm erythema, tenderness, unable to open eye * Fever * Proptosis * Chemosis
49
Features of dry and wet age related macular degeneration
* **Drusen** (yellow deposits of proteins and lipids) * Atrophy of the retinal pigment epithelium * Degeneration for eh photoreceptors
50
Features unique to wet AMD
Development of new vessels growing from the choroid layer into the retina.
51
Risk factors for age related macular degeneration
* Age * Smoking * White or Chinese ethnic origin * Family history * Cardiovascular disease
52
Presentation of AMD
* Gradual worsening **central visual field loss** * Reduced **visual acuity** * **Crooked or wavy appearance to straight lines**
53
Examination in AMD
* Reduced acuity using a **Snellen chart** * **Scotoma** (a central patch of vision loss) * **Amsler grid test** can be used to assess the distortion of straight lines * **Fundoscopy:** drusen are the key finding * **Slit lamp biomicroscopic fundus examination** by a specialist can be used to diagnose AMD * **Optical coherence tomography** * **Fluorescein angiography**
54
Management of dry age related macular degeneration
55
Managment of wet age related macular degeneration
**Anti-VEGF medications** (ranibizumab) are injected directly into the vitreous chamber of the eye once a month.

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