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Ophthalmology Flashcards

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1
Q

4 types of change in appearance of the eyelid

A

Ptosis
Swelling
Entropion (turning in)
Ectropion (turning out)

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2
Q

Which muscles are innervated by CN3?

A

Medial rectus
Superior rectus
Inferior rectus
Inferior oblique

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3
Q

What is the appearance of the eye due to 3rd nerve palsy?

A

Down and out
Ptosis
Fixed dilated pupil

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4
Q

What is strabismus

A

Misalignment of the eyes (squint)

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5
Q

What vascular disease is important to exclude in transient loss of vision?

A

Giant cell arteritis

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6
Q

What is the management of giant cell arteritis?

A

Steroids - 60mg oral prednisolone
Urgent referral to specialist
Temporal artery biopsy
Very high inflammatory markers

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7
Q

What common eye condition causes loss of peripheral vision?

A

Glaucoma

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8
Q

5 causes of gradual vision loss?

A 
Glaucoma
Cataracts
Macular degeneration 
Diabetic retinopathy
Increased intracranial pressure
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9
Q

What are the 3 types of cataracts?

A

Nuclear sclerosis
Cortical
Posterior subcapsular

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10
Q

Which type of cataracts causes temporary improvement in short sightedness?

A

Nuclear sclerosis

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11
Q

Which type of cataracts causes wedge shaped opacities/fragments/streaks?

A

Cortical (aka spokes)

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12
Q

Which groups of people are most likely to get posterior subcapsular cataracts?

A

Diabetics

Patients taking high dose steroids

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13
Q

Which type of cataracts causes poor vision in bright light eg glares and haloes?

A

Posterior subcapsular

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14
Q

What is phacoemulsification?

A

Fragmentation of lens fibres using ultrasound.

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15
Q

What is the most common type of glaucoma?

A

Chronic open angle glaucoma

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16
Q

What does the ‘angle’ refer to in glaucoma?

A

The angle between the posterior surface of the cornea and the anterior surface of the iris (iridocorneal angle)

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17
Q

What produces the aqueous in the eye?

A

Ciliary body

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18
Q

Where does aqueous leave the eye?

A
  • Trabecular meshwork in the iridocorneal angle

- Enters the episcleral veins

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19
Q

What is normal intraocular pressure?

A

<21mmHg

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20
Q

What is chronic open angle glaucoma?

A

Optic neuropathy where by there is:

  • Increased IOP >21 mmHg
  • Enlargement of the optic disc cup (results in loss of neurones). Normal cup to disc ratio is <0.5)
  • Progressive loss of visual field (results in tunnel vision)
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21
Q

What sort of vision is characteristic of open-angle glaucoma?

A

Tunnel vision (peripheral visual loss)

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22
Q

Types of glaucoma syndromes

A

Manifest glaucoma = High IOP, large cup, field loss
Glaucoma suspect = Abnormal disc or field loss (not both)
Ocular hypertension = High IOP, normal disc and fields
Normal tension glaucoma = normal IOP, large cup, field loss
Secondary glaucoma = after trauma, use of steroids or inflammation

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23
Q

What size should the optic disc cup be?

A

Less than half the diameter of the disc

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24
Q

Which visual fields do arcuate scotomas begin in?

A

Superior or inferior

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25
What is the 1st line treatment of glaucoma?
Topical ophthalmic prostaglandins eg lantanoprost
26
What classes of medications are used to treat glaucoma other than prostaglandins?
Beta adrenergic antagonists (B blockers) eg timolol Carbonic anhydrase inhibitors eg dorzolamide Alpha-2 adrenergic agonists eg brimonidine
27
What surgical treatment is there for glaucoma?
Laser trabeculoplasty
28
At what part of the retina is visual acuity highest?
Macula
29
Where is the macula located?
3mm temporal to the optic disc
30
What are the 2 types of photoreceptors? Where are they located? What are they responsible for?
Rods - Peripheral vision, vision at low light levels (scotopic), not present in fovea centralis of macula Cones - Central vision, high spatial acuity, vision at higher light levels (photopic vision). Found in the fovea centralis of macula
31
What 3 things does good visual acuity depend upon?
- Functioning photoreceptors - Healthy retinal pigment epithelium - Perfusion of the capillary layer of the choroid (the choriocapillaris)
32
What are drusen?
Yellow fatty lipid deposits (waste material from photoreceptors) which accumulates below the retinal pigment epithelium
33
What is the most common type of age related macular degeneration?
Dry AMD
34
What is the visual loss seen in dry AMD?
Central scotoma with good peripheral vision
35
What is the pathology of dry AMD?
Atrophy of the retinal pigment epithelium, choroid and photoreceptors in retina
36
What can be seen with opthalmoscope in patient with dry AMD?
Drusen
37
What can be seen with opthalmoscope in a patient with wet AMD?
Exudates and haemorrhage
38
What percentage of AMD cases are wet AMD?
10%
39
What is the pathology of wet AMD?
New vessels in choroid are formed (choroidal neovascularisation) New vessels leak fluids, lipids and blood into layers behind retina Localised retinal detachment Retinal scarring
40
Visual loss in wet AMD?
Distorted central vision eg microscopia, which develops into central scotoma. More rapid change than dry AMD
41
What does myopia mean? What type of lens is required to correct it?
Short sighted | Concave
42
What does hyperopia mean? What type of lens is required to correct it?
Long sighted | Convex
43
3 features of glaucoma
loss of visual fields cupping of optic disc intra ocular hypertension
44
Side effect of carbonic anhydrase?
Pins and needles
45
What can make the intraocular pressure appear higher than it is?
Thick central cornea - some people are born with this
46
Treatment options for wet AMD?
Laser photocoagulation | Intravitreal anti-VEGF
47
What is the treatment of early dry AMD?
Nutritional therapy - high in antioxidants, carotenoids and omega 3 fatty acids.
48
In what groups of people can wet AMD occur other than the elderly?
``` Myopic patients (extreme short sightedness) Choroidal rupture after blunt trauma Angioid streaks associated with psuedoxanthoma elasticum ```
49
What can be seen with opthalmoscope in a patient with diabetic retinopathy?
``` Haemorrhages Microaneurysm Cotton wool spots Neovascularisation Exudate Macular oedema ```
50
Differential diagnoses for causes of microaneurysms?
Diabetes Retinal vein occlusion Ocular ischaemia Any cause of retinal/general slow flow
51
What are the classifications of diabetic retinopathy in the UK?
Background Background/preproliferative Preproliferative Proliferative
52
What is the management of background diabetic retinopathy?
No treatment as not currently sight threatening Annual review Investigation of other organs that are affected by diabetes.
53
What area does the macular cover?
A circle whose radius is the distance from the foveola to the temporal edge of the optic disc.
54
What are the causes of visual loss of diabetic maculopathy?
Macular oedema Foveal ischaemia Foveal haemorrhage
55
What are the treatment options for diabetic maculopathy?
Macular grid laser | Intravitrial steroid eg triamcinolone
56
How do you determine the sites of leakage in diabetic maculopathy?
Flourescein angiography
57
What are the symptoms of diabetic retinopathy?
Sudden changes in vision/blurred vision Eye floaters and spots Double vision Eye pain
58
Symptoms of diabetic maculopathy
Blurring in the central vision causes trouble reading and recognising faces in the centre of the vision
59
Treatment options for proliferative retinopathy?
Laser photocoagulation Anti-VEGF injections Virectomy surgery
60
What muscle and nerve is responsible for pupillary constriction?
Pupillary constrictor muscle | Parasympathetic fibres on CN III
61
What neurotransmitter is involved in pupillary constriction? And which receptors does it bind to?
Acetylcholine | M3 muscarinic receptors
62
What muscle is responsible for pupillary dilation and what is it innervated by?
Dilator pupillae muscle | Sympathetic fibres carries to the eye via blood vessels
63
What neurotransmitter is involved in pupillary dilation and what receptors does it bind to?
Noradrenaline | Alpha 1 adrenergic receptors
64
What nucleus supplies the preganglionic parasympathetic fibres to the eye?
Edinger Westphal nucleus (CN III nucleus)
65
What are the 3 pupillary reflexes?
Reaction to light - constriction Reaction to dark - dilation Reaction to near target - convergence
66
What is anisocoria?
Pupils of different sizes
67
What does an afferent pupillary defect indicate there is a problem with?
Pupil or optic nerve
68
What does an efferent pupillary defect indicate there is a problem with?
CN III or sphincter muscle
69
What are the causes of rapid afferent pupillary defect (RAPD)?
``` Sudden: Retinal vein/artery occlusion Retinal detachment GCA Gradual: Glaucoma Macular degeneration Other: Optic nerve damage eg trauma, radiation, tumour (anterior ischaemic optic neuropathy) Retinal disease Optic neuritis Retinal infection ```
70
If there was a problem with the retina in the right eye and RAPD was present, what would you expect to see?
Pupils equal before illumination Neither pupil constricts in response to illumination of right eye Both pupils constrict in response to illumination of left eye Appearance of right pupil dilating in response to light when illumination changes from left to right, when in actual fact the eyes are returning to normal state after left eye being illuminated.
71
If there was an efferent defect associated with a problem with the right eye, what would you expect to see?
Right pupil > left pupil Right eye will not response to illumination Left eye constricts in response to illumination from either eye.
72
Causes of anisocoria?
``` Horner's syndrome Adie's pupil (efferent defect) 3rd nerve palsy Drugs eg atropine/pilocarpine Iris damage eg glaucoma, iritis, surgery ```
73
Features of horner's syndrome?
Miosis Ptosis Anhidrosis Enophthalmos
74
Features of 3rd nerve palsy
Fixed dilated pupil Ptosis Eye deviated downwards and out (divergent eye)
75
What is miosis?
Constriction of pupil
76
Causes of horner's syndrome
Apical lung tumour eg pancoast tumour Thyroid surgery Internal carotid artery dissecting aneurysm Cavernous sinus and orbital disease
77
Test to confirm horner's syndrome
Cocaine test Cocaine prevents the reuptake of noradrenaline. It dilates the pupil in the normal eye, but eye affected by horner's syndrome fails to dilate, due to lack of noradrenaline.
78
Features of Adie's pupil?
Caused by parasympathetic denervation. Mydriasis (dilated pupil) Reduced accommodation (blurred vision when reading) Light near dissociation
79
What is important to exclude with 3rd nerve palsy?
Posterior communicating artery aneurysm
80
How is RAPD detected?
Swinging torch test
81
What are the 3 layers of the eyeball?
Sclera, Choroid, Retina
82
Which muscles are responsible for the focussing of the lens?
Ciliary muscles
83
Which muscles are responsible for the dilation and constriction of the iris?
Pupillary dilator and pupillary constrictor muscles
84
Which eye conditions are associated with rheumatoid arthritis?
Sjogren's Episcleritis/sceritis Anterior uveitis
85
What are the 4 symptoms of Horner's syndrome?
Ptosis Meiosis Anhydrosis Enophthalmos
86
What tumour causes a bitemporal hemianopia?
Pituitary adenoma - pressing on the optic chiasm
87
What are the causes of Horner's syndrome?
Central: Stroke, MS Pre-ganglionic: Pancoast tumour Post-ganglionic: Carotid artery dissection
88
What are the most common cause of bacterial conjunctivitis?
Staph aureus Haemophilus influenza Strep pneumoniae
89
What antibiotics are used to treat conjunctivitis?
1st line: Chloramphenicol | 2nd line: Fusidic acid
90
Most common cause of keratitis (corneal ulceration)?
Non infectious eg dryness, contact lens injury
91
Most common infectious cause of keratitis?
HSV1
92
What are my 7 differentials for red eye?
``` Conjuntivitis Keratitis Episcleritis Scleritis Subconjunctival haemorrhage Anterior uveitis Acute closed-angle glaucoma ```
93
What is reiter's syndrome?
Conjunctivitis Urethritis Arthritis (reactive)
94
How does keratitis present?
Painful red eye Photophobia Watery eye Blurred vision
95
What investigation is specific for keratitis caused by HSV1?
Branching dendrite is seen on cornea when using Fluorescein and cobalt blue light
96
Presentation of episcleritis?
Can be asymptomatic | Mild pain, redness and irritation
97
How can you tell between episcleritis and scleritis?
Episcleritis - mild pain, vessels are mobile and blanch with phenylephrine drops Scleritis - Severe pain (patient will not let you touch eye) , vessel are not mobile, aderhent to globe and do NOT blanch with phenylephrine drops
98
How do you treat scleritis?
Oral NSAIDs Topical steroid drops Systemic immunosuppression (corticosteroids/cyclophosphamide)
99
How does subconjunctival haemorrhage present?
Harmless collection of blood under conjunctiva, looks a lot worse than it is
100
How does scleritis present?
Severe pain Blurred vision Photophobia Headache
101
What conditions is scleritis associated with?
Rheumatological disease eg RA, SLE, ank spond, GPA
102
What is a complication of scleritis?
Globe perforation
103
Which causes of red eye cause photophobia?
Keratitis Scleritis Anterior uveitis
104
How do you differentiate between keratitis and anterior uveitis?
The redness in anterior uveitis starts at the circumcorneal injection. The pupil may also appear irregular due to the iris sticking to the lens (posterior synechiae). Branching dendrite might be seen in keratitis when due to HSV1 Talbot's test is positive in anterior uveitis
105
What is Talbot’s test?
Pain increases as the eyes converge and pupils constrict (ask the patient to watch their finger approach their nose) Specific for anterior uveitis
106
How do you treat anterior uveitis?
Steroid eye drops (decreases inflammation) | Cyclopentolate (dilates pupil and prevents iris sticking to lens)
107
What is the pathology behind acute closed-angle glaucoma?
Sudden rise in intra-ocular pressure due to lens pushing up against iris and preventing flow of aqueous humour (pupillary block) Closure of iridocorneal angle preventing drainage Raised intra-ocular pressure leads to fixed dilated pupil and axonal death
108
What is the presentation of acute closed-angle closure?
Extremely red and painful eye Nausea and vomiting Glare, halos around lights Blurred vision
109
What is the management of acute closed-angle glaucoma?
IV Carbonic anhydrase inhibitors eg acetazolamide Topical: B blockers eg timolol Steroids Mitotic eg pilocarpine (constricts pupil to open angle)
110
What investigations are used to diagnose acute closed-angle closure?
Fundoscopy Slit-lamp examination Tonometry Gonioscopy (measures angle)
111
What is seen in fundoscopy for acute closed-angle glaucoma?
Pale cupped optic disc
112
What are the 5 differentials for sudden loss of vision?
``` Central retinal artery occlusion Central retinal vein occlusion Retinal detachment Giant cell arteritis Amourosis Fugax ```
113
How do you differentiate between ischaumic and non-ischaemic retinal vein occlusion?
Fluorescein angiography
114
Complications of ischaemic central retinal vein occlusion
Neovascular glaucoma | Retinal detachment
115
Visual acuity is improved with pinhole when it is due to what cause?
Refractive error
116
What is seen on fundoscopy for central retinal artery occlusion?
Cherry red spot
117
What is the management of central retinal artery occlusion?
``` Occular massage (<100 mins) IV Acetazolamide ```
118
What is seen on funcodscopy for central retinal vein occlusion?
Widespread haemorrhages Swollen optic disc Stormy sunset appearance
119
What is the treatment of central retinal vein occlusion?
Anti-VEGF agents | Laser treatment if ischaemic
120
What are the complications of ischaemic central retinal vein occlusion?
Neovascular glaucoma | Retinal detachment
121
What is the presentation of retinal detachment?
Sudden loss of vision preceded by flashing lights, floaters and visual field defects
122
What are the risk factors for retinal detachment?
Trauma Diabetic retinopathy Myopic individuals Previous eye surgery
123
Which artery supplies the optic nerve?
Central retinal artery
124
What is anterior and posterior synechia?
Posterior synechia - iris sticking to lens | Anterior synechia - iris sticking to cornea
125
What complications of intra-ocular surgeries causes a red eye?
Endopthalmitis

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