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Year 3 core conditions > ophthalmology > Flashcards

ophthalmology Flashcards

1
Q

what is acute angle closure glaucoma

A

rapid rise in intraocular pressure due to sudden obstruction to the flow of aqueous humor within the eye

obstruction from iris pushed or pulled forward so obstructs the trabecular network

pressure leads to compression of the optic nerve and visual loss

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2
Q

risk factors of acute angle closure glaucoma

A 
family history
older age
female
ethnicity - Chinese
anatomy - long sighted
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3
Q

symptoms of acute angle closure glaucoma

A

blurred vision /halo around lights
headache (not relived by analgesia)
vomiting
watering eyes

red eye
fixed mid-dilated pupil
globe hard to touch
corneal oedema - cloudy cornea

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4
Q

investigations for acute angle closure gluacoma

A

measure intra-ocular pressure (digital or tonometry)

gonioscopy by ophthalmology to assess angle

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5
Q

management of acute angle closure glaucoma

A

pilocarpine eye drops
acetaxolamide to reduce production of aqueous humour
analgesia +/- antiemetic

laser iridotomy - make hole in iris to re-establish drainage

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6
Q

chemical eye injuries

A

can produce extensive damage to ocular surface and anterior segment leaidng to visual impairment and disfigurement

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7
Q

severity of chemical eye injuries depends on

A

toxicity of the chemical
how long in contact with eye
depth of penetration
area of involvement

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8
Q

symptoms of chemical eye injury

A

severe pain
epiphora (excessive eye watering)
blepharospasm
reduced visual acuity

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9
Q

investigations for chemical eye injury

A

pH of the eye

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10
Q

management of chemical eye injurys

A 
irrigation 
topical anaesthetic
topical antibiotic
cycloplegic agents for comfort
lubricating eye drops
steroid drops
may need surgical treatment
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11
Q

irrigation in chemical eye injurys

A

remove offending substance and restore physiologic pH

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12
Q

penetrating eye injury

A

injuries that penetrate the eye but not through (no exit wound)

full thickness rupture of the cornea and/or sclera

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13
Q

risk factors for penetrating eye injury

A 
risk behaviour
men
30s
home and workplace
failure to wear eye protection
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14
Q

symptoms of penetrating eye injury

A 
pain
double vision
foreign body sensation
blurred vision
subconjunctival haemorrhage, peaked pupil., hyphema, iris deformities, lens distruption, virteous haemorrhage, retinal tears
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15
Q

conjunctivitis

A

inflammation of the conjunctiva

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16
Q

causes of conjunctivitis

A

infectious bacterial

infectious viral

noninfectious (allergic)

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17
Q

pathophysiology of conjunctivitis

A

infection inflammation

dilatation of conjunctival vessels

conjunctival hyperemia and oedema

inflammatory discharge

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18
Q

risk factors of conjunctivits

A

exposure to causative AGENT, immunocompromised state and atopy

contact lens wear

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19
Q

presentation of conjunctivits

A

itching eye + redness and purulent discharge (if bacterial) - unilateral

unaffected vision

eyelid oedema, chemosis, excessive lacrimation

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20
Q 
discharge in conjunctivitis:
bacterial
gonococcal
viral
allergic
nonallergic
A 
bacterial = purulent, white/yellow/green
gonococcal = hyperpurulent, profuse
viral = watery, stringy
allergic = watery, mucoid
nonallergic = mucoid
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21
Q

management of conjunctivitis

  • in general
  • allergic
  • chlamydia
  • bacterial
A

ocular lubricant drops/ophthalmic ointment

allergic conjunctivitis = antihistamine drops

systemic therapy to eradicate chlamydia infection

bacterial conjunctivitis = topical antibiotics

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22
Q

corneal ulcers

A

inflammatory condition of the cornea = open corneal sore

many causes - bacterial, fungi, viruses, protozoa

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23
Q

risk factors for corneal ulcers

A 
improper contact lens use
corneal abrasions
eye burns
xerophthalmia (dry eyes)
eyelid disors
steroid eye drops
vitamin A deficiency
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24
Q

presentation of corneal ulcers

A 
red eye
severe pain
soreness
discharge (tearing, pus)
eyelid swelling
blurred vision
vision loss 
photophobia
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25
Q

investigations for corneal uclers

A

slit lamp
fluorescein dye - ulcer margins
herpes simplex ulcers - typical dendritic/geographic pattern
history + decreased visual acuity

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26
Q

management of corneal ulcers

A

meds -
antimicrobial eye drops,
analgesic for pain control
steroid eye drops (after infection irradiation to reduce swelling and prevent scarring)

surgery - corneal transplantation to reduce damaged cornea if scarring decreases vision

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27
Q

giant cell arteritis

A

inflammation of the lining of the arteries in head

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28
Q

causes of giant cell arteritis

A

inflammation of artery walls –> swelling –> narrowing of vessels –> reduced O2/nutrient supply

genetic and environmental factors increase suseptibility to inflammation

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29
Q

risk factors for giant cell arteritis

A 
age 70-80
women 2x more
white northern european or scandinavian
polymyalgia rheumatica
family history
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30
Q

presentation of giant cell arteritis

A

unilateral head pain/tenderness - affecting temples

scalp tenderness

jaw pain when chew or open wide

fever, fatigue, unintended weight loss

vision loss or double vision

sudden permanent loss of vision in one eye

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31
Q

giant cell arteritis is related to

A

polymyalgia rheumatica

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32
Q

complications of giant cell arteritis

A

blindness
aortic aneurysm
stroke

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33
Q

investigations of giant cell arteritis

A

reduced pulse and hard cord like feel and appearance of temporal arteires on examination

blood tests - ESR and CRP

imaging - USS, MRA, PET

biopsy of temporal atery

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34
Q

management of giant cell arteritis

A

high dose corticosteroids for one to 2 years (lower dose)

methotrexate

keep an eye on bone density, prescribe calcium and vit D supplements

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35
Q

retinal detachment

A

emergency situ where retina pulls away from its normal position - separating from layer of blood vessels

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36
Q

types of retinal detachment

A

rhegmatogenous - hole or tear allowing fluid out

traction - scar tissue on retina surface

exudative - fluid accumulates, no whole or tear

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37
Q

risk factors for retinal detachment

A 
aging
prev retinal detachment in one ey
family history 
extreme near sightedness
prev eye surgery
prev eye injury
prev eye disease or disorder
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38
Q

presentation of retinal detachment

A

painless but warning signs include::

  • sudden appearance of many floaters
  • photopsia (flashes of light)
  • blurred vision
  • gradually reduced peripheral vision
  • curtain like shadow over visual feild
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39
Q

investigations for retinal detachment

A

retinal examination -look for tears

USS - look for bleeding

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40
Q

management of retinal detachment

A

before detached - laser surgeyr and cryopexy to secure retina down

after detached - pneumatic retinopexy + cryopexy, scleral buckling or vitrectomy

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41
Q

vitrectomy

A

draining and replacing fluid in the eye

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42
Q

orbital cellulitis

A

infection of the fat and muscles around the eye - affecting the eyelids, eyebrows and cheeks

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43
Q

causes of orbital cellulitis

A

children - often bacterial sinus infection in beginning

more in <7yo

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44
Q

risk factors for orbital cellulitis

A 
recent URTI
sinus infection
younger
foreign bodies in orbit
trauma
immunosuppression
systemic infection
dental infection
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45
Q

presentation of orbital cellulitis

A 
painful swelling in upper and lower eyelid 
bulging eyes
decreased vision
pain when moving eye
fever
generally ill feeling
difficult eye movements, perhaps double vision
shiny, red or purple eyelid
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46
Q

investigations of orbital cellulitis

A

bloods - FBC, blood culture and spinal tap

xray of sinuses, CT or MRI of sinuses and orbit, culture of eye and nose drainage, throat culture

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47
Q

management of orbital cellulitis

A

intravenous antibiotics

surgeyr to drain abscess ir relieve pressure

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48
Q

meibomian cyst

A

chalazion

= sterile inflammatory granuloma caused by obstruction of sebaceous gland

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49
Q

cause of meibomian cyst

A

obsturction of meibomian gland can cause to enlarge and rupture
triggers inflammatory reaction against lipid content

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50
Q

risk factors for meibomian cysts

A

pregnant women with

  • chronic belpharitis
  • seborrheic dermaittis
  • rosacea
  • pregnancy
  • diabetes mellitus
  • elevated cholesterol
  • chronic hordeola (styes)
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51
Q

presentation of meibomian cyst

A

firm, painless, localised eyelid swellings that develop over several weeks

more common in upper than lower eyelid

unilateral

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52
Q

management of meibomian cyst

A

warm compres 10-15min + masage 5 times a dya

urgent referral if malignancy suspected

refer to ophthalmologist if vision affected, discomfort or cosmetic issues

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53
Q

blepharitis

A

chronic condition - inflammation of the eyelids

affects both eyes

when oil glands at the base of eyelashes get clogged = irritation and redness

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54
Q

causes/risk factors of blepharitis

A 
seborrhoeic dermatitis
infection
clogged or malfunctioning oil glands in eyelids
rosacea
allergies
eyelash mites or lice
dry eyes
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55
Q

presentation of blepharitis

A 
watery, red eyes
gritty, uring or stinging sensation in the eyes
eyelids appear greasy
itchy eyelids
flaking of skin around the eyes
crusted eyelashes
sensitivity to light
blurred vision improving when blinking
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56
Q

investigaitons for belpharitis

A

examination of the eye

swabbing skin for testing

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57
Q

management of blepharitis

A

fight infection - eyedrops, creams etc

inflammation - steorid eyedrops

immune systen - cyclosporine (symptom relief)

treat underlying cause

clean eyes daily, lubricate eyes, control dandruff and mites

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58
Q

cataract

A

clouding of the normally clear lens of the eye

protein and fibres in lens break down and clump together –> clouding the lens –> cataract scatters and blocks the light as it passes –> blurred vision

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59
Q

causes of cataract

A 
aging
injury
inherited genetic disorders
eye conditions, past surgery or diabetes
long term steroid use
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60
Q

risk factors of cataract

A 
older
diabetes
excessive exposure to sunlight
smoking
obesity
high blood pressure
prev eye injury or inflammation
prev eye surgeyr
prolonged use of corticosteroid meds
drinking excessive alcohol
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61
Q

presentation of cataract

A 
clouded, blurred vision or dim vision
increasing difficulty with vision at night
sensitivity to light and glare
need for brighter light for reading and other activities
seeing halos and lights
frequent changes in eyeglasses
fading or yellowing of colours
double vision in a single eye
both eyes
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62
Q

investigations for cataract

A

visual acuity test
slit lamp examination
retinal exam
applanation tonometry

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63
Q

management of cataract

A 
regular eye exams
quit smoking
manage other health problems
sunglasses
reduce alcohol
surgery
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64
Q

open angle glaucoma

A

drainage from cornea and iris remains open but trabecular meshwork is partially blocked

intraocular pressure increase

damage to optic nerve

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65
Q

risk factors of open angle glaucoma

A 
high intraocular pressure
>60yo
black, Asian, Hispanic
family history
diabetes, heart disease, HTN, sickle cell anaemia
cornea thin in centre
extreme vision (near/far)
prev eye surgery
corticosteroids - espec. eye drops
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66
Q

clinical presentation of open angle glaucoma

A

patchy blind spots in peripheral or central vision, freq bilateral

tunnel vision in lateral stages

if untreaded = blindness

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67
Q

investigations of open angle glaucoma

A

measure intraocular pressure (tonometry)

test optic nerve damage

check for areas of vision loss (visual feild loss)

measure corneal thickness

inspect drainage angle

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68
Q

treatment of open angle glaucoma

A

lower intraocular pressure - prostaglandin eyedrops, beta blockers eyedrops, alpha adrenergic agonist eyedrops, carbonic anhydrase inhbitor eyedrops, rho kinase inhibitor, miotic or cholinergic agents

srugery - laser therapy, filtering surgery, drainage tubes, minimally invasive glaucoma surgery

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69
Q

macular degenration

A

age related damage to the macula

2 types - wet and dry

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70
Q

dry macular degernation

A

dry = macula gets thinner with age - progressive and develops over several years - no treatment

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71
Q

wet macular degernation

A

abnormal blood vessels grow in the back of the eye and damage macula - treatment available

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72
Q

risk factors of macular degeneration

A

family hsitory
>55yo
caucasian
smoke

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73
Q

presentation of macular degeneration - early, intermediate and late

A

early dry AMD - no symptoms

intermediate dry AMD - either no symptoms or mild blurriness in central vision, trouble seeing in low light

later AMD (wet or dry type - straight lines look wavy or crooked, blurry area near centre of vision, blank spots appear and blurry area enlarges, colours seem less bright, trouble seeing in low light

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74
Q

investigations of macular degeneration

A

eye exam

optical coherence tomography - pictures of inside of eye

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75
Q

management of macular degeneration

A

prevention - stop smoking, exercise, maintain good BP and cholesteral

treatment - vitamins and minerals to prevent further degeneration, anti VEGF drugs to inject into eye (if wet AMD), photodynamic therapy - injections and laser treatment

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76
Q

causes of red eye

A 
acute close angle glaucoma
penetrating/perforating eye injury
chemical eye injury
conjunctivitis
corneal ulcers
corneal abrasion
corneal foreign body
uveitis
episcleritis and scleritis
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77
Q

neurological conditons thar may present with ocular signs

A

cranial nerve palsy’s - CN III, IV and VI
horners syndrome
papilloedema

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78
Q

causes of acute/subacute vision loss

A 
giant cell arteritis
retinal detatchment
amaurosis fugax
posterior vitreous detachment
vitreous haemorrhage
vaascular occlusion of retinal circulation 
retinal artery occlusion
retinal vein occlusion
optic neuritis
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79
Q

cuases of gradual loss of vision

A

cataract
open angle glaucoma
macular degeneration
refractive issues- myopia/hypermetropia/presbyopia

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80
Q

oculoplastics/eyelid conditopns

A 
orbital cellulitis
meibomian cyst aka chalazion
blepharitis
dry eyes
blocked nasolacrimal duct
skin cancer of the eyelid
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81
Q

paediatric eye conditions

A

amblyopia
squints
congenital/paediatric cataracts
inherited diseases

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82
Q

inherited paediatric eye diseases

A

retinitis pigmentosa
petinoblastoma
keratoconus

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83
Q

general medical conditons affecting the eye

A

diabetes
hyeprtension
thyroid eye disease

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84
Q

define corneal abrasion

A

superficial scratch to the cornea

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85
Q

what increases risk of corneal abrasion

A 
dry or weak cornea
wearing contact lenses
working in settings with eye hazards
sports w eye injuries
bells palsy - lid closure
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86
Q

presentation of corneal abrasion

A 
pain
gritty feeling in the eye 
tearing
redness
sensitivity to the light
headache
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87
Q

if left untreated corneal abrasion can become

A

corneal ulcer

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88
Q

investigations of corneal abrasion

A

fluorescein drops to highlight imperfections in cornea

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89
Q

initial management of corneal abasion - patient

A

rinse eye - water/saline
blinking
pull upper lid over lower

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90
Q

treatment of corneal abrasion

A

not deep - antibiotic ointment singular dose and pain relief

deep - dilating drop to relax eye and ease pain, antibitoic ointment 1 week, eye pad, pain releif and rest

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91
Q

red flag symptoms for corneal abrasion

A

sudden pain in eye of injury, often on waking in morning

watering and sensitivity to light

blurred vision

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92
Q

define corneal foreign body

A

object in eye that should not be there

either conjunctival, corneal, subtarsal (under eyelid)

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93
Q

presentation of corneal foreign body

A

foreign body entering eye through wind blowing/hgh velocity etc

unilateral
ocular irritation, red eye, watering, blurred vision

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94
Q

investigations for corneal foreign body

A

slit lamp examination or torch examination
evert eye lids to check for subtarsal FB
fluorescein staining
siedels test for penetrating globe injury

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95
Q

siedels test

A

looks for fluprescein stained aqueous running down ocular surface if eye penetrated

= penetrating globe injury

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96
Q

management of corneal foreign body

A

removal of FB - (loose can be irrigated with saline, conjunctival removed by sterile cotton bud, corneal needs referral to ophthal and removal using green needle with slit lamp)

7 days topical chloramphenical post removal

97
Q

uevitis

A

eye inflammation affecting the uvea = iris, ciliary body and choroid

98
Q

causes of uevitis

A

autoimmune or inflammatory disroder e.g. sarcoidosis, SLR, crohns, akylosing spondylitis

infection - cat scratch disease, herpes, syphilis, toxoplasmosis, tuberculosis

medication side effect

eye injury or surgery

cancer- lymphoma

99
Q

risk factor for difficult to control uevitis

A

smoking

100
Q

presentation of uevitis

A

eye redness, pain, light sensitivity, blurred vision, floaters, decreased vision

symptoms sudden and get worse quickly

101
Q

investigations of uevitis

A

assessment of vision and response to light

tonometry

slit lamp examination

fundoscopy

102
Q

management of uevitis

A 
drugs that reduce inflammation - corticosteroids
drugs to control spasms and relieve pain
drugs to fight bacteria or viruses
immunosuppressants
surgery - vitrectomy
103
Q

define episcleritis

A

idiopathic inflammation of the superficial episcleral layer of the eye.

relatively common, benign and self limiting

104
Q

define scleritis

A

autoimmune dysrefulation causing inflammation of the whole thickness of the sclera
with ocular complications

requiring systemic treatment

105
Q

presentation of episcleritis vs scleritis

A

episcleritis = acute onset, mild pain, redness and irritation

scleritis - subacute onset of severe pain with eye movement, blurred vision, vision loss and photophobia

106
Q

examination of episcleritis vs scleritis

A

episcleritis = mobile vessels, blanch with phenylephrine drops, reddish hue

scleritis = adherent vessels, not blanching with phenylephrine drops, bluish, hue, slit lamp reveals nodules, scleral thinning and corneal changes, systemic inflammation

107
Q

episcleritis management

A

self limiting normally

can consider topical steroids in refractory cases

108
Q

treatment of scleritis

A

systemic steroids/NSAIDS/topical antibiotics

109
Q

what is posterior vitreous detachment (PVD)?

A

when vitreous gel separates from the retina - normal part of ageing

110
Q

how does PVD occur?

A

vitreous gel becomes liquird and condenes due to age

eventually cannot fill entire vitreous cavity, hence gel separates from retina

sometimes abnormal adhesion occurs between vitreous gel and retina = tear in retina or retinal blood vessel

111
Q

presentation of PVD

A

Floaters
flashes
symptoms become less intense over several weeks

112
Q

investigations of PVD

A

optical coherence tomography or ocular ultrasound

113
Q

management of PVD

A

no specific treatment needed since symptoms subside in 3 months
complications are rare but serious

vitrectomy surgery to remove floaters if persist

114
Q

what is vitreous haemorrhage

A

bleeding into the vitreous humour - from blood vessels at back of eye

caused by trauma or fragility of vessels

115
Q

causes of vitreous haemorrhage

A

bleeding from abnormal blood vessels - metastatic disease, diabetic eye disease, macular degeneration, retinal vein occlusion, Sickle cell disease

bleeding from tears in retina from PVD

trauma to eye

116
Q

risk factors for vitreous haemorrhage

A 
diabetes
>60
smoking
HTN
high risk activities
117
Q

presentation of vitreous haemorrhage

A

mild floaters and haziness to complete vision loss

painless
comes on quickly
unilateral
red tint to vision

118
Q

investigations for vitreous haemorrhage

A

slit lamp examination to see if blood in vitreous

ultrasound if cant see source of bleeding

angiogram to look at abnormal blood vessels

CT if suspected penetrating injury

119
Q

management of vitreous haemorrhage

A

find source of bleeding
stop bleeding - lazer treatment, avoid exercise
repair damage to retina to prevent permanent vision loss

vitrectomy if vitreous obscures view and prevents treatment

120
Q

retinal artery occlusion

A

blockage of retinal artery - carrying oxygen to nerve cells at back of eye = severe vision loss

121
Q

causes of retinal artery occlusion

A

embolus

thrombolus

122
Q

presentation of retinal artery occlusion

A

sudden painless loss of vision in one eye
- CRAO (central retinal artery occlusion) = severe loss of vision

  • BRAO (branch retinal artery occlusion) = loss of section of vision, may go unnoticed
123
Q

investigations for retinal artery occlusion

A

dilated eye examination shows cherry red spot
centre of macula appears red with surrounding retina pale
fluorescein angiography shows delay in retinal artery filling

optical coherence tomography shows swelling in inner layers of retina which atrophy over time and

124
Q

management of retinal artery occlusion

A

hyperventilation to dilate retinal arteries allowing clot to dislodge

paracentesis to lower intraocular pressure to dislodge embolus

lowering intraocular pressure with medication

ocular massage with thumb to dislodge clot

125
Q

`retinal vein occlusion

A

when blood clot blocks the vein so blood cannot drain from retina leading to haemorrhage and leakage of fluid from blocked blood vessels

126
Q

CRVO vs BRVO

A

central retinal vein occlusion = blcokage to main retinal vein

BRANCH retinal vein occlusion = blockage of one of the smaller branch veins

127
Q

risk factors of retinal vein occlusion

A

diabetes, HTN, hypercholesterolaemia

128
Q

clinical presentation of retinal vein occlusion

A

causes vision loss due to macular oedema, neovascularisation, neovascular glaucoma

painless vision loss or blurring - gets worse over hrs-days
complete visio loss almost immediately sometimes

129
Q

investigations of retinal vein occlusion

A

OCT
ophthalmoscopy
flurescein angiography

130
Q

management of retinal vein occlusion

A

cant unblock veins but treat problems related to the occlusion

  • VEGF
  • intravitreal injection of corticosteroid drugs
  • focal laser therapy
  • pan retinal photocoagulation therapy
131
Q

optic neuritis

A

infalmmation of the optic nerve

132
Q

causes of optic neuritis

A

not always clear
infection
MS

133
Q

risk factors for optic neuritis

A

MS
high altitudes
caucasian

134
Q

clinical presentation of optic neuritis

A 
diminished vision
trouble distinguishing colours
blurry vision
inability to see out of one eye
abnormal reaction of pupil to light
pain in eye on movement
135
Q

investigations of optic neuritis

A 
examination
response to direct light
visual acuity
MRI brain
ability to differentiate colour
fundocsopy
136
Q

management of optic enuritis

A

can resolve my itself

breif course of steorids injected into vein to improve inflammation and swelling

137
Q

dry eyes

A

common condition when tears arent able to provide adequate lubrication to eyes

tear instability leads to inflammation and damage to surface of the eyes

138
Q

causes of dry eyes

A

decreased tear production - aging, medical conditions, medications, corneal nerve desensivity

increased tear evaporation - blocked meibomian glands

139
Q

risk factors for dry eyes

A

older
women
low vit A or omega 3
wearing contact lenses or having refractive surgery

140
Q

presentation of dry eyes

A 
stinging, burning or scratchy sensation of eyes
stringy mucus 
sensitivity to light
eye redness
diffculty wearing contact lenses
difficulty night time driving
watery eyes
blurred vision or eye fatigue
141
Q

investigations of dry eyes

A 
eye exam
blotting strips to measure tears
tear quality test
tear osmolarity test
tear samples for markers of dry eyes = matrix metalloproteinase-9 or decreased lactoferrin
142
Q

treatment of dry eyes

A

medications - antibiotics, eyedrops for inflammation, eye inserts (artificial tears), tear stimulaters (choinergics), eye drops from own blood

closing tear ducts to reduce tear loss

using speicial contact lenses

unblocking oil glands - warm compresses

using light therapy and eye lid massage

143
Q

blocked nasolacrimal duct

A

means tears cannot drain normally = watery, irritated eyes

144
Q

causes of blocked nasolacrimal duct

A

Congenital blockage

Age-related changes

Infection or inflammation

Injury or trauma

Tumor

Eyedrops

Cancer treatment

145
Q

presentation of bloocked nasolacrimal duct

A 
excessive tearing
redness of white of eye
recurrent eye infection or inflammation
painful swelling near the inside corner of eye
crusting of eyelids
mucus or pus discharge from lids
blurred vision
146
Q

investigations of blocked nasolacrimal duct

A

tear drianage test
irrigation and probing
eye imaging - XRAY, CT, MRI to find location of blockage

147
Q

treatment of blocked nasolacrimal duct

A 
medications to fight infection - antibiotic eyedrips
watch and wait or massafe
dilation, probing and flushing
stenting or intubation
balloon catheter dilation
148
Q

most common types of eye lid cancer

A

basal cell carcinoma - lower eyelid, pale skin

squamous cell carcinoma - sun exposure, more aggressive and metastatic

melanoma - deepest layer of epidermis, most serious

149
Q

presentation of eyelid cancer

A 
change in appearance of eyelid
eyelid swelling/thickening
chronic infection
non healing eyelid ulceration
spreading, colourless mass
150
Q

treatment of eyelid cancer

A

surgery, eye removal, radiation therapy, chemotherapy

151
Q

types of diabetic retinopathy

A

early diabetic retinopathy/non-proliferating diabetic retinopathy

advanced diabetic retinopathy

152
Q

early diabetic reitnopathy

A 
new blood vessels arent proliferating
walls of vessel in retina weaken
larger vessels dilate and become irregular
leads to oedema of reitna (macula)
can affect vision
153
Q

advanced diabetic retinopathy

A

progresses from earlt
damaged blood vessels close off = growth of abnormal blood vessels which are fragile and leak into vitreous fluid
scar tissue from growth of new blood vessels can cause retinal detachment
can cause glaucoma

154
Q

risk factors for diabetic retinopathy

A 
duration of DM
poor control of DM
high BP
smoking
pregnancy
155
Q

presentation of diabetic retinopathy

A

spots or dark strings floating in vision
blurred vision
dark or empty areas of vision
vision loss

156
Q

complications of diabetic retinopathy

A

vitreous haemorrhage
retinal detachment
glaucoma
blindness

157
Q

investigations of diabetic reitnopathy

A

fundoscopy
intravenous fluorescein angiogram
optical coherence tomography

158
Q

management of diabetic retinopathy

A

retinal screening

control diabetes

if advanced - vascular endothelial growth factor inhibitors injected into vitreous, macular oedema treated with ranibixumab, photocoagulation to stop leakage of blood and fluid, panretinal photocoagulation to shrink blood vessels, vitrectomy

159
Q

what is thyroid eye disease

A

autoimmune disorder characterised by lymphocyte infiltrate of the orbit causing muscle and fatty tissues to become inflamed

in extremes can cause compartment syndrome, compromsing optic nerve and signigicant proptosis may compromise cornea= urgent orbital decompression

160
Q

presentation of TED

A

proptosis (bluging eyes)
red, swollen or retracted eyelids
corneal irritation
extraocular muscle compression and inflammation = diplopia/restricted eyemovement

optic nerve compromise = vision loss, blurred vision, reduced colour vision

161
Q

investigations of TED

A

TFT - but can be euthyroid with evidence of TED (past hyperthyroid)

162
Q

management of TED

A

symptomatic management during active disease - ocular lubricatns, prisms for diplopia, good thyroid hormone control

if evidence of optic nerve compression or residual symptoms - orbital decompression (surgery)

life style = stop smoking, selenium supplements

163
Q

causes of CN III palsy

A

aneurysm - posterior communicating artery = PAINFUL

vasculitis = mononeuritis in diabetes and hypertension

pathology near cavernous sinus in sof or orbit

164
Q

clinical presentation of CNIII palsy

A

DOWN AND OUT
ptosis
dilated pupil - pupil involvement = bad
pain = aneurysm

ipsilateral to side of lesion

165
Q

investigations for cranial nerve palsys

A

MRI or CT to determine cause

full CN exam

166
Q

management of CN III palsy

A

surgery if tumor or aneurysm to releive pressure on nerve and promote healing

eliminate double vision and improvement eye alignment - vision therapy, patching one eye, prism lenses, eye muscle surgery, eyelid surgery to correct ptosis

167
Q

CNIV palsy causes

A

trauma affecting orbit (longest cranial nerve so vulnerable to damage)
vasculiitis (DM, HTN)
congenital
tumor

168
Q

presentation of CNIV palsy

A

incomplete depression in adducted position
torsion of eye in orbit
compensatory head tilt towards shoulder
ipsilateral bhypertrophy and excyclotorsion
double vision when try to read book

169
Q

CNVI palsy cause

A

vasculitis (DM HTN)

high intracranial pressure

170
Q

presentation of CNVI palsy

A

double vision when look to side of lesion
inturning of eye and double vision in primary position
compensatory head turning to the right
no abduction in the eye

171
Q

causes of horners syndrome

A

damage to sympathetic nervous system pathway

first order, second order and third order neurons

172
Q

things causing damage to first order neurons (hypothalamus to spinal cord)

A

Stroke

Tumour

Diseases causing loss of myelin

Neck trauma

Cyst or cavity in spinal colum (syingomyelia)

173
Q

things causing damage to second order neurons (spinal column to neck)

A

Lung cancer

Tumour of the meylin sheath (schwannoma)

Damage to aorta

Surgery in chest cavity

Traumatic injury

174
Q

things causing damage to third order neurons (side of neck to facial skin and muscles of iris and eyelid)

A

Dmaage to carotid artery along side of neck

Damage to jugular vein

Tumour or infection near base of skull

Migraines

Cluster headache

175
Q

presentation of horners syndrome

A

miosis, ptosis and anhydrosis

176
Q

cause of papilloedema

A

optic disc swelling secondary to elevated intracranial pressure

177
Q

presentation of papilloedema

A

raised ICP symptoms - headache, nausea, vomiting

chronicity, blurring of vision and loss of visual feild

transient eppisodes of visual loss

diplopia if VI crannial nerve palsy

178
Q

myopia

A

nearsightedness
- near objects = clear, far = blurry

focus image in front of retina

179
Q

causes of myopia

A

long eyeball

cornea over curved

180
Q

causes of hypermetropia

A

short eyeball

cornea too little curved

181
Q

hypermetropia

A

long sightedness
distances = clear, close = blurry

focuses images behind the retina

182
Q

presbyopia

A

gradual loss of eyes ability to focus on nearby objects

183
Q

cause of presbyopia

A

hardening of the lens with aging,

less flexible and no longer changes shape to focus on close images

184
Q

risk factors for presbyopia

A

age
DM, MS, CVD
drugs

185
Q

presentation of presbyopia

A

hold reading material far away
blurred vision at normal reading distance
eyestrain or headahces after reading or doing close up work

186
Q

management of myopia

A

concave lenses

laser eye surgery

187
Q

management of hypermyopia

A

convex lenses

laser eye surgery

188
Q

treatment of presbyopia

A 
eyeglasses
contacts
refractive surgery to change cornea shape
corneal implants
corneal inlays
189
Q

amblyopia

A

lazy eye

reduced vision in one eye caused by abnormal visual development early in life

190
Q

causes of amblyopia

A

muscle imbalance (stabrismus ambylopia)

refractive differences

deprivation - problem with one eye such as cataract

191
Q

risk factors for ambylopia

A

premature birth
small size at birth
family history of lazy eye
developmental disabilities

192
Q

presentation of ambylopia

A 
eye wanders inwards or outwards
eyes dont appear to work together
poor depth perception
squinting or shutting an eye
head tilting
193
Q

treatment of amblyopai

A 
corrective eywear
eyepatches
bangerter filter glasses
eyedrop (temp blur vision)
surgery
activity based treatments
194
Q

squint/strabismus

A

misalignment of the visual axis

195
Q

causes of squint

A

refractive errors
causes of poor acuity in one or both eyes
neurodevelopmental conditions

196
Q

management of squinty

A

glasses to correct refractive error
occlusion or penalization therapy to treat amblyopia
surgery to correct misalignment

197
Q

congenital/paediatric cataracts

A

congenital clouding of lens

198
Q

risk factors for congenital cataracts

A

infection before or soon after birth
family history
premature

199
Q

management of congenital cataracts

A

referral to ophthal and removal 6-8 weeks of age

put in flexible palstic artifical lens instead
will need contacts or glasses to help focus

200
Q

retinitis pigmentosa

A

inherited degenerative disease involving breakdown and loss of cells in the retina

slowly affects retina and causes loss of night and side vision

inherited

201
Q

retinoblastoma

A

eye cancer that begins in retina affecting young children

= poor vision eye redness, swelling of eye, higher risk of other cancers

inherited

202
Q

keratoconus

A

occurs when cornea thins and gradually bulges outwards into cone

203
Q

presentation of keratoconus

A 
blurred vision
sensitivity to light and glare
frequent changes to prescription
sudden worsenign or clouding of vision
both eyes
10-25 yo
slow progression 10 years
204
Q

Presentation of retinoblastoma

A 
white colour in pupil when light shone on it
eyes appear to look in diff directions
poor vision
eye redness
eye swelling
205
Q

presentation of retinitis pigmentosa

A

early stages = night blindness and progressive loss of visual feild

late stages = more loss of visual field = tunnel vision

206
Q

preseptal vs orbital cellulitis ocular motility

A

preseptal cellulitis has intact ocular motility

orbital cellulitis has restricted ocular motility and has pain on eye movement

207
Q

orbital cellulitis management

A

urgent admission and imaging (ct)

IV antibiotics

surgical draINAGE

untreated = 40% mortality - intracranial infection and cavernous sinus thrombosis

208
Q

giant cell arteritis

A

life threatening inflammation of medium and large vessels

immediate systemic steroids and refer to rheumatology

209
Q

symptoms of giant cell arteritis

A 
new onset headache
jaw claudication
constitutional symptoms
PMR
visual symptoms
fever
limb claudication
210
Q

acute 3rd nerve palsy

outcomes and causes

A

life threatening - aneurysm (PCA which ruptures in 2/3 untreated cases = 50% fatal)

microvascular
tumour
demyelination
vasculitis

211
Q

painless, sponataneous bleeding
no treatment
if recurrent check clotting, FBC, BP

remember base of skull if history of trauma

refer if- proptosed, pulsatile, painful or poor vision

A

subjunctival haemorrhage

212
Q

Common! Normally strep. Pneumoniae, H. influenzae or staph. Aureus/epidermis
Signs/Symptoms:
• Bilateral (usually)
• Mucopurulent or purulent (if +++ consider Gonococcal)
• FB sensation (burning / stinging)
• No photophobia
• Lids and conjunctiva may be oedematous
Investigations:
• ? Swab
Treatment:
Topical abx e.g. Chloramphenicol QDS 5-7

A

bacterial conjunctivitis

213
Q

conjunctival follicles

A

viral e.g. chlamydial
‘grains of rice’ appearance
hyperplastic lymphoid tissue
most prominent in fornices

214
Q

conjunctival papillae

A

allergic or bacterial
velvety cone shaped elevations
hyperplastic epithelium with vascular tuft
most prominent in palpebral and limbal conjunctiva

215
Q 
Symptoms/Signs: 
Bilateral 
Watery (no discharge) 
Soreness, FB sensation  
No photophobia

Examination:
Conjunctiva is often intensely hyperaemic

May be associated: 
Follicles, 
Haemorrhages 
Inflammatory membranes 
Lymphadenopathy (esp.preauricular node)

Aetiology is normally adenoviral ?recent URTI

No treatment needed but advice as very contagious (note topical antivirals if herpes)

A

viral conjunctivitis

216
Q 
Signs/Symptoms:
Itch
Bilateral
Watery discharge
Chemosis (oedema)
Papillae
?Hayfever, atopy, family history
Treatment:
Cold compress
Reduce/remove allergen
Antihistamines
NSAIDS
Mast cell stabilizers
Topical corticosteroids
?immunosuppression
A

allergic conjunctivitis

217
Q

Normally idiopathic (rarely RA, Polyarteritis nodosa, SLE, IBD, Sarcoid, GPA, Herpes Zoster, Syphilis)

Signs/Symptoms:
Often asymptomatic 
Mild tearing/irritation
Tender to touch
Localised or diffuse
Treatment:
Self limiting but can last for months
Lubricants
NSAIDs
Sometimes steroids
Phenylephrine drops?
A

episcleritis

218
Q

Deeper layers affected

Signs/Symptoms:
Much more painful – intense boring pain in eye, worse on eye movement
Ocular tenderness
Watering and photophobia
More commonly has medical associations (Note RA and scleromalacia perforans)
Does NOT blanche with vasoconstrictors such as phenylephrine
Can be localised, diffuse or nodular.

Treatment:
Frequent steroids, refer to ophthalmology.

A

scleritis

219
Q

70% Idiopathic but can be:

Systemic associations: Sarcoid, AS, IBD, Reiter’s, Psoriatic arthritis, Behcets)
Infection
Trauma
Post-op
Masquerade (retinal detachment, retinoblastoma, lymphoma)

Signs/Symptoms:
Pain/ache
Photophobia
Perilimbal conjunctival injection
Blurred vision
?Miotic pupil
AC flare/calls, KPs, hypopyon, Posterior synechiae

Treatment:
Topical steroids and mydriatic/cycloplegics

Investigate if recurrent or atypical

A

anterior uveitis

220
Q 
Signs/Symtoms:
Unilateral (trigeminal nerve distribution)
Painful
?Hutchinson sign
Eye not always involved in V1 HZ

Treatment:
Oral antivirals e.g. acyclovir PO 5x per day for 10/7.

A

herpes zoster ophthalmicus

221
Q

hutchinsons sign

A

Hutchinson’s pupil, an unresponsive and enlarged pupil on the side of an intracranial mass

222
Q

Most commonly:
Bacterial (Staph, strep, pseudomonas)
Viral (Herpes simplex and zoster)
Often associated CL use or trauma but may be secondary to lid/conjunctival disease

Signs/Symptoms:
Ocular pain
Watering and discharge (bacterial)
Decreased vision
Photophobia
Visible lesion – note size/shape and staining
Treatment:
Intensive antibiotics e.g. levofloxacin, exocin. 
Anti-virals
Mydriatics
(steroids?)
Avoid CL use
A

microbial keratitis - inflammation of the cornea

223
Q

Signs/Symptoms:
Extreme pain in orbit and head, ?worse when reading/in reduced light
Nausea, vomiting, abdominal pain
Vision loss
Injected eye
Hazy, oedematous cornea
Pupil often oval, non-reactive and mid dilated
?History of narrow angles ?FH ?Hypermetrope ?Pseudophakic

Treatment:
Urgent referral!
Pain relief +/- anti-emetics as required
Diamox 500mg IV, pilo 2% stat, timolo 0.25%, iopidine 0.5% stat, pred forte, lie supine, analgesia and antiemetic, ?PI ?admit ?diode

A

acute angle closure gluacoma

224
Q

Intra-ocular inflammation and progressive vitritis

Infective vs sterile

85% exogenous
Surgery (?complicated/prolonged), FBs, Penetrating injury, Injections

15% endogenous
Eg haematogenous spread

Mortality of 4%

Timeframe:
1-2/7 = toxic reaction
<6/52 = bacterial (normally 7-14 days)
>6/52 = chronic, 90% are propionibacterium acnes.

Refer urgent for tap and inject

A

endophthalmitis

225
Q

ocular emergencies that may lead to blindness

A 
acute angle closure glaucoma
penetrating/perforating eye injury
orbital cellulitis
giant cell arteritis
chemical injuries
226
Q

acute neurological conditions that may present with ocular signs

A

painful third nerve palsy

painful horners syndrome

227
Q

the red eye

A 
conjunctivitis - all causes
corneal ulcers
acute angle closure glaucoma
uveitis
episcleritis/scleritis
228
Q

trauma

A

corneal abrasion
foreign bodies
chemical injuries
blunt/penetrating injury

229
Q

drusen spots

A

found in macular degeneration

found in choroid naevi - benign

230
Q

HLA B27

A

ankylosing spondylitis

231
Q

how does diabetes affect the eye - pathphysiology

A

cant use up sugars due to hyperglycaemia

water comes into blood vessels

weakens walls of blood vessels (leaky)

therefore affects end blood vessels first - feet and eyes

232
Q

flames

A

retinal arteries weak = bleed and leak

233
Q

cotton wool spots

A

reitnopathy - parts of retna die off due to ischamia - diabetes

234
Q

makes new blood vessels - immature and week leading to more bleeding

A

VEGF

235
Q

Treatment of diabetic retinopathy with neovascularisation

A

anti VEGF injections

236
Q

esotropia vs exotropia

A

eso = eyes point inwards

exo = eyes point outwarda

237
Q

latent squint

A

phoria

238
Q

mulberry sign on retina

A

astrocytic hamartoma

239
Q

endopthalmitis

A

Endophthalmitis is infection inside the globe and most commonly occurs after surgery (although rarely endogenous infections can seed to the eye).

Year 3 core conditions (15 decks)

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