Ophthalmology 2 Flashcards by John Darlington

In addition to the ptosis, anhidrosis and miosis what other feature may be seen in Horner’s syndrome?

Enophthalmos
- posterior displacement of the eye

Iris heterochromia

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How does fundoscopy of the eye appear when there is a central vein occlusion?

Like a Cheese and tomato pizza

oedema
Optic disc swelling
Dilated vessels
Haemorrhages

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How is episcleritis differentiated from scleritis?

Pain
- scleritis is painful

*both may have watering and visual changes

Treated with NSAIDs

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What investigation should be done into orbital cellulitis to assess degree of spread/ complications?

Contrast enhanced CT of:

orbit
sinuses
Brain

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What are the different types of amblyopia in children?

Strabismic

esotropia
Exotropia

Refractive
- long/ short sighted

Deprevitional
- cataracts

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What is it called when there is a complete cure of the squint via glasses?

Fully accommodative squint

A partially accommodative squint is when there is still some squint even after glasses.

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When is the red reflex carried out in babies, and list some differentials for leukocoria:

New-born baby check and 6 week baby check.

Cataracts
- most common

Retinoblastoma

Congenital syphilis - scarring of the cornea

Toxoplasmosis
- congenital cataracts

Uveitis

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What eye pathology is seen in NF-1? and in Down syndrome?

Lisch nodules
- iris hamartomas

Down syndrome:
- Brushfield spots

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What is the most common cause of viral keratitis and how does it present?

HSV -1

Dendritic pattern
*may be vesicular to begin with

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List some symptoms the patient may experience with cataracts:

Blurring of vision

Dazzling of light
- especially at night

Myopia of vision

use their reading glasses less
the lens focuses the light more

Squint / nystagmus

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Which medication given for acute angle glaucoma causes eye lashes to lengthen?

Latanoprost

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What is the treatment for anterior uveitis and name a common disease it is associated with:

Topical steroids
+
Cycloplegics such as cyclopentolate

Associated with Ulcerative colitis

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What is the definitive diagnostic investigation for acute closed angle glaucoma?

Tonometry will be the one that establishes pressure

Gonioscopy
- allows differentiation between open and closed angle glaucoma

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What is surgery carried out for acute closed angle glaucoma?

Laser Iridotomy

- small hole into the iris allowing an alternative route for aqueous humor to leave

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During a visual acuity testing, when the patient looks through the pinholes and vision improves - what is this suggestive of?

Refractive error

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How should anisocoria be assessed? and what do some findings suggest?

Assessed in light and dark

Smallest in dark pupil in dark is pathological one

Largest in the light is the abnormal one

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List some causes of absent light reflex on fundoscopy:

Dense cataracts
Retinal detachment
Vitreous haemorrhage
Tumour

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How can you identify true strabismus in a child’s eye?

Where the light reflects
- it should reflect equally in the pupils.

*note you can get a pseudostrabismus where the reflection of light is equal but cause of epicanthal folds it may appear like stabismus

Cover test

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What are some risk factors and investigations should be done into retinal detachment?

Risk factors:

Trauma
DM
Previous cataract surgery
Myopia
Retinopathy of prematurity

Investigations:
Slit lamp examination

OCT

B-Scan - ultrasound scan

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Define tropia and phoria:

tropias are when the eyes are squint even when trying to focus on the same target.
- can be brought on by cover test

phorias are misalignment brought on when the eyes stop synchronising together to focus on the same thing. in other words, the only reason they are no tropia is because the muscles are focusing it.
- brought on by cross cover test

Basically this demonstrates if the squint is paralytic or not. if when covering the good eye, the squint eye realigns - it tells you its not paralytic.

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What is it called when the lens loses its accommodative capacity?

Presbyopia

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What are the medical terms for lens, artificial lens and lens removal?

Phakic

Pseudophakic

Aphakic

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Before dilating ones eyes what must first be checked?

Study These Flashcards

Intraocular pressures

What is the surgery done for cataracts and what are some potential complications?

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Phacoemulsion + intraocular lens inplacement

Complications:

Endophthalmitis
Posterior capsule thickening
Acute angle glaucoma
retinal haemorrhage

What does a vertical anopia suggest?

A neurological cause to the loss of vision Horizontal vision occlusion is much more suggestive of a retinal defect. i.e. retinal detachment is more likely to cause horizontal vision loss

In a >40 year old with unilateral optic nerve swelling what is the biggest cause?

GCA

List some investigations that should be done into central artery occlusion:

``` Bloods: - CRP - ESR (thinking GCA) - lipids - coagulation *consider other causes of stroke ``` X-rays: - temporal US - Carotid US - echocardiogram (clots thrown off) ECG - A fib?

What is the most common cause of central retinal vein occlusion and how is it managed?

HTN Atherosclerosis Glaucoma polycaethemia Investigation: - Fluorescein Angiography - OCT - Slit lamp examination ``` Treatment: - control HTN - VEGF injections +/- - intra-ocular steroids to control macular oedema ``` *it is the macular oedema which causes the vision loss

What is the diagnostic investigations for vitreous haemorrhage? and what are the two main causes?

B scan - diabetes - trauma

What is called when there is blood in the anterior chamber of eye?

Hyphema

What is the differentials for a fixed dilated pupil?

Mydriatics - tropicamide Iris trauma Acute glaucoma CN3 compression/ palsy

What is the condition associated with a non-responsive constriction to light and sluggish accommodative reflex? name some other features and the systemic syndrome:

Holme's Adie - pupil. - worm like movements of iris on slit lamp (small parts of iris trying to dilate) - Tonic - failure to constrict to light and slow to accommodation - usually unilateral becoming bilateral Holme Adie Syndrome - Holme's adie pupil - low BP - loss of reflexes

What is the diagnostic investigation into glaucoma and what is the investigation to differentiate between open and closed?

Tonometry - goldman application Gonioscopy - to differentiate

What are the features of anterior uveitis and what conditions is it associated with? What is management?

``` Small - irregular shaped pupil Posterior synechia Keratic precipitates Hypopyon Ciliary flush ``` Causes: - Seronegative arhropathies - Bechets - inflammatory bowel disease - TB - syphilis Management: - refer same day to ophthalmology - investigate cause * topical steroids * cycloplegics to prevent iris and lens adherence (synechia)

What is seen on fundoscopy of a central retinal artery occlusion?

Pale retina with red cherry fovea - which retains its redness since it is usually avascular structure

What are the 4 F's and P to retinal tear?

``` Floaters Flashes Field loss Fall in acuity Painless ```

What is the organism that causes keratitis in those with contact lenses, typically contracted from swimming pools?

Acanthamoeba

What is the management of central retinal artery occlusion?

``` If within the first 100mins then the aim is to increase ocular blood flow. This includes: - ocular massage - surgical removal of aqueous humour - Intraocular hypotensive treatment ```

What vision loss is expected in ARMD?

Central vision | - the macula is affected

What testing can be done to test for visual distortion in wet macular degeneration?

Amsler grid

What are the treatment options for wet Macular degeneration?

Photocoagulation intra-ocular Anti-VEGF injections Antioxidant vitamins - Vitamin C, + Zinc

What are the risk factors for chronic open angle glaucoma?

``` Family history Black afro Caribbean >35 years old Steroid use Myopia ```

What is the most common cause of blindness world wide?

Trachoma - form chlamydia followed by cataracts

What are the visual changes that occur in cataracts?

Increasing myopia Blurring of vision dazzling of light at night Yellowing of vision *children may have nystagmus

What is the surgery for cataracts and list some potential complications:

Phacoemulsion + lens replacement Side effects 1%: - anterior uveitis - retinal detachment - vitreous haemorrhage - Endophthalmitis

Define entropion and ectropion:

Entropion - lid turns inwards Ectropion - lid turns outwards risking keratitis - usually lower lid, associated with aging and nerve palsies

In ptosis which muscle is weak?

Levator palpebrae superioris

What is the name of the tissue which can grow from the cornea across the eye obstructing vision?

Pterygium Assocaitted with wind and sun exposure

What are the signs of a carotid- cavernous fistula?

Engorgement of eye vessels Lid and conjunctiva oedema Pusatile exophthalmos eye bruit

What is the correction for myopia?

Concave lenses

List some causes of floaters and flashes:

Floaters: - Retinal detachment - Vitreous haemorrhage - Hypertensive crisis - Old retinal vein occlusion Flashes: - Retinal detachment - migraine - intracranial pathology

How is chlamydia trachoma spread and what is the treatment?

Spread by flies which causes infection under the lids causing scarring and entropion leading to blindness. Treatment: - Tetracycline ointment + oral tetracycline

Name some drugs used in ophthalmology which are anti-muscarinics and what is an important fact about them?

Tropicamide Cyclopentolate - paralysing agent there is loss of pupillary light reflex *this drug is a mydriatic

Name some drugs used in ophthalmology which are sympathometics and name an important fact about them:

Para-hydroxyamphentamine Phenylephrine * there is no loss of pupillary light reflex. * this drug is a mydriatic

Name some drugs which can be used to diagnose and localise horners syndrome:

Topical hydroxyamphetamine - will promote release of noradrenaline. if the 3rd order neuron is not the one damaged it will release its noradrenaline and cause dilation. localising the lesion to the 1st or 2nd order neuron Topical Apraclonidine -alpha 2 agonist. Will cause dilation of the horner's eye and constriction of the normal eye.

Name a miotic drug and its class:

Pilocarpine | - muscarinic agonist

What is the most common inherited cause of blindness, how does it present?

Retinitis Pigmentosa - usually AR, but AD and x-linked exist Loss of peripheral vision Tunnel vision Night blindness

Ophthalmology 2 Flashcards

(57 cards)