1
Q
Define Acute Closed Angle Glaucoma:
A
Characterised by the blocking/ narrowing of the drainage angle formed by cornea and iris, resulting in a sudden increase in intra-ocular pressure.
Can cause optic nerve damage
2
Q
Risk factors of developing Acute Closed Angle Glaucoma:
A
- > 40 yrs
- hyperopia (long sighted)
- short axial length of eyeball
- asian
- pupillary dilation
- dim environment
3
Q
Sx of Acute Closed Angle Glaucoma:
A
- severe eye pain
- blurred vision
- Haloes around light
- n+v
4
Q
Signs of Acute Closed Angle Glaucoma:
A
- red eye
- mild dilated/ fixed pupil
- closed iridocorneal angles
- corneal oedema
- raised IOP >21 mmHg
- hard eye
5
Q
Management of Acute Closed Angle Glaucoma:
A
Emergency referral to ophthal
Medical management:
* IOP lowering agents
- BB + pilocarpine + IV azetazolamide
- 4% pilocarpine drop every 15 mins
- Prophylactic 1% pilocarpine to other eye
* analegesia (IV morphine + antiemetic)
* Hyperosmotics of IOP not improve w prev tx
- 20% 500ml mannitol IV over 1 hr
Surgical Management:
* Peripheral iridotomy (laser)
* Surgical iridotomy (rare)
6
Q
Define Blepharitis:
A
Chronic inflammation of the eyelid margins.
7
Q
Common causes of Blepharitis:
A
- staphylococcus
- HSV
- VZV
- meibomian gland dysfunction
- seborrheic dermatitis
- rosacea
8
Q
Sx of Blepharitis:
A
- painful gritty itch eye
- eyelid stuck together in the morning
- dry eye
9
Q
Signs of Blepharitis:
A
- erythema of eyelid margin
- crusting/ scasling at eyelid margin
- visibly blocked meibomian glands orifaces
10
Q
Management of Blepharitis:
A
- lid hygiene BD
- avoid contact lens during flare ups
11
Q
Risk Factors of Uveitis:
A
- 20-50 yrs
- HLA-B27
- autoimmune
- infections
- trauma
- iatrogenic
- ischaemic
12
Q
Management of Uveitis:
A
Urgent referral to ophthal
Acute Tx:
* cycloplegic mydriatic drops - cyclopentolate
* corticosteroids
* analgesia
Chronic Tx:
* Methotrexate/ mycophenolate
* adalimumab
Self-limiting
13
Q
Signs of Anterior Uveitis:
A
- painful red eye worsening over several days
- photophobia
- blurred vision
- headache
- hypopion
- conjunctival injection
- keratic precipitates
- pos. synchaie and irregular pupil
- ant. chamber flares and cells
14
Q
Signs of Intermediate Uveitis:
A
- painless
- floaters
- blurred vision
- no external signs of inflammation
- inflammatory cells in vitreous
15
Q
Signs of Posterior Uveitis:
A
- blurred vision
- progressive vision loss
- flashes/ floaters
- yellow/ white retina
- cystoid macular oedema
16
Q
Define Stye:
A
Abscess at an eyelash follicle; commonly caused by staphylococcus.
17
Q
Sx of Stye:
A
- painful red hot lump
- point outwards causing localised inflammation
18
Q
Define Chalazions:
A
Abscess of meibomian gland which then becomes blocked causing Chalazions.
19
Q
Sx of Chalazions:
A
- initially painful but then develops into a non-tender lump that points inwards.
20
Q
Tx of Styes and Chalazions:
A
- warm compress
- analgesia
- topical abx
- surgical drainage
21
Q
Define Cataracts:
A
Opacity in lens which is caused by the denaturation of the lens proteins
22
Q
Risk Factor of Cataracts:
A
- > 65 yrs
- congenital
- smoking
- DM
- corticosteroid use
- etoh
- UV/ trauma
- Hx of eye surgery
- radiation
23
Q
Sx of Cataracts:
A
- gradual painless loss of vision
- difficult reading/ watching TV
- difficulty recognising faces
- haloes around lights esp around nighttime
- kids may squint
24
Q
Signs of Cataracts:
A
- loss of red reflex
- brown/ white appearance of lens upon slit-lamp biomicroscopy
25
Complications of Cataracts:
* endophthalmitis
* pos. lens capsule opacification
* oedema
* retinal detachment
26
Management of Cataract:
* surgical = phacoemulsification with topic anaesthetic
* kids under general anaestetic
27
Define Optic Neuritis:
Inflammation of the optic nerve, common in women.
The inflammation triggers t-cell activation which pass through BBB causing hypersensitivity reaction against neuronal structures.
28
Causes of Optic Neuritis:
* demyelinating lesions (MS)
* autoimmune disorders
* infections
29
Sx of Optic Neuritis:
* visual loss
* periocular pain
* dyschromatopsia (color discrimination difficulty)
30
Management of Optic Neuritis:
1st IV METHYLPREDNISALONE
31
Risk Factors of Hypertensive Retinopathy?
HTN
DM
Black
Older age
32
Sx of Hypertensive Retinopathy:
* sudden vision loss
* blurred vision
* floaters in visual field
33
Classification of Hypertensive Retinopathy?
Grade I
* vascular attenuation
* narrowing of the retinal arteries
Grade II
* I + AV nipping
Grade III
* II + retinal Haemorrhage + cotton wool spots
Grade IV
* III + optic nerve oedema + silver wiring
34
Management of Hypertensive Retinopathy?
* BP control
* lifestyle
* laser photocoagulation (macular oedema/ neovascularization)
* VEGF inhibitors
35
Define Diabetic Retinopathy:
Vascular occlusions and leakage from capillaries that supply the retina, causing retinal ischaemia, neovascularization and potential loss of sight.
36
Classification of Diabetic Retinopathy:
NON PROLIFERATIVE DIABETIC RETINOPATHY
* Mild: microaneurysms + dot haemorrhages
* Moderate: MILD + blot haemorrhage, cotton wool spots, hard exudates
* Severe: beaded veins, extensive retinal haemorrhages
PROLIFERATIVE DIABETIC RETINOPATHY
* Neovascularization, fibrous proliferation of retina/ vitreous meaning increased risk of vision loss
37
Sx of Diabetic Retinopathy:
* floaters/ dark spots in vision
* blurred/ distorted vision
* difficulty seeing at night
* sudden loss of vision
38
Management of Diabetic Retinopathy:
* optimise blood glucose control
* laser photocoagulation
* anti-VEGF (intravitreal injections)
* Vitrectomy
39
Complications of diabetic Retinopathy:
* vitreous haemorrhage
* tractional retinal detachment
* macular oedema
* neovascular glaucoma
* Blindness
40
Sx of Conjunctivitis:
General sx:
* red eye
* itchy
* irritation
* teary
* discharge
* photophobia
Viral:
* unilateral
Bacterial:
* purulent discharge
* eyelids stuck together
* Staph. epidermis
41
Causes of Conjunctivitis
Allergic:
* Type I hypesensitivity reaction
* pollen/ dust/ pet
Virus:
* adenoviris, HSV
* URTI/ colds
Bacterial:
* staph a.
* strep p.
* Haemophilus influenzae
* STIs
42
Tx of Conjunctivitis:
Allergic:
* avoid triggers
* artificial tears
* topic anti-histamines
* mast cell stabilizers (topical sodium cromoglycate)
Viral:
* self-limiting
* hygiene
Bacterial:
* Topical abx- Chlorophenicol
43
Define Bacterial Keratitis:
999- sight threatening
bacterial infection of the Cornea
44
Causes of Bacterial Keratitis:
* minor trauma to cornea
* contact lens use = pseudomonas
* ocular surgery
45
Sx of Bacterial Keratitis:
* pain
* foreign body sensation
* tearing/ purulent discharge
* red eye
* corneal ulcer
46
Tx of Bacterial Keratitis:
* emergency
* cessation of contact lens use
* topical quinolone/ oral
* Cyclopentolate of analgesia
47
Causes of Herpes Simplex Keratitis:
HSV 1
48
Risk F of Herpes Simplex Keratitis:
* autoimmune
* stress
* UV exposure
49
Sx of Herpes Simplex Keratitis:
* acute pain/ discomfort
* visual distortion
* photophobia
* epiphora (tearing/ dendritic ulcers)
* blindness when severe
50
Tx of Herpes Simplex Keratitis:
* topical acyclovir
* prophylaxis if recurrent with oral acyclovir
* transplant if severe
51
Define Scleritis:
Severe inflammation of the sclera, autoimmune associated (RA/ GP)
52
Define Episcleritis:
Severe inflammation of the episclera
53
Sx of Scleritis:
* red eye
* severe orbit pain
* pain on eye movement
* bluish tinge to white of eye/ necrotising scleritis
* systemic sx
* unilateral
54
Sx of Episcleritis:
* sectoral redness
* tender over inflamed area
* milder pain compared to scleritis
* episcleral vessels blanch when pressed with a cotton bud
* no pain
* bilateral
55
Tx of Scleritis:
* NSAIDs: fluriprofen 100mg TDS)
* corticosteroids (iv methylpred if severe otherwise oral pred)
56
Tx of Episcleritis:
* artificial tears
* supportive
57
Define Age related Macular Degeneration:
This is the leading cause of blindness, degeneration of the photoreceptors in central retina (macula) that leads to the formation of drusen.
58
Risk factors of Age related Macular Degeneration:
* men
* ege
* fhx
* smoking
* CVS risk factors
59
Sx of Age related Macular Degeneration:
* reduced visual acuity (struggle seeing faces)
* variability daily in visual disturbance
* poor vision at night
* photophobia (thickening of lights)
* glare
60
Signs of Age related Macular Degeneration:
* Visual distortion esp. line perception (amsler grid)
* Druse in Dry ARMD= yellow pigmented spots on the retina which collect around the macula
* Subretinal and intraretinal haemorrhages in WET ARMD (red patches around macular)
61
What are the two types of Age related Macular Degeneration:
DRY ARMD:
* most common
* drusen macular thinning
* SLOW PROGRESSION
WET ARMD
* Less common
* Neovascularization: bleeding, leakage of fluid
* rapid progression over fluids
62
What is the Tx of Age related Macular Degeneration:
DRY ARMD
* Zinc and antitoxident vit A, C, E
WET ARMD
* anti-VEGF monthly
63
Define Central Retinal Artery Occlusion (CRAO)
Sudden, painless loss of vision happens over seconds.
Less common than vein occlusion but has a faster rate of vision deterioration.
64
Risk factors for developing Central Retinal Artery Occlusion (CRAO):
* atherosclerosis
* embolism
* inflammatory
* thrombophilla
* carotid bruis
* HTN, DM, AF
* smoking
* hyperlipidaemia
65
Sx of Central Retinal Artery Occlusion (CRAO)
* sudden painless loss of vision
* over seconds
* vision reduced to counting fingers
* hx of amaurosis fugax
* pale retina with cherry red spot on macula
* afferent pupillary defect
66
What is the Tx of Central Retinal Artery Occlusion (CRAO)
* after 90-100 mins, vision is unlikely to improve with tx
* aim is to reperfuse the ischaemia retina
* ocular massage to dislodge embolus
* vasodilation with isosorbide dinitrate
* Ant. chamber paracentesis to reduce IOP to help dislodge embolus
67
What are the risk factors of developing Central Retinal Vein Occlusion:
* age
* smoking
* HTN, DM
* obese
* glaucoma
* myeloma
* factor V leiden
* antiphospholipid syndrome
* Protein S/ c/ antithrombin deficiency
68
Sx of Central Retinal Vein Occlusion:
Sudden painless loss of vision/ visual fields
Stormy sensation fundocope
* Numerous flame haemorrhages
* clot and blot haemorrhages
* cotton wool spots
* retinal oedema
* dilated/ tortuous retinal veins
* visual field defects
69
The management of Central Retinal Vein Occlusion:
* conservative
* retinal neovascularization with laser photocoagulation
* intra-vireal anti-VEGF injections
70
Define Retinoblastoma:
Malignant neoplasm originating from retina
71
Sx of Retinoblastoma:
* failure to thrive
* strabismus
* deteriorating vision
* leukocoria/ white pupil
* eye enlargement
72
Management of Retinoblastoma:
* radiotherapy
* enucleation
* chemotherapy
73
Define Orbital-blow out fracture:
Fractured orbital wall due to a sudden increase in intra-orbital pressure from impact.
Compression in the eye in an antero-pos. direction (orbital floor +/- medial orbit)
74
Causes of Orbital-blow out fracture?
Facial trauma
75
Sx of Orbital-blow out fracture:
* pain esp on eye movement
* swelling/ bruising
* visual disturb : diplopia
* reduced eye movement
* numb at the infra-orbital nerve
* HALLMARK= restriction of upward gaze and vertical diplopia
76
Management of Orbital-blow out fracture:
* ophthal referral
* abx prophylaxis
* surgery
* nasal decongestants
* ice packs
* "don't blow nose"
77
Define Orbital Cellulitis:
999
infection of the structures behind the orbital septum.
78
Sx of Orbital Cellulitis:
* periocular pain/ swelling
* fever, malaise
* red, swollen sore eyelid
* chemosis
* proptosis
* restricted eye movement +/ diplopia
79
Tx Orbital Cellulitis:
Admit IV abx
80
Define Pre-septal Cellulitis:
Common in kids <10 yrs
infection of the tissue anterior to orbital septum
81
Sx of Pre-septal Cellulitis:
* no proptosis
* normal eye movement
* no chemosis
* normal optic nerve function
82
Tx of Pre-septal Cellulitis:
* young/ unwell = admit IV abx
* systemically well = oral abx with daily outpatient f/u
83
What are the risk factors of developing Pre-septal Cellulitis/ Orbital Cellulitis?
* Trauma
* sinus disease
* other facial infections
* surgical
84
Sx of Corneal Abrasion
* no FB visible
* irritation
* photophobia
* lacrimation
85
Tx of Corneal Abrasion:
* Oral analgesia
* Reg abx ointment
- Non Cl wearer = Chlorophenicol
- CL wearer = g.moxifloxacin
* eye patch to seal eyelid close
* to dilate pupils
- 1% cyclopentolate (reduced iris spasms)
- 0.1% diclofenac 1 drop
85
Sx of Corneal Foreign Body:
pain of blinking
86
What are the type of Corneal Foreign Body:
* Conjunctival FB = dust/ grit blown into eye via wind: lower fornix
* Subtarsal FB = stuck under eyelids
87
Tx of Corneal Foreign Body:
* evert eyelid and remove with cotton bud + topical abx and fusidic acid
* if unsuccessful to remove FB
- irrigate eye
- local anaesthetic eye drops + slit lamp + remove with 25G needle from the side
* Topical abx:
- non CL wearer = CPL QDS 7/7
- CL wearer = g.moxifloxacin
88
Sx of Globe Rupture:
* pain
* loss of vision
* diplopia
89
SIgns of Globe Rupture:
* retinal damage
* choroid damage
* lens discoloration
* ocular herniaition
* distorted shape of globe
90
Tx of Globe Rupture:
* no eye patch
* use polystyrene cup
* antiemetics
* abx
* tetnus prophylaxis
* send for ophthal
91
Define Retrobulbar Haemorrhage:
* accumulation of blood in retrobulbar space
92
Management of Chemical Burns:
* immediate referral to acid and alkali burns
* check toxobase and irrigate with lukewarm saline until pH of tears id 7.4.
93
Causes of Retrobulbar Haemorrhage:
* orbital trauma
* anticoagulation
* arteriovenous malformation
* posy-eye surgery
93
Sx of Retrobulbar Haemorrhage:
* Pain
* pre-orbital echymosis
* eyelid hematoma
* proptosis
* visual loss
* subconjunctival haemorrhage
* n+v
94
What is the management of Retrobulbar Haemorrhage:
* 1st surgery:
- lateral canthotomy
* IV acetozalamide 500mg
* IM/ IV hydrocortisone 100 mg
94
Complications of Retrobulbar Haemorrhage:
* orbital compartment syndrome
* optic nerve ischaemia
* blindness
95
Risk Factors of Penetrating Eye Injuries:
* metal
* work involving metals
* not wearing protective goggles
96
Signs of Penetrating Eye Injuries:
97
Tx of Penetrating Eye Injuries:
* analgesia
* tetnus prophylaxis
* IV abx
* IMMEDIATE REFERRAL DO NOT TRY TO REMOVE
98
What is Arc (Welder's eye)
Snow Blindness
99
Risk factors of Welder's eye:
* climbers
* skiier
* welders
* sunbed users
* not wearing protective goggles
100
Sx of Welder's eye:
* UV light = superficial keratitis
* pain
* watering
* Blepharospasm
101
Management of Welder's eye:
* 1 drop 1% cyclopentolate/ 0/1% diclofenac B/L
* eye pad
* oral analgesia
* don't drive
* 24 hr f/u
102
Define Retinal Detachment:
A medical condition that refers to the separation of the retina from the retinal pigment epithelium.
103
What is the most common type of Retinal Detatchment:
* Rhegmatogeous Retinal detachment caused by trauma
104
What are the risk F of Retinal Detachment
* age >40 yrs
* severe myopia
* hx retinal eye surgery
* trauma
* SCD
105
Sx of retinal detatchment:
* floaters
* photopsia (flashes of light)
* progressively and rapidly declining visual acuity and visual field loss
* painless usually
106
Tx of Retinal Detatchement:
* laser therapy/ cryotherapy
* vitrectomy
* scleral bucking
* Pneumatic retinopexy
107
FCM
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