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Ophthalmology Flashcards

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1
Q

What is open angle glaucoma?

A

it is damage to the optic nerve due to raised IOP leading a blockage of the aqueous humour leaving the eye
rise of IOP over 21mmHg leads to increase in resistance and further pressure - chronic
acute - iris bulges and seals off the meshwork

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2
Q

what is the normal role of the aqueous humour?

A

it supplies the nutrients to the cornea - made by the ciliary body
flows from CB around the lens and under the iris, through the anterior chamber and into canal of schlem which enters circulation

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3
Q

what are the risk factors for open angle glaucoma?

A

increasing age, FHx, black, myopia

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4
Q

how does open angle glaucoma affect the optic disc?

A

it causes cupping

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5
Q

how does open angle glaucoma present?

A

can be asymptomatic for a long time - routine screening picks it up
affect peripheral vision first resulting in tunnel vision, gradual onset fluctuating pain, headaches, blurred vision and haloes at night

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6
Q

how is open angle glaucoma investigated?

A

air puff or Goldmann applanation tonometry, fundoscopy, visual field assessment

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7
Q

how is open angle glaucoma managed?

A

management starts at 24mmHg
prostaglandin eye drops such as lantaprost to increase outflow
BB to reduce production
carbonic anhydrase inhibitors to reduce production
sympathomimetics
trabeculectomy

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8
Q

what is the pathophysiology of acute angle closure glaucoma?

A

the iris bulges forwards and seals off the trabecular network from anterior chamber so the aqueous humour cannot escape

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9
Q

what are the risk factors for acute AC glaucoma?

A

increasing age, female, FHx, chinese, east asian, shallow anterior chamber, drugs

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10
Q

how does acute AC glaucoma present?

A

unwell, severely painful red eye, blurred vision, haloes, headache, N+V
red teary eye
hazy cornea
decreased VA
dilatation of the affected pupil
fixed pupil size
firm eyeball on palpation

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11
Q

how is acute AC glaucoma managed?

A

initially - lie on back, pilocarpine eye drops, acetazolamide, analgesia, antiemetics
secondary care - pilocarpine, acetazolamide, hyperosmotic agents, timolol, dorzolamide, brimonidine, laser iridotomy

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12
Q

what is diabetic retinopathy?

A

it is when the retinal vessels are damaged due to chronic hyperglycaemia, this damage causes hard exudates, blot haemorrhages, microaneurysms, cotton wool spots, intraretinal microvascular abnormalities, neovasculariation

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13
Q

what is the difference between proliferative and non proliferative diabetic retinopathy?

A

proliferative - neovascularisation and vitreous haemorrhage
non - mild, moderate and severe all signs except neovascularisation

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14
Q

what is diabetic maculopathy?

A

it is macular oedema and ischaemia maculopathy

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15
Q

how is diabetic retinopathy managed?

A

laser photocoagulation, antiVEGF, vitreoretinal surgery

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16
Q

what are complications of diabetic retinopathy?

A

retinal detachment, vitreous haemorrhage, rebeosis iridis, optic neuropathy, cataracts

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17
Q

what is ARMD?

A

it is macular degeneration that can be wet (10%) or dry (90%)
results in drusen, atrophy of retinal pigment epithelium, degeneration of photoreceptors

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18
Q

what is wet ARMD?

A

it is new vessels from choroid layer into retina, which then leaks, results in oedema and more visual loss - stimulated by VEGF

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19
Q

how is ARMD investigated?

A

decreased VA, scotoma, Amsler grid testing, drusen on fundoscopy, slit lamp biomicroscopic fundus exam, optical coherences tomography, fluroescein angiography

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20
Q

how does ARMD present?

A

gradual worsening central vision, decreased acuity, crooked or wavy appearance to straight lines, more acute if wet

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21
Q

how is ARMD managed?

A

avoid smoking, control BP, vitamin supplementation
wet - antiVEGF monthly

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22
Q

what controls pupil constriction and dilatation?

A

circular muscles in iris controlled by PNS through oculomotor control - constriction
dilatation - dilator muscles are stimulated by SNS using adrenalin

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23
Q

what can result in an abnormal shaped pupil?

A

trauma, anterior uveitis, acute ACG, rubeosis iridis

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24
Q

what causes mydriasis?

A

third nerve palsy, Holmes Adie syndrome, increased ICP, trauma, congenital, stimulants, anticholinergics

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25
summarise Horners?
it is ptosis, miosis, enopthalmos and anhidrosis causes - stroke, MS, syringomyelia, tumour, trauma, thyroidectomy, carotid artery dissection, cavernous sinus thrombosis, cluster headaches ix - cocaine drops give no response, adrenalin drops will dilate horners pupil but not a normal pupils
26
what can cause miosis?
horners, cluster headaches, opiates, nicotine, Argyll Robertson pupil
27
summarise CNIII palsy?
ptosis, non reactive dilated pupil, divergent strabismus idiopathic, DM, HTN, ischaemia, ICP, tumour, trauma
28
what is Holmes Adie puil?
unilateral dilated pupil with sluggish reaction to light that gets smaller over time absent knee and ankle reflexes - HA syndrome can be viral cause
29
what is a Argyll Robertson pupil?
neurosyphilis - accommodates to near object but not light, irregular and constricted
30
summarise belpharitis?
inflammation of the eyelid margins gritty, itchy, dry eye can lead to styes and chalzions mx - hot compress, lubricant eye drops, keep clean
31
summarise stye?
externum is glands of Zeus or Moll internum is Meibomian tender red lump on eye lid mx - analgesia, hot compress, topical ABx if required
32
summarise trichiasis?
inward eyelash growth - corneal damage and ulceration mx - epilation, electrolysis, cryotherapy, laser
33
summarise orbital cellulitis?
infection involving the orbital septum, preceded by preseptal (swelling, redness, hot skin - CT to r/o orbita, give IV ABx or PO, admission if needed) as before plus pain on eye movement, decreased movement, abnormal pupil reactions, forward movement of eye ball IV ABx and drainage if needed
34
summarise ectropion?
eyelid turns out - commonly bottom exposure keratopathy mild - conservative with eye drops severe - same day referral
35
summarise entropion?
eye lid inverts - corneal damage and ulceration mx - tape eyelid, lubrication, urgent referral
36
summarise chalazion?
blocked meibomian gland non tender eyelid swelling mx - compress and analgesia topical ABX and surgical drainage if needed
37
what is a cataract?
it is when the lens becomes cloudy and opaque - decreased VA it is screened for at birth can be caused by increasing age, smoking, alcohol, DM, steroids, decreased Ca
38
how does cataract present?
asymmetrical, very slow visual reduction and blurring, change in colour vision, starbursts, loss of red reflex
39
how is cataract managed?
manage symptoms, surgery for artificial lens, r/v after operation as it can cover up other issues
40
what is endophthalmitis?
serious rare complication of cataract surgery - overwhelming infection and inflammation of eye - intravitreal ABx
41
what is conjunctivitis?
it is inflammation of the conjunctiva - inside of the eye lid to sclera can be bacterial, viral, allergic etc
42
what is the presentation of conjunctivitis?
bacterial - purulent discharge, inflamed conjunctiva, eyes stuck together in morning, contagious, spreads uni to bilateral viral - clear discharge, dry cough, sore throat, blocked nose, tender periauricular noes allergic - swelling of conjunctival sac, watery discharge, itch generally - uni or bilateral, red, bloodshot, itchy, gritty, discharge, no pain, decreased VA or photophobia
43
how is conjunctivitis managed?
allergic - antihistamines, topical mast cell stabilisers self resolving otherwise, good hygiene, cooled boiled water and cotton wool, avoid contact lenses, topical chloramphenicol and fusidic acid is needed refer neonates
44
what is hypertensive retinopathy?
it is damage to the small blood vessels in retina due to HTN silver or copper wiring, AV nipping, cotton wool spots, hard exudates, retinal haemorrhages, papilloedema
45
how is hypertensive retinopathy managed?
control BP and RFs
46
what is anterior uveitis?
it is inflammation of the anterior uvea (iris, CB, and choroid) infiltration by neutrophils, lymphocytes, macrophages - autoimmune, infection, trauma, ischaemia and cancer can cause
47
what are the associations of uveitis?
acute - HLAB27 chronic - granulomatous - TB, HSV, Lymes, sarcoidosis, syphilis
48
how does anterior uveitis present?
floaters, unilateral dull, aching, painful, red ciliary flush, decreased VA, miosis, photophobia, hyperlacrimation, pain on movement, abnormal shaped pupil, hypopyon
49
how is anterior uveitis managed?
urgent same day referral, steroids, cycloplegic mydriatics, immunosuppressants, laser cryotherapy, vitrectomy
50
what is episcleritis?
it is a benign, self limiting inflammation of the episclera
51
how does episcleritis present?
mild pain, segmental redness, lateral FB sensation, dilated vessels, watering, no discharge
52
how does scerlitis present?
it is pain, with movement, eye watering, decreased VA, photophobia, abnormal light reactions, tender on palpation
53
how is episcleritis managed?
refer to ophthalmology, self limiting, lubricants, cold compress, analgesia, safety net, top steroid drops, systemic NSAIDs
54
what is scleritis and how is it managed?
it is full thickness inflammation of the sclera that can result in necrosis same day referral, investigate for underlying condition, NSAIDs and steroids, immunosuppressants appropriate to underlying condition
55
what are corneal abrasions?
they are scratches or damage to the cornea resulting in a painful red eye, FB sensation, history of contact lenses or FB, watering, photophobia, blurred vision can cause severe damage and loss of vision
56
how is corneal abrasion investigated?
fluorescein stain slit lamp
57
how is corneal abrasion managed?
same day referral remove FB simple analgesia, lubricating eye drops, irrigation if chemical, cyclopentolate
58
what is a corneal ulcer?
it is more common in contact lenses - causes eye pain, photophobia, watering, focal staining mx - treat cause
59
what is herpes keratitis?
inflammation of the cornea - HSV most common but also pseudomonas, staph, fungal, contact lens acute red eye and exposure
60
what is a complications of herpes keratitis?
stromal keratitis - inflammation of stroma - vascularisation, necrosis, scarring - blindness
61
how does herpes keratitis present and how is it diagnosed?
painful red eye, photophobia, vesicles around eye, FB sensation, watering, reduced VA fluorescein stain - dendritic corneal ulcers, slit lamp, swabs and scrapings for PCR
62
how is herpes keratitis managed?
aciclovir topical or oral gangciclovir gel steroids antivirals stromal - corneal transplant
63
what is a subconjunctival haemorrhage?
small vessel in conjunctiva ruptures and released into space between sclera and conjunctiva associated with HTN, bleeding disorders, pertussis, drugs, NAI
64
how does subconjunctival haemorrhage present?
bright red patch, painless, no visual change, hx precipitating event
65
how is subconjunctival haemorrhage managed?
self resolving around 2w investigate underlying cause lubricating eye drops if FB sensation
66
what is a posterior vitreous detachment?
the vitreous body becomes less firm with age and gradually withdraws from retina
67
how does posterior vitreous detachment present?
painless, spots of loss of vision, floaters, flashes
68
how is posterior vitreous detachment managed?
the symptoms improve as the brain adjusts can predispose to retinal tears and detachment - r/o so refer to ophthalmology
69
what is retinitis pigmentosa?
it is a congenital inherited condition of degeneration of rods and cones mostly rods>cones presents with night blindness, loss of central and peripheral vision
70
what conditions are associated with retinitis pigmentosa?
Ushers, Basser Kornzweig, Refsums
71
how is retinitis pigmentosa investigated?
pigmentation, arteriole narrowing and pale optic disc on fundoscopy
72
how is retinitis pigmentosa managed?
refer, genetic counselling, vision aids, sunglasses, inform DVLA, f/u regularly, vitamin and antioxidants, PO acetazolamide, TOP dorzolamide, steroid injections
73
what is retinal vein occlusion?
a thrombus forms in the retinal veins - one of the four small or central results in pooling of blood, fluid leak, macular oedema and retinal haemorrhage, lost vision and release of VEGF - neovascularisation sudden painless loss of vision
74
what are risk factors for retinal vein occlusion?
hypercholesterolaemia, DM, smoking, glaucoma, SLE
75
how is retinal vein occlusion investigated and managed?
fundoscopy - flame and blot haemorrhages, optic disc oedema, macular oedema FBC - check leukaemia, ESR, BP, glucose mx - refer - laser photocoagulation, intravitreal steroids, antiVEGF
76
what happens in retinal detachment?
flow of blood is blocked from vessels of choroid body to retina - sight threatening retinal separation from choroid due to retinal tear allowing vitreous fluid to get under retina and fill space between retina and choroid
77
how does retinal detachment present?
peripheral visual loss, blurred or distorted vision, flashes, floaters
78
how it retinal detachment managed?
tears - laser or cryotherapy detachment - vitrectomy, scleral bulking, pneumatic retinopexy
79
what is central retinal artery occlusion?
when the flow of central retinal artery is blocked usually due to atherosclerosis or GCA
80
what are risk factors for central retinal artery occlusion?
increasing age, FHx, smoking, DM, HTN, alcohol, poor diet, inactivity, obesity, female>50, GCA, PMR
81
what is the presentation of central retinal artery occlusion?
sudden, painless loss of vision, RAPD, pale retina, cherry red spot
82
how is central retinal artery occlusion managed?
refer GCA - ESR and TA biopsy, high dose steroids ocular massage, remove fluid from anterior chamber to reduce IOP inhaled carbogen sublingual isosorbide dinitrate prevent and treat RFs and secondary prevention of CVD

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