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Flashcards in Ophthalmology Deck (210):
1

CNIII palsy

down + out pupil (diplopia), ptosis, mydriasis

2

down + out pupil, ptosis, mydriasis

CNIII palsy

3

surgical CNIII palsy

down + out pupil (diplopia), ptosis, mydriasis, fixed dilated pupil

4

down + out pupil, ptosis, mydriasis, fixed dilated pupil

surgical CNIII palsy

5

ciliary body produces

aqueous humour

6

aqueous humour is produced by the

ciliary body

7

Horner's syndrome

partial ptosis, fixed constricted pupil (miosis), enopthalmos, anhidrosis

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partial ptosis, fixed constricted pupil

Horner's syndrome

9

superior oblique is supplied by

CNIV

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CNIV supplies the

superior oblique

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lateral rectus is supplied by

CNVI

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CNVI supplies the

lateral rectus

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surgical CNIII palsies are most likely caused by

posterior communicating artery aneurysms

14

(non-surgical) CNIII palsies are more likely caused by

ischaemia

15

levator palpebrae

lid opening, CNIII

16

Muller muscle

lid opening, sympathetic

17

orbicularis oculi

lid closing, CNVII

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why partial ptosis in Horner's?

sympathetic affected, levator palpebrae superior still able to open the eye a bit

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lid opening, CNIII

levator palpebrae

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lid opening, sympathetic

Muller muscle

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lid closing, CNVII

orbicularis oculi

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8-20 mmHg

normal intraocular pressure

23

things to describe on fundoscopy (optic disk)

colour, CDR, contour, anything else (tortuous blood vessels, neovascularisation, haemorrhage, drusen)

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Argyll-Robertson pupil

small irregular pupils, no response to light but response to accommodate

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small irregular pupils, no response to light but response to accommodate

Argyll-Robertson pupil

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Argyll-Robertson pupil

ARP but PRA = accommodation reflex present but pupillary reflex absent

27

ARP but PRA = accommodation reflex present but pupillary reflex absent

Argyll-Robertson pupil

28

Holmes-Adie pupil

ux, dilated pupil, once constricted remains small for a long time

29

ux, dilated pupil, once constricted remains small for a long time

Holmes-Adie pupil

30

Holmes-Adie pupil is associated with

absent ankle/knee reflexes

31

absent ankle/knee reflexes are associated with

Holmes-Adie pupil

32

Argyll-Robertson pupil is caused by

diabetes mellitus, syphilis

33

diabetes mellitus, syphilis can cause

Argyll-Robertson pupil

34

ghost veins

sign of a previous occlusion, remnants of the vessel

35

sign of a previous occlusion, remnants of the vessel

ghost vessels

36

blot haemorrhage vs aneurysm on fundoscopy

can't tell the difference

37

asteroid hyalosis

degenerative condition, small white opacities in vitreous humour

38

degenerative condition, small white opacities in vitreous humour

asteroid hyalosis

39

ocular hypertension

intraocular presssure over 20, without nerve damage

40

intraocular presssure over 20, without nerve damage

ocular hypertension

41

glaucoma pressure

intraocular presssure over 20, with nerve damage

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intraocular presssure over 20, with nerve damage

glaucoma

43

posterior vitreous detachment

age related change where vitreous shrinks and pulls some of the retina with it

44

age related change where vitreous shrinks and pulls some of the retina with it

posterior vitreous detachment

45

photocoagulation

using laser to seal off holes in retina, shrink unhealthy tissue/blood vessels

46

using laser to seal off holes in retina, shrink unhealthy tissue/blood vessels

photocoagulation

47

drusen

yellow round spot in Bruch's membrane, linked with dry/early age-related macular degeneration

48

yellow round spot in Bruch's membrane, linked with dry/early age-related macular degeneration

drusen

49

types of AMD (age-related macular degeneration)

dry/early = drusen, changes to retinal pigment epithelium
wet/late = exudative, choroidal neovascularisation, worse prognosis, potential for rapid decrease in visual acquity

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AMD (age-related macular degeneration) risk factors

over 60, smoking, family history, Caucasian, sunlight exposure, female sex

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over 60, smoking, family history, Caucasian, sunlight exposure and female sex are risk factors for what

age-related macular degeneration

52

features of age-related macular degeneration

reduced visual acquity (blurred, distorted, central vision affected first, straight lines appear crooked/wavy), central scotoma

53

reduced visual acquity (blurred, distorted, central vision affected first, straight lines appear crooked/wavy), central scotoma are features of

age realted macular degeneration

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general treatment for age related macular degeneration

stop smoking, high dose beta carotene, vitamins C, E, zinc

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stop smoking, high dose beta carotene, vitamins C, E, zinc is advised in

age related macular degeneration

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wet/late age-related macular degeneration treatment

photocoagulation, photodynamic therapy, anti-VEGF

57

photocoagulation, photodynamic therapy, anti-VEGF is treatment for

wet/late age related macular degeneration

58

general cataract causes

age, sunlight exposure

59

age, sunlight exposure generally cause

cataracts

60

systemic causes of cataracts

diabetes mellitus, steroids, infection (congenital rubella), metabolic (hypocalcaemia, galactosaemia), myotonic dystrophy, Down syndrome

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diabetes mellitus, steroids, infection (congenital rubella), metabolic (hypocalcaemia, galactosaemia), myotonic dystrophy, Down syndrome are systemic causes of

cataracts

62

ocular causes of cataracts

trauma, uveitis, high myopia, topical steroids

63

trauma, uveitis, high myopia, topical steroids are ocular causes of

cataracts

64

classification of cataracts

nuclear = change lens refractive index, common in elderly
polar = localised, inherited, in visual axis
subcapsular = steroid use, in visual axis
dot opacities = normal lenses, diabetes, myotonic dystrophy

65

acute angle closure glaucoma symptoms

red eye, severe pain, reduced visual acquity, hazy cornea (corneal oedema), haloes, semi-dilated non-reactive pupil, worse with mydriasis, hard eye, systemic upset e.g. N, V, abdo pain

66

acute anterior uveitis symptoms

red eye, acute onset, pain, blurred vision, photophobia, small fixed oval pupil, ciliary flush

67

red eye, severe pain, reduced visual acquity, hazy cornea, haloes, semi-dilated pupil are symptoms of

acute angle closure glaucoma

68

red eye, acute onset, pain, blurred vision, photophobia, small fixed oval pupil, ciliary flush are symptoms of

uveitis

69

scleritis symptoms

red eye, severe pain (maybe worse on movement), tenderness, deep injection, ?underlying autoimmune condition e.g. rheumatoid arthritis

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red eye, severe pain (maybe worse on movement), tenderness, ?underlying autoimmune condition e.g. rheumatoid arthritis are symptoms of

scleritis

71

conjunctivitis symptoms

red eye, purulent discharge (bacterial), clear discharge (viral)

72

red eye, purulent discharge (bacterial), clear discharge (viral) are symptoms of

conjunctivitis

73

subconjunctival haemorrhage

red eye, history of trauma/coughing

74

red eye, history of trauma/coughing are symptoms of

subconjunctival haemorrhage

75

blepharitis causes

meibomian gland dysfunction (common posterior blepharaitis), or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis)

76

meibomian gland dysfunction (common posterior blepharaitis), or seborrhoeic dermatitis/staphylococcal infection (less common, anterior blepharitis) are causes of

blepharitis

77

blepharitis is more common in patients with

roseacea

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patients with roseacea are more likely to develop

blepharitis

79

features of blepharitis

bilateral, grittiness, discomfort around lid margins, morning sticky eyes, red eyelid margins, swollen in staphylococal blepharitis, styes + chalazion are more common, secondary conjunctivitis may occur

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bilateral, grittiness, discomfort around lid margins, morning sticky eyes, red eyelid margins, swollen, styes + chalazion are more common, secondary conjunctivitis may occur in

blepharitis

81

management of blepharitis

hot compressions BD, mechanical removal of debris, artificaial tears

82

hot compressions BD, mechanical removal of debris, artificaial tears is the management of

blepharitis

83

most common causes of sudden painless loss of vision

ischaemic optic neuropathy, occlusion of central retinal vein, artery, vitreous haemorrhage, retinal detachment

84

ischaemic optic neuropathy, occlusion of central retinal vein, artery, vitreous haemorrhage, retinal detachment are the most common cause of

sudden painless loss of vision

85

ischaemic optic neuropathy may be due to

arteritis (e.g. temporal arteritis) or atherosclerosis (hypertensive, diabetic, older patient)

86

arteritis (e.g. temporal arteritis) or atherosclerosis (hypertensive, diabetic, older patient) may cause

ischaemic optic neuropathy

87

the pathophysiology of ischaemic optic neuropathy is

occlusion of the short posterior ciliary arteries causing damage to the optic nerve, leading to sudden painless loss of vision

88

occlusion of the short posterior ciliary arteries causing damage to the optic nerve causes

ischaemic optic neuropathy

89

field defects in ischaemic optic neuropathy are

altitudinal field defects

90

altitudinal field defects are

when only the upper or lover half of the field is affected by vision loss

91

when only the upper or lover half of the field is affected by vision loss

altitudinal field defect

92

altitudinal field defects are seen in

ischaemic optic neuropathy

93

central retinal artery occlusion is due to

thromboembolism (from atherosclerosis) or arteritis (temporal arteritis)

94

thromboembolism (from atherosclerosis) or arteritis (temporal arteritis) can cause

central retinal artery occlusion

95

central retinal vein occlusion incidence

increases with age, more common than central retinal artery occlusion

96

increases with age, more common than central retinal artery occlusion

central retinal vein occlusion

97

causes of central retinal vein occlusion

glaucoma, polycythaemia, hypertension

98

glaucoma, polycythaemia, hypertension can cause

central retinal vein occlusion

99

central retinal vein occlusion on fundoscopy

severe retinal haemorrhages

100

severe retinal haemorrhages seen of fundoscopy

central retinal vein occlusion

101

features of central retinal artery occlusion

relative afferent pupillary delay, cherry red spot on a pale retina, sudden painless loss of vision

102

relative afferent pupillary delay, cherry red spot on a pale retina, sudden painless loss of vision are features of

central retinal artery occlusion

103

causes of vitreous haemorrhage

diabetes, bleeding disorders

104

diabetes, bleeding disorders can cause

vitreous haemorrhage

105

features of vitreous haemorrhage include

sudden painless visual loss (large bleeds), dark spots (moderate bleeds), floaters (small bleeds)

106

sudden painless visual loss, dark spots, floaters

vitreous haemorrhage

107

posterior vitreous detachment features

photopsia (peripheral vision), floaters (temporal side of central vision)

108

photopsia (peripheral vision), floaters (temporal side of central vision) are features of

posterior vitreous detachment

109

retinal detachment features

dense shadow (starts peripherally, moves centrally), veil/curtain over field of vision, straight lines appear curved, central vision loss

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dense shadow (starts peripherally, moves centrally), veil/curtain over field of vision, straight lines appear curved, central vision loss are features of

retinal detachment

111

symptoms of retinitis pigmentosa

night blindness, tunnel vision

112

night blindness, tunnel vision are symptoms of

retinitis pigmentosa

113

retinitis pigmentosa on fundoscopy

black bone spicule shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium

114

black bone spicule shaped pigmentation in peripheral retina, mottling of retinal pigment epithelium on fundoscopy indicates

retinitis pigmentosa

115

features of dacryocystitis

epiphoria, swelling and erythema at the inner canthus of the eye

116

epiphoria, swelling and erythema at the inner canthus of the eye are features of

dacryocystitis

117

management of dacryocystitis

systemic antibiotics (IV if periorbital cellulitis)

118

systemic antibiotics (IV if periorbital cellulitis) is the management for

dacryocystitis

119

congenital lacrimal duct obstruciton features

epiphoria, secondary infection may occur, resolves by 1 year of age

120

epiphoria, secondary infection may occur, resolves by 1 year of age describes features of

congenital lacrimal duct obstruction

121

suspected CNIII palsy management

CTA head to rule out post communicating a aneurysm

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CTA head to rule out post communicating a aneurysm

in suspected CNIII palsy

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retinoblastoma

leukocoria

124

leukocoria causes

retinoblastoma, cataracts

125

retinoblastoma management

radiotherapy, chemotherapy, eye enucleation, surveillance of other eye (if inheritable form), genetic counselling

126

radiotherapy, chemotherapy, eye enucleation, surveillance of other eye (if inheritable form), genetic counselling management for

retinoblastoma

127

optic neuritis

inflammation of optic nerve, sudden deterioration in VA, colur desaturation, eye pain, think MS

128

inflammation of optic nerve, sudden deterioration in VA, colur desaturation, eye pain, think MS

opti neuritis

129

osteogenesis imperfecta eye signs

blue tinge to sclera

130

blue tinge to sclera

osteogenesis imperfecta

131

infective causes of uveitis

viral: HSV, CMV, HZV, EBV
bacterial: TB, Borrelia burgdorferi, syphilis
fungal: Candida, Aspergillus, histoplasmosis
protozoal: Toxoplasma gondii, Toxocara canis

132

non-infective causes of uveitis

granulomatous: sarcoid, GPA, vasculitidies
non-granulomatous, seropositive: RA, Sjogren's, polyarteritis nodosa, juvenile idiopathic arthritis
non-granulomatous, seronegative: ankylosing spondylitis, Bechet's

133

complications of uveitis

posterior synaechiae, glaucoma, hypotony, band keratopathy, cataract, cystoid macular oedema

134

which type of uvelitis can cause loss of vision

posterior uveitis

135

uveitis can causes posterior synaechiae by

iris + lens adhesion make it increasingly difficult for aqueous to leave pupil into trabeculum, post chanber build up of P, iris bows forward, compromises angle further called an iris bombe

136

uveitis can causes glaucoma by

clogging up trabecular meshwork from inflammatory cells, iris bombe, steroid induced increased ocular P

137

uveitis can cause hypotony by

inflammation + shutdown of the cilliary body

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uveitis can cause band keratopathy by

chronic inflammation changes pH of ocular surface favouring Ca salts precipitaion

139

uveitis can cause cataracts by

1' or 2' to systemic steroids/long term steroid drops

140

uveitis can cause cystoid macular oedema by

inflammation disturbing the blood-retina barrier

141

uveitis is

inflammation of the uveal tract

142

uveitis can be

anterior, intermediate, posterior, pan-uveitis

143

acute anterior uveitis describes inflammation of the

iris + cilliary body

144

retinitis describes inflammation of the

retina

145

scleritis describes inflammation of the

sclera

146

acute anterior uveitis O/E

red eye, conjunctival circumciliary injection , kerato precipitates (WBC) on corneal endothelium, posterior synechiae, cells + flare in ant chamber (slit lamp)

147

intermediate uveitis symptoms

floaters, blurred vision, no pain

148

intermediate uveitis O/E

vitreous cells, snowballs, snow-banking, macular oedema

149

posterior uveitis symptoms

painless bluring of vision, floaters, photopsia,

150

posterior uveitis O/E

variable cells in ant chamber + vitreous, choroiditis, retinitis (cotton wool spots, haemorrhages, cuffing, attenuation/dilatation of vessels),

151

uveitis Ix

FBC, U+E, CXR, ACE, HLA-B27, HLA-A29, syphilis, lyme serology, anti-ANA, anti-ANCA

152

Mx of non-infectious uveitis

corticosteroids (topical/PO/IV)

153

posterior scleritis

white eye, posterior scleral thickening, vision loss, severe pain, ocular tenderness, diplopia, painful eye movements

154

posterior scleritis Ix

Rh factor, ANA, p-ANCA, c-ANCA

155

posterior scleritis Mx

NSAIDs, corticosteriods (topical/PO/IV),

156

acute vision loss

posterior scleritis, posterior uveitis, anterior ischaemic optic neuropathy, optic neuronitis, idiopathic intracranial hypertension, migraine, haemorrhage from pituitary tumour

157

sudden loss of vision w/o inflammation suspect

temporal arteritis

158

consider temporal arteritis in

>50, visual disturbance, headache

159

glaucoma Mx

refer immediately to hospital/opthalmologist, medical, surgical (e.g. iridotomy/trabeculotomy)

160

orbital cellulitis vs preorbital cellulitis

orbital = reduced VA, proptosis, painon eye movements

161

orbital cellulitis features

eye pain, swelling, erythema around eye, fever, lethargy/malaise, opthalmoplegia, proptosis

162

complications of untreated entropion

corneal ulcer

163

entropion Mx

Sx, eye lubrication, tape to pull eyelid outwards

164

eye pain, swelling, erythema around eye, fever, lethargy/malaise, opthalmoplegia, proptosis describes

orbital cellulitis

165

diabetic retinopathy pathophysiology

hyperglycaemia causes increased retinal blood flow, abnormal metabolism in the retinal vessel walls, damage to endothelial cells + pericytes, increased vascular permeability

166

diabetic retinopathy can be divided into

non-proliferative diabetic retinopathy (NPDR) + proliferative diabetic retinopathy (PDR)

167

mild NPDR

1 or > aneurysm

168

moderate NPDR

microaneurysms, blot haemorrhages, hard exdate, cotton wool spots, venous bleeding/looping, intraretinal microvascular abnormalities

169

severe NPDR

blot haemorrhages + microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant

170

PDR

retinal neovascularisation (my lead to vitreous haemorrhage), fibrous tissue forming ant to retinal disc, > common in T1DM, blind in 5 years

171

maculopathy

based on location > severity, hard exudate, background changes to macula, check VA, > common in T2DM

172

1 or > aneurysm

mild NPDR

173

microaneurysms, blot haemorrhages, hard exdate, cotton wool spots, venous bleeding/looping, intraretinal microvascular abnormalities

moderate NPDR

174

blot haemorrhages + microaneurysms in 4 quadrants, venous bleeding in 2 quadrants, intraretinal microvascular abnormalities in 1 quadrant

severe NPDR

175

retinal neovascularisation (my lead to vitreous haemorrhage), fibrous tissue forming ant to retinal disc, > common in T1DM, blind in 5 years

PDR

176

based on location > severity, hard exudate, background changes to macula, check VA, > common in T2DM

maculopathy

177

mydratic drops can precipitate

AACG

178

AACG can be orecipitated by

mydratic drops

179

factors predisposing to AACG

hypermetropia (long-sightedness), pupillary dilatation, lens growth with age

180

hypermetropia (long-sightedness), pupillary dilatation, lens growth with age are predisposing foactors for

AACG

181

hypertensive retinopathy classification

I = arteriolar narrowing, tortuosity, increased light reflex = silver wiring
II = AV nipping
III = cotton wool exudates, flame + blot haemorrhages
IV = papilloedema

182

AMD Ix

optical coherence tomography (cross sectional views of macula), fluorescein angiography (if neovascularisation present)

183

optical coherence tomography (cross sectional views of macula), fluorescein angiography (if neovascularisation present) Ix for

AMD

184

optic neuritis O/E

RAPD, elevated optic disc, blurred margins

185

causes of optic neuritis

MS, DM, syphilis

186

optic neuritis Mx

high dose steroids, 4-6/52 recovery

187

RAPD, elevated optic disc, blurred margins O/E

optic neuritis

188

MS, DM, syphilis can be causes of

optic neuritis

189

Marcus Gunn pupil is diagnosed during the

swinging light test, affected eye dilates when light shines in

190

Marcus Gunn pupil can be found in

MS, retinal detachment, optic neuritis

191

Argyll Robertson pupil is normally bx or ux?

bx

192

Marcus Gunn pupil is characterised by

RAPD

193

Holmes-Adie's pupil is characterised by

dilated pupil which poorly reacts to direct light, slowly reacts to accommodation

194

Argyll Robertson pupil is characterise by

constricted pupil that doesn't respond to light, responds to accommodation (ARP accommodation reactive pupil)

195

swinging light test, affected eye dilates when light shines in

Marcus Gunn pupil

196

type of pupil seen in MS

Marcus Gunn

197

type of pupil that has RAPD

Marcus Gunn

198

dilated pupil which poorly reacts to direct light, slowly reacts to accommodation

Holmes-Adie's pupil

199

constricted pupil that doesn't respond to light, responds to accommodation

Argyll Robertson pupil

200

Argyll Robertson pupil is associated with

neurosyphilis

201

RAPD is caused by a lesion

anterior to the optic chiasm (optic n or retina)

202

RAPD causes

MS, optic neuritis, retinal detachement

203

causes of mydrasis

CNIII palsy, Holmes-Adie's pupil, traumatic iridoplegia, phaeochromocytoma, congenital

204

drug causes of mydrasis

topical mydratics: tropicamide, atropine
sympathomimetics: amphetamines, cocaine
anticholinergic drugs: TCA

205

CNIII palsy, Holmes-Adie's pupil, traumatic iridoplegia, phaeochromocytoma, congenital can all causeq

mydrasis

206

ptosis + dialted pupil

CNIII palsy

207

ptosis + constricted pupil

Horner's S

208

eyelid problems

blepharitis (inflammation of eyelid margins), stye (infection of eye gland), chalazion (Meibomian cyst), entropion, ectropion

209

types of stye

external (hordeolum externum) staph infection of glands of Zeis or Moll
internal (hordeolum internum) infection of Meibomian glands

210

causes of tunnel vision

papilloedema, glaucoma, retinitis pigmentosa, choroidoretinitis, optic atrophy 2' to tabes dorsalis, hysteria