Ophthalmology Flashcards
(30 cards)
Symptoms of cataracts?
Signs of cataracts?
Symptoms:
Gradual painless loss of vision
Difficulty reading/watching television
Difficulty recognising faces
Haloes around lights, particularly at night
In children, cataracts may present with a squint
Signs:
Loss of red reflex
Primary investigation- Brown/white appearance of the lens upon slit-lamp bio-microscopy
Complications of cataract surgery?
Endophthalmitis
Posterior lens capsule opacification
Rare- retinal detachment, macular oedema, glaucome
What is optic neuritis?
Symptoms?
Inflammation and demyelination of the optic nerve
Symptoms:
-sudden onset VA loss, unilateral, over hours/ days
-painful eye movements
-headaches
-changes in colour vision
-RAPD positive
-central scotoma
Associations with optic neuritis?
Multiple sclerosis- most common
Syphilis- can be infective
Diabetes
Investigations for optic neuritis?
Full eye exam + Ishihara
MRI head and spine with contrast- GOLD-STANDARD
Optic neuritis management?
Oral/ IV steroids- methylprednisolone
Immunosuppressant
Common causes for periorbital cellulitis?
> in winter from a URTI
S. aureus
Common causes for orbital cellulitis?
> in children
lack of Hib vaccine
previous sinus infection
URTI
Insect bite
dental abscess
recent eye surgery
Signs and symptoms of periorbital cellulitis?
Painful eye and eyelid/ skin
Fever
warmth
red eye
NO CHEMOSIS
NO PAINFUL EYE MOVEMENTS
NO PROPTOSIS
NORMAL OPTIC NERVE FUNCTION
Signs and symptoms of orbital cellulitis?
Painful red eye
eyelid swelling
painful eye movements
chemosis
proptosis
fevers
drowsiness +/- N&V
Investigations for orbital and periorbital cellulitis?
Blood- FBC, CRP, ESR, cultures
Eye swabs and cultures
CT-orbit- GOLD-STANDARD
Management for periorbital/ orbital cellulitis?
Hospitalisation (may not be needed for periorbital cellulitis)
IV Abx- co-amoxiclav
NSAIDs
Fluid management
Abscess drainage
Warm compress
Complications of orbital/ periorbital cellulitis?
-Permanent VA loss/ impairment
-Meningitis
-Cavernous sinus thrombosis (blood clot in the cavernous sinus)
-Brain abscess
Signs on fundoscopy for diabetic retinopathy?
Mild disease
-microaneurysms
-hard exudates
-blot haemorrhages
Severe disease
-engorged tortuous veins
-cotton wool spots
-large blot haemorrhages
Proliferative diabetic retinopathy
-neovascularisation near the retina/ optic disc
Management of diabetic retinopathy?
-Blood sugar control
-Laser photocoagulation
-Anti-VEGF injections (aimed at neovascularisation)
-vitrectomy surgery (for advanced cases)
Grades of hypertensive retinopathy?
GRADE 1
-vascular attenuation
GRADE 2
-above + AV nipping
GRADE 3
-above + retinal haemorrhages, cotton wool spots and hard exudates
GRADE 4
-above + papilloedema + silver wiring
Management for acute closed-angle glaucoma?
Aim is to lower IOP
Combination of eye drops, for example:
a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
Beta-blocker (e.g. timolol, decreases aqueous humour production)
Alpha-2 agonist (e.g. apraclonidine, dual mechanism, decreasing aqueous humour production and increasing uveoscleral outflow)
Intravenous acetazolamide- reduces aqueous secretions
NSAIDs
Anti-emetics
Definitive treatment: laser iridotomy
Acute management of amaurosis fugax?
-aspirin
-stroke referral
Signs and symptoms of retinal detachment?
-new onset flashes and floaters
-sudden onset painless VA field loss
-swinging light test -> RADP
-red light reflex may be lost
Investigations for GCA?
Initial management of GCA?
Bloods- ESR (50mm/hr) , CRP, LFTs
Temporal artery biopsy
Duplex USS-> halo sign and stenosis of carotid artery
High-dose oral steroids (prednisolone)
If evolving VA lass -> IV methylprednisolone
Urgent ophthalmology review
How to differ episcleritis and scleritis?
Episcleritis
-red eye
-typically not painful
-watering and photophobia
-phenylephrine drops blanch conjunctival and episcleral vessels
-in episcleritis, the injected vessels are mobile when gentle pressure is applied on the sclera
-if the eye redness improves after phenylephrine a diagnosis of episcleritis can be made
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
-vessels do not blanch with with phenylephrine
Anterior uveitis management?
urgent review by ophthalmology
cycloplegics (dilates the pupil which helps to relieve pain and photophobia)-Atropine, cyclopentolate
steroid eye drops
Complication of diabetic eye disease?
Proliferative retinopathy (haemorrhages and exudates)
severe form of diabetic eye disease that occurs when blood vessels in the retina close, preventing adequate blood flow. The retina responds by growing new blood vessels, which are fragile and can bleed easily.
Eye condition associated with syphilis?
Argyll-Robertson pupil.
This is a condition typically associated with neurosyphilis, a tertiary form of syphilis caused by the spirochete Treponema pallidum.
