Ophthalmology Flashcards by Hania Azraa

What is diabetic retinopathy?

A condition where the blood vessels in the retina are damaged by prolonged exposure to high blood sugar levels causing a progressive deterioration in the health of the retina

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Pathophysiology of diabetic retinopathy

Hyperglycaemia leads to damage of the retinal small vessels and endothelial cells. Increased vascular permeability leaks to leakage from blood vessels, blot haemorrhages and formation of hard exudates.

Damage to blood vessels causes microaneurysms and venous bleeding.

Damage to nerve fibres cause fluffy white patched to form on the retina called cotton wool spots

Neovascularisation is the growth of new vessels

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Types of diabetic retinopathy

Non-proliferative and Proliferative - depends on whether new blood vessels developed. Non-proliferative can develop into proliferative.

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Complications of diabetic retinopathy

Retinal detachement
Vitreous haemorrhage
Rebeosis Iridis (new blood vessels formation in the iris)
Optic neuropathy
Cataracts

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Complications of diabetic retinopathy

Retinal detachement
Vitreous haemorrhage
Rebeosis Iridis (new blood vessels formation in the iris)
Optic neuropathy
Cataracts

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Management of diabetic retinopathy

Laser photocoagulation
Anti-VEGF e.g. ranibizumab
Vitreoretinal surgery - keyhole surgery in severe disease

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What is laser photocoagulation?

A procedure whereby light energy is applied to the retina with the aim of stopping the growth and development of new blood vessels, and thereby preserving vision.

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Causes of hypertensive retinopathy

Chronic hypertension or can develop quickly in response to malignant hypertension

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What are signs of hypertensive retinopathy?

Silver wiring or copper wiring - where the walls of the arterioles become thickened and sclerosed causing increased reflection of the light

Ateriovenous nipping - where the arterioles cause compression of the veins where they cross

Cotton wool spots - caused by ischaemia and infarction in the retina causing damage to nerve fibres

Hard exudates - caused by damage to vessels leaking lipids into the retina

Retinal haemorrhages - caused by damage to vessels rupturing and releasing blood into the retina

Papilloedema - caused by ischaemia to the option nerve resulting in optic nerve swelling and blurring of the disc margins

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Classification of hypertensive retinopathy

Stages 1: Mild narrowing of the artioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema

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Management of hypertensive retinopathy

Management is focused on controlling blood pressure and other risk factors such as smoking and blood lipid levels

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What is cataracts?

Where the lens in the eye becomes cloudy and opaque.

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Types of cataracts

Age related
Congenital cataracts

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Risk factors for cataracts

Increasing age
Smoking
Alcohol
Diabetes
Steroids
Hypocalcaemia

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Presentation of cataracts

Symptoms are usually asymmetrical as both eyes are affected separately. Presents with:

Very slow reduction in vision
Progressive blurring of vision
Change of colour of vision with colours becoming more brown or yellow
Loss of the red reflex

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Management of cataracts

If the symptoms are manageable then no intervention may be necessary

Cataracts surgery

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Complications of cataracts surgery

Endophthalmitis - inflammation of the vitreous or aqueous humour. Treated with intravitreal Abx which can lead to loss of vision and loss of the eye itself

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What causes the pupils to constrict and what part of the nervous system is responsible for this happening?

Circular muscles in the iris - parasympathetic nervous system

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What causes the pupils to dilate and what part of the nervous system is responsible for this happening?

Dilator muscles - sympathetic nervous system

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Causes of abnormal pupil shape

Trauma to sphincter muscles
Anterior uveitis - can cause adhesions in the iris to make pupils misshapen
Acute angle closure glaucoma - can cause ischaemic damage to the sphincter muscles
Rubeosis iris (neovascularisation in the iris) can distort the shape of the iris and pupil. Usually associated with diabetes and diabetic retinopathy

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Causes of Mydriasis

Third nerve palsy
Raised intracranial pressure
Congenital
Trauma
Cocaine
Anticholinergics

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Causes of miosis

Horner’s syndrome
Opiates
Nicotine

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Third nerve palsy signs

Ptosis
Dilated non-reactive pupil
Divergent strabismus - eye is down and out position

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What is the third cranial nerve?

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Oculomotor nerve

What does the oculomotor nerve supply

All the extra ocular muscles except for the lateral rectus and superior oblique. It also supplied the superior levator muscle

Causes of third nerve palsy

Idiopathy Diabetes HTN Ischaemia Tumour Raised intracranial pressure

Horner's syndrome triad

Ptosis Miosis Anhidrosis

What causes Horner's syndrome

Damage to the sympathetic nervous system supplying the face

How to determine the location of Horner's syndrome (damage to the sympathetic nervous system)?

Can be determined by the anhidrosis. Central lesions cause anhidrosis of the arms and trunk and face. Pre-ganglionic lesions cause anhidrosis of the face And post-ganglionic does not cause anhidrosis

Causes of central lesions causing Horner's syndrome

4Ss Stroke MS Swelling (Tumours) Syringomyelia

Causes of pre-ganglionic lesions causing Horner's syndrome

4Ts Tumour (Pancoats) Trauma Thyroidectomy Top rib

Causes of post-ganglionic lesions causing Horner's syndrome

4Cs Carotid aneurysm Carotid artery dissection Cavernous sinus thrombosis Cluster headache

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Blepharitis

What is blepharitis?

Inflammation of the eyelid margins which causes gritty, itchy, dry sensation in the eye and is associated with dysfunction of the melbomian glands which secretes oil onto the surface of the eye. It can lead to styes and chalazions.

Management of blepharitis

Hypromellose Polyvinyl alcohol Carbomer

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Stye

What is a stye?

Infection of the glands of Zeis or glands of Moll

Treatment of styes

Hot compression and analgesia. Consider Abx if associated with conjunctivitis or persistent

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Chalazion

What is a Chalazion?

Occurs when a Meibomian gland becomes blocked and swells up. Presents with swelling in the eyelid that is not typically tender. Treatment is hot compress and analgesia Consider Abx if acutely inflamed

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Entropion

What is an entropion?

When the eyelid turns inwards with the lashes against the eyeball. This results in pain and corneal damage and ulceration.

What is the management of entropion?

Taping the eyelid down to prevent it turning inward. Definitive management is with surgical intervention. Same day referral to ophthalmology required if there is a risk to sight

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Ectropion

What is an ectropion?

When the eyelid turns outwards in the inner aspect of the eyelid exposed it usually affects the bottom lid. Mild cases may not require treatment. Regular lubricating eye drops are used to protect the surface of the eye. More significant cases may require surgery to correct the defect.

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Periorbital cellulitis

What is periorbital cellulitis?

Infection of the eyelid and skin in front of the orbital septum. Presents with swelling, redness and hot skin around the eyelids and eye

Treatment of periorbital cellulitis

Systemic antibiotics. Periorbital cellulitis can develop into orbital cellulitis so vulnerable patients may require admission for observation

What is orbital cellulitis?

Infection of the eyeball that involves tissues behind the orbital septum.

How to differentiate between periorbital and orbital cellulitis?

Key features that differentiate this from periorbital cellulitis is pain on eye movement, reduced eye movements, changes in vision, abnormal pupil reactions and forward movement of the eyeball.

Management of orbital cellulitis

Medical emergency and requires admission and IV antibiotics May require surgical drainage if abscess forms.

Types of conjunctivitis

Bacterial Viral Allergic

Presentation of conjunctivitis

Unilateral or bilateral Red eyes Bloodshot Itchy or gritty sensation Discharge from the eye

Differential diagnosis of painless red eye

Conjunctivitis Episcleritis Subconjunctival haemorrhage

Differentials of painful red eye

Glaucoma Anterior uveitis Scleritis Corneal abrasions or ulceration Keratitis Foreign body

Management of conjunctivitis

Usually resolves without treatment after 1-2 weeks Bacterial conjunctivitis - often better without treatment but Chloramphenicol can be used

What is anterior uveitis?

Inflammation in the anterior part of the uvea.

Association of acute anterior uveitis

Ankylosing spondylitis IBD Reactive arthritis

Association of chronic anterior uveitis

Sarcoidosis Syphilis Lyme disease TB Herpes virus

Ophthalmology Flashcards

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