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MIND AND MOVEMENT > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

Things that make diabetic retinopathy more likely

A 
Long duration of diabetes
Type of diabetes (more common in type 1)
Poor glycemic control
Increased BP
Presence of macro or microalbuminuria
Increased serum cholesterol levels
Pregnancy
Cigarette smoking
Genetic factors
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2
Q

Screening for diabetic retinopathy

A

All diabetics need annual screening
Children screened after five years if have type 1
Increased checks if pregnant
Photographs taken - 2 photos of each eye. Disc centred and macula centred,
Slit lamps used

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3
Q

Why can diabetes lead to blindness

A

Maculopathy
New vessel formation
Cataracts
CVA with field loss

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4
Q 
Stages of diabetic eye disease
0
1
2
3
A

0- no retinopathy
1- microaneurysms, any exudate, venous loops
2- any microvascular changes, venous beading, multiple blot haemorrhage
3- proliferative disease

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5
Q

What is glaucoma

A

Chronic progressive optic neuropathy
Thinning of neuroretinal rim of the optic disc results in characteristic cupping of optic nerve head and visual field loss

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6
Q

Risks for primary open angle glaucoma

A 
Age
IOP
race
Family history 
High myopia
Corneal thickness
Diabetes 
Vascular factors eg CV disease, vasospasms, systemic hypotension
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7
Q

Normal intraocular pressure

A

10-21 mmHg

15.5 average

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8
Q

Optic changes in glaucoma

A

Enlargement of optic cup
Loss of disc rim
Vascular changes
Peripappillary atrophy

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9
Q

Treatment of primary open angle glaucoma

A

Control the IOP
Options:
Prostaglandin analogues eg latanoprost. These increase outflow
Beta blockers eg timolol. Decrease production
Carbonic anyhydrase inhibitors eg dorzolamide. Decrease production
Alpha agonists decrease production
Cholinergic agonists eg pilocarpine. Increase trabecular outflow.

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10
Q

Ocular muscles and innervation

A

Medial rectus- adduction. Third cranial nerve
Lateral rectus- abduction. Fourth cranial nerve
Superior rectus- up. Third
Inferior rectus- down. Third
Superior oblique- fourth
Inferior oblique- third

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11
Q

Horizontal Diplopia cause

A

Sixth nerve palsy as lateral rectus not working - could be trauma, neoplasms, ischamia, demyelination. Autoimmune disorders

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12
Q

Vertical diplopia

A

Fourth or third cranial nerve palsy- superior oblique or superior rectus

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13
Q

Causes of a mechanical restriction in eye movement

A

Trauma leading to orbital floor fracture leading to vertical Diplopia usually
Thyroid eye disease

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14
Q

How to test for RAPD

A

Swinging light test
Detects if there is paradoxical dilatation of the pupil when light is shone into it due to an afferent defect
Detects an optic neuritis

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15
Q

Causes of optic neuritis

A

MS or neuromyelitis optica

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16
Q 
Blindness by age group
16-64
65-74
75-84 
85+
A

16-64 diabetic retinopathy, macular disorders, optic atrophy, hereditary
65-74 AMD
75-84 glaucoma
85+ cataracts

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17
Q

What eye diseases is smoking linked to?

A 
Cataracts 
Macular degeneration
Thyroid eye disease
Retinal vein occlusion
Retinal artery occlusion
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18
Q

How do you perform a visual acuity test?

A

Corrective lenses should be worn
Test each eye individually
Should be 6m away with snellen or 3m with a 3m snellen
Number on chart says distance at which most people can read it

Record as distance from chart over number on chart

Test near vision and colour vision

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19
Q

Charts to measure visual acuity

A

Snellen

Logmar

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20
Q

Eye symptoms history questions

A 
Has vision been affected 
When did it start
Sudden or gradual
Are the eyes uncomfortable 
Pain?
Grittiness, dryness, feel tired- dryness problem
Sharp or stabbing pain- ocular surface problems 
Dull ache- uveitis, raised IOP, scleritis
Redness
Previous eye history or surgery
FH
smoking, alcohol, job, driver
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21
Q

Total blindness of right eye- where is lesion

A

Right optic nerve

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22
Q

Bitemporal hemianopia- where lesion

A

Optic chiasm- think pituitary tumour

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23
Q

Left visual field loss

A

Right occipital lobe- could be posterior circulation stroke

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24
Q

Peripheral field loss- what’s the problem

A

Could be glaucoma

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25
Q

Left homonymous inferior quadrantanopia

A

Right parietal lobe lesion or stroke

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26
Q

Right homonymous superior quadrantanopia

A

Left temporal lobe lesion or stroke

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27
Q

What are you looking for on optic disc

A

Cup
Colour- should be orange with pale centre. Can be pale in optic atrophy eg optic neuritis advanced glaucoma
Contour- circle should be well defined, if not then could be papilloedema

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28
Q

Cataracts

A

Common cause of visual loss in the elderly
Gradual blurring of distant then near vision
If cataracts is posterior in the lens then they experience glare and vision is better out of sunlight
Correct with surgery and intraocular implant

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29
Q

Younger patients with cataracts

A

Diabetes, steroid use, chronic uveitis, FH

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30
Q

Primary open angle glaucoma
How does it present
Who is at risk

A

Progressive painless visual field loss
Risk factor include Afro Caribbean, family history, hypertension
Often picked up by opticians or at glaucoma screening

31
Q

What are changes in ARMD?

A

Central vision
Reading, faces and fine detail affected.
Colour is also affected

32
Q

Dilating agents

A

Tropicamide
Cyclopentolate
Phenylephrine

33
Q

Absent red reflex

A

Cataracts

Retinoblastoma (rare)

34
Q

Drusen

A

Lipid deposits

Think ARMD

35
Q

Flat retina- means not

A

Not glaucoma as this causes cupping

36
Q

Retinal haemorrhages

A

Hypertension
Retinal vein occlusion
Diabetes

In baby could be shaken baby

37
Q

Retinal elevation

A

Retinal detachment

38
Q

Dry ARMD

A

Gradual loss of central vision

Risk factors- female, smoking, HTN, previous cataracts surgery

39
Q

Side effects of latanoprost

A

Blurred vision, stinging, long eyelashes, foreign body sensation, hyperaemia

40
Q

Eyes and the DVLA

Acuity
Glaucoma 
ARMD
Cataracts
Optic neuritis 
Diplopia
A

Must have at least 6/12 vision
If glaucoma need to inform DVLA so they can do tests to see if safe
Macular degeneration- inform if both eyes affected
Cataracts- don’t need to tell DVLA if still over 6/12
Optic neuritis- tell DVLA
Diplopia- can drive once adaptations of once settled. HGV drivers can’t even with prisms

41
Q

What is wet macular degeneration

A

Fluid and or blood develops in the retina
Sudden loss of central vision
Needs instant referral for anti VEGFV injections

42
Q 
Blurred vision 
Red eye 
Nausea and vomiting 
Headache 
Differential?
A

Acute angle closure glaucoma

43
Q

Why blurred vision in AACG

A

IOP increases leading to oedema of cornea and it becomes cloudy
Therefore affects vision

44
Q

Who does AACG affect

A

Long sighted

Female

45
Q

Treatment of acute angle closure glaucoma

A

Reduce pressure with drops- acetazolamide
Peripheral iridotomy to restore aqueous flow

Treat other eye prophylactically

46
Q

Cherry red spot with pale retina

A

Central retinal artery occlusion

47
Q

Why does central retinal artery occlusion happen

A

Non inflammatory vascular problems
Raised cholesterol, HTN, atherosclerosis, diabetes
Alongside angina and TIA

Get smoking Hx, CV exam, routine bloods

48
Q

Sudden onset of floaters

A

Most likely to be retinal detachment

49
Q

Risk factors for retinal detachment

A

Trauma eg high velocity

Myopia is also a risk

50
Q

Treatment for retinal detachment

A

Surgery! Vitreous removed. Flatten retina with gas or oil

51
Q

Child with eye pain, oedema, erythema, chemosis (swelling of conjunctiva), restricted eye movement, systemically unwell

A

Orbital cellulitis!

52
Q

Once identified or suspected orbital cellulitis, what is next step

A

True emergency! Get senior!
May need referral to oculoplastic team or ENT.

Investigation- blood cultures, swabs, orbital scan, FBC

Cephalosporins or penicillin IV. If abscess present may need surgery

Check obs and visual acuity hourly

53
Q

Common organisms causing orbital cellulitis

A

Usually a bacterial infection spread from paranasal sinuses. Commonly staphylococcus aureus, strep pneumoniae, h influenzae. Could be fungal in severely immunosuppressed.

54
Q

What is a hypopyon?

A

Red eye, fluid level in anterior chamber of the eye, this indicates an accumulation of WBC
Can be a sign of bacterial keratitis.
Leads to a risk of corneal perforation
Treat with broad spec antibiotics

55
Q

Red eye, pain and reduced vision

A

Refer!

56
Q

Questions with query conjunctivitis

A 
Contact lenses
Sexually active (could be chlamydial) 
URTI recently (indicates probably viral cause)
Any contact with people with red eyes
Allergies
57
Q

Symptoms of conjunctivitis

A

Redness of conjunctiva
Normal visual acuity
Reactive pupils
Mucoid discharge

58
Q

Tests in conjunctivitis

A

Swabs- bacterial, viral, chlamydial

59
Q

Treatment of conjunctivitis

A

Usually bacterial usually self limiting. 60% resolve in five days without treatment.

Chloramphenicol drops. Ointments and gel provide a higher concentration for longer periods than drops but daytime use is limited because of blurred vision.

Cold compresses
Lubricants

If allergic conjunctivitis then remove trigger. Antihistamines.

60
Q

If conjunctivitis does not go away after chloramphenicol…

A

PCR may be required as more likely to be viral or chlamydial

61
Q

Fluoroscein eye drops would help reveal..

A

Corneal abrasion, dendritic ulcers and microbial keratitis

62
Q

Dendritic ulcers

A

When herpes simplex infects corneal epithelium

Treat with Aciclovir drops

63
Q

Young male with red eye

A

Conjunctivitis?
Anterior uveitis? Ask about back pain
Ask about IBD

64
Q

Investigation into Diplopia

A 
History
Tests to measure squint
Assess range of eye movements 
Use Hess chart
Do bloods and head scans to determine cause of eye palsy (could be aneurysm, SOL, could be microvascular infarcts)
65
Q

Treatment of eye palsy

A

80% of palsies due to microvascular infarct resolve in 6 months. Therefore symptom treatment eg temporary plastic prism can be fitted to patients glasses then Botox into medial rectus muscle to reduce size of squint

66
Q

Ptosis, eye divergent and depressed. Large pupil

A

The pupil involvement suggests pressure on nerve rather than microvascular cause

67
Q

Causes of Diplopia

A

Poor blood supply, direct pressure on nerve (aneurysm), tumour, head injury, inflammation near nerve

68
Q

Presence of large pupil as well as nerve palsy, treatment

A

Indicates Pressure on nerve. Therefore is a medical emergency! This could be dangerous swelling of blood supply in the brain (posterior communicating artery). Imaging required! Go from there.

69
Q

Trauma to eye area

A

Could lead to inferior orbital floor fracture. Orbital fat and muscle can get stuck in fracture and lead to diplopia. Get max fax involved, prescribe broad spec antibiotic. Do not blow nose! Ask about loss of sensation below orbit

70
Q

Variable or progressive weakness of eyelid and ocular muscle

A

Think myasthenia gravis

71
Q

Symptoms of optic neuritis

A

Sudden vision loss
Decreased contrast and colour sensitivity
Pain with eye movement
RAPD

72
Q

Child with white pupil

A

Retinoblastoma!

Congenital cataracts

73
Q

Retinopathy of prematurity

A

Underdeveloped Retina. The retina is susceptible to the high oxygen that premature babies are often exposed to.
Babies born on or before 31 weeks gestation, under 1500g.
Laser photocoagulation is the treatment of choice.

MIND AND MOVEMENT (6 decks)

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