Ophthalmology Flashcards
(162 cards)
1
Q
what is affected in Holmes-Adie pupil?
A
the ciliary ganglion
can be because of infection
2
Q
is the pupil constricted or dilated in Holmes-Adie?
A
dilated
3
Q
causes of dilated pupil [5]
A
Holmes-Adie
Oculomotor nerve palsy
Cocaine, Amphetamines
atropine, tropicamide
Phaeochromocytoma
4
Q
does Horner’s cause a constricted or dilated pupil?
A
constricted
[when you are horny, you aim for the constricted hole]
5
Q
features of optic neuritis [5]
A
- unilateral decrease in visual acuity over hours or days
- poor discrimination of colours, ‘red desaturation’
- pain worse on eye movement
- relative afferent pupillary defect
- central scotoma
or CRAP
- central scotoma
- RAPD
- acuity loss
- painful eye movement
6
Q
investigation for optic neuritis
A
MRI of the brain and orbits with gadolinium contrast
7
Q
features of mild non proliferative diabetic retinopathy
A
1 or more microaneurysm
8
Q
features of moderate non proliferative diabetic retinopathy [5]
A
- microaneurysms
- blot haemorrhages
- hard exudates
- cotton wool spots (‘soft exudates’ - represent areas of retinal infarction), - venous beading/looping
- intraretinal microvascular abnormalities (IRMA) less severe than in severe NPDR
9
Q
features of severe non proliferative diabetic retinopathy
A
- blot haemorrhages and microaneurysms in 4 quadrants
- venous beading in at least 2 quadrants
- IRMA in at least 1 quadrant
10
Q
features of proliferative diabetic retinopathy [3]
A
- retinal neovascularisation - may lead to vitrous haemorrhage
- fibrous tissue forming anterior to retinal disc
- more common in Type I DM, 50% blind in 5 years
11
Q
treatment of maculopathy
A
VEGF inhibitors
12
Q
treatment of proliferative diabetic retinopathy [3]
A
- panretinal laser photocoagulation
- VEGF inhibitors
- vitreoretinal surgery
13
Q
complications of retinal photocoagulation [4]
A
- MAIN: decreased night vision (reduced rods in the periphery)
- macular oedema
- visual field reduction
- decreased visual acuity
14
Q
causes of anhidrosis of face, arms and trunk [5]
where is the lesion?
A
central lesions
Stroke
Syringomyelia
Multiple sclerosis
Tumour
Encephalitis
15
Q
causes of anhidrosis of the face [4]three Ts
where is the lesion?
A
preganglionic lesions
Pancoast’s tumour
Thyroidectomy
Trauma
Cervical rib
16
Q
causes of postganglionic lesions that don’t cause anhidrosis [4C]
A
Carotid artery dissection
Carotid aneurysm
Cavernous sinus thrombosis
Cluster headache
17
Q
Differentiating orbital from preseptal cellulitis [3]
A
- reduced visual acuity
- proptosis
- ophthalmoplegia/pain with eye movements
are NOT consistent with preseptal cellulitis
18
Q
Main imaging for orbital cellulitis
A
CT with contrast of orbits, sinuses, brain
19
Q
complications of orbital cellulitis [2]
A
cavernous sinus thrombosis and intracranial spread and abscess
20
Q
what structures are affected in orbital cellulitis
A
result of an infection affecting the fat and muscles posterior to the orbital septum, within the orbit but not involving the globe.
21
Q
features of vitreous haemorrhage [3]
A
- PAINLESS visual loss or haze (commonest)
- red hue in the vision
- floaters or shadows/dark spots in the vision
22
Q
patient risk factors in vitreous haemorrhage [3]
A
- proliferative diabetic retinopathy (over 50%)
- posterior vitreous detachment
- ocular trauma: the most common cause in children and young adults
23
Q
cause of sudden vision loss in diabetics
A
vitreous haemorrhage
24
Q
how is a squint (strabismus) detected
A
corneal light reflection test
25
how is a squint in a child managed
referral to ophthalmologist
26
what condition is treated with an eye patch
amblyopia (lazy eye)
27
key feature on fundoscopy of central retinal artery occlusion [3]
* cherry red spot at fovea
* atheromatous plaques
* globally pale retina
28
differential for sudden painless loss of vision [6] NEEDS EDIT
CRVO
CRAO
vitreous haemorrhage
retinal detachement
ischaemic optic neuropathy
occipital stroke
ischaemic/vascular (e.g. thrombosis, embolism, temporal arteritis etc). This includes recognised syndromes e.g. occlusion of central retinal vein and occlusion of central retinal artery
vitreous haemorrhage
retinal detachment
retinal migraine
29
how long does amaurosis fugax last
resolves spontaneously in minutes
30
features on fundoscopy in central retinal vein occlusion [6]
ischaemic:
* extensive, severe flame haemorrhages- 'stormy sunset'
* cotton wool spots
* widespread hyperaemia
* tortuous dilated vessels
* retinal oedema
* hard exudates
non-ischaemic
* haemorrhage in all 4 quadrants
31
MoA of prostaglandin analogues e.g. latanoprost in the treatment of glaucoma
increases uveoscleral outflow
32
MoA of beta blockers in the treatment of glaucoma
reduces aqueous production
33
MoA of carbonic anhydrase inhibitors in the treatment of glaucoma
Reduces aqueous production
34
MoA of sympathomimetics e.g brimonidine in the treatment of glaucoma
Reduces aqueous production and increases outflow
35
MoA of miotics e.g. pilocarpine in the treatment of glaucoma
Increases uveoscleral outflow
36
first line treatment for glaucoma with an IOP of ≥ 24 mmHg
360° selective laser trabeculoplasty (SLT
37
2nd line treatment of primary open angle glaucoma
prostaglandin analogues e.g. latanoprost
38
3rd line treatment of primary open angle glaucoma [3]
beta-blocker eye drops
carbonic anhydrase inhibitor eye drops
sympathomimetic eye drops
39
treatment of refractory glaucoma
trabeculectomy
40
example of sympathomimetic
| MoA
brimonidine
alpha2-adrenoceptor agonist
41
example of Prostaglandin analogue
latanoprost
42
example of carbonic anhydrase inhibitor [2]
* Dorzolamide
* Acetozolamide
43
example of miotic
| MoA
pilocarpine
muscarinic agonist
44
which part of the visual field does glaucoma affect most
peripheral
leads to tunnel vision
45
what eyesight is at risk of primary open angle glaucoma
myopia
46
what happens to the optic disc in primary open angle glaucoma [2]
optic disc cupping and pallor
47
what sort of eyesight is at risk of retinal detachment
myopia
48
how should a patient with a new onset of flashers and floaters be managed
referred urgently (<24 hours) to an ophthalmologist for assessment with a slit lamp and indirect ophthalmoscopy for pigment cells and vitreous haemorrhage
49
what does Amsler grid testing show in age related macular degeneration
distortion of line perception
50
compare the reduction of visual acuity in the two types of age related macular degeneration
gradual in dry ARMD, fluctuating quality of vision
subacute in wet ARMD
51
key feature in dry ARMD
drusen (yellow spots under the retinaantioxidant)
52
key feature in wet ARMD
neovascularisation
53
difference in symptoms between scleritis and episcleritis
no pain in episcleritis
54
treatment of acute angle-closure glaucoma [4]
- a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
- a beta-blocker (e.g. timolol, decreases aqueous humour production)
- an alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
- intravenous acetazolamide
55
definitive treatment of acute angle-closure glaucoma
laser peripheral iridotomy
56
causative agent in contact lens keratitis
Pseudomonas
57
causative agent in keratitis
staph aureus
58
amoebic cause of keratitis
acanthamoebic keratitis
increased incidence if eye exposure to soil or contaminated water
59
4 features of keratitis [4]
red eye: pain and erythema
photophobia
foreign body, gritty sensation
hypopyon may be seen
60
management of keratitis [3]
* stop using contact lens until the symptoms have fully resolved
* topical antibiotics: typically quinolones are used first-line
* cycloplegic for pain relief e.g. cyclopentolate
61
Mydriatic drops are a known precipitant of...
acute angle-closure glaucoma
62
cause of flashers and floater [2]
vitreous haemorrhage
vitreous detachment (which often precedes retinal detachment)
63
cause of central scotoma
optic neuritis
64
metabolic cause of cataract
hypocalcaemia
65
what eye sight is at risk of acute angle closure glaucoma
hypermetropia
66
what happens to the cup to disc ration in chronic open angle glaucoma
increased
67
which eye drops put you at risk of corneal ulcer
steroid
68
what is seen on fundoscopy in CRVO
widespread haemorrhages, well demarcated red patches
69
are vein occlusions associated with flashes and floaters
NO
70
triad of Horner's syndrome
miosis (small pupil)
ptosis (right lid lag)
enophthalmos (a sunken eye appearance due to narrowing of the palpebral fissure)
+/- anhydrosis
71
what MSK symptom can a Pancoast tumour present with
shoulder pain
72
bilateral grittiness cause
blepharitis
73
management of blepharitis
- softening of the lid margin using hot compresses twice a day
- 'lid hygiene' - mechanical removal of the debris from lid margins
- cotton wool buds dipped in a mixture of cooled boiled water and baby shampoo is often used
- an alternative is sodium bicarbonate, a teaspoonful in a cup of cooled water that has recently been boiled
- artificial tears may be given for symptom relief in people with dry eyes or an abnormal tear film
74
what is Hutchinson's sign and what is it predictive of
rash on the tip or side of the nose.
Indicates nasociliary involvement and is a strong risk factor for ocular involvement
75
Herpes zoster ophthalmicus complications [3]
ocular: conjunctivitis, keratitis, episcleritis, anterior uveitis
ptosis
post-herpetic neuralgia
76
treatment of HZO
oral antiviral treatment for 7-10 days
ideally started within 72 hours
intravenous antivirals may be given for very severe infection or if the patient is immunocompromised
review by ENT if ocular involvement
77
what is an entropion
in turning of eye lid
78
what is an ectropion
out turning of eye lid
79
adverse effect of prostaglandin analogues [2]
brown iris pigmentation
eye lash elongation
80
which patients should avoid taking sympathomimetics [2]
Avoid if taking MAOI or tricyclic antidepressants
adverse effect includes hyperaemia
81
adverse effects of miotics like pilocarpine [3]
Adverse effects included a constricted pupil, headache and blurred vision
82
Keith-Wagener classification of hypertensive retinopathy: stage 1
Arteriolar narrowing and tortuosity
Increased light reflex - silver wiring
83
Keith-Wagener classification of hypertensive retinopathy: stage 2
Arteriovenous nipping
84
Keith-Wagener classification of hypertensive retinopathy: stage 3 [3]
Cotton-wool exudates
Flame and blot haemorrhages
These may collect around the fovea resulting in a 'macular star'
85
Keith-Wagener classification of hypertensive retinopathy: stage 4
Papilloedema
86
what is seen in Marcus Gunn pupil (RAPD)
the affected and normal eye appears to dilate when light is shone on the affected
87
where is the lesion in RAPD
anterior to optic chiasm i.e. optic nerve or retina
88
what is a Holmes Adie Pupil associated with [2]
most commonly seen in women
reduced lower limb reflexes
89
3 causes of RAPD
optic neuritis
optic atrophy
retinal disease
90
cause of afferent pupil defect
optic nerve lesion
91
cause of efferent pupil defect
3rd nerve palsy
92
causes of fixed and dilated pupil [4]
acute glaucoma
surgical third nerve palsy
iris trauma
mydriatics e.g. tropicamide
93
which pupillary defect has a sluggish accomodation
Holmes Adie
94
which pupillary defect is seen in syphilis and DM
argyll-robertson
95
which ocular muscles are innervated by CNVI and CNIV
SO4
LR6
96
red flag symptoms for red eyes [4]
photophobia
poor vision
fluorescein staining
abnormal pupil
97
treatment of anterior uveitis [2]
urgent review by ophthalmology
prednisolone and cyclopentolate
98
treatment of scleritis
urgent referral <24 hours
oral NSAIDs are typically used first-line
oral glucocorticoids may be used for more severe presentations
immunosuppressive drugs for resistant cases (and also to treat any underlying associated diseases)
99
differential for sudden vision loss [5]
- anterior ischaemic optic neuropathy
- optic neuritis
- vitreous haemorrhage
- retinal detachment
- retinal vessel occlusion
100
what causes anterior ischaemic optic neuropathy
optic nerve damage due to posterior ciliary artery blockage
101
3 features of AION
visual loss
RAPD
visual field defect
102
3 features on fundoscopy in AION
pale
swollen optic disc
peripheral microaneurysm
103
management of optic neuritis
methylprednisolone IV 72 hours
104
investigation of vitreous haemorrhage
B-scan US
105
treatment of large vitreous haemorrhage
victrectomy
smaller ones--> spontaneous reabsorption
106
main risk factor for vitreous haemorrhage
diabetes
107
aetiology of retinal detachment
holes in the retinal allow fluid to separate the retina from the pigmented epithelium
108
3 causes of retinal detachment
Diabetes
cataract surgery
trauma
109
4 signs of retinal detachment
- flashers
- floaters
- field loss (veil down)
- fall in acuity
all painless
110
fundoscopy features in retinal detachment
grey, opalescent retina
balloons forward
111
difference in visual loss between central retinal artery and branch retinal artery occlusion [2]
total vs partial loss of vision
RAPD +ve vs RAPD -ve
112
management of arterial retinal occlusion
eyeball massage
113
aetiology of venous retinal vessel occlusion [4]
diabetes
hypertension
hypercoaguable state
glaucoma
114
different between central retinal vein and branch retinal vein occlusion
total/moderate loss of vision +/- RAPD
vs
asymptomatic unless macula involved, vision loss in affected area only
115
investigation of venous retinal vessel occlusion
fluorescein angiography
116
common and rare causes of gradual loss of vision
common:
diabetes
open-angle glaucoma
ARMD
cataracts
rare:
retinitis pigments
hypertension
optic atrophy
116
investigations of ARMD
Amsler grid and fundoscopy looking for neovascularisation
slit lamp microscopy upon referral
fluoroscein angio for wet ARM
optic coherence tomography
117
management of ARMD [3]
photodynamic therapy
VEGF inhibitors
anti-oxidant vitamins and zinc
118
management of wet ARMD
**anti VEGF**
laser photocoagulation does slow progression of ARMD
119
management of dry ARMD
zinc+ vitamin A,C,E, beta-carotene supplementation (antioxidant)
120
how to best slow progression of ARMD
stop smoking
121
drugs that reduce aqueous production
BAC
- beta blocker
- alpha 2 agonists
- carbon anhydrase inhibit
122
drugs that increase uveoscleral outflow
Ps
- pilocarpine
- prostaglandin analouges
123
management of proliferative retinopathy
pan-retinal photocoagulation
124
management of maculopathy
grid/focal retinal photocoagulation
125
causes of cataracts [4]
age
steroids
diabetes
smoking
126
investigations for cataracts
tonometry
fundoscopy shows darkened red reflex
acuity test
BMs
127
complication after cataracts surgery
posterior capsular opacification
treated with laser surgery
128
conditions with blurred optic disc margin
optic neuritis and papilloedema
129
inheritance of the most common form of retinitis pigmentosa
which has the best prognosis and the worst prognosis
AR
best: AD
worst: x-linked
130
features of retinitis pigmentosa
night blindness
tunnel vision
blind by mid-30s
Friedrichs ataxia
131
features of retinoblastoma
strabismus
leukocoria (white eye with no red reflex)
131
management of retinoblastoma
depending on size:
- enucleation
- chemo
- radio
132
where is the abscess in chalazion
Meibomian gland
132
what makes a ptosis a true ptosis
LPS weakness
133
causes of blepharitis
seborrhoeic dermatitis
staphylococcus
134
causes of bilateral ptosis
MG
congenital
myotonic dystrophy
senile
135
what is lagopthalmos
difficulty closing lid over the globe leading to exposure keratitis
treat with lubrication and tarsorrhaphy
136
what is pinguecula
yellow vascular nodules on either side of the cornea
136
what is pterygium
yellow vascular nodes the grow over the cornea affecting vision
137
management of orbital cellulitis
urgent referal
IV abx e.g. cefuroxime
138
3 causes of exopthalmos
Graves
orbital cellulits
trauma
138
2 types of strabismus
Concomitant (common) – imbalance in extraocular muscles
Paralytic (rare) – paralysis of extraocular muscles
138
what is a carotid cavernous fistula
carotid aneurysm rupture leading to reflux of blood into cavernous sinus
leads to eye bruit, pulsate exophthalmos
treated with endovascular repair
139
what direction diplopia does a CN IV palsy cause
downwords
140
what direction diplopia does CN VI cause
horizontal
mx: botulinum toxin
141
most common type of squint in children
esotropia/convergent
cause: hypermetropia
142
haloes + eye pain
acute glaucoma
143
causes of haloes [3]
cataract
corneal oedema
acute glaucoma
144
1st line treatment of allergic conjunctivitis
2nd line
antihistamine
2nd: topical cromoglycate (mast cell stabiliser)
145
treatment of trachoma
tetracycline
146
treatment of onchocerciasis (river blindness)
ivermectin
147
treatment of xerophthalmia and keratomalacia
vitamin A
this Vit A def
148
anti muscarinic drugs
examples [2]
what effects do they have
tropicamide (3 hr)
cyclopentolate (24 hr, paeds)
all are mydriatics, cycloplegics paralyse the iris in order to dilate.
effects:
- pupil dilatation
- loss of light reflex
- blurred vision
149
features of scleritis
red eye
classically painful (in comparison to episcleritis), but sometimes only mild pain/discomfort is present
watering and photophobia are common
gradual decrease in vision
150
conditions associated with scleritis
RA and SLE
151
what is anterior uveitis the inflammation of
iris and ciliary body (anterior portion of the uvea)
152
what is blepharitis
inflammation of the eyelid margins. It may due to either meibomian gland dysfunction
153
features of anterior uveitis
acute onset
ocular discomfort & pain (may increase with use)
pupil may be small +/- irregular due to sphincter muscle contraction
photophobia (often intense)
blurred vision
red eye
lacrimation
ciliary flush: a ring of red spreading outwards
hypopyon; describes pus and inflammatory cells in the anterior chamber, often resulting in a visible fluid level
visual acuity initially normal → impaired
154
treatment of central retinal artery occlusion
Management is difficult and the prognosis is poor
any underlying conditions should be identified and treated (e.g. intravenous steroids for temporal arteritis)
if a patient presents acutely then Intraarterial thrombolysis may be attempted but currently, trials show mixed results.
155
Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, 'semi-dilated' pupil
uveitis: small, fixed oval pupil, ciliary flush
156
