Ophthalmology Flashcards
(208 cards)
1
Q
what is the pathogenesis of diabetic eye disease
A
hyperglycaemia and htn ->
biochemical/haemodynamic pathways result in microvascular occlusion and leakage
2
Q
how are patients with diabetes managed by ophthalmology
A
arrange annual fundoscopy and retinal photography
refer to ophthalmology if preproliferative changes or near the macula
3
Q
if presymptomatic screening of diabetic retinopahty is undertaken, what can be done to manage it
A
laser photocoagulation to prevent angiogenesis
4
Q
what are the three stages of diabetic retinopathy
A
1) background retinopathy
2) preproliferative retinopathy
3) proliferative retinopathy
5
Q
what are the features of background diabetic retinopathy on examination of the retina
A
- microaneurysms (dots)
- haemorrhages (blotes)
- hard exudates (lipid deposits)
6
Q
what are the features of preproliferative diabetic retinopathy on examination of the retina
A
- cotton wool spots (infarcts)
- haemorrhages
- venous beading
7
Q
what are the features of proliferative diabetic retinopathy on examination of the retina
A
new vessel formation, rubeosis iridis
8
Q
when should you suspect maculopathy in diabetic patients
A
reduced visual acuity
9
Q
how is maculopathy managed in diabetic patients
A
prompt laser, intravitreal steroids and anti-angiogenic agents may be needed in macular oedema
10
Q
what are the cataract types you would get in diabetic patients
A
juvenile “snowflake” or “senile”, occur earlier in diabetics
11
Q
what is rubeosis iridis
A
new vessel formation on iris , which occurs late and may lead to glaucoma
12
Q
what is the medical management for diabetic retinopathy
A
1) primary medical: good glycaemic control, bp, lipid control
2) antiplatelet
protein kinase c inhibitors
aldose reductase
gh/insulin like gf inhibitor
13
Q
what is the surgical management for diabetic retinopathy
A
- retinal laser
- laser photocoagulation
- intravitreal injection of vegf for maculopahthy
- vitrectomy for vitreal haemorrhage
14
Q
describe the afferent/efferent pathway for pupil reflexes
A
- afferent pupillary fibres travel with the rest of the retinal fibres but leave the pathway just before the LGN
- synapse with pretectal nucleus
- from here the fibres travel to BOTH edinger-westphal nuclei
- they synapse with the efferent pupillary fibres which travel from the CNIII nucleus to the ciliary ganglion via the CNIII to the sphincter pupillae
15
Q
what happens in completely damaged optic nerve when shining a flashlight into it
A
no direct or consensual response if light on affected eye
direct and consensual response when light shone on the normal eye
16
Q
what happens when light is shone into an eye with an incompletely damaged optic nerve
A
sluggish response from afferent system or affected eye but normal response of unaffected eye
17
Q
describe RAPD testing with the swinging flashlight test
A
when light is swung onto normal eye, there is direct and consensual response (as efferent system is still intact in the affected eye)
but when light swung onto affected eye the pupil carries on dilating rather than constrict because the efferent system of the affected eye is overpowered by the intact system of the normal eye which demands dilation due to it being in the dark
18
Q
list the causes of RAPD
A
- optic neuritis (e.g. ms, infection)
- optic nerve tumours, trauma, pressure, glaucoma
- severe retinal pathology e.g. detachment, central retinal artery/vein occlusion
19
Q
how are the recti muscles of the eye arranged
A
they form a fibrous cuff around the optic canal and attahc anteriorly at the sclera
20
Q
which artery does the central artery of the retina come from
A
ophthalmic artery
21
Q
where do ophthalmic veins drain into
A
cavernous sinus
22
Q
what is the presentation of a sixth nerve palsy
A
Esotropia of the affected eye, with inability to abduct the eye.
Binocular diplopia worse in the direction of the impaired muscle
Patient may turn their head towards the direction of the impaired field
23
Q
what are the causes of 6th nerve palsy
A
- microvascular: htn, diabetes
- macrovascular: stroke
- acoustic neuroma
- acute petrositis
- raised ICP
24
Q
what is the presentation of 4th nerve palsy
A
Vertical diplopia - difficulty walking downstairs
Hypertropia of affected eye
Hypertropia worse on opposite gaze therefore tilt head away from affected side
25
which muscles does the 3rd nerve supply
sr, ir, mr, io
lps
sphincter pupillae (parasymp)
26
what is the presentation of a 3rd nerve palsy
Ophthalmoplegia of affected supplied nerves
| Affected eye is down and out, pupil may be dilated, ptosis
27
explain the importance of pupil involvement in the 3rd nerve palsy
it is more worrying if pupil is involved with 3rd nerve palsy (dilation) as the parasympathetic fibres that control constriction run on the outside of the nerve. Therefore, if the nerve is being compressed externally e.g. aneurysm or tumour, it will involve the pupil via more worrying causes
if pupil not involved, less dagnerous paralysis of nerve from ischaemia (e.g. diabetes, or htn)
28
when are swollen optic discs termed papilloedema
when known/proven raised icp is also present
29
what are the visual symptoms of papilloedema
enlarged blind spot, transient loss of vision esp when bending forward (and back again)
30
what are the factors associated with idiopathic intracranial htn
obesity, pregnancy, ocp, tetracycline
31
how s idiopathic intracranial htn diagnosed
mri/ct normal
| increased opening pressure on LP
32
what is the treatment of idiopathic intracranial htn
diamox (acetazolamide), optic nerve decompression, neurosurgical shunts
33
what are the symptoms of optic neuritis
- unilateral gradual visual loss
- loss of colour vision
- pain on movement of the eye
34
what are the causes of optic neuritis
MS most commonly, viral infection, granulomatous inflammation (TB, sarcoid, syphillis)
35
what is the treatment for optic neuritis
Observe vision, as it recovers with MS over 2-3 months
?do MRI
if other treatable cause, manage underlying infection/inflamm etc.
36
describe intranuclear ophthalmoplgia, and why is occurs
Weakness of adduction of the eye and horizontal jerk nystagmus of abducting other eye.
This is because there is a lesion to the MLF (medial longitudinal fasciculus) which connects cniii and cnvi on opposite sides. hence there is a disconnection between conjugate movement of lateral gaze of the eyes.
Impaired adduction of on eye and the other abducting eye experiences nystagmus
37
what is the most common cause of intranuclear opthalmoplegia
MS
38
which part of the orbit is most commonly affected by orbital blowout #
medial wall, or floor of the orbit
39
what are the types of deformity that result from orbital blowout #
- open door type which is large, displaced and comminuted. it may cause the eye to "sink" downwards in the socket (hypotropia)
- trapdoor tupe which is hinged and minimally displaced. Can entrap extraocular nerves and muscles
40
what are the characteristics of blowout fracture on examination, apart from sigs of trauma
double vision, sunken ocular globes, loss of sensation to upper cheek/lip
entrapment can cause painful eye movements, diplopia etc
41
which nerve can be damaged in orbital blowout fracture causing characteristic sensory loss
infraorbital nerve
42
what is the management of an orbital blowout fracture
may be left alone for up to two weeks to either resolve spontaneously or swelling to go down.
surgery can provide relief from sunken eye, diplopia, entrapped muscle etc.
43
what are the jobs of the cornea
- maintain transparecny to look through
- protect eye - corneal reflex
- refraction of light
44
list the 5 layers of the cornea
- epithelium
- bowmans layer
- stroma
- descemets layer
- endothelium
45
what type of epithelium is the corneal
non keratinised squamous
46
how does the cornea repair after damage
migration of cells from the periphery and basal layer when damaged. corneal stem cells at limbus
47
what does corneal oedema appear like
visible lines in the stroma (striae). These are visible stromal lamellae. hazy
48
once which corneal layer is breached, does corneal scarring occur
bowmans layer
49
what will happen if there is damage/cellular loss in the endothelium layer of the the cornea
corneal oedema and poor vision
50
describe the pupil reflex pathways
1) afferent pupillary fibres travel with the rest of the retinal fibres but come off just before the LGN
2) synapse at the pretectal nucleus
3) from here the fibres travel to both the edinger-westphal nuclei (CNIII)
4) then efferent fibres leave the edinger westphal nuclei and travel to the ciliary ganglion and sphincter pupillae
51
which structures make up the uveal tract
iris, ciliary body and choroid (pigmented and vascular structures)
52
what layers does the choroid lie between
retina and sclera
53
what is the function of the choroid
- allows nerves and vessels to reach the anterior eye
- remove waste products from outer retina
- supplies essential nutrients
54
through which structure does the choroid attach to the retina
bruch's membrane (between choroid and RPE)
55
what is the action of tropicamide on the eye
antimuscarinic - mydriasis
56
what is the action of phenylephrine on the eye
sympathomimetic - mydriasis
57
what is the action of pilocarpine on the eye
muscarinic agonist - miosis
58
what is the pathophysiology of posterior vitreous detachment
with age fluid fills in the potential space between the retina and vitreous - it may then detach from the retina. the detachment can tug on areas where it is attached to the retina, and predispose to retinal detachment
59
what are the symptoms of pvd
floaters and flashing lights (due to tugging on retina causing stimulation)
60
what are the two layers of the retina
- inner neural retina
| - outer rpe
61
what is the retina derived from
optic cup
62
what is the potential space between the two layers of the retina called, and why is it important
```
subretinal space (fuses early in foetal life)
these two layers can separate e.g. by trauma - leading to retinal detachment
```
63
what are the symptoms of retinal detachement
flashing lights, floaters, possible visual field defects
64
what are the firm attachments of the neural retina
optic nerve head posteriorly and ora serrata anteriorly
65
what are the functions of rods and cones in vision
```
rods = contrast vision and motion - not good for detial "black and white vision"
cones = fine detail and colour
```
66
what is the blood supply to the retina
inner 2/3 = central retinal artery
| outer 1/3 = choroidal blood supply
67
how does the blood supply of the macula and fovea differ
macula - dense capillary network
| fovea - capillary free zone - dependent on underlying choriocapillaries
68
what is the appearance of the retina like when there is a central retinal artery occlusion
retina becomes pale and oedematous, with changes being irreversible within 1-2 hours.
Fovea can retain red colour however, and appear as a "cherry red spot" due to being supplied by the choriocapillaris
69
which optic fibres travel through the temporal and parietal lobes
parietal - superior fibres from the retina (which cary information from inferior visual field)
temporal - inferior fibres from the retina (which carry information from superior visual field)
70
at which level are the macula sparing visual field loss
striae cortex
71
what is the pattern of visual loss in ARMD
not complete blindness - just loss of central vision so unable to read/recognise faces/perform some adl's
72
what is charles bonnet syndrome
visual hallucinations in armd patients - NOT a sign of mental illness
73
list the risk factors for armd
- incresing age
- smoking
- caucasian
- concomitant disease e.g. htn, cvd
- genetics
74
what is drusen
hallmark of armd - undigested debris of rpe - yellow-white matter that builds up between the rpe and burch's membrane
75
list the classification of armd
- early
- intermediate
- advanced dry or wet
76
what are the characteristics of early armd
few medium-sized drusen and pigmentary abnormalities
77
what are the characteristics of intermediate armd
1 or more large drusen/numerous mendium sized drusen
| geographic atrophy does not extend to macular centre
78
what are the characteristics of severe armd
can be dry or wet
- dry = non exudative/atrophic drusen _ geographic atrophy extending to macular centre
- wet = exudative, choroidal neovascs equelae, rpaid vision loss
79
describe conversion of dry to wet armd
dr amd -> inflammation -> monocytes + macrophages -> vegf + vegf signalling cascade -> aberrant vessel production and neovascularisation -> wet amd
80
how do you recognise the difference between armd and diabetic maculopathy
- history features
- on fundoscopy - diabetic maculopathy will have other typical changes in the retina of diabetic eye disease, which are not seen on armd.
81
what is the pathophysiology of dry armd
drusen accumulation between the rpe and burchs membrane leads to hypoxia and inflammation. visual loss is caused by atrophy or conversion to wet armd
82
what are the retinal photograph features of dry armd
confluent drusen (soft or hard), central nd paracentral degeneration, geographic atrophy extending to the foveal centre
83
what are the early symptoms of dry armd
mild visual loss
reduced visual acuity
loss of contrast sensitivity
abnormal dark adaptation
84
what are the late symptoms of dry armd
mild occassional metamorphosia (due to presence of drusen)
fluctuating vision
loss of central vision
limited night vision/under poor light
85
what are the diagnostic tests you would perform on a patient with armd
1) contrast sensitivity test, and hue test for colour
2) amsler grid
3) snellen chart (at least 2 lines decline)
4) fundus photography
5) fluoroscein angiography (wet amd)
6) optical coherence tomography (slice image of retina)
86
what is the management of dry armd
- manage cvs risk factors
- stop smoking!
- green vegetables (lutein)
87
what is the pathophysiology of wet armd
abnormal blood vessels are leaky and cause fibrosis and central vision loss
bleeding into and below the retina
88
what is a disciform scar in armd
wet armd causes a disc like scar which represents a portion of the macula that has been permanently damaged
causes scotoma
89
what is scotoma
blind spot in field of vision
90
what are the symptoms of wet armd
loss of visual acuity
decreased contrast sensitivity
metamorphosia
central scotoma
91
what is the treatment of wet armd
anti vegf injections - try and stop aberrant vessel growth
92
give an example of anti vegf that is used in armd
ranibizumab
93
what blood test is important to do in a patient with cataracts
bm's to exclude diabetes mellitus
94
list the different types of cataracts on ophthalmoscopy
- nuclear
- cortical
- anterior and posterior polar
- subcapsular
95
what is the presentation of cataracts
- bluured vision
- loss of stereopsis if unilateral (causing difficulty judging vision)
- gradual loss of vision
- dazzle/glare
- monocular diplopia may be present
96
how may cataracts present in children
squint, loss of binocular function, white pupil, nystagmus/amblyopia in infants
97
when is surgery offered with cataracts
impairing daily living activities, impairing driving, vision <6/12
98
what are the risks of cataract surgery in terms of failure to work 100%
eyes may still suffer from dazzle/glare
distant specs often needed
posterior capsule thickening post opmay seem like "cataract is returning)
astigmatism
irritation and dryness
anterior uveitis
vitreous haemorrhages/detachment/glaucoma
99
what drugs are prescribed for a couple of day post-op use in patients who have had cataract surgery
topical antibiotic and antiinflamms
100
list the risk factors for cataracts
- increasing age
- genetic
- diabetes mellitus
- steroid use (topical/po/inhaled)
- high myopia
- dystrophia myotonica
101
what is performed prior to surgery to choose appropriate lens type for patient
ocular biometry - measures curvature of the cornea and length of eye
102
what is the post op advice for patients following cataract surgery
- come in to eye casualty if red eye/loss of vision
- lubricants
- antiobiotics/antiinflamm
- new specs
- imbalance should sette within a few weeks
- can resume activities next day after surgery
103
what is the window for which congenital cataracts must be treated
4 weeks (to prevent significant deprivation/amblyopia)
104
what screenng would you do in a baby presenting with congenital cataracts
TORCH screen
105
what causes presbyopia
with age, the lens becomes flattened and harder so focusing capacity is reduced
106
what is the name of the suspensory ligaments of the lens, arising from the ciliary body
zonular fibres
107
what is the typical cataract shape in dm
snowflake
108
what is the typical cataract shape in myotonic dystrophy
stellate post capsular
109
what is the typical cataract shape in atopic dermatitis
shield-like ant capsular
110
list some ophthalmological conditions that can cause secondary cataracts
- chronic anterior uveitis (can be steroid induced too)
- acute angle closure glaucoma
- hereditary fundus dystrophies
- high myopia
111
list some factors that may contribute to cataract formation
diabetes, inflamm, trauma, steroid use
112
list the steps for the surgical procedure of cataract removal
1) capsulorrhexis (open front surface of lens)
2) hydrodissection (seperate lens from capsule inro 4 chunks)
3) lens fragmentation - phaecoemulsfication (uss)
4) irrigation and aspiration
5) intraocular lens implantation
113
what is the treatment of post-op posterior capsule opacification in cataract surgery
YAG laser
114
what is a complication during surgery for cataracts
posterior capsular rupture and viterous loss
115
when is red reflex checked for newborns
at 6 weeks
116
define glaucoma
a group of eye conditions that result in progessive optic neuropathy and visual loss
117
define glaucoma
a group of eye conditions that result in progessive optic neuropathy and visual loss
(IOP is a key factor but not always riased)
118
what are the symptoms of closed angle glaucoma
severe eye pain, blurred vision, mid dilated pupil, red eye, nausea
119
is visual loss due to glaucoma reversible
no - what is lost is permanent
120
what are the "3 c's" when looking at the optic nerve head on fundoscopy
- colour
- contour
- cup (cup: disc ratio)
121
where is aqueous humor produced
ciliary processes of the ciliary body
122
where is the outlet of aqueous humor in the eye
drainage angle of the eye - trabecular meshwork + canal of schlemm
123
what is the normal range for iop
10-21 mmhg
124
does high iop always mean glaucoma
no - though it increases risk
125
what is the effect of stimulating the alpha 2 receptor in the eye on ocular pressure
decrease iop by reducing aqeuous production and may increase outflow
126
what is the effect of stimulating the beta 2 receptor in the eye on ocular pressure
stimulation increases iop by increasing aqueous production - therefore give beta blockers
127
what is the name of the visual field test performed in glaucoma
humphrey visual field test
128
what does humphrey visual field test show in glaucoma patients
arcuate scotoma, that obeys the horizontal line
129
what are the surgical options for management of gluacoma
- laser
- trabeculectomy
aim to increase drainage
130
list the main classes of drugs used to treat glaucoma
a-agonists, b-blockers, carbonic anhydrase inhibitors, prostaglandin analogues
131
what is the mechanism of a agonists and b blockers in reducing iop
- a agonists: reduce aqueous production and increased drainage
- b blockers: increase aqueous drainage
132
what is the mechanism of carbonic anhydrase inhibitors in reducing iop
reduce aqueous production
133
what is the mechanism of prostaglandin analogues in reducing iop
increase aqueous drainage
134
what is the typical epidemiology of patients with acute angle closure glaucoma
over 50 y/o, female usually
135
what time of the day is acute angle closure glaucoma most likely to present
evening typically
136
what are the signs on examination of a patient with acute angle closure glaucoma
reduced vision, red eye corneal oedema, fixed mid-dilated pupil, visual halos
(tonometry = increased iop)
137
what does increased cup to disc ratio represent in terms of pathology
loss of nerve fibres
138
what is bayonette sign on fundoscopy
vessels appear misaligned when entering the optic disc, due to increased cup to disc ratio
139
what are there symptoms in early open angle glaucoma
asymptomatic until visual fields are impaired, therefore screening
140
what are the groups that are high risk and therefore screened for glaucoma
- over 40(?) yo
- afrocaribbean
- myopia
- diabetic/thyroid eye disease
141
what is tested for when "screening" for glaucoma
- visual field testing
- document cup:disc ratio
- increased iop
142
what is the benefit of pilocarpine in treatment of glaucoma
miotic - reduces resistance to aqueous flow by "opening angle" with pupil constriction
143
why should you take care with sympathomimetics (e.g. brimonidine) in glaucoma
arrhythmias/htn - be careful due to systemic side effects
144
what is the cause of closure angle glaucoma
blocked flow of aqueous humor via the anal of schlemm
145
what examination would be undertaken in eye casualty to examine the anterior chamber in angle closure glaucoma
gonioscopy
146
which nerve supplies the obicularis oculi
cnvii
147
list the layers of the eyelid
skin, obicularis oculi, tarsal plate (meiobian glands, lps), tarsal plate/tarsal muscle, bulbar/palpebral conjunctiva
148
which test can prove shallow anterior chamber
oblique flashlight test
149
whcih questions should you ask in the history of someone with acute red eye
- pain, discomfort
- grittiness, fb sensation, deep ache
- photosensitivity
- watering +/- dc
- change in vision - blurring, halos etc
- trauma
- contact lens wear
- previous ocular hx
- nausea/vomiting
150
what is trichiasis
abnormally-positioned eyelashes e.g. turned inwards
151
give some differentials for deep intense eye pain
corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis
152
list some differentials for photophobia
corneal abrasions, iritis, acute glaucoma
153
where is the episclera located
between conjunctiva and sclera
154
what is ciliary flush
injection of vessels of the eye - superificial or deep (not seen in conjunctivitis)
155
what is blepharitis
inflammation of the lid margin, causing crusting, redness, telangiectasia, trichiasis
156
what are the main causative organisms for blepharitis
staphylococcus and skin flora
157
what does the tarsal plate contain
meiobian glands
158
where do the tarsal glands open
at the lid margin
159
what glands are found at the lid margin
- glands of Moll - modified sweat glands
| - glands of Zeiss - sebaceous glands
160
how do external and internal hordeolums develop
- meiobian cyst = obstruction to tarsal glands (internal)
| - stye = obstruction to gland of moll/zeiss (external)
161
which anatomical area is the lacrimal gland found
lacrimal fossa
162
where does the nasolacrimal duct open
inferior meatus
163
list some of the symptoms of blepharitis
grittiness, fb sensation, itching, redness, mild pain
164
what is the treatment of blepharitis
lid hygeine, warm compress, topical antibiotics, lubricants
165
when would you give doxycycline in eye problems
meiobian gland disease and rosacea
166
what is marginal keratitis
inflammation of the cornea, leading to subepithelial marginal concentrate
167
what is the treatment for marginal keratitis
topical low dose steroids
168
what is the treatment for trichaisis
lubricants, epilation, electrolysis, cryotherapy
169
what is an internal hordeolum
acute chalazion - meiobian gland staph infection
170
what are the examination signs of internal hordeolum
tender nodule within tarsal plate, with or without associated cellulitis
171
what is the treatment for internal hordeolum
hot compress, topical antibiotic ointment, incision and drainage once infection has subsided
172
what is an external hordeolum
stye - staphylococcal abscess of lash follicle and its assocaites gland of zeiss/moll
173
what is the treatment for external hordeolum
hot compress, epilation of lash with infected follicle, topical abx
174
how do you manage subtarsal foreign body
evert eyelid with cotton bud while the patient looks down and remove fb with cotton bud
stain with fluoroscein to look for abrasion
+/- antiobiotics
175
list some causes of dry eyes
- systemic: ra, sjogrens
- use of antihistamines
- cnvii palsy
176
what are the common organisms causing bacterial conjunctivitis
s aureus, s epidermidis, s pneumoniae, h influenzae
177
what are the symptoms of conjunctivitis
redness, grittiness, burning, dc, often bilat
178
what are the signs on examination of the conjunctivitis
crusty lids, conjunctival hyperaemia, mild papillary reaction, lids and conjunctiva may be oedematous
179
when should swabs be taken for conjunctivitis
newborn, uncertain diagnosis
180
what is the treatment for conjunctivitis
chloramphenicol or fusidic acid
| topical abx 2-7days
181
what are the signs and symptoms of chlamydial conjunctivitis
usually unilat, fb sensation, lid crusting with sticky dc, follicles
182
what are the investigations for chlamydial conjucntivitis
swab/smear
direct monoclonal fluorescent ab icroscopy
pcr, naat
183
what is the treatment for chlamydial conjunctivitis
topical tetracycline/po doxycycline or azithromycin
184
what is the main viral cause of conjunctivitis
adenovirus
185
what are the symptoms of viral conjunctivitis
usually bilateral watery eyes, dc, soreness, fb sensation,
186
what is the management of viral conjunctivitis
usually self resolves by 2 weeks
give advice that it is contagious
give topical steroids if risk of keratitis
187
what are the signs and symptoms of allergic conjunctivitis
itch, bilateral watery dc, oedema, papillae (cobblestone)
188
what are the investigations for allergic conjunctivitis
ige levels, patch testing
189
what is the treatment for allergic conjunctivitis
cold compress
remove allergen, nsaids, antihistamines
sodium cromoglycate (mast cell stabiliser)
topical corticosteroids
if steroid resistant - immunosuppression with ciclosporin
(lid steroid injection)
190
what should you check in a patient with spontaneous suconjunctival haemorrhage
bp
191
what is the treatment for spontaneous subconjunctival haemorrhage
lubricants for up to 14 days until it resolves itself
192
what are the symptoms of episcleritis
mild tearing/irritation, tender to touch, blanching with phenylephrine
193
what is the treatment for episcleritis
lubricants, nsaids,
| rarely low dose steroids
194
what is scleritis
scleral inflammation wtih maximal congestion in the deep vascular plexus
195
what are the signs and symptoms of scleritis
pain (severe, boring)
ocular tenderness to movement and palpation
watering and photophobia
bluish red appearance
196
what is the treatment of scleritis
manage underlying condition, nsaids, corticosteroids, immunosuppression
197
what is pterygium
fibrous growth from the conjunctiva onto the cornea
198
what is the management of pterygium
excision and covering with conjunctival autograft
| mitomycin
199
what is infective keratitis
disruption to the epithelial surface of the cornea, and can lead to infection here
200
what are some of the trggers for bacterial keratitis
contact lens wear, small ulcer that has developed, dry eyes, fb, persisting corneal disease
201
what are the symptoms of bacterial keratitis
pain, drop in visual acuity (corneal surface and tear film disruption), fb sensation, watering, photophobia, corneal oedema may be present
202
what would you see on examination of eye with bacterial keratitis
white deposit on cornea (infiltrate) +/- collection of pus in the anterior chamber (hypopyon), "cell and flare" with slight lamp exam of anterior chamber, corneal oedema
203
what is cell and flare representative of
proteins and leucocytes are visible floating in anterior chamber when light shone on pupil (come from leaky iris blood vessels in response to infection)
204
what are the symptoms of corneal abrasion/fb
severe pain, especially with itching, watering
205
what is the management of corneal abrasion
```
remove fb with cotton bud if able to under topical
anaesthetic, exclude intraocular fb
refer if it crosses the visual pathway
chloramphenicol ointment
cyclopentolate
```
206
list the common organisms causing bacterial keratitis
s aureus, strep pyogenes, s pneumoniae, p aeuruginosa
207
what are the investigations for bacterial keratitis
culture
208
what is the treatment for bacterial keratitis
topical ofloxacin, cyclopentolate tds,
| steroids once cultures stable
