Ophthalmology Flashcards by becky Greenbury

What are the main causes of sudden loss of vision?

Non-arteritic anterior ischaemic optic neuropathy (NAION)
Giant cell arteritis
Acute angle-closure glaucoma
Retinal detachment

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What causes acute angle-closure glaucoma?

Blocked drainage of aqueous humour from anterior chamber via canal of Schlemm

iris could be pushed forward against trabecular meshwork
pupil block

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What are the signs and symptoms of acute angle-closure glaucoma?

Unilateral sudden vision loss
PAIN
Unilateral red eye
Haloes around lights
Headache
N+V
Fixed, dilated, oval-shapedpupil
Eye may feel hard
Cloudy cornea (due to oedema)
Raised IOP (greter than 60mmHg)
Hypermetropia
Closed angle
Symptoms worse in dark

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What are the risk factors for acute angle-closure glaucoma?

Hypermetropia
Family Hx
Narrow anterior chamber
Middle aged
Race (Asian)
Female

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What is the treatment for acute angle-closure glaucoma?

Pilocarpine (to cause miosis)
Acetazolamide (reduces formation of aqueous)
Timolol (to reduce pressure)
Apraclonidine (to reduce pressure)
Peripheral iridotomy

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What are the 3 types of retinal detachment?

Serous (fluid collects between neurosensory retina and retinal pigment epithelium)
Rhegmatogenous (retinal tear when vitreous passes through tear and separates retinal layers)
Tractional (retinal scar tissue contracts and pulls retina off retinal pigment epithelium)

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What are the signs and symptoms of retinal detachment?

Floaters
Photopsia (flashing lights)
Visual field loss
Visual acuity loss (if fovea affected)

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What are the risk factors for retinal detachment?

Myopia
Retinal detachment in other eye
Poorly controlled diabetes
Trauma

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What are the ophthalmological signs and symptoms of giant cell arteritis?

Sudden painful monocular vision loss
Swollen optic disc
RAPD
Flame haemorrhages
Cotton wool spots

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What are the risk factors for giant cell arteritis?

Female
Polymyalgia rheumatica
Over 50 years old
Scandinavian

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What are the signs and symptoms of non-arteritic anterior ischaemic optic neuropathy?

PAINLESS, monocular sudden loss of vision
Swollen optic disc
RAPD
Splinter haemorrages
Altitudinal visual field defect

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How is NAION treated?

Treat CV risk factors

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What are the risk factors for NAION?

Male
Hypermetropia
Hypertension
40-60 years old
Diabetes

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What are the common causes of acute red eye?

Infection:

Corneal ulcer, infective keratitis
Conjunctivitis
Endophthalmitis

Inflammation:

allergic conjunctivitis
episcleritis
scleritis
anterior uveitis

Trauma:

Corneal abrasion
Subconjunctival haemorrhage

Other:
-Acute angle closure glaucoma

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What is the anterior uvea?

The iris and the ciliary body

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What are the signs and symptoms of anterior uveitis?

PAIN
Photophobia
Blurred vision
Circumcorneal redness
Small pupil (initially)

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Which investigations are done in anterior uveitis?

Talbot’s test: Increased pain on convergence of eyes

Slit lamp test: Hypopyon (sterile anterior chamber pus)

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Which conditions are associated with anterior uveitis?

Ankylosing spondylitis
Inflammatory bowel syndrome
Sarcoidosis
Infections (syphilis, TB, HSV, HZV)

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What is the treatment for anterior uveitis?

Prednisolone drops

Cyclopentolate (to dilate pupil to prevent adhesions between lens and iris)

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What is visual acuity like in:

1) conjunctivitis
2) anterior uveitis
3) acute glaucoma

1) normal
2) reduced
4) reduced

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What is the pupil size in

1) conjunctivitis
2) anterior uveitis
3) acute glaucoma

1) normal
2) small
3) large

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What is the IOP like in

1) conjunctivitis
2) anterior uveitis
3) acute glaucoma

1) normal
2) normal
3) increased

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What is the cornea like in

1) conjunctivitis
2) anterior uveitis
3) acute glaucoma

1) normal
2) normal
3) hazy

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Is photophobia present in:

1) conjunctivitis?
2) anterior uveitis?
3) acute glaucoma?

1) Yes
2) Yes (lots)
3) No

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Is there pain in: 1) conjunctivitis? 2) anterior uveitis? 3) acute glaucoma?

1) Yes/No 2) Yes 3) Yes (lots)

How is keratitis identified?

A white area on the cornea (collection of WBCs in corneal tissue)

What kind of keratitis is there?

Bacterial | Viral (HSV)

What can keratitis lead to?

Corneal perforation

How is corneal ulceration identified?

``` Fluorescin drops (corneal lesions stain green) Blue light shone tangentially across eye ```

What can corneal ulceration be caused by?

``` Bacteria Viruses (herpes) Fungi Protozoa (acanthamoeba) Vasculitis (in RA) ```

What is the treatment for corneal ulceration?

Chloramphenicol | Aciclovor

What is a dendritic ulcer?

HSV corneal ulcer | Signs: Photophobia, eye watering

What is episcleritis?

Inflammation below conjunctiva in episclera Engorged vessels can be moved over the area Sclera may look blue under engorged vessels

What is the cause of episcleritis?

Usually idiopathic | May occur in rheumatic fever or SLE

What are the symptoms of episcleritis?

Acute onset of grittiness Normal visual acuity Localised redness of eye No discharge

What are the signs and symptoms of scleritis?

Localised diffuse scleral hyperaemia Tender Pale areas within red zone= necrotising scleritis Oedema of conjunctiva

What is the cause of scleritis?

50% idiopathic | 50% with systemic associations (SLE, RA..)

How do bacterial conjunctivitis, viral conjunctivitis and allergic conjunctivitis differ in presentation?

Bacterial: mucopurulent discharge Viral: Follicles, watery discharge Allergic: Papillae

Is conjunctivitis usually unilateral or bilateral?

Bilateral

What is the most common cause of neonatal conjunctivitis?

Chlamydial

What is chalaizon?

Condition caused by inflammation of meibonium glands with secondary lipogranulomatous inflammation More common in pts with seborrheic dermatitis and acne rosacea

How should corneal ulcers be managed?

1. Smear for Gram stain 2. Conjunctival swab to blood agar 3. Corneal scrape 4. Request cultures

Which questions to ask a patient with sudden loss of vision?

Headache associated? Eye movements hurt (optic neuritis) Lights/flashed before vision loss (retinal detachment) Like a curtain descending (amaurosis fugax) Poorly controoled diabetes?

What are the causes of gradual loss of vision?

``` Cataracts Age-related macular degeneration Open-angle glaucoma Diabetic retinopathy Hypertension Optic atrophy Slow retinal detachment Choroidal melanoma ```

What is the difference between wet and dry macular degeneration?

Dry- drusen and degenerative changes at the macula Wet- vessels grow from choroid into neurosensory retina and leak. Visual distortion=key feature. Rapid visual deterioration.

What are the risk factors for age-related macular degeneration?

``` Old age Smoking Hypertension UV Hypercholesterolaemia ```

Does age-related macular degeneration affect central vision or peripheral vision?

Central

Which investigations are done to diagnose age-related macular degeneration?

Fluorescin angiography | Optical coherence tomography

What is the treatment and management of age-related macular degeneration?

Laser photocoagulation Intravitreal anti-VEGF treatment (Ranibizumab, Pegaptanib, Bevacizumab) Intravitreal steroids (Triamcinolone) Vitamin C+E supplements

What does central retinal artery occlusion or retinal vein occlusion cause?

Sudden painless loss of vision

What are the risk factors for the development of open angle glaucoma?

``` Raised IOP Family history of glaucoma Age Diabetes Myopia Race- Afro-Caribbean ```

What are the signs and symptoms of open angle glaucoma?

``` Gradual painless loss of peripheral visual field Optic nerve head damage (disc cupping) Raised IOP Bilateral, but often asymmetric Normal blind spot with scotomas ```

How is IOP measured?

Tonometry

What is the treatment for open-angle glaucoma?

Suppressing aqueous formation - Beta blockers - carbonic anhydrase inhibitors - alpha antagonists Increasing aqueous outflow -prostaglandin analogues Laser therapy to open up trabecular meshwork Claucoma filtration surgery

What are the signs and symptoms of CHRONIC angle-closure glaucoma?

Raised IOP Cupped optic disc Arcuate scotoma

What is the treatment of chronic angle-closure glaucoma?

Surgery to strip peripheral anterior synechiae | Betablocker eye drops= first line

What are risk factors for cataracts?

Diabetes | Steroid use

What is the treatment for cataracts?

Phacoemulsification surgery

What are congenital cataracts linked to?

Maternal infection | Familial

What are early-onset cataracts linked to?

``` Systemic disorders e.g. diabetes Trauma Corticosteroids Inflammatione e.g. uveitis Down's syndrome, Dystrophia myotonica ```

What are the 3 different types of cataract?

1. Nuclear 2. Posterior sub capsular 3. Cortical

What are dendritic ulcers associated with?

Corneal ulceration

What is the treatment for a chalaizon

Apply heat and massage

What are the possible causes of monocular diplopia (i.e. patient complins of diplopia when looking to the left. Dipolopia persists when closing the right eye but resolves when the left eye is closed)

Cataract | Corneal scar

What are the causes of proptosis?

Grave's disease (can be bilateral or unilateral) Retro orbital tumours Aneurysms Trauma

What is the most common cause of sudden onset diplopia?

6th nerve palsy

What are the signs of esotropia (convergent strabismus)?

eye will turn outwards when the other eye is covered

What are the signs of exotropia (divergent strabismus)

eye will turn in wards when the other eye is covered

Which drugs can induce angle closure glaucoma in presdisposed individuals?

Nebulised ipratropic | Antidepressants (anti-muscarinic effect--> pupil dilatation)

Ophthalmology Flashcards

(69 cards)