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Phase 3B > Ophthalmology > Flashcards

Ophthalmology Flashcards

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1
Q

What is the main bacterial cause of infective conjunctivitis?

A

Staph aureus
Staph epidermis
Chlamydia

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2
Q

What are the symptoms of conjunctivitis?

A

Red eye
Irritation/grittiness/discomfort
Sticky/purulent discharge

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3
Q

When should you refer a patient for conjunctivitis?

A

Lots of discharge
Neonatal patient
Refractory

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4
Q

What is the usual treatment for infective conjunctivitis?

A

Conservative treatment such as lid hygiene

Topical chloramphenicol

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5
Q

What is the treatment for allergic conjunctivitis?

A 
Topical antihistamine (antazoline)
Topical sodium cromoglycate
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6
Q

What is the difference between anterior and posterior uveitis?

A

Inflammation of the uveal tract, specifically the iris (anterior) or the choroid (posterior)

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7
Q

Which type of uveitis is more likely to be bilateral?

A

Posterior

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8
Q

What are two risk factors for uveitis?

A

Autoimmune disease

HLA-B27 positivity

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9
Q

What are four causes of uveitis?

A 
Intraocular lymphoma
Trauma
Sarcoidosis
Ischaemic
HSV
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10
Q

What are the main symptoms of anterior uveitis?

A

Painful red eye

Photophobia and diplopia

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11
Q

What are the main symptoms of posterior uveitis?

A

Gradual visual loss

Diplopia and floaters

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12
Q

Posterior uveitis is suggested by inflammatory cells where?

A

In the vitreous

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13
Q

Why is the aqueous hazy in anterior uveitis?

A

Inflamed vessels leak protein

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14
Q

If the retina appears yellow-white on examination, what does this suggest?

A

Retinitis, either in isolation or associated with uveitis

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15
Q

In uveitis, what happens to the optic disc, optic nerve, and IOP on examination?

A

Optic disc - oedema, cupping
Optic nerve - oedema
IOP - decreased as decreased production of aqueous

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16
Q

What is seen on slit lamp examination in uveitis?

A

Cornea - Keratic precipitates (KPs) - cluster of inflammatory cells
Ciliary flush
Cell and flare - hazy aqueous
Hypopyon

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17
Q

What is the management of a suspected uveitis patient?

A

Refer within 24h
Cyclopentolate 1%
Corticosteroids (topical/PO/IV depending on severity)

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18
Q

How does cyclopentolate 1% work?

A

It is a cycloplegic-mydriatic drug

Paralyses the ciliary body, relieves pain, and prevents adhesions

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19
Q

What drug is added if uveitis is persisting?

A

Ciclosporin

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20
Q

Name three complications of uveitis.

A

Secondary cataract
Cystoid macular oedema
Retinal detachment

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21
Q

What are the two types of episcleritis?

A

Simple (vascular congestion on an even surface)

Nodular (discrete elevated area of inflamed episclera)

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22
Q

What is the cause of episcleritis?

A

Idiopathic

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23
Q

What are the symptoms of episcleritis?

A

Mild pain/discomfort

Redness, watering, and mild photophobia

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24
Q

Is visual acuity normal in episcleritis?

A

Yes

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25
How long does episcleritis last before spontaneously resolving?
7-10 days
26
What is the most common form of scleritis?
Anterior - 90%
27
Name six risk factors for scleritis.
``` Rheumatoid arthritis GPA/CTDs Female Ocular surgery Local infections Sarcoidosis ```
28
Describe the pain of scleritis.
Severe, boring Radiates to forehead/brow/jaw Worse with movement and at night
29
What are the other symptoms of scleritis?
Red eye Gradual decrease in vision Diplopia in posterior disease
30
What are the signs of scleritis?
Reduced visual acuity Bluish tinge to sclera and tender globe Scleral, episcleral, and conjunctival vessels all inflamed causing redness
31
What percentage of scleritis patients have a systemic vasculitis?
15%
32
What are the treatment steps for anterior, nodular, and posterior scleritis?
PO NSAIDs PO prednisolone Methotrexate/azathioprine
33
What is the main treatment difference for necrotizing scleritis?
Skip the oral NSAIDs and go straight to oral prednisolone
34
What are the complications of scleritis?
Raised IOP Retinal detachment Uveitis Cataracts
35
What are the three causes of blepharitis?
Staphylococcal Seborrhoeic Meibomian
36
What is the cause of seborrheic blepharitis?
Reaction to malassezia furfur
37
What are two risk factors for blepharitis?
Keratoconjunctivitis sicca | Skin disease
38
What is the management of blepharitis?
Regular eyelid hygiene including warmth, massage, and cleansing Artificial tears
39
What are three complications of blepharitis?
Chalazion Stye Conjunctivitis
40
What does the uveal tract consist of?
Iris, ciliary body, choroid
41
What is intermediate uveitis?
Inflammation of the vitreous, posterior ciliary body, and peripheral retina
42
What are some imaging techniques used to qualify eye inflammation?
Fundus fluorescein angiography | Optical coherence tomography
43
What is glaucoma?
Damage to the optic nerve head with progressive loss of retinal ganglion cells and their axons
44
What is glaucoma commonly associated with?
Raised intraocular pressure
45
Define raised IOP.
>21mmHg on two consecutive occasions in the absence of any glaucomatous change
46
What is the end stage of glaucoma?
Absolute glaucoma | No vision, no pupillary reflex, eye has a stony appearance. Very painful
47
What part of the eye produces aqueous humour?
The ciliary body
48
What is the anterior chamber angle?
The junction of the iris and the cornea at the periphery of the anterior chamber
49
What is primary open angle glaucoma?
Chronic degenerative obstruction of aqueous flow through the trabecular meshwork.
50
What is closed angle glaucoma?
Acutely raised IOP with a physically obstructed iridocorneal angle
51
What causes pressure build up in closed angle glaucoma?
Aqueous humour cannot flow from the posterior to the anterior chamber. Rapid build up of fluid is painful
52
What are the symptoms of the early and late stages of glaucoma?
Early - peripheral visual fields affected | Late - foveal vision and acuity affected
53
What are six risk factors for glaucoma?
``` Raised IOP particularly >26mmhg Women - shallow anterior chambers Eye trauma/uveitis/other eye conditions Family history Myopia Steroids ```
54
What are the symptoms of closed angle glaucoma?
Suddenly painful red eye | Blurred vision rapidly progressing to visual loss
55
What are the extra symptoms of acute angle closure glaucoma (10%)?
Coloured halos around lights Nausea and vomiting Very severe pain
56
What are the symptoms of open angle glaucoma?
Asymptomatic | Peripheral visual loss
57
What investigation measures the iridocorneal angle to test whether the glaucoma is closed or open angle? Which investigation measures intraocular pressure?
Gonioscopy Tonometry
58
Examination of what in glaucoma is a direct marker of disease progression?
Optic disc
59
What suggests glaucoma when examining the optic disc?
Increased diameter of cup compared to overall disc size, with time
60
What is seen on examination in CAG?
CAG - marked redness, hazy cornea, hard globe, non reactive dilated pupil, shallow anterior chambers, closed iridocorneal angles and corneal epithelial oedema
61
What is the treatment of CAG?
Topical IOP lowering drug with IV acetazolamide
62
What are the possible surgical options for CAG?
Peripheral iridotomy Surgical iridectomy Trabeculoplasty
63
Name some IOP lowering drugs, used for both OAG and CAG.
``` Topical BB: timolol Topical PG analogue: Travaprost Topical parasympathomimetics: pilocarpine IV acetazolamide IV mannitol ```
64
What is the aim of OAG treatment with IOP lowering drugs?
Stall progression of glaucoma but not reverse it
65
What are some second line treatment options in glaucoma?
Argon/selective laser trabeculoplasty | Trabeculectomy
66
What are some causes of keratoconjunctivitis sicca?
``` Sjogren's syndrome Lacrimal gland insufficiency Meibomian gland dysfunction (blepharitis, isotretinoin) Reflex hyposecretion Blink disorders e.g. Parkinsons Lagophthalmos ```
67
What are some causes of reflex hyposecretion in keratoconjunctivitis sicca?
``` Contact lens wear Diabetes Corneal surgery Anticholinergic medication Antidepressants ```
68
What are some risk factors for keratoconjunctivitis sicca?
``` Vitamin A deficiency Older age Contact lenses Preservatives in topical drops Post menopausal oestrogen therapy ```
69
What are the symptoms of keratoconjunctivitis sicca?
Gritty irritation and burning/mild pain aggravated by air con, prolonged reading, computer work. Symptoms worse at end of the day
70
What tests can confirm keratoconjunctivitis sicca?
Slit lamp examination Schirmer's test Rose Bengal staining
71
What are some complications of keratoconjunctivitis sicca?
Conjunctivitis Keratitis Corneal ulceration
72
What is macular degeneration?
Ageing changes in the macula (centre of the retina) causing visual loss
73
What are the two types of macular degeneration?
Wet - choroidal neovascularisation | Dry - atrophy and changes to pigmentation of retinal pigment epithelium (RPE)
74
What are three risk factors for macular degeneration, apart from age?
Smoking Family history Prior history of AMD
75
How does macular degeneration present?
Painless scotoma esp. for near vision Reduced acuity and contrast sensitivity Abnormal dark adaptation Photopsia and light glare
76
What tool is used to test visual acuity in macular degeneration?
Amsler grid
77
What is seen on fundoscopy in macular degeneration?
Macular drusen and scarring Dry - Changes in pigmentation to the RPE Wet - intraretinal, subretinal, or sub RPE haemorrhages
78
What is the cause of wet/neovascular AMD?
New blood vessels grow from the choriocapillaris and spread around the RPE. They are fragile and leak easily, causing disciform scarring
79
Name three differentials, apart from AMD, for painless loss of vision.
Cataracts Primary open angle glaucoma Retinal detachment
80
What drug class is used to prevent progression of wet AMD?
Anti-vascular endothelial growth factor (anti-VEGF) | Intraviteal injections
81
How do anti-VEGFs work and give an example.
Decreases angiogenesis and vascular permeability | Ranibizumab
82
What is the pathophysiology of strabismus?
Misalignment of the eyes resulting in the retinal image not being in corresponding areas of both eyes
83
What does strabismus result in?
Adults - diplopia | Children - Amblyopia
84
What prefixes are used in describing strabismus?
Eso - inward ocular deviation Exo - outward ocular deviation Hypo - downward deviation Hyper - upward deviation
85
What is the name of an inward-turning squint?
Esotropia
86
Hypertropic/hypotropic squints are commonly due to what?
Superior oblique paresis
87
What is the leading cause of strabismus in adults?
Stroke
88
What are the symptoms of strabismus in adults?
Diplopia Asthenopia Pulling sensations
89
How is strabismus investigated?
Bruckner and cover tests | Hirschburg's test (corneal reflection test)
90
How is strabismus treated in a patient less than 8 years old
Eye patching and cycloplegic drops
91
What is blepharospasm?
A focal dystonia of the orbicularis oculi muscle resulting in an increased lid closure frequency
92
What is the first line treatment of blepharospasm?
Botulinum toxin A into orbicularis oculi.
93
What is the triad of features in optic neuritis?
Visual loss Eye pain worse on movement Dyschromatopsia especially red desaturation
94
What is the most common cause of optic neuritis?
Multiple sclerosis
95
What are some other causes of optic neuritis?
GCA Sarcoidosis, SLE, Behcet's Post infection Lyme disease
96
What are the signs of optic neuritis?
Decreased pupillary light reflex RAPD Arcuate defects/scotoma/papillitis
97
How is optic neuritis diagnosed?
Clinical diagnosis Fundoscopy - pale optic disc MRI - demyelinating plaque
98
What is the treatment of optic neuritis?
1g methylprednisolone 3 days
99
What features of optic neuritis suggest a cause other than MS?
Patient aged <12 or >50 Bilateral Absent or extremely severe pain Lack of RAPD
100
What are risk factors for diabetic retinopathy?
Pregnancy DM diagnosed before 30 HTN and other CV risk factors, renal disease
101
How is diabetic retinopathy classified?
Non-proliferative (mild, mod, severe) | Proliferative (non high risk to high risk)
102
What is seen on fundoscopy in diabetic retinopathy?
Microaneurysms Hard exudates and cotton wool spots Neovascularisation Intra-retinal haemorrhages
103
How does diabetic retinopathy present?
Painless reduction in central vision | Dark painless floaters (from haemorrhage)
104
What is primary prevention of diabetic retinopathy?
Optimal glycaemic control (HbA1c<7%)
105
A minority of patients with diabetic retinopathy undergo intervention such as...
Laser treatment Intravitreal steroids Vitrectomy
106
What is the gold standard investigation for diabetic retinopathy?
Dilated retinal photography
107
What is a cataract?
Lens opacity
108
What are risk factors for cataracts?
Female, age, smoking, DM, systemic corticosteroids
109
What are the symptoms of cataracts?
Depends on the size and location of the opacity Gradual painless loss of vision. May have halos surrounding light sources
110
What are the four types of cataract?
Nuclear sclerosis Cortical Posterior subcapsular Paediatric
111
What are the signs of cataracts?
Defects in the red reflex | Brown or white lens
112
What is the surgical intervention of cataracts?
Lens extraction and replacement.
113
What is retinal detachment?
The neurosensory layer of the retina separates from the underlying retinal pigment epithelium
114
How are retinal detachments classified?
Rhegmatogenous | Non-rhegmatogenous (exudative/tractional)
115
What are most RDs preceded by?
Posterior vitreous detachment which causes traction on the retina and a retinal tear
116
What are risk factors for RD?
``` Age RD in the contralateral eye Marfan syndrome FH Myopia Previous eye injury/surgery/infection ```
117
What is lattice degeneration?
The peripheral retina becomes thinned/atrophic in a lattice pattern, and is prone to breaks or tears which may further progress to RD.
118
How does RD present?
New onset floaters New onset photopsia Painless sudden visual loss
119
Name some things seen on examination in RD.
Tobacco dust Visual field defects RAPD Billowing sensory retina, and the tear, on fundoscopy
120
How is RD treated?
Cryotherapy/laser photocoagulation
121
What is a hyphaema and how is it treated?
Blood in the anterior chamber | Evacuation
122
How is eye trauma/foreign body managed?
Tetracaine 1% drops allow examination Pad the unaffected eye to prevent damage from conjugate movement X-Ray the orbit, not MRI, as foreign bodies may be magnetic After removal: chloramphenicol 0.5% drops
123
Apart from papilloedema, what are the causes of optic disc swelling?
Optic neuritis GCA Retinal vein occlusion
124
What are the causes of papilloedema and raised ICP?
Tumour Cerebral trauma, haemorrhage, infection, or inflammation Idiopathic intracranial hypertension
125
What is absent on examination if the optic disc is swollen?
Spontaneous venous pulsation
126
What is usually an important investigation in a patient with papilloedema?
Urgent MRI with gadolinium enhancement
127
Why does papilloedema suggest raised ICP?
The optic nerve sheath is continuous with the sub arachnoid space so increased ICP is transmitted to SA space surrounding the optic nerve
128
What is seen on examination in papilloedema?
Blurred optic margins Disc swelling Venous engorgement Paton's lines - radial retinal lines
129
What are the risk factors for primary open angle glaucoma?
``` FH Afro-Caribbean Myopia Hypertension DM Corticosteroids ```
130
How can the red eye of glaucoma be distinguished from uveitis?
Glaucoma: severe pain, haloes, semi-dilated pupil, dull/hazy cornea from oedema Uveitis: small, fixed oval pupil, ciliary flush, blurred vision and photophobia
131
What is the triad of Horner's syndrome?
``` Partial ptosis (eyelid drooping) Miosis (pupil constriction) leading to anisocoria Hemifacial anhidrosis ```
132
What are four causes of Horner's syndrome?
Pancoast's tumour Stroke/MS Herpes Zoster Cluster headaches/migraine
133
What are the key side effects of prostaglandin analogues used to treat glaucoma?
Increased eyelash length Iris pigmentation Periocular pigmentation
134
What is the classification system for hypertensive retinopathy?
Keith-Wagener
135
Describe the Keith Wagener system for hypertensive retinopathy.
1: silver wiring 2: arteriovenous nipping 3: Cotton wool exudates and flame haemorrhages 4: papilloedema
136
Name four causes of tunnel vision.
Papilloedema Glaucoma Retinitis pigmentosa Choroidoretinitis
137
Which cranial nerves supply the extraocular muscles?
Oculomotor - MR, SR, IR, IO Trochlear - SO Abducens - LR
138
What is a Holmes-Adie pupil?
Dilated pupil that shows delayed and incomplete constriction to light, but better response to accommodation
139
What is Holmes-Adie syndrome?
Young females Holmes-Adie pupil Reduced deep tendon reflexes Pilocarpine test
140
What is retinitis pigmentosa?
Inherited condition presenting in young adulthood Loss of rod photoreceptor cells First symptoms: loss of night vision, loss of peripheral vision
141
How can you differentiate viral conjunctivitis from other types?
Tarsal follicles
142
What are the symptoms of keratitis?
Painful red eye Purulent discharge if bacterial Hypopyon - pus in anterior chamber White opacity of corneal ulcer
143
How can you differentiate corneal ulcers from corneal abrasions?
Ulcers - corneal oedema, blurred vision | Abrasions - normal vision, no oedema
144
What is the only treatment of dry AMD?
Vitamin supplementation - C, E, beta-carotene, and zinc.
145
How is retinal detachment with vitreous haemorrhage diagnosed?
USS B scan of the globe
146
What is microbial keratitis and a risk factor?
Corneal ulcer Steroid eye drops/contact lenses

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