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Phase 4 > Ophthalmology > Flashcards

Ophthalmology Flashcards

(70 cards)

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1
Q

Name 3 causes of a painless red eye

A

Episcleritis, conjunctivitis, blepharitis

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2
Q

How does episcleritis present?

A
  • Painless red eye
  • Can see individual red vessels
  • May have watering and photophobia
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3
Q

What will happen if you use phenylephrine drops in episcleritis?

A

The injected vessels will blanch

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4
Q

How is episcleritis managed?

A

It is usually self limiting

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5
Q

What are hallmark symptoms of conjunctivitis?

A

Red bloodshot eye with a gritty/ itchy sensation and discharge.

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6
Q

When might conjunctivitis impact vision?

A

Only if there is discharge in the eye - it will clear when eye is cleaned.

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7
Q

How do symptoms differ in bacterial and viral conjunctivitis?

A

Bacterial - purulent discharge, worse in the morning
Viral - clear discharge, associated with other viral symptoms

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8
Q

What eye drops are used in bacterial conjunctivitis?

A

Chloramphenicol or fusidic acid

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9
Q

What is the cause of blepharitis?

A

Blocked meibomian gland

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10
Q

What are the symptoms of blepharitis?

A
  • Grittiness and discomfort around eye margins
  • Red eyelid margins
  • May have sticky eyelids in the morning
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11
Q

How is blepharitis managed?

A

Hot compress and lid hygiene

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12
Q

How do chelazions present?

A

Firm painless lump on the eyelid with eyelid oedema and erythema

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13
Q

How are chelazions managed?

A

They usually resolve spontaneously but may require surgical drainage

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14
Q

What is another phrase for iritis?

A

Anterior uveitis

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15
Q

What range of conditions is anterior uveitis associated with (including the gene)?

A

HLA-B27
- Ankylosing spondylitis
- Reactive arthritis
- Crohn’s/ UC
- Sarcoidosis
- JIA

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16
Q

What are the features of anterior uveitis?

A
  • Acute onset
  • Eye pain and discomfort
  • Photophobia
  • Blurred vision
  • Red eye and lacrimation
  • Pupil may be smaller +/- irregular
  • Hypopynon - fluid level on slit lamp
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17
Q

How is anterior uveitis managed?

A
  • Urgent ophthal review
  • Cycloplegics (pupil dilators) e.g. atropine
  • Steroid eye drops
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18
Q

What are 4 risk factors for developing a corneal ulcer?

A
  1. Contact lens use
  2. Eye trauma
  3. Vitamin A deficiency
  4. Use of steroid eye drops
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19
Q

What are the features of corneal ulcers?

A

Painful eye with watering and photophobia

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20
Q

How do you diagnose corneal ulcers?

A

On slit lamp with cobalt light - focal fluorescene staining of ulcered area

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21
Q

How are corneal ulcers managed?

A

Eye drops for the causative organism.

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22
Q

What are risk factors for scleritis?

A
  • Rheumatoid arthritis
  • SLE
  • Sarcoidosis
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23
Q

What are the features of scleritis?

A
  • Red eye
  • Classically painful but may be mild
  • Watering and photophobia
  • Gradual decrease in vision
  • Tenderness on eye palpation
  • Pain on eye movements
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24
Q

How is scleritis managed?

A
  • Same day ophthal review
  • Oral NSAIDs first line
  • Oral glucocorticoids for more severe cases
  • Immunosuppression if resistant to management
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25
What are the two ways you can distinguish scleritis from episcleritis?
SCLERITIS - painful, vessels will not blanch with phenylephrine drops EPISCLERITIS - painless, vessels will blanch with phenylephrine drops
26
What is keratitis?
Sight threatening corneal inflammation
27
What are the 5 causes of keratitis?
- Bacterial (most commonly staph aureus or pseudomonas aeruginosa - Fungal - Amoebic (if exposed to soil or water) - Parasitic - Viral (herpes simplex)
28
What are the features of keratitis?
- Red eye - Photophobia - Foreign body with a gritty sensation - May have a hypopynon
29
How is keratitis managed?
- Stop contact lens use until resolves - Abx drops - Cycloplegics e.g. atropine
30
What is acute glaucoma also known as?
Closed angle glaucoma
31
What are the features of acute glaucoma?
- Severe pain - ocular or headache - Decreased visual acuity - Symptoms worsen when pupil dilates (e.g. when watching TV in a dark room) - Haloes around lights - Semi-dilated non-reacting pupil - Hard, red eye - May have systemic symptoms - N+V, abdominal pain
32
How is acute glaucoma diagnosed?
- Tonometry to assess IOP - Gonioscopy - a slit lamp lens that allows visualisation of the angle
33
How is acute glaucoma managed?
- EMERGENCY - urgent ophthal referral - Aim is to reduce aqueous secretions and induce pupillary constriction Reduce secretions - topical beta blockers, carbonic anhydrase inhibitors e.g. PO acetazolomide Pupil constriction - miotic agents e.g. pilocarpine Definitive treatment is laser peripheral iridotomy once acute phase is over
34
What is the cause of open angle glaucoma?
Gradual increase in IOP putting pressure on the optic nerve head
35
What are some risk factors for open angle glaucoma?
- Increasing age - Genetics - Afrocaribbean ethnicity - Myopia - Hypertension - Diabetes - Corticosteroid use
36
What are some features of open angle glaucoma?
- Peripheral visual field loss - nasal scotomas leading to tunnel vision - Decreased visual acuity
37
In open angle glaucoma, what would you see on fundoscopy?
- Optic disc cupping - Optic disc pallor (indicated atrophy)
38
How is open angle glaucoma managed?
- 360o selective laser trabeculoplasty - Prostaglandin analogue eye drops - Beta blocker eye drops
39
What are 4 causes of gradual vision loss?
1. Refractive error 2. Cataract 3. Macular degeneration 4. Open angle glaucoma
40
What are 7 causes of sudden vision loss?
1. Retinal artery occlusion 2. Retinal vein occlusion 3. Optic neuritis 4. Retinal detachment 5. Vitreous haemorrhage 6. Stroke e.g. amaurosis fugax 7. GCA
41
What are the features of a cataract?
- Gradual reduction in vision - Faded colour vision - Glare around lights - seem brighter than usual - Halos around lights - Defect in the red reflex
42
What are the 2 management options for a cataract and when are they chosen?
1. Stronger glasses and brighter lighting - early stages 2. Cataract surgery - based on QoL and level of impairment
43
Name 4 complications of cataract surgery
1. Posterior capsule opacification 2. Retinal detachment 3. Posterior capsule rupture 4. Endophthalmitis
44
Name 4 risk factors for macular degeneration
1. Advancing age 2. Smoking 3. FHx 4. Any cardiovascular risk factors
45
What are the two types of macular degeneration and how do they differ?
Dry (more common) - gradual vision loss Wet - sudden vision loss
46
What are the features of macular degeneration?
- Subacute vision loss - Reduced visual acuity, especially near-vision - Difficulties in dark adaptation - Level of visual disturbance fluctuated - May see flares around objects
47
What are the signs of wet and dry macular degeneration?
Both - distortion of line perception on an Amsler grid Wet - demarcated red patches on fundoscopy Dry - Drusen patches - yellow areas of pigment in the macular
48
What is the management of wet and dry macular degeneration?
Wet - monthly intravitreal anti-VEGF injections Dry - high dose of beta-carotene, vitamin C, vitamin E and zinc
49
How does retinal artery occlusion present?
Sudden painless unilateral vision loss
50
What are two signs of retinal artery occlusion?
- RAPD - Fundoscopy - cherry red spot on a pale retina
51
How is retinal artery occlusion managed?
Treat the underlying condition e.g. IV steroids for temporal arteritis
52
How does retinal vein occlusion present?
Sudden painless unilateral vision loss
53
What are the two types of retinal vein occlusion?
Central and branch
54
What are the signs of central retinal vein occlusion?
Fundoscopy - diffuse severe retinal haemorrhage
55
What are the signs of branch retinal vein occlusion?
Fundoscopy - haemorrhage in a demarcated area
56
Name 3 conditions that can cause optic neuritis
1. MS 2. Diabetes 3. Syphilis
57
What are the features of optic neuritis?
- Unilateral decrease in visual acuity over days or hours - Reduced colour vision ("red desaturation") - Pain worse on eye movement - RAPD - Central scotoma
58
How is optic neuritis diagnosed?
MRI of brain and orbits with gadolinium contrast
59
How is optic neuritis managed?
High dose steroids
60
Name 5 risk factors for retinal detachment
1. Diabetes mellitus 2. Myopia (short sighted) 3. Increasing age 4. Previous cataract surgery 5. Eye trauma e.g. from boxing
61
How does retinal detachment present?
- New onset floaters or flashing - Sudden onset painless progressive vision loss - curtain coming down - Reduced peripheral vision first
62
What are two signs of retinal detachment
- Red reflex lost - May have RAPD
63
How do you manage retinal detachment?
Urgent ophthalmologist referral
64
Which disease is most strongly associated with vitreous haemorrhage?
Diabetes
65
Name 3 common causes of vitreous haemorrhage
1. Proliferative diabetic retinopathy 2. Posterior vitreous attachment 3. Ocular trauma
66
How does vitreous haemorrhage present?
- Painless vision loss/ haze - Red hue to vision (from the blood) - Floaters of shadows/ hard spots in vision
67
What are some signs of vitreous haemorrhage?
- Decreased visual acuity - Cotton wool spots on slit lamp - RBCs in the anterior vitreous
68
What is endophthalmitis?
Infection of the aqueous and vitreous humour
69
How does endophthalmitis present?
Red eye with pain and visual loss commonly following intraocular surgery
70
Name 3 signs of endophthalmitis
1. Hypopynon 2. Hand movement only acuity 3. Periphlebitis on fundoscopy

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