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Its the final countdown > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

presentation of acute glaucoma

A

unwell w/ short history
- severely painful red eye
- blurred vision
- halo around lights
- associated headache, nausea, vom

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2
Q

presentation of acute glaucoma in examination

A
  • Red-eye
  • Teary
  • Hazy cornea
  • Decreased visual acuity
  • Dilatation of the affected pupil
  • Fixed pupil size
  • Firm eyeball on palpation
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3
Q

Ix for primary angle closure glaucoma

A

measuring intraocular pressure
ophthalmological exam

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4
Q

presentation of cute glaucoma

A

62 yo woman with a one day hx of pain around her right eye. She feels nauseated and has vomited once. On examination her right eye is red

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5
Q

open angle glaucoma develops insidiously, how does it first present

A

peripheral field loss –> tunnel vision

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6
Q

what eye conditions present with pain

A

anterior uveitis (acute painful red eye w/ photophobia & reduced visual acuity)

bacterial/viral conjunctivitis (sore red eye w purulent/ serous discharge)

scleritis (subacute red eye, w. pain, exacerbated by eye movement)

orbital cellulitis ( ocular pain & pain on mvmt w/ redness & swelling around eye )

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7
Q

what differentiates scleritis from episcleritis

A

episcleritis - painless ( has p in it)

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8
Q

what group of people are most commonly affected by episcleritis

A

young, middle-aged adults
with inflammatory coinditions ( RA, IBD)

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9
Q

presentation of episcleritis

A

segmental redness (a patch, not diffuse)
non painful( or mild) w/ foreign body sensation
dilated vessels
watery eye
no discharge

cause: not typically infective

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10
Q

Mx episcleritis

A

self-limiting ( recovers 1-4wks)

mild- no tx necessary
Symptomatic:
- lubricating eye drops
- simple analgesia
- scold compress

more severe
- systemic NSAID
- topical steroid eye drops

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11
Q

presentation of scleritis

A

like episcleritis, but: redness is diffuse (not segmental) eye mvmt painful, photophobia

  • Severe pain
  • Pain with eye movement
  • Photophobia
  • Eye watering
  • Reduced visual acuity
  • Abnormal pupil reaction to light
  • Tenderness to palpation of the eye
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12
Q

what is necrotising scleritis

A

most severe type of scleritis
presents: visual impairment , painless

complication: sclera perforation

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13
Q

what conditions are associated with scleritis

A

RA*, SLE, IBD, Sarcoidosis, Granulomatosis with polyangiitis

*RA is most commonly associated

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14
Q

Mx scleritis

A

secondary care - same day assessment
1st line NSAIDs ( topical/systemic)
2nd line steroids (oral glucocorticouids -topical/systemic)
immunosuppression according to underlying condition

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15
Q

what investigation is used to dx wet age-related macular degeneration

A

fluorescein angiography - used to capture images of bloodflow in retina & choroid. macular neovascularisation = wet AMD

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16
Q

most common cause of blindness ( UK )

A

age-related macular degeneration

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17
Q

what are the types of age-related macular degeneration

A

dry (90%) - better prognosis
wet (10%) - worse prognosis

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18
Q

what are the 4 layers of the macular

A

photoreceptors ( top most)
retinal pigment epithelium
bruchs membrane
choroid ( contains blood supply) - bottom layer

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19
Q

drusen are found in what condition

A

age-related macular degeneration

drusen - yellow (protein& lipid) deposits between retinal pigment epithelium & Bruch’s membrane

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19
Q

features of normal drusen

A
  • small (< 63 micrometres)
  • hard.

Larger & greater numbers of drusen - early sign of macular degeneration.

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20
Q

3 features in both wet & dry AMD

A

drusen ( large, more than normal)
atrophy of retinal pigment epithelium (2nd layer of macular)
degeneration of photoreceptors ( 1st layer of macular)

gradual reduction in vision- blindness

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21
Q

what differentiates wet AMD from dry

A

wet
- new vessels grow from choroid into retinna –> leak fluid/blood –> oedema —> more rapid vision loss

in both
- drusen
- atrophy of retinal pigment epithelium
- degeneration photoreceptors

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22
Q

what protein is associated with neovascularisation into the retina in wet AMD

A

VEGF - vascular endothelial growth factor

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23
Q

risk factors of macular degeneration

Study These Flashcards
A

age
white/ chinese

FHx
smoking
CVD

24
key features in presentation of AMD
gradual worsening CENTRAL visual field loss ( peripheral - open-angle glaucoma) reduced visual acuity lines appear crooked/wavy wet - more acute presentation - loss of vision over days --> full loss in 2--3 yrs - progresses to bilateral disease
25
findings on examination in AMD
* Reduced acuity -Snellen chart * Scotoma (central patch of vision loss) * Amsler grid test - distortion of straight lines * Fundoscopy - Drusen
26
Ix used in AMD - Dx - initial Ix for wet MD - second line Ix for wet MD
Dx: slit-lamp biomicroscopic fundus exam wet -1st line: optical coherence tomography ( cross-sectional view of retina layers) - 2nd line: blood supply & oedema in retina)
27
Mx in AMD - general - dry - wet
general - ophtho referral dry: avoid smoking, BP control, Vit supplements wetL anti-VEF meds (ranibizumab, bevacizumab, pegaptanib )
28
what artery does the central retinal artery branch off?
ophtalmic artery internal carotid --> ophthalmic --> central retinal
29
causes of central arterial occlusion (x2)
atherosclerosis ( most common) GCA - vasculitis of ophthalmic/ central retinal
30
risk factors for central renal aerterial occlusion
risk factors from atherosclerosis, and GCA
31
presentation of central retinal arterial occlusion
sudden painless vision loss afferent pupillary defect (more constriction in affected pupil when light is shone in it
32
appearance of central retinal arterial occlusion
Ix - fundoscopy appearance - pale retina/ retinal opacification ( lack of perfusion) - cherry -red spot ( macula) - thinner surface shows red coloured choroid
33
Mx in central retinal artery occlusion
immediate optho referral - GCA suspected, test ( ESR & temporal artery biopsy) & tx ( 60mg pred) - thrombus: o Ocular massage o Removing fluid from the anterior chamber (reduce intraocular pressure.) o Inhaling carbogen (a mixture of 5% CO2 & 95% O2) to dilate the artery o Sublingual isosorbide dinitrate (dilate the artery) long term - Mx reversible risk factors
34
cause of central retinal vein occlusion
thrombus thrombus --> no drainage --> blood pooling in retina --> leakage of fluid & blood --> macular oedema & retinal haemorrhages --> damaged tissue --> vision loss
35
presentation of central retinal vein occlusion
sudden painless loss of vision
36
risk factors for central retinal vein occlusion
thrombus risk factors glaucoma systemic inflammatory conditions e.g. SLE
37
Appearance of central retinal vein occlusion on funduscopy
flame & blot haemorrhages optic disc oedema macula oedema
38
Mx central retinal vein occlusion
laser photocoagulation intravitreal steroids (dex) anti-VEGF - ranibizumab aflibercept, bevacizumab
39
cause of orbital cellulitis
URTI (from sinuses) preseptal ( periorbital ) cellulitis which progressed to orbital celllulitis
40
how does cataracts affect vision
reduces vision blurs vision
41
a pt presents with worsening redness and swelling around her right eye for the past 2 days. On examination of the child, there is tenderness and erythema over the right eyelid and during the assessment of her eye movements, she complains of pain and 'seeing double'. Her temperature is 38°C is this preseptal cellulitis or orbital cellulitis
orbital as - reduced visual acuity (diplopia) -proptosis - pain w/ eye movement painful eye movements and visual disturbance ('seeing double' referring to diplopia) in the context of a red, swollen, tender eye is concerning for orbital cellulitis
42
Mx orbital cellulitis
IV cefotaxime / clindamycin
43
Mx presptal cellulitis
oral co-amox
44
risk factors for orbitak cellulitis (5)
Childhood (7-12 years) Hx sinus infection No Hib vaccination Recent eyelid infection/ insect bite on eyelid (periorbital cellulitis) Ear or facial infection
45
how does orbital cellulitis present
Redness and swelling around the eye Severe ocular pain Visual disturbance Proptosis Ophthalmoplegia/pain with eye movements Eyelid oedema and ptosis
46
most common bacterial causes of orbital cellulitis ( 3)
Streptococcus Staph. aureus HiB.
47
give one potential complication fof preseptal cellulitis
devloping into orbital cellulitis so Adx for observation in severe cases/ vulnerable pts (e.g. children)
48
most common causative organisms of preseptal cellulitis
Staph. aureus, Staph. epidermidis, streptococci and anaerobic bacteria.
49
presentation of preseptal cellulitis
* Erythema and oedema of the eyelids, which can spread onto the surrounding skin * Partial or complete ptosis of the eye (swelling) * Orbital signs (pain on movement of the eye, restriction of eye movements, proptosis, visual disturbance, chemosis, RAPD) - ABSENT
50
light and accommodation reflex findings in Horners syndrome
not affected
51
the location of Horners syndrome can be determined by the anhidrosis. what is the presentation of anhidrosis in - central lesions (spinal cord ) - preganglionic lesions ( chest) - Postganglionic lesions ( base of neck)
central lesions (e.g. stroke) - anhidrosis of arm, trunk & face Pre-ganglionic (e.g. pancoast's tumour) - anhidrosis of face) post-ganglionic (e.g. carotid artery dissection) - no anhidrosis
52
causes of central ( x4), pre-ganglionic (x4) and post-ganglionic (x4) Horners
4Ss (Sentral) , 4Ts (Torso - pre-), 4Cs (Cervical post-) Sentral ( anhidrosis face, arm, trunk) S-Stroke, S- multiple Sclerosis S- Swelling ( tumour) S- syringomyelia (cyst in spinal cord) Torso ( anhidrosis of face) T- tumour (panoast's tumour) T-Trauma T-Thyroidectomy T - Top rib ( cervical rib growing above clavicle) Post-ganglionic lesion ( 4Cs) C- Carotid aneurysm C - Carotid artery dissection C - Cavernous sinus thrombosis C - Cluster headache
53
what eye finding is associated with congenital Horner syndrome
heterochromia
54
what eye drops can be used to test for Horners
Cocaine eye drops - cocaine stops noradrenaline re-uptake in NMJ - so in normal eye: dilate - Horners: no noradrenal being released anyway, so no pupillary change Low conc adrenalin eye drop (0.1%) - Normal pupil: won't dilate - Horner syndrome: pupil dilates
55
apart from miosis, ptosis, anhidrosis, hat other finding is associated with horners
enophthalmos* (sunken eye)
56
mx in diabetic retinopathy
laser photocoagulation anti-VEGF meds ( ranibizumab, bevacizumab) Vitreoretinal surgery
57
unilateral eye pain, photophobia and ciliary congestion suggest which condition?
anterior uveitis Red eye - glaucoma or uveitis? glaucoma: severe pain, haloes, 'semi-dilated' pupil uveitis: small, fixed oval pupil, ciliary flush
58

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