Ophthalmology Flashcards
(154 cards)
1
Q
What are some bacterial causes of conjunctivitis in neonates?
A
Staph Aureus, Neisseria Gonorrhoea, Chlamydia trachomatosis
2
Q
What are some bacterial causes of conjunctivitis in other ages?
A
Staph Aureus, Strep pneumoniae, haemophilus influenzae
3
Q
What are some viral causes of conjunctivitis?
A
Adenovirus, herpes simplex, herpes zoster
4
Q
Which types of organism would cause a purulent discharge?
A
Bacterial
5
Q
Which types of organism would cause a watery discharge?
A
Viral
6
Q
Which type of organism would cause enlarged preauricular lymph nodes?
A
Viral
7
Q
How is conjunctivitis investigated/diagnosed?
A
Do an eye swab
8
Q
How is bacterial conjunctivitis treated?
A
Topical chloramphenicol
9
Q
How is bacterial conjunctivitis treated during pregnancy?
A
Topical fusidic acid
10
Q
What does chloramphenicol during pregnancy cause?
A
Grey baby syndrome
11
Q
How is allergic conjunctivitis treated?
A
Antihistamine drops/tablets
2nd line - sodium cromoglycate drops
12
Q
Who should you suspect chlamydia conjunctivitis in?
A
Young adults where the disease has been unresponsive to treatment
13
Q
How does chlamydial conjunctivitis present?
A
Follicular appearance with subtarsal scarring
14
Q
How is chlamydial conjunctivitis treated?
A
Topical oxytetracycline
15
Q
What is Herpes Zoster Ophthalmicus?
A
Reactivation of varicella zoster in CNV2
16
Q
What is Hutchinson’s sign?
A
Vesicle on tip of nose suggesting nasociliary involvment
17
Q
How is herpes zoster ophthalmicus treated?
A
Oral antivirals and steroids
18
Q
What is keratitis?
A
Inflammation of the cornea
19
Q
What are the broad causes?
A
Infective (bacterial, viral, fungal), autoimmune, vitamin A deficiency
20
Q
How does keratitis present?
A
Circumcorneal red eye, photophobia, profuse lacrimation, reduced acuity, stabbing pain
21
Q
What organism tends to cause a dendritic ulcer?
A
Herpes simplex virus
22
Q
How is keratitis investigated?
A
Corneal scrape
23
Q
What happens if you use steroids on a dendritic ulcer?
A
Corneal melt
24
Q
How is bacterial keratitis treated?
A
Topical ofloxacin +/- gentamicin and cefotuxamine
25
How is viral keratitis treated?
Topical aciclovir
26
How is autoimmune keratitis treated?
Topical steroids
27
What is orbital cellulitis?
Infection that develops BEHIND the orbital septum
28
What organisms commonly cause orbital cellulitis?
Strep pneumoniae, staph aureus
29
How does orbital cellulitis present?
Unilateral red swollen eye lid, difficulty opening the eye, proptosis, reduced vision, reduced eye movements, painful eye movements, ophthalmoplegia
30
How is orbital cellulitis investigated?
CT sinus and orbit (to rule out abscess)
31
How is orbital cellulitis managed?
URGENT ADMISSION
| IV ceftriaxone, metronidazole and flucloxicillin +/- drainage
32
What is peri-orbital cellulitis?
Same as orbital cellulitis but NO proptosis, reduction in vision or eye movements
33
How is peri-orbital cellulitis investigated?
CT sinus and orbit (to rule out abscess)
34
How is peri-orbital cellulitis managed?
Co-amoxiclav
35
What is endophthalmitis?
Sight threatening infection of inside the eye
36
When does endophthalmitis occur?
Usually post eye surgery or penetrating injury
37
What are some causative organisms of endophthalmitis?
Propionbacterium, staph epidermidis
38
How is endophthalmitis investigated?
Vitreal/aqueous humour culture
39
How is endophthalmitis treated?
Intravitreal anikacin and vancomycin
40
What is chorioretinitis?
Inflammation of choroid and retina (posterior uveitis)
41
What are some causes of chorioretinitis?
CMV, Toxoplasma, Toxocara
42
How does chorioretinitis present?
Gradual vision loss, pain, red eyes, floaters, photophobia
43
'Pizza Fundus'
CMV
44
'Punched out chorioretinal scars'
Toxoplasma
45
'Granulomatous damage to retina'
Toxocara
46
How does a CNIII palsy present?
Eye is down and out
Pupil is dilated
Ptosis
47
What are some causes of a CNIII palsy?
Diabetes, vasculitis, cavernous sinus thrombosis, amyloidosis, Webers syndrome
48
What may be the cause in a painful CNIII palsy?
Aneurysm
49
What muscle does a CNIV palsy affect?
Superior oblique
50
What are some features of a CNIV palsy?
Intorsion, depression of eye in adduction, abduction weak, vertical diplopia
51
When may people with CNIV palsy notice diplopia?
On reading/walking up and down stairs (vertical)
52
What are some causes of a CNIV palsy?
Trauma, diabetes, tumour, idiopathic
53
What muscle is affected in a CNVI palsy?
Lateral Rectus
54
What are some features of a CNVI palsy?
Medially deviated eye, unable to abduct, horizontal diplopia
55
What are some causes of a CNVI palsy?
Microvascular, raised ICP, tumour, congenital
56
What is internuclear ophthalmoplegia?
Injury/dysfunction of medial longitudinal fasciculatis
57
What causes internuclear ophthalmoplegia?
MS, stroke
58
How does internuclear ophthalmoplegia present?
Affected eye cannot adduct
| Unaffected eye abducts with nystagmus
59
Where is the affected structure - unilateral vision loss
Optic nerve (causes - MS, ION)
60
Where is the affected structure - bitemporal hemianopia
Optic chiasm (causes - pituitary tumour)
61
Where is the affected structure - homonymous hemianopia
Optic tract (tumour, MS, stroke)
62
Where is the affected structure - superior quadrantopia
Optic radiation in temporal lobe
63
Where is the affected structure - inferior quadrantopia
Optic radiation in parietal lobe
64
Where is the affected structure - homonymous hemianopia with macular sparing
Occipital cortex
65
What is a concomitant squint?
Imbalance of extra-ocular muscles (can be convergent or divergent)
66
What is a paralytic squint?
Due to paralysis of extra-ocular muscles
67
How can a squint be detected?
Corneal light test and cover uncover test
68
What is amblyopia?
Reduced vision in one eye due to a degraded retinal image, therefore leading to poor binocular vision
69
What are the main causes of amblyopia?
Squint, refractive error, obstruction to visual axis
70
How is amblyopia treated?
Occlusion of good eye
71
What are the 3 main ways to treat squints?
Treat refractive errors, treat amblyopia, surgery
72
What is blepharitis?
Inflammation of the eyelid margins
73
What is the cause of posterior blepharitis?
Meibomian gland dysfunction
74
What is the cause of anterior blepharitis?
Sebhorroeic dermatitis, staph infection
75
What condition is associated with blepharitis?
Acne rosacea
76
How does blepharitis present?
Bilateral grittiness and discomfort, eyes sticky in morning, red and swollen, styes common
77
How is blepharitis managed?
Lid hygiene (compresses), mechanical removal of debris, doxycycline
78
What is anterior uveitis?
Inflammation of the uvea (iris, choroid, ciliary body)
79
What are causes of anterior uveitis?
Reactive arthritis, UC, crohns, ankylosing spondylitis, sarcoidosis, leukaemia, TB, syphilis, Behcets
80
How does anterior uveitis present?
Acute onset red eye, discomfort/pain, irregular and small pupil, photophobia, blurred vision, lacrimation, cells and flare in anterior chamber
81
How is anterior uveitis managed?
Urgent review
Cycloplegics (e.g. atropine, cyclopentolate)
Steroid eye drops
82
What is episcleritis?
Inflammation below conjunctiva in episclera
83
How does episcleritis present?
Mild discomfort, red eye, watering, photophobia, vessels on eye BLANCH and are MOBILE
84
How is episcleritis treated?
Self limiting - topical lubricants, NSAIDs
85
What is scleritis?
Vasculitis of the sclera
86
How does scleritis present?
Moderate/severe pain, diffuse deep redness, decreased acuity, watering, photophobia. Vessels CANNOT be moved and do not blanch with phenylephrine
87
How is scleritis treated?
Oral NSAIDs, oral steroids, immunosuppression
88
How should penetrating eye trauma be managed in A&E?
Attempt removal with slit lamp
89
Which substance (acid or alkali) penetrates the eye more?
Alkali
90
How should chemical burns be initially treated?
Urgent washout of eye
91
What are some symptoms of an orbital blowout fracture?
Double vision, sunken ocular globes, loss of sensation of cheek and upper gums due to infra-orbital nerve injury
92
What signs may be seen with orbital blowout fracture?
Peri-orbital bruising, subconjunctival haemorrhage, teardrop sign on x-ray, air-fluid level in maxillary sinuses
93
How is an orbital blowout fracture treated?
Prophylactic antibiotics, oral steroids +/- surgery
94
What are the main causes of SUDDEN vision loss?
CRAO, CRVO, BRAO, BRVO, Amarosis fugax, AION, vitreous haemorrhage, retinal detachment, Wet ARMD, closed angle glaucoma
95
What are the main presenting symptoms of CRAO?
Dramatic visual loss in seconds which is painless
96
What signs may be seen in CRAO?
RAPD
| Pale retina with cherry red spot on macula
97
How is CRAO managed?
Ocular massage, paper bag breathing, IV acetazolamide, establish source of embolus (e.g. carotid doppler). Assess and manage risk factors
98
What is amaurosis fugax?
Transient CRAO
99
How does amaurosis fugax present?
Transient painless monocular vision loss
'Like a curtain coming down'
Lasts around 5 minutes then full recovery
100
How is amaurosis fugax managed?
Referral to TIA clinic. Aspirin
101
How does CRVO present?
Sudden onset blurry vision loss in one eye, painless
102
What signs may be seen with CRVO?
RAPD
Retinal haemorrhages
Dilated tortuous veins
Disc and macular swelling
103
How is CRVO managed?
Observation unless evidence of neorevascularisation (in which case do laser photocoagulation)
104
What is Anterior Ischaemic Optic Neuropathy (AION)?
Occlusion of posterior ciliary arteries leading to infarction of optic nerve head
105
How does AION present?
Sudden onset, profound, irreversible vision loss
106
What is AION associated with?
Giant Cell arteritis (screen for other symptoms)
107
How is AION managed?
High dose steroids (prevent loss of vision in other eye)
| Treat underlying causes
108
What are some causes of vitreous haemorrhage?
Bleeding from neorevascularisation or retinal tears/trauma
109
What are some symptoms of vitreous haemorrhage?
Loss of vision, floaters
110
What are signs of vitreous haemorrhage?
Loss of red reflex, unable to visualise retina
111
What investigation should be done if suspect vitreous haemorrhage?
B scan ultrasound
112
How is vitreous haemorrhage managed?
Identify the cause. Vitrectomy if dense
113
What are some causes of retinal detachment?
Trauma, retinal tear, following vitreous haemorrhage (risk increased in myopes)
114
What are the symptoms of retinal detachment?
Vision loss, flashing, floaters, dark shadow in peripheral vision
115
What are some signs of retinal detachment?
RAPD, tear may be seen
116
How is retinal detachment managed?
If you can see retinal tear - do laser to prevent a full detachment
If detached - vitrectomy, laser, gas bubble tamponade
117
What is the underlying cause of wet age related macular degeneration?
Choroidal neorevascularisation, leakage of fluid causes build up and eventually scarring
118
What are some symptoms of wet ARMD?
Rapid central vision loss and vision distortion (vision seems wavy)
119
What signs of wet ARMD may be seen?
Haemorrhage, exudate
120
How is wet ARMD treated?
Intravitral anti-VEGF injections
121
What are causes of gradual vision loss?
Cataracts, dry ARMD, refractive error, diabetic retinopathy, open angle glaucoma
122
What is a cataract?
An opacity of the lens
123
What are some causes of cataracts?
Age related, UV light, congenital (IU infection), diabetes, hypoglycaemia, trauma, steroids, Downs syndrome
124
What intra-uterine infections can cause cataracts?
Rubella, CMV, toxoplasma
125
What are some types of cataract?
Nuclear, subcapsular, polychromatic
126
What predisposes to subcapsular cataracts?
Steroid use
127
How are cataracts treated?
Phaecoemulsification and IOL
128
What is the commonest cause of vision loss in the elderly?
Dry ARMD
129
What are some causes of Dry ARMD?
Epigenetics, diet, smoking, increased age
130
What are some symptoms of dry ARMD?
Gradual decline in vision, central scotoma
131
What are some signs of dry ARMD?
Drusen, retinal pigment epithelium atrophy
132
How is dry ARMD treated?
Stop smoking, healthy diet, vitamin supplements, visual aids
133
What is myopia and what lens is used to correct it?
Short sighted - concave lens
134
What is hypermetropia and what lens is used to correct it?
Long sighted - convex lens
135
What is astigmatism?
Irregular corneal curvature
136
What is presbyopia?
Loss of accommodation with age due to stiffening of the lens
137
What is the pathogenesis of diabetic retinopathy?
Hyperglycaemia causes increased retinal blood flow and metabolism, leading to endothelial dysfunction, pericyte dysfunction and an increase in growth factor
138
What are the results of the pathogenesis of diabetic retinopathy?
Exudates
Microaneurysms
Neorevascularisation
139
How is diabetic retinopathy classified?
Non proliferative (mild, moderate, severe) and proliferative
140
How is diabetic retinopathy treated?
Tighter diabetic control, laser photocoagulation, anti-VEGF
141
What is glaucoma?
Group of diseases characterised by progressive optic nerve damage and visual field loss
142
What are some signs of glaucoma?
Arcuate field defect, optic disc cupping, raised ICP
143
How is glaucoma diagnosed and monitored?
Tonometry (IOP), perimetry (visual fields), clinical exam (optic nerve)
144
What is the cause of primary open angle glaucoma?
Blocked drainage of aqueous through trabecular meshwork
145
What are some risk factors for POAG?
Increased age, family history, myopes, increased IOP, afro-carribean ethnicity
146
What is the first line treatment for POAG?
Prostaglandins (e.g. Latanoprost)
147
What are some side effects of prostaglandin drops?
Iris colour change, eyelash growth
148
What is second line treatment for POAG?
Beta-blocker (e.g. timolol) - CI in asthma/HF
149
What other treatments are available for POAG?
Carbonic anhydrase inhibitors
Parasympathomimmetics
Sympathomimmetics
150
What surgery can be done for POAG?
Trabeculectomy
151
What is closed angle glaucoma?
Pressure in eye rises very quickly leading to visual symptoms
152
How does closed angle glaucoma present?
Pain, nausea and vomiting, reduced vision
Hazy cornea
Fixed, mid-dilated pupil
Blurred vision and haloes
153
How is closed angle glaucoma initially managed?
```
Pilocarpine (constrict pupil and open angle)
IV acetazolamide (to reduce IOP)
+/- analgesia and antiemetics
```
154
Once the IOP is stabilised in closed angle glaucoma, how is it treated?
Peripheral Laser Iridotomy
| - hole at 12 o'clock in both eyes to allow pressure to equilibriate
