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Phase 4 Medicine > Ophthalmology > Flashcards

Ophthalmology Flashcards

(90 cards)

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1
Q

Give 3 causes of a painful red eye

A

Acute glaucoma

Anterior uveitis

Conjunctivitis

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2
Q

Define conjunctivitis and give 3 possible causes

A

Inflammation of the conjunctiva

Causes;

Viral - Adenovirus

Bacterial - Staph, chlamydia, gonococcus

Allergic

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3
Q

Give 4 clinical features of conjunctivitis

A

Often bilateral

Purulent discharge (sticky = bacterial, watery = viral)

Red, bloodshot eyes

Itchy, gritty sensation

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4
Q

How is conjunctivitis managed? (3)

A

Resolves without treatment in 1-2 weeks

Bacterial = Chloramphernicol/ fusidic acid eye drops

Allergic = Antihistmaines (oral/topical)

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5
Q

What causes a corneal abrasion and how may it present? (3)

A

Cause = Trauma

Presentation;

Pain, foreign body sensaiton

Photophobia

Blurred vision, watering eye

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6
Q

How is corneal abrasion investigated? (1)

A

Slit lamp, fluorescein stains defect yellow/orange

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7
Q

How is corneal abrasion managed? (1)

A

Cyclopentolate to dilate pupil

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8
Q

Define episcleritis and give 2 causes

A

Inflammation of the episclera (outermost layer of the sclera, just below the conjunctiva)

Causes;

Idiopathic

Associated with; RA, IBD, SLE

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9
Q

How may episcleritis present? (4)

A

Painless/mild pain

Mild photophobia

Localised redness

Dilated episcleral vessels

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10
Q

How is episcleritis managed? (3)

A

Self-limiting in 1-4 weeks

Analgesia, cold compress, safety net

Severe = Systemic NSAIDs (naproxen) or topical steroid eye drops (phenylephrine)

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11
Q

Define scleritis and give 3 causes

A

Inflammation of the full thickness of the sclera

Causes;

RA, SLE, Polymyalgia rheumatica

IBD (Ulcerative colitis)

Sarcoidosis, Granulomatosis with polyangitis

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12
Q

How may scleritis present? (4)

A

Severe pain, worse on movement

Blue sclera

Photophobia

Reduced visual acuity

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13
Q

How is scleritis managed? (3)

A

NSAIDs - Topical/systemic

Steroids

Immunosuppression for underlying condition

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14
Q

Define simple open angle glaucoma

A

Describes optic nerve damage due to raised IOP due to blockage from aqueous humour >24mmHg.

Nerve damage and decreased blood flow results in disc atrophy and cupping

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14
Q

Give 4 risk factors for chronic simple open angle glaucoma

A

Increasing age

Black ethnic origin

FHx

Steroids

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15
Q

Define Glaucoma

A

Describes optic neuropathy that occurs due to raised intraocular pressure

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16
Q

How may chronic simple open angle glaucoma present? (2)

A

Peripheral vision loss causing tunnel vision

Gradual onset of fluctuating pain, headaches, blurred vision and halos around lights

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17
Q

How is chronic simple open angle glaucoma investigated? (3)

A

Tonometry = non contact (puff of air on cornea) and Goldman applanation >24mmHg

Fundoscopy = Optic disc cupping

Visual field = Peripheral vision loss

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18
Q

How is chronic simple open angle glaucoma managed? (3)

A

Eye drops to decrease intraocular pressure

1st - Prostaglandin analogue eye drops (latanoprost)

Others;

BB - Timolol

Carbonic anhydrase inhibitor - Dorzolamide

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19
Q

Define acute angle-closure glaucoma

A

Describes a rise in intra-ocular pressure that impairs aqueous outflow.

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20
Q

Name 3 factors that predispose someone to acute angle closure glaucoma

A

Hypermetropia (long-sightedness)

Pupillary dilatation

Lens growth associated with age

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21
Q

Give 5 clinical features of acute angle-closure glaucoma

A

Severe pain (ocular or headache)

Decreased visual acuity

Hard, red eye

Semi-dilated non-reacting pupil

Corneal oedema > Dull/Hazy cornea

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22
Q

What investigations are performed to diagnose acute angle closure glaucoma? (2)

A

Tonometry - To assess for elevated intraocular pressure

Gonioscopy - Allows visualisation of the angle

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23
Q

How is acute angle closure glaucoma initially managed? (3)

A

Urgent referral to ophthalmologist

Combination of eye drops;
Pilocarpine, Timolol or Apraclonidine

IV acetazolamide

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24
What is the definitive management for acute angle closure glaucoma?
Laser peripheral iridotomy (Creates tiny hole in peripheral iris > Aqueous humour flowing to the angle)
25
How does pilocarpine treat relieve symptoms of acute angle closure glaucoma?
Direct parasympathomimetic (Muscarinic Receptor Agonist) Causes contraction of ciliary muscle > opening the trabecular meshwork > increased outflow of the aqueous humour
26
How do beta blockers, like timolol, relieve symptoms of acute angle closure glaucoma?
Decrease aqueous humour production
27
How do alpha-2 agonists, like apraclonidine, help relieve symptoms of acute angle closure glaucoma?
Dual mechanism; Decrease aqueous humour production and increase uveoscleral outflow
28
Define Blepharitis
Describes inflammation of the eyelid margins
29
Name 2 types of Blephraritis
Posterior Blepharitis - meibomian gland dysfunction (most common) Anterior Blephraritis - Seborrhoeic dermatitis/staphylococcal infection
30
Blepharitis is more common in patients with what?
Rosacea
31
What is the function of the meibomian glands?
Secrete oil onto the surface of the eye to prevent rapid evaporation of the tear film. Hence any problem with these glands can lead to irritation.
32
Give 5 clinical features of Blepharitis
Bilateral symptoms Grittiness and discomfort around eye margins Eyes may be sticky in the morning Eyelid margins may be red Styes and chalazions
33
What is the difference between a Chalazion and a Stye? (3)
Styes occur along the eyelash line Chalazions occur further away from the eye on the top eyelid or under the bottom eyelash. Styes are also more painful than chalazions
34
How is Blepharitis managed? (4)
Hot compress 2x per day Lid hygiene - Mechanical removal of debris from lid margins (cotton wool bud dipped in cooled boiled water and baby shampoo) Topical antibiotics (when bacterial infection is suspected) Artificial tears
35
Give 2 risk factors for cataracts
Women > Men Increasing age
36
Define cataracts
A common eye condition where the lens of the eye gradually opacifies (becomes cloudy). Cloudiness makes it difficult for light to reach the retina, causing reduced/blurred vision.
37
Give 5 clinical features of cataracts
Gradual onset of; Reduced vision Faded colour vision Glare (lights appear brighter than usual) Halos around lights
38
Give 4 classifications of cataracts
Nuclear - Common in old age Polar - Localised and inherited Subcapsular - Occurs due to steroid use Dot opacities - Diabetes and myotonic dystrophy
38
Give 1 clinical sign of cataracts observed using an opthalmoscope
Defective red reflex (Red reflex = Light reflecting from retina. Cataracts prevents light reaching the retina, causing a defect in the red reflex.
38
How is cataracts managed non-surgically? (2)
Stronger glasses/contact lenses Encourage using brighter light
39
Give 2 investigations performed to investigate cataracts
Opthalmoscopy (done after pupil dilation) (normal fundus and optic nerve) Slit lamp examination (showing visible cataract)
40
How is cataracts managed surgically?
Removal of cloudy lens and replacement with artificial lens
41
Give 4 complications of cataracts surgery
Posterior capsule opacification (thickening of lens capsule) Retinal detachment Posterior capsule rupture Endophthalmitis (inflammation of aqueous and/or vitreous humour)
42
Describe central retinal artery occulsion
Describes a sudden unilateral visual loss due to thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)
43
Give 3 clinical features of central retinal artery occlusion
Sudden, painless unilateral visual loss Relative afferent pupillary defect "Cherry red" spot on pale retina
44
How is central retinal artery occlusion managed?
Treat underlying cause (i.e IV methylprednisolone for temporal arteritis)
45
Give 3 classifications of diabetic retinopathy
Non Proliferative Diabetic Retinopathy (NPDR) (mild, moderate and severe) Proliferative retinopathy (PDR) Maculopathy
46
How is mild NPDR defined?
1 or more microaneurysm
47
How is moderate NPDR defined? (4)
Microaneurysms Blot haemorrhages Hard exudates Cotton wool spots (represents retinal infarction)
48
How is severe NPDR defined? (3)
Blot haemorrhages and microaneurysms in 4 quadrants Venous beading in at least 2 quadrants Intraretinal microvascular abnormalities in at least 1 quadrant
49
How many proliferative diabetic retinopathy present? (3)
Retinal neovascularisiation - may lead to vitrous haemorrhage Fibrous tissue forming anterior to retinal disc More common in type 1 DM
50
How is maculopathy defined? (4)
Based on location rather than severity Hard exudates and other changes on macula Check visual acuity More common in Type II DM
51
How are all patients with diabetic retinopathy managed? (2)
Optimise glycaemic control, blood pressure and hyperlipidaemia. Regular review by ophthalmology
52
How is maculopathy managed?
If there is change in visual acuity - Give Intravitreal vascular endothelial growth factors (VEGF inhibitor) (Ranibizumab)
53
How is proliferative retinopathy managed?
Panretinal laser photocoagulation Intravitreal VEGF inhibitor - Ranibizumab
54
Give 2 complications of panretinal laser photocoagulation
Reduction in visual fields (due to scarring of peripheral tissue) Decreased night vision (due to reduction in rod cells)
55
Define keratitis
Describes inflammation of the cornea
56
Give 2 bacterial causes of Keratitis
Staphylococcus Aureus (most common) Pseudomonas aeruginosa (in contact lens wearers)
57
Give 1 amoebic cause of keratitis
Acanthamoebic keratitis (5% of cases)
58
Give 4 clinical features of keratitis
Red eye (pain and erythema) Photophobia Foreign body, gritty sensation Hypopyon (milky fluid in inferior part of anterior chamber)
59
How is keratitis diagnosed?
Slit-lamp + Same day referral to eye specialist to rule out microbial keratitis
60
How is keratitis managed? (3)
Stop using contact lenses until Sx have resolved Topical antibiotics (quinolones) Cyclopentolate (for pain relief)
61
Give 4 complications of keratitis
Corneal scarring Perforation Endophthalmitis Visual loss
62
Define anterior uveitis
Describes inflammation of the anterior portion of the uvea (iris and ciliary body)
63
What gene is associated with anterior uveitis?
HLA-B27
64
Give 5 clinical features of anterior uveitis
Acute onset red eye Ocular discomfort and pain Small pupil/Irregular Blurred vision Lacrimation
65
Give 4 conditions associated with anterior uveitis
Ankylosing Spondylitis Reactive arthritis Ulcerative colitis and Crohn's disease Bechet's disease
66
How is anterior uveitis managed? (3)
Urgent review by Ophthalmology Cycloplegics (dilate pupil to relieve pain and photophobia) (Atropine, cyclopentolate) Steroid eye drops
67
Describe macular degeneration
The most common cause of blindness in the UK. Characterised by degeneration of retinal photoreceptors, leading to degeneration of the central retina (macula) Changes are usually bilateral
68
Give 3 risk factors for macular degeneration
Increasing age (greatest risk factor) Smoking Positive Family History
69
Name and describe 2 forms of macular degeneration
Dry macular degeneration; - 90% of cases - Characterised by drusen - Yellow round spots in Bruch's membrane Wet macular degeneration - 10% of cases - Characterised by choroidal neovascularisation - Aka exudative or neovascular macular degeneration
70
Give 4 clinical features of macular degeneration
Subacute vision loss with; - A reduction in visual acuity (gradual in dry, subacute in wet - Poor night vision - Fluctuations in visual disturbance from day to day - Visual hallucinations (Charles-Bonnet syndrome)
71
Give 3 examination findings for macular degeneration
Distortion of line perception on Amsler grid testing Presence of drysen on fundoscopy Demarcated red patches representing haemorrhage (in wet)
72
How is macular degeneration diagnosed? (3)
Slit lamp microscopy + Colour fundus photography (initial investigation of choice) Fluorescein angiography (if neovascular ARMD is susected) Optical coherence tomography
73
How is macular degeneration managed? (3)
Prevention (dry) - Zinc with antioxidant vitamins A, C and E can reduce progression Anti-VEGR agents - Ranibizumab Laser photocoagulation - slows progression but carries risk of acute visual loss after treatment
74
What is the commonest disease associated with optic neuritis?
Multiple Sclerosis
75
Give 5 clinical features of optic neuritis
Unilateral decrease in visual acuity over hours/days Poor discrimination of colours (red desaturation) Pain worse on eye movement Central scotoma Relative afferent pupillary defect
76
What investigation is used to diagnose optic neuritis?
MRI of brain and orbits with gadolinium contrast
77
How is optic neuritis managed? (2)
High dose steroids Recovery usually takes 4-6 weeks
78
Describe orbital cellulitis
Describes infection affecting the fat and muscles posterior to the orbital septum. Usually caused by URTI spreading from sinuses. Medical emergency requiring hospital admission and urgent senior review.
79
Give 4 risk factors for orbital cellulitis
Childhood Previous sinus infection Lack of Hib Vaccination Recent eyelid infection/insect bite on eyelid (periorbital cellulitis)
80
Give 5 presenting features for orbital cellulitis
Redness and swelling around eye Severe ocular pain Visual disturbance Proptosis Pain with eye movements
81
How is orbital cellulitis differentiated from preseptal cellulitis?
Reduced visual acuity, proptosis, eye ophthalmoplegia/pain with eye movements are NOT features of preseptal cellulitis
81
Give 4 investigations for orbital cellulitis
FBC - Raised WBC and CRP/ESR Clinical examination (Decreased vision, afferent pupillary defect, proptosis, dysmotility, oedema, erythema) CT with contrast Blood culture - to determine organism
82
What are the most common bacterial causes of orbital cellulitis? (3)
Streptococcus Staphylococcus aureus Haemophilus influenzae B
83
Describe retinal detachment
Describes when neurosensory tissue that lines the back of the eye comes away from it's underlying pigment epithelium Reversible form of vision loss if recognised and treated before the macula is affected.
84
Give 5 risk factors for retinal detachment
Diabetes mellitus Myopia Age Previous surgery for cataracts Eye trauma (boxing)
85
How can diabetes mellitus cause retinal detachment
Occurs as a result of breaks in the retina due to traction by the vitreous humour.
86
Give 4 clinical features of retinal detachment
Now onset floaters/flashes Sudden onset, painless and progressive visual field loss Relative afferent pupillary defect (if optic nerve is affected) Fundoscopy (loss of red reflex)

Phase 4 Medicine (15 decks)

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