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Ophthalmology Flashcards

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1
Q

What is glaucoma?

A
  • Optic nerve damage caused by intraocular pressure rise
  • Due to blockage in aqueous humour trying to escape eye
  • 2 types-> open + closed angle
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2
Q

What is the anterior chamber?

A
  • Between cornea + iris

- Aqueous humour-> gives nutrients to cornea

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3
Q

What is the posterior chamber?

A
  • Between lens and iris

- Aqueous humour

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4
Q

What is aqueous humour?

A
  • Produced by ciliary body
  • Flows around lens and under iris, through trabecular meshwork + into canal of Schlemm
  • Found in anterior and posterior chamber
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5
Q

What is the normal intraocular pressure?

A
  • 10-21mmHg

- Resistance to flow through trabecular meshwork into canal of Schlemm

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6
Q

What is the pathophysiology of open angle glaucoma?

A
  • Gradual increase in resistance through trabecular meshwork
  • Hard for aqueous humour to flow + exit the eye
  • Pressure builds slowly
  • Can cause optic cupping-> optic cup in disc centre becomes larger + wider
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7
Q

What are the risk factors for developing open angle glaucoma?

A
  • Age
  • FH
  • Black
  • Myopia (near sighted)
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8
Q

What is the vitreous chamber?

A
  • Filled with vitreous humour

- Behind lens-> most of eye

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9
Q

How does open angle glaucoma present?

A
  • Asymptomatic + found on screening
  • Tunnel vision (peripheral)
  • Gradual onset
  • Pain, headaches, blurred vision, halos around lights at night
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10
Q

How is intraocular pressure measured?

A
  • Non-contact tonometry machine-> puff of air + measure corneal response
  • Goldmann applanation tonometry-> contact with cornea + more accurate measurement
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11
Q

How is open angle glaucoma diagnosed?

A
  • Goldmann applantation tonometry
  • Fundoscopy-> cupping + nerve health
  • Visual field assessment
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12
Q

How is open angle glaucoma managed?

A
  • Treatment started at >24mmHg
  • Latanaprost-> prostaglandin analogue eye drops (increase uveoscleral outflow)
  • Timolol-> beta-blocker to reduce humour production
  • Dorzolamide or brimonidine
  • Surgery-> trabeculotomy ie new channel + bleb for drainage
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13
Q

What is latanaprost?

A
  • prostaglandin analogue eye drops (increase uveoscleral outflow)
  • used in open angle glaucoma
  • can cause eyelid + iris pigmentation
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14
Q

What is the pathophysiology of acute angle-closure glaucoma?

A
  • Iris bulge forward + seal off trabecular meshwork from anterior chamber
  • Prevents aqueous humour drainage
  • Pressure builds in posterior chamber
  • Iris bulges
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15
Q

What are the risk factors for acute angle-closure glaucoma?

A
  • Age
  • Female
  • Family history
  • Chinese + East Asian (rare in black people)
  • Shallow anterior chamber
  • Medications-> noradrenaline, oxybutynin, amitriptyline
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16
Q

How does acute angle-closure glaucoma present?

A
  • Unwell
  • Severe red eye pain
  • Blurred vision
  • Halos around lights
  • Headache
  • Nausea + vomiting
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17
Q

What examination findings might be present in acute angle-closure glaucoma?

A
  • Red + teary eye
  • Hazy cornea
  • Decreased acuity
  • Dilated/fixed pupil
  • Firm eyeball
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18
Q

How is acute angle-closure glaucoma managed?

A
  • Same day assessment from ophthalmology
  • Lie on back without pillow
  • Pilocarpine eye drops
  • Acetazolamide
  • Timolol (beta-blocker)
  • Hyperosmotic agents-> glycerol or mannitol
  • Laser iridotomy-> laser hole in eye
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19
Q

What are pilocarpine eye drops?

A
  • Act on muscarinic receptors in sphincter muscles of iris-> pupil constriction
  • Miotic agent
  • Ciliary muscle contraction
  • Cause flow of aqueous humour pathway to open
  • Used in acute angle-closure glaucoma
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20
Q

What is acetazolamide?

A
  • Carbonic anhydrase inhibitor
  • Reduces aqueous humour production
  • Used in acute angle-closure glaucoma
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21
Q

What is age-related macular degeneration?

A
  • Degeneration of macula-> part of retina responsible for central + colour vision
  • Dry (90%) or wet (10%)
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22
Q

What does the macula consist of?

A

Central + colour vision…

  • Choroid layer-> BV supply
  • Bruch’s membrane
  • Retinal pigment epithelium
  • Photoreceptors
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23
Q

What is drusen?

A
  • Fundoscopy finding in age-related macular degeneration
  • Deposits of protein + lipids between Bruch’s membrane + retinal pigment epiethlium
  • Larger + greater than normal-> early sign
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24
Q

What is the pathophysiology of wet age-related macular degeneration?

A
  • New vessels grow from choroid layer into retina
  • Due to vascular endothelial growth factor (VEGF)
  • Leak fluid/blood-> oedema + rapid vision loss
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25
What are the risk factors for age-related macular degeneration?
- Older - Smoking - White - Chinese - Family history - CVD
26
How does wet age-related macular degeneration present?
- Central visual field loss-> over few days then full over a few years - Reduced acuity - Crooked/wavy appearance to straight lines - Often progress to bilateral
27
How does dry age-related macular degeneration present?
- Gradual central visual field loss - Reduced acuity - Crooked/wavy appearance to straight lines
28
How is age-related macular degeneration investigated?
- Full eye exam - Slit lamp biomicroscopic fundus exam - Optical coherence tomography (wet) - Fluorescein angiography
29
How is dry age-related macular degeneration managed?
- Ophthalmology referral | - Lifestyle-> smoking, HTN control, vitamin supplements
30
How is wet age-related macular degeneration managed?
- Ophthalmology referral | - Anti-VEGF meds-> ranibizumab injections
31
What causes diabetic retinopathy?
- Blood vessels in retina damaged by prolonged exposure to hyperglycaemia - Progressive degeneration of retina health
32
What is the pathophysiology of diabetic retinopathy and its features?
- Hyperglycaemia-> retinal small vessel + endothelial damage - Increased vascular permeability-> leakage from BVs, blot haemorrhages - Hard exudates-> yellow/white - Microanurysms-> weakness in walls causes bulges - Venous bleeding-> veins like beads - Nerve fibre damage-> cotton wool spots (fluffy white on retina) - Intraretinal microvascular abnormalities-> dilated capillaries + can act as shunt - Neovascularisation-> GFs released + cause new BV formation
33
What are some features of diabetic retinopathy?
- Blot haemorrhages - Lipid deposits/exudates - Microaneurysms - Venous bleeding - Cotton wool spots - Neovascularisation - Intraretinal microvascular abnormalities
34
What are the two categories of diabetic retinopathy?
- Proliferative | - Non-proliferative
35
What are the categories + features of non-proliferative diabetic retinopathy?
- Mild-> microaneurysms - Moderate-> + blot haemorrhages, hard exudates, cotton wool spots, venous bleeding - Severe-> blot haemorrhages + microaneurysms in 4 quadrants, venous beating in 2 quadrants, IMRA in any quadrant
36
What are the features of proliferative diabetic retinopathy?
- Neovascularisation | - Vitreous haemorrhage
37
What is diabetic maculopathy?
Macular oedema + ischaemic maculopathy
38
What are the complications of diabetic retinopathy?
- Retinal detachment - Vitreous haemorrhage - Optic neuropathy - Cataracts - Rebeosis iridis-> new BVs on iris
39
What is the management of diabetic retinopathy?
- Laser photocoagulation - Anti-VEGF-> ranibizumab - Vitreoretinal surgery-> severe
40
What is the pathophysiology of hypertensive retinopathy?
- Damage to small BVs in retina related to systemic HTN | - Develops from chronic or malignant HTN
41
What are the retinal signs of hypertensive retinopathy?
- Silver/copper wiring-> thick + sclerosed arteriole walls - AV nipping - Cotton wool spots-> ischaemia + infarction causes nerve fibre damage - Hard exudates - Retinal haemorrhages - Papilloedema-> ischaemia to optic nerve so swells
42
What is the Keith-Wagener classification?
For hypertensive retinopathy... - Stage 1-> mild narrowing of arterioles - Stage 2-> focal constriction of BVs + AV nicking - Stage 3-> cotton-wool patches, exudates, haemorrhages - Stage 4-> papilloedema
43
How is hypertensive retinopathy managed?
Control HTN + risk factors-> smoking, lipids etc
44
What is anterior uveitis?
- Inflammation in anterior part of uvea (iris + ciliary body + choroid) - Inflammation + immune cell infiltration of anterior chamber-> floaters
45
What is the choroid?
Layer between retina + sclera all the way around the eye
46
What can cause anterior uveitis?
- Autoimmune - Infection - Trauma - Ischaemia - Malignancy
47
What is associated with anterior uveitis?
- HLAB27 conditions-> IBD, reactive arthritis, ankylosing spondylitis - Chronic-> sarcoidosis, syphilis, Lyme's, TB, herpes
48
What is chronic anterior uveitis and how does it present?
- More granulomatous-> increased macrophage infiltration of anterior chamber - Less severe than acute - Over 3+ months
49
How does anterior uveitis present?
- Unilateral, spontaneous + without trauma - May get flare up if have chronic condition - Pain-> dull, on movement - Red eye + ciliary flush (red ring) - Vision-> reduced acuity, floaters, flashes, photophobia - Pupil-> miosis + abnormal shape as adhesions pull - Excess lacrimation - Hypopyon-> yellow fluid (WBC) in lower iris
50
How is anterior uveitis managed?
- Same say ophthalmology - Steroids - Immunosuppressants-> DMARDs, TNF-inhibitors - Laser therapy - Cyclopentolate or atropine eye drops
51
How do atropine eye drops work?
- Cycloplegic-mydriatic - Paralyse ciliary muscle + dilate pupils - Antimuscarinics
52
What is episcleritis?
- Benign + self-limiting | - Inflammation of episclera-> outer layer of sclera under conjunct
53
Who is episcleritis most common in?
- Young - Middle aged - Associated with RA + IBD - Not usually infection
54
How does episcleritis present?
- Acute onset - Unilateral - None to mild pain - Patch of redness in lateral sclera - Foreign body sensation - Dilated episcleral vessels - Watery eye - No discharge
55
How is episcleritis managed?
- Recovers in 1-4 weeks - No treatment needed usually - Lubricating eye drops - Analgesia + cold compression - Safety netting - Severe-> systemic NSAIDs, topical steroid eye drops
56
What are cataracts?
Lens becomes cloudy + opaque over time due to age + risk factors-> reduced acuity
57
How does the lens of the eye work?
- Focuses light into eye + retina - Held by suspensory ligaments attached to ciliary body - Ciliary body relaxes-> increased tension of suspensory ligaments-> lens narrows - Nourished by surrounding fluid (no blood supply)
58
What are the risk factors for cataracts?
- Older age - Smoking - Alcohol - Diabetes - Steroids - Hypoglycaemia
59
How does cataracts present?
- Asymmetrical reduction + blurring of vision - Colour vision change-> brown/yellow - Starbursts around lights at night - Loss of red reflex
60
How does vision loss in cataracts compare to loss in other eye conditions?
- Cataracts-> general reduction in acuity + starbursts - Glaucoma-> peripheral vision loss + halos round lights - Macular degeneration-> central vision loss + wavy/crooked appearance to straight lines
61
How are cataracts managed?
- None if symptoms manageable | - Surgery-> drill + break lens then remove + implant artificial one
62
What are the complications of cataract surgery?
- Prevent detection of other pathology eg macular degeneration - Poor visual acuity - Endophthalmitis-> infection/inflammation of inner eye contents + can cause loss of vision
63
What causes pupillary constriction?
- Circular muscles in iris - Stimulated by parasympathetic nervous system-> travels to eye via CNIII - Involved acetylcholine NT
64
What causes pupil dilation?
- Dilator muscles from inside to outside of iris - Stimulated by sympathetic nervous system - Adrenaline NT
65
What can cause an abnormal pupil shape?
- Cataract surgery - Trauma - Adhesions/scars from infection - Anterior uveitis - Acute angle closure glaucoma - Rubeosis iridis - Coloboma - Tadpole pupil-> from migraines
66
What is mydriasis?
Dilated pupil
67
What can cause mydriasis (dilated pupil)?
- CNIII palsy - Raised ICP - Holmes-Adie syndrome - Congenital - Trauma - Stimulants (cocaine) - Anticholinergics
68
What is miosis?
Constricted pupil
69
What can cause miosis (constricted pupil)?
- Horner's - Cluster headache - Argyll-Robertson pupil (syphillis) - Opiates - Nicotine - Pilocarpine
70
Which way will an eye affected by CNIII palsy look and why?
- Down and out | - Supplies all muscles apart from superior oblique (CNIV) + lateral rectus (CNVI)
71
How does third nerve palsy present?
- Down + out eye (divergent strabismus) - Dilated fixed pupil - Palsy - Ptosis
72
Why do patients with third nerve palsy get ptosis?
Supplies levator palpebrae superioris muscle which lifts upper eyelid-> lost in palsy
73
Why do patients with third nerve palsy get dilated fixed pupil?
Parasympathetic fibres to sphincter muscles of iris act to constrict pupil-> lost in CNIII palsy
74
What can cause third nerve palsy (with pupil sparing)?
Microvascular-> DM, HTN, ischaemia
75
What can cause third nerve palsy (with full compression)?
- Cavernous sinus thrombosis - Posterior communicating artery aneurysm - Idiopathic - Tumour - Trauma - Raised ICP
76
What causes Holmes-Adie pupil?
Damage to post-ganglionic PSNS fibres
77
How does Holmes-Adie pupil present?
- Unilateral dilated pupil - Sluggish to react to light - Slow dilation after constriction - Smaller over time
78
What causes Argyll-Robertson pupil?
Neurosyphillis
79
How does Argyll-Robertson pupil present?
- Constricted pupil that accommodates to near object but doesn't react to light - History of neurosyphillis
80
What is the pathophysiology of Horner's syndrome?
Sympathetic nerve damage to nerves supplying the face
81
Where do the sympathetic nerves that are affected by Horner's syndrome run?
- Start in spinal cord in chest as pre-ganglionic nerves - Into sympathetic ganglion (at base of neck) - Post ganglionic nerves run alongside internal carotid artery
82
How does Horner's syndrome present?
- Ptosis - Miosis - Anhidrosis
83
How can the location of the cause of Horner's syndrome be determined?
Anhidrosis... - Central lesion-> arm + trunk - Pre-ganglionic-> face - Post-ganglionic-> none
84
What are the causes of Horner's syndrome?
- Central lesions (4Ss)-> stroke, MS, swelling (tumour), syringomyelia - Pre-ganglionic (4Ts)-> tumour (pancoast's), trauma, thyroidectomy, top rib (cervical) - Post-ganglionic (4Cs)-> carotid aneurysm, carotid artery dissection, cavernous sinus thrombosis, cluster headache - Congenital
85
What is associated with congenital Horner's syndrome?
Heterochromia (different coloured eyes)
86
How is Horner's syndrome investigated?
Cocaine eye drops... - Stop noradrenaline re-uptake at NMJ + normal eye dilates (more NA to stimulate iris dilator muscles) - Horner's-> nerves don't release NA-> blocking makes to difference-> no reaction
87
What is blepharitis?
Inflammation of eyelid margins
88
What causes blepharitis?
- Meibomian gland dysfunction (secrete oil onto eye surface) | - Inflammation of eyelid margins
89
What are the symptoms of blepharitis?
Gritty, itchy, dry, can cause styes + chalazions
90
How is blepharitis managed?
- Hot compresses - Gentle cleaning - Hypromellose eye drops
91
What is a stye?
- Hodeolum externum-> gland of Zeis (sebaceous at eyelash base) or glands of Moll (sweat at eyelash base) infection - Hordeolum internum-> Meibomian gland infection
92
How do styes present?
- Hodeolum externum-> red + tender lump along eyelash base +/- pus - Hordeolum internum-> deep + more painful, may point in towards eyeball
93
What is a chalazion?
Meibomian gland blocks + swells-> cyst
94
What are the symptoms of a chalazion?
- Swelling - Non tender - Red
95
How is chalazion treated?
- Hot compress - Analgesia - Chloramphenicol - Surgical drainage
96
What is entropion?
Eyelid turns in with lashes against eyeball
97
How does entropion present?
- Eyelid turns in with lashes against eyeball - Pain - Corneal damage + ulcers
98
How is entropion managed?
- Tape eyelid down - Eye drops - Surgery - Same day referral if sight risk
99
What is ectropion?
Eyelid turns outwards with inner lid exposed
100
What is the complication of ectropion?
Exposure keratopathy
101
How is ectropion managed?
- None - Regular drops - Surgery - Same day referral if sight risk
102
What is trichiasis?
Inward growth of eyelashes
103
How does trichiasis present?
- Inward growth of eyelashes - Pain - Corneal damage - Ulcers
104
How is trichiasis managed?
- Epilation-> removal of eyelashes - Electrolysis - Cryotherapy - Laser-> prevent regrowth - Same day referral is sight risk
105
What is periorbital cellulitis?
Eyelid and skin infection in front of orbital septum
106
How does periorbital cellulitis present?
- Swelling - Hot & red skin - Around the eye
107
What investigation should be done in periorbital cellulitis?
CT-> rule out orbital cellulitis
108
How is periorbital cellulitis managed?
- Systemic antibiotics | - Admission-> if suspect/risk of orbital cellulitis (eg kids)
109
What is orbital cellulitis?
Infection around eyeball + tissues behind orbital septum
110
How does orbital cellulitis present?
- Pain on eye movement - Reduced movement - Change in vision - Abnormal pupil reaction - Proptosis (eyeball moves forward)
111
How is orbital cellulitis managed?
- Admission - IV antibiotics - Surgical drainage if abscess
112
What is conjunctivitis?
Inflammation of conjunctiva (thin tissue covering inside of eyelids + sclera)
113
What are the three types of conjunctivitis?
- Bacterial - Viral - Allergic
114
How does conjunctivitis present (in general)?
- Uni or bilateral - Red - Bloodshot - Itchy - Gritty - Discharge - NOT pain, photophobia or reduced acuity
115
How does bacterial conjunctivitis present?
- Uni or bilateral (spread to other eye) - Red - Bloodshot - Itchy - Gritty - Discharge-> purulent - Worse on a morning-> eyes stuck together - Highly contagious
116
How does viral conjunctivitis present?
- Uni or bilateral - Red - Bloodshot - Itchy - Gritty - Discharge-> clear - Associated-> cough, sore throat, tender preauricular lymph nodes - Contagious
117
What are the differentials for painful red eye?
- Glaucoma - Anterior uveitis - Scleritis - Corneal abrasions - Ulcers - Keratitis - Foreign body - trauma - Chemical injury
118
What are the differentials for painless red eye?
- Conjunctivitis - Episcleritis - Subconjunctival haemorrhage
119
How is conjunctivitis managed (in general)?
- Usually resolves in 1-2 weeks - Good hygiene + avoiding contact lenses - Sterile water cleaning
120
How is bacterial conjunctivitis managed?
- Good hygiene - Chloramphenicol - Fuscidic acid
121
What should happen if a neonate (<1 month) presents with conjunctivitis?
Urgent review-> may be gonococcal + lead to sight loss/pneumonia
122
How does allergic conjunctivitis present?
- Swelling of conjunctival sac + eyelid - Discharge - Itch
123
How is allergic conjunctivitis treated?
- Antihistamines | - Mast-cell stabilisers for few weeks (chronic/seasonal)
124
What is scleritis?
Inflammation of full thickness of sclera-> not infection usually + more serious
125
What are the complications of scleritis?
- Necrosis - Perforation - Visual impairment
126
What conditions are associated with scleritis?
RA, SLE, IBD, sarcoidosis, granulomatosis + polyangiitis
127
How does scleritis present?
- Acute - 50% bilateral - Severe pain worsened by movement - Photophobia - Watery eye - Reduced acuity - Abnormal pupil reactions - Tender on palpation
128
How is scleritis managed?
- Sam day ophthalmology - Topical or systemic steroids - NSAIDs - Immunosuppressant relevant to underlying condition
129
What can cause corneal abrasions?
- Contact lens - Foreign body - Nails - Eyelashes - Entropion (eyelid inward)
130
What can corneal abrasions caused by contact lenses be associated with?
Pseudomonas infection
131
How does corneal abrasion present?
- History - Painful red eye - foreign body sensation - Watery - Blurred vision - Photophobia
132
How is corneal abrasion diagnosed?
Fluorescein stain + slit lamp exam
133
How is corneal abrasion managed?
- Same day ophthalmology - Analgesia - Lubricating eye drops - Chloramphenicol - Review in 1 week - Often heal in 2-3 days
134
What is herpes keratitis?
Inflammation of the cornea (especially epithelial layer) due to herpes simplex
135
What can cause keratitis (inflammation of the cornea)?
- Herpes simplex (most common) - Bacteria-> pseudomonas, staph - Fungus - Contact lens - Exposure keratitis
136
What complications can occur in keratitis and when?
If inflammation to stroma (between epithelium + endothelium)... - Stromal necrosis - Vascularisation - Scarring - Blindness
137
How does herpes keratitis present?
- Painful red eye - Photophobia - Vesicles around eye - Foreign body sensation - Watery - Reduced acuity
138
How is herpes keratitis diagnosed?
- Fluorescein stain-> dentritic (branched/spreading) corneal ulcer - Slit lamp exam - Corneal swabs/scraping-> culture/PCR
139
How is herpes keratitis managed?
- Same day assessment - Acyclovir - Ganciclovir gel - Topical steroids - Corneal transplant-> eg when scarred + resolved
140
What is subconjunctival haemorrhage?
Small vessels in conjunctiva ruptures causing blood to accumulate between sclera + conjunctiva
141
What causes subconjunctival haemorrhage?
- Triggers-> heavy coughing, weight lifting, trauma - Idiopathic - HTN - Bleeding disorder - Whooping cough - Warfarin + DOACs - Non-accidental injury
142
How does subconjunctival haemorrhage present?
- Bright red blood patch covering eye - Painless - Not affect vision - Often triggered by something
143
How is subconjunctival haemorrhage managed?
- Resolves in 2 weeks approx - Address causes - Lubricating eye drops
144
What is the pathophysiology of posterior vitreous detachment?
- Vitreous body-> gel in eye to keep retina pressed on choroid - Less firm as get older - In posterior vitreous detachment-> gel comes away from retina
145
How does posterior vitreous detachment present?
- Painless - Spots of vision loss - Floaters - Flashing lights
146
How is posterior vitreous detachment managed?
- None-> vision improves as brain adjusts | - Retinal tear/detachment risk-> need urgent assessment if suspect
147
What causes retinal detachment?
- Retina separates from choroid | - Usually retinal tear-> lets vitreous fluid out under retina + fills space
148
Why is retinal detachment a sight-threatening emergency?
Outer retina relies on choroid vessels for supply-> may die if too long
149
What are the risk factors for retinal detachment?
- Posterior vitreous detachment - Diabetic retinopathy - Trauma - Retinal malignancy - Older - Family history
150
How does retinal detachment present?
- Flashes/floaters - Peripheral vision loss - Blurred/distorted vision
151
How is retinal detachment managed?
- Immediate referral - Tears-> adhesion via laser/cryotherapy - Reattachment - Vitrectomy + replacement - Scleral buckling - Pneumatic retinoplexy
152
What is the pathophysiology of retinal vein occlusion?
- Thrombus in retinal veins-> block blood draining from retina - Fluid + blood leaks-> macular oedema + retinal haemorrhage - Causes tissue damage in retina + loss of vision - Central vein through optic nerve made from 4 branches-> not as bad if branch thrombus
153
How does retinal vein occlusion present?
Sudden painless loss of vision
154
What are risk factors for retinal vein occlusion?
- HTN - High cholesterol - DM - Smoking - Glaucoma - SLE
155
What fundoscopy findings might be present in retinal vein occlusion?
- Flame + blot haemorrhages - Optic disc oedema - Macular oedema
156
How is retinal vein occlusion managed?
- Immediate referral - Laser photocoagulation - Intravitreal steroids - Anti-VEGF (eg ranibizumab)
157
What is the blood supply to the retina?
Internal carotid artery-> opthalmic artery-> central retinal artery
158
What causes central retinal artery occlusion?
Blockage from artherosclerosis or vasculitis (giant cell arteritis)
159
What are the risk factors for central retinal artery occlusion?
- General-> older, FH, smoking, alcohol, HTN, DM, obesity | - Secondary to GCA-> over 50, female, polymyalgia rheumatica
160
How does central retinal artery occlusion present?
- Sudden painless loss of vision | - Relative afferent pupillary defect
161
What is relative afferent pupillary defect?
- Pupil in affected eye constricts more when light shone in other eye - Normal retina senses consensual light reflex - Indicates CNII problem (light signal not going in properly)
162
What fundoscopy signs might be present in central retinal artery occlusion?
- Pale retina-> lack of perfusion | - Cherry red spot-> macula thinner + shows red choroid below
163
How is central retinal artery occlusion managed?
- Immediate referal - Test for GCA-> ESR + temporal artery biopsy - Ocular massage-> try dislodge thrombus - Inhaled carbogen - Isosorbide mononitrate - 2ndary prevention of CVD
164
What is retinitis pigmentosum?
Congenital and inherited degeneration of rods + cones-> isolated or with systemic disease
165
How does retinitis pigmentosum present?
- Often in childhood - Night blindness - Decreased vision-> peripheral then central
166
What fundoscopy findings might be present in retinitis pigmentosum?
- Bone spicule pigmentation-> bone matrix appearance mostly in mid-peripheral retina - Narrow arterioles - Waxy/pale optic disc
167
How is retinitis pigmentosum managed?
- Referral - Genetic counselling - Vision aids - Driving limits - Regular follow up

Medicine (13 decks)

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