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Phase 3A Revision > Ophthalmology > Flashcards

Ophthalmology Flashcards

(88 cards)

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1
Q

What are the causes of a painful acute red eye?

A

Acute angle-closure glaucoma
Anterior uveitis
Scleritis
Corneal abrasion/ulceration
Keratitis
Foreign body
Traumatic/chemical injury

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2
Q

What are the causes of a painless acute red eye?

A

Conjunctivitis
Episcleritis
Subconjunctival haemorrhage

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3
Q

What is glaucoma?

A

Damage to the optic nerve due to raised intraocular pressure due to a blockage as aqueous humour tries to escape the eye

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4
Q

What are the anterior and posterior borders of the anterior chamber of the eye?

A

Cornea anteriorly
Iris posteriorly

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5
Q

What are the anterior and posterior borders of the posterior chamber of the eye?

A

Iris anteriorly
Lens posteriorly

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6
Q

What is the normal physiological route of aqueous humour?

A

Produced by ciliary body
Supplies the cornea with nutrients
Flows through the posterior chamber and iris into the anterior chamber
Drains through the trabecular meshwork into the canal of Schlemm
Enters the general circulation

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7
Q

What is normal intraocular pressure?

A

10-21 mmHg

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8
Q

How does open-angle glaucoma happen?

A

Gradual increase in resistance to flow through the trabecular meshwork
Pressure slowly builds in the eye

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9
Q

What can be seen on fundoscopy in open-angle glaucoma?

A

Increased cupping of the optic disc (cup-disc ratio of greater than 0.5)

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10
Q

What are risk factors for open-angle glaucoma?

A

Increasing age
Family history
Black ethnic origin
Myopia (nearsightedness)

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11
Q

How does open-angle glaucoma present?

A

May be asymptomatic for a long time before diagnosis on routine eye test
Affects peripheral vision first, causing tunnelling
Fluctuating pain
Headaches
Blurred vision
Halos around lights, particularly at night

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12
Q

What is the first-line medical management for open-angle glaucoma?

A

Prostaglandin analogue eye drops (e.g., latanoprost) –> Increase uveoscleral outflow

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13
Q

What other medications can be used to treat open-angle glaucoma?

A

Beta-blockers (e.g., timolol) –> reduce production of aqueous humour
Carbonic anhydrase inhibitors (e.g., dorzolamide) –> reduce production of aqueous humour
Sympathomimetics (e.g., brimonidine) –> reduce production of humour and increase uveoscleral outflow

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14
Q

What is the NICE guidelines’ first line management for all open-angle glaucoma patients requiring treatment?

A

360° selective laser trabeculoplasty

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15
Q

What is the intraocular pressure treatment threshold in open angle glaucoma?

A

24mmHg

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16
Q

What is the pathophysiology of acute angle-closure glaucoma?

A

Increased pressure causes iris to bulge forward, closing the trabecular meshwork
This causes pressure to continue to build, further worsening the angle closure

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17
Q

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

A

Increasing age
Family history
Female
Chinese and east Asian ethnic origin
Shallow anterior chamber
Medication e.g., noradrenaline, anticholinergics, tricyclic antidepressants

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18
Q

How does acute angle-closure glaucoma present to the patient?

A

Severely painful red eye
Blurred vision
Halos around light
Associated headaches, nausea and vomiting

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19
Q

What are the signs of acute angle-closure glaucoma?

A

Red eye
Hazy cornea
Decreased visual acuity
Mid-dilated, fixed size pupil
Hard eyeball on palpation

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20
Q

What is the initial management of acute angle-closure glaucoma?

A

Immediate blue light admission
Lie patient on their back
Pilocarpine eye drops (2% for blue, 4% for brown)
Acetazolamide 500mg
Analgesia and antiemetic if required

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21
Q

How is acute angle-closure glaucoma managed in secondary care?

A

Pilocarpine eye drops
Acetazolamide
Hyperosmotic agents (e.g., IV mannitol) –> increase the osmotic gradient between blood and eye, aiming to draw fluid out of the eye
Timolol –> reduce humour production
Carbonic anhydrase inhibitors (e.g., dorzolamide) –> reduce production of aqueous humour
Sympathomimetics (e.g., brimonidine) –> reduce production of humour and increase uveoscleral outflow

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22
Q

What is the definitive management of acute angle-closure glaucoma?

A

Laser iridotomy –> hole is made in the iris to allow aqueous humour to move from the posterior to anterior chamber, relieving the pressure

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23
Q

What is blepharitis?

A

Inflammation of the eyelid margins

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24
Q

What is the presentation of blepharitis?

A

Gritty, dry sensation of the eyes

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25
What is the management of blepharitis?
Warm compression and gentle cleaning
26
What is a stye?
Infection of the glands in the eyelids
27
What is the management of a stye?
Hot compression and analgesia Topical antibiotics (e.g., chloramphenicol if symptoms present or conjunctivitis
28
What is a chalazion?
Blockage of the meibomian gland
29
What is an entropion?
When the eyelid turns inwards and lashes are against the eye
30
What is an ectropion?
When the eyelid turns outwards, exposing the inner aspect
31
What is trichiasis?
Inwards growth of eyelashes
32
What is periorbital cellulitis?
Eyelid infection anterior to orbital septum
33
How does periorbital cellulitis present?
Swollen, red, hot skin around eyelid and eye
34
What is the management of periorbital cellulitis?
Systemic antibiotics Monitor progression to orbital cellulitis (medical emergency)
35
What is orbital cellulitis?
Eyelid infection posterior to orbital septum Medical emergency
36
How does orbital cellulitis present?
Painful and reduced eye movement Vision changes Abnormal pupil reactions Bulging of the eyeball
37
What is the management of orbital cellulitis?
Emergency admission IV antibiotics Surgical drainage if abscess forms
38
What are cataracts?
Progressive increasing of opaqueness of the lens, reducing the light entering the eye and reducing visual acuity
39
How are congenital cataracts screened for?
Red reflex test
40
What are risk factors for cataracts?
Increasing age Smoking Alcohol Diabetes Steroids Hypocalcaemia
41
How do cataracts present?
Slow reduction in visual acuity Usually asymmetrical Progressive vision blurring Fading of colour vision Starbursts around light
42
How are cataracts managed?
No intervention necessary if symptoms are manageable Cataract surgery
43
What is a rare but serious complication of cataract surgery?
Endophthalmitis = Inflammation of the inner contents of the eye Managed with intravitreal antibiotics
44
Where does the central retinal artery branch from?
Ophthalmic artery, which branches from the internal carotid artery
45
What are causes of central retinal arterial occlusion?
Atherosclerosis Giant cell arteritis
46
What are risk factors for central retinal arterial occlusion?
(From atherosclerosis) Smoking Hypertension Diabetes Hypercholesterolaemia (From GCA) White ethnicity Older age Female Polymyalgia rheumatica
47
How does central retinal arterial occlusion present?
Sudden painless loss of vision ("curtain coming down")
48
What are the differentials of sudden painless vision loss?
Retinal detachment Central retinal arterial occlusion Central retinal vein occlusion Vitreous haemorrhage Amaurosis fugax
49
What are the signs of central retinal arterial occlusion?
Relative afferent pupillary defect (pupil in affected eye constricts more when light is shone in the other eye than when light is shone in the affected eye) Pale retina with cherry red spot on fundoscopy
50
What is the management of central retinal arterial occlusion?
Immediate referral High-dose prednisolone if suspected due to GCA
51
What are the causes of conjunctivitis?
Bacterial --> Staphylococcus, strep pneumoniae, haemophilus influenzae Viral --> Adenovirus, HSV, VZV Allergic
52
How does conjunctivitis present?
Red, bloodshot eye Itchy or gritty sensation Discharge --> purulent if bacterial, clear if viral
53
What symptoms suggest that a red eye is NOT conjunctivitis?
Pain Photophobia Reduced visual acuity
54
What is the management of conjunctivitis?
Usually resolves in 1-2 weeks without treatment Hygiene measures to prevent spreading as it is highly contagious Clean the eye with cooled boiled water and cotton wool Chloramphenicol or fusidic acid eye drops if indicated in bacterial cause
55
How can diabetes cause retinopathy?
Hyperglycaemia damages the retinal small vessels and endothelial cells Increased vascular permeability causes leaking blood vessels and hard exudates Damage to vessel walls causes microaneurysms and venous beading Damage to nerve fibres forms cotton wool spots to form on the retina Intraretinal dilated and tortuous capillaries form, acting as a shunt between arterial and venous vessels The release of growth factors stimulates neovascularisation
56
What are the complications of diabetic eye disease?
Vision loss Retinal detachment Vitreous haemorrhage Rubeosis iridis --> new blood vessels form in the iris, causing neovascular glaucoma Optic neuropathy Cataracts
57
What features on fundoscopy suggest background diabetic eye disease?
Microaneurysms Retinal haemorrhage Hard exudates Cotton wool spots
58
What features on fundoscopy suggest pre-proliferative diabetic eye disease?
Venous beading Multiple blot haemorrhages Intraretinal microvascular abnormality
59
What features on fundoscopy suggest proliferative diabetic eye disease?
Neovascularisation Vitreous haemorrhage
60
What is the management of non-proliferative diabetic eye disease?
Close monitoring Careful diabetic control
61
What is the management of proliferative diabetic eye disease?
Pan-retinal photocoagulation (laser treatment to suppress new vessels) Intravitreal anti-VEGF medication Surgery e.g., vitrectomy
62
What are some complications of pan-retinal photocoagulation?
Reduction in visual fields Decrease in night vision General decrease in visual acuity Macular oedema
63
What is infective keratitis?
Inflammation of the cornea
64
What are the causes of infective keratitis?
Viral --> herpes simplex Bacterial --> pseudomonas, staphylococcus Fungal --> candida, aspergillus Contact lens induced red eye (CLARE) Exposure --> e.g., with ectropion
65
What is the most common cause of infective keratitis?
Herpes simplex virus
66
How does infective keratitis present?
Primary --> Mild inflammation of the eyelid margins and conjunctiva Recurrent --> Painful red eye, photophobia, vesicles, foreign body sensation, watery discharge, reduced visual acuity
67
What is the management of infective keratitis?
Referral for urgent assessment Topical or oral antivirals --> aciclovir or ganciclovir Corneal transplant to treat permanent scarring and vision loss
68
What are the 2 subtypes of macular degeneration?
Wet/neovascular --> 10% Dry/non-neovascular --> 90%
69
What are the risk factors for macular degeneration?
Older age Smoking Family history Cardiovascular disease Obesity Poor diet
70
How does macular degeneration present?
Unilateral, gradual loss of central vision Reduced visual acuity Crooked or wavy appearance of straight lines
71
What is the management of macular degeneration?
Dry --> No treatment, manage risk factors Wet --> Anti-vascular endothelial growth factor medication intravitreally
72
What is the pathophysiology of retinal detachment?
Retinal tear allows vitreous fluid to get under the neurosensory retina and separate it from the retinal pigment epithelium and choroid The neurosensory retina relies on the choroid for blood supply, so detachment disrupts the blood supply
73
What are the risk factors for retinal detachment?
Lattice degeneration (retinal thinning) Posterior vitreous detachment Trauma Diabetic retinopathy Retinal malignancy Family history
74
How does retinal detachment present?
Painless Peripheral vision loss Blurred or distorted vision Flashes/floaters
75
What is the management of retinal detachment?
Immediate referral Retinal tears --> Aim to re-adhere the retina and choroid with cryotherapy or laser therapy Retinal detachment --> Reattach the retina and reduce any pressure that could cause it to re-detach
76
What is scleritis?
Inflammation of the sclera (the connective tissue that surrounds the eye)
77
What are the causes of scleritis?
Idiopathic Associated with underlying systemic inflammatory cause e.g., rheumatoid arthritis and vasculitis (granulomatosis with polyangiitis) Infection --> pseudomonas or staph aureus
78
How does scleritis present?
Gradual onset Red inflamed sclera Severe pain, including with eye movement Photophobia Excessive tear production Reduced visual acuity
79
What is the management of scleritis?
Urgent referral Screen for underlying systemic inflammatory cause NSAIDs Steroids Immunosuppression Antimicrobials if infective
80
What is episcleritis?
Benign, self-limiting inflammation of the episclera (the outermost layer of the sclera just below the conjunctiva)
81
What is episcleritis often associated with?
Inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease
82
How does episcleritis present?
Acute onset and unilateral Redness No pain Dilated episcleral blood vessels No photophobia Normal visual acuity
83
How can episcleritis be distinguished from scleritis?
Episcleritis does not cause pain, photophobia or reduced visual acuity Phenylephrine drops blanch the episcleral vessels but do not affect scleral vessels
84
What is the management of episcleritis?
Self limiting and will resolve in 1-2 weeks Severe cases may require steroid drops
85
What is anterior uveitis?
Inflammation of the iris, ciliary body and choroid
86
What conditions are associated with anterior uveitis?
Seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis, reactive arthritis)
87
How does anterior uveitis present?
Painful red eye (redness that spreads from the iris) Reduced visual acuity Photophobia Excessive lacrimation
88
What is the management of anterior uveitis?
Urgent assessment Steroids Cycloplegics (e.g., cyclopentolate or atropine eye drops) --> dilate the pupil and reduce ciliary spasm Recurrent cases may required DMARDs or anti-TNF medications

Phase 3A Revision (23 decks)

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