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MIND AND MOVEMENT > Ophthalmology > Flashcards

Ophthalmology Flashcards

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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
Left homonymous inferior quadrantanopia
Right parietal lobe lesion or stroke
26
Right homonymous superior quadrantanopia
Left temporal lobe lesion or stroke
27
What are you looking for on optic disc
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
28
Cataracts
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
29
Younger patients with cataracts
Diabetes, steroid use, chronic uveitis, FH
30
Primary open angle glaucoma How does it present Who is at risk
Progressive painless visual field loss Risk factor include Afro Caribbean, family history, hypertension Often picked up by opticians or at glaucoma screening
31
What are changes in ARMD?
Central vision Reading, faces and fine detail affected. Colour is also affected
32
Dilating agents
Tropicamide Cyclopentolate Phenylephrine
33
Absent red reflex
Cataracts | Retinoblastoma (rare)
34
Drusen
Lipid deposits | Think ARMD
35
Flat retina- means not
Not glaucoma as this causes cupping
36
Retinal haemorrhages
Hypertension Retinal vein occlusion Diabetes In baby could be shaken baby
37
Retinal elevation
Retinal detachment
38
Dry ARMD
Gradual loss of central vision | Risk factors- female, smoking, HTN, previous cataracts surgery
39
Side effects of latanoprost
Blurred vision, stinging, long eyelashes, foreign body sensation, hyperaemia
40
Eyes and the DVLA ``` Acuity Glaucoma ARMD Cataracts Optic neuritis Diplopia ```
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
What is wet macular degeneration
Fluid and or blood develops in the retina Sudden loss of central vision Needs instant referral for anti VEGFV injections
42
``` Blurred vision Red eye Nausea and vomiting Headache Differential? ```
Acute angle closure glaucoma
43
Why blurred vision in AACG
IOP increases leading to oedema of cornea and it becomes cloudy Therefore affects vision
44
Who does AACG affect
Long sighted | Female
45
Treatment of acute angle closure glaucoma
Reduce pressure with drops- acetazolamide Peripheral iridotomy to restore aqueous flow Treat other eye prophylactically
46
Cherry red spot with pale retina
Central retinal artery occlusion
47
Why does central retinal artery occlusion happen
Non inflammatory vascular problems Raised cholesterol, HTN, atherosclerosis, diabetes Alongside angina and TIA Get smoking Hx, CV exam, routine bloods
48
Sudden onset of floaters
Most likely to be retinal detachment
49
Risk factors for retinal detachment
Trauma eg high velocity | Myopia is also a risk
50
Treatment for retinal detachment
Surgery! Vitreous removed. Flatten retina with gas or oil
51
Child with eye pain, oedema, erythema, chemosis (swelling of conjunctiva), restricted eye movement, systemically unwell
Orbital cellulitis!
52
Once identified or suspected orbital cellulitis, what is next step
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
Common organisms causing orbital cellulitis
Usually a bacterial infection spread from paranasal sinuses. Commonly staphylococcus aureus, strep pneumoniae, h influenzae. Could be fungal in severely immunosuppressed.
54
What is a hypopyon?
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
Red eye, pain and reduced vision
Refer!
56
Questions with query conjunctivitis
``` Contact lenses Sexually active (could be chlamydial) URTI recently (indicates probably viral cause) Any contact with people with red eyes Allergies ```
57
Symptoms of conjunctivitis
Redness of conjunctiva Normal visual acuity Reactive pupils Mucoid discharge
58
Tests in conjunctivitis
Swabs- bacterial, viral, chlamydial
59
Treatment of conjunctivitis
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
If conjunctivitis does not go away after chloramphenicol...
PCR may be required as more likely to be viral or chlamydial
61
Fluoroscein eye drops would help reveal..
Corneal abrasion, dendritic ulcers and microbial keratitis
62
Dendritic ulcers
When herpes simplex infects corneal epithelium | Treat with Aciclovir drops
63
Young male with red eye
Conjunctivitis? Anterior uveitis? Ask about back pain Ask about IBD
64
Investigation into Diplopia
``` 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
Treatment of eye palsy
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
Ptosis, eye divergent and depressed. Large pupil
The pupil involvement suggests pressure on nerve rather than microvascular cause
67
Causes of Diplopia
Poor blood supply, direct pressure on nerve (aneurysm), tumour, head injury, inflammation near nerve
68
Presence of large pupil as well as nerve palsy, treatment
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
Trauma to eye area
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
Variable or progressive weakness of eyelid and ocular muscle
Think myasthenia gravis
71
Symptoms of optic neuritis
Sudden vision loss Decreased contrast and colour sensitivity Pain with eye movement RAPD
72
Child with white pupil
Retinoblastoma! | Congenital cataracts
73
Retinopathy of prematurity
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.

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