Ophthalmology Flashcards by Eleanor Heighton

What else should you look for in swollen optic discs?

Venous congestion

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What else should you do in clinic with a patient who has optic disc swelling?

Blood pressure

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What is the natural history of idiopathic intracranial hypertension?

Disc swelling subsides, discs become atrophic and pale

Loss of visual function occurs and blindness may result

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Which two muscles control eye opening?

What is the nerve supply to each?

Levator palpebrae superioris - CN III

Muller’s muscle - under sympathetic control

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What is Horner’s syndrome?

Why does it cause ptosis and miosis

A combination of symptoms that arises when the sympathetic trunk is damaged
Mullers muscle is supplied by sympathetic nerves - ptosis
Dilator pupillae is supplied by sympathetic nerves - miosis

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What lies just posterior to orbicularis oculi?

Orbital septum

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What are the two types of conjunctiva?

Palpebral - on inner surface of eyelid

Bulbar - lines the eyeball

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How do corneal endothelial cells regenerate?

They don’t - born with them and you can’t grow more

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How is near focusing achieved by the ciliary body and zonules?

Ciliary body contracts, pulling the border of the choiroid towards the lens
Zonules (suspensory ligaments) relax
Lens becomes thicker and rounder

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How is far focusing achieved by the ciliary body and zonules?

Ciliary body relaxes, border of choroid moves away from the lens
Zonules (suspensory ligaments) contract
Lens becomes thinner and longer

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Give two differentials for painful Horner’s syndrome

Pancoast tumour - compresses sympathetic fibres at the apex of the lung
Paraganglioma - occurs at carotid

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Eye positioned down and out with ptosis = ?

Complete CN III palsy

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Posterior communicating artery aneurysm = which nerve palsy?

CN III

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What will a lesion in the left trochlear nucleus produce?

Contralateral muscle palsy

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What is Hutchison’s sign?

Herpes zoster on the tip of the nose - likely that the ye will be involved through nasociliary nerve
Start on oral acyclovir asap

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Which ocular nerve palsy can occur in raised ICP?

CN VI - abducens

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Where do the rectus muscles arise from?

Clinical significance?

Common tendinous ring

Attached to the optic nerve sheath - this is why optic neuritis causes pain on eye movement

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What does the ophthalmic artery branch off of?

Internal carotid

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Where do the ophthalmic veins drain into?

Cavernous sinus

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Where do the supraorbital nerve and vessels pass through?

Supraorbital notch

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What is central scomata?

Loss of central vision - occurs in macular degeneration

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What is rubeosis iridis?

Aka neovascular glaucoma
Retina is so ischaemic that new vessels grow on the iris
Occurs in retinal vein occlusion and severe diabetic retinopathy
You cannot recover from this

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Which cells die in retinitis pigmentosa?

Rods

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Which two layers of the eye separate in retinal detachment?

Sensory retina

Retinal pigment epithelium

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What is the most common type of retinal detachment?

Rhegmatogenous

What happens in Rhegmatogenous retinal detachment? | What causes it?

A tear in the retina causes vitreous to pass into the subretinal space Typically caused by trauma

What happens in exudative retinal detachment?

Blood or fluid from the choroid separates the two layers of the retina It does not involve tears in the retina or traction from the vitreous

What happens in tractional retinal detachment? | Most common cause?

Scar/abnormal tissue grows on the surface of the retina, pulling it away from the layer beneath it Diabetic retinopathy

How does retinal detachment present?

- Flashes - Floaters - Field loss - Fall in acuity It is painless May describe curtain falling down over lower half as the retina detaches upward

Treatment for retinal detachment?

If detachment is superior, rest flat etc Laser photocoagulation therapy Vitrectomy and gas tamponade

What is the most commonly inherited degenerative condition of the retina?

Retinitis pigmentosa

Symptoms of retinitis pigmentosa?

Night blindness followed by peripheral and central daytime vision loss

List four risk factors for ARMD

Older age Smoking CVD Cataract surgery

Pathophysiology of wet ARMD?

New blood vessels grow under the retina - leakage causes build up of fluid/blood and eventually scarring

Treatment of wet ARMD?

Anti-VEGF injected into vitreous cavity

Pupil involving CNIII palsy is what until proven otherwise?

Circle of Willis aneurysm

If pupil is not involved in CN III palsy, what is the likely cause?

Microvascular - in middle of nerve bundle

What type of trauma causes CN IV palsy?

Blunt head trauma | CN IV has a long path forward and so is sensitive to stretching injury when head is knocked forward

What head movement do you get in bilateral CN IV palsy?

Torsion and chin depression to get single vision

What diagnosis is important to keep in mind in VIth nerve palsy? If this is the diagnosis, what other symptoms might the patient have?

Raised ICP | Headache, vomiting

Headache, vomiting, convergent squint = ?

Raised ICP

Failure to adduct one eye and abducting nystagmus in the other = ? Who is this common in ?

Medial longitudinal fasiculus problem | MS patients

Describe the aqueous pathway

Produced in ciliary body Passes behind iris/in front of lens Then through pupil In front of the iris Out of eye via irido-corneal angle in the anterior chamber Filters back into blood through the trabecular meshwork and canal of Schlemm

What is the defining feature of glaucoma?

Progressive optic neuropathy

Which vision tends to be spared in open angle glaucoma?

Central vision is spared | Peripheral blindness

Prostanoids in glaucoma - example - mode of action

Latanoprost | Increases aqueous outflow

Beta blockers in glaucoma - example - mode of action

Timolol | Reduce aqueous production

Carbonic anhydrase inhibitors in glaucoma - example - mode of action

Dorzolamide (topical) Acetazolamide (systemic) Decreases aqueous production

List three things which predispose to acute closed angle glaucoma

Hyperopic eyes - naturally shallow anterior chambers Night time - pupil is dilated and so iris is thicker Medications that cause pupil dilatation e.g. antihistamines

Is the pupil dilated or constricted in acute closed angle glaucoma?

Sluggish and dilated

Name a miotic drug (used in acute closed angle glaucoma)

Pilocarpine

What operation should you do in acute closed angle glaucoma?

High intensity laser to burn hole through iris to create communication between anterior and posterior chambers

What happens when you shine light in an eye with afferent defect?

The pupil won't respond to light, but constricts when light is shone in the other eye (consensual response)

Egg yolk macula = ?

Best disease

Give a risk factor for spontaneous rhegmatogenous retinal detachment

Short sightedness (myopic)

Long or short sightedness is a risk factor for acute closed angle glaucoma?

Long sightedness

What is ectropion and entropion? | Give a complication of each

``` Ectropion = out turning of the lower eyelid - can lead to corneal exposure and drying Entropion = in turning of lower eyelid - can lead to corneal abrasion ```

Tender, red, hot, raised lump just medial to medial canthus = ?

Dacrocystitis

Predominant symptom of herpes simplex keratitis?

Photophobia

Which conditions in the eye can cause local lymphadenopathy?

Adenoviral conjunctivitis or keratitis

Treatment of neonatal conjunctivitis?

Erythromycin + referral to paediatrician for risk of pneumonitis

Photophobia with reduced visual acuity in the absence of itch or discharge = ?

Anterior uveitis

Patient with clubbing + eye disease = ?

Think about malignancy which has metastasized to the choroid

Intermittent double vision worse towards the end of the day associated with a variable bilateral ptosis = ?

Myasthenia gravis

What is investigation of CN VI palsy aimed at?

Identifying CVS risk factors e.g. BP, urinalysis, cholesterol, fasting BG

Which glaucoma patients should you not give beta blockers?

Asthmatic ones

Complete left homonymous hemianopia = ?

Right occipital lobe stroke

What is aniscoria?

Unequal sized pupils

What type of disease is scleritis? | What is a systemic association?

Immune complex deposition | Any type III hypersensitivity vasculitic disease

In myopia, where is a distant image focussed? | Type of corrective lens?

In front of the retina Divergent lens More prone to spontaneous retinal detachment

Which type of conjunctivitis can cause pain on eye movement?

Viral

Ophthalmology Flashcards

(71 cards)