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ophthalmology Flashcards

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1
Q

optic neuritis causes (3)

A

MS
DM
syphilis

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2
Q

optic neuritis features: (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

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3
Q

optic neuritis mgt

A

high dose steroids
(usually resolved in 4-6 weeks)

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4
Q

sinister cause of chronic unilateral conjunctivitis

A

orbital lymphoma

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5
Q

bacterial conjunctivitis features:

A

Purulent discharge
Eyes may be ‘stuck together’ in the morning)

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6
Q

viral conjunctivitis features:

A

Serous discharge
Recent URTI
Preauricular lymph nodes

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7
Q

bacterial conjunctivitis mgt:

& mgt if pregnant

A

chloramphenicol
fusidic acid in pregnant

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8
Q

sudden loss of vision causes: (4)

A

ischaemic/vascular
vitreous haemorrhage
retinal detachment
retinal migraine

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9
Q

HSV keratitis presentation: (5)

A

DENDRITIC CORNEAL ULCER

red, painful eye
photophobia
epiphora (watery eyes)
visual acuity may be decreased
fluorescein staining may show an epithelial ulcer

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10
Q

HSV keratitis mgt

A

topical aciclovir
immediate ophthalmology r/v

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11
Q

rheumatoid arthritis ocular manifestations (5)

A

keratoconjunctivitis sicca (= dry eyes, most common)
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis

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12
Q

acute angle closure glaucoma

what happens?

A

rise in IOP secondary to an impairment of aqueous outflow

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13
Q

acute angle closure glaucoma predisposing factors: (3)

A

hypermetropia (long-sightedness)
pupillary dilatation
lens growth associated with age

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14
Q

acute angle closure glaucoma

features: (7)

A

severe pain: may be ocular or headache
decreased visual acuity
sx worse with mydriasis (e.g. watching TV in a dark room)
hard, red-eye
haloes around lights
semi-dilated non-reacting pupil
corneal oedema (dull or hazy cornea)

nausea/vomiting/ abdo pain

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15
Q

acute angle closure glaucoma mgt

A
  1. offer 360° selective laser trabeculoplasty (SLT) first-line to people with an IOP of ≥ 24 mmHg
  2. prostaglandin analogue (PGA) eyedrops should be used next-line
  3. BB eye drops
    carbonic anhydrase inhibitor eye drops
    sympathomimetic eye drops
  4. surgery in the form of a trabeculectomy may be considered in refractory cases.
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16
Q

prostaglandin analogues
example:

A

lantoprost

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17
Q

prostaglandin analogues
SE:

A

brown pigmentation of the iris
increased eyelash length

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18
Q

BB
examples:

A

timolol
betaxolol

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19
Q

groups to avoid BB in:

A

asthmatics
heart block

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20
Q

Sympathomimetics
examples:

A

e.g. brimonidine, an alpha2-adrenoceptor agonist)

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21
Q

Sympathomimetics
who should avoid:

A

Avoid if taking MAOI or tricyclic antidepressants

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22
Q

Carbonic anhydrase inhibitors

example:

A

Dorzolamide

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23
Q

Carbonic anhydrase inhibitors
SE:

A

Systemic absorption may cause sulphonamide-like reactions

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24
Q

miotics
e.g.

A

pilocarpine, a muscarinic receptor agonist

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25
miotics adverse effects:
constricted pupil headacheblurred vision
26
Sympathomimetics adverse effect:
hyperaemia
27
age related macular degeneration presentation (5)
a reduction in visual acuity, particularly for near field objects - gradual in dry ARMD - subacute in wet ARMD poor night vision/ dark adaptation fluctuations in visual disturbance Charles Bonnet syndrome 'flickering'
28
age related macular degeneration signs
distortion of line perception may be noted on Amsler grid testing drusen (yellow areas of pigment deposition in the macular area) which may become confluent in late disease to form a macular scar. in wet ARMD well demarcated red patches (intra-retinal or sub-retinal fluid leakage or haemorrhage)
29
wet macular degeneration mgt:
anti-VEGF
30
anterior uveitis (aka irisitis) associations
HLA-B27 associated conditions: -ankylosing spondylitis -reactive arthritis -ulcerative colitis, Crohn's disease -Behcet's disease -sarcoidosis: bilateral disease may be seen
31
anterior uveitis features
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
32
anterior uveitis mgt (3)
urgent review by ophthalmology cycloplegics (dilates the pupil which helps to relieve pain and photophobia) e.g. Atropine, cyclopentolate steroid eye drops
33
Argyll-Roberston pupil (who is she?)
ARP (Argyll Robertson pupil) Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA) i.e. small, irregular pupils no response to light but there is a response to accommodate
34
ARP (Argyll Robertson pupil) causes: (2)
DM syphilis
35
cataracts causes:
normal ageing Smoking Increased alcohol consumption Trauma Diabetes mellitus Long-term corticosteroids Radiation exposure Myotonic dystrophy Metabolic disorders: hypocalcaemia
36
cataracts presentation: (5)
Reduced vision Faded colour vision: making it more difficult to distinguish different colours Glare: lights appear brighter than usual Halos around lights ABSENT RED REFLEX
37
cataract surgery cx: (4)
Posterior capsule opacification: thickening of the lens capsule Retinal detachment Posterior capsule rupture Endophthalmitis: inflammation of aqueous and/or vitreous humour
38
central retinal a. occlusion features: (3)
sudden, painless unilateral visual loss relative afferent pupillary defect 'cherry red' spot on a pale retina
39
central retinal a. occlusion causes: (2)
thromboembolism (from atherosclerosis) arteritis (e.g. temporal arteritis)
40
central retinal vein occlusion RF (5)
age HTN CVD glaucoma polycythaemia
41
central retinal vein occlusion features (3)
sudden, painless reduction or loss of visual acuity, usually unilaterally fundoscopy: - widespread hyperaemia - severe retinal haemorrhages - 'stormy sunset'
42
central retinal vein occlusion key ddx:
branch retinal vein occlusion (BRVO) - when a vein in the distal retinal venous system is occluded and is thought to occur due to blockage of retinal veins at arteriovenous crossings. - results in a more limited area of the fundus being affected.
43
central retinal vein occlusion mgt (3):
conservative if macular oedema: aanti-VEGF if retinal neovascularisation - laser photocoagulation
44
chorioretinitis features:
unilateral blurred vision scotomas (blind spots) floaters ophthalmoscopic finding - focal or diffuse areas of retinal whitening '- pizza pie' fundus: retinal spots (superficial retinal infarction + flame-shaped haemorrhages
45
chorioretinitis mgt:
if infectious: - pyrimethamine and sulfadiazine for toxoplasmosis - ganciclovir or valganciclovir for CMV if autoimmune: steroids
46
how to differentiate episcleritis/ scleritis:
phenylephrine drops - if eye redness improves following drops = episcleritis
47
scleritis mgt
PO NSAIDs
48
scleritis RF
rheumatoid arthritis: the most commonly associated condition systemic lupus erythematosus sarcoidosis granulomatosis with polyangiitis
49
herpes zoster opthalmicus features:
vesicular rash around the eye Hutchinson's sign: = rash on the tip or side of the nose. Indicates nasociliary involvement, strong RF for ocular involvement
50
Homes-Adie pupil
benign - dilated pupil - once the pupil has constricted it remains small for an abnormally long time - slowly reactive to accommodation but very poorly (if at all) to light - associated with absent knee/ ankle reflex
51
Horner's syndrome features:
miosis (small pupil) ptosis enophthalmos* (sunken eye) anhidrosis (loss of sweating one side)
52
hypertensive retinopathy signs:
I silver wiring of the arterioles II AV nipping III cotton-wool exudates, flame and blot haemorrhages (collect round fovea to make "macular star" IV papilloedema
53
keratitis what is it?
inflammation of the cornea (unlike conjunctivitis can be potenitially sight threatening so needs rx)
54
keratitis causes:
bacterial - s. aureus most commonly - pseudomonas aeruginosa in contact lens wearers fungal amoebic - acanthamoebic keratitis (typically pain is out of proportion with findings) parasitic - onchoceral keratitis (river blindness) viral - HSV keratitis
55
keratitis features:
red eye + pain photophobia foreign body, gritty sensation +/- hypopyon (white milky fluid layer)
56
bacterial keratitis mgt
topical abx - usually quinolones +cycloplegic for pain relief e.g. cyclopentolate
57
keratitis cx
- corneal scarring - perforation - endophthalmitis - visual loss
58
lens dislocation causes:
Marfan's syndrome: upwards homocystinuria: downwards Ehlers-Danlos syndrome trauma uveal tumours autosomal recessive ectopia lentis
59
lens discolation direction in Marfans
upwards
60
lens dislocation: direction in homocystinuria
downwards
61
causes of mydriasis
(large pupil) CN III palsy Holmes-Adie pupil traumatic iridoplegia phaeochromocytoma congenital
62
drug causes of mydriasis
topical mydriatics: tropicamide, atropine sympathomimetic drugs: amphetamines, cocaine anticholinergic drugs: tricyclic antidepressants
63
orbital compartment syndrome features:
eye pain/swelling proptosis 'rock hard' eyelids relevant afferent pupillary defect
64
orbital compartment syndrome mgt
urgent lateral canthotomy (before diagnostic imaging) to decompress the orbit
65
Marcus Gunn pupil what is it?
relative afferent pupillary defect caused by lesion of anterior optic chiasm i.e. optic n/ retina
66
Marcus Gunn pupil causes:
retinal detachment optic neuritis
67
retinitis pigmentosa features:
initial sign = night blindness tunnel vision (as primarily affects peripheral retina) black bone spicule-shaped pigmentation in the peripheral retina, mottling of the retinal pigment epithelium
68
occular manifestations of RA:
keratoconjunctivitis sicca (most common) episcleritis (erythema) scleritis (erythema and pain) corneal ulceration keratitis Iatrogenic steroid-induced cataracts chloroquine retinopathy
69
tunnel vision causes
papilloedema glaucoma retinitis pigmentosa choroidoretinitis optic atrophy secondary to tabes dorsalis hysteria

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